Since the late 1990s, the use of contralateral prophylactic mastectomy to treat unilateral breast cancer has been on the rise. Over the past two decades, dozens of studies have been conducted in order to understand this trend, which has puzzled and frustrated physicians who find it at odds with efforts to curb the surgical overtreatment of breast cancer, as well as with evidence-based medicine, which has established that the procedure has little oncologic benefit for most patients. Based on the work (...) of Annemarie Mol and John Law, this paper argues that these efforts to understand increased CPM use are limited by the “epistemology problem” in medicine, or, in other words, the tendency to view healthcare controversies and decision making exclusively through the lenses of objective and subjective forms of knowledge. Drawing on public discourse about rationales for choosing CPM, we argue that this surgical trend cannot adequately be understood in terms of what doctors and patients know about breast cancer risk and how CPM affects that risk. In addition, it must be recognized as the outcome of how specific practices of screening, detection, and treatment do or enact the bodies of patients, producing tensions in their lives that cannot be remedied with better or better communicated information. Recognizing the embodied realities of these enactments and their effects on patient decision making, we maintain, is essential for physicians who want to avoid the paternalism that haunts breast cancer treatment in the US. (shrink)

People can be disgusted by the concrete and by the abstract -- by an object they find physically repellent or by an ideology or value system they find morally abhorrent. Different things will disgust different people, depending on individual sensibilities or cultural backgrounds. In _Yuck!_, Daniel Kelly investigates the character and evolution of disgust, with an emphasis on understanding the role this emotion has come to play in our social and moral lives. Disgust has recently been riding a swell (...) of scholarly attention, especially from those in the cognitive sciences and those in the humanities in the midst of the "affective turn." Kelly proposes a cognitive model that can accommodate what we now know about disgust. He offers a new account of the evolution of disgust that builds on the model and argues that expressions of disgust are part of a sophisticated but largely automatic signaling system that humans use to transmit information about what to avoid in the local environment. He shows that many of the puzzling features of moral repugnance tinged with disgust are by-products of the imperfect fit between a cognitive system that evolved to protect against poisons and parasites and the social and moral issues on which it has been brought to bear. Kelly's account of this emotion provides a powerful argument against invoking disgust in the service of moral justification. (shrink)

In The Foundations of Arithmetic, Gottlob Frege contended that the difference between concepts and objects was absolute. He meant that no object could be a concept and no concept an object. Benno Kerry disagreed; he contended that a concept could be an object, and that therefore the difference between concepts and objects was only relative. In this book, Jolley aims to understand the debate between Frege and Kerry. But Jolley's purpose is not so much to champion either side; rather, it (...) is to utilize an understanding of the debate to shed light on the work of Ludwig Wittgenstein-and vice versa. Jolley not only sifts through the debate between Frege and Kerry, but also through subsequent versions of the debate in J. J. Valberg and Wilfred Sellars. Jolley's goal is to show that the central notion of Philosophical Investigations, that of a 'conceptual investigation', is a legacy of the Frege/Kerry debate and also a contribution to it. Jolley concludes that the difference between concepts and objects is as absolute in its way in Philosophical Investigations as it was in The Foundations of Arithmetic and that recognizing the absoluteness of the difference in Philosophical Investigations provides a beginning for a 'resolute' reading of Wittgenstein's book. (shrink)

What follows is talky—I skitter across a number of difficult topics much too quickly and with little attempt to defend what I say. I may be able to add some defense later in discussion, but I don't promise anything much and certainly nothing fancy. I am still very much in the process of thinking about these topics, and I aim to do no more than to perhaps nudge you to think about them too.By "poetry" in what follows, I typically mean (...) "lyric poetry." There are poems and poems and poems, and the dactyls make a difference, as do many other features internal to poetry. I will also say upfront that I have no working definition of "lyric poetry." I also have no working definition of "philosophy," although I will be... (shrink)

In this paper we aim to think systematically about, formulate, and begin addressing some of the challenges to applying theories of moral responsibility to behaviors shaped by a particular subset of unsettling psychological complexities: namely, implicit biases.

In this essay, I respond to A. W. Moore’s instructive chapter on Frege. I respond by asking various questions, and I question particularly Moore’s claim that Frege, in reacting to Benno Kerry, falls into Hegelian excess. I toy with responding to my question by regarding Frege as anticipating a Wittgensteinian-Heideggerian exaction. It remains unclear whether this constitutes (much) progress.

