Indigenous nurse scholars across nations colonised by Europeans articulate the need for accomplices (as opposed to mere performative allies) to work alongside them and support their ongoing struggle for health equity and respect and to prioritise and promote culturally safe healthcare. Although cultural safety is now being mandated in nursing codes of practice as a strategy to address racism in healthcare, it is important that white nurse educators have a comprehensive understanding about cultural safety and the pedagogical skills needed to (...) teach it to undergraduate nurses. We open this article with stories of our journeys as two white nurses in becoming accomplices and working alongside Indigenous Peoples, as patients and colleagues. Our lived experience of the inertia of healthcare and education organisations to address systemic and institutional resistance to the practice of cultural safety underpins the intention of this article. We understand that delivering this challenging and complex topic effectively and respectfully is best achieved when Indigenous and white educators work together at the cultural interface. Doing so requires commitment from white nurses and power holders within universities and healthcare institutions. A decolonising approach to nurse education at individual and institutional levels is fundamental to support and grow the work that needs to be done to reduce health inequity and increase cultural safety. White nurse accomplices can play an important role in teaching future nurses the importance of critical reflection and aiming to reduce power imbalances and racism within healthcare environments. Reducing power imbalances in healthcare environments and decolonising nursing practice is the strength of a cultural safety framework. (shrink)

The classification of techniques used in mitochondrial donation, including their role as purported germ-line gene therapies, is far from clear. These techniques exhibit characteristics typical of a variety of classifications that have been used in both scientific and bioethics scholarship. This raises two connected questions, which we address in this paper: how should we classify mitochondrial donation techniques?; and what ethical implications surround such a classification? First, we outline how methods of genetic intervention, such as germ-line gene therapy, are typically (...) defined or classified. We then consider whether techniques of mitochondrial donation fit into these, whether they might do so with some refinement of these categories, or whether they require some other approach to classification. To answer the second question, we discuss the relationship between classification and several key ethical issues arising from mitochondrial donation. We conclude that the properties characteristic of mitochondrial inheritance mean that most mitochondrial donation techniques belong to a new sub-class of genetic modification, which we call ‘conditionally inheritable genomic modification’. (shrink)

The Mental Capacity Act 2005 has provided unified scope in the British medical system for proxy consent with regard to medical decisions, in the form of a lasting power of attorney. While the intentions are to increase the autonomous decision making powers of those unable to consent, the author of this paper argues that the whole notion of proxy consent collapses into a paternalistic judgement regarding the other person’s best interests and that the new legislation introduces only an advisor, not (...) a proxy with the moral authority to make treatment decisions on behalf of another. The criticism is threefold. First, there is good empirical evidence that people are poor proxy decision makers as regards accurately representing other people’s desires and wishes, and this is therefore a pragmatically inadequate method of gaining consent. Second, philosophical theory explaining how we represent other people’s thought processes indicates that we are unlikely ever to achieve accurate simulations of others’ wishes in making a proxy decision. Third, even if we could accurately simulate other people’s beliefs and wishes, the current construction of proxy consent in the Mental Capacity Act means that it has no significant ethical authority to match that of autonomous decision making. Instead, it is governed by a professional, paternalistic, best-interests judgement that undermines the intended role of a proxy decision maker. The author argues in favour of clearly adopting the paternalistic best-interests option and viewing the proxy as solely an advisor to the professional medical team in helping make best-interests judgements. (shrink)

Professor Charles S. Chihara has criticized the views on the subject of inconsistency which Wittgenstein put forward in his recently published 1939 lectures. Chihara notes that these views are not peculiar to the 1939 lectures, and in fact they are to be found in all Wittgenstein's later writings on mathematics . So these ideas about inconsistency appear not to be just a momentary aberration on Wittgenstein's part. One would therefore expect that he had some good reasons for holding them. But (...) Chihara justly complains that the kind of strong argumentation one would hope for is not forthcoming in these lectures. Instead Wittgenstein's usual procedure is to try to defend his views by producing series of rather unconvincing examples. (shrink)

Mitochondrial replacement techniques have the potential to allow prospective parents who are at risk of passing on debilitating or even life-threatening mitochondrial disorders to have healthy children to whom they are genetically related. Ethical concerns have however been raised about these techniques. This article focuses on one aspect of the ethical debate, the question of whether there is any moral difference between the two types of MRT proposed: Pronuclear Transfer and Maternal Spindle Transfer. It examines how questions of identity impact (...) on the ethical evaluation of each technique and argues that there is an important difference between the two. PNT, it is argued, is a form of therapy based on embryo modification while MST is, instead, an instance of selective reproduction. The article's main ethical conclusion is that, in some circumstances, there is a stronger obligation to use PNT than MST. (shrink)

European Journal of Philosophy, Volume 30, Issue 2, Page 578-600, June 2022.

