... and the baby has a large VSD. Otherwise appears well, gaining weight, smiling. No apnea, never been on ventilator. Local cardiac surgeon refused to operate, saying that surgery would be inappropriate. Have reached out to other centers, and some state that they never perform what they said was “futile” heart surgery on children with Trisomy 18, while other sites say they have and will continue to perform these operations. Can someone explain to me what is going on? In the (...) realm of medical care—given enough patients, clinicians, and time—conflict is inevitable. Someone will want to do something, such as give a drug or start a new form of technologic support, and someone else will think that this is a... (shrink)

Since the early 1980’s, with the clinical advent of in vitro fertilization resulting in so-called “test tube babies,” a wide array of ethical considerations and concerns regarding artificial womb technology (AWT) have been described. Recent breakthroughs in the development of extracorporeal neonatal life support by means of AWT have reinitiated ethical interest about this topic with a sense of urgency. Most of the recent ethical literature on the topic, however, pertains not to the more imminent scenario of a physiologically improved (...) method of neonatal care through AWT, but instead to the remote scenario of “complete ectogenesis” that imagines human gestation occurring entirely outside of the womb. This scoping review of the ethical literature on AWT spans from more abstract concerns about complete ectogenesis to more immediate concerns about the soon-to-be-expected clinical life support of what we term the fetal neonate or fetonate. Within an organizing framework of different stages of human gestational development, from conception to the viable premature infant, we discuss both already identified and newly emerging ethical considerations and concerns regarding AWT and the care of the fetonate. (shrink)

Some of the most difficult clinical ethics consultations involve patients who have both medical and mental health needs, as these cases can result in considerable moral distress on the part of the bedside staff. In this article we examine the issues that such consults raise through the illustrative example of a particular case: several years ago our ethics consultation service received a request from a critical care attending physician who was considering a rarely performed psychosurgical intervention to address intractable and (...) life-threatening agitation and aggression in an adolescent patient for whom standard treatments had proven unsuccessful. We consider strategies that may be useful in addressing not only the ethical dilemmas or the clinical problems, but also the emotional, social, and moral distress that arise in delivering care in such complex cases, in which standard routine practices of care have been exhausted. In addition, we explore the processes that led to this situation and suggest ways to promote early recognition and intervention for similar cases in the future. (shrink)

Stephen Nathanson's clear-sighted abridgment of _Principles of Political Economy_, Mill's first major work in moral and political philosophy, provides a challenging, sometimes surprising account of Mill's views on many important topics: socialism, population, the status of women, the cultural bases of economic productivity, the causes and possible cures of poverty, the nature of property rights, taxation, and the legitimate functions of government. Nathanson cuts through the dated and less relevant sections of this large work and includes significant material (...) omitted in other editions, making it possible to see the connections between the views Mill expressed in _Principles of Political Economy_ and the ideas he defended in his later works, particularly _On Liberty_. Indeed, studying _Principles of Political Economy_, Nathanson argues in his general Introduction, can help to resolve the apparent contradiction between Mill's views in On Liberty and those in _Utilitarianism_, making it a key text for understanding Mill’s philosophy as a whole. (shrink)

PONIC P, REID C and FRISBY W.Nursing Inquiry2010;17: 324–335 Cultivating the power of partnerships in feminist participatory action research in women’s healthFeminist participatory action research integrates feminist theories and participatory action research methods, often with the explicit intention of building community–academic partnerships to create new forms of knowledge to inform women's health. Despite the current pro‐partnership agenda in health research and policy settings, a lack of attention has been paid to how to cultivate effective partnerships given limited resources, competing agendas, (...) and inherent power differences. Based on our 10+ years individually and collectively conducting women's health and feminist participatory action research, we suggest that it is imperative to intentionally developpower‐withstrategies in order to avoid replicating the power imbalances that such projects seek to redress. By drawing on examples from three of our recent feminist participatory action projects we reflect on some of the tensions and complexities of attempting to cultivate power‐with research partnerships. We then offer skills and resources needed by academic researchers to effectively harness the collective resources, agendas, and knowledge that each partner brings to the table. We suggest that investing in the process of cultivating power‐with research partnerships ultimately improves our collective ability to understand and address women's health issues. (shrink)

Many people begin to practice yoga for its physical benefits-from exercise to stress relief-but over time more than 60 percent of practitioners say that their primary reason for practice changes from physical to spiritual. Threads of Yoga is written for these practitioners who crave a deeper experience of yoga, as well as the teachers who want to share it. Written by a veteran yoga teacher, Threads of Yoga introduces some of the basics of yoga philosophy, as well as meditations, breathwork, (...) and other subtle practices. Short chapters can serve as inspiration for personal practice or a yoga class. (shrink)

This multidisciplinary collection explores the ethics of social media use during the COVID-19 pandemic, with a focus on misinformation, truth, well-being, and authenticity.

