Decision making capacity (DMC) is a fundamental concept grounding the principle of respect for autonomy and the practice of obtaining informed consent. DMC must be determined and documented every time a patient undergoes a hospital procedure and for routine care when there is reason to believe decision making ability is compromised. In this paper we explore a path toward ethically informed development and implementation of a hospital policy related to DMC assessment. We begin with a review of the context of (...) DMC assessment before discussing some considerations relevant to policy creation by healthcare ethics committees. The discussion concludes in a presentation of a typology of capacity assessment policies, which draws upon a sampling of currently used hospital policies to illustrate relevant ethical considerations. (shrink)

This article addresses the cultural influence of Hindu reflection on human attitudes toward animal welfare at a time of rapid globalization and worldwide environmental destruction. The hope is that it can contribute to deliberations on practical ethics across religious and cultural boundaries. It considers the extent to which existing Vaishnava resources have the potential to advance new transcultural orientations toward the protection of nonhuman forms of life by exploring what the International Society for Krishna Consciousness (ISKCON), a monotheistic Hindu-related movement, (...) says about the condition, purpose, and rights of animals. It analyzes whether in rejecting anthropocentric worldviews ISKCON is able to contribute to broader theological discussion about the place of animals in the world. (shrink)

The past 20 years have seen dramatic rises in suicide rates in the United States and other countries around the world. These trends have been identified as a public health crisis in urgent need of new solutions and have spurred significant research efforts to improve our understanding of suicide and strategies to prevent it. Unfortunately, despite making significant contributions to the founding of suicidology – through Emile Durkheim’s classic Suicide (1897/1951) – sociology’s role has been less prominent in contemporary efforts (...) to address these tragic trends, though as we will show, sociological theories offer great promise for advancing our understanding of suicide and improving the efficacy of suicide prevention. Here, we review sociological theory and empirical research on suicide. We begin where all sociologists must: with Durkheim. However, we offer a more comprehensive understanding of Durkheim’s insights into suicide than the prior reviews provided by those in other disciplines. In so doing, we reveal the nuance and richness of Durkheim’s insights that have been largely lost in modern suicidology, despite being foundational to all sociological theories of suicide – even those that have moved beyond his model. We proceed to discuss broadly acknowledged limitations to Durkheim’s theory of suicide and review how more recent theoretical efforts have not only addressed those concerns, but have done so by bringing a larger swatch of sociology’s theoretical and empirical toolkit to bare on suicide. Specifically, we review how recent sociological theories of suicide have incorporated insights from social network theories, cultural sociology, sociology of emotions, and sociological social psychology to better theorize how the external social world matters to individual psychological pain and suffering. We conclude by making explicit bridges between sociological and psychological theories of suicide; by noting important limitations in knowledge about suicide – particularly regarding the roles of organizations, inequality, and intersectionality in suicide – that sociology is well situated to help address. (shrink)

Both scientists and representatives of industry claim that important advantages can be secured through advances in biotechnology. However, the European public views new developments with caution, in particular when the applications concern animals and food. These differences in attitude cannot be explained merely in terms of differences in knowledge but also seem to be the upshot of contrasting values. One way to understand moral opinions and values is to view them against the background of so-called ethical theories. In this paper (...) we seek to describe the theoretical foundations of different public concerns over animal biotechnology. We also discuss the extent to which the values adhered to by the public are compatible with the visions of scientists regarding applications of biotechnology and other practices involving animals. We conclude that, in general, public worries about animal biotechnology can be located in the different ethical theories with bearings on animals. However, in most cases where biotechnology is found problematic, corresponding problems can be found in other widespread uses of animals that do not involve modem biotechnology. In recognition of this, we argue that the critical analysis not only of new biotechnology but also of existing technologies, gives rise to a-serious discussion of the limits to what it is ethically acceptable to do to animals. (shrink)

