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 Covid‐19 pandemic has revealed myriad social, economic, and health inequities that disproportionately burden populations that have been made medically or socially vulnerable. Inspired by state and local governments that declared racism a public health crisis or emergency, the Anti‐Racism in Public Health Act of 2020 reflects a shifting paradigm in which racism is considered a social determinant of health. Indeed, health inequities fundamentally rooted in structural racism have been exacerbated by the Covid‐19 pandemic, which calls for the integration of (...) antiracist praxis to promote ethical public health research processes. This commentary describes ways in which antiracist praxis—which emphasizes empowerment of traditionally marginalized populations—offers strategies to explicitly address power imbalance, stigmatization, and other consequences of structural racism in public health research. (shrink)

BackgroundSchool violence and bullying are prevalent problems that affect health in general, especially through the development of emotional and behavioral problems, and can result in the deterioration of the academic performance of the student victim. The objective of this study was to determine the prevalence rates of aggressive behaviors according to types of school violence and bullying, sociodemographic characteristics, and variation by department, region, and time in the period between 2014 and 2018 in Peru.MethodsThe design was observational and cross-sectional based (...) on data from the Specialized System for Reporting Cases of School Violence in Peru, which covers a population of 23,641 students at the initial, primary, and secondary levels of Basic Regular Education [Educación Básica Regular ], for the 2014–2018 period. The prevalence rates of the different types of school violence and bullying, the sociodemographic characteristics, and the variation by department, region, and time in the period between 2014 and 2018 were estimated.ResultsPsychological violence/bullying occurred at higher prevalence rates. Women from public institutions reported greater sexual violence, mostly by teachers than by other students. The Selva region had the highest prevalence rate of sexual violence. The departments of Tacna and Piura had the highest and lowest rates of psychological/verbal violence and bullying in 2018.ConclusionPsychological/verbal violence and bullying is highly prevalent among students; women report being victims of sexual violence by administrative personnel of public institutions. The Selva region had the highest rate of sexual violence, and Piura and Tacna had the highest and lowest rates of violence and psychological/verbal bullying. Based on these results, it is suggested to conduct evidence-based prevention programs in Peruvian schools to reduce these social problems. (shrink)

This richly suggestive book challenges many of our fundamental assumptions about ourselves and our world."—Mark C. Taylor, New York Times Book Review "Dazzling analysis. . .

The proliferation of news and information sources has motivated a need to identify those providing legitimate journalism. One temptation is to go the route of such fields as medicine and law, namely to formally professionalize. This gives a clear method for determining who is a member, with an array of associated responsibilities and rewards. We argue that making such a formal move in journalism is a mistake: Journalism does not meet the traditional criteria, and its core ethos is in conflict (...) with the professional mindset. We thus shift the focus from whether the person is journalist to whether the work satisfies the conditions that characterize legitimate journalism. In explaining those conditions we also look at mechanisms for enhancing the power of persons doing journalism, drawing upon lessons from the labor movement. We also consider a self-declaration model while urging increased literacy from all participants in the news gathering and consuming enterprise. (shrink)

Each of us has written about the importance of reframing the debate over public health paternalism. Our individual explorations of the many and varied paths forward from libertarian “nanny state” objections to the “new public health” have been intimately informed by collaboration. This article represents a summary of our current thinking — reflecting the ground gained through many fruitful exchanges and charting future collaborative efforts.Our starting point is that law is a vitally important determinant of population health, and the interplay (...) among law, social norms, cultural beliefs, health behaviors, and healthy living conditions is complex. Anti-paternalists’ efforts to limit the scope of public health law to controlling only the proximal determinants of infectious diseases are utterly unjustifiable in the face of so much preventable death, disability, and disparity. Equally important, the anti-paternalism push is deeply counter-majoritarian and undemocratic, threatening to disable communities from undertaking measures to improve their own well-being. (shrink)

