A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

Background Clinical Ethics Committees are well established at healthcare institutions in resource-rich countries. However, there is limited information on established CECs in resource poor countries, especially in Africa. This study aimed to establish baseline data regarding existing formal CECs in Africa to raise awareness of and to encourage the establishment of CECs or Clinical Ethics Consultation Services on the continent. Methods A descriptive study was undertaken using an online questionnaire via SunSurveys to survey healthcare professionals and bioethicists in Africa. Data (...) were subjected to descriptive analysis and Fischer's exact test was applied to determine associations. Texts from the open-ended questions were thematically analysed. Results In total 109 participants from 37 African countries completed the survey in December 2019. A significant association was found between participants’ bioethics qualification or training and involvement in clinical ethics. All participants were familiar with Research Ethics Committees, and initially conflated RECs with CECs. When CECs were explained in detail, approximately 85.3% reported that they had no formal CECs in their institutions. The constraints to developing CECs included lack of training, limited resources, and lack of awareness of CECs. However, the majority of participants were interested in establishing CECs. Participants listed assistance required in establishing CECs including funding, resources, capacity building and collaboration with other known CECs. The results do not reflect CECs established since the onset of COVID-19 in Africa. Conclusions This study provides a first look into CECs in Africa and found very few formal CECs on the continent indicating an urgent need for the establishment of CECs or CESs in Africa. While the majority of healthcare professionals and bioethicists are aware of ethical dilemmas in healthcare, the concept of formal CECs is foreign. This study served to raise awareness of CECs. Research ethics and RECs overshadow CECs in Africa because international funders from the global north support capacity development in research ethics and establish RECs to approve the research they fund in Africa. Raising awareness via educational opportunities, research and conferences about CECs and their role in improving the quality of health care in Africa is sorely needed. (shrink)

Out from the Shadows showcases the work of 18 analytical feminists from a variety of traditional areas of philosophy: social and political philosophy, normative ethics, virtue theory, metaethics, philosophy of language, metaphysics, epistemology, and philosophy of science. The collection is unique both in its focus on analytical feminism and in its breadth across the subdisciplines within philosophy. The book highlights successful uses of concepts and approaches from traditional philosophy, and illustrates the contributions that feminist approaches have made and could make (...) to the analysis of issues in key areas of traditional philosophy, while also demonstrating that traditional philosophy ignores feminist insights and feminist critiques of traditional philosophy at its own peril. (shrink)

Drug Safety Communications are used by the Food and Drug Administration to inform health care providers, patients, caregivers, and the general public about safety issues related to FDA-approved drugs. To assess patient knowledge of the messaging contained in DSCs related to the sleep aids zolpidem and eszopiclone, we conducted a large, cross-sectional patient survey of 1,982 commercially insured patients selected by stratified random sampling from the Optum Research Database who had filled at least two prescriptions for either zolpidem or eszopiclone (...) between July 1, 2012 and June 30, 2013. Among the 594 respondents, two-thirds reported hearing generally about drug safety information prior to starting a new drug, with the remaining one-third “rarely” or “never” hearing such information. Providers and pharmacists were primary sources of drug safety information. Two-thirds of zolpidem users and half of eszopiclone users reported having heard about the related DSC messages, ability to accurately identify the major factual messages was limited. Respondents reacted to new drug safety information about their sleep aids by reporting that they would want to learn about alternative ways to help them sleep and seek out more information about the safety of their specific sleeping pill. Opportunities may exist for the FDA to work with providers and pharmacies to help ensure the DSC information is more widely received and is more fully understood by those taking the affected medications. (shrink)

