Leeds Teaching Hospitals NHS Trust v Mr & Mrs A & othersThe decision of Dame Butler-Sloss in the case of Leeds Teaching Hospitals NHS Trust v Mr & Mrs A & Others1 has already achieved notoriety. The disturbing facts have received widespread media coverage and fuelled further legal and political debate surrounding the “reproductive revolution”.2 This short paper assesses the context and potential implications of the recent decision and, in particular, the nature and meaning of parenthood and the family.THE CASETwo (...) couples, referred to Mr and Mrs A and Mr and Mrs B, were attending the assisted conception unit at Leeds General Infirmary to receive infertility treatment. Both couples understood that they were participating in a technique called intracytoplasmic sperm injection , a technique which would use the eggs of the wife and the sperm of the husband in each case. Mrs A had consented to her eggs being mixed with her husband’s sperm to create an embryo which would then be implanted in her, hopefully resulting in pregnancy. Mr A had consented to his wife’s treatment. Mr and Mrs B gave their consent to similar IVF procedures, although Mr B had expressly refused to consent to his sperm being used in treating others.Following a mix up at the unit, which Butler-Sloss referred to as “a ‘mistake’ … despite its inadequacy as a description of what occurred”, Mr B’s sperm was injected into Mrs A’s eggs. She became pregnant and later gave birth to healthy twins. The mistake became apparent only on Mrs A’s delivery of twins of mixed race; Mr and Mrs A are both white, Mr and Mrs B both black. DNA testing subsequently established that Mr B was the biological father of the children. He has had no subsequent contact with them and …. (shrink)

Chapter one argues for the important contribution that a natural law based framework can make towards an analysis and assessment of key controversies surrounding the practices of suicide, assisted suicide, and voluntary euthanasia. The second chapter considers a number of historical contributions to the debate. The third chapter takes up the modern context of ideas that have increasingly come to the fore in shaping the 'push' for reform. Particular areas focused upon include the value of human life, the value (...) of personal autonomy, and the rejection of double effect reasoning. Chapter four engages in the task of pointing out structural weakness in utilitarianism and deontology. The thesis argues that major systemic weaknesses in both approaches can be overcome by a teleology of basic human goods. John Finnis' work becomes the underpinning of subsequent applied natural law analysis. Chapter five proceeds to argue for the defence of the intrinsic good of human life from direct attack. The thesis holds out for the proposition "that it is always a serious moral wrong to intentionally kill a human person, whether self or another, regardless of a further appeal to consequences or motive." In support of this, it defends the validity of double effect reasoning as an indispensable part of applied moral decision making. Chapter six critically assesses the arguments of anti-perfectionists that it is not the business of the state to enforce deep or substantive conceptions of the 'good life.' The chapter moves on to argue that the natural law conception of the person in society, centred on the common good, provides a solid framework for assessing both the justification for, as well as the limits on, the role of the state to use its power to legally impose certain moral standards. Chapter seven addresses the concrete relationship between natural law and legal policy by exploring the issue of assisted suicide in the constitutional context of the United States.















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Background: Hospital nurses are frequently the first care givers to receive a patient’s request for euthanasia or physician-assisted suicide (PAS). In France, there is no consensus over which medical practices should be considered euthanasia, and this lack of consensus blurred the debate about euthanasia and PAS legalisation. This study aimed to investigate French hospital nurses’ opinions towards both legalisations, including personal conceptions of euthanasia and working conditions and organisation. Methods: A phone survey conducted among a random national sample of (...) 1502 French hospital nurses. We studied factors associated with opinions towards euthanasia and PAS, including contextual factors related to hospital units with random-effects logistic models. Results: Overall, 48% of nurses supported legalisation of euthanasia and 29%, of PAS. Religiosity, training in pallative care/pain management and feeling competent in end-of-life care were negatively correlated with support for legalisation of both euthanasia and PAS, while nurses working at night were more prone to support legalisation of both. The support for legalisation of euthanasia and PAS was also weaker in pain treatment/palliative care and intensive care units, and it was stronger in units not benefiting from interventions of charity/religious workers and in units with more nurses. Conclusions: Many French hospital nurses uphold the legalisation of euthanasia and PAS, but these nurses may be the least likely to perform what proponents of legalisation call “good” euthanasia. Improving professional knowledge of palliative care could improve the management of end-of-life situations and help to clarify the debate over euthanasia. (shrink)

This paper reports from an ongoing multidisciplinary, ethnographic study that is exploring the views, values and practices (the ethical frameworks) drawn on by professional staff in assisted conception units and stem cell laboratories in relation to embryo donation for research purposes, particularly human embryonic stem cell (hESC) research, in the UK. We focus here on the connection between possible incidental findings and the circumstances in which embryos are donated for hESC research, and report some of the uncertainties and (...) dilemmas of our staff participants. We explore the views of our study participants in relation to two themes: (1) rights to information and anticipating how donors might be informed about future research findings and (2) occupational work goals and trust. (shrink)

Although most studies investigated the impact of infertility and its treatment on the couple, a small body of evidence suggested that infertility care providers may experience different sources of stress related for instance to excessive workload, the complexity of the technique, and relational difficulties with patients. The current study aimed at providing further insight into the understanding of the subjective experience of infertility care providers by highlighting their feelings and emotions, personal meanings, challenges, and opportunities. Following the methodological guidelines of (...) Interpretative Phenomenological Analysis, we conducted individual semi-structured interviews with 23 members of two different fertility units. Interviews were audiotaped and transcribed verbatim. Textual analysis was then conducted to identify emerging dominant themes and subthemes. Three main themes were extracted: dealing with infertile patients and their specificities, performing assisted reproductive technology, being part of a team. These themes related to participants experiencing: difficulties in establishing an empathic connection and communicating with couples, such that women were sometimes perceived as “particular patients” and men as poorly involved in the process; difficulties in dealing with a complex procedure in which errors are not allowed, with a growing number of women aged > 40 seeking assisted reproduction, despite the risks for their health; being part of a team as a resource, although the huge amount of time spent together can involve conflicts and organizational problems. These findings suggested that patients’ overpersistence represents an important source of stress for infertility care providers. At the same time, the concept of particular or difficult patient derives from the combination of multiple factors, including providers’ own history and subjective experience. The presence of mental health professionals in fertility units is essential to help providers improve the quality of doctor-patient communication and relieve the stress related to organizational issues and conflicts. (shrink)

The current article deals with the ethics and practice of physician-assisted suicide (PAS) and dying. The debate about PAS must take the important legal and ethical context of medical acts at the end of life into consideration, and cannot be examined independently from physicians’ duties with respect to care for the terminally ill and dying. The discussion in Germany about active euthanasia, limiting medical intervention at the end of life, patient autonomy, advanced directives, and PAS is not fundamentally different (...) in content and arguments from discussions led in other European countries and the United States. This must be emphasized, since it is occasionally claimed that in Germany a thorough discussion could not be held with the same openness as in other countries due to Germany’s recent history. Still, it is worthwhile to portray the debate, which has been held intensively both among experts and the German public, from the German perspective. In general, it can be stated that in Germany debates about questions of medical ethics and bioethics are taking place with relatively large participation of an interested public, as shown, for instance, by the intense recent discussions about the legalisation of advanced directives on June 18 2009, the generation and use of embryonic stem cells in research or the highly difficult challenges for the prioritizing and rationing of scarce resources within the German health care system. Hence, the current article provides some insights into central medical and legal documents and the controversial public debate on the regulation of end-of-life medical care. In conclusion, euthanasia and PAS as practices of direct medical killing or medically assisted killing of vulnerable persons as “due care” is to be strictly rejected. Instead, we propose a more holistically-oriented palliative concept of a compassionate and virtuous doctor-cared dying that is embedded in an ethics of care. (shrink)

Background Little is known about the attitudes and practices of intensivists working in Lebanon regarding withholding and withdrawing life-sustaining treatments. The objectives of the study were to assess the points of view and practices of intensivists in Lebanon along with the opinions of medical, legal and religious leaders regarding withholding withdrawal of life-sustaining treatments in Lebanese intensive care units. Methods A web-based survey was conducted among intensivists working in Lebanese adult ICUs. Interviews were also done with Lebanese medical, legal and (...) religious leaders. Results Of the 229 survey recipients, 83 intensivists completed it, i.e. a response rate of. Most respondents were between 30 and 49 years old, Catholic Christians, anesthesiologists, working in Beirut. Ninety-two percent of them were familiar with the withholding and withdrawal concepts and 80% applied them. Poor prognosis of the acute and chronic disease and futile therapy were the main reasons to consider withholding and withdrawal of treatments. Ninety-five percent of intensivists agreed with the “Principle of Double Effect”. The main withheld therapies were vasopressors, respiratory assistance and CPR. Most of the respondents reported the decision was often to always multidisciplinary, involving the family, and the patient, or his advance directives or his surrogate and the nurses. The interviewees agreed there was a law governing withholding and withdrawal decisions/practices in Lebanon. Christians and Muslim Sunni leaders declared accepting those practices. Conclusion Withholding and withdrawal of LSTs in the ICU are known concepts among intensivists working in Lebanon and are being practiced. Our results could be used to inform and optimize therapeutic limitation in ICUs in the country. (shrink)

