The ethical obligation to provide a reasonably safe discharge option from the inpatient setting is often confounded by the context of homelessness. Living without the security of stable housing is a known determinant of poor health, often complicating the safety of discharge and causing unnecessary readmission. But clinicians do not have significant control over unjust distributions of resources or inadequate societal investment in social services. While physicians may stretch inpatient stays beyond acute care need in the interest of their patients (...) who are experiencing homelessness, they must also consider the implications of using an inpatient hospital bed for someone without the attendant level of medical need. Caring for patients in an inpatient setting when they no longer require acute care means fewer beds for acute care patients. And when a patient who is experiencing homelessness declines a medically safer option such as a skilled nursing facility, then clinicians may be faced with the sole option of discharge to the street, which raises troubling questions of nonmaleficence and social justice. Here we investigate the different forms of injustice that play out when patients are discharged to the street, and offer a map of the interwoven ethical responsibilities of clinicians, hospitals, and skilled nursing facilities. (shrink)

Dealing with situations where parents’ views about treatment for their child are strongly opposed to doctors’ views is one major area of ethical challenge in paediatric health care. The traditional approach focuses on the child’s best interests, but this is problematic for a number of reasons. The Harm Principle test is regarded by many ethicists as more appropriate than the best interests test. Despite this, use of the best interests test for intervening in parental decisions is still very common in (...) clinical settings and can lead to confusion. In this paper, I propose the Zone of Parental Discretion as a means of putting into practice the key ideas of the Harm Principle, in a clear, step-by-step process. The Zone of Parental Discretion provides a tool for ethical deliberation by clinicians and ethicists about all situations in which parents and doctors disagree about treatment of a child, whether parents are refusing medically recommended treatment, or requesting non-recommended treatment. (shrink)

In the following essay I use an extended commentary on Dave Elder-Vass’s The Reality of Social Construction to explore the issue of what progress in realism means. I set out and critique the concept of the norm circle in order to consider how an argument is developed as realist social theory and what limits that might have in terms of the recognized realist concept of adequacy. Specifically, I address the way realist social theory can become restricted to an internal exploration (...) of realism whilst issues of real world relevance are deferred. (shrink)

Holobionts are multicellular eukaryotes with multiple species of persistent symbionts. They are not individuals in the genetic sense— composed of and regulated by the same genome—but they are anatomical, physiological, developmental, immunological, and evolutionary units, evolved from a shared relationship between different species. We argue that many of the interactions between human and microbiota symbionts and the reproductive process of a new holobiont are best understood as instances of reciprocal scaffolding of developmental processes and mutual construction of developmental, ecological, and (...) evolutionary niches. Our examples show that mother, fetus, and different symbiotic microbial communities induce or constitute conditions for the development and reproduction of one another. These include the direct induction of maternal or fetus physiological changes, the restructuring of ecological relations between communities, and evolutionary selection against undesirable competitors. The mutual scaffolding and niche constructing processes start early—prior to amniotic rupture. We are evolutionarily, physiologically, and developmentally integrated holobiont systems, strung together through mutual reliance and mutual construction. Bringing the processes of niche construction and developmental scaffolding together to interpret holobiont birth conceptually scaffolds two new directions for research: in niche construction, identifying the evolutionary implications of organisms actively constructing multiple overlapping niches and scaffolds, and in Evolutionary Developmental Biology, characterizing evolutionary and ecological processes as developmental causes. (shrink)

In this article, I clarify some of the key concepts and commitments of realist social ontology in economics. To do so, I make use of a recent critique of Lawson’s Reorienting Economics by Mohun and Veneziani. Their article provides a useful foil because responding to their critique allows us to emphasize that realism’s claims are more conditional and less controversial than one might otherwise anticipate. The basic claim is that ontology matters and that explicit recognition and consideration of ontological issues (...) can be beneficial. However, developing a focus on ontology can create problems of interpretation among economists regarding what is being claimed and offered. I discuss some of these with reference to an adaption of Maki’s concept of economics imperialism and also with reference to Mary Morgan’s recent typology of experiments. (shrink)

I outline a pragmatic account of evidence, arguing that it allows us to underwrite two implications of feminist scholarship: that knowledge is socially constructed and constrained by evidence, and that social relations, including gender, race, and class, are epistemologically significant. What makes the account promising is that it abandons any pretense of a view from nowhere, the view of evidence as something only individuals gather or have, and the view that individual theories face experience in isolation.

