Most empirical research examining physician views on physician-assisted suicide has used quantitative methods to characterize positions and identify predictors of individual attitudes. This approach has generated limited information about the nature and depth of sentiments among physicians most impassioned about PAS. This study reports qualitative data provided by 909 physicians as part of a larger survey regarding attitudes toward and experiences with PAS and palliative care. Emergent themes illustrate important clinical, social, and ethical considerations in this area. The data illustrate (...) the diverse and ardent responses that PAS evokes among certain physicians. The role of physicians' personal values is central to discussions about legalization of PAS. Polarized views such as those expressed by physicians in this study are not likely to be reconciled, thereby constraining the development of public policy regarding PAS. (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)

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)

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)

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)

Most political philosophers are reluctant to treat cultural rights as basic. Instead, the predominant view is that cultural interests are only important derivatively, in virtue of their contribution to some other interest. In this chapter I argue that political philosophers ought to follow international human rights norms regarding the importance of culture. Not only do international human rights courts and committees come to the right conclusion about the significance of culture, but, as importantly, they come to this conclusion because they (...) think about what cultural rights protect inthe right way. Contemporary political philosophers prefer to treat cultural rights as derivative in part because they tend to treat culture as a “resource” or a “good,” but this is a mistake. Cultural rights are better understood as protecting and promoting an activity. Respecting and promoting cultural participation is a constitutive element of showing respect for human dignity because, like free expression, political participation, and freedom of conscience, cultural participation is something persons do as part of making a life for themselves. (shrink)

Robert Card argues that although Susan Okin’s analysis in Justice, Gender and the Family leads to the conclusion that justice within the family requires elimination of gendered roles within marriage, this conclusion is not compatible with a conception of justice in which neutrality between reasonable conceptions of the good, and protection of individuals’ contractual capabilities are taken to be fundamental values. Although Card is right that there is tension in Okin’s work between where the analysis of injustice within the gender-structured (...) family leads and where, as a reformer, Okin is willing to go, and he is right to locate the source of that tension in Okin’s attempt to remain within Rawlsian liberalism, Okin’s view has more resources to respond to this critique than Card acknowledges. In the end, these additional resources may not be sufficient to address the problems that Card notes, but they do suggest a more complex relationship between Okin’s view and the liberal tradition than Card allows.. (shrink)

The present study shows that the Internet functions as a gratifying context for the exchange of knowledge and values related to religious matters among youngsters in the Netherlands; they are in the midst of constructing a religious identity. Systematic content analysis complemented by qualitative research was carried out on Maroc.nl, a discussion forum primarily aimed at Moroccan youth. Inspired by Kemper's definitions of experiencing Islam, the recurrence of six dimensions of religious experience was looked into in 1,354 online messages. The (...) purpose of this study is to gain insight into the nature and the relative visibility of each of these dimensions in the online discussions under study. In addition, a number of context-bound and issue-related characteristics of the message were assessed through qualitative analysis, in an effort to find out what key issues were mainly dealt with, what normative statements were made, and how the informants related to one another. (shrink)

Recent events concerning Žižek at the Left Forum in New York have revealed much about the state of the Left. It appears that the Left is weaker than ever before and Žižek’s appeal to return to radical roots, yet also break some Leftist taboos, situates the liberal Left as anxious, insecure and reactionary. It also appears that Žižek is deliberately and steadily undertaking what many have accused him of failing to attain – of not going far enough. Here, Žižek is (...) breaking away from being the poster boy for the liberal Left and refining his commitment to communism through critiquing postmodern representations concerning tolerance, hyper-relativism and culturation. (shrink)

We live in a world of states: a world in which the dominant form of “persisting structure” for the wielding of political power is characterized by territorially concentrated power exercised through political institutions that exert sovereign control in the sense of being able to exclusively command compliance. Within such a world, calls for reorganization of the way these institutions are organized so as to devolve power to groups oppressed or marginalized within existing structures are inevitable. However, for proponents of liberal (...) states, such calls for devolving power pose a problem. When substate groups call for a reorganization in which power is devolved rather than reformed, they imply that within some portions of the state’s territory, or for certain of the state’s inhabitants, state-level political institutions cannot rightfully command compliance, or at least, cannot do so exclusively. Proponents of liberal states might respond to this problem by letting go of the need for exclusive command. However, for many proponents of liberal states, the prospect of a competing source of rightful command that may assert priority over decision making that applies to the entire territory is impractical, and conceptually difficult to sustain. An alternative response, one that preserves the pre-eminent position of institutions that encompass the state’s entire territory and population, is to insist that such institutions have a vital role in ensuring that the decision making of sub-state groups meets minimal conditions of moral equality and respect for human rights. Emphasizing the role of institutions that encompass the entire territory in guaranteeing minimal conditions of moral equality and respect for human rights seems promising, but it cannot provide a satisfactory account of the desirability of empowering state officials to exercise powers of oversight, and so it cannot justify reserving such powers in the face of calls for power to be devolved. This is most obvious in relation to oppressed an marginalized groups, as state officials recognize cannot reasonably expect members of such groups to accept officials as credible guarantors of moral equality or human rights. This problem aside, there is a basic problem with the way decision making is conceived of in arguments for the importance of reserving powers of oversight as groups calling for devolution of power are not susceptible to the kind of characterization that state officials would have to engage in to effectively gauge whether to intervene to secure moral equality and human rights. (shrink)

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 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)

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)

Vladimir Jankélévitch allows us to rethink the relation between negation and refusal as a rift where one is confronted by the repetition of _givenness_ and where refusal upends negation by turning the object being refused into an ineffable question. Here we turn to Freud as a reader of Jankélévitch’s refusal of German culture in order to consider his procedure of radical exclusion as a matter of idealistic temperament marking a transition from knowledge as “knowing how things are” to a different (...) proposition which cultivates knowing “how things should be.”. (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)

This paper involves a case study of physicians working in an urban Midwestern region. It raises questions surrounding how physicians adapted to, encouraged and resisted the increasing presence of managed care in their work lives. The patterning of physician accommodation to managed care and the failure of physicians to mount any effective organized resistance in Metro has some important implications for theories about professional dominance and decline.

