Over the past decade AIDS research has turned toward the use of pharmacology in HIV prevention, including pre-exposure prophylaxis (PrEP): the use of HIV medication as a means of preventing HIV acquisition in those who do not have it. This paper explores the contradictory reasons offered in support of PrEP—to empower women, to provide another risk-reduction option for gay men—as the context for understanding the social meaning of the experimental trials that appear to show that PrEP works in gay men (...) and heterosexual couples but not single women. The PrEP debates reveal the different ideas about “demedicalization” in the earlier gay health and women’s health movements and highlight the relationship between health activism and critique of research ethics in the context of a global pharmaceutical market. (shrink)

"L'usage substantivé du mot 'soi' est intriguant. Le pronom tonique 'soi' ne pose pas de problème particulier dans les expressions comme 'prendre soin de soi', 'compter sur soi' ou 'être hors de soi'. Mais parler d'un 'soi', c'est aller au-delà de la réalité grammaticale et supposer une identité personnelle à travers la diversité des expériences. Or, l'idée de soi et la croyance en l'identité personnelle ont été mises en question par David Hume, dont les arguments résonnent toujours dans la philosophie (...) contemporaine. Le but de ce livre est double : montrer, en historiens de la philosophie, de quelle façon le philosophe britannique a répondu à ces problèmes, et évaluer la fécondité de ces résultats pour les sciences de l'esprit."--Page 4 of cover. (shrink)

Multicultural Odysseys by Will Kymlicka is a textbook example of how to effectively integrate empirical research and philosophical analysis. In it Kymlicka offers a measured and scrupulously honest assessment of what he takes to be both the potential and the limits of liberal multiculturalism as a model for democratization, seeking not to defend his views on multiculturalism in so much as try to understand them. In particular, he seeks to understand how his views on multiculturalism can be correct in the (...) context of Western democracies (as he does not doubt they are) and yet be limited in their potential for export. In approaching his project in this way, Kymlicka raises a number of questions about multiculturalism, about theorizing across borders, and about the nature of Western democracy that he does not directly address, but toward which the reader is inevitably spurred. In this commentary I focus on one especially important question: What does the analysis of this book imply about the future prospects for ideal theorizing? I argue that, without the author intending or necessarily foreseeing it, Multicultural Odysseys has made the world of political philosophy a much less hospitable place for ideal theorizing, at least as it has traditionally been understood. In the wake of Kymlicka’s treatment of the limits on liberal multiculturalism’s exportability it is difficult to imagine that ideal theorizing can occupy the same central place in normative analyses of multiculturalism, minority rights, liberalism, democracy, and global justice. (shrink)

Everyone agrees that the international community must develop better mechanisms for responding to humanitarian crises. The best mechanism for responding is simply to intervene to prevent a crisis from developing in the first place. However, because the principle of sovereignty imposes strict constraints on action across state borders, international actors are often unwilling or unable to interpose themselves until after conditions have escalated into a full-blown crisis, by which time it has usually become a matter of managing human misery rather (...) than ending or averting it. Respect for sovereignty is an organizing principle of the existing international legal system, and so abandoning it would fundamentally change how the units of international politics are constituted and relate to one another. The strongest argument against abandoning sovereignty is the potential for unintended consequences with respect to peace, political stability, and the effective protection and promotion of human rights. One way to defuse this worry is to frame interventions across borders as principle-based exceptions to a general rule of state sovereignty. If we assume that protecting and promoting individual human rights is the primary goal of the international system, and that both state sovereignty and peace and security are important to us primarily as vehicles for achieving this, then (it is argued) we may use the standards of international human rights to identify, and limit, cases in which the presumption of sovereignty may legitimately be set aside. However, the relationship between sovereignty and humanitarian crises is more complex than this picture allows. Theorizing about humanitarian crises inevitably includes recommendations about states and this makes it a species of non-ideal theory. All actual states are rife with injustice, both in their internal structures and in the relationships these structures establish with those outside a state’s borders. This fact must be reflected in our reasoning about humanitarian responses. (shrink)