A reductive reading of Humanae vitae seeks to limit its appeal to a ban on contraception. In truth, however, it offers a vision of human sexuality and conjugal love with broad and enduring relevance. In setting forth the intrinsic complementarity and irreducibility of the unitive and procreative dimensions of the conjugal act, Paul VI has given us a hermeneutical key for assessing many contemporary ethical dilemmas in human reproductive medicine. From this perspective, this article seeks to apply the logic of (...) Humanae vitae to several real-life scenarios confronted by medical practitioners, educators, and ethicists working in the field of fertility and reproductive health. These include a consideration of the ethics of prescribing hormonal contraceptives, the possibilities of investigating male infertility, issues of cooperation in counseling and assisting conception in same-sex relationships, the ethics pertaining to assisted reproductive technology, the contested case of prenatal adoption, and the application of double-effect reasoning. On the occasion of the fiftieth anniversary of the promulgation of Pope Paul VI's encyclical Humanae vitae, this article seeks to defend its enduring relevance to modern-day society, through application of its reasoning to contemporary dilemmas in reproductive medicine. It considers real cases of the ethics of prescribing hormonal contraceptives, of investigating male infertility, of cooperating in counseling and assisting conception in same-sex relationships, of ART, of prenatal adoption, and the application of double-effect reasoning. (shrink)

After almost two years of armed conflict between Arab militias and African farmers in Sudan, the United Nations Security Council passed resolution 1556 in July 2004, calling upon the Sudanese government to end the violence or face possible diplomatic and economic sanctions. The militias, known as the Janjiwid, arose after African farmers in the Darfur region formed the Sudanese Liberation Army and attacked the government in February 2003. Human rights organizations, such as Amnesty International, claim that the government gave the (...) militias logistical assistance to attack the farmers. Since 2003, tens of thousands have been killed and more than a million people displaced from their homes, pushed into concentration.. (shrink)

Religion has a considerable influence over the public’s attitudes towards science and technologies. The objective of the paper is to understand the ethical and religious problems concerning the use of embryo for research in assisting conception for infertile couples from the perspective of Catholic Christians. This paper seeks to explain our preliminary reflections on how religious communities particularly the Catholic Christian communities respond to and assess the ethics of reproductive technologies and embryo research. Christianity as a whole lacks a (...) unified and definitive statement on when an embryo becomes a person, although fundamentalist Christians tend to be opposed to embryo experimentation. Roman Catholics tend to believe that the embryo should be treated as human life from the moment of conception or fertilisation. As opposed to this preconception I have tried to point out that a foetus is a clump of cells and lacks individuality as a conscientious human being and thus can be used for research for therapeutic reason. The paper concluded that the Church accepts techniques on embryo that respect their life. So they would allow procedures that are akin with healing and improvement of life without involving undue risks. The Church feels children should arise out of act of love between man and his wife in co-operation with God. In this regard, it may be pointed out though the creation of a child through a conjugal act in a wed lock is the preferred method since it is the most natural, least expensive one. But that does not mean, it should be the only acceptable means to conception. To state a child born using ARTs would be less perfect compared to a child born through conjugal act of husband and wife is absurd one to be mentioned. (shrink)

Research ethics education has taken many forms since federal funding agencies issued regulatory guidance directing those supported by these agencies to complete required training. In the absence of a standard training approach among institutions such as universities, the design and content of courses, workshops, and seminars varies widely. Here we describe a southwestern United States research university program that employed six teaching strategies to assist students in deep learning of ethical principles and behavior. Our purpose was to determine how these (...) strategies impact understanding and empowerment among an interdisciplinary group of graduate students. Results suggested that deep learning design can result in learning that requires students not only to remember and understand key ethics concepts but also to analyze and apply them in a broader ethical domain. Key findings inform design and delivery of future research ethics courses for instructional designers and instructors in higher education. (shrink)

The United Nations Scientific, Education and Cultural Organisation (UNESCO) has commenced drafting a Universal Bioethics Declaration. Some in the relevant UNESCO drafting committee have previously desired to restrict its content to general principles concerning the application (but not necessarily the goals) of science and technology. As potentially a crucial agenda-setting statement of global bioethics, however, it is arguably important the Universal Bioethics Declaration transparently address major bioethical dilemmas in the field of public health, such as universal access to affordable, essential (...) medicines. Article 13 (Social Responsibility) of the Preliminary Draft Universal Bioethics Declaration states: ‘Any decision or practice shall ensure that progress in science and technology contributes, wherever possible, to the common good, including the achievement of goals such as: (i) access to quality health care and essential medicines, including for reproductive health and the health of children.’Cost effectiveness pricing systems, such as that most notably used in Australia’s Pharmaceutical Benefits Scheme (PBS), arguably represent one of the most scientifically effective mechanisms whereby public monies may be utilised to assist in the provision of medicines for the common good. They contain two essential elements: first, a process of scientific evaluation of objectively demonstrated therapeutic significance, and then, a fiscal lever (the government reimbursement price) attached to that evaluation.It is now well established that the US Pharmaceutical Research and Manufacturers Association (Pharma), through the assistance of the US Trade Representative (USTR), saw the Australia United States Free Trade Agreement (AUSFTA) as an opportunity to fulfill a legislative mandate to ‘eliminate ’ the cost-effectiveness pricing system in Australia’s PBS. One of the most remarkable features of the arguments raised against the PBS in this context was the fact that they made almost no reference to the normative discourse of bioethics or international human rights. Provisions such as Article 13 in UNESCO’s Universal Bioethics Declaration, although they will create no immediate obligations under international law, may play an extremely valuable role in legitimising the use of bioethical and human rights concepts in access to medicines debates surrounding multilateral and bilateral international trade deals such as the AUSFTA. (shrink)

The central importance of reproduction in all human cultures has given rise to many methods and techniques of assisting reproduction or overcoming infertility. Such methods and techniques have achieved spectacular successes in the Western world, where processes like in vitro fertilization (IVF) constitute a remarkable breakthrough. In this paper, the author attempts to reflect critically on assisted reproduction technologies (ART) from the background and perspective of African culture, a culture within which human reproduction is given the highest priority but (...) which also exhibits a highly ambivalent attitude to modern technology-assisted methods of reproduction. The author considers the ethical crux of reproductive technologies to be linked to the issue of the moral status of the human embryo and argues that a morally significant line of demarcation cannot be drawn between embryos and other categories of humans. (shrink)

Background: The concept of dignity can be divided into two main attributes: absolute dignity that calls for recognition of an inner worth of persons and social dignity that can be changeable and can be lost as a result of different social factors and moral behaviours. In this light, the nursing profession has a professional dignity that is to be continually constructed and re-constructed and involves both main attributes of dignity. Objectives: The purpose of this study was to determine how nurses (...) described nursing’s professional dignity in internal medicine and surgery departments in hospital settings. Research design: The research design was qualitative. Ethical considerations: This study was approved by the ethics committees of the healthcare organizations involved. All the participants were provided with information about the purpose and the nature of the study. Participants: A total of 124 nurses participated in this study. Method: The data were collected using 20 focus group sessions in different parts of Italy. The data were analysed by means of a conventional inductive content analysis starting from the information retrieved in order to extract meaning units and sorting the arising phenomena into conceptually meaningful categories and themes. Results: Nursing’s professional dignity was deeply embedded in the innermost part of individuals. Regarding the social part of dignity, a great importance was put on the values that compose nursing’s professional identity, the socio-historical background and the evolution of nursing in the area considered. The social part of dignity was also linked to collaboration with physicians and with healthcare assistants who were thought to have a central role in easing work strain. Equally important, though, was the relationship with peers and senior nurses. Conclusion: The organizational environments under scrutiny with their low staffing levels, overload of work and hierarchical interactions did not promote respect for the dignity of nurses. To understand these professional values, it is pivotal to comprehend the role of different health professions in their cultural milieu and the evolution of the nursing profession in diverse countries. (shrink)

The relationships between socioeconomic and biogenetic reproduction are always socially constructed but not always acknowledged. These relationships are examined as they apply to an instance of infertility and assisted reproduction presented in a seventeenth-century English play, Thomas Middleton’s 1613 comedy, A Chaste Maid in Cheapside. Middleton’s satirization of the effects of secrecy on the category of reproductive disability is analyzed and its applicability to our own time considered. The discussion is in four parts, focusing on: the attribution of disabled (...) status to one member of the couple, the wife; the use of this attribution to protect the husband’s reputation for sexual and reproductive health; the concealment of the nature of assisted reproduction; and the interests of the child conceived with such assistance. (shrink)

During the period covered by this volume, Bertrand Russell first retired from and then resumed his philosophical career. In 1927 he published two philosophy books, The Analysis of Matter and An Outline of Philosophy . His next book in academic philosophy, An Inquiry into Meaning and Truth , was not published until 1940. Yet, Russell published a significant amount of essays and popular books between 1927 and 1946, mostly to finance the running of Beacon Hill School, and his growing family. (...) Those years also saw his break-up with Dora Russell, his marriage to Patricia Spence and a move of the family to the United States. Volume 10 brings together Russell's writings on ethics, politics, religion and academic philsophy. It is an invaluable guide to the thought and development of one of the most famous philosophers of this century. (shrink)

