This article examines the barriers to quality health care for transgender, nonbinary, and gender-expansive people (TGE) who become pregnant and give birth, identifying three central themes that emerge from the literature. These insights suggest that significant reform will be necessary to ensure access to safe, appropriate, gender-affirming care for childbearing TGE people. After illustrating the need for systemic changes that untether rigid gender norms from the provision of perinatal care, the article proposes that the Midwives Model of Care offers a (...) set of values and clinical practices that are well-suited to meet the needs of many TGE patients during pregnancy and childbirth and which should be incorporated into the healthcare system more broadly. (shrink)

This article argues that the Supreme Court’s decision in Dobbs is likely to impact medical decision-making by pregnant patients in a variety of contexts. Of particular concern are situations where a patient declines treatment recommended for its potential benefit to the fetus and situations where treatment is withheld due to potential risk to the fetus. The Court’s elevation of fetal interests, combined with a history of courts using abortion jurisprudence to guide their reasoning in compelled treatment cases, means that Dobbs (...) has the potential to limit patient autonomy in a wide array of clinical settings. The article calls on professional medical associations to issue ethical guidance affirming the duty to respect the medical self-determination of pregnant patients. (shrink)

I am pleased to introduce this Symposium Edition of The Journal of Law, Medicine & Ethics, which covers a wide variety of issues central to transgender health equity, including Dr. Jamison Green’s recent history of the impact of health policy on transgender communities, Dr. M. Killian Kinney, Ms. Taylor Pearson, and Prof. Julie Ralston Aoki’s transgender equity tool for legal policy analysis, and Prof. Elizabeth Kukura’s analysis of issues facing transgender, non-binary, and gender expansive people during pregnancy and (...) childbirth. (shrink)

In their paper, ‘How to reach trustworthy decisions for caesarean sections on maternal request: a call for beneficial power’, Eide and Bærøe present maternal request caesarean sections (MRCS) as a site of conflict in obstetrics because birthing people are seeking access to a treatment ‘without any anticipated medical benefit’. While I agree with the conclusions of their paper -that there is a need to reform the approach to MRCS counselling to ensure that the structural vulnerability of pregnant people making birth (...) decisions is addressed—I disagree with the framing of MRCS as having ‘no anticipated medical benefit’. I argue that MRCS is often inappropriately presented as unduly risky,without supporting empirical evidence,and that MRCS is most often sought by birthing people on the basis of a clinical need. I argue that there needs to be open conversation and frank willingness to acknowledge the values that are currently underpinning the presentation of MRCS as ‘clinically unnecessary’; specifically there needs to be more discussion of where and why the benefits of MRCS that are recognised by individual birthing people are not recognised by clinicians. This is important to ensure access to MRCS for birthing people that need it. (shrink)

The number of cesarean sections performed globally has been consistently rising since the 1980s.1 The number of cesareans performed now greatly exceeds the number that experts predict are necessary.2 In Brazil, the world's "cesarean capital," over half of births are surgical. In the United States, approximately one third of babies are delivered by cesarean, and in the United Kingdom around 26 percent of births are by cesarean.3 Cesarean section can be a life-saving intervention when vaginal birth poses a risk to (...) woman or fetus.4 However, some doctors believe that cesareans performed in the absence of an emergency carry substantial risks for limited or no benefit (Wagner 2000... (shrink)

I begin by examining the answer to a traditional puzzle concerning supererogatory acts: if they are good to do, why are they not required? The answer often given is that they are optional acts because they cost the agent too much. This view has parallels with the traditional view of religious sacrifice, which involves offering up something or someone valuable as a gift or victim and experiencing a ‘cost’ as part of the ritual. There are problems with the idea that (...) costs justify the optional nature of supererogatory acts, however, and I suggest that these problems mirror the tensions that are found in Christian theology when a traditional view of sacrifice is adopted. (shrink)