Este estudio examina la frecuencia de colocaciones gramaticales verbo + preposición en aprendientes anglófonos de Español como Lengua Extranjera de nivel A2 y B1 bajo el modelo de Análisis Contrastivo de la Interlengua. Para ello, se implementa una tipología colocacional sustentada en un criterio de fijación intermedia de estas unidades. Los resultados muestran mayor frecuencia en el nivel B1, pero no en la variedad de unidades, y un mayor número de usos correctos que en A2. Respecto de las diferencias encontradas (...) según el patrón sintáctico-semántico, las variables competencia, complejidad del patrón y temáticas aparecen como factores importantes para explicarlas en el contexto del corpus de aprendientes examinado. Este trabajo aporta al estudio de las ColGram v+p, y de otros tipos en ELE. (shrink)

Over the past decade work engagement has gained both business and academia attention. With growing number of studies and meta-analyses the concept of work engagement is one of the pillars of positive work and organizational psychology. This systematic review presents the current state of research on work engagement in Poland. Results confirmed that work-engagement studies have not yet reached the threshold to conduct meta-analysis. The review of measurement methods and synthesis of findings allows to identify strengths and gaps in Polish (...) studies. Discussion of limitations and biases in current research is accompanied with urge to overcome them and develop thriving stream of research on work engagement. (shrink)

This article explores the relationship between medicine’s history and its digital present through the lens of the physician-patient relationship. Today the rhetoric surrounding the introduction of new technologies into medicine tends to emphasize that technologies are disturbing relationships, and that the doctor-patient bond reflects a more ‘human’ era of medicine that should be preserved. Using historical studies of pre-modern and modern Western European medicine, this article shows that patient-physician relationships have always been shaped by material cultures. We discuss three activities (...) – recording, examining, and treating – in the light of their historical antecedents, and suggest that the notion of ‘human medicine’ is ever-changing: it consists of social attributions of skills to physicians that played out very differently over the course of history. (shrink)

For Knox, ‘spacetime’ is to be defined functionally, as that which picks out a structure of local inertial frames. Assuming that Knox is motivated to construct this functional definition of spacetime on the grounds that it appears to identify that structure which plays the operational role of spacetime—i.e., that structure which is actually surveyed by physical rods and clocks built from matter fields—we identify in this paper important limitations of her approach: these limitations are based upon the fact that there (...) is a gap between inertial frame structure and that which is operationally significant in the above sense. We present five concrete cases in which these two notions come apart, before considering various ways in which Knox’s spacetime functionalism might be amended in light of these issues. (shrink)

Phase transitions are an important instance of putatively emergent behavior. Unlike many things claimed emergent by philosophers, the alleged emergence of phase transitions stems from both philosophical and scientific arguments. Here we focus on the case for emergence built from physics, in particular, arguments based upon the infinite idealization invoked in the statistical mechanical treatment of phase transitions. After teasing apart several challenges, we defend the idea that phase transitions are best thought of as conceptually novel, but not ontologically or (...) explanatorily irreducible to finite physics; indeed, by looking at ongoing work on “smooth phase transitions” we even suggest that they’re not even conceptually novel. In the case of renormalization group theory, consideration of infinite systems and their singular behavior provides a central theoretical tool, but this is compatible with an explanatory reduction. Phase transitions may be “emergent” in some sense of this protean term, but not in a sense that is incompatible with the reductionist project broadly construed. (shrink)

'Anita L. Allen breaks new ground...A stunning indictment of women's status in contemporary society, her book provides vital original scholarly research and insight.' |s-NEW DIRECTIONS FOR WOMEN.