The author has previously shown that for a certain class of structures $\mathcal {I}$, $\mathcal {I}$-indexed indiscernible sets have the modeling property just in case the age of $\mathcal {I}$ is a Ramsey class. We expand this known class of structures from ordered structures in a finite relational language to ordered, locally finite structures which isolate quantifier-free types by way of quantifier-free formulas. This result is applied to give new proofs that certain classes of trees are Ramsey. To aid this (...) project we develop the logic of EM-types. (shrink)

The persistence, and international expansion, of food banks as a non-governmental response to households experiencing food insecurity has been decried as an indicator of unacceptable levels of poverty in the countries in which they operate. In 1998, Poppendieck published a book, Sweet charity: emergency food and the end of entitlement, which has endured as an influential critique of food banks. Sweet charity‘s food bank critique is succinctly synthesized as encompassing seven deadly “ins” (1) inaccessibility, (2) inadequacy, (3) inappropriateness, (4) indignity, (...) (5) inefficiency, (6) insufficiency, and (7) instability. The purpose of this paper is to examine if and how the contemporary food bank critique differs from Sweet charity’s “ins” as a strategy for the formulation of synthesizing arguments for policy advocacy. We used critical interpretive synthesis methodology to identify relationships within and/or between existing critiques in the peer-reviewed literature as a means to create “‘synthetic constructs’ (new constructs generated through synthesis)” of circulating critiques. We analyzed 33 articles on food banks published since Sweet charity, with the “ins” as a starting point for coding. We found that the list of original “ins” related primarily to food bank operations has been consolidated over time. We found additional “ins” that extend the food bank critique beyond operations (ineffectiveness, inequality, institutionalization, invalidation of entitlements, invisibility). No synthetic construct emerged linking the critique of operational challenges facing food banks with one that suggests that food banks may be perpetuating inequity, posing a challenge for mutually supportive policy advocacy. (shrink)

The relationship between ethics and economics has never been easy. Opponents in a tug of war, friends in a warm embrace, ships passing in the night—the relationship has been highly variable. In recent years, the friendship model has been gaining credence, particularly among U.S. corporate executives. Increasingly, companies are launching ethics programs, values initiatives, and community involvement activities premised on management’s belief that “Ethics pays.”.

This paper examines, on the basis of a longitudinal corpus of 50 early modern authors, how change at the aggregate level of the community interacts with variation and change at the micro-level of the individual language user. In doing so, this study aims to address the methodological gap between collective change and entrenchment, that is, the gap between language as a social phenomenon and the cognitive processes responsible for the continuous reorganization of linguistic knowledge in individual speakers. Taking up the (...) case of the prepositional passive, this study documents a strong community-wide increase in use that is accompanied by increasing schematicity. A comparison of the 50 authors reveals that regularities arising at the macro-level conceal highly complex and variable individual behavior, aspects of which may be explained by studying the larger (social) context in which these individuals operate (e. g., age cohorts, community of practice, biographical insights). Further analysis, focusing on how authors use the prepositional passive in unique and similar ways, elucidates the role of small individual biases in long-term change. Overall, it is demonstrated that language change is an emergent phenomenon that results from the complex interaction between individual speakers, who themselves may change their linguistic behavior to varying degrees. (shrink)

Scotland is usually portrayed as being a country that had weak and terrible queens, like Margaret Tudor and Mary Queen of Scots. Saint Margaret is the only queen who is constantly portrayed positively. However, that is not because of her actions as queen consort, but because she was a devote Christian. Scotland is also portrayed for not producing well known or strong female rulers. This essay will examine two contemporary female rulers from the mid-fifteenth century, one from Scotland, Eleanor of (...) Scotland, and one imported to Scotland, Mary of Gueldres. Using these case studies it will be demonstrated that Scotland did produce strong female rulers along with acquiring them. (shrink)

Used in China as a book of divination and source of wisdom for more than three thousand years, the _I Ching_ has been taken up by millions of English-language speakers in the nineteenth century. The first translation ever to appear in English that includes one of the major Chinese philosophical commentaries, the Columbia _I Ching_ presents the classic book of changes for the world today. Richard Lynn's introduction to this new translation explains the organization of _The Classic of Changes_ (...) through the history of its various parts, and describes how the text was and still is used as a manual of divination with both the stalk and coin methods. For the fortune-telling novice, he provides a chart of trigrams and hexagrams; an index of terms, names, and concepts; and a glossary and bibliography. Lynn presents for the first time in English the fascinating commentary on the _I Ching_ written by Wang Bi, who was the main interpreter of the work for some seven hundred years. Wang Bi interpreted the _I Ching_ as a book of moral and political wisdom, arguing that the text should not be read literally, but rather as an expression of abstract ideas. Lynn places Wang Bi's commentary in historical context. For beginners and devotees alike, Columbia's _I Ching_ is the clearest and most authoritative translation of this ancient classic. (shrink)

