Volume 19, Issue 6, June 2019, Page 28-29.

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

In this article, I describe how gender bias can affect the design, testing, clinical trials, regulatory approval, and clinical use of implantable devices. I argue that bad outcomes experienced by women patients are a cumulative consequence of small biases and inattention at various points of the design, testing, and regulatory process. However, specific instances of inattention and bias can be difficult to identify, and risks are difficult to predict. This means that even if systematic gender bias in implant design is (...) an ethical issue, it is one with no clearly blameworthy player. From a practical perspective, there is no single obvious point at which to intervene. Philosophers working in other areas have explored structurally similar moral problems—sometimes referred to as “moral aggregation problems”—such as the type of environmental harm caused by small actions of many players. I describe key features of these type of problems and strategies to address them. I then draw on these to suggest an approach to gender bias in medical implant design and use. (shrink)

Despite its place in the humanities, the career prospects and numbers of women in philosophy much more closely resemble those found in the sciences and engineering. This book collects a series of critical essays by female philosophers pursuing the question of why philosophy continues to be inhospitable to women and what can be done to change it. By examining the social and institutional conditions of contemporary academic philosophy in the Anglophone world as well as its methods, culture, and characteristic commitments, (...) the volume provides a case study in interpretation of one academic discipline in which women's progress seems to have stalled since initial gains made in the 1980s. Some contributors make use of concepts developed in other contexts to explain women's under-representation, including the effects of unconscious biases, stereotype threat, and micro-inequities. Other chapters draw on the resources of feminist philosophy to challenge everyday understandings of time, communication, authority and merit, as these shape effective but often unrecognized forms of discrimination and exclusion. Often it is assumed that women need to change to fit existing institutions. This book instead offers concrete reflections on the way in which philosophy needs to change, in order to accommodate and benefit from the important contribution women's full participation makes to the discipline. (shrink)

Women are under-represented in surgery, especially in leadership and academic roles, and face a gender pay gap. There has been little work on the role of implicit biases in women’s under-representation in surgery. Nor has the impact of epistemic injustice, whereby stereotyping influences knowledge or credibility judgements, been explored. This article reports findings of a qualitative in-depth interview study with women surgeons that investigates gender biases in surgery, including subtle types of bias. The study was conducted with 46 women surgeons (...) and trainees of the Royal Australasian College of Surgeons. Maximum variance sampling strategies ensured a comprehensive set of perspectives. Data were analysed using iterative thematic analysis to document and classify forms of gender bias experienced by the participants, including implicit bias and epistemic injustice. It found four types of bias affecting women surgeons: workplace factors such as access to parental leave and role models; epistemic injustices—unfair assessments of women surgeons’ credibility by patients and colleagues; stereotyped expectations that they will carry out more of surgery’s carework, such as meeting the emotional needs of patients and objectification. Implicit biases arose in each category. Given that many of the biases identified in this study are small, are harmless on their own and are not necessarily under anyone’s conscious control, important questions arise regarding how they cause harm and how to address them. I draw on theoretical work on cumulative harm to answer these questions. (shrink)

Medical devices with built-in bias can both result from, and contribute to, harmful systemic racial oppression—a point that Liao and Carbonell (2023) argue convincingly in the target article of thi...

Patient or public involvement in health research is increasingly expected as a matter of policy. In theory, PPI can contribute both to the epistemic aims intrinsic to research, and to extrinsically valued features of research such as social inclusion and transparency. In practice, the aims of PPI have not always been clear, although there has been a tendency to encourage the involvement of so-called ordinary people who are regarded as representative of an assumed patient perspective. In this paper we focus (...) on the epistemic potential of PPI, using theoretical work in epistemology to develop a nuanced account of patients’ experiential knowledge and how this might contribute directly to conceptual development, hypothesis generation and data interpretation. We also consider how some features of health research pose barriers to this kind of epistemic contribution. Drawing on Miranda Fricker’s idea of testimonial injustice, we explore how disciplinary indicators of credibility in clinical and academic health research contexts might be wrongly applied to those involved in PPI, undermining their potential to contribute. Finally we argue for a range of strategies to maximize opportunities for patients to engage with research teams and make epistemologically significant contributions to research. (shrink)