This paper scrutinizes the topic of meaning manifestation and signification made known by the act of interpretation, which amounts to finding the organising principles of a text and rules of combination. The language of narrativity is a set of generational and transformational instances disguising textual content and initiating interpretation as such. The paper discusses the levels of description which assist in tackling the concept of change, or difference in degrees, as the result of both the artificial operation of rewriting the (...) text on various methodological grounds and real dynamics justified by the obvious layers of the plot. The elementary units of meaning articulation covered by this article run the gamut from Roland Barthes’ distributional and integrational narrative units to Algirdas Julien Greimas’ deep and surface structures with special stress on the narrative programs and narrative analysis, which is of primary interest here. The Greimassian narrative grammar successfully describes what exists and how to capture the process of signification. In the end, analytical instruments elaborated by Greimas are effectively adapted to interpret the case of Edgar Allan Poe’s story William Wilson. The story itself is retold and interpreted through narrative formalisation, which consists in speaking of the plot transformations in terms of utterances of states and utterances of doing. Within the framework of narrative structures that emerge on the way to the formalisation of William Wilson, small changes in narrative trajectories seem to be out of sight, not even readable. Contrariwise, Barthes’ touch on what the text is all about enables the reader to be engaged in looser textual interpretations, to gain more variable, highly detailed experience in noticing the slightest movement and tasting each nuance of the overall setting. This paper first and foremost takes on board the structural narrative analysis as it is set out in Greimas’ narrative grammar leading to a special kind of severe narrative absolutism; on top of that, the paper gives a clue of a couple of alternative views on the problem, views represented by Barthes. (shrink)

Despite legislation and public education, racism and sexism are alive and well. Though pre‐conceptive gender selection may enhance procreative liberty, this technology presents two disturbing questions. First, does sex selection represent underlying parental sexism? Second, by performing gender selection, do medical professionals perpetuate sexism? It will be maintained that pre‐conceptive sex selection is sexist as it reflects parental anticipation of stereotypical gender based behavior. Perhaps even more incriminating, sex selection forces parents to prefer one sex over another, to place a (...) value on gender. This emphasis on sex conflicts with societal goals which urge, and often legally require, individuals to ignore gender. We will assert that pre‐conceptive gender selection exemplifies sexism in its purest most blatant form as prior to conception, before parents can possibly know anything about their child, gender dominates the calculus of a child’s worth. We will also emphasize that physicians, by facilitating sex selection, legitimize the motivations of their patients and provide de facto support of sexism. In a similar vein, arguments against pre‐conceptive race selection will be made. (shrink)

This book argues for the importance of writing to conceptions of language, technology, and civilization in the early modern era.

John Locke (29 August 1632 - 28 October 1704) was an English philosopher and physician, widely regarded as one of the most influential of Enlightenment thinkers and commonly known as the "Father of Liberalism". Considered one of the first of the British empiricists, following the tradition of Sir Francis Bacon, he is equally important to social contract theory. His work greatly affected the development of epistemology and political philosophy. His writings influenced Voltaire and Jean-Jacques Rousseau, many Scottish Enlightenment thinkers, as (...) well as the American revolutionaries. His contributions to classical republicanism and liberal theory are reflected in the United States Declaration of Independence.Locke's theory of mind is often cited as the origin of modern conceptions of identity and the self, figuring prominently in the work of later philosophers such as David Hume, Rousseau, and Immanuel Kant. Locke was the first to define the self through a continuity of consciousness. He postulated that, at birth, the mind was a blank slate or tabula rasa. Contrary to Cartesian philosophy based on pre-existing concepts, he maintained that we are born without innate ideas, and that knowledge is instead determined only by experience derived from sense perception. This is now known as empiricism. An example of Locke's belief in Empiricism can be seen in his quote, "whatever I write, as soon as I discover it not to be true, my hand shall be the forwardest to throw it into the fire." This shows the ideology of science in his observations in that something must be capable of being tested repeatedly and that nothing is exempt from being disproven. Challenging the work of others, Locke is said to have established the method of introspection, or observing the emotions and behaviors of one's self.Locke's concept of man started with the belief in creation. We have been "sent into the World by order, and about his business, are his Property, whose Workmanship are, made to last during his, not one anothers Pleasure." Like the two other very influential natural-law philosophers, Hugo Grotius and Samuel Pufendorf, Locke equated natural law with the biblical revelation, since in their view both had originated in God and could therefore not contradict each other. "As a philosopher, Locke was intensely interested in Christian doctrine, and in the Reasonableness he insisted that most men could not hope to understand the detailed requirements of the law of nature without the assistance of the teachings and example of Jesus.". (shrink)

In the United States, judicialrulings that unrealistically addressed the complexityof cases and demonstrated limited understanding ofprinciples, helped to create a legal quagmire whichlegislatures had to confront. Moreover, thelegislative response was often slow and inadequate interms of both the scope and clarity of the laws. However, since the 1970s, progress has been made onmany fronts, particularly in regard to advancedirectives dealing with end-of-life decisions. Thedebate over physician-assisted suicide has spawned arepetition of moral and legal arguments. Thoseagainst legalization have failed to (...) make a realisticappraisal of the dilemmas facing patients and theirfamilies in an age of technological medicine deliveredin the context of the marketplace. The underlyingproblem is a system in dire need of reform that willno longer treat health care as a commodity of themarketplace and provide universal health care. Terminal care as an integral part of health care willsubstantially benefit from such reforms because amajor obstacle to comprehensive palliative care is thecondition of the present system. (shrink)

Infertile couples have come to take assisted reproductive technologies (ART) for granted. An increasing number of single women and lesbian couples also desire to have children and turn to ART, especially donor insemination, to fulfill this desire. While most married couples find that access to ART is limited primarily by the ability to pay, for single women and lesbian couples, the story may be much different. In the United States, they may find that doctors and infertility clinics view their (...) desires as immoral and refuse to accept them as patients, although other doctors and clinics readily accept them. In most other countries, however, it is against the law for single women and lesbian couples to make use of ART, including donor insemination. In this paper I will argue that marital status and sexual orientation should not serve as a barrier to accessing the world of reproductive medicine. I will base this conclusion on two arguments. First, that justice requires that we treat like cases alike. Just as we would not accept or reject patients for cardiac rehabilitation programs based on factors such as a history of poor eating habits, so too we should not look at nonmedical factors such as marital status when deciding whether to treat infertility. For the second justification for the conclusion of equal access to ART, I will examine the concept of the family. I will argue that it is morally acceptable for single women and lesbian couples to have children and to head families. (shrink)

The paper adopts an inter-theoretical socio-cultural and -material perspective on the relationship between human + machine learning to propose a new way to investigate the human + machine assistive assemblages emerging in professional work (e.g. medicine, architecture, design and engineering). Its starting point is Hutchins’s (1995a) concept of ‘distributed cognition’ and his argument that his concept of ‘cultural ecosystems’ constitutes a unit of analysis to investigate collective human + machine working and learning (Hutchins, Philos Psychol 27:39–49, 2013). It argues (...) that: (i) the former offers a way to reveal the cultural constitution of and enactment of human + machine cognition and, in the process, the limitations of the computational and connectionist assumptions about learning that underpin, respectively, good old-fashioned AI and deep learning; and (2) the latter offers a way to identify, when amplified with insights from Socio-Materialism and Cultural-Historical Activity Theory, how ML is further rearranging and reorganising the distributed basis of cognition in assistive assemblages. The paper concludes by outlining a set of conjectures researchers that could use to guide their investigations into the ongoing design and deployment of HL + ML assemblages and challenges associated with the interaction between HL + ML. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.4 (2001) 317-322 [Access article in PDF] On Wolfgang Blankenburg, Common Sense, and Schizophrenia Aaron L. Mishara Introduction In its increasing openness to neuroscience (Cowan, Harter, and Kandel 2000) and other of its neighboring disciplines, mainstream biological psychiatry has allowed psychopathology, philosophy, and philosophical approaches to psychopathology to play an increased role in current research interests. Given this new openness, and the acknowledgment of the (...) severity of one of psychiatry's most debilitating, costly, and intractable disorders, 1 the translation of W. Blankenburg's 1969 article concerning the psychopathology of common sense does not merely serve historical interest. It is an exceptional example of a not well-known trend in German- and French-speaking psychiatry to apply philosophical phenomenology and existentialism to psychopathological research. This trend, which reached a peak in the late 1950s and was strong well into the 1970s, has dwindling, but nevertheless, current representatives in Heidelberg and Zurich and is scattered in a few other places in Europe, Japan, the United States, and South America. The view of the Zeitgeist—which may sound astonishing, even antiquated to contemporary readers—was highly ambitious: Conceptual approaches, such as philosophical ("transcendental") phenomenology, were expected to supply knowledge about the structure of consciousness and its disturbance in various mental disorders.Following the lead of Binswanger and Szilasi, who viewed schizophrenia as an "experiment of nature" that enables us to view underlying processes otherwise hidden to "natural, everyday consciousness," Blankenburg believed that it may be possible to map the formal properties of the psychopathology of schizophrenia—precisely in the loss of common sense—as a disturbance to the basic organization of conscious experience. Any attempt to summarize this rather abstract and complex approach in a brief commentary would be ill advised. In passing, rather, I will remark that such efforts could have profound relevance to the current research of schizophrenia and its underlying neurobiology. This research has gradually acknowledged the importance of taking the patient's subjective experience of the disorder into account (Mishara, Parnas, and Naudin 1998). In this commentary, I will first give an account of the biographical and clinical reasons that led Blankenburg to turn to the problem of common sense and its relevance for schizophrenia. I will then explore what implications [End Page 317] his work may have for more recent findings concerning schizophrenia. Blankenburg's Intellectual Development Born in 1928, W. Blankenburg, the son of a Lufthansa pilot who pioneered transatlantic commercial flights, began his studies in Freiburg im Breisgau in 1947. While at Freiburg, Blankenburg heard lectures in philosophy given by E. Fink (the former assistant to Husserl) and Max Mueller, and in psychology, by R. Heiss and others. After three years, Blankenburg turned to the study of medicine, producing a dissertation in 1956 on an application of Daseinsanalysis (Heidegger and Binswanger) to a case of paranoid schizophrenia. Binswanger wrote the forward to the publication. Between 1956 and 1958, Blankenburg studied internal medicine in Heidelberg with the accomplished phenomenologist of bodily experience (Leibphaenomenologer) and student of V. von Weizsaecker Herbert Pluegge. He spent one semester in Goettingen where he attended lectures by the ontological philosopher Nicolai Hartmann, who provided for Blankenburg a more useful approach to the problem of nature and natural science than Heidegger's primary emphasis on the question of Being. During his Freiburg years, Blankenburg attended small seminars led by Heidegger in the Schwarzwald forest. (Heidegger had been forbidden to teach after the end of World War II.) Blankenburg recalls that the participants would sit on logs in an open field as if to invoke Heidegger's concept of the clearing (Lichtung) of Being. While not entirely sympathetic with Heidegger's philosophy, Blankenburg learned to carefully "listen"—as Heidegger would repeatedly emphasize—to language, not merely poetic or philosophical language, but the language of the patients he would meet in clinical practice.During this time, Blankenburg heard lectures by W. Szilasi, the philosopher-scientist who held Husserl's and Heidegger's chair in the department of philosophy. Szilasi collaborated with the phenomenological psychiatrist, L. Binswanger. Their effort to apply concepts from Husserl's... (shrink)

