This book addresses the problem of how to make democratically-legitimate public policy on issues of contentious bioethical debate. It focuses on ethical contests about research and their legitimate resolution, while addressing questions of political legitimacy. How should states make public policy on issues where there is ethical disagreement, not only about appropriate outcomes, but even what values are at stake? What constitutes justified, democratic policy in such conflicted domains? Case studies from Canada and Australia demonstrate that two countries sharing historical (...) and institutional characteristics can reach different policy responses. This book is of interest to policymakers, bioethicists, and philosophers, and will deepen our understanding of the interactions between large-scale socio-political forces and detailed policy problems in bioethics. (shrink)

ObjectiveApproximately half of all people living with amyotrophic lateral sclerosis experience persistent or recurrent emotional distress, yet little is known about the psychological processes that maintain emotional distress in this population. The self-regulatory executive functioning model specifies that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. This study explored whether maladaptive metacognitive beliefs are associated with emotional distress after controlling for demographic factors, time since diagnosis, and current level of physical functioning.DesignIn a cross-sectional (...) design, 75 adults with a diagnosis of ALS completed self-report questionnaires. Participants had a mean age of 60.40 years, mean duration of symptoms 63.92 months, and male:female gender ratio of 14:11.Main Outcome MeasuresQuestionnaires assessed emotional distress, physical functioning, repetitive negative thinking, metacognitive beliefs, and demographic factors.ResultsMaladaptive metacognitive beliefs explained additional variance in emotional distress after controlling for age, gender, time since diagnosis, physical functioning, and repetitive negative thinking. Repetitive negative thinking partially mediated the relationships between positive and negative metacognitive beliefs and emotional distress.ConclusionsThese data support the utility of the metacognitive model in understanding emotional distress in people with ALS. Examination of the temporal relationship between maladaptive metacognitive beliefs and emotional distress in people living with ALS may help to guide the development of therapeutic approaches. (shrink)

This paper considers the legislative debates in Australia that led to the passage of the Research Involving Human Embryos Act (Cth 2002) and the Prohibition of Human Cloning Act (Cth 2002). In the first part of the paper, we discuss the debate surrounding the legislation with particular emphasis on the ways in which demands for public consultation, public debate and the education of Australians about the potential ethical and scientific impact of human embryonic stem cells (hESC) research were deployed, and (...) the explicit and implicit framing of the scope of public consultation. We then ask whether, given the calls for public consultations, debate and understanding, current work in democratic theory could be helpful in analysing the process of policy-making in these areas. In particular, we canvass the literature relating to aggregative and deliberative models of democracy for processes that support the legitimacy of policy. We identify features of the debate that reflect the appeal of deliberative approaches as well as some of the possible hurdles or limitations to developing deliberative democratic approaches to policy in ethically contentious areas. (shrink)

The increasing popularity of local food consumption can be attributed to the heightened awareness of food safety concerns, carbon emissions produced from food transportation, and an understanding of how large corporations’ obtain their food supplies. Although there is increasing discussion on both the local and organic food movement independently, there is not a wide availability of literature examining the motivations and perceptions of consumers with regard to farmers’ markets. Issues such as perceptions about what type of food consumers are purchasing (...) at markets, nor the main motivations for frequenting such establishments are discussed. Therefore the purpose of this study was to determine consumer motivations, benefits, and perceptions of farmers’ markets. Using the case study location of Toronto, Canada, this study surveyed 300 participants during the fall of 2011. Findings indicated that the main purpose for visiting famers’ markets is not solely to fulfill grocery needs. Quality of products offered and the ability to support the local community were the primary motivators to visit the markets. (shrink)

This volume breaks new ground by investigating the ethics of vulnerability. Drawing on various ethical traditions, the contributors explore the nature of vulnerability, the responsibilities owed to the vulnerable, and by whom.