International human rights concepts and documents figure prominently within theories of global justice. Appeals to human rights often rely on theories and interpretations that rank human rights in relation to one another designating some as more important or more crucial than others such that they may or must be given priority. In this paper I argue that hierarchical ranking of human rights should be rejected by theorists of global justice because such ranking: (a) undermines the effectiveness with which human rights (...) operate as principled constraints on state actors; and (b) is inconsistent with the international legal framework and practice from which the human rights concepts and documents draw their rhetorical force. Instead theorists of global justice should accept the indivisibility principle, which states that all human rights are interrelated and interdependent and must be treated on the same footing and given the same emphasis. The attraction of hierarchical ordering rests on misguided concerns about the practicality of indivisibility that fail to properly distinguish between rights and claims and ignore important dimensions of human rights implementation and assessment. I argue that indivisibility is both pragmatically defensible, provides a better theoretical grounding for understanding complaints about violations, and offers a better framework for understanding the relationship between human rights and legitimacy than hierarchical ordering. (shrink)

Conventional wisdom suggests that promoting self-determination for peoples and protecting the human rights of individuals are competing priorities. However, many recent international human rights documents include rights of peoples in their lists of basic human rights. In this paper, I defend including at least one people’s right, the right to self-determination, in the list of basic rights. Recognizing that self-determination is a constitutive element of human dignity casts state sovereignty in a different light, with interesting consequences both for international law (...) and for philosophical debates about the rights of minorities. (shrink)

In A Moral Theory of Political Reconciliation Colleen Murphy develops a rich and potentially transformative account of political reconciliation. The potential of this account is not fully realized because of limitations in how Murphy conceptualizes political relationships. For example, group-differentiated integration into states opens up important questions about partial legality and group-differentiated experiences of repression that Murphy does not address. Murphy’s framework is well-suited to take up these questions, once they are acknowledged. But doing so requires a revised understanding of (...) how states’ relationships with individuals structure individuals’ relationships with one another. (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)

Why is it that we sometimes think of Lacan as Marxist when he is so assertive in being Freudian? Perhaps it is because Lacan perceives Marx rather than Freud as the discoverer of the symptom and furthermore places Marx as central to his fifth Capitalist discourse, in contrast with his previous discourses which are all inspired by Freud. This article considers how Lacan’s final and arguably unfinished Capitalist discourse stands apart from all the others, yet at the same time it (...) reveals contradictions and possible parallels with them as it attempts to unravel the dialectical tensions between the problematic production and consumption of meaning. (shrink)

A dominant belief in political philosophy is that states must be entitled to authorize the use of coercion in order to justifiably coerce its subjects. Call this view the entitlement view. On this view, for a state to justifiably coerce its subjects, a necessary condition is that it is entitled to authorize the use of coercion. Sceptics hold the entitlement view. However, they deny that states are entitled to authorize the use of coercion. This denial informs their views regarding the (...) permissible use of political power. Skeptics believe that nearly all uses of political power is impermissible. In this paper, I present a challenge to the skeptical view that nearly all uses of political power is impermissible. I also present a view on the justification of certain uses of political power that is an alternate to the entitlement view. My alternate view allows me to demonstrate that a state can engage in permissible uses of political power over a broad range of domains without possessing any entitlements. (shrink)

Are there wrongs for which states cannot apologise? In this chapter, I argue that the answer is 'Yes'. I begin with the simple observation that reasoning as a state official requires a conception of what officials do, and so a conception of what is - and is not - properly undertaken on behalf of the state. To act as an official, then, requires a theory of what happens in a well functioning state: it requires a 'normative theory of the state. (...) What officials believe to be necessary for a state to be a good example of its kind will affect what they recognise as outside the bounds of what a state official ought to do. This limit on what can be recognised as something prior officials ought not to have done is illustrated by Canada's official apology for imposing residential schools on indigenous peoples. Canada's official apology left out a crucial feature of the schools policy in part because of the influence of integrationist theories of the state. An integrationist view of good statehood has limited officials' ability to see the project of restructuring indigenous communities and inculcating attachment to an overarching identity as a wrong in itself, and distorted officials' diagnosis of what went wrong in previous policy. One effect has been to allow contemporary officials to offer a sincere and comprehensive apology for past officials' human rights violations in indigenous communities while themselves pursuing policies in these communities that violate human rights. The lesson of the Canadian apology is that how state officials theorise the state can undermine their capacity to recognise human rights violations for what they are and distort their judgements of what must be done in remedy. (shrink)

In Global Justice: A Cosmopolitan Account Gillian Brock makes three important claims: that we have duties of justice to all human beings and not only those with whom we share a state; that our duties to those outside our states are of the same scope and normative weight as our duties to those with whom we share a state; and that the existing framework of international institutions affords us a number of straightforward and accessible means to act on our duties (...) to persons outside our states that we ought to pursue. These claims are important in themselves, but the real interest of Brock’s book lies with the argumentative strategy she uses in support of them. This strategy, which includes emphasizing the compellingness of specific institutional and policy prescriptions and distancing her arguments from debates about the structure and plausibility of Rawlsian internationalism, bears interesting fruit in a number of respects. However, it also raises difficult questions about the coherence of the distinction between cosmopolitanism and nationalism on which Brock relies, and about the value of institutionalist approaches to justice more generally. (shrink)