Susan Kahn rend compte dans cet ouvrage d’une recherche ethnographique menée en Israël sur l’usage des nouvelles techniques de reproduction et sur les interrogations qu’elles soulèvent concernant la parenté, la paternité, la maternité et la fabrique de citoyens juifs. Son travail s’appuie sur des entretiens avec des Israéliennes non mariées qui ont eu recours à une insémination artificielle, des rabbins et des juifs orthodoxes, ainsi que sur une observation participante dans une clinique de...

This paper considers the roles and definitions of expert and lay members of ethics committees, focussing on those given by the National Research Ethics Service which is mandated to review all research conducted in National Health Service settings in the United Kingdom. It questions the absence of a specified position for the ‘professional ethicist’ and suggests that such individuals will often be lay members of ethics committees, their participation being a reflection of their academic interest and expertise. The absence of (...) a specified position for professional ethicists and the concomitant but implicit denial of ethical expertise appear to be an anomalous state of affairs if one considers that the training offered to members of ethics committees is often delivered by academic ethicists. It is suggested that this is based on a misunderstanding of the concept ‘ethical expertise’ and that properly understood the ethicist can assist the work of ethics committees by drawing on their expert knowledge. (shrink)

This article is based on ethnographic research conducted between 1998 and 2000 in British Columbia, Canada. In this article Luce brings together the narratives of queer women she interviewed about their experiences of trying to become parents with her own stories about doing the research. Both sets of stories explore the ways in which relationships between people are reproduced and represented through images of sexuality, reproduction, queerness, parents, and families. Shifting between telling about the tensions she experienced while doing ethnographic (...) fieldwork and retelling women's stories about how their relationships to partners, fetuses, babies, and donors were perceived, the article draws attention to both political and methodological questions. (shrink)

In an age of rapid advances inlife-prolonging treatment, patients and caregivers areincreasingly facing tensions in making end-of-lifedecisions. An examination of the history of healthcare in the United States reveals technological,economic, and medical factors that have contributed tothe problems of terminal care and consequently to themovement of assisted suicide. The movement has itsroots in at least two fundamental perceptions andexpectations. In the age of technological medicineenergized by the profit motive, dying comes at a highprice in suffering and in personal economic (...) loss. Thefailure to provide affordable resources for terminalcare is the result of the marketplace in health care. The medical profession has been painfully slow inresponding to the challenges of terminal care, mainlybecause of the pressures of the marketplace and lackof adequate training. This has occurred at a time ofrapid advances in life-sustaining treatment and ofexpanding public awareness of personal rights underthe law. Overly aggressive treatment in the finalstages of terminal illness has enhanced anxieties overa painfully prolonged and expensive dying. Thesefactors have promoted the movement to assistedsuicide. In the U.S. debate of the issues, ethiciststend to argue abstractly without examiningadequately the context of terminal care that is thehealth care system. It is a system in dire need of areform that will remove it from the marketplace. (shrink)

California is the global hub for assisted reproductive technology practices, including egg donation. The rise of egg donation in the United States is surprising given the cultural context linking genetics and motherhood and rejecting the commodification of reproduction. Scholars in the hostile worlds camp have grappled with the relationship between intimacy and economics, yet employing this theory to explain the increase in egg donation is unsatisfactory. The concept of relational work, developed by Viviana Zelizer, provides scholars with a robust (...) analytical tool to account for the rise in egg donation. This paper analyzes the relational work of egg donors and fertility center staff. I argue that donors and staff construct an understanding of egg donation that avoids directly challenging the cultural context mentioned above. Analyzing egg donation as a case of relational work demonstrates the need to move beyond the reciprocity/market dichotomy upheld by the hostile worlds framework. (shrink)

Hard cases make bad law. In a matter of months, two such cases involving assisted reproduction have appeared before the U.K. High Court and legislation has been enacted. The common threads between them are consent and fatherhood. The first case concerns a ‘mistake’ resulting in sperm from the wrong man being used to create an embryo for a couple and the second the revocation of consent by a man to his former partner being allowed to use an embryo they (...) created together. Furthermore, Parliament has intervened, passing legislation which sets out when sperm from a dead man may be used by his former partner to generate an embryo. This note argues that the three developments cannot be reconciled with one another and that the cases in particular, decided on a narrow legal basis, convey contradictory messages, leading in at least one instance to a gross injustice. (shrink)

When Nadya Suleman gave birth to eight babies in January 2009, the story ignited a media frenzy—first because the babies were only the second set of octuplets born in the United States, and later because of the irregularities of their conception by in vitro fertilization and the personal details of their mother's life. Hidden beneath the sensational aspects of the story, though, are a number of fundamental ethical, medical, and legal issues concerning assisted reproductive technologies. Three essays examine (...) these questions. (shrink)

