Background: It has been widely reported that medical trainees experience situations with profound ethical implications during their clinical rotations. To address this, most U.S. medical schools include ethics curricula in their undergraduate programs. However, the contents of these curricula vary substantially. Our pilot study aimed to discover, from the students’ perspective, how ethics pedagogy prepares medical students for clerkship and what gaps might remain. Methods: This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns (...) encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus-group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students’ experiences. Results: While students’ accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks’ particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education. Conclusion: We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students’ apprehension about acting on ethical concerns. (shrink)

While there is significant consensus that undergraduate medical education should include bioethics training, there is widespread debate about how to teach bioethics to medical students. Educators disagree about course methods and approaches, the topics that should be covered, and the effectiveness and metrics for UME ethics training. One issue that has received scant attention is the timing of bioethics education during medical training. The existing literature suggests that most medical ethics education occurs in the pre-clinical years. Follow-up studies indicate that (...) medical students in their clinical rotations have little recall or ability to apply ethics concepts that were learned in their pre-clinical training. Trainees also report a desire for medical ethics to be taught in the context of practical application, which would suggest that the timing of pre-clinical ethics education is flawed. However, moving bioethics training to the clinical years should not be assumed to be the solution to the problems of recall and theory application. We argue that the effectiveness of timing bioethics education will depend on when medical students witness or experience particular categories of ethical dilemmas during their training. Our overarching hypothesis is that ethics education will be most effective when the bioethics training on a particular topic correlates to experiential exposure to that ethical issue. The purpose of our current study was to describe medical students exposure to particular categories of ethical conflicts, dilemmas, or issues. Our results may help bioethics educators better strategize about the most effective timing of medical ethics training in UME. (shrink)

Metaphor plays a unique role in cognitive development by structuring abstract concepts and leading to conceptual change. Existing work suggests early emergence of metaphorical abilities, with five-year-olds understanding and explaining metaphors that involve cross-domain comparisons (e.g., SPACE to TIME). Yet relatively little is known about the factors that explain this developmental change. This study focuses on spatial metaphors for time, and asks whether cognitive and/or verbal factors best explain developmental changes in three- to six-year-old children's comprehension and explanation of metaphors. (...) The results show that children's grasp of the time concept—but not verbal ability—predicts their metaphor comprehension. Verbal ability, on the other hand, is a predictor of metaphor explanation, even after controlling for age. The results thus suggest that cognitive and verbal factors selectively predict children's emerging metaphorical abilities. (shrink)

Over the course of human life, health care decision‐making is often interdependent. In this article, we use “interdependence” to refer to patients’ engagement of nonclinicians—for example, family members or trusted friends—to reach health care decisions. Interdependence, we suggest, is common for patients in all stages of life, from early childhood to late adulthood. This view contrasts with the common bioethical assumption that medical decisions are either wholly independent or dependent and that independence or dependence is tightly coupled with a person's (...) decision‐making capacity. In this article, we array various approaches to decision‐making along a continuum of interdependence. An appreciation of this continuum can empower patients and elucidate ethical challenges that arise when people transition between different kinds of interdependence across the life span. (shrink)

Philosophical theories of gender are typically understood as theories of what it is to be a woman, a man, a nonbinary person, and so on. In this paper, I argue that this is a mistake. There’s good reason to suppose that our best philosophical theory of gender might not directly match up to or give the extensions of ordinary gender categories like ‘woman’.