In order to strengthen civic education in elementary schools, research is needed to understand preservice teachers’ ideas about civic teaching. The current study examined the degree to which elementary preservice teachers’ civic competencies (i.e., civic awareness, dispositions, and interpersonal skills) and the grades they plan to teach are associated with expected future civic teaching. Survey data were collected from 235 undergraduate students majoring in early childhood or elementary education. Results from hierarchical multiple regression showed that greater civic awareness and lower (...) levels of trust in the American promise were associated with expected future teaching about politics, while greater civic awareness, stronger commitment to social issues, and better interpersonal skills were associated with expected future teaching about community engagement. Additionally, those who plan to teach the upper elementary grades (third–fifth) were more likely to report that they will teach about politics and community engagement in their future classrooms when compared to those who plan to teach younger grades (PreK–second). Practical implications for preservice teacher preparation are discussed. (shrink)

There is an emerging ethical consensus that injured research participants should receive medical care and compensation for their research-related injuries. This consensus is premised on notions of beneficence, distributive justice, compensatory justice and reciprocity. In response, countries around the world have implemented no-fault compensation systems to ensure that research participants are adequately protected in the event of injury. The United States, the world's leading sponsor of research, has chosen instead to rely on its legal system to provide injured research participants (...) with medical care and compensation. This article argues that US reliance on its legal system leaves injured research participants unprotected in the event of injury. Nearly every injured research participant will have difficulty receiving compensation in court, and certain classes of research participants will be barred from receiving compensation altogether. The United States’ outlier status also threatens to impede US-sponsored multinational research, potentially delaying important biomedical advances. To rectify this injustice, researchers, Institutional Review Boards, sponsors and research institutions should advocate systematic no-fault compensation in the United States to bring US law into accord with global ethical norms and ensure that injured research participants are adequately protected. (shrink)

: The natural philosopher Michael Faraday and the psychologist Jean Piaget experimented directly with natural phenomena and children. While Faraday originated evidence for spatial fields mediating force interactions, Piaget studied children's cognitive development. This paper treats their experimental processes in parallel, taking as examples Faraday's 1831 investigations of water patterns produced under vibration and Piaget's interactions with his infants as they sought something he hid. I redid parts of Faraday's vibrating fluid activities and Piaget's hiding games. Like theirs, my experiences (...) showed that incomplete observations and confusions accompanied—and facilitated —experimental developments. While working with things in their hands, these experimenters' minds were also engaged, inferring new, more coherent understandings of the behaviors under study. Transitory ripples disclosed distinct patterns; infants devised more productive search methods. From the ripples, Faraday discerned an oscillatory condition that informed his subsequent speculations about light. From the infant search, Piaget identified experimenting as a child's means of developing self and world, later envisioning its infusion into education. Taken together, these two stories demonstrate that cognitive capacities emerge in the actual process of experimenting. This finding eclipses the historical context in its implications for education today. When learners pursue their own experiments, their minds develop. (shrink)

An examination of crucial questions about the relationship between rationality and femininity.

Historical method rests on the common-denominator values that characterize modernity. Postmodernity challenges those values across the range of practice and with them the very foundations of historical explanation. Responding to this challenge is central to the ethics of history at the present time. An adequate response requires at least three things summarized here: a clear understanding of the cultural function of history as one of the representational methods characterizing modernity; a definition of postmodernity and its challenges that is less trivial (...) than those currently prevailing in North America; and even some experimental effort to explore some of the positive possibilities of the postmodern challenge, including alternative uses for “the past.”. (shrink)

A 35-year-old woman presents to the hospital after a fall at home. A routine medical history and physical examination reveal that the patient identifies as intersex, and an X-ray of the left hip demonstrates profound osteopenia. The patient is admitted to the hospitalist service for further evaluation. What does it mean to identify as intersex? In the medical world, “intersex” is usually referred to as DSD, or “disorders of sex development.” Until the 1990s, physicians referred to this condition as hermaphroditism, (...) but this label is no longer used because it evokes mythical creatures rather than real human beings. Even the DSD label is controversial, and the patient in our case study does not think... (shrink)