Deriving ethical conclusions from arguments that rely heavily on metaphysical foundations, as Parfit (1984) does in generating his Nonidentity Problem, is an approach fraught with problems. Sparrow...

_Wittgenstein's Art of Investigation_ is one of the first to focus on and provide an original and detailed analysis of Wittgenstein's grammatical investigations. Beth Sarkey offers us new insight into the historical context and influences on method which will help students understand the intricacies and depth of his work.

Extending her earlier work on a theory of human rights in her 1993 Operative Rights, Singer (emerita, American philosophy presumably, City U. of New York) critiques philosophies from Rousseau to Kymlicka in clarifying her views--influenced by Dewey and Mead (George Herbert, not Margaret)--and applying them to such issues as multiculturalism, minority rights, and conflict resolution. The analysis pivots on her concept of "a normative community" rather than natural rights. Annotation copyrighted by Book News, Inc., Portland, OR.

The standard by which we apply decision-making for those unable to do so for themselves is an important practical ethical issue with substantial implications for the treatment and welfare of such individuals. The approach to proxy or surrogate decision-making based upon substituted judgement is often seen as the ideal standard to aim for but suffers from a need to provide a clear account of how to determine the validity of the proxy's judgements. Proponents have responded to this demand by providing (...) the truth-conditions for the substituted judgement in terms of counterfactual reasoning using a possible worlds semantics. In this paper, I show how these underpinnings fail to support the substituted judgement approach as a reasonable standard for decision-making. Firstly, I show how this counterfactual element has been poorly interpreted. I then explain how various accounts have failed to reflect problems and limitations associated with providing an interpretation of their truth-conditions using counterfactuals. Finally, I argue that, even when we attend to the initial problems of providing a counterfactual analysis, it still deeply problematic as a means of determining the validity of substituted judgements for two main reasons. Firstly, making determinate judgements as to the truth-value of these judgements will often not be possible and, secondly, there is a strong requirement when interpreting many counterfactual claims to charitably accede to their being true. I conclude that substituted judgements, as interpreted through counterfactual reasoning and possible worlds semantics, do not therefore provide an adequate standard for surrogate decision-making. (shrink)

This book focuses on material culture as a subject of philosophical inquiry and promotes the philosophical study of material culture by articulating some of the central and difficult issues raised by this topic and providing innovative solutions to them, most notably an account of improvised action and a non-intentionalist account of function in material culture. Preston argues that material culture essentially involves activities of production and use; she therefore adopts an action-theoretic foundation for a philosophy of material culture. Part 1 (...) illustrates this foundation through a critique, revision, and extension of existing philosophical theories of action. Part 2 investigates a salient feature of material culture itself—its functionality. A basic account of function in material culture is constructed by revising and extending existing theories of biological function to fit the cultural case. Here the adjustments are for the most part necessitated by special features of function in material culture. These two parts of the project are held together by a trio of overarching themes: the relationship between individual and society, the problem of centralized control, and creativity. (shrink)

To address growing concerns about academic integrity, college students (n?=?758) at honor system and non-honor system institutions were presented with eight scenarios to determine the influence of an honor system on their perceptions of and responses to academic dishonesty. Main effects for honor code status emerged. Students from traditional honor system schools considered the behaviors to be more dishonest, and were more likely to respond that they would report the incident when compared to students attending modified and non-honor system institutions. (...) Findings suggest traditional honor systems, with specific rules and regulations in place, are more effective at cultivating academic integrity among students; modified honor systems may not be as effective as previous research suggests. (shrink)

Parfit’s (1984) Non-Identity Problem provides a strong line of argument that we cannot be harmed by pre-conception choices or actions. I argue that we can no longer appeal to the Non-Identity problem in order to justify using pre-conception genetic screening and selection techniques as a harmless tool to determine the genetic constitution of future individuals. My criticism of the Non-Identity problem is based on a rejection of the metaphysical foundations of Parfit’s argument - Kripke’s (1980) essentialist arguments for the necessity (...) of origin. I offer an alternative account of modal harms based on counterpart theory such as that offered by David Lewis (1986). On this account, individuals can make legitimate harm claims in regard to pre-conception choices made in determining their genetic constitution by appeal to their counterparts across possible worlds. (shrink)