One of the most intriguing of philosophical puzzles concerns other minds. How do you know there are any? Yes, you're surrounded by living organisms that look and behave much as you do. They even say they have minds. But do they? Perhaps other humans are mindless zombies: like you on the outside, but lacking any inner conscious life, including emotions, thoughts, experiences and even pain. What grounds do you possess for supposing that other humans aren't zombies? Perhaps less than you (...) think. Anita Avramides tackles this fascinating question. (shrink)

Can the government stick us with privacy we don't want? It can, it does, and according to this author, may need to do more of it. Privacy is a foundational good, she argues, a necessary tool in the liberty-lover's kit for a successful life. A nation committed to personal freedom must be prepared to mandate inalienable, liberty-promoting privacies for its people, whether they eagerly embrace them or not. The eight chapters of this book are reflections on public regulation of privacy (...) at home; isolation and confinement for punitive and health reasons; religious modesty attire; erotic nudity; workplace and professional confidentiality; racial privacy; online transactions; social networking; and the collection, use and storage of electronic data. (shrink)

How do I know whether there are any minds beside my own? This problem of other minds in philosophy raises questions which are at the heart of all philosophical investigations--how it is that we know, what is in the mind, and whether we can be certain about any of our beliefs. In this book, Anita Avramides begins with a historical overview of the problem from the Ancient Skeptics to Descartes, Malebranche, Locke, Berkeley, Reid, and Wittgenstein. The second part of (...) the book investigates the views of influential contemporary philosophers such as Strawson, Davidson, Nagel and Searle. (shrink)

Recent work in the physics literature demonstrates that, in particular classes of rotating spacetimes, physical light rays in general do not traverse null geodesics. Having presented this result, we discuss its philosophical significance, both for the clock hypothesis, and for the operational meaning of the metric field.

The Ontology for Biomedical Investigations (OBI) is an ontology that provides terms with precisely defined meanings to describe all aspects of how investigations in the biological and medical domains are conducted. OBI re-uses ontologies that provide a representation of biomedical knowledge from the Open Biological and Biomedical Ontologies (OBO) project and adds the ability to describe how this knowledge was derived. We here describe the state of OBI and several applications that are using it, such as adding semantic expressivity to (...) existing databases, building data entry forms, and enabling interoperability between knowledge resources. OBI covers all phases of the investigation process, such as planning, execution and reporting. It represents information and material entities that participate in these processes, as well as roles and functions. Prior to OBI, it was not possible to use a single internally consistent resource that could be applied to multiple types of experiments for these applications. OBI has made this possible by creating terms for entities involved in biological and medical investigations and by importing parts of other biomedical ontologies such as GO, Chemical Entities of Biological Interest (ChEBI) and Phenotype Attribute and Trait Ontology (PATO) without altering their meaning. OBI is being used in a wide range of projects covering genomics, multi-omics, immunology, and catalogs of services. OBI has also spawned other ontologies (Information Artifact Ontology) and methods for importing parts of ontologies (Minimum information to reference an external ontology term (MIREOT)). The OBI project is an open cross-disciplinary collaborative effort, encompassing multiple research communities from around the globe. To date, OBI has created 2366 classes and 40 relations along with textual and formal definitions. The OBI Consortium maintains a web resource providing details on the people, policies, and issues being addressed in association with OBI. (shrink)

Anita Chari revives the concept of reification from Marx and the Frankfurt School to spotlight the resistance to neoliberal capitalism now forming at the level of political economy and at the more sensate, experiential level of subjective transformation. Reading art by Oliver Ressler, Zanny Begg, Claire Fontaine, Jason Lazarus, and Mika Rottenberg, as well as the politics of Occupy Wall Street, Chari identifies practices through which artists and activists have challenged neoliberalism's social and political logics, exposing its inherent tensions (...) and contradictions. (shrink)

Supersymmetry (SUSY) is a proposed symmetry between bosons and fermions. The structure of the space of SUSY generators is such that the distinction between internal and spacetime symmetries is blurred. As a result, there are two viable candidates for the correct spacetime setting for a flat supersymmetric field theory---Minkowski spacetime and superspace. an extension of four- dimensional Minkowski spacetime to include (at least) four new dimensions, coordinatised by mathematical objects known as supernumbers. These objects are, in one significant way, quite (...) different from real or complex number---some of them have the property that their order of multiplication makes a difference; in mathematical terms, they are said to have nontrivial commutation properties. This paper argues for two theses: first, that one standard set of arguments, related to universality of symmetry behaviour, that motivate a particular choice of spacetime structure in familiar spacetime theories motivates the choice of superspace as the appropriate spacetime for SUSY field theories. And second, that the metaphysical utility of the concept of spacetime requires more than just the satisfaction of this universality condition; in supersymmetric theories, the spacetime concept is not as useful as in special relativity. (shrink)