We examined unconscious priming in a stem-completion task with both identity and form-related primes. Participants were given exclusion instructions to avoid completing a stem with a briefly flashed masked word . In Experiment 1, priming of around 7% occurred for both identity and form-based primes at a 33 ms exposure duration. When examining only trials in which the participants failed to identify the prime, this effect increased to 12% for identity primes, but remained the same for form-based primes. In Experiment (...) 2, priming without prime identification was 9% for identity primes, 4% for homophone primes, and 3% for orthographic control primes. Although identity priming was greater than form priming in both experiments, regression analyses revealed that orthographic and phonological overlap alone between the flashed primes and targets could completely account for unconscious identity priming. Hence, we conclude that masked words may only activate their sublexical orthographic and phonological representations and not their lexical representations. (shrink)

What is the role of cultural archives in creating and sustaining connections between diasporic communities? Through an analysis of an audiovisual archive that has sought to bring together representations of and by African, Caribbean and Asian people, this article discusses the relationship between diasporic film, knowledge production and feminist solidarity. Focusing on a self-curated, UK-based archive, the June Givanni Pan-African Cinema Archive, we explore the potentiality of archives for carving out spaces of diasporic connectivity and resistance. This archive assembles (...) the holdings of pan-African films and film-related materials, built over several decades by June Givanni, a Guyanese-born London-based film curator. Givanni’s archive embodies her long relationship with the intersecting worlds of African and Asian diasporic cinema, which hold deep connections to Black British heritage through global networks spanning across empire. In the making of this cultural analysis, we employ a co-produced, decolonial methodological approach by designing and producing the article in collaboration with Givanni over a two-year period. We aim to foreground the role of feminist labour (academic and practitioner) as agents of change who are reclaiming stories, voices and memory-making. The wider backdrop to this co-produced analysis is the ongoing resilience of a cultural amnesia that has pervaded the Black British experience and the current fragility of Black arts and cultural spaces in the UK. Our question is how might archives help us map the connections between racialised ideas of belonging, memory politics and the reconfiguration of colonial power whilst also operating as a site of feminist connectivity? (shrink)

This paper raises questions about the epistemological foundations of evidence-based medicine . We argue that EBM is based upon reliabilist epistemological assumptions, and that this is appropriate - we should focus on identifying the most reliable processes for generating and collecting medical knowledge. However, we note that this should not be reduced to narrow questions about which research methodologies are the best for gathering evidence. Reliable processes for generating medical evidence might lie outside of formal research methods. We also question (...) the notion of the knower that is assumed by EBM. We argue that EBM assumes an enlightenment conception of knowers as autonomous, substitutable individuals. This conception is troubled by the way that clinicians learn the role of anecdote in health care and the role of patient choice, all of which bring into play features of clinicians and patients as situated individuals with particular backgrounds and experiences. EBM's enlightenment conception of the knower is also troubled by aspects of the way evidence is produced. Given these limitations, we argue that EBM should retain its reliabilist bent, but should look beyond formal research methodologies in identifying processes that yield reliable evidence for clinical practice. We suggest looking to feminist epistemology, with its focus on the standpoints of individual situated knowers, and the role of social context in determining what counts as knowledge. (shrink)

This paper rejects a traditional epistemic interpretation of conditional probability. Suppose some chance process produces outcomes X, Y,..., with probabilities P(X), P(Y),... If later observation reveals that outcome Y has in fact been achieved, then the probability of outcome X cannot normally be revised to P(X|Y) ['P&Y)/P(Y)]. This can only be done in exceptional circumstances - when more than just knowledge of Y-ness has been attained. The primary reason for this is that the weight of a piece of evidence varies (...) with the means by which it is provided, so knowledge of Y-ness does not have uniform impact on the probability of X. A better updating of the probability of X is provided by P(X|Y*), where Y* is not an outcome of the chance process being observed, but the sentence 'the outcome Y has been observed', an 'outcome' of the subsequent observation process. This alternative formula is widely endorsed in practice, but not well recognized in theory, where the oversight has generated some unsatisfactory consequences. (shrink)