The concept of vulnerability has been subject to numerous different interpretations but accounts are still beset with significant problems as to their adequacy, such as their contentious application or the lack of genuine explanatory role for the concept. The constant failure to provide a compelling conceptual analysis and satisfactory definition leaves the concept open to an eliminativist move whereby we can question whether we need the concept at all. I highlight problems with various kinds of approach and explain why a (...) satisfactory account of vulnerability is unlikely ever to be offered if we wish the concept to play a genuinely explanatory role in bioethical contexts. I outline why an eliminativist position should be taken with regard to this concept in light of these concerns but mitigate some of the severity of this position by arguing that we can still make sense of retaining our widespread use of the term by viewing it as nothing more than a useful pragmatic linguistic device that acts as a marker to draw attention to certain kinds of issue. These issues will be entirely governed by other, better understood ethical concepts and theories. (shrink)

Inherent in providing healthcare for youth lie tensions among best interests, decision-making capacity, rights, and legal authority. Transgender youth experience barriers to needed gender-affirming care, often rooted in ethical and legal issues, such as healthcare provider concerns regarding youth capacity and rights to consent to hormone therapy. Even when decision-making capacity is present, youth may lack the legal authority to give consent. The aims of this paper are therefore to provide an empirical analysis of minor trans youth capacity to consent (...) to hormone therapy and to address the normative question of whether there is ethical justification for granting trans youth the authority to consent to this care. Through qualitative content analysis of interviews with trans youth, parents, and healthcare providers, we found that trans youth demonstrated the understandings and abilities characteristic of the capacity to consent to hormone therapy and that they did consent to hormone therapy with positive outcomes. Employing deontological and consequentialist reasoning and drawing on a foundation of empirical evidence, human rights, and best interests we conclude that granting trans youth with decisional capacity both the right and the legal authority to consent to hormone therapy via the informed consent model of care is ethically justified. (shrink)

“My first long haul flight that didn’t fill up and an empty row for me. I have been blessed by the algorithm ”. The phrase ‘blessed by the algorithm’ expresses the feeling of having been fortunate in what appears on your feed on various social media platforms, or in the success or virality of your content as a creator, or in what gig economy jobs you are offered. However, we can also place it within wider public discourse employing theistic conceptions (...) of AI. Building on anthropological fieldwork into the ‘entanglements of AI and Religion’, this article will explore how ‘blessed by the algorithm’ tweets are indicative of the impact of theistic AI narratives: modes of thinking about AI in an implicitly religious way. This thinking also represents continuities that push back against the secularisation thesis and other grand narratives of disenchantment that claim secularity occurs because of technological and intellectual progress. This article will also explore new religious movements, where theistic conceptions of AI entangle technological aspirations with religious ones. (shrink)

Corporate Philanthropy is multi-dimensional, differs between sectors and involves both individual and organisational decision-making to achieve business and social goals. However, the CP literature characteristically focuses on strategic decisions made by business leaders and ignores the role of employees, especially those in lower status and lower paid positions. To redress this imbalance, we conducted a qualitative study of employees’ involvement in CP processes in ten workplaces in the South East of England to identify whether and how they are involved in (...) CP decision-making and to capture their perspective on the nature of CP and the benefits generated by such activities. We specifically chose to study workplaces where employees are involved in the actual execution of the CP strategy, prioritising companies with a visible presence on the high street. The results illustrate the benefits of involving employees in CP decision-making, which we argue derives in part from the ‘liminal-like states’ that typify CP activities organised by shop floor staff, involving the temporary overturning of hierarchies, humanising of workplaces and opportunities for lower level staff to prioritise their personal philanthropic preferences and signal their charitable identity to colleagues and customers. Whilst the data also suggest that CP decision-making remains predominantly top-down and driven by profit-oriented goals, we conclude that employees should be involved in choosing charitable causes as well as in designing and implementing workplace fundraising, in order to maximise the advantages of CP for the company and for wider society. (shrink)

Non-Identity arguments have a pervasive but sometimes counter-intuitive grip on certain key areas in ethics. As a result, there has been limited success in supporting the alternative view that our choices concerning future generations can be considered harmful on any sort of person-affecting principle. However, as the Non-Identity Problem relies overtly on certain metaphysical assumptions, plausible alternatives to these foundations can substantially undermine the Non-Identity argument itself. In this paper, I show how the pervasive force and nature of Non-Identity arguments (...) rely upon a specific adoption of a theory of modality and identity and how adopting an alternative account of modality can be used to reject many conclusions formed through Non-Identity type arguments. By using Lewis’s counterpart-theoretic account to understand ways we might have been, I outline the basis of a modal account of harm that incorporates a person-affecting aspect. This, in turn, has significant implications for ethical decision-making in areas such as reproductive choice and the welfare of future generations. (shrink)