This article describes a study carried out among 14-18-year-old nursing students in Hungary. The students were asked to consider an ethical problem. The parents of a sick child ask that she should not be told of a forthcoming operation. Are the nurses to agree to this demand or not? The author concluded from this study that nurses need more training in ethical decision-making, that they need to know about the rights of children in hospital, and that nursing training should start (...) when students are older. (shrink)

Brandt addresses what has been called an “embarrassment” in Socratic studies: in the Crito, Socrates claims that he is only persuaded to act on the basis of propositions that appear to him to be best upon rational examination (45b). However, in several other dialogues, Socrates appears to contradict himself: He obeys the commands of his supernatural daimonion, thereby suggesting that divine command - something that is not the product of human reasoning - can also persuade Socrates to act. Herein lies (...) the apparent conflict: If Socrates is the paragon of rationality, why would he unreflectively obey the commands of his daimonion, an extra rational source? After exposing the weaknesses in arguments from the recent scholarship on this issue, Brandt undertakes the formidable task of proposing an alternative way of understanding Socrates as the “ideal rational agent.” While Brandt’s project is admirable and creative, I argue that parts of it are inconsistent with essential theses of Socratic philosophy. I address four issues that concern me. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Aristotle on the Sources of the Ethical Life by Sylvia BerrymanElizabeth C. Shaw and Staff*BERRYMAN, Sylvia. Aristotle on the Sources of the Ethical Life. Oxford: Oxford University Press, 2019. vii + 220 pp. Cloth, $70.00—Berryman’s goals in Aristotle on the Sources of the Ethical Life are threefold: to establish that Aristotle practiced what contemporary philosophers call metaethics; to refute the idea that Aristotle justified those ethics by recourse (...) to human nature, understood as an “external point” for “establishing substantial ethical truths from a value-neutral perspective”; and to demonstrate that, for Aristotle, the source and justification for ethical demands is human practical reason.Locating the source of normativity in practical reason does not mean that there are no “standards of truth other than human beings as a species.” Positioning Aristotle against both “Archimedean” naturalisms as well as relativisms and subjectivisms, Berryman sees Aristotle’s appeals to nature as delimiting “the kinds of normative positions that could guide practical reason,” and practical reason as responsive to biological constraints. Still, nature is no fulcrum. It does not mandate the contents of the life we should live. All of this together makes Berryman’s Aristotle a “constitutive constructivist,” which is to say, a nonskeptical, cognitivist nonfoundationalist.Chapter 1’s “Introduction” sets the stage for the book’s metaethical project. Chapters 2 and 3 argue against two versions of the claim that “Aristotle was not reflective on the sources and justifications for his ethical views.” Chapter 2 places “Aristotle in the Ethics Wars” of the twentieth and twenty-first centuries, challenging the historicist view that “the kind of metaethical reflection about the sources of normativity” that preoccupies modern philosophy in response to “‘disenchantment’ of the modern world picture” would not have been available to Aristotle. Chapter 3, “Nature and the Sources of Normativity,” positions itself against scholars who maintain that Aristotle was complacent about the values of his own society and/or “too philosophically naïve to even reflect on the sources and justifications of ethical claims.” Inhabiting Aristotle’s social and intellectual milieu, it shows how the epistemological questions, commitments to materialist-scientific worldviews, as well as challenges to divine authority posed by fifth-century sophists, Plato, and fourth-century [End Page 381] hedonists meant that “a philosopher in Aristotle’s position could hardly avoid being reflective on questions of the status of ethics.”After establishing in chapter 3 that Aristotle could have grounded ethical claims in his natural philosophy, chapters 4 through 6 make the case that he did not. Exploring the philosophical work done by Aristotle’s appeals to nature, chapter 4, “Is Aristotle an Archimedean Naturalist?”, focuses on the apparent directionality of human development as well as references to “natural justice” and “natural virtue” in Aristotle’s ethical writings, while chapter 5, “Naturalism in Aristotle’s Politics,” scrutinizes the “naturalness of the polis” and “natural slavery” in Politics 1. Finding “only very minimal appeal to human nature” in the ethical treatises, Berryman sees Aristotle’s recourse to nature in Politics 1 as “the main anomaly” for which her refutation of Archimedean naturalism must account. Based on internal evidence in the Politics and comparison with Aristotle’s biological writings, Berryman concludes that Aristotle wrote the Politics before he “developed his more detailed biological theories.” Rather than evidence of naturalism, Aristotle’s appeals to nature in Politics 1, Berryman argues, are an early reflection of the “nomos-phusis distinction found in sophistic controversies” and a “kind of rhetorical move” based on thorough “prejudice and not reasoned inference.” Concluding “The Case Against a Naturalist Reading,” chapter 6 sets the stage for Berryman’s resourcing of Aristotle’s metaethics away from nature by exploring the inadequacies of the instrumental and theoretical rule-guiding reasoning implicit in naturalist accounts of Aristotelian practical reason.Chapters 7 and 8 offer the book’s positive account. After elaborating Aristotle’s rejection of “metaphysical abstractions” as action-guiding, chapter 7, “Aristotle’s Metaethics,” recovers from the Eudemian Ethics human agency as the source of normativity in Aristotle. Action “carries with it an implicit commitment to the norms of practical reasoning,” and “Aristotle’s insight,” Berryman writes, “is the metaethical recognition that the practical... (shrink)