What is it to read Wittgenstein resolutely? In this essay, I make a suggestion about how to answer that question. I backtrack in time to a debate about Philosophical Investigations between O. K. Bouwsma and Gilbert Ryle. I selectively reconstruct that debate, highlighting features of it that I take to be interesting in their own right and in relation to debates about PI, but also interesting in analogy with debates about resolute and standard readings of Tractatus logico-philosophicus. As will be (...) clear, my sympathies are with Bouwsma against Ryle, and with resolute readers against standard readers. But I do not vindicate Bouwsma; I will, in fact, be critical, carefully or guardedly critical of him.Nor do I vindicate resolute reading of TLP. I suggest a way of seeing resolute reading that makes clearer what it is and how it contrasts with standard reading, and, in so doing, that makes clearer what some of the difficulties of the debate between the readings really are, whether about TLP or about PI. (shrink)

In this essay, we focus primarily on Moore’s “Proof of an External World” and Kant’s “Refutation of Idealism.” We are not exactly commenting on Clarke’s “The Legacy of Skepticism,” interpreting it, although what we do involves us in (some of) that. Instead of directly commenting on it, we do things with Legacy; we read Moore’s Proof and Kant’s Refutation with Clarke in mind. And by way of doing this, we bring onto the stage a post-Legacy Moore, and a post-Legacy Kant. (...) We do not claim to present Moore and Kant per se (to use Clarke’s term); we do not portray Moore and Kant as they are independently of “The Legacy of Skepticism.” We propose instead Moore and Kant as we read them after Legacy, i.e., in light of the pure/plain distinction. (shrink)

In the last half century, oral history has emerged as a historical approach that is being considered by archivists involved with the collection and accessibility of archival collections for researchers and interested members of the public. The approach to ethics by oral historians has emerged from two major fears: the fear of failing as researchers and the fear of failing the narrators and doing harm. Archivists also need to be cognisant of these fears when collecting oral history. Confronting these fears (...) makes it possible to understand the complex questions behind oral historians’ and archivists’ preoccupations and sheds light on how oral history has evolved and expanded as a field. The research objectives of this article are to determine the three principles identified from the Belmont Report that relate and should be applied to the collection of oral histories by archivists and historians from communities and individuals residing and working in and alongside the Kruger National Park. The theoretical framework for this article is the critical race theory to address historical accounts from communities and individuals sidelined by the mainstream media in South Africa. For the purposes of this article, the study was conducted with the Makuleka and Tsonga communities to determine what ethical implications need to be respected when conducting oral history projects with communities.Contribution: This article will contribute to ethics concerning social sciences and specifically the collection of oral history. (shrink)

ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not reporting and (2) not obtaining consent.MethodsSurvey of primary trial reports, published 2014–2019, identified using an electronic search filter for pragmatic trials implemented in MEDLINE, and registered in ClinicalTrials.gov.ResultsAmong 1988 trials, 132 (6.6%) did not include a statement about participant consent, 1691 (85.0%) reported consent had been obtained, 139 (7.0%) reported a (...) waiver and 26 (1.3%) reported consent for one aspect (eg, data collection) but a waiver for another (eg, intervention). Of the 165 trials reporting a waiver, 76 (46.1%) provided a justification. Few (53, 2.9%) explicitly reported use of alternative approaches to consent. In multivariable logistic regression analyses, lower journal impact factor (p=0.001) and cluster randomisation (p<0.0001) were significantly associated with not reporting on consent, while trial recency, cluster randomisation, higher-income country settings, health services research and explicit labelling as pragmatic were significantly associated with not obtaining consent (all p<0.0001).DiscussionNot obtaining consent seems to be increasing and is associated with the use of cluster randomisation and pragmatic aims, but neither cluster randomisation nor pragmatism are currently accepted justifications for waivers of consent. Rather than considering either standard written informed consent or waivers of consent, researchers and research ethics committees could consider alternative consent approaches that may facilitate the conduct of pragmatic trials while preserving patient autonomy and the public’s trust in research. (shrink)

In 2017, Partridge et al. published remarkable experimental results concerning the use of a new artificial womb technology (AWT) with lambs, developed at Children’s Hospital of Philadelphia, called...