Background Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design. Methods We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. (...) We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism. Results Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism. Conclusions Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism. (shrink)

In this rich cultural history, Pamela Robertson Wojcik examines America's ambivalent and shifting attitude toward homelessness through a close study of film cycles from five distinct historical moments that show characters as unhomed and placeless, mobile rather than fixed: failing, resisting, or opting out of the mandate for a home of one's own. From the tramp films of the Silent Era to the Oscar-winning Nomadland in 2021, Wojcik shows how film cycles reveal a tension in the American imaginary between (...) viewing homelessness as, on the one hand, deviant or threatening, and, on the other, emblematic of freedom and independence. Blending social history with insights drawn from a complex array of films, both canonical and fringe, Wojcik effectively 'unhomes' dominant narratives that cast aspirations for success and social mobility as the focus of American cinema, reminding us that genres of precarity have been central to the American cinema (and American story) all along. (shrink)

Although theoretically rigorous, the book is comprehensible to the beginning qualitative researcher.

Examines the relationship between making objects and knowing nature in Europe from the mid-15th to mid-19th centuries.

A good number of people currently thinking and writing about reasons identify a reason as a consideration that counts in favor of an action or attitude.1 I will argue that using this as our fundamental account of what a reason is generates a fairly deep and recalcitrant ambiguity; this account fails to distinguish between two quite different sets of considerations that count in favor of certain attitudes, only one of which are the “proper” or “appropriate” kind of reason for them. (...) This ambiguity has been the topic of recent discussion, under the head “the wrong kind of reasons problem.”2 I will suggest that confusion about “the wrong kind of reason” will be dispelled by changing our account of what a reason is. While I agree both that reasons are considerations and that certain.. (shrink)

Many assume that we can be responsible only what is voluntary. This leads to puzzlement about our responsibility for our beliefs, since beliefs seem not to be voluntary. I argue against the initial assumption, presenting an account of responsibility and of voluntariness according to which, not only is voluntariness not required for responsibility, but the feature which renders an attitude a fundamental object of responsibility (that the attitude embodies one’s take on the world and one’s place in it) also guarantees (...) that it could not be voluntary. It turns out, then, that, for failing to be voluntary, beliefs are a central example of the sort of thing for which we are most fundamentally responsible. (shrink)

I hope to show that, although belief is subject to two quite robust forms of agency, "believing at will" is impossible; one cannot believe in the way one ordinarily acts. Further, the same is true of intention: although intention is subject to two quite robust forms of agency, the features of belief that render believing less than voluntary are present for intention, as well. It turns out, perhaps surprisingly, that you can no more intend at will than believe at will.

According to ‘Excluders’, descriptive uncertainty – but not normative uncertainty – matters to what we ought to do. Recently, several authors have argued that those wishing to treat normative uncertainty differently from descriptive uncertainty face a dependence problem because one's descriptive uncertainty can depend on one's normative uncertainty. The aim of this paper is to determine whether the phenomenon of dependence poses a decisive problem for Excluders. I argue that existing arguments fail to show this, and that, while stronger ones (...) can be found, Excluders can escape them. (shrink)

In this paper I consider fairness of blaming a wrongdoer. In particular, I consider the claim that blaming a wrongdoer can be unfair because blame has a certain characteristic force, a force which is not fairly imposed upon the wrongdoer unless certain conditions are met--unless, e.g., the wrongdoer could have done otherwise, or unless she is someone capable of having done right, or unless she is able to control her behavior by the light of moral reasons. While agreeing that blame (...) has a characteristic force, I am skeptical of this charge of unfairness. My skepticism concerns itself less with the particular conditions of fairness proposed than with the idea that blame can be rendered unfair by its characteristic force. If to blame a person were simply to perform certain intentional actions, then, as we will see, blame could be rendered unfair by its force. But to blame a person is not just to act in certain ways. It is, at least in large part, to make certain judgments or adopt certain attitudes. However, it is unclear how these attitudes or judgments carry "force"? and also unclear whether they can be rendered unfair by their force. Examining these issues, I will suggest that much of the force of blame is found in a set of judgments--most centrally, the judgment that one person failed to show proper regard for others. But, I will argue, once it is granted that such judgments are true, their characteristic force cannot render them unfair. (shrink)

I first pose a challenge which, it seems to me, any philosophical account of forgiveness must meet: the account must be articulate and it must allow for forgiveness that is uncompromising. I then examine an account of forgiveness which appears to meet this challenge. Upon closer examination we discover that this account actually fails to meet the challenge—but it fails in very instructive ways. The account takes two missteps which seem to be taken by almost everyone discussing forgiveness. At the (...) end, I sketch an alternative account of forgiveness, one that I think meets the challenge and avoids the missteps. (shrink)

