Despite enthusiasm for patient-centered care, the practice of patient-centered care is proving challenging. Further, it is curious that the literature about this subject does not explicitly address patient autonomy, since patients guide care in patient-centered care, and respect for patient autonomy is a prominent health-care value. We argue that by explicitly adopting a relational conception of autonomy as an essential component, patient-centered care becomes more coherent, is strengthened, and could help practitioners to make better use of a principle of respect (...) for autonomy. Hence, its use appears promising to narrow the theory–practice gap. (shrink)

The purpose of this paper is to show that the standard notion of informed choice is unacceptable and must be replaced. To do so, I examine Foucault's analysis of people in contemporary society, drawing attention to the ways power relations act upon us, and to the possibility of resistance. I show how feminist moral theory can be enriched by Foucault's analysis. Applying this new understanding of people and moral theory to an analysis of informed choice, I claim that the standard (...) notion of informed choice is unacceptable, in part because it relies on a false conception of people. Its “necessary” features—intention, understanding, and absence of controlling influences—are much more difficult, if not impossible, to obtain than proponents of the standard notion believe. I end by offering direction for creating a new, Foucault-inspired, feminist theory of informed choice. (shrink)

(2010). Levels of Intervention: Communicating with More Precision About Planned Use of Critical Interventions. The American Journal of Bioethics: Vol. 10, No. 1, pp. 78-79.

Some feminists have been critical about the dominant conception of autonomy, questioning, for example, its conception of persons and ideal of personhood. Tom Beauchamp and James Childress (BC), the major proponents of the dominant conception of autonomy, believe that these feminists have misunderstood their theory and, moreover, that their theory is immune to feminist attack. Their response to feminist critics, however, has been dismissive and does nothing to assuage these critics concerns. In this paper I briefly review the state of (...) play in this debate about autonomy, showing that BC are not without positive rejoinders to objections raised by feminist critics. These rejoinders rest on the notion that feminist concerns are a matter of what is logically entailed by BCs theory of autonomy and attempt to show that feminist commitments are logically consistent with that theory. However, these rejoinders are less than convincing for reasons illuminated by Cheshire Calhoun. Calhoun reminds us that feminists are sensitive to ways in which the shape of discourse is influenced by non-epistemic considerations. In particular, Calhoun draws our attention to the cumulative effect of a whole tradition of moral reasoning that focuses on too narrow a range of moral problems and too narrow an understanding of people and the human condition. BCs conception of autonomy relies on and reinforces ideologies of the moral life created in just this way. Following Calhoun, I show that criticism of their theory as ideology is not criticism of its logical implications, but something far more damaging, something without available rejoinders. (shrink)

Lisa A. Eckenwiler and Felicia G. Cohn, The ethics of bioethics: Mapping the moral landscape, Baltimore: The Johns Hopkins University Press, 2009, reviewed by Carolyn Ells.

The Ethics of Bioethics: Mapping the Moral Landscape is a compelling, thoughtful, sobering examination of the moral practice of bioethics. Jonathan D. Moreno sets the tone in the foreword by unsettling the reader with questions from critics about the intellectual legitimacy of bioethics (e.g., the frequent tensions of political ideology with normative expertise in the public debate) and the practices of some in bioethics (e.g., the controversial roles in for-profit industry or health care). Twenty-five essays follow, addressing issues and activities (...) that mark the relatively brief history and much of the scope of bioethics practice. Each essay turns bioethics practice inward to lay bare, explore, and possibly .. (shrink)

