Marie was 15 when her abdominal pain began. After two years of negative work-ups, countless visits to gastroenterologists, and over 70 days of high school missed, she found herself readmitted to the hospital. “Refractory abdominal pain” was her ostensible diagnosis; “troubled teen” who was “going to be difficult” was embedded in the emergency department’s sign-out. When the medical team arrived to meet Marie, she was huddled in the corner of her hospital bed, silent and withdrawn. Her intern noted the numerous (...) scars cutting across her forearms as she felt for her radial pulses. Marie squirmed in pain when the intern palpated her abdomen.The ED’s work-up had been negative for abdominal pathology. When the... (shrink)

Whether you are a sophisticated critic or an untrained spectator, when it comes to our experience of dance, we are generally able to appreciate the way a dancer’s bodily movements fit the music. Our experience of dance thus lends itself to a range of crossmodal judgments, that is, our perception of dance enables us to make claims that purport to be about how bodily movements which can be visually seen fit together with aspects of the music which can be heard (...) or felt. But we are not determined to perceive every case of fit unproblematically. That it is possible one may fail to initially perceive a fit that others claim ought to be viewable suggests that there is a normative dimension to this phenomenon. In this article, I argue that we can explain the source of this normativity with a multisensory account of dance. More specifically, I argue that dance is a novel feature type, a feature of perceptual experience that is essentially multimodal. The basic perception of dance, which grounds more sophisticated forms of judgment concerning crossmodal fit downstream, is the actualization of a unique multisensory capacity that non-inferentially tracks a real, fundamental connection between music and movement. (shrink)

An investigation of some of the most contentious debates of our time, Galileo's Middle Finger describes Alice Dreger's experiences on the front lines of scientific controversy, where for two decades she has worked as an advocate for victims of unethical research while also defending the right of scientists to pursue challenging research into human identities. Dreger's own attempts to reconcile academic freedom with the pursuit of justice grew out of her research into the treatment of people born intersex (formerly (...) called hermaphrodites). The shocking history of surgical mutilation and ethical abuses conducted in the name of "normalizing" intersex children moved her to become a patient rights' activist. By bringing evidence to physicians and the public, she helped change the medical system. But even as she worked to correct these injustices, Dreger began to witness how some fellow liberal activists, motivated by identity politics, were employing lies and personal attacks to silence scientists whose data revealed inconvenient truths. Troubled, she traveled around the country digging up sources and interviewing the targets of these politically motivated campaigns. Among the subjects she covers in the book are the anthropologist Napoleon Chagnon, falsely accused in a bestselling book of committing genocide against a South American tribe; the psychologist Michael Bailey, accused of abusing transgender women; and the evolutionary biologist E. O. Wilson, accused of fomenting rightwing ideas about human nature. Galileo's Middle Finger describes Dreger's long and harrowing journey back and forth between the two camps for which she felt equal empathy: social justice warriors and researchers determined to put truth before politics. (shrink)

As I stood outside of Carlos's room, I felt caught on the horns of a dilemma. It seemed impossible to truly “be there” for Carlos without sacrificing my other intern duties. This tension pervaded much of my residency training, as I often found myself spending more time completing chart notes, answering pages, and giving sign out than I did at the bedside with my patients. I knew I had a duty to “do my job”—I could not let my team (...) down. But what about my duty to Carlos, a duty to act on my intuition and try to “get to the bottom” of his illness, if that was even possible? And what about my thirteen other patients? Wasn't I was their doctor as well? I have spent countless hours studying the ethical frameworks for medical rationing. And yet no framework could have told me how to weigh my intuition in that crucial moment of decision-making, or when it was okay to leave a few notes unfinished in order to have the time to talk with Carlos. Suddenly, I knew what I had to do. (shrink)

The essays collected in this volume, appearing between the years 1939 and 1958, include all of the late Professor J. L. Austin's published papers, and in addition two unpublished papers, ‘The Meaning of a Word’ and ‘Unfair to Facts’, as well as an unscripted talk, ‘Performative Utterances’, given in the Third Programme of the B.B.C. in 1956. The editors, J. O. Urmson and G. J. Warnock, have performed a real service in making these papers available in one volume; for the (...) cumulative impact of the method Austin pursued in doing philosophy, and the questions this method raises, can be felt and appreciated more fully when a considerable assemblage of illustrative papers is brought together. The debt Austin owes to the tradition to which G. E. Moore and Wittgenstein contributed is quite clear, and the divergences from them are equally clear. In reviewing the contents of the ten articles in this volume I shall try to single out what is unique about his contribution, in particular what features of his procedure, falling as it does under the general classification ‘linguistic analysis’, were so distinctive as to win for it the attention accorded to a new departure. (shrink)