Like all human activities, scientific research is infused with values. Scientific discovery can, for example, be valued as an end in itself. The phrase ethical values is an umbrella term for much of what people care about aside from knowledge for its own sake. Ethical values encompass reasons for caring about the harms caused by climate impacts or the injustice of how those harms are distributed. The closer that research gets to informing real-world actions, the more the design of that (...) research can be examined from the perspective of ethical values. Which societal challenges does the research aim to inform? From whose perspective does a policy analysis view potential outcomes? In this chapter we use a series of examples to illustrate how researchers’ choices regarding the treatment of uncertainties can have important consequences from the perspective of ethical values. Our aims in this chapter are: to familiarize readers with the key concept of coupled ethical–epistemic choices; to build capacity for recognizing such choices within the treatment of uncertainties; to encourage engagement with ethical values as a part of climate change research; and to offer some guidance on how to start doing so. (shrink)

From the mid nineteenth to mid twentieth century sanatoria loomed large in the popular consciousness as the space for the treatment of tuberculosis (TB). A review of the historiography of sanatoria at the beginning of this paper shows that the nursing contribution to the care of TB patients is at best ignored and at worst attracts negative comment. Added to this TB nursing was not viewed as prestigious by contemporaries, leading to problems attracting recruits. Using a case study approach based (...) on surviving archival material, this paper sets out to provide a glimpse of the work of TB nurses in a rural sanatorium at Westwood, Queensland, Australia. For the nurses geographical isolation was compounded by professional stagnation, which created a working environment influenced by friction and discord among the staff. It reveals how despite this, nurses coped with working in hostile conditions, to make the long stay of their patients, separated from their families and familiar life style more bearable. (shrink)

Nursing faces an uncertain future as technological developments, structural changes within health systems and rapidly evolving health needs create new and challenging possibilities. This article draws on the results of a qualitative study undertaken with a range of Queensland nurse leaders to explore their perceptions of these changes. The study re‐surfaced, and allows for a re‐examination of, four issues that have long created tension within nursing and which continue to have a negative impact on the profession as a whole. These (...) are as follows: professionalisation; preparation of graduates; myths and narratives of nursing; and leadership. We provide a metaphor that imagines all of these tensions operating in dynamic interplay. The image is that of a Newton's Cradle – a model for energy and momentum. The metaphor allows one to see the wide context of changes affecting nursing and the significance of the interconnections. If tensions within nursing maintain their own integrity through containment, understanding and development, they remain in alignment, and energy is conserved rather than wasted or misdirected. It suggests that with increased awareness and attention paid to internal challenges, and by taking a broad‐based approach to systemic improvements, nursing could become more effective, progressive and proactive in shaping its own future. (shrink)

Clinical trials play a crucial role in generating evidence about healthcare interventions and improving outcomes for current and future patients. For individual trial participants, however, there are inevitably trade‐offs involved in clinical trial participation, given that trials have traditionally been designed to benefit future patient populations rather than to offer personalised care. Failure to understand the distinction between research and clinical care and the likelihood of benefit from participation in clinical trials has been termed the ‘therapeutic misconception’. The evolution of (...) the clinical trials landscape, including greater integration of clinical trials into healthcare and development of novel trial methodologies, may reinforce the significance of the therapeutic misconception and other forms of misunderstanding while at the same time (paradoxically) challenging its salience. Using cancer clinical trials as an exemplar, we describe how methodological changes in early‐ and late‐phase clinical trial designs, as well as changes in the design and delivery of healthcare, impact upon the therapeutic misconception. We suggest that this provides an impetus to re‐examine the ethics of clinical research, particularly in relation to trial access, participant selection, communication and consent, and role delineation. (shrink)