In response to Hirsch's deflationary arguments, Sider attempts to introduce a special Ontologese quantifier to preserve the substantivity of fundamental debates in metaphysics. He claims that this strategy can be effected by two distinct means, one of which is a list of instructions for metaphysicians, which he argues suffice to give the new quantifier a meaning that carves nature at the joints. I argue that these instructions will not allow someone to start speaking Ontologese if their prior language is sufficiently (...) deviant with respect to it, and that natural languages may be in just such a position. (shrink)

The Liverpool Care Pathway for the Dying has recently been the topic of substantial media interest and also been subject to the independent Neuberger Review. This review has identified clear failings in some areas of care and recommended the Liverpool Care Pathway be phased out. I argue that while the evidence gathered of poor incidences of practice by the Review is of genuine concern for end of life care, the inferences drawn from this evidence are inconsistent with the causes for (...) the concern. Seeking to end an approach that is widely seen as best practice and which can genuinely deliver high quality care because of negative impressions that have been formed from failing to implement it properly is not a good basis for radically overhauling our approach to end of life care. I conclude that improvements in training, communication, and ethical decision-making, without the added demand to end the Liverpool Care Pathway would have resulted in a genuine advance in end of life care. (shrink)

This paper examines the potential for abstracting propositions – an as yet untested way of defending the realist thesis that propositions as abstract entities exist. I motivate why we should want to abstract propositions and make clear, by basing an account on the neo-Fregean programme in arithmetic, what ontological and epistemological advantages a realist can gain from this. I then raise a series of problems for the abstraction that ultimately have serious repercussions for realism about propositions in general. I first (...) identify problems about the number of entities able to be abstracted using these techniques. I then focus on how issues of language relativity result in problems akin to the Caesar problem in arithmetic by exposing circularity and modal concern over the status of the criterion of identity for propositions. (shrink)

A paradigm case of demanding involves making utterances designed to influence addressees to accede.1 It would be incoherent to say, "I demand that you do x, but I am not saying that you ought to do x," or "I demand that you do x, although I am fully aware that you cannot do x." The extraordinary nature of demanding may be gleaned from anomalous utterances such as "employees may demand time off by notifying scheduling managers at least one month in (...) advance" and "faculty members may demand an extension of the tenure clock in writing to the provost." Demanding is less anomalous in protest rhetoric and in fact an important strategy for marginalized groups who are "criticized for not handling conflicts and controversies... (shrink)

Recent legal rulings concerning the status of advance statements have raised interest in the topic but failed to provide any definitive general guidelines for their enforcement. I examine arguments used to justify the moral authority of such statements. The fundamental ethical issue I am concerned with is how accounts of personal identity underpin our account of moral authority through the connection between personal identity and autonomy. I focus on how recent Animalist accounts of personal identity initially appear to provide a (...) sound basis for extending the moral autonomy of an individual - and hence their autonomous wishes expressed through an advance directive - past the point of severe psychological decline. I argue that neither the traditional psychological account nor the more recent Animalist account of personal identity manage to provide a sufficient basis for extending our moral autonomy past the point of incapacity or incompetence. I briefly explore how analogies to similar areas in law designed to facilitate autonomous decision, such as wills and trusts, provide at best only very limited scope for an alternative justification for granting advance statements any legal or moral authority. I conclude that whilst advance statements play a useful role in formulating what treatment is in a patient’s best interests, such statements do not ultimately have sufficient moral force to take precedence over paternalistic best interest judgements concerning an individual’s care or treatment. (shrink)

In this paper I provide an account of the metaphysical foundations of mental illness in terms of a realism debate. I motivate the importance of such metaphysical analysis as a means of avoiding some intractable problems that beset discussion of the concept of mental illness. I apply aspects of the framework developed by Crispin Wright for realism debates in order to examine the ontological commitments to mental illness as a property that humans may exhibit and to examine the various arguments (...) that realists and anti-realists can use to defend their position on mental illness. I pay particular attention to characterising Szasz's account of mental illness as that of an anti-realist error-theory and present ways in which a realist may counter such a position. Ultimately I argue that in order to hold a realist position on mental illness one would have to adopt some form of realism towards values, such as moral realism. (shrink)