This paper argues that independent auditors have lost sight of their obligation to be truly impartial, and have increasingly adopted an attitude of client advocacy. We argue that auditors have a professional obligation to go beyond merely passing judgment on whether client accounting methods are acceptable under GAAP, and to judge whether the principles adopted are the most appropriate under the circumstances. We then review recent evidence which suggests that auditors have abandoned this objective in favor of advocating client-preferred principles. (...) The results of a survey of public accountants employed by small CPA firms indicates that, in a scenario in which an auditor did not feel that the client's accounting treatment was the most appropriate under the circumstances but it was recognized as an acceptable alternative under GAAP, advocacy of the client-preferred approach is considered appropriate and is very likely to occur in practice. In less subtle cases (e.g., when the auditor did not feel that the client's treatment provided the best reflection of the economic substance of the underlying transactions), survey participants as a group were ambivalent regarding the appropriateness of client advocacy, and felt that subordination of judgment was likely to occur in practice. The results also indicate that engagement risk, or the risk that the firm will be harmed by aggressive behavior, affects judgments of both the appropriateness and likelihood of subordination of judgment. These findings suggest that auditors have adopted an ideology of client advocacy, within the constraints of engagement risk. (shrink)

Book synopsis: New work on a hot topic by an outstanding team of authors At the intersection of several central areas of philosophy It is the linguistic job of singular terms to pick out the objects that we think or talk about. But what about singular terms that seem to fail to designate anything, because the objects they refer to don't exist? We can employ these terms in meaningful thought and talk, which suggests that they are succeeding in fulfilling their (...) representational task. A team of leading experts presents new essays on the much-debated problem of empty reference and thought. In the 1960s and 1970s Keith Donnellan, David Kaplan, Saul Kripke and Hilary Putnam initiated a revolution in the then standard conception of reference—a concept at the core of philosophical inquiry. The repercussions of the revolution, particularly felt in metaphysics and epistemology, were soon refined by other influential writers such as Tyler Burge, Gareth Evans, and John Perry. They argued that some linguistic and mental representations have contents individuated by what they are about—by ordinary referents of expressions such as proper names, indexicals, definite descriptions and common nouns, i.e. by planets, people or natural kinds. The view was at odds with a central philosophical presumption at that time: that cognitive and linguistic access to objective reality is indirect and accidental, mediated by general descriptive characterizations, the only constitutive semantic feature of the expressions; hence its ontological and epistemological repercussions. A turning-point in the debate about how linguistic and mental representation reach external contents concerned the nature of empty mental and linguistic representations, framed by means of the very same expressions crucially invoked in the Donnellan-Kaplan-Kripke-Putnam arguments. The papers in this volume address different aspects of reference and thought about the non-existent. (shrink)

Argument for Epiphenomenalism [I]: (A) Mental event-tokens are identical with physical event-tokens. (B) The causal powers of a physical event are determined only by its physical properties; and (C) mental properties are not reducible to physical properties.

Maps and realist pictures comprise prominent sub-classes of iconic representations. The most basic, most important sub-class is perception. Other types are drawings, photographs, musical notations, diagrams, bar graphs, abacuses, hieroglyphs, and color chits.

I shall propose five theses on de re states and attitudes. To be a de re state or attitude is to bear a peculiarly direct epistemic and representational relation to a particular referent in perception or thought. I will not dress this bare statement here. The fifth thesis tries to be less coarse. The first four explicate and restrict context- bound, singular, empirical representation, which constitutes a significant and central type of de re state or attitude.

I want to reflect on some functions of memory and their relations to traditional issues about personal identity. I try to elicit ways in which having memory, with its presupposition of agent identity over time, is integral to being a person, indeed to having a representational mind.