The last phase of Greek philosophy has until recently been less intelligently studied than any other, and in our understanding of its development there are still lamentable lacunae. Three errors in particular have in the past prevented a proper appreciation of Plotinus' place in the history of philosophy. The first was the failure to distinguish Neoplatonism from Platonism: this vitiates the work of many early exponents from Ficinus down to Kirchner. The second was the belief that the Neoplatonists, being ‘mystics,’ (...) were necessarily incomprehensible to the plain man or even to the plain philosopher. To have encouraged the persistence of this superstition in the nineteenth century is the least pardonable of Creuzer's many sins. The third was the chronological confusion involved in the ascription to Saint Paul's contemporary of the works of the pretended Dionysius Areopagita, which contain a fully-developed Neoplatonic theology. Though the fraud had been exposed by Scaliger, these writings continued down to the beginning of the nineteenth century to be used as evidence that the ‘Nsoplatonic trinity’ was an inferior imitation of the Christian one. When this false trail was at length abandoned the fashion for orientalizing explanations persisted in another guise: to the earliest historians of Neoplatonism, Simon and Vacherot, the school of Plotinus was ‘the school of Alexandria,’ and its inspiration was mainly Egyptian. Vacherot says of Neoplatonism that it is ‘essentially and radically oriental, having nothing of Greek thought but its language and procedure.’ Few would be found to-day to subscribe to so sweeping a pronouncement; but the existence of an important oriental element in Plotinus' thought is still affirmed by many French and German writers. (shrink)

Jealousy is an emotion that arises in diverse circumstances and is experienced in phenomenologically diverse ways. In part because of this diversity, evaluations of jealous subjects tend to be conflicting and ambiguous. Thus philosophers who are interested in the moral status of jealousy face a challenge: to explain how, despite the diversity of jealous subjects and experiences of jealousy, our moral evaluations of those subjects in light of those experiences might be unified. In this project, I confront and respond to (...) this challenge, which I call the challenge of heterogeneity. -/- In Part I, I refine and expand on existing descriptive accounts of jealousy, defending an account with three necessary but not sufficient conditions. On my view, if one is jealous: -/- A. One desires that oneself stand in some relation to a specific, non-replicable good. B. One has in mind a (possibly imagined) rival and regards the rival’s having the good as logically or causally inconsistent with the satisfaction of this desire C. One has in mind some (possibly imagined) set of circumstances in which this desire would be satisfied. -/- In discussing this view I emphasize the role that relationships play in giving rise to jealousy, since its connections to relationships make jealousy descriptively and normatively unique. -/- In Part II, I develop an account of jealousy’s moral significance. To do so, I divide cases of jealousy into three types: those involving jealous desires relating to (1) caring relationships, (2) non-caring relationships, and (3) material goods or personal qualities. I argue that in all three types of cases, jealousy undermines the actual or potential moral value of the jealous subjects’ relationships, and that this undermining provides the paradigmatic moral reason to criticize jealous subjects. Thus I respond to the challenge of heterogeneity without simply portraying jealous subjects as selfish or insecure. -/- After doing so, I consider multiple arguments for the claim that a person’s being jealous sometimes constitutes a moral reason to praise that person. I critique each of those arguments and conclude that we have good reasons to see jealous subjects as worthy of moral criticism but not moral praise. (shrink)

A major goal of this work is to specify some steps of the process by which participants maintain coherency in their conversations.The underlying element of the analysis is a construct called a “context space.” Roughly, a group of utterances that refers to a single issue or episode forms the basis for a context space. Superficially, a conversation is a sequence of utterances; at a deeper level it is a structured entity whose utterances can be parsed into hierarchically related context spaces.As (...) a conversation proceeds, each conversant builds a discourse model that includes the conversation's context space structure, a notion of the present discourse topic, and a list of items being focused upon. Conversational coherency depends upon a lack of conflict between the respective models of the participants. Conflicts are prevented by speakers following high level syntactic and semantic relational rules that enable listeners to identify their discourse models. These rules, given in the study, are highly integrated with the view of conversation presented here—a hierarchy of related context spaces. (shrink)