This study analyzed 328 single- and group-authored stories composed by nine 4-year-olds in a mixed-age preschool class participating in a peer-oriented storytelling and story-acting practice. Group-authored stories were overwhelmingly told by same-gender groups. The frequencies, developmental trajectories, and functions of group-authored stories were different for girls and boys. Girls told mostly group-authored stories in the fall and single-authored stories in the spring. Group-authoring provided ‘brain-storming sessions’ for narrative experimentation; these stories were longer, with more dramatic problems and more sophisticated character (...) portrayals. By the spring, girls’ single-authored stories also included these features, suggesting internalized narrative gains. Boys consistently preferred single-authored stories, though in the spring the frequency and quality of their group-authored stories increased. These were longer, with more sophisticated character portrayals, than single-authored stories. Group-authored stories made a distinctive contribution to narrative development, partly by helping boys and girls overcome limitations of their preferred narrative genres. (shrink)

This essay will concentrate, somewhat voyeuristically, on a particular and very special textual encounter. For if there is one text in the psychoanalytic tradition that will have caused Derrida to spill more ink than any other – it's Freud's Beyond the Pleasure Principle (1920). For ten years, from 1970–1980, Derrida returns not once but three times, on three separate occasions, in three different contexts, to Freud's text on repetition compulsion and the death drive, each time devoting more time and energy (...) – that is to say, more pages – to it. As we will see in this essay, what emerges from this textual encounter is not only a new kind of pleasure; it is also a chance event of repetition that brings with it something strikingly new. (shrink)

The goal of the symposium 'Integrating Perspectives on the Relation between Mind and Brain' was to get people with different views and from different disciplines to open up a dialogue by focusing on answering a set of questions. In this paper I present a view of the relation between the mind and the brain that is informed by recent work in the philosophy of science. The basic idea is that the mind is more than the brain because mental states are (...) identical to the activity of groups of organized neurons. Unlike the standard non-reductive materialism irreducibility is not seen as related to multiple realisability. The upshot is that we can bring the relation between the mind and the brain in line with other clear cases of ontological emergence, we can see how psychology can be an independent science, and yet how important explanatory connections can be made between psychology and neuroscience. (shrink)

