Background In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents. Objective To discuss who can best protect a child9s interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership. Methods We describe the case of a 3-year-old boy with acquired (...) brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians. Conclusions Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team. (shrink)

Despite the widespread popularity of the Creating Shared Value discourse, its ‘business case’ and ‘win–win’ rhetoric remain problematic. This paper adds an inclusive development perspective to the debate, arguing that analysing CSV strategies through an inclusivity lens contributes to a better operationalisation of societal value; makes tensions and contradictions between economic and societal value explicit and uncovers processes of inclusion, exclusion and adverse inclusion. We illustrate this by analysing Nestlé’s CSV strategy in its cocoa supply chains in Ghana based on (...) content analysis of company documents, interviews with value chain actors and stakeholders, and focus groups with farmers. We ask how Nestlé frames and implements its CSV discourse in practice and how this relates to the social, relational and environmental dimensions of inclusive development. Findings show how the company addresses inclusive development dimensions in its corporate discourse, practices and business operations, and what trade-offs it faces. We then unmask the inherent tension between business objectives and societal interests and explain why the scope, issues addressed and societal impacts of CSV remain constrained. We conclude that CSV can help reduce a company’s impact on some persistent societal issues, but that its contribution to transformational change remains limited because the need to uphold competitive advantages and short-term financial performance narrows its ability to address all inclusivity dimensions. Legislation mandating responsible business conduct and due diligence can reduce this inherent tension by levelling the playing field between companies addressing inclusivity issues vis-à-vis those who do not. (shrink)

Patient-reported outcomes are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts and dispositions. We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. If influences of response (...) shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used. (shrink)

Until recently, moral case deliberation (MCD) sessions have mostly been facilitated by external experts, mainly professional ethicists. We have developed a train the facilitator programme for healthcare professionals aimed at providing them with the competences needed for being an MCD facilitator. In this paper, we present the first results of a study in which we evaluated the programme. We used a mixed methods design. One hundred and twenty trained healthcare professionals and five trainers from 16 training groups working in different (...) healthcare organisations throughout the Netherlands were included. After completion of the programme, participants feel sufficiently confident and equipped to facilitate an MCD session. Feeling competent does not mean that participants have no doubts or questions left. Rather, they are aware of their limitations and see the need for continuous learning. According to the respondents, the actual exercise of facilitating MCD during and in between the training sessions contributed most to the development of competences necessary for being an MCD facilitator. Respondents without prior experience of participating in MCD sessions felt less competent after the training than those who had participated in MCD sessions before. Self-attributed competence varied between participants with different professional backgrounds. (shrink)

Boorse’s biostatistical theory states that diseases should be defined in ways that reflect disturbances of biological function and that are objective and value free. We use three examples from contemporary medicine that demonstrate the complex issues that arise when defining the boundaries of disease: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction. We argue that the biostatistical theory fails to provide sufficient guidance on where the boundaries of disease should be drawn, contains ambiguities relating to choice of reference class, (...) and is out of step with medical processes for identifying disease boundaries. Although proponents of the biostatistical theory might regard these practical issues as irrelevant to the aim of providing a theoretical account of disease, we take them to indicate the need for a theoretical account that is adequate for current needs—including limiting new forms of medicalization that are driven by the identification of disease based on dysfunction. Our processes for determining the boundaries for disease need to recognize that there is no value-free method for making these decisions. (shrink)

Public education is not just a way to organise and fund education. It is also the expression of a particular ideal about education and of a particular way to conceive of the relationship between education and society. The ideal of public education sees education as an important dimension of the common good and as an important institution in securing the common good. The common good is never what individuals or particular groups want or desire, but always reaches beyond such particular (...) desires towards that which societies as a whole should consider as desirable. This does, of course, put the common good in tension with the desires of individuals and groups. Neo-liberal modes of governance have, over the past decades, put this particular educational set up under pressure and have, according to some, eroded the very idea of the common good. This set of contributions reflects on this state of affairs, partly through an exploration of the idea of publicness itself – how it can be rearticulated and regained – and partly through reflections on the current state of education in the ‘north’ and the ‘south.’. (shrink)