Bioethics has entered a new era: as many commentators have noted, the familiar mantra of autonomy, beneficence, nonmaleficence, and justice has proven to be an overly simplistic framework for understanding problems that arise in modern medicine, particularly at the intersection of public policy and individual preferences. A tradition of liberal pluralism grounds respect for individual preferences and affirmation of competing conceptions of the good. But we struggle to maintain (or at times explicitly reject) this tradition in the face of individual (...) preferences that we find distasteful, suspect, or even repugnant, especially where the broader social good or respect for equality is at stake. Directed donation presents us with such a dilemma: can we uphold the right of self-determination through respect of individual preferences regarding disposition of transplantable organs while at the same time maintaining an allocation system that reflects values of equity and justice claimed to underlie the socially negotiated practice of transplantation? Or are some preferences simply to be deemed unethical and not respected, even if that leads to a reduction in the number of transplantable organs available and to an apparent disregard for the autonomous decisions of the recently deceased? (shrink)

Autonomy and the Situated Self offers a critique of contemporary mainstream bioethics and proposes an alternative framework for the exploration of bioethical issues. It also contrasts two conceptions of autonomy, one based on a liberal model but detached from its political foundation and one that is responsive to the concerns of virtue ethics and connected to the concept of human flourishing.

This paper critically examines several game theoretic interpretations of Hobbes' state of nature, including Prisoner's Dilemma and Assurance Game, and argues instead that the best matrix is that of a combination of the two, an Assurance Dilemma. This move is motivated by the fact that Hobbes explicitly notes two distinct personality types, with different preference structures, in the state of nature: dominators and moderates. The former play as if in a Prisoner's Dilemma, the latter play as if in an Assurance (...) Game. But when meeting one another, the Assurance Dilemma represents their differing strategies, and can explain various other features of Hobbes' state of nature, as well as a key informational role played the Sovereign. (shrink)

Extensive and diverse conceptual work towards developing a definition of ‘mental disorder’ was motivated by the declassification of homosexuality from the Diagnostic and Statistical Manual in 1973. This highly politicised event was understood as a call for psychiatry to provide assurances against further misclassification on the basis of discrimination or socio-political deviance. Today, if a definition of mental disorder fails to exclude homosexuality, then it fails to provide this safeguard against potential abuses and therefore fails to do an important part (...) of the work it was intended to do. We argue that fact-based definitions of mental disorder, relying on scientific theory, fail to offer a robust definition of mental disorder that excludes homosexuality. Definitions of mental disorder based on values do not fare better: these definitions are silent on questions about the diagnostic status of individuals in oppressive societies and over-inclusive of mental or behavioural states that happen to be negatively valued in the individual's social context. We consider the latest definition proposed for the Diagnostic and Statistical Manual-5 in light of these observations. We argue that definition fails to improve on these earlier deficiencies. Its inclusion in the manual may offer false reassurance against repetition of past misclassifications. We conclude with a provocation that if candidate definitions of mental disorder are unable to exclude homosexuality, it might perhaps be preferable not to attempt a definition at all. (shrink)

Autonomy and the Situated Self offers a critique of contemporary mainstream bioethics and proposes an alternative framework for the exploration of bioethical issues.

ABSTRACT We argue that in societies like our own the prevailing view that parents have both special responsibilities for and special rights over their children fails to give a proper understanding of the autonomy both of parents and of children. It is our claim that there is a logical priority of the separable interests of a child over the autonomy of its parents in the fulfilment of their special responsibilities for and the exercise of their special rights over their children. (...) However, we believe that in acknowledging the child as a distinct locus of interests appropriate weight can still be given to parental autonomy. In particular, since raising a child is a long‐term commitment which plays a central role in the life‐plans of many adults it will be a legitimate exercise of an adult's autonomy strongly to influence the future of any children involved in such a plan. Such influence will be quite separate from paternalistic concern for those children. But the logical priority of the child's interests will at the same time show why parents are not entitled to behave proprietorially toward their children, even when paternalistic concern is called for. (shrink)

This paper surveys recent trends in the history of science, using quotations from works published in the last decade. It suggests that philosophers of science have not yet come to terms with those changes, indicates which might or might not lead to productive interchange, and concludes that history and philosophy of science are now further apart than at any time since the early 1960's.

