Discrimination and inequalities in healthcare can be experienced by many patients due to many characteristics ranging from the obviously visible to the more subtly noticeable, such as race and ethnicity, legal status, social class, linguistic fluency, health literacy, age, gender and weight. Discrimination can take a number of forms including overt racist statement, stereotyping or explicit and implicit attitudes and biases. This paper presents the case study of a complex transcultural clinical encounter between the mother of a young infant in (...) a highly vulnerable social situation and a hospital healthcare team. In this clinical setting, both parties experienced difficulties, generating explicit and implicit negative attitudes that heightened into reciprocal mistrust, conflict and distress. The different factors influencing their conscious and unconscious biases will be analysed and discussed to offer understanding of the complicated nature of human interactions when faced with vulnerability in clinical practice. This case vignette also illustrates how, even in institutions with long-standing experience and many internal resources to address diversity and vulnerability, cultural competence remains a constant challenge. (shrink)

Discrimination and inequalities in healthcare can be experienced by many patients due to many characteristics ranging from the obviously visible to the more subtly noticeable, such as race and ethnicity, legal status, social class, linguistic fluency, health literacy, age, gender and weight. Discrimination can take a number of forms including overt racist statement, stereotyping or explicit and implicit attitudes and biases. This paper presents the case study of a complex transcultural clinical encounter between the mother of a young infant in (...) a highly vulnerable social situation and a hospital healthcare team. In this clinical setting, both parties experienced difficulties, generating explicit and implicit negative attitudes that heightened into reciprocal mistrust, conflict and distress. The different factors influencing their conscious and unconscious biases will be analysed and discussed to offer understanding of the complicated nature of human interactions when faced with vulnerability in clinical practice. This case vignette also illustrates how, even in institutions with long-standing experience and many internal resources to address diversity and vulnerability, cultural competence remains a constant challenge. (shrink)

Controlled human malaria infection (CHMI) studies involve the deliberate infection of healthy volunteers with malaria parasites under controlled conditions to study immune responses and/or test drug or vaccine efficacy. An empirical ethics study was embedded in a CHMI study at a Kenyan research programme to explore stakeholders’ perceptions and experiences of deliberate infection and moral implications of these. Data for this qualitative study were collected through focus group discussions, in‐depth interviews and non‐participant observation. Sixty‐nine participants were involved, including CHMI study (...) volunteers, community representatives and research staff. Data were managed using QSR Nvivo 10 and analysed using an inductive‐deductive approach, guided by ethics literature. CHMI volunteers had reasonable understanding of the study procedures. Decisions to join were influenced by study incentives, trust in the research institution, their assessment of associated burdens and motivation to support malaria vaccine development. However, deliberate malaria infection was a highly unusual research strategy for volunteers, community representatives and some study staff. Volunteers’ experiences of physical, emotional and social burdens or harms were often greater than anticipated initially, and fluctuated over time, related to specific procedures and events. Although unlikely to deter volunteers' participation in similar studies in furture, we argue that the dissonance between level of understanding of the burdens involved and actual experiences are morally relevant in relation to community engagement, informed consent processes, and ongoing support for volunteers and research staff. We further argue that ethics oversight of CHMI studies should take account of these issues in deciding whether consent, engagement and the balance of benefits and harms are reasonable in a given context. (shrink)

