Chronic diseases are major causes of health inequalities. Community nurses can potentially make large contributions to chronic illness prevention and management in Israel but may be obstructed by professional dominance of physicians. However, insufficient research exists about community nursing in Israel, and how it may differ from other countries. This study aims to document chronic disease‐related community nursing roles in Israel, identify changes and trends in community nursing roles that may increase social justice, and understand how the roles and trends (...) in community health nursing in Israel may differ from developments in other countries. In‐depth interviews were performed with 55 Israeli health system professionals, and 692 nurse care‐givers were asked open‐ended questions. Interview answers were analyzed to find themes and trends. The study found that community nurse roles in Israel have expanded, especially for chronic disease control. Commonalities exist with countries such as the United States and the UK, albeit with important differences. However, continued conflicts with physicians exist, which can limit nurses' contributions to reducing health inequalities. Community nurses' importance is growing. Enabling them to overcome professional dominance and improve chronic disease control can help reduce health inequalities in Israel and elsewhere. (shrink)

Background Coping with end-of-life issues is a major challenge for governments and health systems. Despite progress in legislation, many barriers exist to its full implementation. This study is aimed at identifying these end-of-life barriers in relation to Israel. Methods Qualitative in-depth interviews using professionals and decision makers in the health-care and related systems were carried out, along with two focus groups based on brainstorming techniques consisting of nurses and social workers. Data was managed and analyzed using Naralyzer software. Results Qualitative (...) analysis showed identification of six primary barriers: 1) law, procedures, and forms; 2) clinical aspects; 3) human aspects; 4) knowledge and skills of medical teams; 5) communication; and 6) resource allocation. These were further divided into 44 sub area barriers. Conclusions This study highlights the role of the family doctor in end-of-life by training physicians in decision-making workshops and increasing their knowledge in the field of palliative medicine. Effectively channeling resources, knowledge, and support for medical teams, by accounting for the structure and response of the units for home treatment will improve patient’s access to information on and support for end-of-life laws, as well as reduce legislative barriers in other countries that face the same issues. (shrink)

What words we use, and what meanings they have, is important. We shouldn't use slurs; we should use 'rape' to include spousal rape (for centuries we didn’t); we should have a word which picks out the sexual harassment suffered by people in the workplace and elsewhere (for centuries we didn’t). Sometimes we need to change the word-meaning pairs in circulation, either by getting rid of the pair completely (slurs), changing the meaning (as we did with 'rape'), or adding brand new (...) word-meaning pairs (as with 'sexual harassment'). A problem, though, is how to do this. One might worry that any attempt to change language in this way will lead to widespread miscommunication and confusion. I argue that this is indeed so, but that's a feature, not a bug of attempting to change word-meaning pairs. The miscommunications and confusion such changes cause can lead us, via a process I call transformative communicative disruption, to reflect on our language and its use, and this can be further, rather than hinder, our goal of improving language. (shrink)

This article discusses recent theories of the meaning of generics. The discussion is centred on how the theories differ in their approach to addressing the primary difficulty in providing a theory of generic meaning: The notoriously complex ways in which the truth conditions of generics seem to vary. In addition, the article summarizes considerations for and against each theory.

In Talking about, Unnsteinsson defends an intentionalist theory of reference by arguing that confused referential intentions degrade reference. Central to this project is a “belief model” of both identity confusion and unconfused thought. By appealing to a well‐known argument from Campbell, I argue that this belief model falls short, because it fails to explain the inferential behavior it promises to explain. Campbell's argument has been central in the contemporary literature on Frege's puzzle, but Unnsteinsson's account of confusion provides an opportunity (...) for more clarity about how the argument is best interpreted, and what it shows. (shrink)