A common line of thought claims that we are responsible for ourselves and our actions, while less sophisticated creatures are not, because we are, and they are not, self-aware. Our self-awareness is thought to provide us with a kind of control over ourselves that they lack: we can reflect upon ourselves, upon our thoughts and actions, and so ensure that they are as we would have them to be. Thus, our capacity for reflection provides us with the control over ourselves (...) that grounds our responsibility. I argue that this thought is subtly, but badly, confused. It uses, as its model for the control that grounds our responsibility, the kind of control we exercise over ordinary objects and over our own voluntary actions: we represent to ourselves what to do or how to change things, and then we bring about that which we represent. But we cannot use this model to explain our responsibility for ourselves and our actions: if there is a question about why or how we are responsible for ourselves and our actions, it cannot be answered by appeal to a sophisticated, self-directed action. There must be some more fundamental account of how or why we are responsible. I replace the usual account with a novel but natural view: responsible mental activity can be modeled, not as an ordinary action, but as the settling of a question. This shift will require abandoning the tempting but troublesome thought that responsible activity involves discretion and awareness—which, I argue, we must abandon in any case. (shrink)

We sometimes seem to face fundamental moral uncertainty, i.e., uncertainty about what is morally good or morally right that cannot be reduced to ordinary descriptive uncertainty. This phenomenon raises a puzzle for noncognitivism, according to which moral judgments are desire-like attitudes as opposed to belief-like attitudes. Can a state of moral uncertainty really be a noncognitive state? So far, noncognitivists have not been able to offer a completely satisfactory account. Here, we argue that noncognitivists should exploit the formal analogy between (...) moral uncertainty and moral multi-objective decision problems. Our ‘multi-objective story’ enables noncognitivists to save our moral uncertainty thought and talk by explaining how the underlying phenomenon could be noncognitive. (shrink)

I argue to a conclusion I find at once surprising and intuitive: although many considerations show trust useful, valuable, important, or required, these are not the reasons for which one trusts a particular person to do a particular thing. The reasons for which one trusts a particular person on a particular occasion concern, not the value, importance, or necessity of trust itself, but rather the trustworthiness of the person in question in the matter at hand. In fact, I will suggest (...) that the degree to which you trust a particular person to do a particular thing will vary inversely with the degree to which you must rely, for the motivation or justification of your trusting response, on reasons that concern the importance, or value, or necessity of having such a response. (shrink)

The popularity and profitability of American gridiron football is beyond dispute. Recent polls put football as the overwhelming favorite of people who follow at least one sport and huge revenues are reported at both the professional and the university level. We know, however, that what is the case tells us little about what ought to be the case, and it is to the latter question that this paper is directed. I offer a three-pronged attack on the ethical acceptability of American (...) football, both amateur and professional, based on harm to the players, objectification of the players, and harm to others done by the players, leading to the conclusion that the sport, as currently constituted, is morally unacceptable. (shrink)

In the classical Turing test, participants are challenged to tell whether they are interacting with another human being or with a machine. The way the interaction takes place is not direct, but a distant conversation through computer screen messages. Basic forms of interaction are face-to-face and embodied, context-dependent and based on the detection of reciprocal sensorimotor contingencies. Our idea is that interaction detection requires the integration of proprioceptive and interoceptive patterns with sensorimotor patterns, within quite short time lapses, so that (...) they appear as mutually contingent, as reciprocal. In other words, the experience of interaction takes place when sensorimotor patterns are contingent upon one’s own movements, and vice versa. I react to your movement, you react to mine. When I notice both components, I come to experience an interaction. Therefore, we designed a “minimal” Turing test to investigate how much information is required to detect these reciprocal sensorimotor contingencies. Using a new version of the perceptual crossing paradigm, we tested whether participants resorted to interaction detection to tell apart human from machine agents in repeated encounters with these agents. In two studies, we presented participants with movements of a human agent, either online or offline, and movements of a computerized oscillatory agent in three different blocks. In each block, either auditory or audiovisual feedback was provided along each trial. Analysis of participants’ explicit responses and of the implicit information subsumed in the dynamics of their series will reveal evidence that participants use the reciprocal sensorimotor contingencies within short time windows. For a machine to pass this minimal Turing test, it should be able to generate this sort of reciprocal contingencies. (shrink)