The aim of this study is to provide a discussion on the definitions and conceptual dimensions of Responsible Research and Innovation based on findings from the literature. In the study, the outcomes of a literature review of 235 RRI-related articles were presented. The articles were selected from the EBSCO and Google Scholar databases regarding the definitions and dimensions of RRI. The results of the study indicated that while administrative definitions were widely quoted in the reviewed literature, they were not substantially (...) further elaborated. Academic definitions were mostly derived from the institutional definitions; however, more empirical studies should be conducted in order to give a broader empirical basis to the development of the concept. In the current study, four distinct conceptual dimensions of RRI that appeared in the reviewed literature were brought out: inclusion, anticipation, responsiveness and reflexivity. Two emerging conceptual dimensions were also added: sustainability and care. (shrink)

Graphical AbstractSocial learning and culture occur in a wide variety of animal species and across many different types of community structures. In article number 1900060, Jenny A. Allen present an overview of social learning in species across a spectrum of community structures, providing the necessary infrastructure to allow a comparison of studies that will help move the field of animal culture forward. Art designer: Emma Hilton.

It has become increasingly clear that social learning and culture occur much more broadly, and in a wider variety of animal communities, than initially believed. Recent research has expanded the list to include insects, fishes, elephants, and cetaceans. Such diversity allows scientists to expand the scope of potential research questions, which can help form a more complete understanding of animal culture than any single species can provide on its own. It is crucial to understand how culture and social learning present (...) in different communities, as well as what influences community structure and culture may have on one another, so that the results across these different studies may most effectively inform one another. This review presents an overview of social learning in species across a spectrum of community structures, providing the necessary infrastructure to allow a comparison of studies that will help move the field of animal culture forward. (shrink)

This edition includes a new chapter on scepticism.

The early literature on base of the pyramid strategies argued that multinational enterprises can contribute significantly to poverty alleviation of the poorest population in the world. An emergent perspective suggests that the solution to poverty lies within the BOP itself. Here, entrepreneurship within the BOP population is seen as the more credible solution to poverty. In this Special Issue introduction, we briefly present how the literature has further shifted the discussion of BOP strategies toward issues such as innovation, networks, business (...) models, and sustainability at the BOP. This analysis signals a gap in our knowledge related to the success factors in business models of BOP entrepreneurs, with attention to economic, social, and environmental impacts. We present the five articles accepted for publication in this Special Issue, of which three contribute to our knowledge of BOP business models and two to our knowledge of sustainability at the BOP. In conclusion, we propose several avenues for future research. (shrink)

Our daily experience, dominated by the corporate clock that so many of us contort ourselves to fit inside, is destroying us. It wasn't built for people, it was built for profit. This is a book that tears open the seams of reality as we know it-the way we experience time itself-and rearranges it, reimagining a world not centered around work, the office clock, or the profit motive. Explaining how we got to the point where time became money, Odell offers us (...) new models to live by--inspired by pre-industrial cultures, ecological, and geological time--that make a more humane, more hopeful way of living seem possible. In this dazzling, subversive, and deeply hopeful reframing of time, Jenny Odell takes us on a journey through other temporal habitats. As planet-bound animals, we live inside shortening and lengthening days, alongside gardens growing, birds migrating, and cliffs eroding. The stretchy quality of waiting and desire, the way the present may suddenly feel marbled with childhood memory, the slow but sure procession of a pregnancy, or the time it takes to heal from injuries--physical or emotional. Odell urges us to become stewards of these different rhythms of life, to imagine a life, identity, and source of meaning outside of the world of work and profit, and to understand that the trajectory of our lives--or the life of the planet--is not a foregone conclusion. In that sense, "saving" time-recovering its fundamentally irreducible and inventive nature-could also mean that time saves us. (shrink)