We discuss a case where medically optimal investigations of health problems in a donor-conceived child would require their egg donor to participate in genetic testing. We argue that it would be justified to contact the egg donor to ask whether she would consider this, despite her indicating on a historical consent form that she did not wish to take part in future research and that she did not wish to be informed if she was found to be a carrier of (...) a ‘harmful inherited condition’. We suggest that we cannot conjecture what her current answer might be if, by participating in clinical genetic testing, she might help reach a diagnosis for the donor-conceived child. At the point that she made choices regarding future contact, it was not yet evident that the interests of the donor-conceived child might be compromised by her answers, as it was not foreseen that the egg donor’s genome might one day have the potential to enable diagnosis for this child. Fertility consent forms tend to be conceptualised as representing incontrovertible historical boundaries, but we argue that rapid evolution in genomic practice means that consent in such cases is better seen as an ongoing and dynamic process. It cannot be possible to compel the donor to aid in the diagnosis of the donor-conceived child, but she should be given the opportunity to do so. (shrink)

Four experiments and 2 corpus-based studies demonstrate that negation is a determinant factor affecting novel nonliteral utterance-interpretation by default. For a nonliteral utterance-interpretation to be favored by default, utterances should be potentially ambiguous between literal and nonliteral interpretations. They should therefore be (a) unfamiliar, (b) free of semantic anomaly or any kind of internal incongruity, and (c) unbiased by contextual information. Experiments 1–3 demonstrate that negative utterances, meeting these 3 conditions, were interpreted metaphorically (This is not a safe) or sarcastically (...) (Ambitious she is not) when presented in isolation and were therefore processed faster in contexts strongly biasing them toward their nonliteral than toward their (equally biased) literal interpretation. Experiment 4 reduces the possibility that it is structural markedness on its own that induces nonliteralness. Two corpus-based studies provide corroborating evidence, supporting the view of negation as an operator generating nonliteral interpretations by default. (shrink)

Despite moves to enhance the autonomy of clients of health care services, the use of a variety of physical restraints on the freedom of movement of frail, elderly patients continues in nursing homes. This paper confronts the use of restraints on two grounds. First, it challenges the assumption that use of restraints is necessary to protect the welfare of frail, elderly patients by drawing on a range of data indicating the limited efficacy of restraints. Secondly, it argues that the duty (...) to respect individual autonomy extends to a duty to respect the autonomy of patients who are elderly, frail and living in nursing homes. (shrink)

This paper attributes to Nietzsche a theory of cultural development according to which pyramid societies—steeply hierarchical societies following a unified morality—systematically alternate with motley societies, which emerge when pyramid societies encounter other cultures or allow their strict mores to relax. Motley societies contain multiple value systems due to individual innovation or intercultural contact, and are less stringent in dictating individuals' roles. Consequently, many people are torn between incompatible values and lack direction, so they are drawn to a morality of mediocrity, (...) which offers the modest goals of comfort and conformity. However, the need to mediate between conflicting values also tends to yield exceptional individuals who create new values, and can reshape the society into a new pyramid society governed by those values. I argue that Nietzsche favors neither type of society at the expense of the other, but believes the alternation itself is valuable: a pyramid society develops a value system to its full potential; then, when it encounters alternative values, the extraordinary individuals in the resulting motley society synthesize the competing systems into a fuller vision of human flourishing. (shrink)

It is necessary to recognize the variety of levels at which values and norms may inappropriately affect the equity of the transplantation process, including candidate selection. Using a revised, richer concept of objectivity, adopted from Longino's work in the philosophy of science and empirical studies of candidate selection, this paper examines what sort of objectivity can be obtained in the transplant candidate selection process, and the closely related question of how selection can occur in an equitable manner. This concept of (...) objectivity requires that transformative criticism occur so that (1) the conceptual and normative commitments underlying selection may be articulated and perhaps challenged, and (2) the relationship between those commitments and criteria for candidate selection may be examined and justified, or revised. Through such transformative criticism, a greater degree of objectivity may be attained, which in turn will increase the likelihood of equity. (shrink)