For graduate students to succeed as professionals, they must develop a set of general “survival skills”. These include writing research articles, making oral presentations, obtaining employment and funding, supervising, and teaching. Traditionally, graduate programs have offered little training in many of these skills. Our educational model provides individuals with formal instruction in each area, including their ethical dimensions. Infusion of research ethics throughout a professional skills curriculum helps to emphasize that responsible conduct is integral to succeeding as a researcher. It (...) also leads to the consideration of ethical dimensions of professional life not covered in traditional ethics courses. (shrink)

Two notable limitations exist on the use of personhood arguments in establishing moral status. Firstly, although the attribution of personhood may give us sufficient reason to grant something moral status, it is not a necessary condition. Secondly, even if a person is that which has the ‘highest’ moral status, this does not mean that any interests of a person are justifiable grounds to kill something that has a ‘lower’ moral status. Additional justification is needed to overcome a basic wrongness associated (...) with killing something possessing moral status. There are clear arguments already available in this regard in the case of a foetus that are not available in the case of a newborn infant. Hence, there is scope to consistently hold that abortion may be permissible but that after-birth abortion may not be permissible. (shrink)

Increased productivity may have negative impacts on farm animal welfare in modern animal production systems. Efficiency gains in production are primarily thought to be due to the intensification of production, and this has been associated with an increased incidence of production diseases, which can negatively impact upon FAW. While there is a considerable body of research into consumer attitudes towards FAW, the extent to which this relates specifically to a reduction in production diseases in intensive systems, and whether the increased (...) incidence of diseases represents a barrier to consumer acceptance of their increased use, requires further investigation. Therefore a systematic review of public attitudes towards FAW was conducted, with a specific focus on production diseases in intensive systems. Four databases were searched to identify relevant studies. A screening process, using a set of pre-determined inclusion criteria, identified 80 studies, with the strength of evidence and uncertainty assessed for each. A thematic analysis led to the identification of 6 overarching themes constructed from 15 subthemes. The results demonstrate that the public are concerned about FAW in modern production systems. Concern varied in relation to age, gender, education and familiarity with farming. Naturalness and humane treatment were central to what was considered good welfare. An evidence gap was highlighted in relation to attitudes towards specific production diseases, with no studies specifically addressing this. However, the prophylactic use of antibiotics was identified as a concern. A number of dissonance strategies were adopted by consumers to enable guilt free meat consumption. (shrink)

This book details a pragmatic approach to the ethical and religious implications of a Darwinian perspective, drawing on the work of thinkers both secular and religious. The approach taken by James, Santayana, Addams, and Dewey should be of interest to scholars of religious naturalism and humanistic ethics.

Every day, medical interpreters encounter the vulnerabilities of patients with limited English proficiency and systemic barriers to doing the right thing for patients. The narratives in this issue of NIB demonstrate a love of the interpretive practice. There are many stories of advocacy that go above and beyond what is expected of them. Yet, even with national standards, tensions exist as to the boundaries of their role—how much advocacy is expected and how much is above and beyond? What are the (...) emotional costs of advocating for patients who are so vulnerable and in a system that is both huge and changing all the time? Overall, the narratives convey a sense of being situated within teams and within healthcare organizations as moral communities. As you read their stories, circle back to this context every now and then to ground the narratives and yourself in what it means to be a member of a team and moral community. I hope this grounding will help us be better at what we do together. (shrink)

The presence of parents or other guardians (commonly termed ‘supervision’) and parental knowledge are factors that are both robustly negatively associated with a range of anti-social and risky behavioural outcomes such as adolescent crime. However, parental presence/supervision and parental knowledge are both (i) regularly used inaccurately as proxies for parental monitoring, (ii) poorly defined and operationalised, and (iii) rarely linked to negative behavioural outcomes with plausible mechanisms that adequately explain their association. These problematic aspects of the parental monitoring literature are (...) a barrier to research into adolescent outcomes and the varied role of parents. This theoretical paper facilitates solutions these problems by clarifying the concepts of parental presence, supervision and knowledge. This discussion delineates presence from supervision and knowledge from monitoring. It specifies how presence and knowledge are not parenting actions, and neither constitute parental monitoring. These concepts are clarified within the parameters of a recent framework of goal-directed parental action and parental monitoring. Doing so constitutes under-labouring that facilitates future discovery of their distinct and yet inter-related mechanisms of influence on adolescent action and development. These structured conceptual developments are also of benefit for our better future understanding of parenting and parental monitoring by providing a framework within which to re-situate existing empirical research findings. (shrink)