This paper investigates the dynamic and performative construction of publics in public engagement exercises. In this investigation, we, on the one hand, analyse how public engagement settings as political machineries frame particular kinds of roles and identities for the participating publics in relation to ‘the public at large’. On the other hand, we study how the participating citizens appropriate, resist and transform these roles and identities, and how they construct themselves and the participating group in relation to wider publics. The (...) empirical basis of our argument is a discussion of four different kinds of participation events in Austria. Building on these observations we develop conclusions about the public up-take of public participation in technoscience and the role of public engagement in current techno-political cultures. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors’ NoteJames M. DuBois, Ana S. Iltis, and Heidi A. WalshFrom childhood, David Slakter had undergone tests and invasive procedures to monitor his nephritis. It was not a surprise when in 2015, doctors told him he needed a kidney transplant. The wife of a childhood friend was a close match and gave him one of her kidneys. Before his transplant, aerobic exercise was difficult; a few months after transplant, (...) Slakter could ride his bike, hike, and work out with a personal trainer. He no longer had to weigh food or gauge his potassium consumption, a concern for people with kidney failure. For Slakter, “life post-transplant has been a significant improvement.”Individuals or family members of those who have received an organ transplant from a living or deceased donor share their stories in this issue of Narrative Inquiry in Bioethics. The symposium is titled “Receiving the Gift of Life: Stories from Organ Transplant Recipients.” Organ transplantation can extend an individual’s life by decades. It can also greatly improve an individual’s quality of life, as was Slakter’s experience. At the same time, organ transplantation is expensive and stressful. Recipients can experience complications, including organ rejection, and there are few appealing alternatives.After her heart transplant, author Leilani R. Graham required four open-heart surgeries, ECMO, and an intra-aortic balloon pump. She experienced delirium, necrotizing pneumonia, and severe muscular atrophy that required her to re-learn how to walk. She struggled with weight gain, explosive mood swings, hair loss, and was terrified that her body would reject the new heart. For Graham, “[Transplant] was not the miracle [she] was hoping for.” Graham says she felt unprepared for and inadequately informed about what to expect after her transplant, which left her “battered, beaten, and bruised” with a 12-inch line from neck to navel and “bullet holes” up and down her torso from the chest tubes. When reflecting on her experience post-transplant, Graham says, “It wasn’t the physical trauma that hurt the most. It was that no one seemed surprised [by the aftereffects of transplant].” Seemingly no one, that is except Graham, who calls on transplant providers to “prioritize empathy.”The symposium editors are Jason T. Eberl and Tristan McIntosh. Three commentary articles, written by Macey Leigh Levan, Heather Lannon, and Vidya A. Fleetwood, Roslyn B. Mannon & Krista L. Lentine, offer important insights into the authors’ stories. The editors thank Mid-America Transplant, the UCSF Lung Transplant Program, Donor Connect, William L. Freeman, MD, MPH, MJIL, CIP, Janet Monk, and the individuals who gave anonymous donations to support the publication of this issue, an open-access VOICES edition of the symposium, and accompanying teaching guides.The research article in this issue, “‘A Shell of My Former Self’: Using Figurative Language to Promote Communication about Patient Suffering,” was written by Tyler Tate, Elizabeth Stein, and Robert A. Pearlman. The relief of suffering is a primary goal of medicine. However, the authors note that clinicians often miss or ignore suffering because they focus on the causes rather than the experience of suffering, or the subjective nature of suffering makes it difficult to discuss. The authors believe that “the key to communicating about suffering lies in finding [End Page vii] the right kind of words to describe the experience” and say that figurative language offers a promising approach. In their research, the authors performed qualitative analysis on 52 works of literature and identified 254 excerpts of figurative language with themes of non-physical or psychological suffering. The authors found 13 salient themes: brokenness, diminishment, disorientation, drowning, emptiness, imprisonment, battle, darkness, isolation, invisibility, lifelessness, punishment, and torture. The authors reiterate that developing a shared language of suffering could foster a therapeutic patient-clinician relationship and improve clinicians’ ability to recognize and address a patient’s experience of suffering.María Susana Ciruzzi wrote the first of two case studies included in this issue. “The Sword of King Solomon” addresses a tragic and difficult subject—how to navigate the situation posed by conjoined twins when “any decision will produce damage and suffering.” The case involves two infant male patients born at 37 weeks gestation as omphalo-ischiopagus conjoined twins... (shrink)

This article explores how abortion bans in states with large Black populations will exacerbate existing racial inequities in those states’ child welfare systems.