This paper is about the relevance of attitude-ascriptions to debates about singular thought. It examines a methodology (common to early acquaintance theorists [Kaplan 1968] and recent critics of acquaintance [Hawthorne and Manley 2012], which assumes that the behaviour of ascriptions can be used to draw conclusions about singular thought. Although many theorists (e.g. [Recanati 2012]) reject this methodology, the literature lacks a detailed examination of its implications and the challenges faced by proponents and critics. I isolate an assumption of the (...) methodology, which I call the tracking assumption: that an attitude-ascription which states that s Φ's that P is true iff s has an attitude, of Φ-ing, which is an entertaining of the content P (with entertain used in a stipulated sense). I argue that the tracking assumption must be rejected, not because it has deflationary consequences, but because it leads to unstable commitments. I also show that there are independent reasons to reject it, because ordinary attitude ascriptions underdetermine even the truth-conditions of the mental-states they ascribe. However, I argue, this does not involve rejecting the claim that attitude-ascriptions express relations between agents and contents. Instead, they state different relations depending on contextual factors other than the nature of the mental-states ascribed. (shrink)

How should knowledge be analyzed? Compositionally, as having constituents like belief and justification, or as an atomic concept? In making arguments for or against these perspectives, epistemologists have begun to use experimental evidence from developmental psychology and developmental linguistics. If we were to conclude that knowledge were developmentally prior to belief, then we might have a good basis to claim that belief is not a constituent of knowledge. In this review, I present a broad range of developmental evidence from the (...) past decade and discuss some of the implications it has for the proper analysis of knowledge. The orthodox perspective from the developmental literature was one where children fail to understand belief and knowledge concepts until later in childhood, with typical asymmetries in belief attribution and knowledge attribution. But what emerges from both a discussion of newer findings and a contextualization of older findings is a picture of development whereby core competence with belief and knowledge concepts emerges much earlier than previously thought that apparent failures in later childhood may be explained by other aspects of development than conceptual development and that there is no clear evidence that knowledge attributions emerge earlier than belief attributions. (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)

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)

Can we feel emotions about abstract objects, assuming that abstract objects exist? I argue that at least some emotions can have abstract objects as their intentional objects and discuss why this conclusion is not just trivially true. Through critical engagement with the work of Dacher Keltner and Jonathan Haidt, I devote special attention to awe, an emotion that is particularly well suited to show that some emotions can be about either concrete or abstract objects. In responding to a possible objection, (...) according to which we can only feel emotions about things that we take to matter to our flourishing, and thus cannot feel emotions about causally inefficacious abstract objects, I explore how abstract objects can be relevant to human flourishing and discuss someemotions other than awe that can be about abstract objects. I finish by explaining somereasons why my conclusion matters, including the fact that it presents a challenge to perceptual theories of emotion and causal theories of intentionality. (shrink)

The so-called ‘mental files theory’ in the philosophy of mind stems from an analogy comparing object-concepts to ‘files’, and the mind to a ‘filing system’. Though this analogy appears in philosophy of mind and language from the 1970s onward, it remains unclear to many how it should be interpreted. The central commitments of the mental files theory therefore also remain unclear. Based on influential uses of the file analogy within philosophy, I elaborate three central explanatory roles for mental files. Next, (...) I outline several common criticisms of the file picture, which have been a source of resistance to the view. Finally, I outline several interpretations of the theory, thus highlighting that the best interpretation of the file-theory's central analogy remains a live issue. (shrink)

In this article, I compare and evaluate R. D. Laing and A. Esterson’s account of schizophrenia as developed in Sanity, Madness and the Family, social models of disability, and accounts of extended mental disorder. These accounts claim that some putative disorders should not be thought of as reflecting biological or psychological dysfunction within the afflicted individual, but instead as external problems. In this article, I consider the grounds on which such claims might be supported. I argue that problems should not (...) be located within an individual putative patient in cases where there is some acceptable test environment in which there is no problem. A number of cases where such an argument can show that there is no internal disorder are discussed. I argue, however, that Laing and Esterson’s argument—that schizophrenia is not within diagnosed patients—does not work. The problem with their argument is that they fail to show that the diagnosed women in their study function adequately in any environment. (shrink)