Th is paper investigates the epistemic powers of democratic institutions through an assessment of three epistemic models of democracy : the Condorcet Jury Th eorem, the Diversity Trumps Ability Th eorem, and Dewey's experimentalist model. Dewey's model is superior to the others in its ability to model the epistemic functions of three constitutive features of democracy : the epistemic diversity of participants, the interaction of voting with discussion, and feedback mechanisms such as periodic elections and protests. It views democracy as (...) an institution for pooling widely distributed information about problems and policies of public interest by engaging the participation of epistemically diverse knowers. Democratic norms of free discourse, dissent, feedback, and accountability function to ensure collective, experimentallybased learning from the diverse experiences of diff erent knowers. I illustrate these points with a case study of community forestry groups in South Asia, whose epistemic powers have been hobbled by their suppression of women's participation. (shrink)

: The underdetermination argument establishes that scientists may use political values to guide inquiry, without providing criteria for distinguishing legitimate from illegitimate guidance. This paper supplies such criteria. Analysis of the confused arguments against value-laden science reveals the fundamental criterion of illegitimate guidance: when value judgments operate to drive inquiry to a predetermined conclusion. A case study of feminist research on divorce reveals numerous legitimate ways that values can guide science without violating this standard.

Complex cognitive skills such as reading and calculation and complex cognitive achievements such as formal science and mathematics may depend on a set of building block systems that emerge early in human ontogeny and phylogeny. These core knowledge systems show characteristic limits of domain and task specificity: Each serves to represent a particular class of entities for a particular set of purposes. By combining representations from these systems, however human cognition may achieve extraordinary flexibility. Studies of cognition in human infants (...) and in nonhuman primates therefore may contribute to understanding unique features of human knowledge. 2020 APA, all rights reserved). (shrink)

In this project I am concerned with the extent to which conceptual engineering happens in domains outside of philosophy, and if so, what that might look like. Specifically, I’ll argue that...

We citizens of the 21st century live in a world where division of epistemic labour rules. Most of what we know we learned from the spoken or written word of others, and we depend in endless practical ways on the technological fruits of the dispersed knowledge of others—of which we often know almost nothing—in virtually every moment of our lives. Interest has been growing in recent years amongst philosophers, in the issues in epistemology raised by this fact. One issue concerns (...) the depth and extent of our epistemic dependence on testimony, as we may label this broad epistemic source: Do we have any knowledge at all that is free of epistemic dependence on what we have learned from others? A related question is whether our entitlement to believe what we have learned from others can be explained without invoking any epistemic principles special to testimony. These questions concern, as it were, the macro-epistemology of testimony. In the present discussion I shall focus instead on the micro foundations. Testimony, in our broad sense, can occur through an extensive range of types of spoken and written means of purportedly factual communication, including telephone calls, e-mails and personal letters, lectures and radio broadcasts, newspapers, textbooks and encyclopaedias, personal diaries, and public records of all kinds. But the central paradigm—what started the whole communication thing off—is surely that of face-to-face spoken encounter, when one person tells something to another, thereby intending and hoping to share her knowledge with her audience. I begin by describing the speech act of telling, identifying what takes place in a felicitous act of telling. From the nature of the speech act of telling, we see precisely how it is that knowledge is, when all goes as it should, acquired from teller by trusting hearer, in such an act, and in acts of testimony more broadly. (shrink)

Much recent literature in metaphysics attempts to answer the question, ‘What is metaphysics?’ In this paper I argue that many of the most influential contemporary answers to this question yield the result that feminist metaphysics is not metaphysics. I further argue this result is problematic.

Many of us are tempted by the thought that the future is open, whereas the past is not. The future might unfold one way, or it might unfold another; but the past, having occurred, is now settled. In previous work we presented an account of what openness consists in: roughly, that the openness of the future is a matter of it being metaphysically indeterminate how things will turn out to be. We were previously concerned merely with presenting the view and (...) exploring its consequences; we did not attempt to argue for it over rival accounts. That is what we will aim to do in this paper. (shrink)

Does it ever happen that there are things we shouldn’t do and the reasons we shouldn’t do them are moral reasons, yet doing them is not morally wrong? Surprisingly, yes. I argue for a category that has not been recognized by moral theorists: morally permissible moral mistakes. Sometimes a supererogatory action is the thing a person should do; in failing to act, one makes a morally permissible moral mistake. Recognizing the category of morally permissible moral mistakes solves a puzzle about (...) supererogation, expands the universe of possible moral views, and shows some apparently inconsistent moral views to be consistent. (shrink)