Women's access to health and medicine in developed countries has been characterized by a range of inconsistent inclusions and exclusions. Health policy has been asymmetrically interested in womens reproductive capacities and has sought to regulate, control, and manage aspects of womens reproductive decision making in a manner unwitnessed in relation to men's reproductive health and reproductive decision making. In other areas, research that addresses health concerns that affect both men and women sometimes is designed so as not to yield data (...) relating to the ways in which women's physiology and gendered location may affect their experience of the condition and its response to treatment, despite a literature on the significance of sex and gender differences in health research. This paper draws on the situation in Australia to explore the ethical significance of these inconsistencies as failing the ideals of high-quality medical research and evidenced-based health care. (shrink)

This article describes a new prenatal genetic test that is painless, early, and increasingly available. State legislatures have reacted by prohibiting abortion for reason of fetal sex or of fetal diagnosis and managing genetic counseling. This article explores these legislative responses and considers how physicians and genetic counselors currently communicate post-testing options. The article then examines the challenges ahead for genetic counseling, particularly in light of the troubling grip of abortion politics on conversations about prenatal diagnosis.

This paper presents results from a survey of 344 individuals who engage in climate change mitigation action, contributing to debates about whether it is necessary to promote 'nature experiences' and biospheric values to encourage pro-environmental behaviour. We investigate three factors - values, motivations and formative experiences - that underlie such behaviour, but that usually have been considered in isolation from each other. In contrast to previous studies of environmentalists' significant life experiences, outdoor/nature experiences were not frequently mentioned as being influential. (...) Altruistic concerns about climate change impacts on future human generations and on poorer or more vulnerable people were considered more motivating than other reasons for action. There was no significant difference in how respondents rated altruistic and biospheric values. Variations in responses from those involved in 'biospherically-oriented' organisations (such as traditional environmental or conservation organisations) versus those involved in climate change groups suggest that there are different routes into climate change mitigation action, and our results show that it is not essential to cultivate biospheric values or the love of nature to encourage such action. (shrink)

Cultural forces such as film create and reinforce rigidly-defined images of a doctor's identity for both the public and for medical students. The authoritarian and hierarchical institution of medical school also encourages students to adopt rigidly-defined professional identities. This restrictive identity helps to perpetuate the power of the patriarchy, limits uniqueness, squelches inquisitiveness, and damages one's self-confidence. This paper explores the construction of a physician's identity using cultural theorists' psychoanalytic analyses of gender and race as a framework of analysis. Cultural (...) theorists' politically-motivated work provides an excellent point of departure for destabilizing parts of the authoritarian medical hierarchy that can damage a student's professional development. Drawing on such discourse, this paper examines the processes by which a doctor's identity becomes rigidly defined and fixed by daily training. It finally proposes a way for a medical student to extrapolate himself from the current definitions of this identity and create a broader, more malleable concept of professional identity by defining himself from outside of, rather than through, difference. (shrink)

A first-person account of some victims of the virus, the author puts faces and circumstances to the tragedy of the Covid-19 pandemic. Told from a chaplain’s point of view, these narratives will take the reader beyond the numbers and ask questions like: What is the cost of keeping families separated at the end of life, and, if patient/family centered care is so central to healthcare these days, why was it immediately discarded? Is potentially saving human lives worth the risk of (...) damaging them beyond repair? (shrink)

The complex regulatory framework governing the U.S. health care system can be an obstacle to programming that address health-related social needs. In particular, health care fraud and abuse law is a pernicious barrier as health care organizations may minimize or forego programming altogether out of real and perceived concern for compliance. And because health care organizations have varying resources to navigate and resolve compliance concerns, as well as different levels of risk tolerance, fears related to the legal landscape may further (...) entrench inequities in access to meaningful programs that improve health outcomes. This article uses food and nutrition programming as a case study to explore the complexities presented by this area of law and to highlight pathways forward. (shrink)

ABSTRACT In establishing National Bioethics Organisations (NBOs), liberal democracies seek to acknowledge the diversity of strongly held ethical positions and the imperative to engage in public debate about important bioethical decisions. NBOs are typically given a range of responsibilities, including contributing to and stimulating public debate; providing expert opinion on relevant issues for policy deliberations; and developing public policy. The state is now found to have an interest in areas previously thought to be a matter of individual choice. NBOs can (...) provide one way of opening up public debate to allow the diversity of views to be heard in a manner that is well‐informed, articulate and responsive to both expert and ‘lay’ public views. We draw on debates in political theory about democratic decision‐making and on the policy making roles of some key NBOs. We are particularly interested in examining the capacity of NBOs to meet the democratic ideal of effective participation by the public, or citizenry, especially by those who are directly affected by the policies, in the development of effective public policy. We provide a basic framework for policy development involving NBOs that can begin to meet this ideal, a process of ‘contested deliberation’. (shrink)

