The clinical ethics literature is striking for the absence of an important genre of scholarship that is common to the literature of clinical medicine: systematic reviews. As a consequence, the field of clinical ethics lacks the internal, corrective effect of review articles that are designed to reduce potential bias. This article inaugurates a new section of the annual "Clinical Ethics" issue of the Journal of Medicine and Philosophy on systematic reviews. Using recently articulated standards for argument-based normative ethics, we provide (...) a systematic review of the literature on concealed medication for the management of psychiatric disorders. Four steps are completed: identify a focused question; conduct a literature search using key terms relevant to the focused question; assess the adequacy of the argument-based methods of the papers identified; and identify conclusions drawn in each paper and whether they apply to the focused question. We identified seven papers and provide an assessment of them. While none of the papers fully meet the standards of argument-based ethics, they did provide rationales for the use of concealed medications, with the important requirement such a practice be accountable in explicit organizational policy to prevent abuse of patients with mental illness or dementia. (shrink)

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III clinical trials (...) to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

Despite its prominence in the abortion debate and in public policy, the discourse of 'unborn patient' has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of 'unborn child.' There is a long history of the descriptive use of 'unborn child.' Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion (...) want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of 'unborn child' should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

Volume 20, Issue 3, March 2020, Page 65-68.

"Alternative Selves" and Authority in the Fiction of Jane Urquhart The article engages with "alternative selves," a concept found in The Stone Carvers by a Canadian writer, Jane Urquhart. Her fiction is first seen in the context of selected texts by Lucy Maud Montgomery, Margaret Laurence and Alice Munro, who explore the clash between female characters' conventional roles and their "secret" selves. My analysis was inspired by Pamela Sue Anderson's A Feminist Philosophy of Religion, which stresses the need for (...) "reinventing ourselves as other" in the face of biased beliefs and dominant epistemology. In particular, my article refers to Anderson's concern with Kant's imaginary from The Critique of Pure Reason, where "the territory of pure understanding" is projected on the island, while desire, chaos and death are identified with the sea. Seen through the prism of a feminist reading of the philosophical imaginary, the sea becomes the female beyond. Urquhart's three novels: Away, The Stone Carvers and A Map of Glass dissolve the opposition between Kantian island and water, by showing how reason is invaded by desire and death, and how the female protagonist embodies the elements that have been repressed. Urquhart's fiction, which is "landscape driven," provides the image of a dynamic relationship between the qualities that form a static binary opposition in Kantian discourse. Mary in Away, Klara in The Stone Carvers and Sylvia in A Map of Glass all subvert the dominant epistemology by following their desire, which becomes "a positive energy" and not "a deviation from a good rational norm," to refer to another concept by Anderson. Urquhart's Mary, Klara and Sylvia have to contend with power vested in collective beliefs and stereotypical construction of femininity. By venturing into the liminal zone beyond the territory of "pure understanding," the three protagonists regain their voices and discover their authority. The article ends with the analysis of a Homeric intertext in A Map of Glass, where Sylvia identifies with Odysseus "lashed to mast" so that he would not respond to the call of the siren song. Reading Homer's passage on the siren song, one realizes that the use of the Kantian imaginary turns Ithaca into the island of truth, and the sea into the stormy beyond, identified with desire, death and femaleness. While the Odyssey suppresses the dangerous message of the siren song, Urquhart's fiction rewrites it and reclaims it as positive inspiration for the female protagonist. (shrink)

Managed care employs two business tools of managed practice that raise important ethical issues: paying physicians in ways that impose conflicts of interest on them; and regulating physicians' clinical judgment, decision making, and behavior. The literature on the clinical ethics of managed care has begun to develop rapidly in the past several years. Professional organizations of physicians have made important contributions to this literature. The statements on ethical issues in managed care of four such organizations are considered here, the American (...) Medical Association, the American College of Physicians, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics. Three themes common to these statements are identified and critically assessed: the primacy of meeting the medical needs of each individual patient; disclosure of conflicts of interest in how physicians are paid; and opposition to gag orders. The paper concludes with an argument for a basic concept in the clinical ethics of managed care: physicians and institutions as economically disciplined moral co-fiduciaries of populations of patients. (shrink)

Physicians make some medical decisions without disclosure to their patients. Nondisclosure is possible because these are silent decisions to refrain from screening, diagnostic or therapeutic interventions. Nondisclosure is ethically permissible when the usual presumption that the patient should be involved in decisions is defeated by considerations of clinical utility or patient emotional and physical well-being. Some silent decisions - not all - are ethically justified by this standard. Justified silent decisions are typically dependent on the physician's professional judgment, experience and (...) knowledge, and are not likely to be changed by patient preferences. We condemn the inappropriate exclusion of the patient from the decision-making process. However, if a test or treatment is unlikely to yield a net benefit, disclosure and discussion are at times unnecessary. Appropriate silent decisions are ethically justified by such considerations as patient benefit or economy of time. (shrink)