Human Infection Studies have emerged as an important research approach with the potential to fast track the global development of vaccines and treatments for infectious diseases, including in low resource settings. Given the high level of burdens involved in many HIS, particularly prolonged residency and biological sampling requirements, it can be challenging to identify levels of study payments that provide adequate compensation but avoid ‘undue’ levels of inducement to participate. Through this embedded ethics study, involving 97 healthy volunteers and other (...) research stakeholders in a malaria HIS programme in Kenya, and using in-depth interviews, focus group discussions and observations during and after a malaria HIS, we give a grounded account of ethical issues emerging in relation to study payments in this setting. While careful community, national, international scientific and ethics review processes meant that risks of serious harm were highly unlikely, the levels of motivation to join HIS seen could raise concerns about study payments being too high. Particular value was placed on the reliability, rather than level, of study payment in this setting, where subsistence livelihoods are common. Study volunteers were generally clear about the study aims at the point of recruitment, and this knowledge was retained over a year later, although most reported experiencing more burdens than anticipated at enrolment. Strict study screening procedures, regular clinical and laboratory monitoring of volunteers, with prompt treatment with antimalarial at predetermined endpoints suggested that the risks of serious harm were highly unlikely. Ethical concerns emerged in relation to volunteers’ attempts to conceal symptoms, hoping to prolong residency periods and increase study payments; and volunteers making decisions that compromised important family relationships and personal values. Our findings support an interpretation that, although study volunteers were keen to join the study to access cash payments, they also paid attention to other features of the study and the general clinical research landscape, including levels of risk associated with study participation. Overall, our analysis shows that the ethical concerns emerging from the study payments can be addressed through practical measures, hinged on reducing burdens and strengthening communication, raising important issues for research policy and planning. (shrink)

Irene Alexander’s article in last spring’s issue of this journal criticizes the new natural law account of sexual ethics, including Melissa Moschella’s defense of that view in a previous article also in this journal. Alexander claims that the NNL account adopts an empiricist view of nature and that NNL’s rejection of the perverted faculty argument is contrary to the Magisterium. Here Moschella responds to Alexander’s criticisms by clarifying NNL theorists’ understanding of the distinction between speculative and practical reason through an (...) explanation of Aquinas’s account of the four orders, correcting Alexander’s erroneous portrayal of NNL arguments against contraception, and arguing that the NNL account of sexual ethics is not only in line with magisterial teaching, but offers a better philosophical defense of that teaching than the view Alexander proposes. (shrink)

Written by two of the leading figures in the field, this is a lucid and systematic introduction to semantics as applied to transformational grammars of the ...

On a version of consent theory that tempts many, predatory sexual relations involving significant power imbalances (e.g. between professors and students, adults and teenagers, or employers and employees) are wrong because they violate consent-centric norms. In particular, the wronged party is said to have been _incapable_ of consenting to the predation, and the sexual wrong is located in the encounter’s nonconsensuality. Although we agree that these are sexual wrongs, we resist the idea that they are always nonconsensual. We argue instead (...) that it is possible for students, teenagers, employees, etc. to fully consent to sexually predatory encounters; denying as much renders survivors of predation vulnerable to compounding harms. Survivors face a dilemma: give up either their understanding of their experience as wrong, or their self-conception as an agent capable of consenting. We call the latter phenomenon _agential demotion_. (shrink)

Competition among scientists for funding, positions and prestige, among other things, is often seen as a salutary driving force in U.S. science. Its effects on scientists, their work and their relationships are seldom considered. Focus-group discussions with 51 mid- and early-career scientists, on which this study is based, reveal a dark side of competition in science. According to these scientists, competition contributes to strategic game-playing in science, a decline in free and open sharing of information and methods, sabotage of others’ (...) ability to use one’s work, interference with peer-review processes, deformation of relationships, and careless or questionable research conduct. When competition is pervasive, such effects may jeopardize the progress, efficiency and integrity of science. (shrink)

Ethics researchers advise managers of organizations to link rewards and punishments to ethical and unethical behavior, respectively. We build on prior research maintaining that organizations operate at Kohlbergs stages of moral reasoning, and explain how the over-reliance on rewards and punishments encourages employees to operate at Kohlbergs lowest stages of moral reasoning. We advocate designing organizations as ethical communities and relying on different assumptions about employees in order to foster ethical reasoning at higher levels. Characteristics associated with ethical communities are (...) identified and AES Corporation and Semco S/A serve as examples of corporations exhibiting the design characteristics and assumptions of ethical organizations. (shrink)

