Background Antimicrobial resistance (AMR) is a global threat to human and livestock health. Although AMR is driven by use of antimicrobials, it is often attributed to “misuse” and “overuse”, particularly for antibiotics. To curb resistance, there has been a global call to embrace new forms of moral personhood that practice “proper” use, including prescription, dispensing and consumption of antimicrobials, especially antibiotics. This paper seeks to reflect on complex questions about how morality has become embedded /embodied in the AMR discourse as (...) presented in the data collected on antimicrobial prescription, dispensing and use in human and livestock health in Tanzania, primarily focusing on antibiotics. Methods This reflection is anchored on Jarrett Zigon’s morality framework that is comprised of three dimensions of discourse; the institutional, public, and embodied dispositions. The data we use within this framework are derived from a qualitative study targeting human and animal health care service providers and community members in northern Tanzania. Data were collected through 28 in-depth interviews and ten focus group discussions and analysed through content analysis after translation and transcription. In addition, a review of the Tanzania’s National Action Plans on antimicrobial resistance was conducted. Results Application of the framework demonstrates points of convergence and divergence in the institutional morality discourse articulated by the Tanzania National Action Plans, the public discourse and the embodied dispositions/ lived experiences of human and animal health care service providers and community members. We demonstrate that AMR is not just associated with “inappropriate” behaviour on the part of drug prescribers, dispensers, and users but also with shortcomings in health systems and service delivery. Conclusion Antibiotic dispensing and use practices that may be associated with the development of AMR should not be viewed in isolation from the broader health context within which they occur. (shrink)

A fundamental cognitive function found across a wide range of species and necessary for survival is the ability to navigate complex environments. It has been suggested that mobility may play an important role in the development of spatial skills. Despite evolutionary arguments offering logical explanations for why sex/gender differences in spatial abilities and mobility might exist, thus far there has been limited sampling from nonindustrialized and subsistence-based societies. This lack of sampling diversity has left many unanswered questions regarding the effects (...) that environmental variation and cultural norms may have in shaping mobility patterns during childhood and the development of spatial competencies that may be associated with it. Here we examine variation in mobility, performance on large-scale spatial skills, and performance on small-scale spatial skills among Twa forager/pastoralist children whose daily lives have been dramatically altered since settlement and the introduction of government-funded boarding schools. Unlike in previous findings among Twa adults, boys and girls show similar patterns of travel on all measures of mobility. We also find no significant differences in spatial task performance by gender for large- or small-scale spatial skills. Further, children performed as well as adults did on mental rotation, and they outperformed adults on the water-level task. We discuss how children’s early learning environments may influence the development of both large- and small-scale spatial skills. (shrink)

Nurse engagement, empowerment and strong relationships among staff, residents and families, are essential to attract and retain a suitably qualified and skilled nursing workforce for safe, quality care. There is, however, limited research that explores engagement, empowerment and relational coordination in long‐term care (LTC). Nurses from an older persons’ mental health and dementia LTC unit in Australia participated in this study. Forty‐one nurses completed a survey measuring psychological empowerment, work engagement and relational coordination. Twenty‐nine nurses participated in individual interviews to (...) further explore these concepts. Although nurses reported high psychological empowerment and work engagement, their relationships with key stakeholders varied. Our findings suggest that nurses in LTC require both supports and opportunities to contribute as active members of the multiprofessional care team that includes tailored education, professional development and positive interactions within the care team. Regular support is needed to enable nurses to feel empowered, foster relationships and communication, and facilitate work engagement. Based on these findings, we suggest that it is important to find ways to ensure that all who provide care perceive that they are part of the whole care team and able to contribute to the care and well‐being of people in LTC. (shrink)

A Correction to this paper has been published: https://doi.org/10.1007/s12110-021-09400-0.

Navigational performance responds to navigational challenges, and both decline with age in Western populations as older people become less mobile. But mobility does not decline everywhere; Tsimané forager-farmers in Bolivia remain highly mobile throughout adulthood, traveling frequently by foot and dugout canoe for subsistence and social visitation. We, therefore, measured both natural mobility and navigational performance in 305 Tsimané adults, to assess differences with age and to test whether greater mobility was related to better navigational performance across the lifespan. Daily (...) mobility was measured by GPS tracking, regional mobility through interview, navigational performance through pointing accuracy and perspective taking in environmental space, and mental rotation by a computerized task. Although mental rotation and spatial perspective taking declined with age, mobility and pointing accuracy remained high from mid-life through old age. Greater regional mobility was associated with greater accuracy at pointing and perspective taking, suggesting that spatial experience at environmental scales may help maintain navigational performance in later adulthood. (shrink)