Numerous issues confront women's healthcare today, among them the medicalization of women's bodies, cosmetic genital surgery, violence against women, HIV, perinatal mental health disorders. This volume uniquely explores such difficult topics and others at the intersection of clinical practice, policy, and bioethics in women's health care through a feminist ethics lens. With in-depth discussions of issues in women's reproductive health, it also broadens scholarship by responding to a wider array of ethical challenges that many women experience in accessing health care. (...) Contributions touch on many themes previously tackled by feminist ethics, but in new, contemporary ways. Some chapters expand into new fields in the bioethics literature, such as the ethical issues related to the care of Indigenous women, uninsured refugees and immigrants, women engaged in sex work, and those with HIV at different life stages and perinatal mental health disorders. Authors seek to connect theory and practice with users of the health system by including women's voices in their research. Bringing to bear their experience in active clinical practice in medicine, nursing, and ethics, the authors contemplate new conceptual approaches to important issues in women's healthcare, and make ethical practice recommendations for those grappling with these issues. Topical and up-to-date, this book provides a valuable resource for physicians, nurses, clinical ethicists, and researchers working in some of the most critical areas of women's health and applied ethics today. (shrink)

Immigration medicine and the work carried out by Panel Physicians within the Canadian immigration system give rise to ethically troublesome practices and consequences. In this analysis in three parts, we explore the context of the immigration medical examination, characterize the observed and potential burdens and harms for immigrant and refugee applicants with HIV, and critically assess the possibilities for transforming immigration medical practices and policy to reduce inequities. We use the Code of Ethics of the Canadian Medical Association and the (...) Medical Ethics Manual of the World Medical Association to analyse six practices that fail to meet ethical expectations. This analysis opens up new lines of inquiry into the medico-administrative practices regulating immigration to Canada. It also extends knowledge about the functioning of immigration medical policy and the collection and uses of HIV-related health information. We argue that to reduce burdens and harms to prospective immigrants and refugees to Canada with HIV, changes must occur in how Citizenship and Immigration Canada asks Panel Physicians to work with these applicants. This argument is empirically informed by institutional ethnographic research results of the Canadian immigration system and its treatment of applicants with HIV. (shrink)

Ethical review and analysis of health policy may help to ensure policies address the needs of society and align with relevant values and principles. Indeed, researchers and bioethicists have recognized the need for ethical frameworks specifically for public health applications. The objective of this research was to compile structured tools for ethical review of health policy and to analyze these tools for their scope and philosophical underpinnings. A systematic search and review of academic and grey literature was conducted to compile (...) existing tools designed for health policy ethics review. The search yielded 13 health policy ethical review tools. Qualitative content analysis revealed that all of the tools were influenced by multiple ethical values and that a majority were influenced by more than one ethical theory. The most common values were non-maleficence and beneficence. The most common influencing ethical theory was the Principles Approach. The structure of the tools demonstrates a heterogeneity of methodology designs to approach policy ethics review. This research offers a unique contribution to the bioethics field that provides a useful resource and understanding of the current ethical review tools for health policy. (shrink)

The Declaration of Helsinki is recognised worldwide as a cornerstone of research ethics. Working in the wake of the Nazi doctors’ trials at Nuremberg, drafters of the Declaration set out to codify the obligations of physician-researchers to research participants. Its significance cannot be overstated. Indeed, it is cited in most major guidelines on research involving humans and in the regulations of over a dozen countries.Although it has undergone five revisions,1 and most recently incorporated language aimed at addressing concerns over research (...) carried out in resource-poor countries,2–5 the Declaration could go much farther in addressing the profoundly altered landscape of research with humans. Research involving humans is now a global enterprise and often involves participants from resource-poor countries. Rather than being carried out at single institutions by veteran researchers, many studies are now conducted at many locations—including sites that are not academic medical centres—by new and relatively inexperienced investigators. A growing number of projects involve novel agents, based on innovative work in genomics and proteomics. Increasingly, research is sponsored by the for-profit sector. National governments and professional organisations around the globe provide laws, regulations and standards for the conduct of research involving humans. Considerable scholarship also critiques and guides this endeavour.In light of the current effort of the World Medical Association to revise the Declaration, we offer ideas on how to re-conceive the concept of “vulnerability” and its links with the principle of justice and, in turn, redirect the attention of researchers towards those who might be so designated.In the research context, “vulnerability” is associated with an inability partly or totally to protect one’s own interests. Typically, conceptions of vulnerability centre upon characteristics associated with particular groups that …. (shrink)