Despite its enduring insights, Durkheim’s theory of suicide fails to account for a significant set of cases because of its overreliance on structural forces to the detriment of other possible factors. In this paper, we develop a new theoretical framework for thinking about the role of culture in vulnerability to suicide. We argue that by focusing on the cultural dynamics of excessive regulation, particularly at the meso level, a more robust sociological model for suicide could be offered that supplements structure-heavy (...) Durkheimian theory. In essence, we argue that the relevance of cultural regulation to suicide rests on the (1) degree to which culture is coherent in sociocultural places, (2) existence of directives related to prescribing or proscribing suicide, (3) degree to which these directives translate into internalized meanings affecting social psychological processes, and (4) degree to which the social space is bounded. We then illustrate how our new theory provides useful insights into three cases of suicide largely neglected within sociology: specifically, suicide clusters in high schools, suicide in the military, and suicides of “despair” among middle-aged white men. We conclude with implications for future sociological research on suicide and suicide prevention. (shrink)

Several writers on animal ethics defend the abolition of most or all animal agriculture, which they consider an unethical exploitation of sentient non-human animals. However, animal agriculture can also be seen as a co-evolution over thousands of years, that has affected biology and behavior on the one hand, and quality of life of humans and domestic animals on the other. Furthermore, animals are important in sustainable agriculture. They can increase efficiency by their ability to transform materials unsuitable for human consumption (...) and by grazing areas that would be difficult to harvest otherwise. Grazing of natural pastures is essential for the pastoral landscape, an important habitat for wild flora and fauna and much valued by humans for its aesthetic value. Thus it seems that the environment gains substantially when animals are included in sustainable agricultural systems. But what about the animals themselves? Objections against animal agriculture often refer to the disrespect for animals’ lives, integrity, and welfare in present intensive animal production systems. Of the three issues at stake, neither integrity nor animal welfare need in principle be violated in carefully designed animal husbandry systems. The main ethical conflict seems to lie in the killing of animals, which is inevitable if the system is to deliver animal products. In this paper, we present the benefits and costs to humans and animals of including animals in sustainable agriculture, and discuss how to address some of the ethical issues involved. (shrink)

Previous research on consumers’ willingness to choose a green hotel has yielded mixed results, with some studies indicating a positive relationship with the hotel’s CSR initiatives, while others suggesting that there is no booking advantage for hotels going green. The present research seeks to understand the social nature of green hotel booking decisions and proposes a conceptual framework elucidating three primary factors that underlie consumers’ propensity to choose a green hotel. The study findings indicate that, importantly, a consumer’s social relationship (...) situation with other consumers, self-affirmation, and the option popularity jointly influence consumers’ willingness to choose a green hotel. The authors adopt a 2 × 2 × 2 factorial experimental design to test the proposed hypotheses. Theoretical and managerial implications are discussed. (shrink)

Animal welfare and the ethical issues it raises have been discussed intensively for a couple of decades. The emphasis has been on the direct effects of housing and husbandry, but more attention is now being given to problems originating in selective breeding. European attempts to adjust animal welfare legislation to deal with these problems have been largely unsuccessful, but the fact that selective breeding can introduce welfare problems continues to place an ethical responsibility on the animal breeding industry. Since breeding (...) decisions are made centrally and, increasingly, internationally, strategic change is only likely to occur if it is embedded in an international agreement of some kind. The aim of this paper is to describe the key ethical issues facing animal breeding and assess the suggestion that the breeding industry itself can deal with ethical issues by means of an ethical code. Results from recent projects involving commercial breeding enterprises are presented. (shrink)

Empirical evidence, including a recent field study in Northwest Indiana, indicates that supermarkets and other retail merchants frequently incorporate quantity surcharges in their product pricing strategy. Retailers impose surcharges by charging higher unit prices for products packaged in a larger quantity than smaller quantity of the same goods and brand. The purpose of this article is to examine the business ethics of such pricing strategy in light of empirical findings, existing government regulations, factors that motivate quantity surcharges and prevailing consumer (...) perceptions. (shrink)

Animal use in medical research is widely accepted on the basis that it may help to save human lives and improve their quality of life. Recently, however, objections have been made specifically to the use of animals in scientific investigation of human obesity. This paper discusses two arguments for the view that this form of animal use, unlike some other forms of animal-based medical research, cannot be defended. The first argument leans heavily on the notion that people themselves are responsible (...) for developing obesity and so-called ‘lifestyle’ diseases; the second involves the claim that animal studies of obesity's causes and therapies distract attention from preventive efforts. Drawing on both empirical data and moral reasoning, we argue that the relevant attributions of responsibility and claims about distraction are not plausible, and that, therefore, there is no reason to single out the use of animals in obesity research as especially problematic. (shrink)