Simple claims with the verb ‘seem’, as well as the specific sensory verbs, ‘look’, ‘sound’, etc., require the speaker to have some relevant kind of perceptual acquaintance (Pearson, 2013; Ninan, 2014). But different forms of these reports differ in their perceptual requirements. For example, the copy raising (CR) report, ‘Tom seems like he’s cooking’ requires the speaker to have seen Tom, while its expletive subject (ES) variant, ‘It seems like Tom is cooking’, does not (Rogers, 1972; Asudeh and Toivonen, 2012). (...) This contrast has led some theorists to hold that the matrix subject in CR constructions is uniformly interpreted as the perceptual source (p-source) (Asudeh and Toivonen, 2012; Rett and Hyams, 2014). Others, based on examples of CR reports that seem not to require perception of the referent of the matrix subject, have taken the p-source interpretation instead to be non-uniform across CR reports (Landau, 2011; Doran, 2015). We reconsider these theoretical approaches to copy raising in light of new experimental work probing the sensitivity of these requirements to the matrix verb, the embedded ‘like’-clause, and the context. While we find some motivation for a non-uniform p-source analysis, it comes from importantly different cases than those others have relied on. Furthermore, our findings cast doubt on the prevalent assumption that the perceptual requirements of CR reports are to be captured solely by the presence or absence of the p-source interpretation. We suggest that the data motivating a non-uniform p-source view are better captured by an alternative approach, which makes use of a more minimal evidential source role, in place of the perceptual source role. We close by considering the relationship between English copy raising and evidential constructions cross-linguistically. (shrink)

It is widely held by commentators that in the Protagoras, Socrates attempts to explain the experience of mental conflict and weakness of the will without positing the existence of irrational desires, or desires that arise independently of, and so can conflict with, our reasoned conception of the good. In this essay, I challenge this commonly held line of thought. I argue that Socrates has a unique conception of an irrational desire, one which allows him to explain the experience of mental (...) conflict and weakness of the will, while still holding the Socratic thesis that we always do what we think is good. The resulting picture is both psychologically plausible and philosophically distinctive. (shrink)

In the Critique of Practical Reason, Kant argues that morality obliges us to believe in the immortality of the soul and the existence of God. I argue, however, that in two late essays – “The End of All Things” and “On the Miscarriage of all Philosophical Trials in Theodicy” – Kant provides moral counterarguments to that position: these beliefs undermine moral agency by giving rise to fanaticism or fatalism. Thus, I propose, the Kantian position on the justification of religious belief (...) is ultimately antinomial. One ought, moreover, to understand Kant’s considered position concerning the immortality of the soul and the existence of God to be similar to that he proposes concerning the theoretical ideas of reason in the Appendix to the Dialectic of the Critique of Pure Reason: they are necessary as regulative ideas guiding moral action, not endorsed or even postulated as propositions. In other words, they are subject matters not of belief, but of hope. (shrink)

Some assertions give rise to the acquaintance inference: the inference that the speaker is acquainted with some individual. Discussion of the acquaintance inference has previously focused on assertions about aesthetic matters and personal tastes (e.g. 'The cake is tasty'), but it also arises with reports about how things seem (e.g. 'Tom seems like he's cooking'). 'Seem'-reports give rise to puzzling acquaintance behavior, with no analogue in the previously-discussed domains. In particular, these reports call for a distinction between the specific acquaintance (...) inference (that the speaker is acquainted with a specific individual) and the general acquaintance inference (that the speaker is acquainted with something or other of relevance). We frame a novel empirical generalization -- the specific with stage-level generalization -- that systematizes the observed behavior, in terms of the semantics of the embedded 'like'-clause. We present supporting experimental work, and explain why the generalization makes sense given the evidential role of 'seem'-reports. Finally, we discuss the relevance of this result for extant proposals about the semantics of 'seem'-reports. More modestly, it fills a gap in previous theories by identifying which reports get which of two possible interpretations; more radically, it suggests a revision of the kind of explanation that should be given for the acquaintance behavior in question. (shrink)