This commentary was submitted to the World Medical Association on behalf of the International Network on Feminist Approaches to Bioethics. Our submission included a description of feminist research ethics, suggestions for specific revisions to the Declaration, and elements found in other international research ethics codes that are important from a feminist perspective. Our goals were to encourage the WMA to craft a declaration that: conceptualizes issues of vulnerability in richer and more nuanced ways, resists the influence of profit motives, and (...) extends the scope of responsibility for ethical research more broadly. (shrink)

Comme son titre l’indique, l’ouvrage, publié en 2012 et édité par Margaret Jolly, Christine Stewart et Carolyn Brewer, vise à réinvestir la question de la violence en Papouasie Nouvelle Guinée (PNG) à partir d’une lecture par le genre : il s’agit de « genrer » (engender) la violence, dans un pays où elle apparaît omniprésente. Les huit chapitres du livre, écrits en majorité par des anthropologues sur un terrain classique de l’anthropologie, s’inscrivent ainsi dans l’abondante littérature prod...

The main questions in philosophical research on attention concern its nature and impact. Regarding its nature, one might ask what sort of thing attention is; regarding its impact, one might ask what sort of thing attention does. While these questions have been asked by philosophers for thousands of years, they have had a resurgence in recent years due to advancements in the cognitive and neural sciences. This chapter will cover some historical context as prelude to a discussion of the contemporary (...) debates, ending with issues that are as of yet still on the horizon. Topics covered include the divide between voluntary/involuntary, endogenous/exogenous, and top-down/bottom-up attention; the Posner cueing task; Treisman and the binding problem; Mack and Rock on inattentional blindness; Grassia, Campbell, and Dickie on attention, perception, and knowledge; the debate between Block, Dehaene, and others on consciousness and attention; Wu on attention and action; and future directions for attention research in predictive processing models, neuroethics, technology, and addiction. (shrink)

In the first edition of Radical Ecology --the now classic examination major philosophical, ethical, scientific, and economic roots of environmental problems--Carolyn Merchant responded to the profound awareness of environmental crisis which prevailed in the closing decade of the twentieth century. In this provocative and readable study, Merchant examined the ways that radical ecologists can transform science and society in order to sustain life on this planet. Now in this second edition, Merchant continues to emphasize how laws, regulations and scientific (...) research alone cannot reverse the spread of pollution or restore our dwindling resources. Merchant argues that in order to maintain a livable world, we must formulate new social, economic, scientific, and spiritual approaches that will fundamentally transform human relationships with nature. She analyzes the revolutionary ideas of visionary ecologists for a new economy, society, science, and religion, and examines their efforts to bring environmental problems to the attention of the public. This new edition features a new Introduction from the author, a thorough updating of chapters, and two entirely new chapters on recent global movements and globalization and the environment. It is a timely update that will give students everything they need to know on the most recent philosophical positions and social movements that characterize the radical ecology spectrum. (shrink)

The process of adopting a child is “not for the faint of heart.” This is what we were told the first time we, as a couple, began this process. Part of the challenge lies in fulfilling the licensing requirements for adoption, which, beyond the usual home study, can include mandatory participation in parenting classes. The question naturally arises for many people who are subjected to these requirements whether they are morally justified. We tackle this question in this paper. In our (...) view, while strong reasons exist in favour of licensing adoptive parents, these reasons support the licensing not only of adoptive parents, but of all or some subset of so-called “natural” parents as well. We therefore conclude that the status quo with respect to parental licensing, according to which only adoptive parents need to be licensed, is morally unjustified. (shrink)

John Earman and John Norton have argued that substantivalism leads to a radical form of indeterminism within local spacetime theories. I compare their argument to more traditional arguments typical in the Relationist/Substantivalist dispute and show that they all fail for the same reason. All these arguments ascribe to the substantivalist a particular way of talking about possibility. I argue that the substantivalist is not committed to the modal claims required for the arguments to have any force, and show that this (...) naturally leads to an alteration in the way determinism is characterized for local spacetime theories. (shrink)