Photo by Jonathan Ford on Unsplash ABSTRACT Since 2008, an average of twenty million people per year have been displaced by weather events. Climate migration creates a special setting for a duty to rescue. A duty to rescue is a moral rather than legal duty and imposes on a bystander to take an active role in preventing serious harm to someone else. This paper analyzes the idea of expanding a duty to rescue to climate migration. We address who should have (...) the duty and to whom the duty should extend. The paper discusses ways to define and apply the duty to rescue as well as its limitations, arguing that it may take the form of an ethical duty to prepare. INTRODUCTION Climate migration creates a special setting for a duty to rescue. A duty to rescue is a moral rather than legal duty and imposes on a bystander to take an active role in preventing serious harm to someone else. Examples of circumstances range from person-to-person intimate rescue to saving those in poverty, even in distant parts of the world.[1] Since 2008, an average of twenty million people per year have been displaced by weather events.[2] Circumstances like being thrust from homes under the threat of fire, mudslide, and flooding vary greatly from long-term changes like land becoming too arid for crops or temperatures increasing annually gradually pushing up the number of heat-related deaths, with the area slowly becoming uninhabitable. Imminence in fleeing affects resettling and need for rescue with important implications for how the duty to rescue might apply. This paper reevaluates the ethical framing of the duty to rescue and, while it is arguably a stretch, applies it to climate migration. Climate migration has become common and is expected to increase due to rises in sea level, increases in weather events that make areas uninhabitable, and changes to land that preclude farming or other necessary land uses. We argue that a duty to rescue may help highlight who has moral obligations to whom. Because the problem is so large in scope, we suggest a change in the ethical limits to humans' duty to rescue other humans who are in distress. We imagine an expansion or extension of the duty to rescue to meet some of the basic needs created by climate migration. Yet how it should expand, and how much depend on ethical framing and practical limitations. l. Expanding the Geographical Boundaries Two commonly recognized emergencies, Hurricane Katrina in the case of weather events and the current COVID-19 pandemic, provide a historical and current backdrop to evaluate ethical obligations as more disasters displace people. A significant reassessment of the ethical scope of an obligation to rescue in the case of weather events will be limited by the ability to render aid to those in distress in the case of a planet-wide weather catastrophe. The problems may overwhelm the ability to rescue or the reasonableness of attempting rescue. The extent of the moral obligation borne by humans to other humans in the case of a weather event has been largely defined by its locality and limited geographic influence. Whether we are imagining the scope of ethical obligation in the case of hurricane, flood, tornado, drought, or wildfire events, the perceived ethical obligation is significantly defined by the limited impact of these weather events on people outside the zone of the weather event's direct impact, yet close to that zone. A hurricane affecting New Orleans will not have immediate impact on the residents of California or even those on the northeast coast of the United States until a later time. Wildfires in the Pacific Northwest do not impair the ability of those in the rest of the country to come forward with assistance. But as climate migration crosses international borders, and climate events occur simultaneously in many regions, a more expansive duty to rescue may provide the ethical impulse to help those who live afar or migrate long distances. In this respect, the need for help in the event of widespread climate migration due to global warming is more like a pandemic than a weather event. Its broad impact area diminishes the capability of nearly the entire balance of the human population to help due to those populations' awareness that they will, in short order, have the same need for the same resources, from the same cause. Those living near current flood zones may find their historically safe havens are also a flood zone. Those previously best positioned to rescue may find themselves also needing to relocate. Thus, we may observe the need for new rescuers. ll. The Rule of Rescue The Rule of Rescue as defined by Al Jonsen describes the moral impetus or knee jerk reaction to save identifiable people facing death.[3] A duty to rescue has since been expanded beyond imminent death and beyond the near and identifiable. But there are limitations. For example, by most accounts, the ethical duty tends not to require extreme bodily risk or financial depletion. In comparing Good Samaritans to humanitarians, Scott M. James argues the duty to rescue arises from unique dependence, but the ethical obligation to help strangers through humanitarian aid is of a different nature.[4] The wrongness of failing to help is arguably more egregious when one is in a unique position to help. Like in the tragedy of the commons, where there is no unique positioning, when the global community is called upon to help, each individual in it may feel less obliged to do so. Climate migration falls in between—it requires helping strangers, yet it may move forward without anyone seeing themselves as uniquely positioned to help until those strangers become part of communities, at which time, there may be more moral justification to help a community member in need. Generally, arguments about Good Samaritans hinge on extraordinary acts, praiseworthy because they are acts of compassion, not obligation. Now all US states have Good Samaritan laws[5] which protect helpers from liability for help gone wrong or for a failure to succeed once engaged in an act of rescue. Extraordinary help as a moral good is thus somewhat encouraged through legal protection, but not imposed. Conversely, jobs like firefighting, search and rescue, and emergency medical care tend to oblige employees to take on risks that would be extraordinary if undertaken by the average bystander, yet they are rendered ordinary rescue as part of the job. Three states, Minnesota, Rhode Island, and Vermont have a broad duty to rescue, adding legal considerations to an otherwise moral conundrum. The laws do not require bystanders to take on risk for the sake of rescuing strangers.[6] The moral duty will require looking beyond law, but it is unclear how the moral duty to rescue should be distributed in the case of climate migration. A bare minimum would prevent taking advantage of newcomers, paying sub-minimum wage, and discriminating against them. Yet such a minimum is hardly rescue. lll. An Ethical Rather than Legal Duty The difficulty in defining the duty to rescue as a legal obligation is that it is difficult to determine the extent of risk a rescuer ought to be required to take. The nature of this ethical duty is also arguably tied to the experiences of both the rescuer and the rescued. There are subjective aspects like what someone perceives as a danger that make it difficult to write enforceable laws requiring rescue. It is one thing to expect a rescuer to step into several inches of relatively warm water to lift a person lying face down in a pond and enable them to breathe. It is something altogether different to expect that rescuer to dive into frigid water and attempt to extricate someone trapped in a submerged automobile. As the legal philosopher H.L.A. Hart observed, it is always easier to define application of the core intention of any rule, whether law or ethical norm. It is more difficult to create legal certainty about how the law applies to what he described as “penumbra circumstances”. In the case of a hurricane, it is easier to define what surplus resources are available in areas geographically remote from the impact of the storm and demand, as a moral obligation, that those nearby but outside the area provide assistance. It is more difficult to obligate people, organizations, or governments to supply a quantity of medication or some number of ventilators to an adjacent community when they expect to imminently need them for their own community. In the early stages of climate migration, the ethics of extreme weather event assistance, a common application of the duty to rescue, will be useful and appropriate. The rising sea levels first experienced by island nations in the South Pacific[7] will not render those living in other coastal communities, those with greater available “high ground”, unable to supply resources to those in need. But when sea level rise and climate change affect more communities simultaneously, albeit in varying degree, the task of defining what response is ethically obligatory becomes increasingly complicated. Pinpointing the obligations of those communities which are resource rich to those communities which are resource deprived, and of those partly affected to those more severely affected may become necessary. The limitations of the traditional duty to rescue could expand to meet the needs. lV. Contribution to the Problem Many argue that the duty to rescue may depend on any appropriate claim of those needing rescue. One issue is whether preferential claims among those who can identify the source of the harm should call for a greater duty or whether everyone in need should be approached as like candidates for rescue, shaping the duty as equal across those on the receiving end. As climate change does have human-made causes, there are strong arguments to impose a greater ethical duty on any entity that caused the climate-related problems leading to the mass exodus. While the global north is often implicated in pollution that causes migration, industries like energy, transportation, and agriculture are tied to climate change and associated with significant greenhouse gas emissions.[8] Practices like directing agriculture to less sustainable single crop growth generally made land less farmable. Yet it is difficult to place blame and identify specific causal relationships as most migration is due to many factors. A movement toward greater accountability can be reframed as a greater duty to rescue, a duty to engage in the extraordinary. The fossil fuel industry, for example, should have a larger obligation than the average person. Similarly, some may argue anyone unjustly enriching themselves while contributing to climate change or people who over-consume have an elevated duty to rescue.[9] Climate change lawsuits demonstrate an eagerness to hold governments and corporations accountable, despite difficulty proving causation. V. The Most Vulnerable One ethical dimension of climate migration that remains unexplored is how a duty to rescue applies to vulnerable populations who stand to be left behind or unable to migrate without assistance. Researchers from the Global North working across the Global South are increasingly observing the phenomenon of ethics dumping, where the research ethics of some countries are imposed on research subjects in other countries.[10] In that vein, rescuers should be careful not to impose unwelcome cultural standards or exploit people who are in the process of migrating. There is a gap in discussions reflecting voices that have been left out. The duty to rescue is incomplete without an attempt to understand the ethical experiences of those being rescued. The actual people affected by climate migration who are the least likely to have the means to migrate, or to do so without extreme hardship, should have a voice informing the global community including those in a position to carry out rescue. People who have the means and are young and healthy may easily make decisions to avoid the catastrophic consequences that climate migration brings. However, what about those who are left behind? For example, especially recognizing cultural differences, the homeless community, disabled community, refugees, the elderly community, and women[11] and children may suffer differently and call for more attention. In some parts of the world, human rights are severely constrained. An ethical duty to rescue, with many considerations and variables, may be more justified in the case of those most in need. As climate migration continues and increases significantly, it may be reasonable to ask the local and global community to focus on those least well positioned to migrate successfully. In this context, the use of phenomenology to understand the lived experiences of those migrating, sometimes termed “ethical experiences”, may help flesh out how a duty to rescue takes shape. The discussion of duty and obligation requires an articulation of the ethical experiences (how the local community in need of rescue views the proposed rescue). Then, the obligation to interpret the duty as ‘one shall not’ or ‘one must’ can be focused on the migrants’ needs rather than the rescuers’ feelings of obligation.