In this paper, we identify some key features of what makes something a disease, and consider whether these apply to pregnancy. We argue that there are some compelling grounds for regarding pregnancy as a disease. Like a disease, pregnancy affects the health of the pregnant person, causing a range of symptoms from discomfort to death. Like a disease, pregnancy can be treated medically. Like a disease, pregnancy is caused by a pathogen, an external organism invading the host’s body. Like a (...) disease, the risk of getting pregnant can be reduced by using prophylactic measures. We address the question of whether the ‘normality’ of pregnancy, its current necessity for human survival, or the value often attached to it are reasons to reject the view that pregnancy is a disease. We point out that applying theories of disease to the case of pregnancy, can in many cases illuminate inconsistencies and problems within these theories. Finally, we show that it is difficult to find one theory of disease that captures all paradigm cases of diseases, while convincingly excluding pregnancy. We conclude that there are both normative and pragmatic reasons to consider pregnancy a disease. (shrink)

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations (...) and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts. (shrink)

It is commonly held that our intuitive judgements about imaginary problem cases are justified a priori, if and when they are justified at all. In this paper I defend this view — ‘rationalism’ — against a recent objection by Timothy Williamson. I argue that his objection fails on multiple grounds, but the reasons why it fails are instructive. Williamson argues from a claim about the semantics of intuitive judgements, to a claim about their psychological underpinnings, to the denial of rationalism. (...) I argue that the psychological claim — that a capacity for mental simulation explains our intuitive judgements — does not, even if true, provide reasons to reject rationalism. (More generally, a simulation hypothesis, about any category of judgements, is very limited in its epistemological implications: it is pitched at a level of explanation that is insensitive to central epistemic distinctions.) I also argue that Williamson’s semantic claim — that intuitive judgements are judgements of counterfactuals — is mistaken; rather, I propose, they are a certain kind of metaphysical possibility judgement. Several other competing proposals are also examined and criticized. (shrink)

The litmus test for the development of a metarepresentational Theory of Mind is the false belief task in which children have to represent how another agent misrepresents the world. Children typically start mastering this task around age four. Recently, however, a puzzling finding has emerged: Once children master the FB task, they begin to fail true belief control tasks. Pragmatic accounts assume that the TB task is pragmatically confusing because it poses a trivial academic test question about a rational agent’s (...) perspective; and we do not normally engage in such discourse about subjective mental perspectives unless there is at least the possibility of error or deviance. The lack of such an obvious possibility in the TB task implicates that there might be some hidden perspective difference and thus makes the task confusing. In the present study, we test the pragmatic account by administering to 3- to 6-year-olds TB and FB tasks and structurally analogous true and false sign tasks. The belief and sign tasks are matched in terms of representational and metarepresentational complexity; the crucial difference is that TS tasks do not implicate an alternative non-mental perspective and should thus be less pragmatically confusing than TB tasks. The results show parallel and correlated development in FB and FS tasks, replicate the puzzling performance pattern in TB tasks, but show no trace of this in TS tasks. Taken together, these results speak in favor of the pragmatic performance account. (shrink)

This volume is a collection of papers that advance our understanding of the metaphysics of powers — properties such as fragility and electric charge. The metaphysics of powers is a fast developing research field with fundamental questions at the forefront of current research, such as Can there be a world of only powers? What is the manifestation of a power? Are powers and their manifestations related by necessity? What are the prospects for dispositional accounts of causation? The papers focus on (...) questions concerning the metaphysics of powers that cut across any particular subject-specific ontological domain -- whether philosophy of science, philosophy of mind, ethics, epistemology – investigating the metaphysical structure of powers, the nature of the manifestation of powers, the necessity or contingency of a power’s relation to its manifestations, and powers and causation. A number of authors also engage in discussion with Humean and neo-Humean treatments of causation, thereby making contributions to a larger metaphysical debate beyond powers. Additionally, the authors engage critically with the latest contributions to the debate on powers in the literature, thereby bringing together in a wholesome and analytical way the most recent and noteworthy theoretical developments in this research field. (shrink)