Visionary quests to return to the Garden of Eden have shaped Western culture from Columbus' voyages to today's tropical island retreats. Few narratives are so powerful - and, as Carolyn Merchant shows, so misguided and destructive - as the dream of recapturing a lost paradise. A sweeping account of these quixotic endeavors by one of America's leading environmentalists, Reinventing Eden traces the idea of rebuilding the primeval garden from its origins to its latest incarnations in shopping malls, theme parks (...) and gated communities. With eloquence and insight, Merchant shows how the drive to conquer nature and to explore and settle the globe, springs from this utopian pastoral impulse throughout Western history. Time and again, human manipulation of the environment is our downfall: Eden is achieved by fencing off pristine beauty in national parks and wildlife preserves, while leaving the majority of the earth in ruins. Challenging both narratives, Merchant argues that the green veneer of city-park conservation has become a cover for the corruption of the earth and the neglect of its environment. Reinventing Eden is a bold new way to think about the earth that includes green political parties, sustainable development and a partnership between humans and earth that is nothing short of an ecological revolution. (shrink)

A collection of 17 meditative essays and 52 weekly reflections, this book is for readers who are concerned about the daunting future humankind has created and who seek inspiration, wisdom, and spiritual purpose in the face of the collapse of industrial civilization.

Fundamental terms in the field of ecology are ambiguous, with multiple meanings associated with them. While this could lead to confusion, discord, or even tests that violate core assumptions of a given theory or model, this ambiguity could also be a feature that allows for new knowledge creation through the interconnected nature of concepts. We approached this debate from a quantitative perspective, and investigated the cost of ambiguity related to definitions of ecological units in ecology related to the general term (...) “community.” We did a meta-analysis of tests associated with two bodies of literature, Hubbell’s unified neutral theory of biodiversity and biogeography and Diamond’s assembly rules, that rely on a specific ecological unit that assumes that species are existing within a local area and that they have overlapping resource needs. We predicted that if ambiguous terminology is widespread, then researchers will have tested them with many different ecological units, that in addition some of these ecological units will violate the core assumptions of the theory, and finally that the overall level of support for a theory will be stronger if appropriate ecological units were used. We found that indeed multiple different ecological units were used in the literature to test both theories, with 65 percent appropriate ecological units for neutral theory tests, and only 6 percent for assembly rule tests. Finally, there was some evidence that the support for a theory depended on whether appropriate ecological units were used for neutral tests, but there was not enough data for the assembly rule tests. These results thus show that ambiguous terminology in ecology is having measurable effects on research and is not of solely philosophical concern. We advocate that authors be explicit in their writing and outline core assumptions of theories, that researchers apply these consistently in their tests, and that readers be attentive to what is written and cognizant of their potential biases. (shrink)

The hole argument contends that a substantivalist has to view General Relativity as an indeterministic theory. A recent form of substantivalist reply to the hole argument has urged the substantivalist to identify qualitatively isomorphic possible worlds. Gordon Belot has argued that this form of substantivalism is unable to capture other genuine violations of determinism. This paper argues that Belot's alleged examples of indeterminism should not be seen as a violation of a form of determinism that physicists are interested in. What (...) is undetermined in these examples, and in the hole argument, is a haecceitistic feature of the world. It is argued that these features are not among those we should expect the physical state of the world to determine. This vindicates the substantivalist reply to the hole argument, but also illustrates that philosophers of physics cannot ignore metaphysics when characterizing determinism for a physical theory. (shrink)

Much recent research has sought to uncover the neural basis of moral judgment. However, it has remained unclear whether "moral judgments" are sufficiently homogenous to be studied scientifically as a unified category. We tested this assumption by using fMRI to examine the neural correlates of moral judgments within three moral areas: (physical) harm, dishonesty, and (sexual) disgust. We found that the judgment ofmoral wrongness was subserved by distinct neural systems for each of the different moral areas and that these differences (...) were much more robust than differences in wrongness judgments within a moral area. Dishonest, disgusting, and harmful moral transgression recruited networks of brain regions associated with mentalizing, affective processing, and action understanding, respectively. Dorsal medial pFC was the only region activated by all scenarios judged to be morally wrong in comparison with neutral scenarios. However, this region was also activated by dishonest and harmful scenarios judged not to be morally wrong, suggestive of a domain-general role that is neither peculiar to nor predictive of moral decisions. These results suggest that moral judgment is not a wholly unified faculty in the human brain, but rather, instantiated in dissociable neural systems that are engaged differentially depending on the type of transgression being judged. (shrink)