'This is the most lucid and engaged account of Stuart Hall's work. Meticulously, and with an exemplary generosity, Helen Davis patiently unravels the threads of Hall's intellectual history. The result is a most useful and thoughtful book, which could prove to be indispensable for students of cultural studies' - Graeme Turner, University of Queensland Understanding Stuart Hall traces the development of one of the most influential and respected figures within cultural studies. Focusing on Stuart Hall's writings over a (...) period of nearly fifty years, this volume offers students and academics a cogent and exploratory route through complex and overlapping areas of analysis. In her critical assessment of Hall's most important contributions to academic and public debate, Davis shows the extent to which his analyses of race and ethnicity have been informed by early studies of Marxism, class and 'societies structured in dominance'. Davis offers fresh insight into the formation of one of the most prolific, charismatic and controversial intellectuals of his generation. Despite having been branded a 'cultural pessimist', Stuart Hall has long been associated with encouraging new, cutting-edge scholarship within the field. This volume concludes with a discussion of Hall's most recent political and academic interventions and his continuing commitment to innovation within the visual arts. (shrink)

In this special issue of Human Nature we explore the possible adaptive links between teaching and learning during childhood, and we aim to expand the dialogue on the ways in which the social sciences, and in particular current anthropological research, may better inform our shifting understanding of how these processes vary in different social and ecological environments. Despite the cross-disciplinary trend toward incorporating more behavioral and cognitive data outside of postindustrial state societies, much of the published cross-cultural data is presented (...) as stand-alone population-level studies, making it challenging to extrapolate trends or incorporate both ecological and developmental perspectives. Here, contributors explore how human life history, ecological experience, cumulative culture, and ethnolinguistics impact social learning and child development in foraging and transitioning societies around the world. Using historical ethnographic data and qualitative and quantitative data from studies with contemporary populations, authors interrogate the array of factors that likely interact with cognitive development and learning. They provide contributions that explore the unique environmental, social, and cultural conditions that characterize such populations, offering key insights into processes of social learning, adaptive learning responses, and culture change. This series of articles demonstrates that children are taught culturally and environmentally salient skills in myriad ways, ranging from institutionalized instruction to brief, nuanced, and indirect instruction. Our hope is that this collection stimulates more research on the evolutionary and developmental implications associated with teaching and learning among humans. (shrink)

In the last decade, reading research has seen a paradigmatic shift. A new wave of computational models of orthographic processing that offer various forms of noisy position or context-sensitive coding have revolutionized the field of visual word recognition. The influx of such models stems mainly from consistent findings, coming mostly from European languages, regarding an apparent insensitivity of skilled readers to letter order. Underlying the current revolution is the theoretical assumption that the insensitivity of readers to letter order reflects the (...) special way in which the human brain encodes the position of letters in printed words. The present article discusses the theoretical shortcomings and misconceptions of this approach to visual word recognition. A systematic review of data obtained from a variety of languages demonstrates that letter-order insensitivity is neither a general property of the cognitive system nor a property of the brain in encoding letters. Rather, it is a variant and idiosyncratic characteristic of some languages, mostly European, reflecting a strategy of optimizing encoding resources, given the specific structure of words. Since the main goal of reading research is to develop theories that describe the fundamental and invariant phenomena of reading across orthographies, an alternative approach to model visual word recognition is offered. The dimensions of a possible universal model of reading, which outlines the common cognitive operations involved in orthographic processing in all writing systems, are discussed. (shrink)

After introducing the new field of cultural evolution, we review a growing body of empirical evidence suggesting that culture shapes what people attend to, perceive and remember as well as how they think, feel and reason. Focusing on perception, spatial navigation, mentalizing, thinking styles, reasoning (epistemic norms) and language, we discuss not only important variation in these domains, but emphasize that most researchers (including philosophers) and research participants are psychologically peculiar within a global and historical context. This rising tide of (...) evidence recommends caution in relying on one’s intuitions or even in generalizing from reliable psychological findings to the species, Homo sapiens. Our evolutionary approach suggests that humans have evolved a suite of reliably developing cognitive abilities that adapt our minds, information-processing abilities and emotions ontogenetically to the diverse culturally-constructed worlds we confront. (shrink)