In recent years there has been a powerful resurgence of settler colonialism as an interpretive framework through which to understand the Israeli-Palestinian conflict. Attached to the burgeoning field of settler colonial studies, this so-called ‘turn’ to settler colonialism has seen Israel-Palestine increasingly compared alongside New World white settler societies like Australia, Canada and the United States. In seeking to undercut the lens of exceptionalism through which the conflict has conventionally been viewed, the settler colonial paradigm has some important counter-hegemonic implications (...) for reframing Israel-Palestine, not least of which is its prescription for decolonization. However, it is paradoxically in the context of decolonization that the limits of the settler colonial paradigm become most apparent. I argue that these limitations are connected to the dominance of Patrick Wolfe’s structural account of settler colonialism, which leaves very little room for transformation, and to the particular connotations settler colonial studies has acquired from the New World contexts in which it is most often articulated. This is particularly the case in Israel-Palestine, where these connotations preclude engagement with the national aspects of the conflict and leave under-examined the unique resonances of the settler/native distinction, which need reckoning with in any serious account of decolonization. (shrink)

Hume’s moral philosophy makes sentiment essential to moral judgment. But there is more individual consistency and interpersonal agreement in moral judgment than in private emotional reactions. Hume accounts for this by saying that our moral judgments do not manifest our approval or disapproval of character traits and persons “only as they appear from [our] peculiar point of view... ” Rather, “we fix on some steady and general points of view; and always, in our thoughts, place ourselves in them, whatever may (...) be our present situation” (T 581-82), in order to “correct” our situated sentiments. This seems to create two serious difficulties for Hume’s theory. First, moral evaluations become inductive, empirical beliefs about what we would feel if we really occupied the imagined common point of view, and hence are the deliverances of causal reason; this contradicts Hume’s claim that the making of a moral evaluation is not an activity of reason but of sentiment. Secondly, given Hume’s thesis that the passions do not represent anything else, he cannot say that our moral evaluations will better represent the object being judged if they are made from the common point of view. This leaves no clear reason to adopt it, rather than making judgments from our real position. Hume says that left to our particular points of view, we will encounter contradictions and be unable to communicate, but it is hard to see why.My interpretation resolves these two difficulties. I argue that every time we reflect upon someone’s character from the common point of view, we feel an actual sentiment of approbation or disapprobation, which may alter and merge with the situated sentiment or may fail to do so, leaving two different feelings about the same character. Furthermore, whenever we make moral evaluations we also simultaneously make objective, causal judgments about the love and hatred, pride and humility that the trait will produce. We routinely take up the common point of view in order to achieve truth and consistency in our causal judgments, to avoid grave practical problems. (shrink)

Surgical training has traditionally involved a lengthy apprenticeship to a series of master surgeons, who teach medical students and residents the techniques of surgery while allowing them to work on patients in the operating room. This article examines surgical training as a structured environment that prepares students for the embodied lessons taught by a surgeon. It argues that even the most seemingly mechanical of surgical techniques contains social lessons when taught by a surgeon within the rich environment of the operating (...) room. (shrink)

Global production networks connect multiple producers involved in fragmented manufacturing processes. Major brands and retailers, considered as lead firms, are under increasing pressure to ensure products made through GPNs are produced sustainably. Theories of governance developed to understand dynamics in outsourced production can provide insight into this issue. However, these theories and related empirical research have often focused on relationships between lead firms and upper-tier suppliers. When manufacturing involves multiple fragmented stages, understanding the role of lead firms becomes more difficult. (...) This article considers new governance roles that lead firms, as buyers, are playing when attempting to promote sustainable practices across all stages of production for buyer-driven industries. The focus is exploring the nature of new governance approaches which lead firms have developed in order to address diverse sustainability challenges found within GPNs, particularly related to lower-tier suppliers. These approaches can involve lead firms working through vertical buyer–seller links or developing new horizontal relationships, which link lead firms with lower-tier suppliers and governance processes in these suppliers’ local productive systems. The findings draw from field research examining how top UK garment retailers provide governance to producers involved in creating cotton garments in India and a review of publicised policies and practices of these retailers related to promoting sustainable production. Five types of governance mechanisms that can involve vertical or horizontal links are identified. Considering the growth of new governance relationships expands previous conceptions of the roles of lead firm governance. (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.