While ethics and evidence‐based medicine are often viewed as separate domains of inquiry and practice, what we know influences what we can ethically justify doing, and what we see as our moral obligations shapes the way we interpret evidence. The boundaries between the moral and epistemic spheres become particularly blurred when the health of people is at stake and even more so when no “officially” recommended medical intervention is available to help a patient in need. The treatment of major hemorrhages (...) using recombinant factor VIIa (rFVIIa), which was originally approved under orphan drug legislation to treat hemophilia, is a case in point.Following reports in the late 1990s that rFVIIa was success­fully used to stop bleeding in gunshot trauma, there was much excitement about its potential to help patients with uncontrolled bleeding in other clinical settings, leading to wide‐spread off‐label use of the drug. In recent years, new evidence has raised questions about the off‐label use of rFVIIa for severe bleeding. Nonetheless, while some clini­cians are now adamantly opposed to prescribing rFVIIa for massive bleed­ing, many remain determined to continue the practice. This raises the question: why do clinicians have such variable responses to the same body of evidence?We analyzed the debate around off‐label use of rFVIIa and character­ized its main conceptual features and tensions. We did not seek to provide a normative analysis as to whether the evidence supports the case for off‐label prescribing, nor did we try to provide a historical analysis of how attitudes and clinical practice have changed. Rather, we sought to make visible the moral and epistemic values underpinning stakeholders’ opinions and practices. On the basis of our analysis, which is described in this ar­ticle, we suggest that debates such as those surrounding rFVIIa will not be resolved simply by conducting more studies and that, therefore, there is also a need for conceptual and pro­cedural frameworks that more sys­tematically incorporate values into clinical policy‐making. (shrink)

The analysis and understanding of multilingualism, and its relationship to identity in the face of globalization, migration and the increasing dominance of English as a lingua franca, makes it a complex and challenging problem that requires insights from a range of disciplines. With reference to a variety of languages and contexts, this book offers fascinating insights into multilingual identity from a team of world-renowned scholars, working from a range of different theoretical and methodological perspectives. Three overarching themes are explored – (...) situatedness, identity practices, and investment – and detailed case studies from different linguistic and cultural contexts are included throughout. The chapter authors' consideration of 'multilingualism-as-resource' challenges the conception of 'multilingualism-as-problem', which has dogged so much political thinking in late modernity. The studies offer a critical lens on the types of linguistic repertoire that are celebrated and valued, and introduce the policy implications of their findings for education and wider social issues. (shrink)

While Sarah Hoagland's conception of a lesbian ethic offers a promising route toward articulating an ethics of resistance, her notion of self in community does not provide a conception of "subject" capable of both embracing political action as fundamental to personal life and explicitly recognizing cultural, ethnic, and sexual multiplicity as central to ethical decision-making. Such a notion can be found, however, in the remarks of later Wittgenstein concerning the "language games" of describing.

The aim of the following paper is, firstly, to provide the reader with a brief exposition of the critical response offered by some current french feminists of the largely American, compensatory approach to feminist historiography. Secondly, I wish to show why the french feminist alternative itself provides an inadequate methodology for the resolution of the problems that it raises in its critique. Lastly, I shall suggest that the Wittgensteinian concept of ‘family resemblance’ contains the seeds of a plausible alternative to (...) either the compensatory or the french structuralist approach to feminist historiography. The upshot of this latter claim is that the historical subject may be most fruitfully conceived genealogically, that is, as the dynamic product of an inexhaustible complex of historical and contextual resemblances constructed on the behalf of a specific interpretational task. (shrink)

I argue for a Wittgensteinian reading of Judith Butler's performative conception of identity in light of Marilyn Frye's analysis of lesbian as nonexistent and Butler's analysis of abject. I suggest that the attempt to articulate a performative lesbian identity must take seriously the contexts within which abjection is vital to maintaining gender, exposing the intimate link between context and the formulation of intention, and shedding light on possible lesbian identities irreducible to abjection.

I argue for a Wittgensteinian reading of Judith Butler's performative conception of identity in light of Marilyn Frye's analysis of lesbian as nonexistent and Butler's analysis of abject. I suggest that the attempt to articulate a performative lesbian identity must take seriously the contexts within which abjection is vital to maintaining gender, exposing the intimate link between context and the formulation of intention, and shedding light on possible lesbian identities irreducible to abjection.