Many philosophers believe that there is a causal condition on perception, and that this condition is a conceptual truth about perception. A highly influential argument for this claim is based on intuitive responses to Gricean style thought experiments. Do the folk share the intuitions of philosophers? Roberts et al. (2016) presented participants with two kinds of cases: Blocker cases (similar to Grice’s case involving a mirror and a pillar) and Non-Blocker cases (similar to Grice’s case involving a clock and brain (...) stimulation). They found that a substantial minority agreed that seeing occurs in the Non-Blocker cases, and that in the Blocker cases significantly less agreed that seeing occurs. They thus hypothesized that folk intuitions better align with a no blocker condition than with a causal condition. This paper continues this line of enquiry with two new experiments. The paper investigates the generality and robustness of Roberts et al.’s findings by expanding the sense modalities tested from only vision to audition and olfaction as well. The paper also uses Gricean style thought experiments as a case study for investigating the “reflection defense” against the negative project in experimental philosophy. Our results replicate and extend Roberts et al.’s study and support their hypothesis that folk intuitions better align with a no blocker condition. They also provide an empirical reason to doubt the reflection defense. (shrink)

Despite apparent political concern and action—often fuelled by high-profile cases and campaigns—legislative and institutional responses to image-based sexual abuse in the UK have been ad hoc, piecemeal and inconsistent. In practice, victim-survivors are being consistently failed: by the law, by the police and criminal justice system, by traditional and social media, website operators, and by their employers, universities and schools. Drawing on data from the first multi-jurisdictional study of the nature and harms of, and legal/policy responses to, image-based sexual abuse, (...) this article argues for a new joined-up approach that supports victim-survivors of image-based sexual abuse to ‘reclaim control’. It argues for a comprehensive, multi-layered, multi-institutional and multi-agency response, led by a government- and industry-funded online or e-safety organisation, which not only recognises the diversity of victim-survivor experiences and the intersection of image-based sexual abuse with other forms of sexual and gender-based violence and discrimination, but which also enables victim-survivors to reclaim control within and beyond the criminal justice system. (shrink)

Kevin T. Kelly, Cory Juhl and Clark Glymour. Reliability, Realism, and Relativism.

Drawing extensively on Bentham's unpublished civil and distributive law writings, classical and recent Bentham scholarship, and contemporary work in moral and political philosophy, Kelly here presents the first full-length exposition and sympathetic defense of Bentham's unique utilitarian theory of justice. Kelly shows how Bentham developed a moderate welfare-state liberal theory of justice with egalitarian leanings, the aim of which was to secure the material and political conditions of each citizen's pursuit of the good life in cooperation with each (...) other. A striking and original addition to the growing literature on Bentham's legal and political thought, this incisive study also makes a valuable contribution to contemporary political philosophy. (shrink)

We contribute to the literature on ethics in the professions by theorizing how global mobility precipitates professional insecurity and constrained moral agency. We present our findings of a study of accountants migrating to Canada. Using postcolonial theory and relational/poststructuralist theories of identity and ethics, we contrast the experiences of marginalized and privileged migrant accountants to show how those with “diverse” social identities are not recognized by professionals in Canada and must seek recognition from Canadian colleagues, employers, and clients to reconstitute (...) their professional identities and moral agency. We discuss the implications of the exclusion and marginalization of professionals for migrants, the profession, and society more generally. (shrink)

speaking there are only two sorts of opposition to be found here. One is the opposition between motion and rest, together with the opposition between ...

For decades, aesthetics has been subjected to a variety of critiques, often concerning its treatment of beauty or the autonomy of art. Collectively, these complaints have generated an anti-aesthetic stance prevalent in the contemporary art world. Yet if we examine the motivations for these critiques, Michael Kelly argues, we find theorists and artists hungering for a new kind of aesthetics, one better calibrated to contemporary art and its moral and political demands. Following an analysis of the work of Stanley (...) Cavell, Arthur Danto, Umberto Eco, Susan Sontag, and other philosophers of the 1960s who made aesthetics more responsive to contemporary art, Kelly considers Sontag's aesthetics in greater detail. In _On Photography_ (1977), she argues that a photograph of a person who is suffering only aestheticizes the suffering for the viewer's pleasure, yet she insists in _Regarding the Pain of Others_ (2003) that such a photograph can have a sustainable moral-political effect precisely because of its aesthetics. Kelly considers this dramatic change to be symptomatic of a cultural shift in our understanding of aesthetics, ethics, and politics. He discusses these issues in connection with Gerhard Richter's and Doris Salcedo's art, chosen because it is often identified with the anti-aesthetic, even though it is clearly aesthetic. Focusing first on Richter's Baader-Meinhof series, Kelly concludes with Salcedo's enactments of suffering caused by social injustice. Throughout _A Hunger for Aesthetics_, he reveals the place of critique in contemporary art, which, if we understand aesthetics as critique, confirms that it is integral to art. Meeting the demand for aesthetics voiced by many who participate in art, Kelly advocates for a critical aesthetics that confirms the limitless power of art. (shrink)