Resilience is the process and outcome of healthy adaptation despite significant adversity. Proliferation of research on the resilience construct has led to scientific concerns about the operationalization and measurement of resilience for assessment science and practice. Various studies that have investigated the psychometric properties and construct validity of the Resilience Scale for Adolescents have yielded inconsistent findings, which could partly be due to variations in the methodological approaches. This study investigated the factor structure and construct validity of the READ in (...) four European regions participating in the Universal Preventive Resilience Intervention Globally Implemented in Schools to Improve and Promote Mental Health for Teenagers project. Participants included adolescents aged 10–15 years from Spain, Iceland, Italy, and Poland. The five-factor model of the READ was similar across gender and participating regions. Construct validity of the READ was supported. After establishing construct separability, incremental validity was supported. The READ is a valid and reliable measure of protective factors involved in resilience and demonstrates promise for cross-cultural applicability. Recommendations for measuring resilience and validating the READ in future investigations are provided. (shrink)

This review provides an overview of the ethics of extinctions with a focus on the Western analytical environmental ethics literature. It thereby gives special attention to the possible philosophical grounds for Michael Soulé’s assertion that the untimely ‘extinction of populations and species is bad’. Illustrating such debates in environmental ethics, the guiding question for this review concerns why – or when – anthropogenic extinctions are bad or wrong, which also includes the question of when that might not be the case (...) (i.e. which extinctions are even desirable). After providing an explanation of the disciplinary perspective taken (section “Introduction”), the concept of extinction and its history within that literature are introduced (section “Understanding extinction”). Then, in section “Why (or when) might anthropogenic extinctions be morally problematic?”, different reasons for why anthropogenic extinctions might be morally problematic are presented based on the loss of species’ value, harm to nonhuman individuals, the loss of valuable biological variety and duties to future generations. This section concludes by also considering cases where anthropogenic extinctions might be justified. Section “How to respond to extinctions?” then addresses a selection of topics concerning risks and de-extinction technologies. Finally, the section on “Extinction studies” introduces other viewpoints on the ethics of extinction from the extinction studies literature, followed by the “Conclusion”. (shrink)

Epistemic injustice is a kind of injustice that arises when one’s capacity as an epistemic subject is wrongfully denied. In recent years it has been argued that psychiatric patients are often harmed in their capacity as knowers and suffer from various forms of epistemic injustice that they encounter in psychiatric services. Acknowledging that epistemic injustice is a multifaceted problem in psychiatry calls for an adequate response. In this paper I argue that, given that psychiatric patients deserve epistemic respect and have (...) a certain epistemic privilege, healthcare professionals have a pro tanto epistemic duty to attend to and/or solicit reports of patients’ first-person experiences in order to prevent epistemic losses. I discuss the nature and scope of this epistemic duty and point to one interesting consequence. In order to prevent epistemic losses, healthcare professionals may need to provide some patients with resources and tools for expressing their experiences and first-person knowledge, such as those that have been developed within the phenomenological approach. I discuss the risk of secondary testimonial and hermeneutical injustice that the practice of relying on such external tools might pose and survey some ways to mitigate it. (shrink)

The volume uncovers the most pragmatic and pragmatist aspects of Ludwig Wittgenstein’s philosophy, particularly of On Certainty, through a comparison with the pragmatist tradition as expressed by Charles S. Peirce and William James. On Certainty is often described as 'pragmatic' in literature and this pragmatic aspect is said to characterize a new turn in its author’s thought. Yet, what is still missing is a study of what specifically are the features which make these writings 'sound like pragmatism', as Wittgenstein himself (...) put it (OC 422). The book therefore aims to verify if and to what extent it is possible to sustain that there is an objective convergence between his thought and pragmatism. In doing so, the volume also proposes a clarification of the main differences between Peirce’s and James’ vision of some key ideas of classical pragmatism like doubt and certainty, common sense, the pragmatic maxim, action. Among the achievements of the work are: an analysis of Wittgenstein’s first mention of pragmatism; some pieces of evidence in favour of the hypothesis that Wittgenstein did read some works by Peirce; a documented investigation on the relevance of Frank Ramsey for the development of Wittgenstein’s idea of pragmatism. The volume does not sustain the thesis that Wittgenstein was a pragmatist (nor the opposing thesis that he was not), but highlights the objective convergences and the divergences between his perspective and pragmatism through a balanced analysis running both on an exegetical and on a theoretical level. (shrink)