With candid, witty, and compelling experiences of yoga from renowned memoirists, including Cheryl Strayed (author of the number-one New York Times bestseller Wild), Claire Dederer (author of national bestseller Poser: My Life in 23 Yoga Poses), Dinty W. Moore (author of The Accidental Buddhist), Neal Pollack (author of Stretch: The Making of a Yoga Dude) and many others, Going Om shares a range of observations about this popular practice. Unlike books on yoga that provide instruction on technique, Going Om is (...) a unique collection of personal narratives from celebrated authors. This anthology of original material values the quality of writing over the authors' flexibility. Ira Sukrungruang shares his heartbreaking struggle as a 375 pound yoga student discovering self-worth on his mat; Gloria Munoz explores the practice of stillness with lyrical elegance in the midst of her busy mind; Neal Pollack's signature sarcasm leads to surprising turns at yoga class with his dad; Elizabeth Kadetsky uses yogic wisdom while coping with her mother's devastating Alzheimer's. (shrink)

Many extant theories of placebo focus on their causal structure wherein placebo effects are those that originate from select features of the therapy (e.g., client expectations or “incidental” features like size and shape). Although such accounts can distinguish placebos from standard medical treatments, they cannot distinguish placebos from everyday occurrences, for example, when positive feedback improves our performance on a task. Providing a social-epistemological account of a treatment context can rule out such occurrences, and furthermore reveal a new way to (...) distinguish clinical placebos from standard medical treatments. (shrink)

Many prescriptions offered in the literature for enhancing creativity and innovation in organizations raise ethical concerns, yet creativity researchers rarely discuss ethics. We identify four categories of behavior proffered as a means for fostering creativity that raise serious ethical issues: (1) breaking rules and standard operating procedures; (2) challenging authority and avoiding tradition; (3) creating conflict, competition and stress; and (4) taking risks. We discuss each category, briefly identifying research supporting these prescriptions for fostering creativity and then we delve into (...) ethical issues associated with engaging in the prescribed behavior. These four rubrics illustrate ethical issues that need to be incorporated into the creativity and innovation literature. Recommendations for how organizations can respond to the ethical issues are offered based on practices of exemplary organizations and theories of organizational ethics. A research agenda for empirically investigating the ethical impact these four categories of behavior have on organizations concludes the article. (shrink)

Programs, policies, and technologies — particularly those concerned with health equity — are often designed with justice envisioned as the end goal. These policies or interventions, however, frequently fail to recognize how the beneficiaries have historically embodied the cumulative effects of marginalization, which undermines the effectiveness of the intended justice. These well-meaning attempts at justice are bounded by greater socio-historical constraints. Bounded justice suggests that it is impossible to attend to fairness, entitlement, and equity when the basic social and physical (...) infrastructures underlying them have been eroded by racism and other historically entrenched isms. Using the case of Brazil’s National Health Policy for the Black Population, this paper proposes that bounded justice can contribute to justice discourses by serving as a concept, a proffering to a multi-disciplinary conceptual framework, and a potential analytic for those interested in the design of policy, technology, and programmatic interventions towards health equity. (shrink)

Journal of Philosophy of Education, EarlyView.

Within the growing developmental literature on children's testimonial learning, the emphasis placed on children's evaluations of testimonial evidence has shielded from view some of the more collaborative dimensions of testimonial learning. Drawing on recent philosophical work on testimony and interpersonal trust, we argue for an alternative way of conceptualizing the social nature of testimonial learning. On this alternative, some testimonial learning is the result of a jointly collaborative epistemic activity, an activity that aims at the epistemic goal of true belief, (...) but that does so by means of an irreducibly social process. (shrink)