Background Social media and Internet technologies present several emerging and ill-explored issues for a modern healthcare workforce. One issue is patient-targeted Googling, which involves a healthcare professional using a social networking site or publicly available search engine to find patient information online. The study’s aim was to address a deficit in data and knowledge regarding PTG, and to investigate medical student use of SNSs due to a close association with PTG. Method The authors surveyed final year medical students at the (...) Otago Medical School, University of Otago in January 2016. A subset completed focus groups that were analysed using thematic analysis to identify key themes relating to students’ attitudes towards PTG, and reasons why they might engage in PTG. Results Fifty-four students completed the survey, which showed that PTG was uncommon. Attitudes were varied and context dependent. Most participants saw problems with PTG and favoured more explicit guidance on the issue. SNS usage was high ; participants were concerned by the content of their SNS profiles and who they were connecting with online. Participants showing high SNS use were 1.83 times more likely to have conducted PTG than lower use groups. Conclusions The diverse attitudes uncovered in this study indicated that teaching or guidelines could be useful to healthcare professionals considering PTG. Though ethically problematic, PTG may be important to patient care and safety. The decision to conduct PTG should be made with consideration of ethical principles and the intended use of the information. (shrink)

Reflecting upon the recent growth of interest in feminist ideas of philosophy of science, this book traces the development of the subject within the confines of feminist philosophy. It is designed to introduce the newcomer to the main ideas that form the subject area with a view to equipping students with all the major arguments and standpoints required to understand this burgeoning area of study. Arranged thematically, the book looks at the spectrum of views that have arisen in the debate. (...) It is broadly arranged into sections dealing with concepts such as the notion of value free-science, values, objectivity, point of view and relativism, but also details the many subsidiary ideas that have sprung from these topics. (shrink)

In this text, the authors examine the relationship between political and feminist theory, characterizing and criticizing liberalism and communitarianism from a feminist perspective.

Many people face a problem about potentiality: their moral beliefs appear to dictate inconsistent views about the significance of the potentiality to become a healthy adult. Briefly, the problem arises as follows. Consider the following two claims. First, both human babies and cats have moral status, but harms to babies matter more, morally, than similar harms to cats. Second, early human embryos lack moral status. It appears that the first claim can only be true if human babies have more moral (...) status than cats. Among the properties that determine moral status, human babies have no properties other than their potentiality that could explain their having more moral status than cats. So human babies’ potentiality to become adult persons must explain their having more moral status than cats. But then potentiality must raise moral status generally. So early human embryos must have some moral status. It appears that the view that must underlie the first claim implies that the second claim is false. (shrink)

Under some circumstances, individuals are willing to engage in unethical behaviors that benefit another entity. In this research we advance the unethical pro-organizational behavior construct by showing that individuals also have the potential to behave unethically to benefit their supervisors. Previous research has not examined if employees engage in unethical acts to benefit an entity that is separate from oneself and if they will conduct these acts to benefit a supervisor. Our research helps to address these gaps. We also demonstrate (...) that unethical behavior to benefit a supervisor, what we term unethical pro-supervisor behavior, is more likely to occur if individuals are more (versus less) identified with their organization or supervisor. That is, feeling a sense of oneness with one’s organization or supervisor can result in employees engaging in unethical behavior to help their supervisor. Further, this positive relationship is weakened if the employee possesses higher levels of moral identity. We test our hypotheses with a two-part laboratory study, a field study, and a time-lagged field study. Theoretical and practical implications of this work are discussed. (shrink)