A recent focus on philosophical methodology has reinvigorated ordinary language philosophy with the contention that philosophical inquiry is better served by attending to the ordinary use of language. Taking cues from findings in the social sciences that deploy methods utilizing language, various ordinary language philosophers embrace a guiding mandate: that ordinary language usage is more reflective of our linguistic and conceptual competencies than standard philosophical methods. We analyze two hypotheses that are implicit in the research from which ordinary language approaches (...) take their cues. This pair of optimistic assumptions (a) bind word meanings to properties of their corresponding concepts and (b) regard language as a direct reflection of our underlying cognitive processes and competencies. Polysemy and pragmatics complicate each assumption. Because the ordinary language philosopher’s methodological mandate compels us to consider how individuals process the utterances they encounter in deciphering the communicative intentions of speakers, failing to attend to the import of polysemy and pragmatics in philosophical and empirical methods has the potential to frustrate the aims of their insightful mandate. The significance of those two complications is worked out with the case study of knowledge. (shrink)

This paper asks what it means to say that a disorder is a “real” disorder and then considers whether culture-bound syndromes are real disorders. Following J.L. Austin I note that when we ask whether some supposed culture-bound syndrome is a real disorder we should start by specifying what possible alternatives we have in mind. We might be asking whether the reported behaviours genuinely occur, that is, whether the culture-bound syndrome is a genuine phenomenon as opposed to a myth. We might (...) be wondering whether the condition should rightly be considered a disorder, as opposed to some sort of non-disorder condition. We might want to know whether the culture-bound syndrome is really a distinct disorder, in the sense that scientific classification systems should include it as a separate category, or whether it is just a variant of a universally occurring disorder. I argue that some specific difficulties can arise with determining whether a culture-bound syndrome is a real disorder in each of these three senses. However, the frequent assumption that real disorders will necessarily occur universally, and that those that occur only in certain environments are suspicious is not generally justified. (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 rich historical pastiche of 17th- and 18th-century philosophy, science, and religion."—G. Y. Craig, New Scientist "This book, by a distinguished Italian historian of philosophy, is a worthy successor to the author's important works on Francis Bacon and on technology and the arts. First published in Italian (in 1979), it now makes available to English readers some subtly wrought arguments about the ways in which geology and anthropology challenged biblical chronology and forced changes in the philosophy of history in the (...) early modern era.... [Rossi] shows that the search for new answers about human origins spanned many disciplines and involved many fascinating intellects—Bacon, Bayle, Buffon, Burnet, Descartes, Hobbes, Holbach, Hooke, Hume, Hutton, Leibniz, de Maillet, Newton, Pufendorf, Spinoza, Toland, and, most especially, Vico, whose works are impressively and freshly reevaluated here."—Nina Gelbart, American Scientist. (shrink)

Plato’s attitude towards women in his major political works, the Republic and Laws, is complex. On the one hand, Plato argues that in well-run cities, women should hold positions of rule; but on the other, he suggests that women are inferior to men with respect to virtue. To reconcile these conflicting attitudes, some scholars argue that Plato’s progressive proposals are about women as they could be given the right education and environment, while his derogatory comments are about women as they (...) are. Surprisingly, however, commentators who defend this line of thought fail to identify which aspect or aspects of women’s current social position is the problem. I argue that a central problem is women’s role in the private family. More specifically, I argue that Plato thinks the institution of the private family and household is an impediment to virtue; since the private family and household is the primary domain of women, they will be particularly susceptible to its ill effects. In short, individuals’ characters are shaped by the institutions they inhabit; the private family and household is a character-shaping institution that is the primary domain for women, and as a result their characters will be shaped for the worse. (shrink)