Intensive care nurses, like professionals in other intense occupations characterized by high degrees of uncertainty, manage the emotions that result from their work both on and off the job. We focus on the job strategies – calling‐in, sharing their experiences with others and engaging in a range of activities oriented to emotional recovery – that 37 intensive care nurses use to manage their emotions off the job. These strategies show how the social organization and division of labor in intensive care (...) units influences nurses' emotional management outside of them and how organizational troubles for hospitals becomes personal ones for staff. They further support theoretical approaches that view emotions as dynamic elements belonging to individuals rather than aspects of people that can be fully appropriated by organizations. (shrink)

: I argue for a Wittgensteinian reading of Judith Butler's performative conception of identity in light of Marilyn Frye's analysis of lesbian as nonexistent and Butler's analysis of abject. I suggest that the attempt to articulate a performative lesbian identity must take seriously the contexts within which abjection is vital to maintaining gender, exposing the intimate link between context and the formulation of intention, and shedding light on possible lesbian identities irreducible to abjection.

Purpose‐driven businesses have a stated objective to contribute to the welfare of society and the planet alongside generating shareholder value. As interest in purpose‐driven businesses grows, an emerging “purpose ecosystem” of advisers, investors, and enablers offers different types of support for businesses wanting to transition to sustainability. This paper examines how the transition towards purpose‐driven business in Australia and the United Kingdom requires addressing challenges facing this support ecosystem at three levels. First, at the individual level where support providers need (...) to build the capabilities of managers who are experiencing tensions around integrating societal and environmental purpose while facing pressure for maximizing shareholder value. Second, the support providers working within the purpose ecosystem offering professional advice and finance face their own tensions between environmental or social objectives and commercial pressures. Third, there are challenges facing actors in the ecosystems aiming to change the wider policy and institutional environment but facing lobbying from those wanting to keep “business as usual.” We identify practical implications for those parts of the purpose‐driven business ecosystem providing support. This includes building capabilities to combine social, environmental, and commercial purpose; coordination among support providers; and creating an institutional environment to avoid “purpose wash.”. (shrink)

In the following essay, I argue for an alternative anthropocentrism that, eschewing failed appeals to traditional moral principle, takes (a) as its point of departure the cognitive, perceptual, emotive, somatic, and epistemic conditions of our existence as members of Homo sapiens, and (b) one feature of our experience of/under these conditions particularly seriously as an avenue toward articulating this alternative, the capacity for aesthetic appreciation. To this end, I will explore, but ultimately reject philosopher Allen Carlson's ecological aesthetics, and I (...) will adopt with modification aspects of the work of Ronnie Hawkins, Val Plumwood, and Donna Haraway. My central claim is that, equipped with a better understanding of our interdependent relationship to/within human and nonhuman nature, an understanding made especially available to those who occupy situations imbued by subjugation, we can come to understand our human-centeredness not as a justification of entitlement, but as an opportunity for critical self-reflection upon those actions which endanger the ecological conditions of human and nonhuman being. I suggest, then, that developing criteria for an aesthetic appreciation ground in such a centeredness can make a vital contribution to a more ecologically defensible moral and political activism. (shrink)

Following the confirmation of U.S. Supreme Court Justice Brett Kavanaugh in one of the most sensational jurisprudence events of the modern era, we examine potential repercussions across multiple themes in public health, law, and policy stemming from his ideology and the confirmation process.

While earlier research considered Simone de Beauvoir in the perspectives of Existentialism or Feminism, this work is the first to emphasize her reflective and descriptive approach and the full range of issues she addresses. There are valuable chapters and sections that are historical and/or comparative, but most of the contents of this work critically examine Beauvoir's views on old age (whereon she is the first phenomenologist to work), biology, gender, ethics, ethnicity (where she is among the first), and politics (again (...) among the first). Besides their systematic as well as historical significance, these chapters show her philosophy as on a par with those of Merleau-Ponty and Jean-Paul Sartre in quality, richness and distinctiveness of problematics, and the penetration of her insight into collective as well as individual human life within the socio-historical world. (shrink)