Nearly sixty years after its publication, P. F. Strawson’s “Freedom and Resentment” continues to inspire important work. Its main legacy has been the notion of “reactive attitudes.” Surprisingly, Strawson’s central argument—an argument to the conclusion that no general thesis (such as the thesis of determinism) could provide us reason to abandon these attitudes—has received little attention. When the argument is considered, it is often interpreted as relying on a claim about our psychological capacities: we are simply not capable of abandoning (...) the reactive attitudes, across the board, in something like the way we are simply not capable of remembering everything we are told. A different line interprets Strawson as relying on something like a conceptual point: you can neither support nor call into question the whole of a practice using notions that are, themselves, constituted by that practice. Neither interpretation would lead to you to expect what you will find, looking at the central text: Strawson twice accuses his opponent of being caught in some kind of contradiction. So neither interpretation, on its own, is correct. By providing a close reading of the central text, I do my best to articulate Strawson’s more interesting, and more powerful, argument. The argument depends on an underlying picture of the nature of moral demands and moral relationships—a picture that has gone largely unnoticed, that is naturalistic without being reductionistic, and that is, I think, worthy of serious consideration. (shrink)

It has seemed to many philosophers—perhaps to most—that believing is not voluntary, that we cannot believe at will. It has seemed to many of these that this inability is not a merely contingent psychological limitation but rather is a deep fact about belief, perhaps a conceptual limitation. But it has been very difficult to say exactly why we cannot believe at will. I earlier offered an account of why we cannot believe at will. I argued that nothing could qualify both (...) as having been done “at will,” in the relevant sense, and as a belief. Thus, no believer could believe at will. If my arguments are correct, our inability to believe at will reveals no genuine lack in our powers of mind, any more than an inability to draw a square circle reveals a lack of artistic skill. My account has been recently criticized by Kieran Setiya, who has provided an account of his own. Here I revisit and defend my account, hopefully in a way that will both make my thought clearer and illumine some of the broader differences between Setiya’s approach and my own. I then briefly consider Setiya’s own argument, in part to further develop the contrast. (shrink)

ABSTRACTExperiences that contradict one's core concepts elicit intense emotions. Such schema incongruence can elicit awe, wherein experiences that are too vast...

Here I defend my solution to the wrong-kind-of-reason problem against Mark Schroeder’s criticisms. In doing so, I highlight an important difference between other accounts of reasons and my own. While others understand reasons as considerations that count in favor of attitudes, I understand reasons as considerations that bear (or are taken to bear) on questions. Thus, to relate reasons to attitudes, on my account, we must consider the relation between attitudes and questions. By considering that relation, we not only solve (...) the wrong-kind-of-reason problem, but we also bring into view rational agency—the use of reasons in thought. (shrink)

Donald Davidson opens ‘Actions, Reasons, and Causes’ by asking, ‘What is the relation between a reason and an action when the reason explains the action by giving the agent's reason for doing what he did?’ His answer has generated some confusion about reasons for action and made for some difficulty in understanding the place for the agent's own reasons for acting, in the explanation of an action. I offer here a different account of the explanation of action, one that, though (...) minimal and formal, preserves the proper role for the agent's own reasons for acting. (shrink)

I will argue that making a certain assumption allows us to conceptualize more clearly our agency over our minds. The assumption is this: certain attitudes (most uncontroversially, belief and intention) embody their subject’s answer to some question or set of questions. I will first explain the assumption and then show that, given the assumption, we should expect to exercise agency over this class of attitudes in (at least) two distinct ways: by answering for ourselves the question they embody and by (...) acting upon them in ways designed to affect them according to our purposes—in roughly the way we exercise agency over most ordinary objects. (shrink)

Recent experiments have been used to “edit” genomes of various plant, animal and other species, including humans, with unprecedented precision. Furthermore, editing the Cas9 endonuclease gene with a gene encoding the desired guide RNA into an organism, adjacent to an altered gene, could create a “gene drive” that could spread a trait through an entire population of organisms. These experiments represent advances along a spectrum of technological abilities that genetic engineers have been working on since the advent of recombinant DNA (...) techniques. The scientific and bioethics communities have built substantial literatures about the ethical and policy implications of genetic engineering, especially in the age of bioterrorism. However, recent CRISPr/Cas experiments have triggered a rehashing of previous policy discussions, suggesting that the scientific community requires guidance on how to think about social responsibility. We propose a framework to enable analysis of social responsibility, using two example.. (shrink)

Much research on women’s religious participation centers on their abilities to act within constricted institutional spaces. Drawing on five years of ethnographic fieldwork, this study analyzes how African American Muslim women use the mosque as a physical space to enact public performances of religious identity. By occupying, protecting, and appropriating spaces in the mosque for meaningfully gender-specific ways of engaging Islam, the women further a project of religious self-making that bonds African American Muslim women together. In their maneuverings of different (...) forms of physical space as a sisterhood, the women enable themselves to resist gender, economic, and racial oppression. This study reveals that even within men-dominated religious organizations with limited symbolic and material spaces for women, women participants successfully exert agency over their own religious experiences. (shrink)