La présente contribution propose une étude de la périphérie gauche au sein d’un corpus oral multigenres, représentant douze activités de communication orale, annoté syntaxiquement et prosodiquement. La segmentation discursive du corpus en unités de base du discours (BDU) résulte d’une coïncidence entre unités syntaxiques et prosodiques, correspondant à des encodages linguistiques distincts mais complémentaires. Partant du postulat selon lequel ces unités discursives remplissent une fonction cognitive dans la planification et l’interprétation du discours, nous nous intéressons à l’étude de leur périphérie (...) gauche. Ce lieu, qui constitue le point d’ancrage du message, joue en effet un rôle important dans la négociation de la structure discursive. Dans l’objectif d’étudier les stratégies discursives à l’œuvre dans les différents genres du corpus, nous faisons l’inventaire des types formels observés et étudions finalement les fonctions discursives que ces éléments périphériques peuvent revêtir. (shrink)

This book examines the negative power that child maltreatment has on individuals and society ethically and politically, while analyzing the positive power that parental love and healthy families have. To address how best to confront the problem of child maltreatment, it examines several policy options, ultimately defending a policy of licensing parents, while carefully examining the tension between child and adult rights and duties.

Published to commemorate the centennial of the publication of Darwin's "Origin of Species", this volume brings together several important essays on the history of the idea of evolution. Included are discussions of Maupertuis, Buffon, Diderot, Kant, Herder, Lamarck, and Schopenhauer by such leading scholars as Arthur O. Lovejoy, Bentley Glass, Owsei Temkin, C. C. Gillispie, Francis C. Haber, and Jane Oppenheimer.

Aristotelianism remained the dominant influence on the course of natural philosophy taught at the University of Paris until the 1690s, when it was swiftly replaced by Cartesianism. The change was not one wanted by church or state and it can only be understood by developments within the wider University. On the one hand, the opening of a new college, the Collège de Mazarin, provided an environment in which the mechanical philosophy could flourish. On the other, divisions within the French Catholic (...) Church between Austinians and Molinists led to Cartesianism finding support within an important section of the faculty of theology, which was the traditional guardian of philosophical orthodoxy. The conversion of the University of Paris to Cartesianism had important consequences. It encouraged similar changes to the natural philosophical curriculum throughout France and affected the structure and raison d'être of the Académie des Sciences. (shrink)

Many assumptions are made about public willingness to participate in epidemiological research, yet few empirical studies have been conducted to ascertain whether such assumptions are correct. Our qualitative study of the public and of expert stakeholders leads us to suggest that people are generally prepared to participate in epidemiological research, particularly if it is conducted by a trusted public institution such as a government health department, charity, or university. However, there is widespread community distrust of research conducted or sponsored by (...) pharmaceutical companies. Individuals are prompted to take part if the study concerns an illness they or a family member or friend have personally experienced or if they believe the research will confer a widespread public benefit. Preferences vary about the mode of contact for the research to be conducted. Willingness to participate in telephone surveys has decreased in recent years, and this may be a consequence of an increase in calls to homes by telemarketers and market researchers. Participants also stressed the importance of knowing where their names and contact details were sourced and suggested that this information be available to prospective study participants as a matter of course in the first approach or letter. We provide valuable information to epidemiologists in designing studies. (shrink)