[12] A revised theory of the duty to rescue taking into account the asymmetrical experiences of communities involved could ensure that the needs of people whose living situations, gender, ethnicity, age, or race impact their ability to even begin the migration process are considered. In this discussion, the rescuing is directed toward communities /collectives of persons migrating, whether at once or across a period of time. Often, the climate migrant may not be in a state to articulate the nature of this event when it happens, given its subjective proximity. Yet, when communities are given the space and opportunity to articulate their shared values, the ethical action of rescue derives its meaningfulness from the community rather than the rescuers. In other words, allowing climate migrants to explain their feelings can add complexity to what some see as a binary receiver-giver (of rescue) dynamic. This is necessary because the concept of vulnerable populations is fraught with problematic assumptions. There have been various definitions and criteria to determine what would constitute vulnerable populations.[13] For example, the United Nations Framework Convention on Climate Change[14] identifies and assesses vulnerable populations. These criteria may be helpful. However, they do not provide the full picture. Rather than identifying categorical criteria of vulnerable populations, engaging with people who are experiencing climate migration and listening to their current experiences and concerns helps determine need. Knowing what people need may prevent the kneejerk reaction to label people who are quite resilient yet have appropriate needs “vulnerable”. Proceeding with caution is important because the duty to rescue has hierarchical underpinnings of "us" and "them." Often when people swoop in to save, there are good and bad consequences of the intervention. We should proceed with caution because often the helper misses the actual needs of those in need. The only way to combat this would be to make sure that people are empowered to inform those agencies that are able to help. In addition to more practical approaches, large scale oral histories could allow those who have migrated already to share their experiences. It would be important to capture the lived experiences of people who are already experiencing the consequences of climate migration or of other migration like that due to political or economic extreme events. These experiences could shape our analysis of whether people in fact wish for rescue. If so, further conversations can determine best actions as well as give important insight into what resources might be necessary to empower people now and in the future. Vl. A Duty to Rescue as a Duty to Prepare If we view Good Samaritans as going above and beyond, then a duty to rescue, something ethically compelled, must bring rescue out of the framework of charity and place it in the context of humanity and obligations. Such a view would also support expanding the geographical reach of the otherwise more proximate duty. The duty may be stronger and take shape in a more workable way if it applies to preparing places expecting to see an influx of people due to climate migration and to helping those most in need. The duty may arise out of expectations of what type of community the place welcoming those migrating due to climate should be—does it want to offer good housing, schooling, and medical care as well as economic opportunity to new people? And if so, at what cost, or with which risks? If the newcomers are viewed as community members rather than strangers, a model of acceptance may lead to better preparation. Some considerations like whether the actions will reasonably help the persons in need of rescue[15] will shape the application of a duty to rescue in the context of climate migration. Similarly, ensuring that people have the chance to articulate their values may help communities support the newcomers. New relationships should not be defined as migrant and rescuer. Voluntariness in participation and not forcing any action deemed rescue would help ensure the human rights of those migrating. In the United States, President Biden issued an executive order addressing impending climate migration steeped in a duty to prepare by making plans for resettlement and to address the impact of climate migration.[16] Vll. At What Risk? As we investigate the ethical obligations to meet even basic needs, we must also ask what level of risk is ethically compelled. There is an extraordinary need to integrate newcomers successfully, but it is difficult to stretch an ethical duty to rescue to require all the prerequisites for successful climate migration. Even defining success would create deep ethical arguments. As observed in almost all migrations, extraordinary charitable acts may be the key to success, while an ethical duty to rescue must try to require the important government and community-based basics and ensuring respect for human rights. That is, the migrating people should be rescued from circumstances that contradict basic human rights. Rather than comparing communities to bystanders, mere places where people will arrive and need to hash out how to find housing, jobs, education, and opportunity, a duty of preparation may be the key to rescue those disenfranchised by migration. There are cultural, personal, physical, psycho-social, and geopolitical issues surrounding how to best help those needing to permanently relocate. Ethics arguments will certainly range from “do nothing”, which may fail people, to “do everything”, which could waste taxpayer money in futile over-preparation while failing to actually help. Communities must avoid planning exclusively for one scenario only to have it not take place. Striking the balance, a duty to rescue as it could apply to climate migration should set goals of societal integration, and providing the basics like education, housing, food, health care, and job opportunity, the precursors to flourishing. Recommending the extraordinary, morally preferred but perhaps not compulsory, when charitable actors are participating, or when wrongdoers are compensating, may be more workable than seeing the duty to rescue as compelling people or local governments to take on significant financial and personal risk for newcomers. While humanitarian ethics supports helping everyone, it is likely that people who resettle in advance of a need to flee will find themselves with more choices and opportunities. Help is warranted for those with more dire needs. Preparing for them may do just that. Vlll. Rescue Prior to Migration and Rescue in the Process of Resettlement The duty to enable the migration in the first-place hints to the inadequacy of a duty to prepare. The traditional duty to rescue perhaps steps in if rescue looks like those geographically just out of harm's way rescuing those in danger. That resembles the traditional moral requirement, or duty to rescue according to the Rule of Rescue. Humanitarian aid typically provided by many institutions makes sense and is in place, although financial support for additional humanitarian aid is always needed. Despite having moved to purportedly more capable communities, migrant communities may be able to develop more egalitarian orders of living. Rather than continually being identified as having been rescued, it is important to make sure people keep or make social ties during and after migration. Immigrants often face social isolation.[17] Small shifts in gestural language also have the potential to welcome people and show they are valued. For instance, some migrants may not like questions like “Where are you from?” and “What brings you here?” as they emphasize differences over fitting in. CONCLUSION The ethical duty to rescue should be expanded to better match those in need of relocation with a welcome environment and the resources needed to achieve success and fully integrate socially and culturally. Expanding a dialogue that includes the voices of people who have recently migrated whether due to violence, poverty, or climate, could properly frame the extent of the duty. If we are to apply the duty of rescue to climate migration, rescuers should avoid labeling people vulnerable, dependent, or needy, although there is reason to focus on those whose needs are the most dire. A soft duty to rescue people during the course of climate migration can come in the form of preparation. People will need help finding housing, education, access to food, and employment. Ultimately, to help them help themselves may be the best goal. While the obligations should be borne differently by people, whether due to a special responsibility, or a special relationship that creates a clearer duty, the global community must prepare for its role in rescuing those displaced by climate events. By helping those displaced at the start of the climate migration process according to a more commonly held notion of the duty to rescue, and by preparing to incorporate newcomers successfully according to an expanded duty to rescue, effectively a duty to prepare, countries that take on climate refugees may find themselves rewarded by the cultural diversity and workplace talents that people bring. A duty to those at a distance is a reasonable expansion of the duty to rescue. But what one ought to do in the global community varies somewhat from the traditional Rule of Rescue. - [1] Singer, P. (1972). Famine, Affluence, and Morality. Philosophy and Public Affairs, 1(3): 229-43. [2] Irfan, U. (2022, March 16). Why We Still Don’t Yet Know How Bad Climate Migration Will Get. Vox. https://www.vox.com/2022/3/16/22960468/ipcc-climate-change-migration-migrant-refugee, citing the International Panel on Climate Change (IPCC) (2022). Sixth Assessment Report, Climate Change 2022, Impacts, Adaptation, and Vulnerability. https://www.ipcc.ch/report/ar6/wg2/ [3] McKie, J., Richardson, J. (2003) The Rule of Rescue. Social Science & Medicine, 56(12): 2407-2419. https://doi.org/10.1016/S0277-9536(02)00244-7. [4] James, S.M. (2007). Good Samaritans, Good Humanitarians. Journal of Applied Philosophy, 24(3):238-254. [5] Overview of Good Samaritan laws. https://worldpopulationreview.com/state-rankings/good-samaritan-law-states [6] Fifield, J. (2017, Sept. 19). Why It’s Hard to Punish ‘Bad Samaritans’. Stateline Blog, Pew Charitable Trusts, https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/09/19/why-its-hard-to-punish -bad-samaritans [7] Cassella, C. (2019). There’s a Climate Threat Facing Pacific Islands That’s More Dire Than Losing Land, Science Alert, https://www.sciencealert.com/pacific-islanders-are-in-a-climate-crisis-as-rising-sea-levels-threaten -water; Hassan, H. R., and Cliff, V. (2019). For Small Island Nations, Climate Change is not a Threat. It’s Already Here, World Economic Forum, https://www.weforum.org/agenda/2019/09/island-nations-maldives-climate-change/ [8] For example, Lyons, K. (2019). Australia Coal use is Existential threat to Pacific Islanders, The Guardian. https://www.theguardian.com/world/2019/aug/12/australia-coal-use-is-existential-threat-to-pacific-is lands-says-fiji-pm [9] Cripps, E. (2013). Climate Change and the Moral Agent: Individual Duties in an Interdependent World. Oxford: Oxford University Press. [10] Schroeder, D., Chatfield, K., Singh, M., Chennells, R., and Herissone-Kelly, P.. Ethics Dumping and the Need for a Global Code of Conduct. In Cham. (Ed.)(2019). Equitable Research Partnerships. SpringerBriefs in Research and Innovation Governance. Springer. 2019. https://doi.org/10.1007/978-3-030-15745-6_1 [11] Giudice L.C., Llamas-Clark E.F., DeNicola N., Pandipati, S., Zlatnik, M.G., Decena, D.C.D., Woodruff, T.J., Conry, J.A. (2021). Climate Change, Women’s Health, and the Role of Obstetricians and Gynecologists in Leadership, International J Gynecol Obstet, 155(3), 345-356. 10.1002/ijgo.13958 [12] See Ferrarello, S. and Zapien, N. (2020). Ethical Experience: A Phenomenology, Bloomsbury. (for understanding phenomenological determinants of ethical action). [13] McLeman, R.A., Hunter, L.M., (2010). Migration in the context of vulnerability and adaptation to climate change: insights from analogues. Wiley Interdiscip Rev Clim Change, 1(3): 450-461. [14] Least Developed Countries Expert Group. (2018). Considerations Regarding Vulnerable Groups, Communities and Ecosystems in the Context of the National Adaptation Plans: United Nations Framework Convention on Climate Change. [15] Jecker, N.S. 2013. "The Problem with Rescue Medicine." J Med Philos, 38(1):64-81. [16] White House Report. (February 9, 2021), Executive Order (E.O.) 14013, “Rebuilding and Enhancing Programs to Resettle Refugees and Planning for the Impact of Climate Change on Migration.” (calls on the National Security Advisor to prepare a report on climate change and its impact on migration. “This report marks the first time the U.S. Government is officially reporting on the link between climate change and migration.” https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/27/executive-order-on-tackling -the-climate-crisis-at-home-and-abroad/ [17] Torres, J.M., Casey, J.A. (2017) The centrality of social ties to climate migration and mental health. BMC Public Health, 17: 600. https://doi.org/10.1186/s12889-017-4508-0. (shrink)