Nurses are encountering an increasing number of ethical dilemmas in clinical practice. Ethics courses for baccalaureate nursing students provide the opportunity for the development of critical thinking skills in order to deal with these effectively. The purpose of this descriptive qualitative study was to describe ethical reasoning in 70 baccalaureate nursing students enrolled in a nursing ethics course. Reflective clinical journals were analyzed as appropriate for qualitative inquiry. The overriding theme emerging from the data was `in the process of becoming', (...) which includes: practicing as a professional, lacking the confidence as a student nurse to take an ethical stand, advocating for patients, being just in the provision of care, identifying the spiritual dimensions of nursing practice, confronting the `real world' of health care, making a commitment to practice with integrity, and caring enough to care. The development of critical thinking and ethical reasoning within the framework of knowing and connecting is essential in nursing education. (shrink)

: Some commentators have recently proposed that "clinical equipoise," although widely accepted, is not necessary for morally acceptable research on human subjects. If this concept is rejected, however, we may find that trials not in the best medical interests of their subjects--bad deal trials--could be justified. To avoid exploiting participants, we must find a way to distribute the risks fairly, even if it means embracing radical changes in the way clinical research is conducted.

In this article, we critique two theoretical positions that analyze the place of emotions in education: the psychological strand and the cultural feminist strand. First of all, it is shown how a social control of emotions in education is reflected in the combination of psychological and cultural feminist discourses that function to govern one’s self effectively and efficiently. These discourses perpetuate an assumed divide between the rational and the emotional, and reinforce the existing power hierarchies and the status quo of (...) stereotypes about the role of emotion in education. Then we use the Foucauldian notions of parrhesia and care of the self to suggest alternative ways of thinking about emotions in education. Instead of campaigning for one side or the other of the rational/emotional divide, we suggest that it may be more interesting and fruitful to examine the particular ways discourses of emotion in education construct their own brand of parrhesia. (shrink)

Usage-based linguistics postulates that multi-word expressions constitute a substantial part of language structure and use, and are formed through repeated chunking and stored as exemplar wholes. They are also re-used to produce new sequences by means of schematization. While there is extensive research on multi-word expressions in many spoken languages, little is known about the status of multi-word expressions in the mainstream U.S. variety of American Sign Language. This paper investigates recurring multi-word expressions, or sequences of multiple signs, that involve (...) a high-frequency sign of visual perception glossed as look and the family of ‘look’ signs. The look sign exhibits two broad functions: look/‘vision’ references literal or metaphorical vision and look/‘reaction’ signals a person’s reaction to a visual stimulus. Data analysis reveals that there are recurring sequences in distinct syntactic environments associated with the two functions of look, suggesting that look is in the process of grammaticalization from a verb of visual perception to a stance verb. The sequences demonstrate the emergence of linguistic structure from repeated use through the domain-general cognitive process of chunking in ASL. (shrink)

: This paper offers a new interpretation of the first chapter of Aristotle’s Rhetoric and of Aristotle’s understanding of rhetoric throughout the treatise. I defend the view that, for Aristotle, rhetoric was a skill in offering the listener ‘proofs’, that is, proper grounds for conviction. His arguments in the opening chapters of the treatise state and defend this controversial, epistemically normative view against the rival views of Gorgias, Thrasymachus and the rhetorical handbook writers, on the one hand, and against those (...) of Plato, on the other. Aristotle defends his view on the basis that rhetoric is a skill in discharging an important role in the state – the role of helping citizens to good publicly-deliberated judgements. (shrink)

Edwin, a person contemplating a career in teaching, has a conversation with Phyllis, a teacher and amateur theorist, about reasons to become a teacher.