This essay is a critical review of two recent collections, Feminism and Foucault: Reflections on Resistance, edited by Irene Diamond and Lee Quinby and Feminism as Critique: On the Politics of Gender, edited by Seyla Benhabib and Drucilla Cornell. While the collections differ in their manner of addressing the critical sources that have inspired them-the former relying upon a single theorist, the latter attempting to move through some of the philosophical history that constitutes our present theoretical terrain-both attempt to think (...) through and thus revisualize some of the categories of difference which we have inherited. Though the best essays from these collections are celebrated for demonstrating how "feminism as critique" can work to move us toward a clearer and more inclusive feminist theory, questions are raised about what the inattention to race in these volumes suggests about our own role in the construction of power and knowledge, and the erasures that help to secure them both. (shrink)

In recent essays, Jürgen Habermas endorses an account of political liberalism much like John Rawls'. Like Rawls, he argues that laws and public policies should be justified only in neutral terms, i.e. in terms of reasons that people holding conflicting world-views could accept. Habermas also, much like Rawls, distinguishes reasonable religious citizens, whose views should be included in public discourse, from unreasonable citizens in his expectation that religious citizens self-modernize. But in sharing these Rawlsian features, Habermas is vulnerable to some (...) of the same objections posed to Rawls. In this article I assess Habermas' ability to overcome two objections frequently posed to Rawls: (1) that religious citizens are unfairly expected to split their identities in public discourse, and (2) that the burdens of citizenship are asymmetrically distributed. I conclude that while he may be able to overcome the second, the first remains a problem for him. (shrink)

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity for rational choice in (...) alignment with one's values and goals). (shrink)

I propose a unified solution to two puzzles: Ross's puzzle and free choice permission. I begin with a pair of cases from the decision theory literature illustrating the phenomenon of act dependence, where what an agent ought to do depends on what she does. The notion of permissibility distilled from these cases forms the basis for my analysis of 'may' and 'ought'. This framework is then combined with a generalization of the classical semantics for disjunction — equivalent to Boolean disjunction (...) on the diagonal, but with a different two-dimensional character — that explains the puzzling facts in terms of semantic consequence. (shrink)

Fodor argues that speech perception is accomplished by a module. Typically, modular processing is taken to be bottom-up processing. Yet there is ubiquitous empirical evidence that speech perception is influenced by top-down processing. Fodor attempts to resolve this conflict by denying that modular processing must be exclusively bottom-up. It is argued, however, that Fodor's attempt to reconcile top-down and modular processing fails, because: (i) it undermines Fodor's own conception of modular processing; and (ii) it cannot account for the contextually varying (...) top-down influences that characterize speech perception. (shrink)

Journal Name: Semiotica Issue: Ahead of print.

Doctoral students receive many kinds of assistance from faculty members, but much of this support falls short of mentoring. This paper takes the perspective that it is more important to find out what kinds of help students receive from faculty than to assume that students are taken care of by mentors, as distinct from advisors or role models. The findings here are based on both survey and interview data collected through the Acadia Institute’s project on Professional Values and Ethical Issues (...) in the Graduate Education of Scientists and Engineers. The paper describes various kinds of assistance that students receive (or do not receive) from faculty members in their roles as teacher/coach, sponsor, and counselor, It concludes with a section on advisors assigned to doctoral students, notably the extent of their contact with and influence on students. (shrink)

Observers have difficulty detecting visual changes. However, they are unaware of this inability, suggesting that people do not have an accurate understanding of visual processes. We explored whether this error is related to participants’ beliefs about the roles of intention and scene complexity in detecting changes. In Experiment 1 participants had a higher failure rate for detecting changes in an incidental change detection task than an intentional change detection task. This effect of intention was greatest for complex scenes. However, participants (...) predicted equal levels of change detection for both types of changes across scene complexity. In Experiment 2, emphasizing the differences between intentional and incidental tasks allowed participants to make predictions that were less inaccurate. In Experiment 3, using more sensitive measures and accounting for individual differences did not further improve predictions. These findings suggest that adults do not fully understand the role of intention and scene complexity in change detection. (shrink)