Definition of the problemFeminist approaches to medical ethics are well established in international discourses. By contrast, in the German-speaking medical ethical discourse, they still seem to be rather marginal. In this article, we analyze which feminist perspectives are prominent in German medical ethics and suggest new approaches.ArgumentsWe present our results from a systematized review of the literature, in which we identify existing feminist approaches within the German-speaking medical ethics discourse as well as research gaps. Based on the review, our preliminary (...) research and discussions in the working group “Feminist perspectives in bio and medical ethics”, we defend three hypotheses aimed at advancing the German feminist medical ethical discourse. We posit that (1) feminist medical ethics aim at (epistemic) justice, (2) feminist medical ethics are critical and context-sensitive, and (3) intersectional and postcolonial approaches within feminist medical ethics may contribute to epistemically just, critical, and context-sensitive medical ethics.ConclusionWe argue that feminist perspectives should be implemented as a fundamental perspective in medical ethics because they can bring together key dimensions such as epistemically just, critical, context-sensitive, intersectional, and postcolonial thinking. (shrink)

Was passiert mit Universalsemantiken wie der Ästhetik oder der Ethik um 1900, als die deutsche Gesellschaft den Umbruch von einer stratifiktorischen hin zu einer funktionalen Differenzierungsform vollzieht? Die Studie diskutiert anhand von Ästhetiken damaliger Denkrichtungen die Denkfiguren, auf denen sich der Universalanspruch ästhetisch-moralischer Kommunikation aufbaut. Am Beispiel der Debatte um Schmutz und Schund zeigt sie, wie die meisten Diskutanten die >Rede über Kunst.

The Enlightenment commitment to reason naturally gave rise to a belief in the perfectibility of man. Influenced by John Locke and Jean-Jacques Rousseau, many eighteenth-century writers argued that the proper education and upbringing—breeding—could make any man a member of the cultural elite. Yet even in this egalitarian environment, the concept of breeding remained tied to theories of blood lineage, caste distinction, and biological difference. Turning to the works of Locke, Rousseau, Swift, Defoe, and other giants of the British Enlightenment, (...) class='Hi'>Jenny Davidson revives the debates that raged over the husbandry of human nature and highlights their critical impact on the development of eugenics, the emergence of fears about biological determinism, and the history of the language itself. Combining rich historical research with a keen sense of story, she links explanations for the physical resemblance between parents and children to larger arguments about culture and society and shows how the threads of this compelling conversation reveal the character of a century. A remarkable intellectual history, _Breeding_ not only recasts the fundamental concerns of the Enlightenment but also uncovers the seeds of thought that bloomed into contemporary notions of human perfectibility. (shrink)

In October 2022, the International Association of Bioethics announced that the 17th World Congress of Bioethics (WCB) 2024 would be held in Doha, Qatar. The International Network on Feminist Approaches to Bioethics (FAB) traditionally holds its World Congress jointly with the WCB. As part of the ongoing debate about the ethics of bioethics conferencing, the FAB provided a detailed statement discussing concerns about choosing Qatar as the site for a feminist bioethics conference. In order to explore possible approaches towards the (...) FABs decision, the German Feminist Perspectives in Medical Ethics and Bioethics working group (FME) dedicated one of its meetings to the topic. In this commentary, we present two aspects that we consider particularly important for this current debate: (1) the participation of LGBTQIA+ people in the conference and (2) the possibility of racist and anti-Muslim bias in the evaluation of Qatar as the site for the WCB 2024. As members of the FME, we aim to contribute to an exchange of various perspectives within the international feminist bioethics community. (shrink)

The coronavirus pandemic has stirred interest in viruses. This has been accompanied by a proliferation of popular works trying to explain how viruses fit into the Christian worldview. In an anthropocentric perspective, viruses are easily regarded as malicious entities. This article, however, shows that a proper understanding of the biology of viruses actually adds another level of complexity to our perception of good and evil. Interestingly, this additional layer of complexity might help us solve some of the most urgent difficulties (...) in the discussion about good and evil, if we recognize the subjective nature of what we call natural evil. We need to be more nuanced not merely in our theological discussion about good and evil, but also in the way we talk about viruses. (shrink)

