In lieu of an abstract, here is a brief excerpt of the content:Translating Care for the Voiceless PatientLeo AlmazanUndocumented immigrants do not have the luxury of having a professional interpreter by their bedside to help them navigate the complexities of their often-dire situation. Most of the time, they have to rely on the kindness of volunteers or untrained medical personnel to help them. In 2001, I was a non-clinical student in training at a level 1 trauma hospital in the Midwest. (...) The night in question, one of the residents asked me to go to the infectious diseases unit to translate for a newly admitted undocumented patient. [End Page 152]The patient was in his early twenties. This was the second time he had arrived in the US after walking through the desert. His diagnosis was dire—he drank stagnant water during his journey, and he had acquired an aggressive type of infection whose origin (viral? bacterial?) the specialists could not as yet determine. After initial testing, the doctors discovered that he was also suffering from full-blown AIDS.When I entered the room where the young man was lying, shaking violently due to a high fever, I felt deep anger and profound sadness. People looked at the young man with a mixture of disdain and anger. He was, after all, "wasting" the hospital's precious resources. At the same time, his immediate reaction after hearing me speak to him in his native language and sensing that I understood him, that is, that I could empathize with his fears, made me decide that I would do whatever I could to help him.After a brief initial conversation, it became painfully clear that he neither had any formal education nor did he understand the gravity of his medical condition, aggravated by AIDS. Besides that, he did not comprehend what was being done to him, which included the use of experimental drugs that he had not consented to take.My task then morphed from an untrained translator trying to help someone understand a foreign language to a new ally trying to help someone navigate the short-, mid-, and long-term life-altering decisions he would have to make without full knowledge or understanding of his actual circumstances. In short, I quickly transition from interpreter to advocate.It was probably the result of the stress and pressure I suddenly found myself experiencing, but I remember thinking back to my high school etymologies class and realizing that the verb "to advocate," from ad-vocare, means to support, defend, or protect someone. "When did I commit to any of those things?" I thought to myself. And then I immediately remember thinking, "Not at all! I did not commit to any of those things! All I said "yes" to was to lend my voice for a couple of minutes so that a doctor and a patient could understand each other. I surely did not intend to lend my voice to someone who has no voice!"A second and even bigger surprise for me, however, was that, in the process of translating, I could hear what the young man and the physician were truly saying to each other. In other words, as my mouth moved to speak, now in Spanish and now in English, I was able to capture and translate not only the words being said but also the feelings and emotions and the deeper meaning of what was being communicated. For example, when the young man asked, "¿Voy a estar bien?" ["Am I going to be OK?"] I could "hear" his real question, "Am I dying?" When the doctor said, "Your CD4+ cell count is less than 200," I heard him say, "Couldn't you have chosen another place to die?" Conscious of my role, however, I limited myself to performing my duties as professionally and precisely as possible.The following day, I consulted with a professional interpreter who worked at the same hospital, and I asked her how I could be more helpful to the young man. As she advised me how to proceed, I could tell she was truly torn.On the one hand, she wanted me to proceed with the outmost professionalism, to remain "neutral," "objective," and to avoid, at all... (shrink)

In recent years, many states in the United States have passed legislation requiring laboratories to report the names of patients with low CD4 cell counts to their state Departments of Health. This name reporting is an integral part of the growing number of “HIV Reporting and Partner Notification Laws” which have emerged in response to recently revised guidelines suggested by the National Centers for Disease Control (CDC). Name reporting for patients with low CD4 cell counts allows for a more accurate (...) tracking of the natural history of HIV disease. However, given that this test is now considered to be an “indicator” of HIV, should it be subject to the same strict consent required for HIV testing? While the CDC has recommended that each state develop its own consent requirements for CD4 cell testing, most states have continued to rely on the presumed consent standards for CD4 cell testing that were in place before the passage of name reporting statutes. This allows physicians who treat patients who refuse HIV testing to order a CD4 cell blood analysis to gather information that is indicative of their patient’s HIV status. This paper examines the ethical and legal issues associated with the practice of “conscientious subversion” as it arises when clinicians use CD4 cell counts as a surrogate for HIV testing. (shrink)

The bitter, public contest for priority over the discovery of the virus that causes AIDS was officially closed in 1987 with equal credit being awarded to two parties from opposite sides of the Atlantic. One was led by Robert C. Gallo of the Laboratory of Tumor Cell Biology at the National Cancer Institute in the United States and the other was led by Luc Montagnier of the viral-oncology unit at the Pasteur Institute in France. Using citation counts from articles published (...) by the scientific community, a process of alloca tion of credit is examined and compared with this official settlement. A novel pattern emerges. It is found that the scientific community began to redistribute priority when the dispute became highly publicized and took little notice of the official settlement. This, along with the fact that Gallo has now officially been charged with misconduct by an investigative committee, may mean that Montagnier's team may eventually receive sole creditfor the discovery of the AIDS virus. The importance of examining priority disputes from many different angles and the potential for citation analysis in such cases are highlighted. (shrink)

Memory for numbers improves with age. One source of this improvement may be learning linear spatial-numeric associations, but previous evidence for this hypothesis likely confounded memory span with quality of numerical magnitude representations and failed to distinguish spatial-numeric mappings from other numeric abilities, such as counting or number word-cardinality mapping. To obviate the influence of memory span on numerical memory, we examined 39 3- to 5-year-olds’ ability to recall one spontaneously produced number (1-20) after a delay, and the relation between (...) numeric recall (controlling for non-numeric recall) and quality of mapping between symbolic and non-symbolic quantities using number-line estimation, give-a-number estimation, and counting tasks. Consistent with previous reports, mapping of numerals to space, to discrete quantities, and to numbers in memory displayed a logarithmic-to-linear shift. Also, linearity of spatial-numeric mapping correlated strongly with multiple measures of numeric recall (percent correct and percent absolute error), even when controlling for age and non-numeric memory. Results suggest that linear spatial-numeric mappings may aid memory for number over and above children’s other numeric skills. (shrink)

Background: The prevalence of anxiety and depression in young students is associated with biosocial factors and scholastic stress. However, few studies have evaluated emotional-affective symptoms that are related to the immune system and antioxidant parameters in young individuals without diagnoses of affective disorders.Aim: This study aims to assess the relationship between emotional-affective symptoms and glutathione concentrations and CD4 and CD8 lymphocyte counts in college students.Methods: College students completed standardized psychometric instruments, including the Perceived Stress Scale, Hamilton Anxiety Scale, Beck Depression (...) Inventory, Familiar Social and Friends Support Scale, and Rosenberg Scale. Blood samples were biochemically analyzed. Analyses of variance were conducted between four groups according to symptom severity.Results: A considerable prevalence of stress, anxiety, and depression symptoms was observed and negatively correlated with self-esteem and socio-familiar support. Perceived stress was sexually dimorphic. Although biochemical parameters were within reference ranges, glutathione, CD4, and CD8 tended to be lower in participants with anxiety and depression symptoms, which may be of predictive value.Conclusion: The relationship between antioxidant/immune parameters and socio-affective scores is latent in undiagnosed college students who might develop affective disorders. The findings suggest that during the initial development of affective disorders, stress management strategies should be implemented to help college students cope with the academic load and monitor negative changes in their physiological state. (shrink)

This paper examines cumulative ethical and self-interested reasons why wealthy developed nations should be motivated to do more to improve health care in developing countries. Egalitarian and human rights reasons why wealthy nations should do more to improve global health are that doing so would (1) promote equality of opportunity, (2) improve the situation of the worst-off, (3) promote respect of the human right to have one's most basic needs met, and (4) reduce undeserved inequalities in well-being. Utilitarian reasons for (...) improving global health are that this would (5) promote the greater good of humankind, and (6) achieve enormous benefits while requiring only small sacrifices. Libertarian reasons are that this would (7) amend historical injustices and (8) meet the obligation to amend injustices that developed world countries have contributed to. Self-interested reasons why wealthy nations should do more to improve global health are that doing so would (9) reduce the threat of infectious diseases to developed countries, (10) promote developed countries' economic interests, and (11) promote global security. All of these reasons count, and together they add up to make an overwhelmingly powerful case for change. Those opposed to wealthy government funding of developing world health improvement would most likely appeal, implicitly or explicitly, to the idea that coercive taxation for redistributive purposes would violate the right of an individual to keep his hard-earned income. The idea that this reason not to improve global health should outweigh the combination of rights and values embodied in the eleven reasons enumerated above, however, is implausibly extreme, morally repugnant and perhaps imprudent. (shrink)

HIV/AIDS is the leading cause of morbidity and mortality in the southern African country of Malawi. At the largest referral health facility in Blantyre, the Queen Elizabeth Central Hospital, the majority of patients hospitalized in medical wards and up to a third of those in the maternity unit are infected with HIV. Many patients in the surgical wards also have HIV/AIDS. Health professionals in Blantyre, however, often choose not to write down the diagnosis of HIV or AIDS; rather, they prefer (...) to use ‘SGOT’, ‘ELISA’ and ‘spot test’ to represent the HIV test, while ‘immunosuppression’, ‘↓ CD4 disease’ and ‘ARC’ are preferred instead of ‘AIDS’. It is possible that health professionals’ belief that mentioning HIV and/or AIDS will harm patients is encouraging them to use these euphemisms. The use of less than exact terms to label HIV and AIDS may not be without cost. For instance, future attempts to conduct retrospective case study research may be hampered by this practice, which is not in accordance with the international classification of diseases. It is suggested that, although stigmatization and discrimination could be important driving factors in the use of cryptic language, it may be more worthy to fight discrimination and stigmatization head-on, rather than create avenues where these reactions may be perpetuated. (shrink)

This note suggests that the exercise of measuring poverty in a society is greatly aided by clarity on precisely what one means by “the extent of poverty”. The latter concept may refer to the extent of poverty normalized for population size, or to the extent of poverty not so normalized. Absence of clarity on this distinction – which is both simple and non-trivial – could lead to rather straightforward problems of coherence and consistency in the measurement of poverty.

O trabalho teve como objetivo investigar a qualidade de vida em mulheres portadoras de HIV/AIDS, em destaque as relações sociais e a sexualidade. Foram analisados também aspectos sociodemográficos e situação clínica (marcadores biológicos CD4+ e carga viral) de 63 mulheres entre 18 e 65 anos em uso ..

Herein I engage with the very difficult question of whether the duty to aid (sometimes called a duty of assistance or a duty of beneficence) extends so far as to justify harming persons, perhaps even lethally, in order to protect wild animals. I argue that this question is not nearly as settled as our intuitions may suggest and that Shelly Kagan’s arguments on Defending Animals, contained in his book How to Count Animals, More or Less, provide a rich substrate (...) in which to cultivate ideas on this subject (2019, pp. 248–279). My intuition is that killing a person, even one ‘guilty’ of trying to kill an animal for sport or leisure, is far beyond what a duty to aid can command, though admittedly I find my own intuition somewhat morally dumbfounding. I argue further that Tom Regan’s ‘worse-off principle’ may ease the ever-uncomfortable sense of moral dumbfounding by providing a surer foundation for the intuitive sense that we cannot ethically go so far as to threaten a person with lethal force in defense of nonhuman animals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Closing the Gaps in Pediatric HIV/AIDS Care, One Step at a TimeLisa V. Adams, Helga Naburi, Goodluck Lyatuu, Paul Palumbo, and C. Fordham von ReynFatuma's* doctors were completely perplexed. It was 2003 and she had returned to the DARDAR clinic in her hometown of Dar es Salaam, Tanzania three times that week with vague complaints of various pains and aches. Her doctors were considering whether these symptoms were due (...) to the initiation of her recent treatment with antiretroviral medications for her HIV infection or related to the last administration of the investigational tuberculosis (TB) vaccine that the DARDAR Health Study was evaluating. Fatuma's doctor, Dr. Lillian Mtei, consulted with Dartmouth's chief of Infectious Disease, Dr. Ford von Reyn, who happened to be in Dar that week on a site visit. Neither physician could determine the basis for her symptoms. Dr. Mtei returned to the exam room once more and this time emerged with the answer: Fatuma had just learned that her three year old daughter was HIV-infected, likely contracted from Fatuma during or shortly after she gave birth to her daughter. Fatuma believed that her HIV diagnosis was a death sentence for her daughter since antiretroviral therapy was not widely available for children.Dr. von Reyn, Dartmouth's lead clinical researcher in Africa and a father, knew too well the harsh reality of inequities in a resource-limited country. He turned to Dr. Mtei and said decidedly, "we need to do something about this."Thus the DARDAR Pediatric Program was born.Pediatric HIV: A Neglected DiseaseThe need for HIV treatment among children in Tanzania, as in most of sub-Saharan Africa, is compelling. At the end of 2009, approximately 160,000 children aged zero to fourteen in Tanzania were living with HIV (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2011). Even with successful roll out of prevention of mother to child transmission programs in Tanzania, there were nearly 29,000 perinatal infections in 2009. As of December 2010, only 18% of these were enrolled in HIV treatment programs (UNAIDS, 2011; World Health Organization [WHO], 2011). Without antiretroviral therapy (ART), one-half of HIV-infected children will die before their second birthday. Since clinical research to determine efficacy and safety of new medical treatments is conducted almost exclusively in adults, provision of new medical treatments to [End Page 75] children always lags behind advances for adults. Furthermore, children are often underrepresented in programs for antiretroviral drugs for the following reasons: 1) they are not prioritized for care; 2) facilities lack infant diagnostic capabilities; 3) there is limited pediatric HIV training and consequently, a shortage of pediatric providers; and 4) pediatric antiretroviral formulations are frequently unavailable. The unacceptable delays in pediatric HIV drug development and treatment access led the international organization Drugs for Neglected Diseases initiative to publish an editorial in which they referred to pediatric HIV as a "neglected disease" (Lallemant, Chang, Cohen, & Pecoul, 2011).The Tip of the Iceberg: More than Just MedicinesWith a grant from the New York-based Foundation for the Treatment of Children with AIDS, the DARDAR Pediatric Program, a joint collaboration between Geisel School of Medicine at Dartmouth and Muhimbili University of Health and Allied Sciences, began seeing patients in May 2006. It was the first dedicated pediatric HIV Care and Treatment Center in Tanzania and operates in accordance with Tanzania's National AIDS Control Programme's guidance. Testing for both children and infants (the latter of which requires a more sophisticated assay) is available.The day the clinic opened we celebrated this collaborative effort that would provide HIV-infected children in Dar es Salaam access to antiretroviral treatment. One of our first patients was a six-year-old boy whose mother, like Fatuma, was a participant in our TB vaccine trial. She had been advised to bring her son to us for HIV screening. Her son looked healthy so she was surprised and understandably distraught when his test results indicated that not only was he HIV-infected, but his CD4 percentage was very low. His mother was reluctant to have him started on antiretrovirals given his general appearance and young age—and that he was... (shrink)