This chapter discusses whether patients should face penalties for unhealthy lifestyle choices. The idea that people should be held responsible for their bad health decisions is often associated with “luck egalitarianism”. This chapter explains the connection between responsibility-sensitive health care policies and luck egalitarianism and outlines some criticisms that have been made of luck egalitarianism in this context. It then highlights the implications of moral responsibility scepticism for luck egalitarians and other proponents of similarly responsibility-sensitive approaches to health care. Theorists (...) who have discussed the practical implications of moral responsibility scepticism have focused primarily on criminal punishment and, in that context, have often invoked an epistemic argument, maintaining that there are at least serious doubts about whether people are morally responsible (in the sense required for retributive punishment) and that, in view of this uncertainty, retributive punishment is unjust, given the serious harm it inflicts on offenders. This chapter argues that this type of reasoning also implies that we should not take patients’ responsibility for their poor health into account when deciding whether to give these patients treatments and that the health system should not impose significant penalties on individuals for harming their own health. Culpability-based desert seems to stand a better chance of helping luck egalitarians (and others with related views) to justify responsibility-sensitive health care policies compared with some alternative approaches. However, this chapter casts doubt on the idea that responsibility-sensitive health care policies based on this kind of desert are justifiable, focusing on doubts about whether people are morally responsible for harming their own health, whether harming one’s own health is morally wrong, and whether significant penalties for harming one’s health would be proportionate. (shrink)

In opposition to modernist conceptions of the “self,” some environmental philosophers argue that human identity is first and foremost wild and natural because it is a product of an ontologically independent nature. They use evolutionary theory to create and maintain a division between our wild, natural human identity and our artifactual culture. Their position is supported by a misunderstanding of both early hominid evolution and artifacts. Artifacts are not the neutral instruments of human will, but exist with us in “economies” (...) that constantly create unintended consequences. In terms of recent work in the field of philosophical anthropology, a reexamination of the evolutionary evidence suggests that our identity is not natural but completely artifactual. This artifactual identity provides us with new ways of conceptualizing our present ecological problems. (shrink)

The results of two experiments examining infants at 6, 9, 12, 15, 18, and 21 months 0f age and varying levels of father interaction are summarized to show that separation protest is more a function of a strange person remaining in an unfamiliar laboratory situation with the infant than the temporary loss of a specific parent. The use of protest as an index of infant-parent attachment seems undesirable.

Faraday demonstrated electromagnetic induction in 1831 using an iron ring wound with two wire coils; on interrupting battery current in one coil, momentary currents arose in the other. Between Faraday's ring and the induction coil, coiled instruments developed via meandering paths. This paper explores the opening phase of that work in the late 1830s, as the iron core, primary wire coil, and secondary wire coil were researched and differentiated. ‘Working knowledge’ gained with materials and phenomena was crucial to innovations. To (...) understand these material-based interactions, I experimented with hand-wound coils, along with examining historical texts, drawings, and artefacts. My experience recovered the historical dead-end of two-wire coils and ensuing work with long-coiled single conductors initiated by Faraday and Henry. The shock and spark heightened in these coils provided feedback to the many instrumental configurations tested by Page, Callan, Sturgeon, Bachhoffner, and others. The continuous conductor differentiated into two segments soldered together: a thick short wire carrying battery current and a long thin wire for elevating shocks . The joined wires eventually separated, yet their transitional connection documents belief that the induced effects depend on continuity. These coiled instruments, with their intertwined histories, show experimental work and understandings in the process of developing. Seeing the nonlinear paths by which these instruments developed deepens our understanding of historical experiences, and of how people learn. (shrink)

Feminist science scholars need models of science that allow feminist accounts, not only of the inception and reception of scientific theories, but of their content as well. I argue that a "Network Model," properly modified, makes clear theoretically how race, sex and class considerations can influence the content of scientific theories. The adoption of the "corpuscular philosophy" by Robert Boyle and other Puritan scientists during the English Civil War offers us a good case on which to test such a model. (...) According to these men, the minute corpuscles constituting the physical world are dead, not alive; passive, not active. I argue that they chose the principle that matter is passive in part because its contrary, the principle that matter is alive and self-moving, had a radical social meaning and use to the women and men working for progressive change in mid-seventeenth century England. (shrink)