This article comments on the treatment of critical-care ethics in four preceding articles about critical-care medicine and its ethical challenges in mainland China, Hong Kong, Japan, and the Philippines. These articles show how cultural values can be in both synchrony and conflict in generating these ethical challenges and in the constraints that they place on the response of critical-care ethics to them. To prevent ethical conflict in critical care the author proposes a two-step approach to the ethical jus tification of (...) critical-care management: (1) the decision to resuscitate and initiate critical-care management, which is based on the obligation to prevent imminent mortality without permanent loss of consciousness; and (2) the decision to continue critical-care management, which is based on the obligation both to prevent imminent death without permanent loss of consciousness and to avoid unnecessary, significant iatrogenic costs to the patient and psychosocial costs to the family when the reduction of morta lity risk is marginal. Physicians and hospitals should restore the critical-care physician's authority and power - against prevailing cultural values, if necessary - to control when critical-care intervention is offered, when it is recommended to continue, and when it is recommended to be discontinued and the patient allowed to die. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bioethics in the Twenty-First Century: Why We Should Pay Attention to Eighteenth-Century Medical EthicsLaurence B. McCullough (bio)Those of us who work in the field of bioethics tend to think that, because the word “bioethics” is new, so too the field is new in all respects, but we are not the first to do bioethics. John Gregory (1724–1773) did bioethics just as we do it, at least two centuries before (...) we thought to do it (Gregory 1772). He deployed philosophical methods as sophisticated as our own. Indeed, Gregory took up the very best moral philosophy available to thinkers of the Scottish Enlightenment, namely, David Hume’s moral philosophy and its core concept of sympathy. Gregory also responded in a conceptually powerful and clinically applicable way to the problems of his time, just as we do. I want here to outline Gregory’s accomplishment and to identify some aspects of its importance for bioethics in the twenty-first century.Gregory’s “Problem List”Gregory wrote his medical ethics as a response to the then current state of medicine in Britain. We now follow Gregory in our writing of bioethics and clinical ethics in response to the problems of our time. A great deal that we now take for granted did not then exist. 1There was not, as there is now, any uniform pathway into medicine. Nor did there exist universal licensure. The Royal Colleges did attempt to assert, but failed to achieve, monopoly control of medical practice. The concepts of health and disease were themselves contested and therefore competed for their success in the market place. There was a marked oversupply of practitioners who competed fiercely—very fiercely indeed—in the medical market place for their concepts of health and disease, their treatments, and therefore their livelihoods. Patients had their own concepts of health and disease, engaged in “self-physicking” or self-care, and often traded physician’s prescriptions.Medicine exhibited little scientific discipline in its accounts of disease and in determining the efficacy of treatments, a fact that Gregory (1743) laments as a [End Page 329] medical student. There was no marked improvement when he began to give his medical ethics lectures nearly a quarter of a century later. Treatments failed as often, perhaps more often, than they succeeded in benefiting patients. The sick usually sought out the help of a physician after trying self-physicking.Physicians, Gregory taught, could not hope to control human biology, though they could aim to manage its processes well. When nature underresponds to disease the physician should assist her processes; when nature overresponds, the physician should tamp down nature’s responses, to lessen their “violence”—in both cases always attentive to the limits of medicine’s capacities in treating disease.Physicians attended the well-to-do sick at home, and the sick person summoned and dismissed physicians, surgeons, or apothecaries at will. A physician therefore might find himself—no women had yet been admitted to the ranks of university-trained physicians—summoned before, after, or simultaneously with a competitor, with his concepts and diagnosis and treatment put to the acid test. In this setting, there existed only a patient-physician relationship, not a physician-patient relationship.Physicians left off the care of dying patients, a practice that was made a matter of duty by Friederich Hoffmann (1749). One would suffer punishing economic consequences if one had a high mortality rate. Better, then, to label the patient incurable, withdraw, and turn matters over to clergy. Gregory attacks this practice as intellectual fraud and calls for the physician to continue to attend the dying. Indeed, he says, “It is as much the business of a physician to alleviate pain, and to smooth the avenues of death, when unavoidable, as to cure diseases” (Gregory 1772, p. 35). He does not explicitly address what we now call physician-assisted suicide; neither does he condemn it, and he is quick to condemn some things—e.g., sexual abuse of female patients or “sporting” with patients in the Royal Infirmary by using experiments as the first line of treatment.The Royal Infirmary was established to care for the deserving, working poor, who received free care... (shrink)

La science du bien et du mal n'a jamais existé, et si Platon s'en désolait, nous avons cessé, nous, les Modernes, de nous en offusquer. Et pourtant, des questions d'ordre éthique nous sont incessamment posées aujourd'hui, ni plus ni moins que par le passé: quelles valeurs morales devons-nous promouvoir à l'école? Est-il acceptable d'abandonner à leur sort les familles de migrants fuyant la guerre? Notre pays, la France, doit-il intervenir militairement contre tel ou tel État dit "terroriste"?, etc. Face à (...) de telles interrogations, nous ne pouvons nous contenter de suspendre notre jugement sous couvert de relativisme ("À chacun sa conception du bien et du mal"). Prenant appui sur les réflexions de grands philosophes et théologiens face au défi du mal, tout en interrogeant la montée de nouvelles formes de violences au XXIe siècle, Laurence Hansen-Love pose la question: le bien et le mal sont-ils vraiment des notions obsolètes? Une fois récusée la fausse évidence d'une symétrie entre le bien et le mal, il est possible de prendre acte de la préséance du mal sur le bien. Dès lors, la certitude du mal, posée comme un fait, cesse de contredire l'incertitude du bien, à laquelle il apparaît sage de se résoudre."--Page 4 of cover. (shrink)