Good academic practice is more than the avoidance of clear-cut cheating. It also involves navigation of the gray zones between cheating and good practice. The existing literature has left students’ understanding of gray zone practices largely unexplored. To begin filling in this gap, we present results from a questionnaire study involving N = 1639 undergraduate students from seven European countries representing all major disciplines. We show that large numbers of these students are unable to identify gray area issues and lack (...) sensitivity to the context dependence of these. We also show that a considerable proportion of students have a poor understanding of concepts like plagiarism and falsification, not only in gray zone scenarios, but also in cases of relatively clear-cut cheating. Our results are similar across the faculties and countries of study, and even for students who have attended academic integrity training. We discuss the implications of this for academic integrity training. (shrink)

During the pandemic of Covid-19, internet-based communication became for many the primary, or only, means of interaction with others, and it has been argued that this had a host of negative effects on emotional and mental health. However, some people with a lived experience of mental ill-health also perceived improvements to their wellbeing during the period in which social activities were moved online. In this paper, I explore the possibility that some of these improvements are due to the partial “disembodiment” (...) of emotions facilitated by internet-mediated interaction. In particular, I consider the phenomenology of social anxiety and how it may be impacted upon by encountering others primarily through the medium of internet-enabled technology. I will start by reconstructing a phenomenological account of social anxiety to which disruptions of bodily experience are central. I will then move to consider how the experiential dynamics that are particularly prominent in social anxiety can be weakened when communicating with others via video calls, instant messages, and social media more broadly. I will suggest that this is the case due to the diminished visibility of the body online, and the higher degree of control and agency over one’s experience that can be exercised in this context. Finally, I will argue that the weakening of social anxiety through internet-mediated contact exemplifies some of the processes which are key to emotion regulation more widely, thus suggesting that communication and interaction online could have a positive effect on a wider range of affective disturbances. (shrink)

Plagiarism and other transgressions of the norms of academic integrity appear to be a persistent problem among upper secondary students. Numerous surveys have revealed high levels of infringement of what appear to be clearly stated rules. Less attention has been given to students’ understanding of academic integrity, and to the potential misconceptions and false beliefs that may make it difficult for them to comply with existing rules and handle complex real-life situations.In this paper we report findings from a survey of (...) European upper secondary students’ views on issues relating to academic integrity. We relate these findings to the students’ training about academic integrity, self-reported level of questionable behavior and country of study.A total of 1654 students at 51 institutions located in 6 European countries participated in the study. The participants generally believed they had a good understanding of the rules applying to them and knew how to behave in compliance with norms of academic integrity. The results indicate, however, that often, in practice, this belief was mistaken. Many students had an inadequate understanding of core elements of academic integrity. They were uncertain about how to act, and they struggled in the handling of complex situations that require context-sensitive judgement. While some differences between countries were identified, they were modest and exhibited no clear pattern. Our results also suggest that reducing students’ level of uncertainty and, to a lesser degree, improving their level of knowledge could lead them to engage less in certain types of questionable behaviours. Surprisingly, the effect of academic training is modest and ambiguous. The study also confirms that perception of peer behaviour has the strongest association with student engagement in questionable behaviours. Thus, academic integrity at the upper secondary level cannot be explained simply in terms of individual ethics or knowledge. (shrink)

‘The Union of Cause and Effect in Aristotle : Physics III 3’, Oxford Studies in Ancient Philosophy, 32, pp. 205-232, May 2007.: I argue that Aristotle introduced a unique realist account of causation, which has not hitherto been appreciated in the history of philosophy: causal realism without a causal relation. In his account, cause and effect are unified by the ectopic actualization of the agent’s potentiality in the patient. His solution consists in the introduction of a property that belongs to (...) one subject but is realized in another subject on whose state this realization depends. I identify and analyze the multiple ontological dependencies between the causal state of the agent and that of the patient during their causal activity. (shrink)