This paper puts Jane Bennett’s vital materialism into dialogue with Luce Irigaray’s ontology of sexuate difference. Together these thinkers challenge the image of dead or intrinsically inanimate matter that is bound up with both the instrumentalization of the earth and the disavowal of sexual difference and the maternal. In its place they seek to affirm a vital, generative materiality: an ‘active matter’ whose differential becomings no longer oppose activity to passivity, subject to object, or one body, self or entity to (...) its ‘other’. For both thinkers, displacing the hylomorphic conceptual structures that have tended to dominate western metaphysical thought is inseparable from critiquing the model of the individual subject as bounded, autonomous and self-identical. Such individualism is countered by the relational ontologies figured in Bennett’s ‘distributed agencies’ and Irigaray’s ‘placental economy’, and by a shared attentiveness to the capacities of the human body to bear others within. Nonetheless, this paper argues that each thinker renders this ‘other within’ in very different ways. On the one hand, Bennett’s approach complements and expands Irigaray’s notion of the elemental by affording a greater attentiveness to inorganic and non-sexuate matters. On the other, Irigaray’s conception of generative relationality and the ontological priority of the in-between allows us to think such material entanglements in ways that more fully displace the twinned logics of individualism and instrumentalization. Her project thereby affirms the relational and irreducible differences on which the ‘vitality’ of a vital materiality depends. If there is no more “earth” to press down/repress, to work, to represent, but also and always to desire, no opaque matter which in theory does not know herself, then what pedestal remains for the ex-sistence of the “subject”? If the earth turned and more especially turned upon herself, the erection of the subject might thereby be disconcerted and risk losing its elevation and penetration. For what would there be to rise up from and exercise his power over? And in? Irigaray, Speculum of the Other Woman Jane Bennett has recently argued that “the image of dead or thoroughly instrumentalized matter feeds human hubris and our earth-destroying fantasies of conquest and consumption”, continuing that: “The figure of an intrinsically inanimate matter may be one of the impediments to the emergence of more ecological and more materially sustainable modes of production and consumption”.11J. Bennett, Vibrant Matter: A Political Ecology of Things, Durham and London: Duke University Press, 2010, ix. Henceforth VM. View all notes This insight is prefigured and re-affirmed by the work of Irigaray. Her sustained analysis of western thought and culture shows how its constitutive disavowal of sexual difference and the maternal is inextricably bound up with an equally deep-rooted disavowal of matter and corporeality. As the above passage from Speculum suggests,22L. Irigaray, Speculum of the Other Woman, trans. G. Gill, Ithaca: Cornell University Press, 1985, 133. Henceforth S. View all notes Irigaray seeks to expose woman's reduction to an object for a subject and a maternal-material resource for man's speculations; but in disentangling woman from her symbolic identification with the earth, she also seeks to release the earth from its identification with a passive and manipulable matter. Her work thus bears directly on the revaluation required to transform human beings' relations to materiality: both their own, and that of the earth they inhabit. At the centre of this revaluation is Irigaray's work to displace the image of dead or intrinsically inanimate matter that Bennett also critiques, and to affirm instead a sexuate materiality that is both living and generative. Her consistent troubling of hylomorphism is as unsettling for the subject as her question: “But what if the ‘object’ started to speak?” This question is echoed in Bennett's concern with “the moment when the object becomes the Other, when the sardine can looks back, when the mute idol speaks”.33 VM, 2, citing W.J.T. Mitchell, What Do Pictures Want?, Chicago, Chicago University Press, 2005, 157. View all notes As this passage indicates, Bennett's own project is more concerned with the agency of non-human materialities – including their role in the constitution of the human – than with specifically sexed bodies or a materiality inflected by sexual difference. It is these crucial differences in emphasis, I will suggest, that allow the work of these two thinkers to be brought together in productive dialogue. On the one hand, Bennett's approach affords a greater attentiveness to inorganic and non-sexuate matter; on the other, Irigaray's twinned ontology of sexual difference and maternal relation is better able to affirm the relational differences on which the “vitality” of a vital materiality depends. The paper begins by outlining several key elements of Irigaray's philosophy of sexual difference to show how it leads necessarily to a rethinking of matter. This rethinking is especially helpful for shifting away from the hylomorphism that has been a dominant strand in western thought, informing an understanding of the earth as a fundamentally inert and ever-ready resource. As I will show, the figures through which Irigaray re-articulates female specificity also allow her to refigure the earth as active matter that “turns upon herself ” in generative flux. In the second section, I will situate Irigaray's re-thinking of matter in relation to Bennett's “vital materiality”.44Bennett can be aligned with a number of thinkers who have come to be grouped under the heading “new materialisms”. See S. Alaimo and S. Hekman, eds., Material Feminisms, Bloomington & Indianapolis: Indiana University Press, 2008; D. Coole and S. Frost, eds., New Materialisms: Ontology, Agency, and Politics, Durham and London: Duke University Press, 2010. View all notes An advantage of this concept is that it refuses the separation between humans and matter still implicit in concepts such as “the environment”. By attending to “our own constitution as vital materiality”, as well as the ways our “own” bodies are never “fully or exclusively human”, Bennett adjusts the status of human actants while re-evaluating non-human bodies “as actants rather than as objects”. As I will show, her approach provides a constructive critical perspective on Irigaray's work by drawing attention to the specifically non-sexuate nature of the elemental. Equally, however, Irigaray's insistence on sexuate difference problematises any appeal to a generic notion of “the human”. This is especially helpful, I will suggest, in relation to contemporary descriptions of climate change as “anthropogenic”. By homogenising human beings, such descriptions make it more difficult to address the ways in which current ecological problems are inseparable from global patterns of social, political and economic inequity. For both thinkers, challenging hylomorphism needs to be matched with a critique of the dominant modern model of the subject as bounded, autonomous and self-identical. And for both, this model is displaced and undone by the capacity of the human body to bear others within, in ways that engender and sustain human life. Yet as I will discuss in the final two sections, each thinker renders this “other within” in very different ways, with significant implications for the ethics and politics of a “vital materiality”. In the end it is Irigaray's rendering of a distinctively female capacity to bear an other within, explored via the generative relationality of a placental economy, that more fully escapes the individualism of the One and the Same. Together, Irigaray and Bennett show that to take seriously the ecological crises that currently confront us means overcoming the disavowal of both human beings' own fundamental materiality and our dependency on the sustaining materialities of the earth. In contrast, a dominant strand in contemporary responses to these crises is an environmental politics of “enlightened self-interest”55I borrow this phrase from H. Kopnina's critical discussion in “Forsaking Nature? Contesting ‘Biodiversity’ Through Competing Discourses of Sustainability”, Journal of Education for Sustainable Development 7, no. 1 : 51–63. that precludes any serious re-evaluation of human beings' relations to matter and the earth. If human beings can be persuaded that current levels of environmental degradation are damaging to them, threatening perhaps their very survival, they are more likely to take decisive steps to alter their behaviour. Insofar as such approaches demand action only for the sake of human interests and ends, they are both anthropocentric and spring from the same instrumentalising rationality that has engendered the ecological crises we currently face. They may well be successful in prompting action. But by foregrounding the survival of “the human species” per se, such approaches foreclose discussion of whose interests are served if survival is all that is allowed to be at stake, and whose lives are thereby consigned to ongoing exploitation. Moreover, as I will argue below, the instrumental rationality that serves survival is at odds with an affirmation of life, as a becoming that depends on difference. With this in mind, I will problematise Bennett's proposed politics of “expanded self-interest”, while seeking to retain many of the insights her approach brings. To more fully displace the “rational” self-interest that has encouraged human exploitation of the earth, we might take up Bennett's “vital materiality” in ways informed by Irigaray's conception of generative difference and the relational space-time of the in-between. (shrink)