Pierson et al. (2024) surveyed 824 U.S. bioethicists on a wide range of ethical issues, including topics related to abortion, medical aid in dying, and resource allocation, among others. They conte...

PurposeTo explore and describe a trained communication partner’s use of responsive strategies in dyadic interaction with adults with Rett syndrome.IntroductionResponsive partner strategies facilitate social, communicative, and linguistic development. The common feature is that the communication partner responds contingently to the other’s focus of attention and interprets their acts as communicative. Research on responsive partner strategies that involves individuals with significant communication and motor disabilities remains sparse. The same applies to if, and how, the use of communication aids impacts on the (...) partner’s use of responsive strategies.Materials and methodsA therapist, trained in responsive partner strategies and aided communication interacted during 14 sessions with each of three participants. The participants were adults with Rett syndrome. A gaze-controlled device and responsive strategies were used during all sessions. The Responsive Augmentative and Alternative Communication Style scale was used to assess the partner’s responsiveness. RAACS consists of 11 items including ratings of to what extent the partner is being attentive to, confirms, and expands the individual’s communication. During eight of the 14 sessions, aided AAC Modelling was also used, i.e., the communication partner pointed at symbols on the gaze-controlled device while interacting. In addition to RAACS, each time the communication partner confirmed or expanded on communication when the participants used the gaze-controlled device and the participants did not use the gaze-controlled device was counted. Descriptive statistics were used to present the results. Non-parametric tests were used to compare means between the two conditions and between participants.ResultsInter-rater agreement for the different RAACS items ranged from 0.73 to 0.96 and was thus found to be fair to excellent. The communication partner’s use of responsive strategies varied when communicating with different participants and the scores were higher when aided AAC modeling was used. The communication partner’s number of responses and use of responsive strategies were higher when the participants communicated through a gaze-controlled device.ConclusionThe communication partner’s use of responsive and scaffolding strategies is not a fixed construct but varies in interactions with different non-speaking persons. The same is true whether the non-speaking person uses a gaze-controlled device with digitized speech or not. (shrink)

Business professions are increasingly faced with the question of how to best monitor the ethical behavior of their members. Conflicts could exist between a profession's desire to self-regulate and its accountability to the public at large. This study examines how members of one profession, public accounting, evaluate the relative effectiveness of various self-regulatory and externally imposed mechanisms for promoting a climate of high ethical behavior. Specifically, the roles of independent public accountants, regulatory and rule setting agencies, and undergraduate accounting education (...) are investigated. Of 461 possible respondents, 230 questionnaires (a 49.6% response rate) indicated that the profession's own rule setting body (The American Institute of Certified Public Accountants) and the use of peer review were perceived as the most effective mechanisms, while government regulation was ranked least. Respondents also evaluated the extent to which ethics should be covered in the accounting curriculum. For every course, the CPAs believed a greater emphasis on ethics is appropriate than presently exists. Suggestions for more effectively integrating ethics into accounting courses are made. Finally, respondents were also asked whether in answering the questionnaire they used a definition of ethics as either the Professional Code of Conduct or a moral and philosphical framework for guiding beliefs. Those who viewed ethics as abiding by a professional code had more confidence in the mechanisms addressed in this study to aid the public accounting profession's ability to ensure high ethical standards of conduct. Methodological implications of this distinction for future studies in business ethics are discussed. (shrink)

Far from an elite practice reserved for the highly educated, criticism is all around us. We turn to the Yelp reviewers to decide what restaurants are best, to Rotten Tomatoes to guide our movie choices, and to a host of voices on social media for critiques of political candidates, beach resorts, and everything in between. Yet even amid this ever-expanding sea of opinions, professional critics still hold considerable power in guiding how we make aesthetic judgements. Philosophers and lovers of art (...) continue to grapple with questions that have fascinated them for centuries: How should we engage with works of art? What might enhance such encounters? Should some people’s views be privileged? Who should count as a critic? And do critics actually help us appreciate art? In Two Thumbs Up, philosopher Stephanie Ross tackles these questions, revealing the ways that critics influence our decisions, and why that’s a good thing. Starting from David Hume’s conception of ideal critics, Ross refines his position and makes the case that review-based journalistic or consumer reporting criticism proves the best model for helping us find and appreciate quality. She addresses and critiques several other positions and, in the process, she demonstrates how aesthetic and philosophical concerns permeate our lives, choices, and culture. Ultimately, whether we’re searching for the right wine or the best concert, Ross encourages us all to find and follow critics whose taste we share. (shrink)

This impressive and informative book deserves a wider readership than it is likely to get. Unfortunately there are still too many people who consider they have no need to read anything about the virus as it will, to their way of thinking, never touch them. In addition there will be those who think that a volume by Catholic ethicists will be too narrow in outlook to be worthwhile. Both sets of people are mistaken: HIV is here to stay, there is (...) no cure nor is there likely to be and sooner or later it will affect, let alone infect, millions across the world. On the second count readers will be surprised and energised by the clear and honest debate concerning the teachings of the Catholic Church. The first and longest section is made up of a series of case studies ranging from needle exchange in Puerto Rico, to confronting social stigma in Uganda, and matters relating to confidentiality in Australia. The second consists of seven …. (shrink)

Despite abundant evidence associating CD38 overexpression and CD4 T cell depletion in HIV infection, no causal relation has been investigated. To address this issue, a series of mechanisms are proposed, supported by evidence from different fields, by which CD38 overexpression can facilitate CD4 T cell depletion in HIV infection. According to this model, increased catalytic activity of CD38 may reduce CD4 T cells’ cytoplasmic nicotin‐amide adenine dinucleotide (NAD), leading to a chronic Warburg effect. This will reduce mitochondrial function. Simultaneously, CD38's (...) catalytic products ADPR and cADPR may be transported to the cytoplasm, where they can activate calcium channels and increase cytoplasmic Ca2+ concentrations, further altering mitochondrial integrity. These mechanisms will decrease the viability and regenerative capacity of CD4 T cells. These hypotheses can be tested experimentally, and might reveal novel therapeutic targets. (shrink)

Propositional logic, with the aid of SAT solvers, has become capable of solving a range of important and complicated problems. Expanding this range, to contain additional varieties of problems, is subject to the complexity resulting from encoding counting constraints in conjunctive normal form. Due to the limitation of the expressive power of propositional logic, generally, such an encoding increases the numbers of variables and clauses excessively. This work eliminates the indicated drawback by interpolating constraint symbols and the set of natural (...) numbers \ into the alphabet of propositional logic and adjusting the underlying language accordingly. In the extended logic counting constraints are naturally formulated, while many important aspects, such as Boolean nature and the soundness and completeness theorems, are kept preserved. (shrink)

Mobile health devices pose novel questions at the intersection of philosophy and technology. Many such applications not only collect sensitive data, but also aim at persuading users to change their lifestyle for the better. A major concern is that persuasion is paternalistic as it intentionally aims at changing the agent’s actions, chipping away at their autonomy. This worry roots in the philosophical conviction that perhaps the most salient feature of living autonomous lives is displayed via agency as opposed to patiency—our (...) lives go well in virtue of what we do, rather than what happens to us. Being persuaded by a device telling us how to conduct our lives seemingly renders the agent passive, an inert recipient of technological commands. This agential bias, however, has led to a marginalization of patiential characteristics that are just as much part of our lives as are agential characteristics. To appreciate the inherent interlocking of acting and being acted upon, it is vital to acknowledge that agency and patiency are correlates, not mutually exclusive opposites. Furthermore, it is unclear whether an action can only count as agential so long as its causes are internal. Drawing on the extended mind and extended will framework, I argue that mHealth applications merely serve as volitional aids to the agent’s internal cognition. Autonomously set goals can be achieved more effectively via technology. To be persuaded by an mHealth device does not mainly—let alone exclusively—emphasize patiency; on the contrary, it can be an effective tool for technologically enhancing agency. (shrink)

"Robert Brandom" is one of the most significant philosophers writing today, yet paradoxically philosophers have found it difficult to get to grips with the details and implications of his work. This book aims to facilitate critical engagement with Brandom's ideas by providing an accessible overview of Brandom's project and the context for an initial assessment. Jeremy Wanderer's examination focuses on Brandom's inferentialist conception of rationality, and the core part of this conception that aims to specify the structure that a set (...) of performances within a social practice must have for the participants to count as sapient beings by virtue of their participation in the practice, and for the performances within the practice to have objective semantic content by virtue of their featuring within the practice. Wanderer's exploration of these two goals forms the structure to the book. It Includes: Part I that provides a structural model of linguistic practice and considers various groups of potential participants in terms of their relationships to this practice; and, Part II that examines the meaning of the performances that are caught up in this gameplaying practice. Brandom's approach to semantics is outlined and the challenge such an approach has in allowing for a representational dimension of language and thought is explored. Wanderer offers readers a valuable framework for understanding the Brandomian system and helps situate Brandom's systematic theorizing within contemporary Anglo-American philosophy. This book will be a sought after aid to reading Brandom for advanced students and philosophers engaging with his challenging body of work. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Philosophy’s Second Revolution: Early and Recent Analytic Philosophy by D. S. Clarke, and: The Rise of Analytic Philosophy ed. by Hans-Johann Glock, and: Early Analytic Philosophy: Frege, Russell, Wittgenstein. Essays in Honor of Leonard Linsky by William W. TaitCharles LandesmanD. S. Clarke. Philosophy’s Second Revolution: Early and Recent Analytic Philosophy. Chicago: Open Court Publishing Company, 1997. Pp. xii + 232. Cloth, $42.95. Paper, $19.95.Hans-Johann Glock, editor. The Rise (...) of Analytic Philosophy. Oxford: Blackwell Publishers, 1997. Pp. xiv + 95. Paper, $19.95.William W. Tait, editor. Early Analytic Philosophy: Frege, Russell, Wittgenstein. Essays in Honor of Leonard Linsky. Chicago: Open Court Publishing Company, 1997. Pp. viii + 291. Cloth, $54.95. Paper, $26.95.A remark once made by a justice of the Supreme Court about pornography may also apply to analytic philosophy: one can’t define it, but one knows it when one sees it. Can one do better than this? For D. C. Clarke, Western philosophy has undergone two revolutionary breaks with its past: the first initiated by Descartes directed against classical philosophy and the second initiated at the turn of this century that came to be known as analytic philosophy. (Continental philosophy is barely mentioned. Heidegger is briefly referred to as a bad example of a philosopher who “employs vacuously general language better designed for expressing attitudes than for advancing claims vulnerable to criticism” [192].) A revolutionary shift of framework, for Clarke, eliminates a whole set of problems. Even though the problems discussed by analytic philosophers seem similar to many of those discussed by Plato and Descartes, in fact the relation is tenuous, and current problems have new meanings (190).Clarke offers little help in defining analytic philosophy for “we find today the clear sense of purpose of analytic philosophy which flourished forty years ago being replaced by a variety of programs sharing no easily discernible common thread” (xi). It looks as if the revolutionary élan has been replaced by business as usual. Clarke’s volume is not, however, a history of analytic philosophy but a survey intended for students and the general reader of the views of analytic philosophers on a selected group of problems: approaches to language, the relation of mind to body, the nature of belief, knowledge, and understanding, the relation between philosophy and science, ethics, and philosophical method. Clarke discusses each issue with clarity and insight and argues for his own views, which are always interesting. He criticizes the current tendency in analytic philosophy toward excessive specialization and argues that the special task of philosophy is to search for a framework capable of integrating various aspects of culture. He emphasizes the importance of the study of the history of philosophy: “The central concepts of any integrating framework are few.... The history of philosophy is an indispensable aid in providing such understanding in choosing those [End Page 481] concepts that can serve this function in the present” (191). This book can be recommended for courses in analytic philosophy and in the history of philosophy in the twentieth century.Most of the essays in the volume edited by Glock are concerned to advance ways of characterizing analytic philosophy. Most of them reject Dummett’s claim that analytic philosophy is distinguished by its concern with explaining thought by giving an account of language. In his essay, Dagfinn Føllesdal recognizes the difficulty of constructing any useful classification of intellectual trends. Because analytical philosophy cannot be characterized by reference to doctrines or problems, he proposes to distinguish it by reference to its approach to philosophical problems: “analytic philosophy is very strongly concerned with argument and justification. An analytic philosopher asks: what reasons are there for accepting or rejecting this position?” (7). The interest in language is merely an offshoot of this more fundamental concern. It follows that “the analytic/non-analytic distinction runs across other divisions.... Whether one is an analytic philosopher depends on what importance one ascribes to argument and justification” (14). Thus Aquinas and Descartes, among others, count as analytic philosophers but not Heidegger or Derrida because “they predominantly make use of rhetoric” (12). Føllesdal thinks that there are ethical reasons for being an analytic philosopher... (shrink)