The philosophical debate around moods has mainly focused on whether and how their seeming recalcitrance to representationalist treatment can be overcome by accommodating moods’ apparent undirectedness through a peculiar representational structure. Through these theoretical efforts, though, most theorists have taken a double wrong turn (or so I argue), by maintaining that (i) (if directed,) moods are outwardly directed (i.e., directed toward something external to and independent of the subject’s mind) and (ii) moods are discrete mental states (on a par with (...) emotions, perceptual experiences, thoughts, etc.). By pointing at three as yet overlooked phenomenological features of moods—subjective salience, undetachability, and globality—I suggest that moods are (i) inwardly oriented (i.e., they pertain to the subjective aspect of experience and, if directed at all, they are directed toward one’s experiences) and (ii) structural features of consciousness (rather than discrete mental states). I thus explore a new approach to the nature of mood experience, one that aims to do justice to those phenomenological features: I call this the “ways of inner awareness” view. On this view, moods are ways of being aware of one’s own experiences. Different versions of the view may be developed, depending on various metaphysical commitments. I do not defend or recommend, here, any specific version. The aim of the paper is to motivate the general ways-of-inner-awareness approach to mood and hint at some possible ways it may be elaborated. (shrink)

The Reflection Principle can be defended with a Diachronic Dutch Book Argument (DBA), but it is also defeated by numerous compelling counter-examples. It seems then that Diachronic DBAs can lead us astray. Should we reject them en masse—including Lewis’s Diachronic DBA for Conditionalization? Rachael Briggs’s “suppositional test” is supposed to differentiate between Diachronic DBAs that we can safely ignore (including the DBA for Reflection) and Diachronic DBAs that we should find compelling (including the DBA for Conditionalization). I argue that Brigg’s (...) suppositional test is wrong: it sets the bar for coherence too high and places certain cases of self-doubt on the wrong side of the divide. Given that the suppositional test is unsatisfactory, we are left without any justification for discriminating between Diachronic DBAs and ought to reject them all—including the DBA for Conditionalization. (shrink)

We present a new argument in favor of the Awareness Principle, the principle that one is always aware of one’s concurrent conscious states. Informally, the argument is this: (1) Your conscious states are such that you can attend to them without undertaking any action _beyond mere shift of attention_; but (2) You cannot come to attend to something without undertaking any action beyond mere shift of attention unless you are already aware of that thing; so, (3) Your conscious states are (...) such that you are aware of them. We open by introducing more fully the Awareness Principle (§ 1) and explicating the crucial notion of “mere shift of attention” (§ 2). We then develop the argument more fully, first in an intuitive form (§ 3) and then more formally (§ 4), before replying to a series of objections (§§ 5–7). (shrink)

The Stoic theory of knowledge was founded by Zeno on a perceptual and crudely materialistic base, but subsequently developed into an elaborate theory involving λεκτ which has proved difficult to reconstruct. The evolution of the school, influenced not only by internal differences but also by interaction with the Platonic Academy, certainly contributed to this development. Hence any adequate reconstruction of the Stoic theory of knowledge must take account of the differences among the positions of the different representatives of the school (...) with respect to the criticism put foward by the Academics. I propose here to clarify Zeno's position, showing how Arcesilaus' criticism helped to expose certain lacunae and thus to bring about changes in doctrine on the part both of Zeno himself and of his immediate successors. (shrink)

This reflection contrasts the dominant imaginary underlying ‘lawofthe Anthropocene’ with an imaginary reaching towards ‘law/sforthe Anthropocene’. It does so primarily by contrasting two imaginaries of human embodiment—law’s existing imaginary of quasi-disembodiment and an alternative imaginary of embodiment as co-woven with the lively incipiencies and tendencies of matter. It draws on ‘transcorporeality’ and ‘sympoiesis’ as inspiration for ‘sympoietic normativities’ as ways of co-living and co-organizing in the face of the catastrophic implications of the Anthropocene emergency.