Although there are notable exceptions, examination of nursing's participation in colonizing processes and practices has not taken hold in nursing's consciousness or political agenda. Critical analyses, based on the examination of politics and power of the structural determinants of health, continue to be marginalized in the profession. The goals of this discussion article are to underscore the urgent need to further articulate postcolonial theory in nursing and to contribute to nursing knowledge about paths to work toward decolonizing the profession. The (...) authors begin with a description of unifying themes in postcolonial theory, with an emphasis on colonized subjectivities and imperialism; the application of a critical social science perspective, including postcolonial feminist theory; and the project of working toward decolonization. Processes involved in the colonization of nursing are described in detail, including colonization of nursing's intellectual development and the white privilege and racism that sustain colonizing thinking and action in nursing. The authors conclude with strategies to increase the counter‐narrative to continued colonization, with a focus on critical social justice, human rights and the structural determinants of health. (shrink)

The physical nearness, or proximity, inherent in the nurse–patient relationship has been central in the discipline as definitive of the nature of nursing and its moral ideals. Clearly, this nearness is in service to those in need of care. This proximity, however, is not unproblematic because it contributes to two of the most prolonged difficulties, both for individual nurses and the discipline of nursing — moral distress and moral ambiguity. In this paper we explore proximity using both a moral and (...) geographical lens and offer some insights regarding this practice reality. We examine the effect of proximity to patients on nurses’ moral responsiveness, particularly as it affects nurses’ moral distress. Proximity is paradoxical in this regard because, while it propels nurses to act, it can also propel nurses to ignore or abandon. Likewise, we argue that nursing's tendency to define itself in relation to the closeness of the nurse–patient relationship leads to problems of moral ambiguity. Our recommendations include moving others closer to the bedside and thus to the work of nursing in the literal and theoretical sense. (shrink)

I define a social norm as a regularity in behavior whose persistence is causally explained by the existence of sanctioning attitudes of participants toward violations—without these sanctions, individuals have motive to violate the norm. I show how a universal precept "When in circumstances S, do action F" can be sustained by the conditional preference of each to conform, given that others do, of a convention, and also reinforced by the sanctions of a norm. I observe that a precept with moral (...) force can be reinforced by a social norm. I then consider constitutive norms and show by means of an example, competitive figure skating, how a type of activity or practice G can have a constitutive norm NG. An ongoing activity in a community is engagement in that practice only if NG is reinforced as a social norm by participants. I apply this to the case of assertion: the speech act type Assertion has a constitutive norm NA, and a practice of making speech acts in a community is one of making assertions only if it is controlled by NA enforced by the sanctions of a social norm. (shrink)

Sider (Four-dimensionalism 2001; Philos Stud 114:135–146, 2003; Nous 43:557–567, 2009) has developed an influential argument against indeterminacy in existence. In what follows, I argue that the defender of metaphysical forms of indeterminate existence has a unique way of responding to Sider’s argument. The response I’ll offer is interesting not only for its applicability to Sider’s argument, but also for its broader implications; responding to Sider helps to show both how we should think about precisification in the context of metaphysical indeterminacy (...) and how we should understand commitment to metaphysically indeterminate existence. And if I’m right that metaphysical indeterminacy can allow for indeterminate existence in a way that semantic indeterminacy can’t, indeterminate existence might actually give us a reason to accept metaphysical indeterminacy (rather than a reason to reject it, as is commonly assumed). (shrink)

Introspective and phenomenological methods are once again being used to support the use of subjective reports, rather than objective behavioural measures, to investigate and measure consciousness. Objective measures are often seen as useful ways of investigating the range of capacities subjects have in responding to phenomena, but are fraught with the interpretive problems of how to link behavioural capacities with consciousness. Instead, gathering subjective reports is seen as a more direct way of assessing the contents of consciousness. This article explores (...) three different ways of gathering subjective reports that have been discussed in recent literature on consciousness, including immediate retrospection (Schwitzgebel [2007]) and two types of introspective training (Overgaard et al. [2004]; Schwitzgebel [2008]). Although not an exhaustive survey of the range of introspective methods now used, the discussion below highlights a range of general methodological problems with introspective methods, many identified up to a century ago. It is argued that none of the methodological problems established in earlier criticisms of the use of subjective reports have been dealt with, yet are still valid criticisms. Given that this is not the first time proponents of introspective, subjective measures of conscious have failed to answer these criticisms, this raises the question of whether the goal of providing a measure of consciousness is a methodological muddle worth pursuing. (shrink)

The COVID-19 pandemic has been devastating for people living with dementia (PLWD) and their caregivers. While prior research has documented these effects, it has not delved into their specific causes or how they are modified by contextual variation in caregiving circumstances.