In this paper, I assume, perhaps controversially, that translation into a language of formal logic is not the method by which mathematicians assess mathematical reasoning. Instead, I argue that the actual practice of analyzing, evaluating and critiquing mathematical reasoning resembles, and perhaps equates with, the practice of informal logic or argumentation theory. It doesn’t matter whether the reasoning is a full-fledged mathematical proof or merely some non-deductive mathematical justification: in either case, the methodology of assessment overlaps to a large extent (...) with argument assessment in non-mathematical contexts. I demonstrate this claim by considering the assessment of axiomatic or deductive proofs, probabilistic evidence, computer-aided proofs, and the acceptance of axioms. I also consider Jody Azzouni’s ‘derivation indicator’ view of proofs because it places derivations—which may be thought to invoke formal logic—at the center of mathematical justificatory practice. However, when the notion of ‘derivation’ at work in Azzouni’s view is clarified, it is seen to accord with, rather than to count against, the informal logical view I support. Finally, I pose several open questions for the development of a theory of mathematical argument. (shrink)

Religion and spirituality seem to be very important for HIV-positive patients believers. Indeed, a recurring number of studies show strong correlations between religiosity/spirituality of individuals and different dimensions of health. The majority of these studies show most positive associations of religiosity/spirituality to physical health through reducing emotional distress, reduced rates of depression, greater optimism, better psychological adjustment, better preservation of CD4 cells, better control of viral load. The objective of this research is to understand the nature of the relationship between (...) religiosity and emotional health among HIV-positive patients, migrants from sub-Saharan Africa. Religiosity, the frequency of depressive episodes and subjective health 81 asymptomatic HIV patients regularly followed, were evaluated. Regression models and mediation, backed by a resampling procedure were tested. From mediation analyzes, the results show that through the mediating effect of subjective health, religiosity explains a decrease in the number of depressive episodes in people with HIV migrants from sub-Saharan Africa. (shrink)

In the movie, Memento, the hero, Leonard, suffers from a form of anterograde amnesia that results in an inability to lay down new memories. Nonetheless, he sets out on a quest to find his wife’s killer, aided by the use of notes, annotated polaroids, and body tattoos. Using these resources he attempts to build up a stock of new beliefs and to thus piece together the puzzle of his wife’s death. At one point in the movie, a character exasperated by (...) Leonard’s lack of biological recall, shouts: “YOU know? What do YOU know. YOU don’t know anything. In 10 minutes time YOU won’t even know you had this conversation” Leonard, however, believes that he does, day by day, come to know new things. But only courtesy of those photos, tattoos, tricks and ploys. Who is right?These are the kinds of question addressed at length in the paper ‘The Extended Mind’. Is the mind contained in the head? Or does the notion of thought allow mental processes to inhere in extended systems of body, brain and aspects of the local environment? The answer, we claimed, was that mental states, including states of believing, could be grounded in physical traces that remained firmly outside the head. As long as a few simple conditions were met, Leonard’s notes and tattoos could indeed count as new additions to his store of long-term knowledge and dispositional belief. In the present treatment I revisit this argument, defending our strong conclusion against a variety of subsequent observations and objections. In particular, I look at objections that rely on a contrast between the intrinsic content of neural symbols and the merely derived content of external inscriptions, at objections concerning the demarcation of scientific domains via natural kinds, and at objections concerning the ultimate locus of agentive control and the nature of perception versus introspection. I also mention a possible alternative interpretation of the argument as a reductio of the very idea of the mind as an object of scientific study. This is an interesting proposal. (shrink)

According to Brad Hooker's rule-consequentialism, as well as ordinary moral prohibitions against lying, stealing, killing, and harming others, the optimific code will include an over-riding “prevent disaster clause”. This paper explores two issues related to the disaster clause. The first issue is whether the disaster clause is vague—and whether this is a problem for rule-consequentialism. I argue that on Hooker's rule-consequentialism, there will be cases where it is indeterminate whether a given outcome counts as a disaster such that it is (...) permissible to infringe a given prohibition to avoid that outcome. I argue that it counts in favour of Hooker's rule-consequentialism that it makes this space for vagueness. The second issue is how to understand the disaster clause so that it does not make rule-consequentialism intolerably demanding—and more particularly whether avoiding over-demandingness requires the rule-consequentialist to place a counterintuitive limit on requirements to aid. I will argue that rule-consequentialism can avoid over-demandingness without placing a counterintuitive limit on requirements to aid. (shrink)

In this paper I attempt to show, first, that doxastic theories of seeing must be rejected on at least two counts: paradoxically, they commit us on the one hand to pyrrhonic skepticism and on the other they fail to account for cases of defeasibility that a theory of perceiving ought to account for. So much for the “why”. As for the “how” I attempt to show that a non-doxastic conception of seeing can be formulated, with the aid of theoretic interpretations (...) of the perceiving of brute animals, which succeeds in overcoming the above two failings of doxastic theories. (shrink)

Since the election of Philippine President Rodrigo Duterte in 2016, extra-judicial killings have become commonplace as a result of his administration’s declaration of war on drugs. Empirical cross-national work on examining determinants behind state repression remains scant especially in understanding the phenomenon at the sub-national level. This study investigates what accounts for variations on EJKs at the level of Philippine provinces. Using monthly panel-data for 62 provinces and employing various count-model regressions, the findings indicate that Philippine provinces which have (...) large populations, stronger state capacity, and are more affluent in terms of the human development index are more likely to exhibit higher rates of EJKs. Furthermore, the vote share of the President in the 2016 elections and presidential visits to specific provinces are correlated with higher incidences of EJKs—corroborating theories on delegative democracies and penal populism. Lastly, it is found that drug-prone provinces are more likely to experience a higher share of human rights violations in terms of EJKs, compared to provinces that have lower affectation rates. The implications suggest that the Philippine war on drugs seem to promote vertical accountability as international criticism and domestic opposition mounts. (shrink)

During the first half of the twentieth century, the horticulturist Luther Burbank was largely considered an irrelevant figure by the scientific community, despite winning acclaim from the public as an eminent scientist. In examining the intellectual, social, and political claims embedded in texts by and about Burbank, this essay argues that consideration of the Burbank stories as they circulated in the vernacular realm can aid historians in understanding the dynamics of science in American life. Among the themes it addresses are (...) how the Burbank stories directly engaged the question of who should legitimately count as a student of nature; the varied philosophical perspectives that derived from siting science within the domestic sphere; and how these stories played with the possibility of a philosophy of nature based on the concept of "living matter," as opposed to one grounded on mechanistic principles. The essay also discusses how Burbank's views on evolution were mediated by the image of the child and the way in which his convictions regarding the power of the environment to release latent characteristics in physiological material presented a view of the future of the American "race" that was at odds with conventional eugenic thinking and assigned a central role to women in the drama of American evolution. (shrink)

Radical forms of geoengineering, such as stratospheric sulfate injection (SSI), raise serious concerns about justice and the plight of the most vulnerable. However, these are sometimes dismissed on the basis of a challenge: “What if, in the face of catastrophic impacts, the most vulnerable countries initiate geoengineering themselves, or beg the richer, more technically sophisticated countries to do it? Wouldn’t geoengineering then be ethically permissible? Who could refuse them?” As a US tech billionaire put it, “Frankly, the Maldives could say, (...) ‘F--- you all—we want to stay alive’. Would you blame them? Wouldn’t any reasonable country do the same?” Such questions are intended to be rhetorical: it is assumed simply to be obvious that the appeals of the desperate would justify radical geoengineering. Moreover, the framing suggests that other nations would have strong moral reasons either to respect intervention by the desperate, or even to aid them by deploying themselves. Sometimes such arguments are also used to justify accelerating research on geoengineering now. If the desperate might attempt geoengineering, it is said, we should work out how best to do it, so as to assist them through advice. In general, the overriding thought is that the threat of catastrophe coupled with the plight of vulnerable populations provides most of the justification needed for the wider pursuit of a geoengineering agenda. Desperation becomes a trump card in the policy discourse. In this article, I argue that the desperation argument misses much of what is at stake, ethically speaking, in geoengineering policy. I focus on two further questions. The more obvious—the justificatory question—asks “under what conditions would geoengineering become justified?”, where the conditions to be considered would include, for example, the threat to be confronted, the governance mechanisms, the individual protections to be provided, the compensation provisions to be made, and so on. The less obvious question is the contextual question: “What is the ethical context within which geoengineering is likely to occur, and what difference does this make to our analysis of it?” (Gardiner 2013). In light of this distinction, I argue for two claims. First, on neither of the two most obvious interpretations of it does the desperation argument clearly justify the pursuit of geoengineering. Indeed, it may even count against such pursuit. Second, in any case, the context in which SSI is actually being pursued reveals more about the live threats and ethical import of geoengineering. For example, to push the most vulnerable to the point where they feel forced to accept pronounced subjugation to those who have made them desperate is a morally horrifying prospect which we have strong ethical reason to avoid. Such possibilities should not be concealed behind the superficial bravado of “f--- you all” and “what any reasonable country would do.” None of this implies that ethical geoengineering is impossible. However, it does suggest that geoengineering is morally complex in ways unappreciated by simple appeals to desperation. (shrink)

The notion that something can exist a se is central to Descartes’s overall metaphysics of causation. In the Meditations, divine aseity plays the role of explaining not only God’s existence but ultimately the existence of everything else apart from God. Yet in the Meditations proper, as well as in the early Replies, Descartes does little to clarify exactly what his view of divine aseity is and how it might differ from the sort of aseity commonly posited by the Scholastics. Despite (...) Descartes’s later attempts to assuage this worry and clarify his position, the positive aseity charge has not gone away. Here I shall argue that the charge is unjustified on all counts. Baldly stated, Descartes’s notion of aseity is no different than the negative sense of aseity endorsed by his Scholastic predecessors - especially Aquinas. Understanding this not only helps in clarifying the overall picture of Cartesian causality but also aids in seeing how commentaries on the Meditations, old and new, have obscured it. (shrink)

We clarify options for conceptualizing equity, or what we refer to as justice, in resource allocation. We do this by systematically differentiating, expounding, and then illustrating eight different substantive principles of justice. In doing this, we compare different meanings that can be attributed to “need” and “the capacity to benefit”. Our comparison is sharpened by two analytical tools. First, quantification helps to clarify the divergent consequences of allocations commended by competing principles. Second, a diagrammatic approach developed by economists Culyer and (...) Wagstaff offers a visual and conceptual aid. Of the eight principles we illustrate, only two treat as relevant both a person’s initial health state and a person’s CTB per resource unit expended: allocate resources so as to most closely equalize final health states and allocate resources so as to equally restore health states to population norms. These allocative principles ought to be preferred to the alternatives if one deems relevant both a person’s initial health state and a person’s CTB per resource unit expended. Finally, we examine some possibilities for conceptualizing benefits as relative to how badly off someone is, extending Parfit’s thought on Prioritarianism. Questions arise as to how much intervention effects accruing to the worse off count for more and how this changes with improving health. We explicate some recent efforts to answer these questions, including in Dutch and British government circles. These efforts can be viewed as efforts to operationalize need as an allocative principle. Each effort seeks to maximize in the aggregate quanta of effect that are differentially valued in favor of the worst off. In this respect, each effort constitutes one type of Prioritarianism, which Parfit failed to differentiate from other types. (shrink)