In lieu of an abstract, here is a brief excerpt of the content:Women and Health Research:A Report from the Institute of MedicineAnna C. Mastroianni (bio), Ruth Faden (bio), and Daniel Federman (bio)In recent years, claims have been made by segments of the research community and by women's health advocacy groups that clinical research practices and policies have not benefitted women's health to the same extent as men's health. Central to these claims has been an assertion that women have been inadequately (...) represented as subjects of clinical studies and that as a result neither health conditions unique to women—e.g., menopause—nor women's manifestations of health problems affecting both sexes—e.g., heart disease—have been investigated sufficiently.The scientific community, including federal agencies that sponsor and regulate clinical studies, is increasingly responsive to these claims and is taking steps to raise the level of women's participation in clinical studies. Controversy and concern have surrounded these actions, however. Two of the claims that have been made are: (1) that women are more difficult to study than men because of their cyclical hormonal changes; and (2) that conducting gender-specific subgroup analyses would increase the size of study populations, raise the cost of studies, and thereby reduce the number of studies that could be performed with the limited resources available. In addition, controversy over the inclusion of women of childbearing potential and pregnant women has been particularly salient. Concerns have been expressed about avoiding potential harm to existing or potential fetuses and about the possible legal and financial ramifications of such harm. A further concern involves the perceived difficulties in enrolling women in studies and retaining them for the duration of the studies.Against this backdrop, the Office of Research on Women's Health at the National Institutes of Health (NIH) asked the Institute of Medicine (IOM) in October 1992 to establish the Committee on the Ethical and Legal Issues Relating to the Inclusion of Women in Clinical Studies. The Committee's charge was to: (1) consider the ethical and legal implications of including women, particularly pregnant women and women of childbearing potential, in clinical studies; (2) examine known instances of litigation regarding injuries to research subjects [End Page 55] and describe existing legal liabilities and protections; and (3) provide practical advice on these issues for consideration by NIH, institutional review boards (IRBs), and clinical investigators.The 16 Committee members came from diverse backgrounds: bioethics, law, epidemiology and biostatistics, public health policy, obstetrics and gynecology, clinical research, pharmaceutical development, social and behavioral sciences, and clinical evaluative sciences.1 Chaired by two of the authors of this article, Ruth Faden and Daniel Federman, and coordinated by the third, IOM Study Director Anna Mastroianni, the Committee met five times over a fourteen-month period, convened a one-and-one-half day invitational workshop, and commissioned several background papers. The Committee's deliberations were complicated by the announcement of new federal policies late in its term. Specifically, the Food and Drug Administration (FDA) issued guidelines (FDA 1993) to replace its 1977 guidelines, which prohibited the inclusion of women of childbearing potential in early phases of most clinical drug trials. In addition, Congress passed the NIH Revitalization Act of 1993 (P.L. 103-43), which contains provisions mandating the inclusion of women and racial and ethnic minorities in NIH-sponsored clinical research. In February 1994, the IOM Committee publicly issued its final report and recommendations, Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies, publishing the workshop presentations and commissioned papers in a separate volume.Deliberations of the CommitteeA number of issues arose at the outset as the Committee considered its charge. A few members initially believed that verification of the underrepresentation of women relative to men in clinical studies as a whole was a prerequisite to providing policy recommendations. Others believed that such an examination would be an important contribution to the knowledge base, but that it was not necessary for addressing the Committee's charge. As summarized in the Committee's report, the Committee's research indicated that firm conclusions about the relative underrepresentation of women could not be drawn from the available data because of the lack of systematic information... (shrink)

Philosophical literature has focused on the concept of trust, but often considers distrust merely as an afterthought. Distrust however, because of its pervasive role in our everyday lives, can be quite damaging. Thus, understanding the rationality of distrust is crucial for understanding our testimonial practices. In this paper I analyze whether it is rational or irrational to distrust an informant on the basis of identity bias. My aim is to show that distrust is irrational when based on negative identity bias. (...) First, I adopt Annalisa Coliva’s account of social hinge epistemology where it is rationally required to assume certain basic presuppositions, such that people are generally reliable informants, to obtain propositional justification and participate in the testimonial practice. Secondly, I show how distrust based on negative identity bias can spread across other domains of interaction and jeopardize the testimonial practice as we fail to assume that people are generally reliable informants. Thirdly, I argue that considering bias as a defeater is beneficial to maintain the claim that bias-based distrust is irrational, as it prevents the acquisition of propositional justification. Finally, I show that distrust is rational when based on evidence and reason that the speaker is not reliable or sincere. (shrink)

Background Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy. Aim To describe ambulance clinicians’ understanding of older patients’ self-determination when the patient’s decision-making ability is impaired. Research design A qualitative (...) design with an inductive approach, guided by descriptive phenomenology. Participants In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews. Ethical considerations The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority. Findings The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination. Conclusion The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous. (shrink)

Self-illness ambiguity is a difficulty to distinguish the ‘self’ or ‘who one is’ from one's mental disorder or diagnosis. Although self-illness ambiguity in a psychiatric context is often deemed to be a negative phenomenon, it may occasionally have a positive role too. This paper investigates whether and in what sense self-illness ambiguity could have a positive role in the process of recovery and self-development in some psychiatric contexts by focusing on a specific case of mental disorder – anorexia nervosa.