In health care, the provision of pertinent information to patients is not just a moral imperative but also a legal obligation, often articulated through the lens of obtaining informed consent. Codes of medical ethics and many national laws mandate the disclosure of basic information about diagnosis, prognosis, and treatment alternatives. However, within publicly funded health care systems, other kinds of information might also be important to patients, such as insights into the health care priorities that underlie treatment offers made. While (...) conventional perspectives do not take this as an obligatory part of the information to be shared with patients, perhaps through viewing it as clinically “non-actionable,” we advocate for a paradigm shift. Our proposition diverges from the traditional emphasis on actionability. We contend that honoring patients as equal moral agents necessitates, among other principles, a commitment to honesty. Withholding specific categories of information pertinent to patients’ comprehension of their situation is inherently incompatible with this principle. In this article, we advocate for a recalibration of the burden of proof. Rather than requiring special justifications for adding to the standard set of information items, we suggest that physicians should be able to justify excluding relevant facts about the patient’s situation and the underlying considerations shaping health care professionals’ choices. This perspective prioritizes transparency and empowers patients with a comprehensive understanding, aligning with the ethos of respect for the patient as person. (shrink)

This paper explores the complex relationship between the meaning of predicates and the morphosyntactic expression of their arguments, as manifested in the swarm-class alternations in Czech. One way of getting at the nature of the alternations is to take a frame-semantic approach, which allows us to introduce the notion of scene as an important factor in linking relationships. It is proposed that linking patterns are organized in a network of generalized scene types, each of which represents a particular role configuration (...) structured in such a way that one of its roles can be singled out as the vantage point from which that event type is conventionally presented in a particular diathesis; the analysis argues for the notion of viewpoint as an event-structuring concept (distinct from discourse-based topicness) that is directly reflected in certain conventionalized linking patterns. The results of the investigation show that what may appear to be hard-to-predict variations in subject selection can be treated as instances of regular linking relations. (shrink)

Bioethics increasingly recognizes the impact of discriminatory practices based on social categories such as race, gender, sexual orientation or ability on clinical practice. Accordingly, major bioethics associations have stressed that identifying and countering structural discrimination in clinical ethics consultations is a professional obligation of clinical ethics consultants. Yet, it is still unclear how clinical ethics consultants can fulfill this obligation. More specifically, clinical ethics needs both theoretical tools to analyze and practical strategies to address structural discrimination within clinical ethics consultations. (...) Intersectionality, a concept developed in Black feminist scholarship, is increasingly considered in bioethical theory. It stresses how social structures and practices determine social positions of privilege and disadvantage in multiple, mutually co-constitutive systems of oppression. This article aims to investigate how intersectionality can contribute to addressing structural discrimination in clinical ethics consultations with a particular focus on mental healthcare. To this end, we critically review existing approaches for clinical ethics consultants to address structural racism in clinical ethics consultations and extend them by intersectional considerations. We argue that intersectionality is a suitable tool to address structural discrimination within clinical ethics consultations and show that it can be practically implemented in two complementary ways: 1) as an analytic approach and 2) as a critical practice. (shrink)

Bilateral investment treaties constitute an important instrument to facilitate global investment. Recent discussions in political theory have highlighted several normative concerns raised by bilateral investment treaties. One worry is that investment treaties undermine national self‐determination as they grant investors far‐reaching protections that can be legally enforced. Another worry is that the benefits and burdens entailed in bilateral investment treaties are distributed unfairly in a way that benefits investors at the expense of states and disadvantaged groups within states. Instead of critiquing (...) bilateral investment treaties from a perspective of global (distributive) justice, in this article I develop a class‐based critique. This involves a twofold departure. First, the article shifts the focus from distributions to the power relations that are built into the global capitalist economy and that come into sharp relief in the practice of global investment. Second, rather than focusing on the relation between states and investors, I claim that in a class‐based critique the relation between workers and investors should take centre stage. I argue that bilateral investment treaties are effectively an instrument of class domination, insofar as they reproduce and increase the power of transnational corporations while at the same time decreasing the power of workers. (shrink)