Following extensive examination of published and unpublished materials, we provide a history of the use of dexamethasone in pregnant women at risk of carrying a female fetus affected by congenital adrenal hyperplasia (CAH). This intervention has been aimed at preventing development of ambiguous genitalia, the urogenital sinus, tomboyism, and lesbianism. We map out ethical problems in this history, including: misleading promotion to physicians and CAH-affected families; de facto experimentation without the necessary protections of approved research; troubling parallels to the history (...) of prenatal use of diethylstilbestrol (DES); and the use of medicine and public monies to attempt prevention of benign behavioral sex variations. Critical attention is directed at recent investigations by the U.S. Food and Drug Administration (FDA) and Office of Human Research Protections (OHRP); we argue that the weak and unsupported conclusions of these investigations indicate major gaps in the systems meant to protect subjects of high-risk medical research. (shrink)

In this article, I offer a foundation for the prima facie idea of a right to welfare based on a neglected aspect of Kant’s legal theory: his account of equity rights. I argue...

This paper concerns top-down approaches in machine ethics. It is divided into three main parts. First, I briefly describe top-down design approaches, and in doing so I make clear what those approaches are committed to and what they involve when it comes to training an AI to behave ethically. In the second part, I formulate two underappreciated motivations for endorsing them, one relating to predictability of machine behavior and the other relating to scrutability of machine decision-making. Finally, I present three (...) major worries about such approaches, and I attempt to show that advocates of top-down approaches have some plausible avenues of response. I focus most of my attention on what I call the ‘technical manual objection’ to top-down approaches, inspired by the work of Annas (2004). In short, the idea is that top-down approaches treat ethical decision-making as being merely a matter of following some ethical instructions in the same way that one might follow some set of instructions contained in a technical manual (e.g., computer manual), and this invites sensible skepticism about the ethical wisdom of machines that have been trained on those approaches. I respond by claiming that the objection is successful only if it is understood as targeting machines that have certain kinds of goals, and it should not compel us to totally abandon top-down approaches. Such approaches could still be reasonably employed to design ethical AI that operate in contexts that include fairly noncontroversial answers to ethical questions. In fact, we should prefer top-down approaches when it comes to those types of context, or so I argue, due to the advantages I claim for them. (shrink)

Before the EU General Data Protection Regulation entered into force in May 2018, we witnessed an intense struggle of actors associated with data-dependent fields of science, in particular health-related academia and biobanks striving for legal derogations for data reuse in research. These actors engaged in a similar line of argument and formed issue alliances to pool their collective power. Using descriptive coding followed by an interpretive analysis, this article investigates the argumentative repertoire of these actors and embeds the analysis in (...) ethical debates on data sharing and biobank-related data governance. We observe efforts to perform a paradigmatic shift of the discourse around the General Data Protection Regulation-implementation away from ‘protecting data’ as key concern to ‘protecting health’ of individuals and societies at large. Instead of data protection, the key risks stressed by health researchers became potential obstacles to research. In line, exchange of information with data subjects is not a key concern in the arguments of biobank-related actors and it is assumed that patients want ‘their’ data to be used. We interpret these narratives as a ‘reaction’ to potential restrictions for data reuse and in line with a broader trend towards Big Data science, as the very idea of biobanking is conceptualized around long-term use of readily prepared data. We conclude that a sustainable implementation of biobanks needs not only to comply with the General Data Protection Regulation, but must proactively re-imagine its relation to citizens and data subjects in order to account for the various ways that science gets entangled with society. (shrink)

This article has a historiographical and a philosophical aim. The historiographical and most difficult objective is to provide a comprehensive presentation of F. W. J. Schelling’s doctrine of the potencies (Potenzlehre) for the English-speaking philosophical community as found in his, for the most part yet to be translated, late lectures on the positive philosophy of mythology and revelation. The philosophical objective is to show how this same doctrine provides a modern response to the assertion that thinking and Being are the (...) same, sometimes rendered as “Thinking and Being belong together” or “Where there is Being, there is thinking.”. (shrink)