Let me first thank Samantha Brennan, Carolyn McLeod and Brandi Braud Scully for their detailed and constructive commentaries. In this brief response I wish to highlight and engage with three main points they raise. First, I will address McLeod’s argument that female surgeons are not merely harmed, but also wronged by the forms of bias found in the study. Second, I will discuss a concern voiced by both Scully and Brennan that my emphasis on small and implicit biases fails to (...) acknowledge the ongoing, significant problem of explicit bias. Third, and finally, I will engage with Brennan’s argument that institutional responses are the best way of addressing cumulative harms caused by microinequities. These concerns all connect with the difficult question of responsibility, a feature I draw out below. Carolyn McLeod argues that female surgeons’ interests in receiving equal treatment and opportunity are morally significant interests. As such, when these interests are set back by cumulative small biases the female surgeons are morally wronged. Moreover, she says, ‘it’s also hard to see how setting them back in this context could possibly be justified.’ McLeod is right to press me on this issue. In the article I have skirted around …. (shrink)

This paper draws attention to gendered dimensions of surgical device failure, focusing on two case studies—hernia repair mesh for pelvic organ prolapse, and metal-on-metal hip implants. We explore possible reasons for higher rates of harms to women, including systematic biases in health research and device regulation. Given that these factors are readily identifiable, we look to feminist scholarship to understand what might maintain them, including the role of cultural factors within surgery, such as gendered communication patterns and sexism. We then (...) canvas potential measures to mitigate the increased risk of harms faced by women who use implanted devices. (shrink)

Available from UMI in association with The British Library. Requires signed TDF. ;This thesis examines the influence and reception of John Locke in France and French-speaking communities in the period 1688 to 1734. We begin with the circumstances of the translation of Locke's works into French, a study of Locke's personal relationships and correspondence with French Protestants chiefly in the Low Countries, and a survey of early references to Locke in literary journals; these establish the initial patterns of dissemination of (...) Locke's ideas. ;Four areas are then examined in detail: the use made of Locke by those writing on natural law, especially Jean Barbeyrac in his influential translations of Grotius and Pufendorf; Locke's contribution to debates on natural order of words in natural languages and on methods of Latin-teaching, chiefly in the work of Du Marsais; the Jesuit educator Claude Buffier and his use of, and reservations about, Locke in the context of educational theory and empirical philosophy; and Locke's place in the debate, set by Cartesian and scholastic traditions, about metaphysical and epistemological questions such as animal souls and thinking matter. ;Voltaire forms the focus of the conclusion: his own study of Locke and his presentation of Locke's ideas are examined by means of his own correspondence and of a detailed study of the Lettres philosophiques and immediate responses to them in literary circles. We conclude that, although Voltaire was not the first French-speaking writer to discover and use Locke, he did importantly popularise Locke by presenting him coherently and comprehensibly. (shrink)

This book offers both the theoretical background behind the minority effect, teachers' personal experiences as they experienced being a minority, and their analyses and insights for teaching diverse learners. This book uses real-life experiences of diverse people to illustrate that, if not understood and addressed, situational minorities at school or work are unlikely to perform at their highest potentials.

We use a transmission chain method to establish how context and category salience influence the formation of novel stereotypes through cumulative cultural evolution. We created novel alien targets by combining features from three category dimensions—color, movement, and shape—thereby creating social targets that were individually unique but that also shared category membership with other aliens (e.g., two aliens might be the same color and shape but move differently). At the start of the transmission chains each alien was randomly assigned attributes that (...) described it (e.g., arrogant, caring, confident). Participants were given training on the alien‐attribute assignments and were then tested on their memory for these. The alien‐attribute assignments participants produced during test were used as the training materials for the next participant in the transmission chain. As information was repeatedly transmitted an increasingly simplified, learnable stereotype‐like structure emerged for targets who shared the same color, such that by the end of the chains targets who shared the same color were more likely to share the same attributes (a reanalysis of data from Martin et al., which we term Experiment 1). The apparent bias toward the formation of novel stereotypes around the color category dimension was also found for objects (Experiment 2). However, when the category dimension of color was made less salient, it no longer dominated the formation of novel stereotypes (Experiment 3). The current findings suggest that context and category salience influence category dimension salience, which in turn influences the cumulative cultural evolution of information. (shrink)