Evolving practice requires peer review of clinical ethics (CE) consultation for quality assessment and improvement. Many institutions have identified the chart note as the basis for this process, but to our knowledge, electronic health record (EHR) systems are not necessarily designed to easily include CE consultation notes. This article provides a framework for the inclusion of CE consultation notes into the formal EHR, describing a developed system in the Epic EHR that allows for the elaborated electronic notation of the CE (...) chart note. The implementation of the “meaningful use” criteria for EHR, mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, requires that health professionals meet certain standards for quality, efficiency, and safety, all of which overlap with the goals of standardization, peer review, and quality improvement within CE consultation. (shrink)

Kevin T. Kelly and Clark Glymour. Inductive Inference from Theory-Laden Data.

Applied ontologies have been used more and more frequently to enhance systems engineering. In this paper, we argue that adopting principles of ontological realism can increase the benefits that ontologies have already been shown to provide to the systems engineering process. Moreover, adopting Basic Formal Ontology (BFO), an ISO standard for top-level ontologies from which more domain specific ontologies are constructed, can lead to benefits in four distinct areas of systems engineering: (1) interoperability, (2) standardization, (3) testing, and (4) data (...) exploitation. Reaping these benefits in a model-based systems engineering (MBSE) context requires utilizing an ontology’s vocabulary when modeling systems and entities within those systems. If the chosen ontology abides by the principles of ontological realism, a semantic standard capable of uniting distinct domains, using BFO as a hub, can be leveraged to promote greater interoperability among systems. As interoperability and standardization increase, so does the ability to collect data during the testing and implementation of systems. These data can then be reasoned over by computational reasoners using the logical axioms within the ontology. This, in turn, generates new data that would have been impossible or too inefficient to generate without the aid of computational reasoners. (shrink)

A step-by-step guide to Foucault's History of Sexuality Volume I, The Will to KnowledgeIn the first volume of his History of Sexuality, The Will to Knowledge, Foucault weaves together the most influential theoretical account of sexuality since Freud. Mark Kelly systematically unpacks the intricacies of Foucault's dense and sometimes confusing exposition, in a straightforward way, putting it in its historical and theoretical context.This is both a guide for the reader new to the text and one that offers new insights (...) to those already familiar with Foucault's work. (shrink)

Background There are intense discussions about the ethical and societal implications of biomedical engineering, but little data to suggest how scientists think about the ethics of their work. The aim of this study is to describe how scientists frame the ethics of their research, with a focus on the field of molecular systems engineering.Methods Semi-structured qualitative interviews were conducted during 2021–2022, as part of a larger study. This analysis includes a broad question about how participants view ethics as related to (...) their work, with follow up probes about the topics they consider most important. Interviews were transcribed, inductively coded by two researchers to consensus, and analyzed thematically.Results Twenty-four scientists participated in the study. Interviewees hold positions as professors, principal investigators, and senior staff researchers in universities or research institutes in the United States and Europe. Among those scientists who reported reflecting on ethical considerations in their work, many equated ethics with research ethics topics (e.g., safety, replicability), or with regulation and guidelines. Participants expressed the view that ethical issues are primarily relevant for clinical trials of bioengineered products, or for those working with animal or human subjects. Scientists described their research as “too early” or “not examining anything living” with regard to ethical reflection. Finally, many felt that ethics is seen as territory for experts and therefore beyond scientists’ competencies.Conclusions Molecular systems engineering scientists currently focus on regulatory aspects as the framework for their ethical analyses. They describe using a framework to define when life arises, as a means to determine when further ethical engagement is warranted. Further research is needed to investigate how scientists relate to the ethics of their scientific work, and build consensus around concepts of life, autonomous behavior, and physiological relevance of bioengineered systems. (shrink)