With robots being introduced into caregiving, particularly for older persons, various ethical concerns are raised. Among them is the fear of replacing human caregiving. While ethical concepts like well-being, autonomy, and capabilities are often used to discuss these concerns, this paper brings forth the concept of social dignity to further develop guidelines concerning the use of robots in caregiving. By social dignity, we mean that a person’s perceived dignity changes in response to certain interactions and experiences with other persons. In (...) this paper, we will first present the concept of social dignity, and then identify a niche where robots can be used in caregiving in an ethical manner. Specifically, we will argue that, because some activities of daily living are performed in solitude to maintain dignity, a care recipient will usually prefer robotic assistance instead of human assistance for these activities. Secondly, we will describe how other philosophical concepts, which have been commonly used to judge robotic assistance in caregiving for the elderly so far, such as well-being, autonomy, and capabilities, are less useful in determining whether robotic assistance in caregiving is ethically problematic or not. To conclude, we will argue that social dignity offers an advantage to the other concepts, as it allows to ask the most pressing questions in caregiving. (shrink)

In May 2013 a new Assisted Dying Bill was tabled in the House of Lords and is currently scheduled for a second reading in May 2014. The Bill was informed by the report of the Commission on Assisted Dying which itself was informed by evidence presented by invited experts.

This article uses narrative accounts of women who are intended parents to show the health and financial implications of infertility treatments, underregulation, and lack of funding in the United States and abroad. It argues that providing access to infertility treatment and regulating for safety are necessary means of protecting the health of women diagnosed with infertility and women who, through the sale of their reproductive goods and services, are the catalysts to conception. Many moral ambiguities arise from the utilization (...) of assistive reproductive technologies to treat infertility, requiring careful scrutiny of market and nonmarket values. (shrink)

In this article, we examine how the U.N. Convention on the Rights of the Child can be useful in pediatric bioethics. Adopted in 1989, the CRC reflects norms that have been deliberated upon for a long period of time and endorsed by most nations. The United States is now the only country that has not ratified the CRC.1 International human rights law shares many key moral concepts with clinical pediatric bioethics, and the CRC provides a considered language common to many (...) jurisdictions that can assist bioethicists in their daily practice and help health-care organizations in their policy development and international interactions. There may, however, be practical challenges with using the CRC in the practice of.. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:preface This issue of Feminist Studies explores the ways institutions—legal, governmental, medical, educational, and household—participate in the gendering of bodies and are themselves gendered. At any given historical moment, dominant and resistant meanings of “women,” “gender,” and “sexuality” are socially and politically constituted in institutions through cultural struggles. The authors in this issue discuss how birth control, assisted reproduction, transsexual transition, hegemonic masculinity, abortion, and domestic violence are (...) each articulated and contested in imperial law and economic discourses (Sreenivas), in medical procedures (Whitehead et al. and DasGupta), in university research regulations (Barnes and Munsch), and in the official practices of presidents (Mattingly ). Our authors elucidate how such institutions are gendered, not just in terms of staffing by males, females, and nongender conforming people, but also in the ways they constitute gender relations in their everyday operations. The articles point to the continuing need for institutional histories and ethnographies that are feminist in conception and design. They also provide openings into more progressive gender and sexuality politics by underscoring the contradictions within all institutions. Mytheli Sreenivas’s “Birth Control in the Shadow of Empire: The Trials of Annie Besant, 1877–1878” visits the contradictory history of institutions of reproduction control. She traces Besant’s contraception advocacy in the 1870s, reminding us of its intimate and unsavory entanglements with the politics of empire. Annie Besant is a complicated figure. South Asianists familiar with her later campaign against British colonialism in India might well be surprised by this earlier incarnation, but Sreenivas demonstrates how and why the early Besant held contradictory positions. As an individual, Besant questioned gender norms and challenged the inequality of women in marriage and divorce. She recognized sexual desire as “natural” (albeit only properly expressed via heterosexual marriage). Yet a signature feature of her political writing 504Preface was an embrace of neo-Malthusianism. Over the course of her activist life, Besant redirected her attention from poverty and women’s health in Britain to contraception as the solution to starvation and overpopulation in India. She did so in “a broader context in which a defense of empire and class-race hierarchy enjoyed far greater legitimacy than a critique of gender and sexual norms.” The repercussions of her actions were global: “Besant’s efforts rendered contraception into a sexual technology that claimed to address the economies of impoverishment in an emerging imperial world. Birth control thus emerged as both an imperial responsibility and as a demonstration of British humanitarianism in support of starving colonized populations.” Sreenivas explicates what the Besant trials reveal about the multiple histories of reproduction control and the conditions under which birth control continues to be both a technology for large-scale population control and “a vehicle for women’s reproductive freedom and gender justice.” Institutions are saturated with power, but they are also arenas where political struggles between different social groups are staged. This is especially evident in White House politics in the United States. In the late 1970s, President Jimmy Carter appointed a large number of women to bureaucratic offices. Many were feminists. Why did they fail to deliver gender justice? This is the puzzle Doreen J. Mattingly seeks to answer in “The Limited Power of Female Appointments: Abortion and Domestic Violence Policy in the Carter Administration.” The article is set in the broader context of a moment in history when the US feminist movement was moving from the streets to state bureaucracies, when women of color had broadened the movement’s mandate, and when the need for government programs to support poor women was a clearly articulated feminist goal. There was an excitement about transforming gender relations as feminists populated multiple organizations and came together to collaborate. However, two important legislative efforts—government funding for abortions for poor women and a national anti-domestic violence bill—failed. Mattingly traces the back and forth between Carter and his Assistant Secretary for Public Liaison, Margaret “Midge” Costanza, drawing on new archival sources. Mattingly’s article underscores how women in public office can be discursively valorized as symbols of change even while politically powerful men oppose meaningful policy that would provide women greater autonomy over their reproductive or violently transgressed bodies. Mattingly’s careful reconstruction... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 61.1 (2000) 153-156 [Access article in PDF] JHI 2000 Donald R. Kelley It was just sixty years ago that this Journal first made its appearance. Two hundred thirty-nine issues later it continues in a world transformed by war, overpopulation, cultural shocks, scientific and technological transformations, globalization, the avalanche of information produced by electronic exchange, and "the acceleration of just about everything." Yet despite (...) these factors and the strains of postmodernism and cultural alterity, 1 it has not entirely lost touch with its intellectual innocence, faith in humanistic learning, and reliance on enlightened reason. This continuity itself may seem something of a novelty in an age of distrust of history and "rage against reason," but for some of us it reflects the critical spirit and intellectual context out of which such ostensibly subversive attitudes emerge, and reemerge. To some extent, moreover, the diversity of opinions about intellectual traditions is the result of specializations, and special interests, which have changed the climate of opinion since the time of Arthur O. Lovejoy, principal founder of the JHI. Lovejoy's vision was super- as well as inter-disciplinary; that is, he intended to include in the agenda of "history of ideas" particular areas of history of philosophy, literature, art, science, social science, etc., as well as the larger intellectual and cultural areas into which these disciplinary histories extend. 2 These days, however, all these disciplinary traditions have their own more specialized journals and do not need to seek a vehicle in publications of more general interest. What remains then, for the most part, is the interdisciplinary arena in which larger questions of human experience should be posed--and for Lovejoy, as for so many epigones and critics, the main "larger question" is not only one of value but also of specifically historical inquiry. 3 [End Page 153]The first issue of the JHI appeared under the editorship of Lovejoy (with Philip Wiener, who did most of the editorial work, as "managing editor"), assisted by a committee that included two historians, three philosophers, four literary scholars, and one political theorist; namely, Crane Brinton, Gilbert Chinard, Morris Cohen, Francis Coker, Richard McKeon, Perry Miller, Marjory Nicolson, J. H. Randall, J. Salwyn Schapiro, and Louis Wright. The first volume featured contributions from each of these, including Wiener, except for Miller (vol. 2), Shapiro (vol. 3), McKeon (vol. 8), and Coker. 4 During the first five years there were also reviews of books by Dilthey (by Horace L. Friess), Croce (Schapiro), Mannheim (Randall), Perry Miller (Herbert W. Schneider), Van Wyck Brooks (Miller) and Alfred Kazin (F. O. Matthiessen). In this period the disciplinary distribution of articles was not markedly different from that of the past five years, nor was the ranking of fields by number of submissions. 5 Most important, the original interdisciplinary thrust of Lovejoy's agenda, if not his attachment to the spiritualist currency of "unit-ideas," has survived growing specialization.At first the history of ideas was pursued largely in the shadow of the history of philosophy; for in this field, according to Lovejoy, "is to be found the common seed-plot, the locus of initial manifestation in writing, of the greater number of the more fundamental and pervasive ideas, and especially of the ruling preconceptions, which manifest themselves in other regions of intellectual history." 6 Lovejoy's concern was always with concepts, especially "-isms," and yet in some ways he anticipated the "linguistic turn" of the later years of this century, pointing out in particular "the role of semantic shifts, ambiguities, and confusions, in the history of thought and taste," for "nearly all of the great catchwords have been equivocal--or rather, multivocal." 7 If ideas could be given stable definitions, they were nonetheless often, in the context of language, in conflict, even in the mind of a single thinker; for such was the "anomaly of knowledge." 8 So Lovejoy was at pains to distinguish the various meanings of [End Page 154] catch-words like "nature," "perfectibility," "romanticism," "progress," and "pragmatism," not to mention more inflammatory terms of wartime ideological debate.But... (shrink)