In spite of their practical importance, the connections between technology and mathematics have not received much scholarly attention. This article begins by outlining how the technology–mathematics relationship has developed, from the use of simple aide-mémoires for counting and arithmetic, via the use of mathematics in weaving, building and other trades, and the introduction of calculus to solve technological problems, to the modern use of computers to solve both technological and mathematical problems. Three important philosophical issues emerge from this historical résumé: (...) how mathematical knowledge depends on technology, the definition of the hybrid concept of a computation, and the usefulness of mathematics in technology. Each of these issues is briefly discussed, and it is shown that in order to analyze them, we need to combine tools and ideas from both the philosophy of technology and the philosophy of mathematics. In conclusion, it is argued that much more of interest can be found in the historically and philosophically unexplored terrains of the technology–mathematics relationship. (shrink)

In response to the ubiquitous graphs and maps of COVID-19, artists, designers, data scientists, and public health officials are teaming up to create counter-plots and subaltern maps of the pandemic. In this intervention, we describe the various functions served by these projects. First, they offer tutorials and tools for both dataviz practitioners and their publics to encourage critical thinking about how COVID-19 data is sourced and modeled—and to consider which subjects are not interpellated in those data sets, and why not. (...) Second, they demonstrate how the pandemic’s spatial logics inscribe themselves in our immediate material landscapes. And third, they remind us of our capacity to personalize and participate in the creation of meaningful COVID visualizations—many of which represent other scales and dimensions of the pandemic, especially the quarantine quotidian. Together, the official maps and counter-plots acknowledge that the pandemic plays out differently across different scales: COVID-19 is about global supply chains and infection counts and TV ratings for presidential press conferences, but it is also about local dynamics and neighborhood mutual aid networks and personal geographies of mitigation and care. (shrink)

Owing to the proliferation of rumors on social media, it is necessary to disseminate debunking information to minimize the harm caused by them. Using content analysis, sentiment analysis, and regression analysis, this study examined the mediating role of follower count in the relationship between the debunker’s identity and sharing behavior, and it explored the relationship between the text sentiment of debunking information and sharing behavior based on data on the spread of three rumors that circulated extensively on social media. (...) Using an ordinary account as a reference, we found that the mediating or suppression effect of follower count in the relationship between debunker’s identity and sharing behavior was significant. The three test identities had more followers than the ordinary account, which resulted in a significant positive effect on the number of reposts. The debunker’s identity did not have a positive effect on the sharing of debunking information when controlling for mediating variables. Debunking information with emotional overtones was shared more widely compared with information with neutral emotions, and the dominant emotional polarity was different in the three different rumors. These findings can contribute to the generation of debunking information content, which can aid in the development of effective communication strategies and improvement in the efficiency of crisis management. (shrink)

David Bloor has claimed that Wittgenstein is best read as offering the beginnings of a sociological theory of knowledge, despite Wittgenstein's reluctance to view his work this way. This leads him to dismiss Wittgenstein's many self?characterizations as mere ?prejudice?. In doing so, however, Bloor misses the import of Wittgenstein's work as a ?grammatical investigation?. The problems inherent in Bloor's interpretative approach can be discerned in his attitude toward Wittgenstein's use of imaginary scenarios: he demands that they be replaced by real (...) natural history and real ethnography. This demand is misplaced. The very self?characterizations Bloor dismisses show how imaginary scenarios have a place in his philosophical project simply by being imagined. Three examples are examined and presented in such a way as to make Bloor's demand for replacement increasingly more difficult to comprehend: while in the first case, the demand seems simply beside the point, in the second and third cases, it becomes difficult to say just what would count as replacements. Wittgenstein's imaginary scenarios are thus best read not as suggestions for further empirical research, but as devices to aid in recovering the naturalness and familiarity of our concepts, which is precisely what one would expect from them as part of a grammatical investigation. (shrink)

In this paper, I defend a version of the medical model of disability, which defines disability as an enduring biological dysfunction that causes its bearer a significant degree of impairment. We should accept the medical model, I argue, because it succeeds in capturing our judgments about what conditions do and do not qualify as disabilities, because it offers a compelling explanation for what makes a condition count as a disability, and because it justifies why the federal government should spend (...) hundreds of billions of dollars, annually, on aid and accommodations for disabled people. After responding to a pair of objections Elizabeth Barnes has raised against the medical model, I contrast it with Guy Kahane and Julian Savulescu's welfarist account of disability, and with Barnes's own mere-difference view. Both of these accounts face serious challenges, although elements of Barnes's view can—and, in my opinion, should—be adopted by proponents of the medical model. (shrink)

Frances Kamm argues that physical distance is per se relevant to our duty to give aid to strangers.
Her methods, however, fail to bring into light the relevance per se of distance. To understand the claim that
distance is per se morally relevant, it is helpful to use distinctions devised by Jonathan Dancy among
different roles a feature may play in the explanation of moral reasons, yielding thus different senses of
relevance. A feature can directly count in favor of an action, enable another (...) feature to count in favor of an
action, or strengthen the favoring already done by another feature. For the relevance of nearness that is at
issue in Kamm's thesis, if nearness is relevant at all to our duty to aid strangers, it cannot be relevant in the
way Kamm takes it to be. It cannot directly count in favor of aiding or be a special reason to aid, someone
that non-near agents lack. Nor can physical distance be seen as a consideration that strengthens our
independently existing pro tanto duty to aid strangers, whenever we are near them. (shrink)

Relationships between current theories, and relationships between current theories and the sought theory of quantum gravity (QG), play an essential role in motivating the need for QG, aiding the search for QG, and defining what would count as QG. Correspondence is the broad class of inter-theory relationships intended to demonstrate the necessary compatibility of two theories whose domains of validity overlap, in the overlap regions. The variety of roles that correspondence plays in the search for QG are illustrated, using (...) examples from specific QG approaches. Reduction is argued to be a special case of correspondence, and to form part of the definition of QG. Finally, the appropriate account of emergence in the context of QG is presented, and compared to conceptions of emergence in the broader philosophy literature. It is argued that, while emergence is likely to hold between QG and general relativity, emergence is not part of the definition of QG, and nor can it serve usefully in the development and justification of the new theory. (shrink)

I argue that our traditional conception of the duties imposed by human rights is unable to acknowledge the nature of many contemporary human rights violations. The traditional conception is based on a broadly deontological view according to which human rights impose primarily negative and perfect duties, and these duties are held to be specific prohibitions on certain kinds of actions . I argue that given this conception of the nature of the duties imposed by human rights, not only claims to (...) aid, but in addition, claims against many of the most serious and prevalent contemporary active harms will not count as genuine human rights claims. These harms increasingly result from extremely complex causal chains involving the behaviour of a huge number of agents, few or none of whom can be singled out as responsible for a serious harm to any specific victim. Institutional structures can have just as central a role to play in specifying and allocating responsibility for fulfilling many of the negative duties imposed by human rights as the positive duties. These structures can therefore be equally important in the realisation of both kinds of rights. Before the necessary institutional reforms have taken place, both kinds of rights are equally genuine, and ground the imperative of justice to reform existing social institutions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Philosophies of America Reader: From the Popol Vuh to the Present ed. by Kim Díaz and Mathew A. FoustBernardo R. Vargas (bio)The Philosophies of America Reader: From the Popol Vuh to the Present. Edited by Kim Díaz and Mathew A. Foust. New York: Bloomsbury, 2021. Pp. 480. Paperback $46.75, isbn 978-1-4742-9626-7.Philosophy in the United States continues to be among the least diverse disciplines in the humanities, dominated (...) statistically by white males, with the next largest group being white female philosophers.1 This lack of diversity affects how we define philosophy and who counts as a philosopher. As the editors of The Philosophies of America Reader, Kim Díaz and Mathew A. Foust, put it, "Just as history has fashioned and popularized distorted accounts of the 'discovery' of America, it has done the same in its presentation of American Philosophy" (p. xv). This exemplary collection of essays from across the Americas allows the readers and instructors to reimagine what we construe as philosophy and who we imagine an American philosopher to be.The editors offer diverse essays covering an impressive timeframe, ranging from the Popol Vuh, whose oral tradition from Guatemala predates Spanish colonization and was recorded in the mid-1500s, to contemporary philosophers such as Gregory Pappas. The collection excels in offering texts that typical philosophy anthologies are unlikely to include, which the editors call "unusual suspects" that have been historically marginalized, while also maintaining more familiar or "classical" figures (pp. xv–xvi). These "unusual suspects" include women, Latinx, American Indigenous, Black, and Caribbean thinkers.The Philosophies of America Reader offers various resources to enhance the student and instructor's experience. The book is structured into four themes: (1) Selfhood and Identity, (2) Knowing and Learning, (3) Aesthetics and Spirituality, and (5) Violence and Peace. The editors design these themes to fit the traditionally understood areas of philosophy of metaphysics, epistemology, and axiology. Even if the instructor's course description does not specifically target American Philosophy, these thematic categories are valuable for th ose who wish to incorporate a more diverse reading list. For example, these essays could easily apply to courses such as Critical Philosophy of Race, Introduction to Philosophy, or Introduction to Ethics. Each thematic section also features a "For Further Reading" segment, which includes selected secondary sources to broaden research or substitute texts. In addition, the editors provide a detailed [End Page 1] syllabus example, including a Course Description and Outline of the Course for a bi-weekly class, which is neatly divided into a 16-week reading schedule. They also include instructive sections such as a Note to the Teacher to aid in thinking through how to interact with the unfamiliar texts and a Note to the Student to guide their disposition and readings.Moreover, the text presents introductory essays for each thematic section. These essays provide an overview of the content and delve into the author's positionality, such as their geography, context, motivations for writing, race, ethnicity, and native tongue. The introductions are philosophically robust yet accessible to new philosophy students and are not filled with unnecessary philosophical jargon.Due to its large scope of thinkers, this text offers a vibrant opportunity to dialogue with philosophers who share or differ in their perspectives across the major thematic categories. The editors emphasize that although this is not a history of thought, the texts present lineages of progression, elaboration, and disagreement intended to guide instructors in connecting the texts with their students (p. xx). Furthermore, this allows the reader and the instructor to avoid isolating their discourse to a particular time, geography, gender, or race and ethnicity. In addition to the biographical and contextual information given in the introductions, a small yet helpful detail is a timeline of the selections that further contextualizes the readings.I wish to underscore two key clusters of essays amidst the vast array of 50 readings related to Asian-American and Mexican-American discourse for the instructor's consideration, particularly those teaching in the United States. These two large population groups deserve consideration as enrollment rates for Asian Americans and Hispanics (of whom Mexicans are the largest population... (shrink)