Recent work in the physics literature demonstrates that, in particular classes of rotating spacetimes, physical light rays in general do not traverse null geodesics. Having presented this result, we discuss its philosophical significance, both for the clock hypothesis (and, in particular, a recent purported proof thereof for light clocks), and for the operational meaning of the metric field. 1Introduction 2Fletcher's Theorem 2.1Maudlin on the clock hypothesis in special relativity 2.2Fletcher’s result in special relativity 2.3Fletcher’s theorem in general relativity 3Electromagnetism and (...) the Geometrical-Optical Limit 3.1Maxwell’s equations in curved spacetime 3.2The geometrical-optical limit 3.3Rotating spacetimes 3.4Aren’t Gödel spacetimes unphysical? 4The Clock Hypothesis and Chronogeometry 4.1Natural and mathematical observations 4.2Clock registry discord 4.3Chronogeometry 5Conclusion. (shrink)

Robustness arguments hold that hypotheses are more likely to be true when they are confirmed by diverse kinds of evidence. Robustness arguments require the confirming evidence to be independent. We identify two kinds of independence appealed to in robustness arguments: ontic independence —when the multiple lines of evidence depend on different materials, assumptions, or theories—and probabilistic independence. Many assume that OI is sufficient for a robustness argument to be warranted. However, we argue that, as typically construed, OI is not a (...) sufficient independence condition for warranting robustness arguments. We show that OI evidence can collectively confirm a hypothesis to a lower degree than individual lines of evidence, contrary to the standard assumption undergirding usual robustness arguments. We employ Bayesian networks to represent the ideal empirical scenario for a robustness argument and a variety of ways in which empirical scenarios can fall short of this ideal. (shrink)

Therapeutic privilege is a defence that may be available to doctors who fail to disclose to the patient relevant information when seeking informed consent for treatment if they have a reasonable belief that providing that information would likely cause the patient concerned serious physical or mental harm. In a landmark judgement, the Singapore Court of Appeal introduced a novel interpretation of TP, identifying circumstances in which it might be used with patients who did not strictly lack capacity but might be (...) inclined to refuse recommended treatments. In this paper, we explore the conceptual and practical challenges of this novel interpretation of TP. We propose that more emphasis should be placed on forms of shared and supported decision-making that foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being. The kind of privilege that doctors might need to invoke is one of time and supportive expertise to ensure a flexible, responsive approach calibrated to the individual patients’ needs. The provision of such service would extinguish the need for the novel TP proposed by the Singapore Court of Appeal. (shrink)

Noncommutative geometries generalize standard smooth geometries, parametrizing the noncommutativity of dimensions with a fundamental quantity with the dimensions of area. The question arises then of whether the concept of a region smaller than the scale—and ultimately the concept of a point—makes sense in such a theory. We argue that it does not, in two interrelated ways. In the context of Connes’ spectral triple approach, we show that arbitrarily small regions are not definable in the formal sense. While in the scalar (...) field Moyal–Weyl approach, we show that they cannot be given an operational definition. We conclude that points do not exist in such geometries. We therefore investigate (a) the metaphysics of such a geometry, and (b) how the appearance of smooth manifold might be recovered as an approximation to a fundamental noncommutative geometry. (shrink)