The mouse t-complex, located on chromosome 17, contains genes known to influence male, but not female, fertility. Although some t-complex genes are recessive lethals, t-chromosomes are maintained in the population by transmission ratio distortion. When male mice heterozygous for the t-chromosome mate with wild-type females, most offspring will possess the t-chromosome, indicating a link between t-complex genes and sperm function. Several proteins coded for by t-complex genes have been localised in the sperm flagellum, suggesting roles relating to motility. Another t-complex (...) protein appears able to regulate the adenylyl cyclase/cAMP signal transduction pathway, known to play an important role in capacitation. Defective motility and/or failure to capacitate (“switch on”) would result in poorly fertile or infertile spermatozoa. Given the existence of human homologues for many genes in the t-complex and the prevalence of “male factor” infertility, information obtained about the t-complex not only will provide insight into basic biological mechanisms but may be of future clinical relevance as well. BioEssays 21:304–312, 1999. © 1999 John Wiley & Sons, Inc. (shrink)

This study compares involuntary and voluntary autobiographical memories in depressed and never depressed individuals. Twenty depressed and twenty never depressed individuals completed a memory diary; recording their reactions to 10 involuntary and 10 voluntary memories over 14–30 days. Psychiatric status , psychopathology, rumination and avoidance were assessed. For both groups, involuntary memories more frequently lead to strong reactions than voluntarily memories. For both modes of retrieval, depressed individuals reported more frequent negative reactions than never depressed individuals and rated memories as (...) more central to identity with higher levels of rumination and avoidance. Depressed individuals retrieved both positive and negative memories during involuntary retrieval. These findings support the view that involuntary memory retrieval represents a basic mode of retrieval during healthy and disordered cognition, and that during depression, both involuntary and voluntary memories are central to identity and associated with rumination and avoidance. (shrink)

Contemporary law and public policy often treat human beings as selfish creatures who respond only to punishments and rewards. Yet every day we behave unselfishly--few of us mug the elderly or steal the paper from our neighbor's yard, and many of us go out of our way to help strangers. We nevertheless overlook our own good behavior and fixate on the bad things people do and how we can stop them. In this pathbreaking book, acclaimed law and economics scholar (...) class='Hi'>Lynn Stout argues that this focus neglects the crucial role our better impulses could play in society. Rather than lean on the power of greed to shape laws and human behavior, Stout contends that we should rely on the force of conscience. Stout makes the compelling case that conscience is neither a rare nor quirky phenomenon, but a vital force woven into our daily lives. Drawing from social psychology, behavioral economics, and evolutionary biology, Stout demonstrates how social cues--instructions from authorities, ideas about others' selfishness and unselfishness, and beliefs about benefits to others--have a powerful role in triggering unselfish behavior. Stout illustrates how our legal system can use these social cues to craft better laws that encourage more unselfish, ethical behavior in many realms, including politics and business. Stout also shows how our current emphasis on self-interest and incentives may have contributed to the catastrophic political missteps and financial scandals of recent memory by encouraging corrupt and selfish actions, and undermining society's collective moral compass. This book proves that if we care about effective laws and civilized society, the powers of conscience are simply too important for us to ignore. (shrink)

This dissertation is about a priori justification and its relationship to experiential evidence. I begin with the assumption that a priori justification is justification that is independent of experience. It has been argued that putative examples of a priori justification are implausible because they are not, in any significant sense, independent of experience. My two central claims are that (a) a subject is plausibly justified a priori in believing a proposition only if the belief is not revisable on empirical grounds, (...) which I will call the empirical unrevisability thesis; and (b) moderate rationalists can resist four empirical challenges considered by many to be decisive against the empirical unrevisability thesis. I begin by developing an account of experiential evidence that is neutral between rationalists and empiricists in order to make clear the distinction between a priori and a posteriori justification. I then argue that a moderate rationalist account of a priori justification is plausible only if the beliefs justified a priori are empirically unrevisable in a qualified sense. I then argue that four classical objections that putative cases of a priori justification are not independent of experience fail, namely, that they are revisable by some instances of contrary testimony, by mistakes in long proofs and memory, that a paradigm example of a priori knowledge was overturned by new evidence in physics, and that psychological data undermines the reliability of sources of a priori justification. I conclude that there is only one potentially threatening case, derived from neurological malfunction, and I leave the solution to this case to future research. (shrink)

Some commentators have recently proposed that “clinical equipoise,” although widely accepted, is not necessary for morally acceptable research on human subjects. If this concept is rejected, however, we may find that trials not in the best medical interests of their subjects—”bad deal trials”—could be justified. To avoid exploiting participants, we must find a way to distribute the risks fairly, even if it means embracing radical changes in the way clinical research is conducted.