Scholars have long recognised the interest of the Stoics' thought on geometrical limits, both as a specific topic in their physics and within the context of the school's ontological taxonomy. Unfortunately, insufficient textual evidence remains for us to reconstruct their discussion fully. The sources we do have on Stoic geometrical themes are highly polemical, tending to reveal a disagreement as to whether limit is to be understood as a mere concept, as a body or as an incorporeal. In my view, (...) this disagreement held among the historical Stoics, rather than simply reflecting a doxographical divergence in transmission. This apparently Stoic disagreement has generated extensive debate, in which there is still no consensus as to a standard Stoic doctrine of limit. The evidence is thin, and little of it refers in detail to specific texts, especially from the school's founders. But in its overall features the evidence suggests that Posidonius and Cleomedes differed from their Stoic precursors on this topic. There are also grounds for believing that some degree of disagreement obtained between the early Stoics over the metaphysical status of shape. Assuming the Stoics did so disagree, the principal question in the scholarship on Stoic ontology is whether there were actually positions that might be called "standard" within Stoicism on the topic of limit. In attempting to answer this question, my discussion initially sets out to illuminate certain features of early Stoic thinking about limit, and then takes stock of the views offered by late Stoics, notably Posidonius and Cleomedes. Attention to Stoic arguments suggests that the school's founders developed two accounts of shape: on the one hand, as a thought-construct, and, on the other, as a body. In an attempt to resolve the crux bequeathed to them, the school's successors suggested that limits are incorporeal. While the authorship of this last notion cannot be securely identified on account of the absence of direct evidence, it may be traced back to Posidonius, and it went on to have subsequent influence on Stoic thinking, namely in Cleomedes' astronomy. (shrink)

In this paper, we develop a theoretical framework for understanding women leaders in working life. Our starting point is in statistics and earlier women-in-management literature, which show that women leaders represent a minority of the managerial population. We assume such underlying mechanisms causing discriminatory practices towards women leaders to exist which have become naturalized and invisible. Our concern is that everyone irrespective of gender should have a fair chance in career progression. This is both a moral and also an economic (...) challenge. The framework we develop in this paper is an alternative approach to studying women leaders compared to traditional women-in-management literature. It aims at revealing the "natural and taken-for-granted" cultural mechanisms behind discriminatory practices. Our framework is based on a critical discursive approach, which draws on ideas of how women''s leadership becomes symbolically represented and constructed in discursive practices. These symbolic constructions, which are mediated through language, often have an ideological loading which positions women leaders and builds their identities in ways that can help to legitimize unequal relations between the genders. However, our framework emphasizes the possibility of multiple discourses and a dynamic view of culture. The cultural constructions of women leaders are, thus, open to change. (shrink)

Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses’ assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The (...) results showed six dimensions, found also in theory and empirical health care studies. Conscience was perceived as authority, a warning signal, demanding sensitivity, an asset, a burden and depending on culture. We conclude that the Perceptions of Conscience Questionnaire is valid for assessing some perceptions of conscience relevant to health care providers. (shrink)

In this paper we investigate composition models of incarnation, according to which Christ is a compound of qualitatively and numerically different constituents. We focus on three-part models, according to which Christ is composed of a divine mind, a human mind, and a human body. We consider four possible relational structures that the three components could form. We argue that a ’hierarchy of natures’ model, in which the human mind and body are united to each other in the normal way, and (...) in which they are jointly related to the divine mind by the relation of coaction, is the most metaphysically plausible model. Finally, we consider the problem of how Christ can be a single person even when his components may be considered persons. We argue that an Aristotelian metaphysics, according to which identity is a matter of function, offers a plausible solution: Christ’s components may acquire a radically new identity through being parts of the whole, which enables them to be reidentified as p. (shrink)