If we cannot directly empirically test the claims of particular scientific theory, then it would be nice to have some other criteria with which to assess its viability. In his 2013 book, String Theory and the Scientific Method, Richard Dawid aims to develop such criteria, with an eye to vindicating research programs in disciplines where direct empirical data is scant or non-existent. In an accompanying paper, Dawid, Hartmann and Sprenger formalise Dawid’s so-called ‘No Alternatives Argument’ using a generalised Bayesian framework, (...) as a first step towards formalising Dawid’s entire re- search programme. In this paper, I argue that the formalisation of the NAA cannot play the central role in Dawid’s programme as intended. This is based on the observation that not all confirmation is non-negligible confirmation. For Dawid’s programme to be useful, it must demonstrate the viability not just of non-empirical theory confirmation, but of non-negligible non-empirical theory confirmation. I argue that Dawid et al.’s appeal to Bayesian confirmation theory to formalise his NAA cannot guarantee non-negligible confirmation. As a result, I conclude that if Dawid’s overall project is to succeed, it must do so without the NAA formalised in this way. (shrink)

This article engages Axel Honneth’s recent work on Georg Lukács’ concept of reification in order to formulate a politically relevant and historically specific critique of capitalism that is applicable to theorizing contemporary democratic practice. I argue that Honneth’s attempt to reorient the critique of reification within the terms of a theory of recognition has done so at the cost of sacrificing the core of the concept, which forged a connection between the socio-political analysis of capitalist domination and an analysis of (...) the unengaged, spectatorial stance of human beings toward the world, showing how they together impede emancipatory social transformation. In order to accomplish the unfinished task of rendering the critique of reification applicable to contemporary critical theory, I seek to synthesize the advantages of Honneth’s approach, which focuses on the normative aspects of the critique of reification, with Lukács’ emphasis on the practical, political-economic dimensions of reification and the historically specific pathologies of the capitalist social form. (shrink)

The value-free ideal in science has been criticised as both unattainable and undesirable. We argue that it can be defended as a practical principle guiding scientific research even if the unattainability and undesirability of a value-free end-state are granted. If a goal is unattainable, then one can separate the desirability of accomplishing the goal from the desirability of pursuing it. We articulate a novel value-free ideal, which holds that scientists should act as if science should be value-free, and we argue (...) that even if a purely value-free science is undesirable, this value-free ideal is desirable to pursue. (shrink)

The Gricean account of language is at the center of much current work in the philosophy of language and the philosophy of mind. Anita Avramides maintains that Grice's paradigm can be used to defend very different conceptions of mind and of meaning. In this clearly argued book she describes Grice's analysis of meaning and proposes two interpretations of it, one reductive and one nonreductive. Much current work in cognitive science assumes that the content of words and thoughts can be (...) explained in naturalistic terms. A leading idea (advanced mainly by Stephen Schiffer and Brian Loar) is that the naturalistic account of content will proceed in two stages: a reduction of the semantic features of word; to the contents of propositional attitudes and then a reduction of the latter to physical or functional notions. The appeal of Grice's work on meaning to this two stage reductionist strategy is that Gricean definitions seem to provide the only way of reducing the semantic to the psychological, a reduction that is required for a naturalistic account of intentionality. While Avramides defends the method of analysis as one suited to the concept of meaning, she rejects a reductive interpretation of the analysis. She argues that any attempt to reduce the semantic to the psychological leads to a mistaken conception of mind. She exposes the assumptions behind the reductive interpretation and offers fresh and original arguments for the antireductionist position. Against the reductive Gricean she defends the idea that there is a deep epistemological symmetry between semantic and propositional attitude notions, a result of which is that semantically characterized linguistic behavior is central to our concept of belief. Anita Avramides is Lecturer in Philosophy at The Queens College, The University of Oxfor. A Bradford Book. (shrink)

Today, more corporations disclose information about their environmental performance in response to stakeholder demands of environmental responsibility and accountability. What information do corporations disclose on their websites? This paper investigates the environmental management policies and practices of the 200 largest corporations in the world. Based on a content analysis of the environmental reports of Fortune’s Global 200 companies, this research analyzes the content of corporate environmental disclosures with respect to the following seven areas: environmental planning considerations, top management support to (...) the institutionalization of environmental concerns, environmental structures and organizing specifics, environmental leadership activities, environmental control, external validations or certifications of environmental programs, and forms of corporate environmental disclosures. (shrink)