Maintaining academic integrity is a growing concern for higher education, increasingly so due to the pivot to remote learning in 2020 caused by the COVID-19 pandemic. We canvassed students, faculty, and tutors at an online Canadian university about their perspectives on academic integrity and misconduct. The survey asked how the university could improve policies concerning issues of academic integrity, how faculty and tutors handled cases of misconduct, about satisfaction with how academic violations were treated, and about the role of students, (...) faculty, and tutors in encouraging academic integrity. As well, we collected suggestions from respondents for reducing cheating, addressing academic misconduct, and general ideas about academic integrity. The distinction between misconduct and integrity was not always clear in their comments. We received responses from 228 students and 73 faculty and tutors, generating hundreds of comments. In this paper we focus only on the answers to open-ended questions. Using content analysis, we categorized the replies into similar threads. After multiple iterations of analysis, we extracted three general recommendation groupings: Policy and Procedures, Compliance and Commitment, and Resources. Based on respondents’ views, we propose a balanced approach to supporting academic integrity. Although we conducted the study pre-COVID-19, the recommendations apply to current and future academic integrity practices in our context and beyond. (shrink)

The practice of placing men and women in the same hospital room (mixed gender rooms) has been prohibited in the UK National Health Service for over a decade. However, recent research demonstrates that the practice is common and increasing in a major New Zealand public hospital. Reports and complaints show that the practice also occurs in Australia. We argue that mixed gender rooms violate the fundamental human rights of personal security and dignity. The high rates of cognitive impairment, sensory impairment (...) and frailty in hospital wards exacerbates the risk for these violations and subsequent harm. We argue for the adoption of specific national policies prohibiting mixed gender rooms and public reporting of breaches. Importantly, these guidelines can be adopted without compromising the rights of gender minorities. In the long term, hospitals should be built with single occupancy rooms. (shrink)

Cultural narratives shape how we think about the world, including how we decide when the end of life begins. Hospice care has become an integral part of the end‐of‐life care in the United States, but as it has grown, its policies and practices have also imposed cultural narratives, like those associated with the “six‐month rule” that the majority of the end of life takes place in the final six months of life. This idea is embedded in policies for a range (...) of care practices and reimbursement processes, even though six months is not always a meaningful marker. In the case of people living with advanced dementia, six months is both too early in the trajectory to facilitate conversations and too late in the trajectory to ensure decision‐making capacity. This essay encourages scholars and policy‐makers to consider how cultural narratives may limit what they think is possible in care for people living with dementia. (shrink)

Breastfeeding remains an understudied topic in research and theorizing about reproductive experience and women's bodies. This article reports on women's experiences of breastfeeding in public as revealed through in-depth interviews with 51 women. The current construction of the good maternal body requires women to carefully manage the performance of breastfeeding in specific ways and with particular attention to the dominant notion of a sexualized rather than nurturing breast. Women accommodate to, and resist, the perceived boundaries of the good maternal body (...) through their breastfeeding behaviors. (shrink)

La conceptualización del saber artesanal es compleja y requiere del reconocimiento epistemológico dentro del contexto sociocultural y económico en el que opera lo artesanal, donde es necesario resaltar el valor ancestral, pues, dentro del aprendizaje hay una transferencia de conocimiento tradicional cuando no hay una ruptura en la producción de sentido que se constituye.Por ello, esta investigación busca, por medio de un documental, visibilizar la labor que cumplen los artesanos y cesteros del municipio de Tocaima, Cundinamarca, logrando construir un espacio (...) de integración y capacitación donde sean los cesteros quienes se beneficien y logren transmitir los saberes de la cestería. (shrink)