Photo ID 222412412 © US Navy Medicine | Dreamstime.com ABSTRACT In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. INTRODUCTION Medical resources in an austere environment without quick recourse for resupply or casualty evacuation are often (...) limited. The shortage extends not only to supplies like blood products and drugs, but physicians and other medical personnel. In the midst of a mass casualty scenario, such as a battle that includes intense ground fighting, the medical staff will stretch scarce resources and triage casualties according to specific criteria. Typically, they proceed by providing care for the most severely wounded first, referred to here as conventional triage. At times, though, the staff may reverse the triage so that soldiers with minor wounds can return to the fight. In a mass casualty situation, when medical personnel apply conventional triage and treat casualties from opposing forces, a dilemma may arise. We argue that it can be permissible for military physicians to prioritize their own soldiers over enemy combatants in a mass casualty triage, where reverse triage does not apply. The case we will focus on is as follows: Battlefield Triage: During combat operations on a remote island in the Pacific Ocean, a compatriot soldier and an enemy combatant arrive at the compatriot soldier country’s medical treatment facility. Both have similar gunshot wounds to the abdomen, and they arrive with similar conditions. Both have low oxygen saturation and excessive blood loss. The sole physician only has enough time to stabilize one person. The scenario is brief, and we are aware that medical rules of eligibility will most often dictate how the physician proceeds,[1] but this scenario is useful in setting up the question we focus on in this paper: would it be wrong to favor the stabilization of a soldier just because the soldier is the physician’s compatriot? In other words, can nationality serve as an ethically justified tiebreaker in a situation such as Battlefield Triage?[2] In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. The AMA’s Code of Medical Ethics asserts that physicians have “ethical obligations to place patients’ welfare above their self-interest and above obligations to other groups.”[3] The World Medical Association’s Declaration of Tokyo affirms that “no motive, whether personal, collective or political, shall prevail against this higher purpose” of alleviating distress.[4] Physicians are taught early on that triage decisions must be medically indicated and made without consideration of factors such as race, ethnicity, religion, social status, and nationality. They are taught that public trust and obligations of justice grounded in equality demand that only medical indications be considered. But military physicians in a military setting are beholden to obligations, duties, and responsibilities as members of the military, and when these obligations, duties, and responsibilities conflict, as they do in Battlefield Triage, which loyalties win out and why?[5] Critics of partiality on national grounds argue that partiality undermines public trust in medicine and justice because everyone should be treated equally regardless of nationality.[6] Proponents of partiality argue that military obligations supersede equality and that justice requires partiality in such cases.[7] Despite the critics’ disagreement, both agree that there is a morally right, perhaps even blameless, course of action. Drawing on insights from virtue ethics, we argue that Battlefield Triage is a moral tragedy in which justice is unattainable and there is no action without moral cost. The assumption that there is a morally right choice is flawed. We argue that while no decision in this scenario is free from moral blame, there are reasons to favor treating one’s soldiers over enemy combatants. I. The Case Against Partiality There is a common assumption that there is a morally right or just decision in Battlefield Triage. A number of organizations and scholars claim that it is wrong for military physicians to favor their own soldiers on the grounds of nationality or some form of ‘group membership.’ (In a conflict involving service members from multiple nations working as a coalition, a soldier from an allied country may receive the same priority as the US service member due to ‘group membership.’) The World Medical Association’s WMA Declaration of Lisbon on the Rights of the Patient, which was reaffirmed in 2015, posits that, “[i]n circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.”[8] This echoes what was set forth in Article 12 of the Geneva Conventions, which states that “[o]nly urgent medical reasons will authorize priority in the order of treatment to be administered.”[9] The argument for impartiality in Battlefield Triage is that every person is morally equal, and equality entails that medical distribution is, “based on a combination of medical need and urgency.”[10] This is in keeping with the bioethical principles that are generally applied.[11] II. The Case for Partiality On the other side, there are arguments that favoritism is the ethically right decision in Battlefield Triage.[12] The argument asserts that members of the military form a morally significant community of friends and participation in these relationships demands partiality. Just as parents have strong ethical duties to their children and not just any children, military personnel have ethical duties to their group, a group that involves an affirmation of mutual aid and support. Some have termed these ‘associative duties. According to Michael Gross, obligations of friendship, care, and solidarity “leave very little room for generally applicable principles of justice that would obligate a medic to treat enemy or non-compatriot wounded ahead of their compatriots.”[13] This is true in Battlefield Triage, but it may also be true even if the enemy’s soldier were more seriously wounded: “the ethics of small group cohesion, largely an ethics of care, mostly replaces the demands of impartial justice.”[14] In a more recent article, Gross explains that preferential treatment is ethically justified based on fighting capability and “the special obligations people owe friends, family, and, no less, comrades-in-arms.”[15] To not show partiality to the US soldier would be morally wrong on the grounds of friendship and mutual care.[16] III. The Moral Tragedy of Battlefield Triage Defenders and critics of Battlefield Triage favoritism based on nationality both frame their position as just or fair. For example, Justin List argues that physicians are “bound to practice medical neutrality,”[17] Marcus Adams denies that physicians “possess special ethical obligations” to enemy combatants because of their profession.[18] These perspectives assume that there is a morally right decision and that justice is attainable. The assumption that there is or can be a morally right Battlefield Triage decision, and we need to put our heads together to figure it out, remains strongly entrenched. However, the facts of the situation should give us pause; there are too many people and too few resources, and this demands a decision-making process that determines who will receive scarce resources. By its very nature, a battlefield triage decision has to be made based on some characteristic or value, a characteristic or value that will inevitably favor some at the expense of others. This is precisely why competing analyses “in the military context struggle to resolve these conflicts satisfactorily.”[19] Drawing on the insights of virtue ethics, we suggest that Battlefield Triage is a moral tragedy. Virtue ethics suggests that morality is about acting virtuously, which is to say that we should do what a virtuous person would do in the situation. Ethics is about figuring out how a just, wise, compassionate, loving, and fair person would act, and then doing that, as one grows in virtue. But life is not always clear cut, and it is possible that virtuous people may find themselves in a moral tragedy, a situation in which, through no fault of one’s own, a person must make a morally objectionable decision. After the action the virtuous person “emerges having done a terrible thing, the very sort of thing that the callous, dishonest, unjust, or in general vicious agent would characteristically do.”[20] Stated differently, a moral tragedy presents a virtuous person with two or more courses of action, all of which have a moral cost.[21] In Battlefield Triage, no matter how the physician goes about deciding, there is going to be defensible concern from those not saved. The fact that there are more people than can be helped fosters competing values in battlefield triage: maximize lives saved, treat people equally, treat the worse off, and support the war effort. Treating people equally may create tension between treating the worse off, maximizing lives saved, and supporting the war effort. Reverse triage is a case in point, as supporting the war effort conflicts with treating the worse off first, as is a fair lottery system since deploying a lottery may not maximize lives saved or support the war effort. There can be reasons why one person is selected over another, to be sure. Yet, there are reasons for making a decision, and that the decision is subject to legitimate moral concern is another. To recognize the moral tragedy of Battlefield Triage is to recognize the impossibility of acting blamelessly in the situation. In this situation, the virtuous military physician is going to have to sacrifice important values such as justice, compassion, and respect for others, even with a defensible criterion in hand. The physician will grieve this sacrifice accordingly. The physician may find her decision difficult or stressful, and rightly so, because of what her circumstances require of her. This kind of moral tragedy results “in actions which betray and violate the rights of persons to whom there may be a strong duty of care. When this happens, it properly triggers an appropriate moral emotion since our moral integrity has been violated and this affects how we think of ourselves and what we have become.”[22] Rather than view her triage decision as the morally superior choice, the virtuous military physician will view her decisions in these circumstances in a different light: it is the least bad option in a terrible situation, and she did something ethically problematic, something that is contrary to her moral character. She deeply regrets the circumstances in which she had to act. IV. Virtue Ethics A virtue ethicist has insight into how one should go about deciding what to do in a moral tragedy, although virtue ethics may not be as helpful as one may hope. The goal of the virtuous military physician in Battlefield Triage is to adopt the best course of action or the action that she feels she ought to do, all things considered. This does not make her choice devoid of serious wrongdoing—a decision must be made, but that does not make it just. The virtuous military physician will approach the situation with courage, responsibility, and insight. She will think about the decision carefully, wisely, and conscientiously; she will weigh the goods and harms of the choices before her, in conjunction with a proper conception of the good life, human worth, and understanding of her obligations to others—including chain of command, fellow soldiers, and the medical community. She is attuned to the value of human life and has a reasonable idea of the various ways her decisions will affect others. She recognizes that she is in this non-ideal situation through no fault of her own: she is not the one fighting in battles; she is serving her country as a physician, whose job it is to save lives, treat everyone justly, and promote military objectives. She regrets the decision she is forced to make in battlefield triage, acting “with immense regret and pain,” Hursthouse explains, “instead of indifferently or gladly.”[23] This is because, no matter what decision is made, the virtuous military physician “does something terrible or horrible,” something she otherwise would not do and is contrary to her values.[24] V. A Resolvable Moral Tragedy Instead of asking whether there is a morally right decision, in which a decision is morally blameless and above reproach, the virtue ethicist asks whether there is a decision with a convincing rationale, knowing that a decision can have a clear rationale but still be morally tragic. It is perfectly reasonable to think that different virtuous persons will arrive at different courses of action: “two virtuous agents, in the same situation,” Hursthouse writes, “may act differently” in irresolvable moral tragedies, in cases in which there is no clear course of action.[25] Because a person must act in a moral tragedy, one goal is to identify reasons for choosing the chosen action. Some decisions are clearly indefensible—treating neither the compatriot soldier nor the enemy combatant in Battlefield Triage would be wrong—and some decisions are more problematic than others. If the military physician selects to treat the soldier because she does not like the enemy combatant’s skin color, such a reason would be deeply problematic. But much of the debate over how to act in a moral tragedy is not over clearly indefensible or problematic criteria. Instead, the literature is largely about different standards or implementations of justice. Some scholars defend nation-impartial triage as right, while others defend nation-aware triage as right, and each argues that the other side is promoting an unjust or otherwise wrong solution to Battlefield Triage. We suggest that Battlefield Triage is a resolvable moral tragedy and that virtue ethics offers convincing reasons to prefer the treatment of the compatriot soldier rather than the enemy combatant on the grounds of national identity. Virtues are integral to living a good life, a flourishing life, but as Aristotle observed long ago, human beings are inherently social, interdependent and interconnected in profound ways.[26] This goes beyond the obvious fact that we need each other to survive day to day (one person makes clothes, another farms, and another makes tools); the claim is that a good or flourishing life depends in large part on one’s social network or community. This is why many of Aristotle’s moral virtues are other facing: justice, friendship, generosity, and magnanimity, to name a few. Courage, a typically self-facing virtue, is understood by Aristotle to be the virtue that regards one’s fear of death in battle, a battle fought on behalf of one’s city.[27] All of this remains true today. Namely, there is an important sense in which our community matters to our lives: it is easier to live a good, flourishing life if one is part of a good, flourishing community. Our community is made up of smaller groups, and it is more accurate to say that we are simultaneous members of different groups within a broader community. A person may be part of a family, friend group, research team, large state university, city, state, and nation. Groups can function well or not, as we all have experienced, and this suggests that there are virtues or excellences that groups can instantiate. Good groups are unified in purpose, with each member doing their duty alongside others for the attainment of that purpose. Good groups manifest solidarity among their members. Although Aristotle does not list solidarity as a virtue, a number of modern-day virtue ethicists have begun examining how group solidarity can be a virtue that contributes to a good or flourishing life.[28] Solidarity is not conceptualized as an individual virtue, a virtue possessed by a person in isolation of others; instead, it is a collective virtue, a virtue that is shared among members of a defined group with particular ends.[29] “A group has solidarity to the extent that its members are disposed to: (1) share values, aims, or goals; (2) care about those values, aims, or goals; (3) act in accordance with those values, aims, or goals; (4) trust the testimony of other group members with respect to those values, aims, and goals; and (5) feel a sense of belonging to the group.”[30] The virtue of collective or group solidarity involves individuals having special concern for each other, shared aims and values, trust, loyalty, and a sense of belonging with these specific others. There is a oneness to the group in the pursuit of a definite goal or purpose, involving mutual support and affirmation of each member. As such, the group has ends and goods above and beyond the good of each individual person. Sometimes solidarity requires personal sacrifice for the collective (for example, a father sacrificing food so his child can eat). The virtue of collective or group solidarity is important to the military and medical community at every level, and for clear reasons. In the military, there is a clear hierarchy of command, unity of purpose and end, mutual trust and support in complex settings, and so on. Soldiers need to know they can count on one another, and solidarity grounds a soldier’s ability to trust others and be assured of mutual aid. In medicine, solidarity maintains self-regulation of the profession, shared values and goals, as well as public support, not to mention that day-to-day operations require physician trust, engagement, and effort toward the ends of clinical care. Physicians need to work together, along with others, in pursuit of health, and disunity is sowed when there is mistrust, selfishness, or disengagement among the healthcare team and organization. Importantly, just as we are all members of various groups and hence may manifest group solidarity in different settings, the virtuous military physician instantiates collective solidarity with both the medical profession and the military. Her dual loyalty contributes to the moral difficulty of acting in Battlefield Triage. The military physician has competing obligations to distinct groups and cannot satisfy all obligations in Battlefield Triage. Solidarity with the military supports the consideration of favoring the soldier for reasons of national identity, whereas solidarity with the medical community does not. Something has to give, which is why it is a moral tragedy. The virtuous military physician, therefore, must weigh the costs of each course of action. To fulfill her obligations to the medical community would require that she does not use nationality and other non-medical considerations in Battlefield Triage. Since the soldier and enemy combatant are equally injured, justice would demand a random process, perhaps a flip of the coin. Although this may satisfy obligations the military physician has to the medical community, this would be costly to the physician’s military group. If word gets out that the physician decides who to treat based on a coin toss, soldiers, families, and citizens may become frustrated and angry. Soldier morale may go down if it becomes known that a coin flip led to the preventable death of a soldier and the saving of an enemy combatant who had killed (or attempted to kill) other soldiers. As Gross highlights, military solidarity involves a mutual aid promise that military personnel promise to help one another.[31] A military physician is part of the military and, as such, is part of the mutual aid promise, which would appear to be violated if the physician flips a coin. Treating a member of one’s own team may be psychologically more beneficial than treating an enemy combatant and may lead to less moral distress.[32] Finally, treating soldiers rather than enemy combatants promotes broader military and social aims, including returning soldiers to health, maintaining unity of purpose, and minimizing community suffering from a soldier’s death. Favoring members of one’s group, that is, triage based on nationality in Battlefield Triage, would fulfill obligations of military group loyalty, which is contrary to the values and duties of medicine. It does not seem as though showing favoritism in this particular situation is very costly to the medical community or general public, but this is because there is recognition that the physician is in the military. Medicine is impartial to non-medical indications partly because of fairness and to promote public trust in medicine. However, Battlefield Triage is unique, as medicine is being practiced in a non-public, wartime setting. In ordinary circumstances, a patient’s identity is irrelevant, and physicians ought not play favorites. Since Battlefield Triage is not an ordinary circumstance, decisions based on patient identity may not undermine public trust in medicine. In addition, it is contestable that fairness in Battlefield Triage requires that no consideration be paid to one’s nationality. Fairness is about giving each person their due, what is owed to them, and the case can be made that soldiers who place themselves in danger for the sake of the common good or a just cause are owed special attention when they suffer harm in the line of duty. In other words, soldiers voluntarily undergo risk to themselves for the greater good, and society owes them for this sacrifice. This plausibly includes preferential treatment in a situation such as Battlefield Triage. So, while the medical community affirms justice demands non-preferential treatment, the military community can affirm the opposite. The demands of fairness are unclear at best or in conflict in this situation: demands of physician justice decry favoritism, while demands of military justice support favoritism. Triage not based on nationality is arguably unfair and triage based on nationality may not undermine public trust, after all. All things considered, there is a clear rationale for favoring nationality-based preferential treatment in Battlefield Triage. Adopting a nationality-based preference in this situation is more defensible than not. This does not make such a decision ethically right or just. Preference based on nationality is the least bad decision, but it is not morally blameless. It involves one in a serious moral wrong, a wrong otherwise avoided and contrary to one’s character. The virtuous military physician is in a situation in which obligations conflict, and we disagree with Gross, who posits that care of fellow soldiers “is important to the near exclusion of all else.”[33] Gross fails to appreciate the collective virtue of solidarity as applied to those in medicine. The military physician has duties to fellow soldiers but also to fellow physicians, to the medical community, and humanity. To favor a soldier on grounds of nationality violates her duties and responsibilities to this latter group. She is involved in a moral tragedy and can only seek the most just action given the circumstances, yet, at least in virtue ethics, the action remains far from blameless. CONCLUSION We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. As such, the virtuous military physician incurs a moral cost to acting as she does—there is a moral residue. However, despite being a moral tragedy, there are clear reasons to act in favor of treating one’s own, considering group solidarity. As such, these kinds of tragedies are resolvable: virtuous military physicians should favor treatment of their own, although they would do so with sorrow. - [1] Militaries set forth medical rules of eligibility or guidelines used to determine whether a person qualifies for specific medical interventions or treatments in certain circumstances, and these guidelines are binding for a military physician. For example, despite opposition from medical organizations, militaries have adopted reverse triage guidelines for military physicians to follow. For ethical discussion, see Falzone, Elisabeth, P. Pasquier, C. Hoffmann, O. Barbier, M. Boutonnet, A. Salvadori, A. Jarrassier, J. Renner, B. Malgras, and S. Mérat. "Triage in military settings." Anaesthesia Critical Care & Pain Medicine 36, no. 1 (2017): 43-51. https://doi.org/10.1016/j.accpm.2016.05.004 [2] There are issues that are related to this, including the triage of civilians and allied soldiers. We set related issues aside for purposes of this paper [3] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [4] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [5] This is termed the “dual loyalty” dilemma in military medicine and has been described at length elsewhere: Institute of Medicine (US) Board on Health Sciences Policy. Military Medical Ethics: Issues regarding Dual Loyalties: Workshop Summary. Washington (DC): National Academies Press (US); 2008. Toward a Framework for Resolving Dual Loyalties. Available from: https://www.ncbi.nlm.nih.gov/books/NBK214853/ [6] See Kenneth G. Swan and K.G. Swan, Jr., “Triage: The Past Revisited,” Military Medicine 161:8 (1996): 448–452. https://doi.org/10.1093/milmed/161.8.448; Jerome A. Singh, “American Physicians and dual loyalty obligations in the ‘war on terror,’” BMC Medical Ethics 4.4 (2003): 1–10. https://doi.org/10.1186/1472-6939-4-4; Beam, Thomas E. "Medical Ethics on the Battlefield." Military Medical Ethics: Sect. IV. Medical ethics in the military. Medical ethics on the battlefield: the crucible of military medical ethics 2 (2003): 369-402; Hereth, Blake. "Health justice for unjust combatants." Journal of Military Ethics 20, no. 1 (2021): 67-81. https://doi.org/10.1080/15027570.2021.1949782. [7] See Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. Gross, Michael L. "Comradery, community, and care in military medical ethics." Theoretical medicine and bioethics 32 (2011): 337-350. https://doi.org/10.1007/s11017-011-9189-6. Gross, Michael L. "The limits of impartial medical treatment during armed conflict." In Military medical ethics for the 21st century, pp. 71-84. Routledge, 2016. [8] World Medical Association, WMA Declaration of Lisbon on the Rights of the Patient. 5 December 2022, https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/ [9] Geneva Convention for the Amelioration of the Condition of Wounded, Sick in Armed Forces in the Field. 12 August 1949. https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.30_GC-I-EN.pdf. [10] List, Justin M. "Medical neutrality and political activism: physicians' roles in conflict situations." In Physicians at war: The dual-loyalties challenge, pp. 237-253. Dordrecht: Springer Netherlands, 2008. 240 [11] Beauchamp, T., and J. Childress. 2013. Principles of Biomedical Ethics, 7th ed. Oxford, United Kingdom: Oxford University Press. [12] Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. [13] Gross, "Comradery, community, and care in military medical ethics," 347. [14] Gross, “Comradery, community, and care in military medical ethics,” 349. [15] Gross, Michael L. "When medical ethics and military ethics collide." Narrative inquiry in bioethics 13, no. 3 (2023): 199-204. 202 https://dx.doi.org/10.1353/nib.2023.a924191 [16] Our argument draws on virtue ethics, from which care ethics derives, and it is worth clarifying how our argument relates to Gross’s. We do not think that the virtue of friendship grounds triage decisions, for we think it is unlikely that the physician and wounded soldier are friends. Instead, as explained below, we think the collective virtue of group solidarity better captures the moral significance of group loyalty and that Gross would agree with us. But since military physicians are part of distinct groups, with competing obligations, the military physician will be forced to sacrifice a value in battlefield triage cases. In other words, we think Gross downplays the dual group membership of a military physician. [17] List,”Medical neutrality and political activism,” 250. [18] Adams,”Triage priorities and military physicians,” 235. [19] London, Leslie, Leonard S. Rubenstein, Laurel Baldwin-Ragaven, and Adriaan Van Es. "Dual loyalty among military health professionals: human rights and ethics in times of armed conflict." Cambridge Quarterly of Healthcare Ethics 15, no. 4 (2006): 381-391. 383. [20] Hursthouse, R. On Virtue Ethics. OUP 1999. 74 [21] Nussbaum, Martha C. "The costs of tragedy: Some moral limits of cost-benefit analysis." The Journal of Legal Studies 29, no. S2 (2000): 1005-1036, 1007. [22] De Wijze, S. (2005). Tragic-remorse–the anguish of dirty hands. Ethical theory and moral practice, 7(5), 453-471, 457. https://doi.org/10.1007/s10677-005-6836-x [23] Hursthouse, 73 [24] Hursthouse, 81 [25] Hursthouse, 72 [26] Aristotle, Politics 1253a8. Reeve, C. D. C., Indianapolis: Hackett Publishing Co., 2017 [27] Aristotle, Nicomachean Ethics. III.6.114a, 34-35. 2002, Nicomachean Ethics, Christopher Rowe (trans.), Oxford: Oxford University Press [28] Byerly, T. Ryan, and Meghan Byerly. "Collective virtue." The Journal of Value Inquiry 50, no. 1 (2016): 33-50. https://doi.org/10.1007/s10790-015-9484-y; Federico, Veronica. "Conclusion: solidarity as a public virtue." Solidarity as a Public Virtue (2018): 495-542. https://doi.org/10.5771/9783845290058. Rehg, William. "Solidarity and the common good: An analytic framework." Journal of Social Philosophy 38, no. 1 (2007): 7-21. https://doi.org/10.1111/j.1467-9833.2007.00363.x [29] Byerly and Byerly. "Collective virtue." 43 [30] Battaly, Heather. "Solidarity: Virtue or vice?." In Social virtue epistemology, pp. 303-324. Routledge, 2022. 304 [31] Ibid., 2011: 341 [32] It might be thought that displaying altruism by helping an enemy combatant at the expense of one’s fellow soldier may be psychologically satisfiying. For evidence that military physicians find it difficult to treat enemy combatants, see Lundberg, Kristina, Sofia Kjellström, Anders Jonsson, and Lars Sandman. "Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties." Military medicine 179, no. 8 (2014): 821-826. https://doi.org/10.7205/MILMED-D-14-00038. Lamblin, Antoine, Clément Derkenne, Marion Trousselard, and Marie-Ange Einaudi. "Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study." BMC Medical Ethics 22 (2021): 1-13. https://doi.org/10.1186/s12910-021-00723-2 [33] Ibid., 2011: 344. (shrink)