The stage is often a space where artists engage in experiments with identity politics. Plays like Welcome to Thebes appear to present global human engagement and a cultural exchange of ideas. However, using European narrative structures as a playground to explore Africana political issues highlights the limitations to cross-cultural exchange between aesthetic paradigms. This essay first articulates a conflict between European and Africana aesthetics and then offers an analysis of gender dynamics operating in the play Welcome to Thebes, arguing that (...) performative conditions not only constrain racialized realities, but also limit the possibility of cross-cultural performances of history. (shrink)

I set out to read the book of Joshua together with its most literal interpreters – those who enacted a version of the war for the Promised Land – and suggest that interpretations of the book are always bound up with current ideas about war and territorial rights. In particular, I analyze how David Ben-Gurion, the first Prime Minister of Israel, and his Bible study group parsed the book of Joshua and argue that their interpretations, like the book of Joshua (...) itself, represent projections of nationalist desire onto a varied, multifarious social setting. Joshua’s conquest and Israel’s founding narrative both involve military narratives generated in order to obscure the presence of non-nationals. In the next stage of the argument, I suggest that the story of the conquest itself attests to the very fluid social setting that it aims to overcome. Just as Ben-Gurion appealed to Joshua as precedent and the contemporary State of Israel looks to Ben-Gurion as a model, post-nationalists can locate a paradigm in the selfsame founding myths. (shrink)

Kant claims in the third Critique that one can make about wine the merely subjective judgment that it is agreeable but never the universally valid judgment that it is beautiful. This follows from his views that judgments of beauty can be made only about the formal (spatiotemporal) features of a representation and that aromas and flavors consist of formless sensory matter. However, I argue that Kant's theory permits judgments of beauty about wine because the experience displays a temporal structure: the (...) aromas and flavors evolve over the course of a tasting from the bouquet through the palate to the finish. An analogy with music, which Kant describes as 'a play of sensations in time', illuminates how wine qualifies as an object of pure judgments of taste: the 'structure' of a wine can be compared to harmonic structure, and its development throughout the taste can be compared to the unfolding of melody and harmonic progression. (shrink)

A medical student's ability to present a case history is a critical skill that is difficult to teach. Case histories presented without theatrical engagement may fail to catch the attention of their intended recipients. More engaging presentations incorporate ‘stage presence’, eye contact, vocal inflection, interesting detail and succinct, well organised performances. They convey stories effectively without wasting time. To address the didactic challenge for instructing future doctors in how to ‘act’, the Mayo Medical School and The Mayo Clinic Center for (...) Humanities in Medicine partnered with the Guthrie Theater to pilot the programme ‘Telling the Patient's Story’. Guthrie teaching artists taught storytelling skills to medical students through improvisation, writing, movement and acting exercises. Mayo Clinic doctors participated and provided students with feedback on presentations and stories from their own experiences in patient care. The course's primary objective was to build students' confidence and expertise in storytelling. These skills were then applied to presenting cases and communicating with patients in a fresher, more engaging way. This paper outlines the instructional activities as aligned with course objectives. Progress was tracked by comparing pre-course and post-course surveys from the seven participating students. All agreed that the theatrical techniques were effective teaching methods. Moreover, this project can serve as an innovative model for how arts and humanities professionals can be incorporated for teaching and professional development initiatives at all levels of medical education. (shrink)

Normative reasons for action are considerations that count in favor of actions. They are the considerations that determine what an agent should do in a given situation. If the agent acts on these considerations, they justify her action. This paper concerns accounts of normative reasons that separate the explanation of why a particular reason counts in favor of an agent’s performing some action from the content of that reason. Elements of this explanation of why the reason is a reason are (...) “background conditions” on that reason, rather than part of the reason itself. (shrink)