Recent developments in neuroscience have enabled technological advances to modulate cognitive functions of the brain. Despite ethical concerns about cognitive enhancement, both individuals and society as a whole can benefit greatly from these technologies, depending on how we regulate their use. To date, regulatory analyses of neuromodulation technologies have focused on a technology itself – for instance, the U.S. Food and Drug Administration regulation of a brain stimulation device – rather than the use of a technology, such as the use (...) of a brain stimulation device at work or school. Given that some forms of cognitive enhancement have already started to penetrate the general public’s everyday life, we should begin our discussion on potential regulatory issues regarding their use in various real-world situations. The goal of the article is to fill the gap by providing an analytic framework to examine these regulatory issues. More specifically, it aims to illustrate the issues around respecting autonomy and preventing coercive use of cognitive enhancement. The proposed framework categories the real-world settings where a neuromodulation technology can be used for cognitive enhancement based on two criteria – who is subjected to cognitive enhancement and who imposes cognitive enhancement. Based on this framework, the article analyzes regulatory issues arising out of every combination of subject/imposing party by taking one example case. Focusing on the regulations in the U.S., this analysis shows the current lack of adequate safeguards against the coercive use and calls for more attention from government agencies and researchers to develop sound policies regarding current and potentially more widespread use of cognitive enhancement. (shrink)

While the effects of COVID-19 are being felt globally, the pandemic disproportionately affects lower- and middle-income countries (LMICs) by exacerbating existing global health disparities. In this article, we illustrate how intersecting upstream social determinants of global health form a disparity pathway that compromises LMICs’ ability to respond to the pandemic. We consider pre-existing disease burden and baseline susceptibility, limited disease prevention resources, and unequal access to basic and specialized health care, essential drugs, and clinical trials. Recognizing that ongoing and underlying (...) disparity issues will require long-term correction efforts, this pathway approach is nonetheless helpful to inform ethical responses to this global pandemic. It can facilitate international cooperation during the pandemic to reduce the disparate burdens among different regions without imposing significant burden on any particular contributor. The pathway approach allows international stakeholders in various social positions to respond to different components of the pathway based on their respective strengths and resources to help break the cycle of global health inequity. Guided by the ethical principles of relational and pragmatic solidarity, we argue for a coordinated global division of labor such that different stakeholders can collaborate to foster equitable healthcare access during this pandemic. (shrink)

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report was prompted (...) by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis on the (...) family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making. (shrink)

It is possible to tease out two questions in connection with the epistemological problem of other minds: (i) How do I know what others think and feel? and (ii) How do I know that others think and feel? Fred Dretske offers a perceptual account of our knowledge of other minds that yields an answer to (i) but not (ii). Quassim Cassam uses Dretske’s perceptual account to show how we can answer both (i) and (ii). In this paper I show how (...) we can use Dretske’s work to understand some work by Stanley Cavell. I suggest that, where Dretske claims that we cannot answer (ii), Cavell holds that (ii) is a question that reflects a misunderstanding of our relations to others. In the place of asking how I can know that others think and feel, Cavell holds that I must acknowledge the other. And at the heart of this acknowledgment is an acceptance of others as separate from me. I must acknowledge the other as an other to me. (shrink)

: The formal theory of rational choice as grounded in desire-satisfaction cannot account for the problem of such deformed desires as women's slavish desires. Traditional "informed desire" tests impose conditions of rationality, such as full information and absence of psychoses, but do not exclude deformed desires. I offer a Kantian-inspired addendum to these tests, according to which the very features of deformed desires render them irrational to adopt for an agent who appreciates her equal worth.