Building trust between academic medical centers and certain communities they depend on in the research process is hard, particularly when those communities consist of minoritized or historically marginalized populations. Some believe that engagement activities like the creation of advisory boards, town halls, or a research workforce that looks more like community members will establish or reestablish trust between academic medical centers and racialized communities. However, without systematic approaches to dismantle racism, those well‐intended actions become public performativity, and trust building will (...) fail. In this essay, we draw upon foundational ethical principles of trust, distrust, and trust building; apply the concept of bounded justice to performative trust acts; and center the works of Black and Indigenous feminist bioethicists to revisit some of the wisdom and valuable lessons they have contributed. Rebuilding trust is hard to do because people and institutions are often not honest about how hard it is and there is no simple box‐checking task that can disentangle our society's injustices, but there are steps to take in this direction. Individuals and institutions can recognize valuable relevant work that has already been written, partake in critical reflection, and then apply insights gained to take both small and sustainable steps toward transformational change and deeper trust. (shrink)

To what extent does a person who prefers hip-hop rather than opera have legitimate reasons for doing so? Should we immediately classify such a judgment as incompetent because it runs counter to the verdicts of experts, including professional art critics? These questions are often associated with the problem of aesthetic akrasia, a concept taken from the vocabulary of ethics, which involves acting against one’s better judgment, that is, demonstrating irrationality by failing to react in what is, theoretically, the most appropriate (...) way. In ethical terms, it would be analogous to failing to help a person in distress when we know very well that it is immoral not to... (shrink)

Delving into the images and technique that made the daguerreotype a cutting-edge technology in 1839, the author uses her access to Harvard's collection of images to explore the early phases of this format.

For the first time, the reader can have a synoptic view of the reception of Pythagoras and Pythagoreanism in the Middle Ages and the Renaissance, East and West, in a multicultural perspective. All the major themes of Pythagoreanism are addressed, from mathematics, number philosophy and metaphysics to ethics and religious thought.

I respond to a dilemma for Causal Decision Theory (CDT) under determinism, posed in Adam Elga's paper “Confessions of a Causal Decision Theorist”. The treatment I present highlights (i) the status of laws as predictors, and (ii) the consequences of decision dependence, which arises natively out of Jeffrey Conditioning and CDT's characteristic equation.My argument leverages decision dependence to work around a key assumption of Elga's proof: to wit, that in the two problems he presents, the CDTer must employ subjunctive-suppositional (rather (...) than evidential) transformations of a shared prior. (shrink)

Some hold that W.K. Clifford's arguments are inconsistent, appealing to the disvalue of likely consequences of nonevidential belief-formation, while also insisting that the consequences are irrelevant to the wrongness of so believing. My thesis is that Clifford's arguments are consistent; one simply needs to be clear on the role consequences play in the "Ethics of Belief" (and, for that matter, in William James's "The Will to Believe"). The consequences of particular episodes of nonevidential belief-formation are, as Clifford insists, irrelevant to (...) the epistemic, and so moral, status of believing. The moral matter is that adopting a policy of nonevidential belief-formation constitutes commitment to antithetical principles, viz. (i) our antecedent moral obligation to minimize the risk of harming ourselves and others and (ii) the flagrant disregard for (i) entailed by employing a policy of risk, i.e. nonevidentialism. Clifford's arguments should be read as demonstrating that a nonevidentialist approach to belief-management constitutes the kind of risk that, in fact, is at odds with this antecedent moral obligation - hence the discussion of likely consequences, despite his claims that they are irrelevant to the moral status of the beliefs yielding them. They are irrelevant to the moral status of nonevidentialism but not irrelevant to the fact of risk. The moral impermissibility of nonevidentialism inheres in the inconsistency of it and our antecedent moral obligations, not in the value or disvalue of the particular consequences of that belief-management style. (shrink)