The right to conceive and bear children has been protected both in law and in policy. Human society has from its earliest time valued children and defended procreation as a basic right.Modern health technology offers the possibility of conception to the estimated 2.5 million infertile couples who may wish to have children. For these persons, infertility treatment offers the hope of having children, an activity deemed basic and essential in human society.In general, the state has been reluctant to directly (...) interfere in the reproductive decisions of individuals. However, the state may act to increase or reduce access to reproductive services in a variety of ways. For example, recent legislation regulating fertility clinics affects the distribution of assisted reproductive technology in the United States. The purpose of this paper is to describe this legislation, project its probable effects on the distribution of ART services, and analyze these effects based on distributive theories of justice. (shrink)

How should a political society be structured so as to legitimately distribute political power? One principle advanced to answer this question is the principle of subsidiarity. According to this principle, the default locus of political power is with the lowest competent political unit. This article argues that subsidiarity is a structural principle of a conception of political legitimacy informed by epistemic considerations. Broadly, the argument is that political societies organised according to the principle of subsidiarity can more effectively (...) achieve political decisions that can justifiably appear to be correct from the point of view of those subject to them. The article presents two considerations in order to establish a pro tanto case for acting separately before presenting five additional epistemic considerations that establish a prima facie case for acting separately. The article then shows that political legitimacy and the epistemic aim of decision-making can sometimes be served more effectively and efficiently by allowing higher-level political units to assist lower-level political units. (shrink)

Philippe Fournier | : Le point de départ de ma proposition est que la responsabilité est un terme plus approprié que la vertu pour désigner les exhortations au devoir civique dans l’ère contemporaine. De même, à défaut de voir l’implication citoyenne comme l’expression de la rationalité individuelle ou de la conscience morale dans la sphère publique, je propose de comprendre la responsabilité comme une matrice discursive et gouvernementale qui perpétue des modèles comportementaux bien spécifiques. J’entends ainsi démontrer que la responsabilité (...) est devenue une modalité indispensable du « gouvernement de la conduite » au sein d’une rationalité néolibérale. En plus de constituer une série de dispositions morales qui remédierait aux failles et aux lacunes de l’individualisme libéral, la responsabilité se matérialise dans les incitations à une citoyenneté active et participe de ce fait à la rationalisation du retranchement de l’État de la sphère sociale. Comme l’illustrent des courants aussi divers que le néoconservatisme, le communautarisme et l’économie sociale, la responsabilité se présente moins comme une solution de rechange aux créneaux du néolibéralisme qu’une série de techniques et de standards comportementaux visant à compléter et renforcer l’application élargie d’une logique micro-économique. Je montrerai que le recours à la notion de responsabilité est particulièrement visible dans les politiques d’aide sociale et au sein des nouveaux partenariats entre l’État, le milieu communautaire et les communautés locales. En effet, l’aide étatique est de plus en plus conditionnelle à la démonstration de certaines dispositions morales et psychologiques comme la volonté, la ténacité et la probité. L’article se divise en quatre parties. La première s’attarde à définir brièvement la « gouvernementalité », concept initialement développé par Michel Foucault. La deuxième se penche sur des travaux plus contemporains, notamment ceux du sociologue britannique Nikolas Rose qui se préoccupe de la responsabilité en tant que modalité gouvernementale au sein du néolibéralisme. La troisième partie met en relief les particularités du néolibéralisme américain. En vue de cerner les pratiques et discours associés à la responsabilité de façon plus précise, la dernière partie examine l’un des principaux programmes d’aide sociale aux États-Unis, l’Aid to Families with Dependent Children, devenu le Temporary Assistance for Needy Families en 1996, des années 1980 jusqu’à aujourd’hui. | : Our point of departure is that responsibility is a more appropriate term than virtue to designate the contemporary exhortations to civic duty. Instead of seeing civic engagement as a means to express individual rationality or moral conscience in the public sphere, this paper suggests that we should understand responsability as a discursive and governmental matrix that perpetuates specific behavioral standards. More specifically, the article aims to show that responsability has become an indispensable instrument of rule within a neoliberal rationality of government. As well as pointing to a range of moral dispositions that can offset neoliberalism’s shortcomings, the notion of responsibility is mobilised in the repeated public calls to active citizenship and plays a strategic role in the discursive justification of the state’s withdrawal from the social sphere. As illustrated by strands of thought as diverse as neoconservatism, communitarianism and social economy, responsibility is less an alternative to neoliberal tenets than a series of techniques and behavioral standards that complement and reinforce the extension of a microeconomic logic to all spheres of human activity. The appeals to responsibility are particularly visible in contemporary social policies and in the strategic partnerships between the state, community organisations and local communities. Indeed, state assistance has become increasingly conditional on the demonstration of aptitudes and moral qualities like earnestness, tenacity and willpower. The article proceeds in four parts. The first part briefly defines governmentality, a concept initially developed by Michel Foucault. The second part explores Nikolas Rose’s work on advanced liberalism and takes a look at contemporary articulations of responsibility. The third part examines the specificities of American neoliberalism. In order to identify the practices and discourses linked to the notion of responsibility, the final part of the article looks at one of the main social programs in the United States, namely the Aid to Families with Dependent Children, renamed the Temporary Assistance for Needy Families in 1996, from the early 1980s to our day. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Representation and the Mind-Body Problem in Spinoza by Michael Della RoccaWilliam SackstederMichael Della Rocca. Representation and the Mind-Body Problem in Spinoza. New York: Oxford University Press, 1996. Pp xiv + 223. Cloth, $39.95.A first virtue in elucidating any great philosopher is stating exactly the project the commentator undertakes, showing what is to be concluded, and how, and what of necessity must be omitted. Here, Della Rocca’s success is (...) exemplary.I cannot do better than to paraphrase, with running quotations, his remarkably succinct preliminaries. He undertakes two problems “crucial to Spinoza’s philosophy of mind,” first, “the requirement for having a thought about a particular object,” and second, “the traditional problem of whether or not the mind is identical with the body.” These inquiries are to be interconnected systematically by showing their dependence on Spinoza’s “denial of causal or explanatory or conceptual relations between the mental and the physical.”With exceptions I note later, the nine chapters of this book follow precisely. Chapter 1 prepares basic concepts and claims, along with formulation of the principle indicated, now called “the barrier between thought and extension.” Chapters 2 through 5 present and question Spinoza’s “theory of representation” (the first problem, as in the title) with its consequences respecting the announced principle. Chapters 7 and 8 turn to insights on “the mind-body problem” (the second problem), as illuminated by these investigations and secured by the governing principle. Della Rocca tidily exemplifies ruling expository virtues, but I question whether this very exactitude does not inhibit a needed species of escapement. Any commentator is obliged to acknowledge and detach himself from his own assumptions, from mannerisms and jargon current in the profession, from his present status or mannered tics, and from accidental skewing subsequent to current practices of language and translation. For such commitments also govern his treatment and they may often occlude his or our understanding. Let me be picky in initial illustration. [End Page 136]On pages 25f., the author correctly warns about pitfalls occasioned by lack of articles, definite or indefinite, in Latin. Thus, as he is aware, both interpretation and translation are queasy and infected with responses and glosses insinuated by demands from our own language, especially our prevailing fondness for definite articles, for solidity, univocal designation, and instantiation. So far, so good. But I invite my readers here to reflect whether Della Rocca’s own pervasive use of the definite article in the quotations I indulged in surveying his task does not distort his whole conception of that project. Momentum from the word the converts issues and verbalisms entertained into furniture of the world.Perhaps even more insidiously, Della Rocca invokes a peculiar itemization whereby recent formulations impose “at least one” and “for any x” on all quantified inferential usages. Moderns need rather liberation from membership suggestions in set theory and its associated logic. His remarks about “extension” and “intension” help, but they do not remedy modernist ineptness regarding Spinoza’s use of ipse, per se, and in se. Further, like precision obscures care about subordinate and causal differentiations. A sort of subsumed merging under a unit whole simple in nature is dear to Spinoza, though such moves are uncongenial to us.My earlier account scanted chapters 6 and 9, which also follow from the basic project, though not as tidily. Chapter 6, “Falsity,” “solves certain thorny problems” in the account of that and its opposite; Chapter 9 gathers ruling materials to shed light on “substantive monism.” Their arrangement ought to assist our perplexities about involvement and simple grasp, whereas 6 is noticeably brief and 9 sketchy. Together, they scant (rather than illuminate) subtlety in Spinoza’s investigations of intellect and its involvment in the nature of things.Expository clarity also shows in current fashions for multiple cross-references between indented and numbered claims, paraphrases, inferential premisses, and glosses by others. But beyond hiding preference for propositional reductions, and beyond hindering smooth reflection, such dismemberment prejudices against modes of reasoning tracing “some certain sort of eternity” or “what is common to all and equally in part and whole.”Efforts to work rigorously with made-up words or adapted phrases only... (shrink)