Braun explores the use of digital twin technology in medicine with a particular emphasis on the question of how such simulations can represent a person.1 In defining some first conditions for ethically justifiable forms of representation of digital twins, he argues that digital twins do not threaten an embodied person, as long as that person retains control over their simulated representation via dynamic consent, and ideally with the option to choose both form and usage of the simulation. His thoughtful elaboration (...) provides insight into the challenges inherent in interactions between a person and their digital twin, emphasising the modes of control required to respect personal modes of freedom. This individual-centric approach to the question of representation leaves out the important ethical consideration of ensuring that all, not merely some, can be represented. Braun describes dynamic consent as a necessary mode of control, arguing that where a person is unable to give consent, ‘such simulations threaten to become illegitimate representations. They would then shift the kind of interaction from representation to illegitimate forms of prediction or surveillance and thereby could lead to infringements to individual modes of freedom.’ Consequently, the implementation of digital twin technology in healthcare would seem to exclude the most vulnerable members of society from participation in and benefiting from medical innovation, …. (shrink)

Alexander of Aphrodisias's commentary (about AD 200) is the earliest extant commentary on Aristotle's Metaphysics, and it is the most valuable indirect witness to the Metaphysics text and its transmission. Mirjam Kotwick's study is a systematic investigation into the version of the Metaphysics that Alexander used when writing his commentary, and into the various ways his text, his commentary, and the texts transmitted through our manuscripts relate to one another. Through a careful analysis of lemmata, quotations, and Alexander's discussion (...) of Aristotle's argument Kotwick shows how to uncover and partly reconstruct a Metaphysics version from the second century AD. Kotwick then uses this version for improving the text that came down to us by the direct manuscript tradition and for finding solutions to some of the puzzles in this tradition. Through a side-by-side examination of Alexander's text, his interpretation of Aristotle's thought, and the directly transmitted versions of the Metaphysics, Kotwick reveals how Alexander's commentary may have influenced the text of our manuscripts at different stages of the transmission process. This study is the first book-length examination of a commentary as a witness to an ancient philosophical text. This blend of textual criticism and philosophical analysis both expands on existing methodologies in classical scholarship and develops new ones. (shrink)

The idea that acquired brain injury (ABI) caused by stroke, hemorrhage, infection or traumatic insult to the brain can result in post-traumatic growth (PTG) for individuals is increasingly attracting psychological attention. However, PTG also attracts controversy as a result of ambiguous empirical findings. The extent that demographic variables, injury factors, subjective beliefs, and psychological health are associated with PTG following ABI is not clear. Consequently, this systematic review and meta-analysis explores the correlates of variables within these four broad areas and (...) PTG. From a total of 744 published studies addressing PTG in people with ABI, eight studies met inclusion criteria for detailed examination. Meta-analysis of these studies indicated that growth was related to employment, longer education, subjective beliefs about change post-injury, relationship status, older age, longer time since injury, and lower levels of depression. Results from homogeneity analyses indicated significant inter-study heterogeneity across variables. There is general support for the idea that people with ABI can experience growth, and that various demographics, injury-related variables, subjective beliefs and psychological health are related to growth. The contribution of social integration and the forming of new identities post-ABI to the experience of PTG is explored. These meta-analytic findings are however constrained by methodological limitations prevalent in the literature. Clinical and research implications are discussed with specific reference to community and collective factors that enable PTG. (shrink)

Purpose – The aim of this paper is to lay out some of the more complex issues arising in the area of publication ethics. The impact of electronic publishing and electronic information is a main focus of the paper. Design/methodology/approach – The paper draws in particular upon the work of the Committee on Publication Ethics including illustrative cases discussed at the forum, guidelines and discussion documents. Findings – Three areas are highlighted to stimulate discussion around challenges of publication ethics in (...) the digital era. These are the role of the internet in facilitating misconduct, the issue of confidentiality in publishing and how incentives in research assessments drive author behavior. Originality/value – The paper brings together a variety of issues discussed under the broader umbrella of electronic information and new technologies in publishing. (shrink)