In his article ‘Saints and Heroes’, Urmson argues that traditional moral theories allow at most for a threefold classification of actions in terms of their worth, and that they are therefore unsatisfactory. Since the conclusion of his argument has led to the widespread use of the term ‘acts of supererogation’, and since I do not believe that such acts exist, I propose to argue that the actions with which he is concerned not only can, but should, be contained within the (...) traditional classification. (shrink)

AbstrctSean Aas, Dana Howard, and Leslie Francis raise compelling and interesting objections to the definition of disability I defend in The Minority Body. In this paper, I reply to these objections and elaborate on my criticisms of the disability/impairment distinction.

This essay addresses various moral objections to polyamory and argues that none succeeds. Brake also argues that in some respects polyamory can be superior to monogamy given that polyamorists often endorse ideals such as radical honesty, non-possessiveness, and rejection of jealousy. Moreover, Brake argues that the effects of polyamory in a society in which it is widespread can be very beneficial.

We use “I’ll be glad I did it” reasoning all the time. For example, last night I was trying to decide whether to work on this paper or go out to a movie. I realized that if I worked on the paper, then today I would be glad I did it. Whereas, if I went out to the movie, today I would regret it. This enabled me to see that I should work on the paper rather than going out to (...) a movie. This looks like excellent reasoning: Paper argument: 1. If I work on my paper, I’ll be glad I did it. 2. Therefore, I should work on my paper. When we’re having trouble making a big life decision, we often try to picture what will happen each way we might choose, and imagine how we’ll feel in that outcome. When choosing between two jobs, we might use this reasoning. Suppose you are choosing between two jobs and you know quite a lot about what the two jobs will be like. In one, you will make a lot of money but have to work eighty-hour weeks and see little of your family. In the other, you will make considerably less money—though enough to support yourself and your family. You’ll have much more time for your family. The money is attractive. But overall, you realize you’ll be glad to have the time with your family if you take the second job—you’ll be glad you made that choice. It seems this is a good way of realizing that you should take the second job. (shrink)

The bioethical principle of respect for a person’s bodily autonomy is central to biomedical and healthcare ethics. In this article, we argue that this concept of autonomy is often annulled in the maternity field, due to the maternal two-in-one body (and the obstetric focus on the foetus over the woman) and the history of medical paternalism in Western medicine and obstetrics. The principle of respect for autonomy has therefore become largely rhetorical, yet can hide all manner of unethical practice. We (...) propose that large institutions that prioritize a midwife–institution relationship over a midwife–woman relationship are in themselves unethical and inimical to the midwifery philosophy of care. We suggest that a focus on care ethics has the potential to remedy these problems, by making power relationships visible and by prioritizing the relationship above abstract ethical principles. (shrink)

This book explores the tradition of the 'science of man' in French medicine of the era 1750-1850, focusing on controversies about the nature of the 'physical-moral' relation and their effects on the role of medicine in French society. Its chief purpose is to recover the history of a holistic tradition in French medicine that has been neglected because it lay outside the mainstream themes of modern medicine, which include experimental, reductionist, and localistic conceptions of health and disease. Professor Williams also (...) challenges existing historiography, which argues that the 'anthropological' approach to medicine was a short-term by-product of the leftist politics of the French Revolution. This work argues instead that the medical science of man long outlived the Revolution, that it spanned traditional ideological divisions, and that it reflected the shared aim of French physicians, whatever their politics, to claim broad cultural authority in French society. (shrink)