The dictate in feminist intersectional theory to not “count oppressions” is difficult to reconcile with the experience of many lesbians of color that “not all differences are created equal” inside social movement organizations. Meso-level factors, such as organizational structure and sociopolitical environment, may result in the perception of individuals or groups that one form of structural inequality is more oppressive than others. The author focuses on the experiences of lesbian staff and clients at Bienestar, a large Latino health organization (...) in Los Angeles focusing primarily on HIV/aids prevention and education. This study demonstrates that oppression can be experienced as additive and that counting and ranking oppressions may remain a common practice and important political strategy in the context of some social movement organizations. This article also responds to the need for more research that builds on the gendered organizations approach by examining some of the factors that contribute to change in organizational gender ideology and practices. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Care of the terminal patient:Are we on the same page?Lauren WancataIn surgical training a “service” or care team consists of sick patients admitted to the hospital and the medical team caring for the patient. Each service consists of an attending physician, a chief resident, a senior resident and junior residents structured as a hierarchy. The chief was gone for the week. As a senior trainee I would be the (...) acting chief—a role I had assumed many times before this month. To prepare for the week of his absence, I read through each patient’s chart, and the chief and I discussed each patient—diagnosis, procedures, and plans.One was a 41–year–old male with cancer—he was young, but a patient like him was not uncommon at my institution. He originally came in through the emergency department with abdominal pain and difficulty with urination. His admitting medical team started the work–up for his symptoms—blood tests, a CAT scan, and consults to other physician services with specialized knowledge. He eventually underwent endoscopy with biopsies of his stomach and placement of stents into his ureter and kidney for his urinary issues. With return of the biopsies, he had a diagnosis—cancer. He required additional procedures, including the placement of stents into his bile ducts, as they, like his ureter, had become affected by the cancer. The next step was staging the cancer to determine his treatment options. Our surgical service was consulted for a diagnostic laparoscopy with washing—we would take a look inside his abdomen with a camera and obtain a fluid sample to be sent to the pathologist for review, the standard of care for this type of cancer. When the camera was placed nodules were seen—a sample of the nodules and the fluid were sent to a pathologist and determined to be positive for cancer: metastatic disease, stage IV. A special feeding tube was placed into his small intestine to aid in nutritional support, as he had already lost a significant amount of weight, and improving his nutrition would be imperative for any further treatments. Following this operation, oversight of his day–to–day care was taken on by our surgical service, and he had been under our care for a period of time before I rotated onto the service for the month.What was the plan for his care in the hospital, and what was his–long–term plan? His cancer could not be surgically removed due to the extent of its spread within his body. He had recently undergone another CAT scan due to an elevation in his white blood cell count (this elevation was a sign of possible infection) and a thoracentesis, a procedure to remove some of the fluid that was collecting around his lungs. Nephrologists (kidney specialist) had been consulted due to his declining kidney function. Throughout the days, his tube feeds, his source of nutrition, would often be turned off due to bloating and feeling full.Each morning, I rounded with our team, and we would see how he was doing. We would discuss how his night went, and make a plan for the day. He was a man of few words, but his wife was always at his bedside, to support him, listen to updates and keep tract of his progress. She had worked at the hospital and had seen a wide range of patients. She would ask about his kidney function, his tube feeds, and his labs. But, she never asked about his prognosis. I would leave his room each day with the unnerving feeling that the patient, family members and care team were not on the same page. Yes, we all wanted him to get better and to leave the hospital. [End Page 28] But, was he really going to get better? What defined better? Did the patient and his family really know the extent of his disease and his prognosis?Towards the end of my week as chief, I started to ask if they had any other questions. It had been a few weeks since his operation. Was there anything that they wanted to discuss or ask me about? At the... (shrink)