One famous debate in contemporary epistemology considers whether there is always one unique, epistemically rational way to respond to a given body of evidence. Generally speaking, answering “yes” to this question makes one a proponent of the Uniqueness thesis, while those who answer “no” are called “permissivists”. Another influential recent debate concerns whether non-truth-related factors can be the basis of epistemic justification, knowledge, or rational belief. Traditional theories answer “no”, and are therefore considered “purists”. However, more recently many theorists have (...) argued to the contrary, claiming that impurist factors, such as practical stakes, can sometimes encroach or even override truth-related considerations. This paper bridges the two debates by presenting and defending what I call “Impurist Permissivism”. I support Impurist Permissivism by showing how it can resist Roger White’s famous Argument from Arbitrariness (2005). (shrink)

In mental health ethics, it is generally assumed that coercive measures are sometimes justified when persons with mental illness endanger themselves or others. Coercive measures are regarded as ethically justified only when certain criteria are fulfilled: for example, the intervention must be proportional in relation to the potential harm. In this paper, we demonstrate shortcomings of this established ethical framework in cases where people with mental illness experience structural racism. By drawing on a case example from mental healthcare, we first (...) demonstrate that biases in assessing whether the coercive intervention is proportional are likely, for example, due to an overestimation of dangerousness. We then show that even if proportionality is assessed correctly, and the specific coercive intervention would thus be regarded as ethically justified according to the standard framework, coercion may still be ethically problematic. This is because the standard framework does not consider how situations in which coercive measures are applied arise. If structural racism causally contributes to such situations, the use of coercion can compound the prior injustice of racist discrimination. We conclude that the ethical analysis of coercion in mental healthcare should consider the possibility of discriminatory biases and practices and systematically take the influence of structural discrimination into account. (shrink)

In this essay, I argue that to create a genomics that offers more gifts than weights, central attention must be paid to questions of justice. This will require expanding bioethical imaginations so that they grasp and can respond to questions of structural inequity. It will necessitate building novel coalitions and collaborations that turn the attention of bioethical governance away from narrow individual questions such as, “Do I consent?” and toward the broader collective question, is this just? What kind of lives (...) and collectivities are made possible? What rights and principles should govern them? The essay ends with one example of this novel coalition building arising from the Science and Justice Research Center at the University of California, Santa Cruz. It draws lessons from this effort to build new alliances that bridge the social sciences and natural sciences, arts and engineering, to create new kinds of training and thinking that create a genomics that more adequately responds to fundamental questions of justice. (shrink)

Emerging from the internationally recognised Theorising Normalcy and the Mundane conference series, the chapters in this book offer wide-ranging critiques of that most pervasive of ideas, 'normal'. In particular, they explore the precarious positions we are presented with and, more often than not, forced into by 'normal', and its operating system, 'normalcy' (Davis, 2010). They are written by activists, students, practitioners and academics and offer related but diverse approaches. Importantly, however, the chapters also ask, what if increasingly precarious encounters with, (...) and positions of, marginality and non-normativity offers us a chance (perhaps the chance) to critically explore the possibilities of 'imagining otherwise'? The book questions the privileged position of 'non-normativity'; in youth and unpacks the expectation of the 'normal' student in both higher and primary education. It uses the position of transable people to push the boundaries of 'disability', interrogates the psycho-emotional disablism of box-ticking bureaucracy and spotlights the 'urge to know' impairment. It draws on cross-movement and cross-disciplinary work around disability to explore topics as diverse as drug use, The Bible and relational autonomy. Finally, and perhaps most controversially, it explores the benefits of (re)instating 'normal'. By paying attention to the opportunities presented amongst the fissures of critique and defiance, this book offers new applications and perspectives for thinking through the most ordinary of ideas, 'normal'. (shrink)

Philosophy: a Beginner's Guide is unique in its approach to introducing philosophy. Its succinct and self-contained chapters make this jargon-free text accessible to people who have had little or no previous contact with philosophy.

A direct and wide-ranging introduction to the main themes and problems of philosophy as it is taught in the anglo-american tradition. An ideal primer for beginning undergraduates.