Dans la perspective du second conflit mondial, la Suisse s’est engagée dans la production massive d’armements militaires. Épargnée par la guerre, elle procède à partir de 1948 à la réduction de ses stocks en privilégiant le rejet des munitions dans ses lacs plutôt que de les faire exploser à ciel ouvert ou de les recycler. Malgré le retour sur la scène publique des munitions immergées, aucune controverse n’a éclaté dans un pays pourtant sensible aux questions environnementales. À partir du cas (...) des munitions immergées dans les lacs, le présent article s’interroge sur les manières dont les stratégies du secret conjuguées avec d’autres facteurs, tels que l’oubli ou d’autres priorités politiques, ont retardé toute réflexion sur ce dossier et ont participé au contingentement de tout débat public. À quelles conditions préalables le dépôt des munitions dans les lacs suisses pourrait-il entrer dans le débat public et engager les pouvoirs publics à agir au-delà même d’un risque potentiel non avéré? Pour y parvenir, il s’agira de s’interroger sur le rôle et la fonction même de la controverse écologique comme moyen de mobilisation de la société civile et des acteurs institutionnels. (shrink)

[P]layers line up in a long line and hold hands. The player at the front of the line is the ‘head’ and the player at the end of the line is the ‘tail’.… The game begins when the head begins to run wildly in any direction, making sharp turns and quick double-backs.… The force created by the twists and turns will often send the tail of the whip flying.… It may be best for the tail to hold on with both (...) hands to keep from flying off the end. Sometimes, however, the tail will go flying no matter how hard they hold on... Be prepared to get dirty if you play this game!--"Crack the Whip: Party Game CentralIf the evolution of American health policy is compared to the children’s game of Crack the Whip, then there is no question that the Medicaid program is the tail of the line. When those at the head of the line start to move. Medicaid receives whatever shocks and unintended consequences result, and when the line “begins to run wildly in any direction,” it receives them faster and harder than the players at the center.Shocks also come from other sources. When the economy slumps, an epidemic arises, or a path in another part of the system becomes a cul-de-sac, new twists and turns occur, with Medicaid absorbing much of the change. (shrink)

It is the praxis of being a subject in the world which enables psychoanalysis to theorise subjectivity. Freud theorised subjectivity from the perspective of desires, those repressed unconscious forces which conflict with the subjects’ need to live in the world. The upshot of this conflict for the subject is trauma and for psychoanalysis such trauma provides a way into a remedy, a cure, the presumption of psychoanalysis being that through its method of transference, it does indeed possess the knowledge to (...) pursue a remedy. Lacan offers a new interpretation of Freud by considering the subject as an ongoing ontological enigma in so far as subjective unconscious desire is not only (potentially) traumatic but necessarily (always) linguistic. How is this an ontological enigma? For Lacan the subject is first and foremost a speaking being engaged in an ongoing struggle to articulate unconscious desire. This is because, claims Lacan, we are born into language which not only pre-exists us but continues after death. In this way subjectivity is inescapably oriented to language as simultaneously intrinsic external to it. The unconscious is therefore a mixture of inside and outside, an enigmatic (pre)ontological space which Lacan calls extimacy. This essay seeks to explore Lacan’s orientation of the subject towards extimacy as the site of subjective conflict where, in its quest for the subject’s desire to know and handle the symptom, transference engages a new ontological dimension in which we can say that the extimate is structured like a sensation. (shrink)

In Singapore’s multicultural society, a sizable proportion of the population subscribes to complementary and alternative medicine. In this article, we discuss the impact this has on medical practice in the context of the four principles of medical ethics. To uphold the principle of autonomy, we propose a non-judgmental approach towards patients who use CAM. Nevertheless, in order to promote health and prevent harm, the safety profiles of CAM must be studied through systematic research. In addition, the principle of justice is (...) one concerned with the fair distribution of scarce healthcare resources, while granting equal access to healthcare regardless of beliefs. Understanding CAM from an ethical perspective allows for the provision of safe, holistic, and culturally relevant care. (shrink)