In this adventurous contribution to the project of combining philosophy and biology to understand the mind, Carolyn Price investigates what it means to say that mental states--like thoughts, wishes, and perceptual experiences--are about things in the natural world. Her insight into this deep philosophical problem offers a novel teleological account of intentional content, grounded in and shaped by a carefully constructed theory of functions. Along the way she defends her view from recent objections to teleological theories and indicates how (...) it might be applied to notable problems in the philosophy of mind. (shrink)

Attention is essential to the life of the mind, a central topic in cognitive science, neuroscience, and psychology. Traditional debates in philosophy stand to benefit from greater understanding of the phenomenon, whether on the nature of the self, the foundation of knowledge, the natural basis of consciousness, or the origins of action and responsibility. This book is at the crossroads of philosophy of mind and cognitive science, offering a new theoretical stance on the concept of attention and how it intersects (...) with other functions of the mind, such as perception, consciousness, and action. It presents attention as directed by a subject, essential for perception, but not consciousness or action. By taking seriously the existence of a subject it stands against current trends in philosophy and cognitive science. This book offers an account of the subject and its role in attention that will both help motivate a subject-centered account and avoid some of the common criticisms regarding its existence. It engages with work by many philosophers, psychologists, and neuroscientists, including Block, Campbell, Dickie, Husserl, James, Koch, Mack and Rock, Merleau-Ponty, Treisman, and Wu. (shrink)

A collection of essays, comments and replies on some of the contentious issues in feminist theory. Specific conversations centre on topics of debate such as feminist standpoint theory; gender as an analytic category; problems with sexual difference; and privacy and representations of the personal. Each exchange covers issues central to feminist scholarship and includes discussions from a cross-section of disciplines: political/social theory, philosophy, sociology, cultural studies and critical theory.

New techniques for the genetic modification of organisms are creating new strategies for addressing persistent public health challenges. For example, the company Oxitec has conducted field trials internationally—and has attempted to conduct field trials in the United States—of a genetically modified mosquito that can be used to control dengue, Zika, and some other mosquito-borne diseases. In 2016, a report commissioned by the National Academies of Sciences, Engineering, and Medicine discussed the potential benefits and risks of another strategy, using gene drives. (...) Driving a desired genotype through a population of wild animals or insects could lead to irreversible genetic modification of an entire species. The NASEM report recommends community, stakeholder, and public engagement about potential uses of the technology, and it argues that the engagement should occur as research advances, well before gene drives are deployed. Yet what “engagement” means in practice is unclear. This article seeks clarity on this problem by offering a justification for community engagement and drawing out implications of this argument for the implementation and desired outcomes of community engagement. Community engagement is essential when it comes to research that would release genetically modified insects or animals into the environment. By contrast, obtaining informed consent from people who live near such a proposed field trial is neither necessary nor sufficient. Drawing on the epistemic and moral arguments for deliberative democracy, I propose two discrete mechanisms of community engagement: community advisory boards and deliberative forums, neither of which has been systematically incorporated into research governance. The proposed mechanisms would engender respect for persons who live near field trials, even when the results of deliberation override some individuals’ preferences. Community engagement foregrounds the community in our thinking about humans’ relationship to nature, and it implies that deciding to release genetically modified insects or animals into the wild ought to be a collective decision, not one made by product developers, policy-makers, private companies, research funders, or scientists alone. (shrink)

This fully illustrated introductory text looks at the key theories and thinkers within art from a philosophical viewpoint. Focusing on the role gender plays, the book covers the most pertinent topics within feminist aesthetics.