This paper focuses on the centrality of permaculture design courses as the principal sociopolitical strategy of the permaculture community in Canada to transform local food production practices. Building on the work of Antonio Gramsci and political agroecology as a framework of analysis, we argue that permaculture instruction remains deeply embedded within market and colonial relations, which orients the pedagogy of permaculture trainings in such a way as to reproduce the basic elements of the colonial capitalist economy among its practitioners. In (...) the specific case of eastern Ontario, this embeddedness had the effect of diluting the transformative capacity of permaculture practitioners who were unable to create its own social movement organization. The paper then highlights key elements of the agroecological pedagogy used by the Brazilian Landless Rural Workers Movement and the Escola Latinoamericana de Agroecología in Paraná, Brazil. The objective is to draw lessons from these inspiring experiences, in a rather unique context of struggles that can help to critically assess the pedagogical practices and principles presently informing permaculture communities in Canada and in advanced industrialized countries more generally. We then conclude by reiterating the key arguments and lessons drawn from the Brazilian pedagogical experiences, pointing out the importance of engagement and coalition-building with established rural and urban movements, as well as progressive farmer, Indigenous, and rural associations to foster a just and sustainable transformation of agri-food systems, starting at the local and regional levels. It also emphasizes the need for the most marginalized sectors to lead the way towards an agroecological transition. (shrink)

This work discusses philosophical problems of perceptual content, the content of deomonstrative thoughts, and the unity of proposition. By demonstrating a connection between phenomenology and analysis, Kelly suggests ways in which they can be fruitfully pursued.

Drawing on the institutional history of the sperm bank and legacies of eugenics, we consider how spectrums of risk simultaneously constrain and expand possibilities for disability justice. We do so by examining the discourses surrounding US-based Xytex Corporation sperm bank Donor 9623, described as the ‘perfect’ donor but later discovered to have a criminal record and a diagnosis of schizophrenia. Haunted by the dread of disability, we examine how parents mark the fate of their donor-conceived child on a graded spectrum (...) of genetic and psychiatric risk, in need of perpetual monitoring and intervention. Using this case to understand the contemporary reorganization of disability via spectral risk, we advocate for a critical engagement with how disability haunting can enable us to better attend to the effects of the past and present in such a way that provokes a more collectively just future. (shrink)

Guanxi is essential to doing business in China. Even those who are minimally familiar with business in the People’s Republic seem to know this. How should Western business organizations look at guanxi? Further, if guanxi is seen as essential, what is the responsible approach to guanxi building? These questions may have different answers depending on one’s perspectives. First, what is guanxi?

Wexler and Sullivan (2023) recommend integration as a guiding principle for translational neuroethics. We agree that collaboration between neuroethicists and other professionals can advance the fie...

Interventional clinical studies of convalescent plasma to treat COVID-19 were predominantly funded and led by public sector actors, including blood services operators. We aimed to analyze the processes of clinical studies of convalescent plasma to understand alternatives to pharmaceutical industry biopharmaceutical research and development, particularly where public sector actors play a dominant role. We conducted a qualitative, critical case study of purposively sampled prominent and impactful clinical studies of convalescent plasma during 2020-2021.

Is there any justification for the common practice of allocating expensive medical resources to rescue a few from rare diseases, when those resources could be used to treat devastating diseases that affect the many? Does the use of Prozac and other anti-depressants make us inauthentic beings? Is it immoral and irrational to have children? What is the force of examples and counterexamples in bioethics? What are the relevance of moral intuition and the role of empirical evidence in bioethical argument? What (...) notion of “function” underlies accounts of the distinction between normality and disease and between therapy and enhancement? Is there an inherent conflict between research aimed at therapy and research aimed at gaining knowledge, such that the very notion of “therapeutic research” is an oxymoron? The twenty-one chapters in this volume strive, through the use of high quality argument and analysis, to get a good deal clearer concerning a range of issues _in _bioethics, and a range of issues_ about _bioethics. The essays are provocative, indeed, some quite radical and disturbing, as they call into question many common methodological and substantive assumptions in bioethics. (shrink)