In what follows we present group rights as portrayed in contemporary theoretical debates; compare this portrayal with some of the claims actually advanced by various indigenous groups throughout the world; and give reasons for preferring the practical to the theoretical treatments. Our findings suggest that liberal-individualist and corporatist accounts of group rights actually agree on the kind of importance that group interests have for persons and on what it is that groups who claim rights are concerned about. Both liberal-individualists and (...) corporatists locate the importance of group interests in the personal psychology of individual group members. As a result, both treat group interests (such as cultural integrity) as not only different in kind from individualized interests such as freedom of expression but as potentially in competition with them. In contrast, the real-world demands of indigenous groups place emphasis on concrete ways in which the preserving of communal life can be important to individuals’ well-being, in addition to the various spiritual and symbolic resources which such life may provide. These practical aspects of communal life make individuals’ group interests a lot like their individualized ones, and so suggest that group rights do not introduce new or distinctive theoretical questions. Instead, group rights are raise familiar questions about how individuals’ interests ought to be balanced against one another when they are in competition; what counts as an adequate institutional structure for the instantiation of a right; and who ought to be recognized as an authoritative judge of whether a right has been respected. (shrink)

This volume considers formalisations of love in the 21st century. Engaging with the Slovenian School of Philosophy, the book contends that psychoanalysis is the one line of thought that exposes the role that love plays in all knowledge, emphasising the importance of love in these unsettled times.

Zaller's model of public-opinion formation portrays the average citizen as an automaton who responds unthinkingly to elite cues. That is, once people have received information from political elites, they tend to abide by whatever their respective cue-givers dictate, since rejecting information is more cognitively costly than simply accepting it. Empirical research in psychology on priming supports this view of the citizen as a passive receiver of information. For example, people are likely to be unconsciously influenced by subtle cues and they (...) tend to base their opinions on the accessibility of information in memory. However, some citizens, under certain conditions, may be ?active processors? of information: actively interpreting it, elaborating on its implications, and negotiating its meaning. Whether or not Zaller's model is an accurate representation of the process of public-opinion formation depends substantially upon the inclusiveness of the researcher's views about what constitutes public opinion and how to study its determinants. (shrink)

The child protection system in France has gradually changed along the lines of the laws enacted in 2002 and 2007 that reasserted the importance of the role played by the parents. Far from condemning the family, it henceforth seeks to provide it with accompaniment so as to ensure the child’s future reintegration. Grounded in psychoanalytical group and family theories, the article investigates the psychic function of the institution and (with case studies to support it) discusses what has to be done (...) to make arrangements within the therapeutic framework for families to make progress and maintain ties despite the absence of direct relations. For it is only after a real period of separation that work on the young person’s psychic group experience will enable the family to move forward. (shrink)

Conventional wisdom suggests that promoting self-determination for peoples and protecting the human rights of individuals are competing priorities. By this is meant that securing individuals in their human rights requires limits on the rights of their peoples, and vice versa. In contrast, the Draft UN Declaration on the Rights of Indigenous Peoples (the Draft Declaration) treats the two as not only mutually supporting but mutually necessary. In the Draft Declaration, the right of peoples to self-determination is more than a principle (...) that constrains states in their behavior towards other states and territories “outre-mer”; it also constrains states within their domestic realm. This view of self-determination reflects the experience of many indigenous groups, for whom refusal to respect the integrity of their group and failure to respect the integrity of their persons have gone hand in hand. In this chapter, I argue that the Draft Declaration’s treatment of self-determination is right: self-determination is a human right and this human right is the same right that underpins the rights of states. Treating an interest of peoples like self-determination as a constitutive element of human dignity raises practical worries about the stability of the international system, and philosophical worries about potential conflicts between individuals and peoples. But it also casts state sovereignty itself in a different light. This new light has interesting consequences both for international law and for philosophical debates about minorities within minorities. In particular, it allows one to think about questions about internal minorities as ultimately questions about legitimacy and representation. (shrink)