La planète est exténuée. L'humanité dans son ensemble traverse une mauvaise passe. A tel point que certains chercheurs professent l'effondrement, voire la fin de notre civilisation. Ces lanceurs d'alerte cosmique ne sont pas de simples illuminés. Ils comptent parmi eux des intellectuels de renom et des savants influents. Dans le même état d'esprit, des ingénieurs futuristes, anticipant une évolution qu'ils jugent inéluctable, programment le remplacement de notre espèce par des créatures hybrides d'un nouveau genre, humains augmentés ou améliorés. Demain, assurent-ils, (...) la "Singularité" assurera la relève du genre humain. L'ère du posthumanisme serait déjà entamée. Faut-il s'en féliciter? Laurence Hansen-Love expose ici les tenants et les aboutissants d'un débat qui nous concerne tous et dont les enjeux sont vertigineux. (shrink)

Connaissons-nous l'enfant? Au sortir du " siècle de l'enfant ", la différence de l'enfance ne cesse de nous interroger. Si l'exigence de penser l'enfance à nouveau est aujourd'hui partagée, les voies de cette entreprise, et plus précisément les problématiques au sein desquelles elle s'impose, sont diverses et mouvantes, à l'image du monde dont héritent ceux que Hannah Arendt appelait " les nouveaux-venus ". Emergent toutefois du foisonnement des pensées de l'enfance quelques paradigmes que l'ouvrage se propose de rendre visibles. Le (...) paradigme démocratique inscrit la question de l'enfance dans la dynamique égalitaire des sociétés démocratiques, et dans l'inéluctable effacement de la différence enfant/adulte auquel les conduit leur " passion de l'égalité ". Le développement de la " philosophie pour enfants " relève-t-il de cette passion de l'égalité? La figure de " l'enfant philosophe " participe-t-elle de cet effacement? Assurément son émergence au cours des vingt dernières années constitue l'un des faits marquants d'une histoire commune à l'enfance et à la philosophie. Que dire alors de la figure de l'enfant artiste, de l'enfance saisie dans sa proximité avec l'artiste? Elle participe d'une tentative de penser l'enfance autrement, d'une pensée esthétique de l'enfance alliant l'héritage schillérien des Lettres sur l'éducation esthétique de l'humanité aux tentations d'une pensée poétique de l'enfance. Que devient alors, dans cette pensée de l'enfance bousculée, cette autre figure qui ne cesse d'accompagner l'enfance, du moins depuis qu'on la pense comme éducable, la figure du pédagogue? Voilà peut-être l'un des points de résistance aux bouleversements postmodernes : l'impossibilité d'une connaissance de l'enfance qui n'en passe pas par l'éducation de l'enfance. Le point de vue paradigmatique n'épuise toutefois pas la question. Par-delà les paradigmes qui tentent de la saisir, quelque chose de l'enfance ne cesse de se dérober. (shrink)

À partir des résultats d’une recherche qualitative et participative ayant impliqué des personnes qui vivent avec un problème de santé mentale, des intervenants et des gestionnaires de milieux de pratique en santé mentale et visant à explorer les représentations d’une intégration sociale jugée réussie, cet article propose une analyse et une réflexion sur les conditions de possibilité d’une société suffisamment bonne et inclusive pour les personnes vivant avec un problème de santé mentale. L’élargissement du prisme de la reconnaissance sociale s’est (...) dégagé comme une condition essentielle à cet égard qui, elle-même, implique certaines conditions, avec en particulier un travail de reconnaissance de la différence en tant que telle et la mise à distance d’une logique d’utilité. (shrink)

A funny, touching look at the life of a social media influencer who starts to question the #goals life she has created for herself. Every day, Élie motivates her hundreds of thousands of followers to become the best versions of themselves by posting videos of exercise routines and high-protein breakfast recipes. Far from the shy teenager that she was, she is now in a very public relationship with singer Samuel Vanasse, and together they have become one of the most popular (...) influencer couples in the country. She has succeeded. She shines. And yet, Élie worries that her life is not as flawless as she makes it seem on YouTube and Instagram. Between her obsession with the "ideal weight," her growing attraction to another man, her family's disdain for her career as a content creator and a collaboration with another influencer who Élie can't stand, a thought haunts her. What if, by trying to become everything she wanted to be, she's lost herself along the way? Suck it In and Smile is an intimate exploration of our obsession with appearances and the hypocrisies that appear when you must craft the perfect online life. (shrink)