One day soon it may be possible to replace a failing heart, liver, or kidney with a long-lasting mechanical replacement or perhaps even with a 3-D printed version based on the patient's own tissue. Such artificial organs could make transplant waiting lists and immunosuppression a thing of the past. Supposing that this happens, what will the ongoing care of people with these implants involve? In particular, how will the need to maintain the functioning of artificial organs over an extended period (...) affect patients and their doctors and the responsibilities of those who manufacture such devices? Drawing on lessons from the history of the cardiac pacemaker, this article offers an initial survey of the ethical issues posed by the need to maintain and service artificial organs. We briefly outline the nature and history of cardiac pacemakers, with a particular focus on the need for technical support, maintenance, and replacement of these devices. Drawing on the existing medical literature and on our conversations and correspondence with cardiologists, regulators, and manufacturers, we describe five sources of ethical issues associated with pacemaker maintenance: the location of the devices inside the human body, such that maintenance generates surgical risks; the complexity of the devices, which increases the risk of harms to patients as well as introducing potential injustices in access to treatment; the role of software—particularly software that can be remotely accessed—in the functioning of the devices, which generates privacy and security issues; the impact of continual development and improvement of the device; and the influence of commercial interests in the context of a medical device market in which there are several competing products. Finally, we offer some initial suggestions as to how these questions should be answered. (shrink)

OBJECTIVES: This article presents an original definition of surgical innovation and a practical tool for identifying planned innovations. These will support the responsible introduction of surgical innovations. BACKGROUND: Frameworks developed for the safer introduction of surgical innovations rely upon identifying cases of innovation; oversight cannot occur unless innovations are identified. However, there is no consensus among surgeons about which interventions they consider innovative; existing definitions are vague and impractical. METHODS: Using conceptual analysis, this article synthesizes findings from relevant literature, and (...) from qualitative research with surgeons, to develop an original definition of surgical innovation and a tool for prospectively identifying planned surgical innovations. The tool has been developed in light of feedback from health care professionals, surgeons, and policy makers. RESULTS: This definition of innovation distinguishes between variations, introduction of established interventions, and innovations in surgical techniques or use of devices. It can be applied easily and consistently, is sensitive to the key features of innovation, is prospective, and focuses on features relevant to safety and evaluation. The accompanying tool is deliberately broad so that appropriate supports may, if necessary, be provided each time that a surgeon does something "new". CONCLUSIONS: The definition presented in this article overcomes a number of practical challenges. The definition and tool will be of value in supporting responsible surgical innovation, in particular, through the prospective identification of planned innovations. (shrink)

Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly fund (...) access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long-term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations. (shrink)

Through an analysis of several high‐profile scandals in health‐care in the UK, this article discusses the nature of scandal and its impact on policy reform. The nursing profession is compared to social work and medicine, which have also undergone considerable examination and change as a result of scandals. The author draws on reports from public inquiries from 1945 to 2013 to form the basis of the discussion about policy responses following scandals in health‐care. In each case, the nature of the (...) scandal, the public and government discourses generated by events and the policy response to those failings are explored. These scandals are compared to the recent scandal at Mid Staffordshire Hospital. Conclusions are drawn about the impact of these events on the future of the profession and on health policy directions. Recent events have raised public anxieties about caring practices in nursing. Health policy reform driven by scandal may obscure the effect of under resourcing in health services and poses a very real threat to the continued support for state‐run services. Understanding the socially constructed nature of scandal enables the nurse to develop a greater critical awareness of policy contexts in order that they can influence health service reform. (shrink)

One of the clear targets of Thomason’s paper is the Feyerabendian portrait of Galileo as epistemic opportunist, hastening to substitute rhetoric for reason. Thomason reveals that Feyerabend has fallen into that awkward trap all critics must fear: when we claim to detect blemishes of logic, the defect may well be in our own grasp of the argument. Yet in making this very point, Thomason is already defending one of Feyerabend’s favourite claims — the reasoning processes used by great scientists are (...) remarkably untidy and do not readily compress themselves into neat philosophic formulation. (shrink)