Este estudio buscó describir e interpretar las teorías subjetivas sobre la identidad profesional docente que se construyen y difunden noticiosamente durante la educación de emergencia por la pandemia de COVID 19. Se utilizó un estudio de análisis documental, metodología cualitativa y un diseño de estudio de casos. El muestreo intencionado y por conveniencia corresponde a 40 noticias de prensa escrita en español, sobre el profesor(a) en pandemia y publicadas en diferentes medios que fueron recolectadas a través de Google Noticias desde (...) el 11 de marzo de 2020 y hasta el 01 de noviembre de 2020. A partir de una codificación temática, los resultados evidenciaron teorías subjetivas asociadas a las exigentes características, roles, funciones y valores con los que se identifica al profesorado durante la pandemia. El análisis mostró los distintos sentidos del ejercicio profesional y las competencias asociadas a su desempeño en la prensa. En la discusión, se utilizaron estudios relativos a la práctica docente para interpretar estos resultados. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Who Tells the StoryCindy BitterThirty years later, I do not remember her name, but I definitely remember her face, and this is how I remember her story.She came into the office for her flu shot. She was in her 70s and had a mild case of COPD attributed [End Page 87] to years of exposure to pesticides on the family farm. She said she was trying to stay healthy, (...) as the grandkids were due for a visit, and everyone had gotten a cold after Thanksgiving the year before. I was a sub-intern doing a required rural medicine rotation and diligently did an exam, finding asymptomatic new-onset atrial fibrillation of uncertain duration. We admitted her to the hospital and started anticoagulation. My attending also ordered a calcium channel blocker to slow her pulse, which was running 90–100 while she was at rest. The attending insisted that it would convert her back to sinus rhythm. The nurses were not experienced with the medication and were uncomfortable giving it. I was pretty sure the calcium channel blocker was not indicated, and a quick check of my pocket manual confirmed the drug would lower her heart rate and maybe her blood pressure but that it would not fix the abnormal rhythm. I refused to administer it. The attending came in, pushed the medication, and returned home. A few minutes later, the patient was struggling to speak. Her pulse fell to in the 30s, and her blood pressure had dropped dangerously low. I asked for the crash cart and calcium, and my attending, then started CPR when she lost her pulse. Half an hour later, my attending called her time of death.Hers was not the first death I'd witnessed, but it was the first time I felt like my patient would have been better off without our interventions. As a medical student hundreds of miles from the main hospital campus, I felt powerless to contradict the attending, and did not know where to turn for support in the moment. I rationalized it by saying that I had not actively contributed to her death by pushing the medication, but I held myself morally culpable for doing the exam and finding an asymptomatic abnormality that started her down that path. I felt I should have known the pathophysiology and medication side effects better, or been more assertive, or called for help.One could argue whether I was suffering from a grief reaction or falling into depression, but I questioned my calling to medicine and seriously considered leaving the field. But I was quite certain that I did not want another patient to be put at risk, or a student to feel cornered into taking actions against their better judgment. After returning to the main hospital, I met with the clerkship director and helped develop a pathway for students to raise safety concerns in real-time. Now I recognize the feeling I experienced as moral injury, but we weren't using that term at the time, or talking about Six Sigma safety, or stopping the line.Ultimately, I continued through medical school and trained as an emergency physician. My prior reverence for my attendings moderated to a healthier respect that had to be earned. I read voraciously, trying to prepare myself for unexpected situations. I became an advocate for patient safety and was an early adopter of shared decision-making. I strive to be a physician who welcomes questions and respects the concerns of all team members. Many of the principles that ground my career in medicine grew out of my exposure to this patient.It was always my least favorite of the tropes common to television medical dramas—the circumstances of the patient-of-the-week illuminated some aspect of our main characters' lives, providing a very important life lesson. I felt it positioned patients to be in service of the physician's aims, using patients as a means to our ends, when we should be using our knowledge and experience to further the patient's goals. Very un-Kantian, in addition to transgressing against multiple other philosophers and medical ethicists. As medicine learns more about the power of... (shrink)