Troisième volet du programme 'Le problème de la réappropriation par la philosophie des discours de savoirs antérieurs,' ce volume entend examiner les citations directes ou indirectes de Platon, non seulement aux poètes archaïques et classiques, mais également aux autres discours de savoir non philosophiques afin de prendre la mesure des ressemblances et des écarts entre la 'source' et l'usage qui en est fait ; de tenir compte du contexte pragmatique d'énonciation et du cadre argumentatif dans lesquels s'insèrent ces 'citations' ; (...) de mesurer ainsi l'intérêt que ces savoirs ont pu susciter, les dangers qu'ils ont pu représenter - notamment en termes de concurrence, les réappropriations et/ou les distorsions dont ils ont été l'objet."--Page 4 of cover. (shrink)

The essays in this volume explore in detail many of the ways power structures our daily personal, political and intellectual lives, and evaluate the workings of power using a variety of theoretical paradigms, from Hobbesian liberalism to Foucauldian feminist postmodernism. Taken as a whole, the book aims towards an end to unjust and destructive uses of power and the flowering of an encouraging, educated empowerment for all human beings in a pluralistic world. Section I offers a progressive chain of arguments (...) that moves from the acceptance of domination, through the rejection of domination and, finally, to a new vision of power based on equality and mutual respect. Section II explores the questions, how is the philosophical self, that is, our very understanding of who we are, implicated in the web of power and domination? Section III responds to political realism as it explores morally ideal solutions to the global problems of poverty, war and hunger. Section IV discusses ways in which our thought and practice in both public and private life are bound up in hierarchies of domination. (shrink)

This essay examines several ethical and epistemological issues that arise when philosophers conduct empirical research focused on, or in collaboration with, community groups seeking to bring about systemic change. This type of research can yield important policy lessons about effective community-driven reform and how to incorporate the voices of marginalized citizens in public policy debates. Community-based reform efforts are also particularly ripe for philosophical analysis since they can demonstrate the strengths and shortcomings of democratic and egalitarian ideals. This type of (...) research also raises unique ethical dilemmas that challenge central tenets of research ethics. We focus on two foundational questions: What does informed consent mean in the context of community-based research when CBR may dissolve differences between researcher and research participant, and its parameters can be hard to delineate? And what ethical, democratic, and epistemic issues arise when conducting research with and on community groups, given potentially competing commitments to respect the epistemological contributions of all participants while also meeting research norms to warrant findings and conclusions? Our examination has two aspects: we grapple with these issues through examples from our work to reveal their significance in our own philosophic practice, and more broadly, to reveal their significance as problems within traditional research ethics. We believe that this approach will demonstrate the utility of philosophic engagement with dilemmas in research ethics as a reflective matter, and in the course of empirical research itself. (shrink)

This book offers original readings of classic and contemporary black texts, highlighting the pain of racism and love-based strategies of antiracist resistance. Kathy Glass gives sustained attention to the impact of racist affect on the black body and how black women writers deploy emotional states to move readers to progressive political action.

After a short introduction, this article contains the text of a previously unpublished interview with Raymond Aron in which he discusses what he takes to be the significance and continuing importance, if any, of the French Revolution. In the course of the interview Aron discusses different interpretations of the Revolution. The interview took place in February 1983.

Cet article de présentation concerne deux notions, l’anaphore et les pronoms, dont nous examinons d’abord successivement l’état actuel des connaissances et des problématiques afférentes. Pour chaque notion, nous présentons aussi des éléments complémentaires issus de l’examen d’un corpus commun en anglais par des chercheurs qui évoluent dans des approches différentes, éléments que nous mettons en dialogue. La dernière partie de l’article vise à mettre en évidence la contribution que peut appor...

" Depuis une trentaine d'années, les historiens s'intéressent aux cadres mentaux des hommes d'antan, à leurs visions du monde, de soi et des autres, à leurs opinions, à leurs motivations. Mais quel est l'enjeu de ce type d'histoire? Quel sens cela a-t-il, par rapport à quel projet historien? Qu'est-ce que cela implique en terme de pratique historienne? Quelles en sont les limites, voire les dérives? " L'élargissement du champ de la recherche historique fait de plus en plus appel à des (...) concepts interdisciplinaires eux-mêmes en pleine évolution et suscite de nombreuses interrogations épistémologiques et méthodologiques, parfois déroutantes pour de jeunes étudiants et chercheurs. A partir des conflits contemporains, fil conducteur de ce manuel inédit, les auteurs abordent des concepts nécessaires à l'histoire culturelle. Ils espèrent ainsi susciter auprès des jeunes générations d'historiens, le goût de la réflexion, de la découverte, de l'utilisation constructive des savoirs afin d'inventer de nouveaux horizons. (shrink)