Chapter 1: An Introduction: The ‘Semantic Sting’ Argument Describes Dworkin’s theory as concerning the conditions of legal validity. “A legal system is a system of norms. Validity is a logical property of norms in a way akin to that in which truth is a logical property of propositions. A statement about the law is true if and only if the norm it purports to describe is a valid legal norm…It follows that there must be certain conditions which render certain norms, (...) but not others, legally valid. Hence it also follows that there can be two types of disagreement over the truth or falsehood of propositions about the law. People can disagree over the question ‘What are the conditions of legal validity?’, in which case their disagreement is a theoretical one. Or they can agree on the conditions of validity, and disagree as to whether or not those conditions actually obtain in a given case or not.” Argues that the best way to interpret Dworkin’s ‘semantic-sting argument’ is as a general argument against conventionalism in legal positivism. Summarizes the outcome of Dworkin’s argument as follows: “[I]f Dworkin is right about the legal reasoning of lawyers and judges, conventionalism would be self-defeating: if lawyers and judges recognize as legally binding not only those norms which are uncontroversially identifiable under the Rule of Recognition, that is, if what they recognize as binding is not only source-based law, then conventionalism turns out to be false on its own terms. In other words, either law is not what lawyers and judges think that it is, in which case law is not a matter of conventions, or – if it is what lawyers and judges think – conventionalism is false, as they do not see the law as purely a matter of conventions.” Dworkin’s theory, then, is a new conception of jurisprudence aiming to present itself as a rival to conventionalism. The book will be concerned with re-examining positivism in light of the interpretative challenge. Chapter 2: Meaning and Interpretation “[R]oughly, interpretation can be defined as an understanding or explanation of the meaning of an object.” Interpretation in this narrow sense is distinct from a less formal and broader use of interpretation that makes it equivalent to explanation. “Hence also, only those objects which are capable of bearing some meaning qualify as objects of interpretation.” [Why shouldn’t we think of interpretation as object-identification? This seems to be closer to what Dworkin has in mind.] Thus, a consideration of the philosophical work on meaning is appropriate. First, a consideration of Davidson on interpretation. The thesis is that Davidson’s “radical interpretation” can only account for sentence meaning and not for linguistic interpretation in general. Davidson cannot account for the non-rule-governed aspects of communication. “Semantics, as opposed to interpretation, concerns those aspects of communication which are rule or convention governed…but such rules are normally unavailable as reasons or justifications for an interpretation. On the contrary, interpretation is usually required because the issue is not determined by rules or conventions.” Interpretation, rather, is parasitic with understanding the meaning of an expression and not equivalent with it. As Dummett notes, any reflection on the meanings of words assumes prior knowledge of ordinary meanings. “This leads to the conclusion that understanding or explaining the meaning of an expression and interpreting it, are two conceptually separate things. It also indicates that seman ics can only be employed, if at all, to elucidate the concept of interpretation by way of contrast: interpretation concerns those aspects of communication which are under-determined by semantic rules or conventions.” Pragmatics, the study of problems posed by discrepancies between utterer’s meaning and sentence meaning, would seem to be closer to inquiry into interpretation. Both are concerned with understanding how meaning is possible where conventional rules leave off. Contemporary pragmatics, moreover, recognizes the logically indeterminate character of communicative inferences beyond conventional meaning and that the contextual conditions that account for the possibility cannot be realized in the semantic structure of the sentence. However, different criteria of success may be at work in pragmatics than interpretation. Pragmatics is concerned with how communication is achieved and thus the criteria of success would be grasping a speaker’s intentions. Many think, however, that communication is unimportant in certain spheres of communication, e.g. artistic interpretation, and that in these cases the aim of interpretation is not to uncover the actual artist’s intentions. What kind of meaning is interpretation aimed at then? It cannot be the meaning the object has for the interpreter. “Interpretation purports to be a statement about the object interpreted, not about the subject who offers the interpretation…it is crucial to remember that not everything we say about a work of art, or any other text, amounts to an interpretation of it. Only those aspects of a text which can shed light on its meaning form part of the text’s interpretation. What the text means for someone rarely entails anything about what the text means.” [This is puzzling to some extent for it remains somewhat ambiguous what it means to talk of subject-independent meaning.] Interpretive meaning attribution is, rather, counterfactual. “In general, I will suggest that the answer to this question consists in the fact that meaning is assigned by a counterfactual statement. Given that x is the meaning attributed to, for instance a text T, and x is not the literal meaning of T, nor is it the meaning of T intended by its author, then the attribution of meaning x to T can only be understood as the contention that on the basis of certain assumptions a certain fictitious or stipulated speaker would have meant x by expressing T.” Thus, on this account, interpretation, when it does not concern an actual speaker, turns out to be a kind of counterfactual intention attribution. Twofold point: “First, that interpretation is essentially a matter of attributing intentions, that is, in the pragmatics sense of ‘meaning’, namely, meaning that such-and-such by an act or expression. At the same time, interpretations need not be based on the intentions of actual authors; the meaning of an act or expression is understandable in terms of counterfactual intentions.” [Are we really restricted to understanding the coherence and integrity of meaning in such a way? Presumably the author is a kind of device for organizing meaning, much like Dworkin’s integrity, but need it take that format?] The logic of interpretation is typically reducible to intention attribution. [What role does the counterfactual author play in structuring meaning?] The criteria of interpretive success will depend upon the object, whether it is the real author or the counterfactual author. If the former, success will depend upon the retrieval of the author’s actual intentions. “Likewise, if the author is characterized in terms of some ideal representative of a certain genre, for instance, the presumptions which are taken to determine this c aracterization would provide the criteria of success for the particular interpretation offered.” [The criteria of success would seem, then, to be the principles, ideals, etc. that we attribute to the counterfactual author. These attributed qualities would be doing all the work – is the attribution of intention to the hypothetical author, then, really necessary at all?] [Does this account presuppose a weird dichotomy between what an object is and what it means? This dichotomy is different, if present at all, in Dworkin.] Chapter 3: Dworkin’s Theory of Interpretation and the Nature of Jurisprudence Three main insights of Dworkin’s theory of interpretation: “First, that interpretation strives to present its object in its best possible light. Second, that interpretation is essentially genre-dependent. And third, that there are certain constraints that determine the limits of possible interpretations of a given object.” Why the best light? Dworkin doesn’t really address this question in depth but claims that otherwise we are left with no way of justifying and choosing an interpretation or we are left with the author’s intention model, which we should reject. [Marmor doesn’t seem clear on what precisely it means to present something in its best light – seems to conflate it with most appealing light which, I take it, is different than what Dworkin has in mind.] “Dworkin is quite right to maintain that without having some views about the values inherent in the genre to which the text is taken to belong, no interpretation can take off the ground. The values we associate with the genre partly, but crucially, determine what would make sense to say about the text, what are the kinds of meaning we could ascribe to it.” There is no necessity for an interpretation to present an object in its best light with regards to the genre it is taken to be part of. Interpretations “could simply strive to present it in a certain light, perhaps better than some, worse than others, but in a way which highlights an aspect of the meaning of the text which may be worth paying attention to for some reason or another.” [What kind of reasons would count in choosing to present it in one light rather than another?] There is simply zero grounds for Dworkin’s assertion that we have no reason to pay attention to an interpretation that does not present it in its best light. Take a psychoanalytic interpretation of Hamlet, for example – not the best light, but a legitimate one. [This seems related to the next criticism – clearly Dworkin would have to loosen his insistence on the best, though not to detriment.] Moreover, especially with regards to art, it doesn’t appear possible to make an all things considered judgment about the best interpretation given the incommensurability of different values that are taken to inhere in a given genre. [Dworkin can respond here that we may have different available interpretations that could be justified with respect to the relevant value. Moreover, a lack of common denominator does not prevent any comparison whatsoever.] Constructive interpretation concerns social practices constituted by norms – it imposes a purpose or value rendering intelligible the normative character of the practice. There is a separate aspect of constructive interpretation that maintains that elements of the practice are sensitive to the point of the practice. It is important to note that different social practices will institutionalize themselves in different ways – thus, different practices will establish varying conditions on how the practice can be altered. The position of the positivists is that evaluative judgments concerning what the law should be are insufficient for determining what the law is given the nature of law’s institutionalization.&nb p; [This would seem to reside on a certain conception of law, i.e. an interpretation about where the value of law lies.] “[T]his being one of the main points of dispute between Dworkin and his positivist opponents, Dworkin cannot at this initial state presume law to be sensitive to its value in the manner that other, non-institutional practices might be, without incurring the charge of having assumed the very point at issue.” The upshot for Dworkin is that any explanation of a social practice such as law requires the same kind of reasoning as participation in that practice. This will be called the hermeneutic thesis. We can try to reconstruct a justification for this view based on the necessity of shared background assumptions – but this will not do since Dworkin’s claim is stronger: it contends that participants’ and theorists’ must “adopt one and the same normative point of view.” [The sense of normative here is unclear. It is true, though, that shared background assumptions do not imply viewing the law as valuable in any particular way, or at least it does not imply this in any strong sense.] Dworkin makes two distinct points with the hermeneutic thesis: “First, that the explanation of a social practice, like law or the arts, is essentially interpretative, and as such, necessarily value laden. Second, that the interpretation of such social practices, which Dworkin calls ‘argumentative’, is unique in the sense that the practice itself is an evaluative enterprise, and that therefore the interpreter of such a practice must form an evaluative judgment of her own about those values which are inherent in the practice that she purports to interpret.” [As stated, the first thesis is terribly ambiguous – for Dworkin, it clear implies a commitment to constructive interpretation. For Marmor, who accepts it, it is totally unclear what commitment he intends to make. He seems to mean simply that we have criteria for success concerning what counts as a successful explanation.] Mamor denies the second thesis. “What Dworkin seems to ignore here is that there is a crucial difference between forming a view about the values which are manifest in a social practice, like law, and actually having evaluative judgments about them.” [The problem, however, it that it is a contentious matter what values are part of the law – a theorist’s account of what values are constitutive of a particular legal system must rely on the kind of arguments which participants rely on. Of course, a theorist might simply note a debate about values and attempt to remain agnostic, but this will fail to be a full theoretical account of what law is!] Dworkin’s thesis seems to depend exclusively on his account of constructive interpretation. [This seems exactly right.] Chapter 4: Coherence, Holism, and Interpretation: The Epistemic Foundation of Dworkin’s Legal Theory Begins with discussion of Rawls’ reflective equilibrium. Sums up dual criticism as follows: “[T]he assumption that intuitions are independently true and the converse one, that their truth depends on fitting a coherent scheme, both seem to yield paradoxical results.” Dworkin, in his article “The Original Position”, claims that Rawls cannot commit himself to ethical realism. “[T]he natural model presupposes some form of ethical realism, while the constructive model does not. One important difficulty arising from an attempt to apply the natural model to Rawls is, that under the natural model, any theory which dopes not account for an intuition, at least for one which is held firmly, cannot be wholly satisfactory, just as scientific theory which does not account for certain observational data it is supposed to cover, would not be satisfactory in a familiar way.” Rawls, rather, is committed to a constructivist view of morality. Moreover, the reason we value coherence epistemically in moral theory is that it itself is a value of political morality – fairness requires consistency and publicity in the application of moral standards. Marmor notes the following problem with such a view: “[I]f coherence is justified, as it is here, with reference to certain moral values, that is, a specific conception of fairness, then we face the following problem: the presupposed values of fairness must themselves be based upon intuitive convictions, in which case the question of their truth cannot be ignored. If they are taken to be true…we are driven back to the perplexities of the natural model.” Discusses, helpfully, the Fish/Dworkin debate. The upshot is that Dworkin’s interpretive model is best off if it commits itself to a Quineian holism. However, this undermines his distinction between internal and external skepticism since holism must deny that moral judgments constitute a closed system. [This analysis seems exactly right.] Endorses Simmonds view that Dworkin’s theory does not meet the requirements of complexity he identifies as necessary to avoid vicious circularity in interpretive judgments of fit and identity. Coherence is doing the work through and through and therefore the interpretive theory of law is circular. [Will require further investigation, though it is unclear how coherence is doing any work in the pre-interpretive stage. At this stage, the judgments, if interpretive, seem to be derived from different sources. In any case, using coherence as a value seems to be highly suspect.] Why doesn’t Dworkin just reject Fish’s assumptions: because of his jurisprudence. “If legal texts can have a meaning that is not entirely dependent on a process of interpretation, then it is at least sometimes the case that the law can simply be understood, and applied, without the mediation of interpretation. And if that is the case, then the argument from interpretation against legal positivism collapses. It is no longer the case that every conclusion about what the law is, depends on evaluative considerations about what it ought to be.” Chapter 5: Semantics, Realism, and Natural Law Assessment of Michael Moore’s legal realism and its implications. [The final criticisms of Moore are not decisive.] Chapter 6: Constructive Identification and Razian Authority A consideration of Dworkin’s denial that the communication model of interpretation is appropriate for legal interpretation. Marmor argues that intentions do play a crucial role in the identification of legal norms in a way that is incompatible with Dworkin’s “coherence thesis”. Marmor takes Dworkin to be committed to the constructive identification thesis: that the identification of something as part of the legal, artistic, etc. genre can be done sufficiently by evaluative considerations. “Here, one must maintain that evaluative considerations are sufficient to determine whether something is a legal norm or a work of art”. [Fit, however, constrains possible evaluative considerations – thus evaluative considerations are not sufficient in themselves.] “Now the crucial point here is this: if you maintain the possibility of constructive identification in art, you must assume that works of art can be identified as such on the basis of certain features they happen to possess, features which contain no reference to any particular intention to create a work of art…unless we take intentions into account, how can we discriminate between the concept of an aesthetic artifact and the con ept of a work of art?” [It is unclear, and I think false, that constructive interpretation of anything requires identifying something irrespective of an artificers intentions. Those intentions may be relevant, dependent upon the genre under which we are trying to classify the object. Nothing, seemingly, about constructive interpretation in general excludes this possibility.] Marmor’s point is that it turns out to be impossible to identify art as art without reference to an artist’s intentions – especially given the state of contemporary art. [It is notable that Marmor’s response to counterexample implicitly depends upon a fully developed theory of aesthetics. His cursory comments on the matter of identifying art seem insufficient to say the least.] The rest of the chapter considers the incompatibility of Raz’s account of authority with constructive interpretation. The incompatibilities mentioned do not move beyond what Raz identifies in his article “Authority, Law and Morality”, but a defense of this notion of authority is defended in several [inconclusive] respects. [Raz and Marmor want to separate identification from content. This is not clearly a defensible separation.] Chapter 7: No Easy Cases? Chapter defends notion that there is a distinction between easy and hard cases in the positivist sense. Takes a Hartian approach and ultimately defends the distinction by associating it Wittgenstein’s conception of rule following. The point is that one need to look the purpose of rule in order to understand what the rule requires. Chapter 8: Legislative Intent and the Authority of Law Examines the following doctrine concerning the role of legislative intent in adjudication: “[F]irst, it would hold that laws, at least in certain cases, are enacted with relatively specific intentions, and that this is a matter of fact which is discernible through an ordinary fact-finding procedure. Second, that in certain cases the presence of such a fact, namely, that the law was enacted with a certain intention, provides judges with a reason to decide the legal dispute in accordance with the relevant legislative intent.” [It is important that for Marmor, interpretive strategies are only appropriate in hard cases. However, we should wonder what grounds positivism can offer for deciding a hard case in any manner which is not the morally best manner according to the judgment of the judge. There are no legal grounds, by definition, in hard cases and so what justificatory strategy would endorse any judicial decision except for the morally best one?] We can ascribe intentions to a legislative body, when this is possible at all, by taking the shared intentions of the majority, rather than some group intention, to be the significant intentions. Moreover, we should expect a good deal of consensus about intentions for otherwise it is hard to explain how legislative bodies are able to produce so much legislation. Discussion of kinds of intentions concludes as follows: “I have distinguished between three main types of intention that are potentially relevant from the legal point of view. Apart from the intentions that are manifest in the language of the law itself, legislators typically have further intentions in enacting a given law, and sometimes they would have certain intentions bearing on its proper application. I have also suggested that some of these further intentions may be essentially non-avowable, in which case they are rendered initially irrelevant. Finally, I have pointed out that considerations of consistency require that the legislator’s application intentions be taken into account only if, and to the extent that, they are in accord with his further intentions.” The manner in which intentionalism is to be justif ed relies on the distinction, Marmor maintains, between expert and mere collective action authority. “The point I wanted to make is strictly conditional: if, and only if, a certain law is justified on the basis of the expertise branch of the normal justification thesis, would it make sense to defer to the legislature’s intentions in the interpretation of the law, that is, to the extent that there is, in fact,; such an intention and it can clarify something that needs clarification.” Insofar as a legislature can be considered an expert on the matter requiring adjudication and interpretation should the body’s intention be taken into account. Chapter 9: Constitutional Interpretation Begins by laying out general necessary features of a constitution. Then Marmor moves on to consider general questions of constitutional legitimacy. First, he considers what grounds might be offered for the legitimacy of a constitution at all. He notes that the central question is what permits a single generation to bind future generations. He then examines four arguments to avoid this problem. The first is based on the moral legitimacy of the constitution; Marmor rejects this solution for the [truly dubious] reason that the constitution would make no practical difference because it would not supply reasons in addition to those provided by morality [but, presumably, the point is that these legally valid rules would be institutionally enshrined]. The second is based on the moral authority of the framers and Marmor rightly rejects this on the basis of the idealization of the framers it requires and less rightly on the basis that there cannot be moral authorities. Third is the “argument from interpretation” which claims that “as long as the particular content of the constitution is determined by its interpretation, and the authoritative interpretation at any time correctly instantiates the values which ought to be upheld in the community, the constitution would be morally legitimate”. The fourth is Raz’s which argues that a constitution is valid so long as its constraints are morally permissible because conventions of this type might aid the continuity of the legal system, i.e. it is important to have a convention of this type and the constitution is a kind of this type. Marmor appears to endorse these two approaches and concludes: “The conditions for the legitimacy of a constitution must comprise the following conditions. First, the values and principles enshrined in it must be morally permissible…Second, when certain choices are made in particular cases, they would be legitimate if they are either morally underdetermined, or else, morally correct…It follows from this that both arguments must assume that at least in those areas in which the constitution would make a moral difference, it can be interpreted to make the difference that it should, that is, according to the true moral principles that should apply to the particular case...the moral legitimacy of constitutions very much dependent on the practices of their interpretation. In other words, a great deal of the burden of moral legitimacy is shifted by these arguments to the application of the constitution, thus assuming that the constitution is legitimate only if the courts are likely to apply the constitution in a morally desirable way.” [This implies that the only significant value constitutions have is in providing a conventional practice where some such practice is required.] Moves on to argue that courts typically rely, and rightly so, on moral considerations when deciding constitutional issues because typically, in cases of the kind that reach the supreme or constitutional court, there is no law on the case. Much of this relies on his earlier discussion about the nature of interpretation in the law – that legal interpretation is always a matter of cha ging the law. (shrink)