The postwar welfare state provides social insurance against economic, health, and related risks in an uncertain world. Because everyone can envision themselves to be among the unfortunate, social insurance fuses self-interest and solidarism in a normative principle Friedman (2020) calls probabilistic justice. But there is a competing principle of status defense, where the aim is to erect boundaries between socioeconomic strata and discourage cross-class mobility. We argue that this principle dominates when inequality is high and uncertainty low. The current moment (...) is one of high inequality and high uncertainty, which results in intense status anxiety, yet does not rule out solidaristic solutions. Our contributions are to diagnose the causes of our current malaise, and to theorize the normative bases for the political choice facing contemporary western democracies. (shrink)

Debates continue to surround the system in the United States for allocating transplantable cadaveric organs, due in large part to the scarcity of such organs in relation to the number of individuals waiting to undergo transplantation. Candidates awaiting transplantation gain access to cadaveric organs by being placed by individual transplant programs on the national list of the Organ Procurement and Transplantation Network, overseen by the United Network for Organ Sharing. In recent years, the UNOS board has visited the issue of (...) multiple listing, that is, allowing one candidate to be registered on the waiting lists of two or more transplant programs, and has continued to permit multiple listing. (shrink)

The author shares her insights into the kabbalistic Judaism of her grandfather, serving up a series of inspiring stories about spiritual life.

The possible integration of genomic sequencing (including whole‐genome and whole‐exome sequencing) into the three contexts addressed in this special report—state‐mandated screening programs, clinical care, and direct‐to‐consumer services—raises related but distinct legal issues. This essay will outline the legal issues surrounding the integration of genomic sequencing into state newborn screening programs, parental rights to refuse and access sequencing for their newborns in clinical and direct‐to‐consumer care, and privacy‐related legal issues attending the use of sequencing in newborns.

The comorbidity of chronic pain and opioid addiction is a serious problem that has been growing with the practice of prescribing opioids for chronic pain. Neuroimaging research has shown that chronic pain and opioid dependence both affect brain structure and function, but this is the first study to evaluate the neurophysiological alterations in patients with comorbid chronic pain and addiction. Eighteen participants with chronic low back pain and opioid addiction were compared with eighteen age- and sex-matched healthy individuals in a (...) pain-induction fMRI task. Unified structural equation modeling (SEM) with Lagrange multiplier (LM) testing yielded a network model of pain processing for patient and control groups based on 19 a priori defined regions. Tests of differences between groups on specific regression parameters were determined on a path-by-path basis using z-tests corrected for the number of comparisons. Patients with the chronic pain and addiction comorbidity had increased connection strengths; many of these connections were interhemispheric and spanned regions involved in sensory, affective, and cognitive processes. The affected regions included those that are commonly altered in chronic pain or addiction alone, indicating that this comorbidity manifests with neurological symptoms of both disorders. Understanding the neural mechanisms involved in the comorbidity is crucial to finding a comprehensive treatment, rather than treating the symptoms individually. (shrink)

Prior to the genomic sequencing era, the bible for those working in clinical genetics was McKusick’s Mendelian Inheritance in Man, which appeared in multiple editions between the 1960s and the late 1990s. This catalogue was organized according to general patterns of inheritance and focused on phenotypes. Beginning in the mid-1980s, it was replaced by Online Mendelian Inheritance in Man, a continuously updated catalogue documenting molecular relationships between genetic variation and phenotypic expression. This paper explores this resource’s evolution with attention to (...) how disease is distinguished from clinically irrelevant variation and how phenotypic similarities are captured in cases where there is no obvious genotypic association. It is argued that hybrid compromises are encoded into OMIM®; in addition to serving its key original purpose of being a diagnostic catalogue, it also began to record detectable variations in the genome even if they were not known to be associated with phenotypically visible disorders or even phenotypic variations. Although the impacts of geneticization have been well recognized, particularly in popular media, this example allows exploration of some of the historic, epistemic, and methodological causes that underlie tendencies toward disease geneticization in contemporary medicine, while highlighting that such gene-focused strategies may in fact be warranted in some contexts. (shrink)

There are many points on which I agree with Kayali Browne. I agree that value judgments necessarily play a role in constructing a classification such as the Diagnostic and Statistical Manual of Mental Disorders. I agree that people with different backgrounds and interests are likely to assess problems differently and that it would be a good idea for a more diverse body of people to have some involvement in revising the DSM. I agree that philosophers might usefully play a role (...) when the DSM is being revised.Overall, however, I am not convinced that Kayali Browne's committee would be a good idea. In her vision, such a committee would constitute a group of wise moral experts who would help to make the... (shrink)