We can freely cross disciplinary boundaries, as well as the line between theory and practice, and allow practices to cast their light back on the theory and show us its deficiencies. In short, this approach reorients some much-discussed issues of professional, business, and military ethics and reveals them as variations on one deeply rooted theme. The author does not treat current institutions as final and unalterable. If these arrangements frustrate moral evaluation, she finds that an argument for change. To make (...) intelligent changes, however, we need a clear view of the reasoning that makes them seem natural and inevitable. That is what this book attempts to do. In the process, the author also reexamines the concept of "person." Not all cultures put so much stress on the idea as Western - and particularly American - cultures do. If we wish to keep this emphasis, then here is another argument for change. (shrink)

A series of experiments investigated the effect of speakers’ language, accent, and race on children’s social preferences. When presented with photographs and voice recordings of novel children, 5-year-old children chose to be friends with native speakers of their native language rather than foreign-language or foreign-accented speakers. These preferences were not exclusively due to the intelligibility of the speech, as children found the accented speech to be comprehensible, and did not make social distinctions between foreign-accented and foreign-language speakers. Finally, children chose (...) same-race children as friends when the target children were silent, but they chose other-race children with a native accent when accent was pitted against race. A control experiment provided evidence that children’s privileging of accent over race was not due to the relative familiarity of each dimension. The results, discussed in an evolutionary framework, suggest that children preferentially evaluate others along dimensions that distinguished social groups in prehistoric human societies. (shrink)

My primary aim is to call into question an influential notion of paternal responsibility, namely, that fathers owe support to their children due to their causal responsibility for their existence. I argue that men who impregnate women unintentionally, and despite having taken preventative measures, do not owe child support to their children as a matter of justice; their children have no right against them to support. I argue for this on the basis of plausible principles of responsibility which have been (...) used to defend abortion rights. I then consider the morally relevant differences between men and women, arguing that while in some cases these differences may justify differential treatment, their import should not be overstated - in many cases, the burden of child support will be too great to impose justly on fathers. This conclusion is not as undesirable as it may seem: I suggest feminist considerations in favor of revising the notion of paternal responsibility and considering alternative arrangements of child support. (shrink)

In this paper I argue that Gareth Evans’ famous proof of the impossibility of de re indeterminate identity fails on a counterpart-theoretic interpretation of the determinacy operators. I attempt to motivate a counterpart-theoretic reading of the determinacy operators and then show that, understood counterpart-theoretically, Evans’ argument is straightforwardly invalid.

There is no prepared script for social and cultural life. People work it out as they go along. Creativity and Cultural Improvisation casts fresh, anthropological eyes on the cultural sites of creativity that form part of our social matrix. The book explores the ways creative agency is attributed in the graphic and performing arts and in intellectual property law. It shows how the sources of creativity are embedded in social, political and religious institutions, examines the relation between creativity and the (...) perception and passage of time, and reviews the creativity and improvisational quality of anthropological scholarship itself. Individual essays examine how the concept of creativity has changed in the history of modern social theory, and question its applicability as a term of cross-cultural analysis. The contributors highlight the collaborative and political dimensions of creativity and thus challenge the idea that creativity arises only from individual talent and expression. (shrink)

The concept of vulnerability is widely used in bioethics, particularly in research ethics and public health ethics. The traditional approach construes vulnerability as inherent in individuals or the groups to which they belong and views vulnerability as requiring special protections. Florencia Luna and other bioethicists continue to challenge traditional ways of conceptualizing and applying the term. Luna began proposing a layered approach to this concept and recently extended this proposal to offer two new concepts to analyze the concept of vulnerability, (...) namely understanding external conditions that trigger vulnerability and layers of vulnerability with cascading effects. Luna's conception of vulnerability is useful, which we demonstrate by applying her layered view and the new analyses in multiple contexts. We begin by outlining Luna's view and we use vignettes from healthcare involving transgender patients, the care of patients in psychiatric contexts, and research involving prisoners to illustrate how each part of Luna's concept elucidates important moral issues. (shrink)