Thirty years ago, the only people drug companies thought worth buying were doctors and politicians. But the ground began to shift in the 1980s, when HIV/aids activists showed everyone how powerful patient advocates could be. It didn't hurt that many advocates were so strapped for money that they could be purchased at bargain prices. Today over 80 percent of patient advocacy groups accept money from the pharmaceutical industry, and the testimony of marginalized patients carries such cultural power that drug companies (...) like Sprout Pharmaceuticals are willing to fake grassroots patient movements. Whether you see this change as a victory for patients or a cautionary tale of institutional corruption depends on how deeply committed you are to the idea that free markets represent our best hope for the future of medicine. Count Sharon Batt as one of the skeptics. Her superb new book, Health Advocacy, Inc.: How Pharmaceutical Funding Changed the Breast Cancer Movement, is a deep scholarly account of the way that pharmaceutical funding has warped the patient advocacy movement into a tool for medical capitalism. Taking the Canadian breast cancer movement as a case study, Batt uses extensive interviews, scholarly resources, and her personal history to explore the struggles faced by patient advocates as they decide whether industry funding is necessary to keep their organizations afloat. (shrink)

For Emily Dickinson, perhaps no more so than for the rest of us, there was a powerful discrepancy between what was "inner than the Bone"1 and what could be acknowledged. To the extent that her poems are a response to that discrepancy—are, on one hand, a defiant attempt to deny that the discrepancy poses a problem and, on the other, an admission of defeat at the problem's enormity—they have much to teach us about the way in which language articulates our (...) life. There is indeed a sense in which these poems test the limits of what we might reveal if we tried and also of what, despite our exertions, will not give itself over to utterance. The question of the visibility of interior experience is one that will concern me in this essay, for it lies at the heart of what Dickinson makes present to us. In "The Dream of Communication," Geoffrey Hartman writes: "Art represents a self which is either insufficiently present or feels itself as not presentable."2 On both counts one thinks of Dickinson, for her poems disassemble the body in order to penetrate to the places where the feelings lie as if hidden, and they tell us that bodies are not barriers the way we sometimes think they are. Despite the staggering sophistication with which we discuss complex issues, like Dickinson we have few words, if any, for what happens inside us. Perhaps this is because we have been taught to conceive of ourselves as perfectly inexplicable or, if explicable, then requiring the aid of someone else to scrutinize what we are explicating to validate it. We have been taught that we cannot see for ourselves—this despite the current emphasis on our proprioceptive functions. But Dickinson tells us that we can see. More important, she tells us how to name what we see. · 1. The Complete Poems of Emily Dickinson, ed. Thomas H. Johnson , n. 321.· 2. Geoffrey Hartman, "The Dream of Communication," in I. A. Richards: Essays in His Honor, ed. Reuben Brower et al. , p. 173. Sharon Cameron, associate professor of English at Johns Hopkins University, is currently preparing a theoretical study of the lyric and is examining the relationship between obsession and lyrical structures. The present essay is part of her Lyric Time: Dickinson and the Limits of Genre. (shrink)

Data-driven historiography of philosophy looks to objective modeling tools for illumination of the propagation of influence. While the system of David Lewis, the most influential philosopher of our time, raises historiographic puzzles to stymie conventional analytic methods, it proves amenable to data-driven analysis. A striking result is that Lewis only becomes the metaphysician of current legend following the midpoint of his career: his initial project is to frame a descriptive science of mind and meaning; the transition to metaphysics is a (...) rhetorically breathtaking escape from this program's (inevitable) collapse. Understanding this process both aids a more focused debate whether it counts as progress, and also presents novel affordances for partisans on both sides to learn from Lewis's right and wrong steps. (shrink)

_Justice and the Just War Tradition_ articulates a distinctive understanding of the reasons that can justify war, of the reasons that cannot justify war, and of the role that those reasons should play in the motivational and attitudinal lives of the citizens, soldiers, and statesmen who participate in war. Eberle does so by relying on a robust conception of human worth, rights, and justice. He locates this theoretical account squarely in the Just War Tradition. But his account is not merely (...) theoretical: _Justice and the Just War Tradition_ has a variety of practical aims, one of the most important of which is to serve as an aid to moral formation. The hope is that citizens, soldiers, and statesmen whose emotions and aspirations have been shaped by the Just War Tradition will be able to negotiate violent communal conflict in ways that respect the demands of justice. So _Justice and the Just War Tradition_ articulates a theoretically satisfying and practically engaging account of the reasons that count in favor of war. Moreover, Eberle develops that account by engaging contemporary theorists, both philosophical and theological, by according due deference to venerable contributors to the Just War Tradition, and by integrating insights from military memoire, the history of war, and the author's experience of teaching ethics at the United States Naval Academy. (shrink)

An imperfect duty such as the duty to aid those in need is supposed to leave leeway for choice as to how to satisfy it, but if our reason for a certain way of satisfying it is our strongest, that leeway would seem to be eliminated. This paper defends a conception of practical reasons designed to preserve it, without slighting the binding force of moral requirements, though it allows us to discount certain moral reasons. Only reasons that offer criticism of (...) alternatives can yield requirements, but our reasons for particular ways of satisfying imperfect duties merely count in favor of the acts in question. When the state is authorized to take over charitable obligations, it should not be seen as enforcing fulfillment of our imperfect duties, but rather as forcing us to help fulfill collective duties that may be substantially modified by transfer to the state, replacing imperfect duties with perfect. Besides the cost to us in freedom of choice there is a moral cost to replacing the virtuous motives of charity with those that tend to accompany paying taxes. However, a compensating feature of state involvement is the fact that its more precise demands come with limits. (shrink)

While classifications of mental disorders have existed for over one hundred years, it still remains unspecified what terms such as 'mental disorder', 'disease' and 'illness' might actually denote. While ontologies have been called in aid to address this shortfall since the GALEN project of the early 1990s, most attempts thus far have sought to provide a formal description of the structure of some pre-existing terminology or classification, rather than of the corresponding structures and processes on the side of the patient. (...) We here present a view of mental disease that is based on ontological realism and which follows the principles embodied in Basic Formal Ontology and in the application of BFO in the Ontology of General Medical Science. We analyzed statements about what counts as a mental disease provided in the research agenda for the DSM-V, and in Pies' model. The results were used to assess whether the representational units of BFO and OGMS were adequate as foundations for a formal representation of the entities in reality that these statements attempt to describe. We then analyzed the representational units specific to mental disease and provided corresponding definitions. Our key contributions lie in the identification of confusions and conflations in the existing terminology of mental disease and in providing what we believe is a framework for the sort of clear and unambiguous reference to entities on the side of the patient that is needed in order to avoid these confusions in the future. (shrink)