The understanding of the soul in the West has been profoundly shaped by Christianity, and its influence can be seen in certain assumptions often made about the soul: that, for example, if it does exist, it is separable from the body, free, immortal, and potentially pure. The ancient Greeks, however, conceived of the soul quite differently. In this ambitious new work, Michael Davis analyzes works by Homer, Herodotus, Euripides, Plato, and Aristotle to reveal how the ancient Greeks portrayed and (...) understood what he calls “the fully human soul.” Beginning with Homer’s _Iliad_, Davis lays out the tension within the soul of Achilles between immortality and life. He then turns to Aristotle’s _De Anima_ and _Nicomachean Ethics_ to explore the consequences of the problem of Achilles across the whole range of the soul’s activity. Moving to Herodotus and Euripides, Davis considers the former’s portrayal of the two extremes of culture—one rooted in stability and tradition, the other in freedom and motion—and explores how they mark the limits of character. Davis then shows how _Helen_ and _Iphigeneia among the Taurians_ serve to provide dramatic examples of Herodotus’s extreme cultures and their consequences for the soul. The book returns to philosophy in the final part, plumbing several Platonic dialogues—the _Republic_, _Cleitophon_, _Hipparchus_, _Phaedrus_, _Euthyphro_, and _Symposium_—to understand the soul’s imperfection in relation to law, justice, tyranny, eros, the gods, and philosophy itself. Davis concludes with Plato’s presentation of the soul of Socrates as self-aware and nontragic, even if it is necessarily alienated and divided against itself. _The Soul of the Greeks_ thus begins with the imperfect soul as it is manifested in Achilles’ heroic, but tragic, longing and concludes with its nontragic and fuller philosophic expression in the soul of Socrates. But, far from being a historical survey, it is instead a brilliant meditation on what lies at the heart of being human. (shrink)

Can new technology enhance purpose-driven, democratic dialogue in groups, governments, and societies? Online Deliberation: Design, Research, and Practice is the first book that attempts to sample the full range of work on online deliberation, forging new connections between academic research, technology designers, and practitioners. Since some of the most exciting innovations have occurred outside of traditional institutions, and those involved have often worked in relative isolation from each other, work in this growing field has often failed to reflect the full (...) set of perspectives on online deliberation. This volume is aimed at those working at the crossroads of information/communication technology and social science, and documents early findings in, and perspectives on, this new field by many of its pioneers. -/- CONTENTS: -/- Introduction: The Blossoming Field of Online Deliberation (Todd Davies, pp. 1-19) -/- Part I - Prospects for Online Civic Engagement -/- Chapter 1: Virtual Public Consultation: Prospects for Internet Deliberative Democracy (James S. Fishkin, pp. 23-35) -/- Chapter 2: Citizens Deliberating Online: Theory and Some Evidence (Vincent Price, pp. 37-58) -/- Chapter 3: Can Online Deliberation Improve Politics? Scientific Foundations for Success (Arthur Lupia, pp. 59-69) -/- Chapter 4: Deliberative Democracy, Online Discussion, and Project PICOLA (Public Informed Citizen Online Assembly) (Robert Cavalier with Miso Kim and Zachary Sam Zaiss, pp. 71-79) -/- Part II - Online Dialogue in the Wild -/- Chapter 5: Friends, Foes, and Fringe: Norms and Structure in Political Discussion Networks (John Kelly, Danyel Fisher, and Marc Smith, pp. 83-93) -/- Chapter 6: Searching the Net for Differences of Opinion (Warren Sack, John Kelly, and Michael Dale, pp. 95-104) -/- Chapter 7: Happy Accidents: Deliberation and Online Exposure to Opposing Views (Azi Lev-On and Bernard Manin, pp. 105-122) -/- Chapter 8: Rethinking Local Conversations on the Web (Sameer Ahuja, Manuel Pérez-Quiñones, and Andrea Kavanaugh, pp. 123-129) -/- Part III - Online Public Consultation -/- Chapter 9: Deliberation in E-Rulemaking? The Problem of Mass Participation (David Schlosberg, Steve Zavestoski, and Stuart Shulman, pp. 133-148) -/- Chapter 10: Turning GOLD into EPG: Lessons from Low-Tech Democratic Experimentalism for Electronic Rulemaking and Other Ventures in Cyberdemocracy (Peter M. Shane, pp. 149-162) -/- Chapter 11: Baudrillard and the Virtual Cow: Simulation Games and Citizen Participation (Hélène Michel and Dominique Kreziak, pp. 163-166) -/- Chapter 12: Using Web-Based Group Support Systems to Enhance Procedural Fairness in Administrative Decision Making in South Africa (Hossana Twinomurinzi and Jackie Phahlamohlaka, pp. 167-169) -/- Chapter 13: Citizen Participation Is Critical: An Example from Sweden (Tomas Ohlin, pp. 171-173) -/- Part IV - Online Deliberation in Organizations -/- Chapter 14: Online Deliberation in the Government of Canada: Organizing the Back Office (Elisabeth Richard, pp. 177-191) -/- Chapter 15: Political Action and Organization Building: An Internet-Based Engagement Model (Mark Cooper, pp. 193-202) -/- Chapter 16: Wiki Collaboration Within Political Parties: Benefits and Challenges (Kate Raynes-Goldie and David Fono, pp. 203-205) -/- Chapter 17: Debian’s Democracy (Gunnar Ristroph, pp. 207-211) -/- Chapter 18: Software Support for Face-to-Face Parliamentary Procedure (Dana Dahlstrom and Bayle Shanks, pp. 213-220) -/- Part V - Online Facilitation -/- Chapter 19: Deliberation on the Net: Lessons from a Field Experiment (June Woong Rhee and Eun-mee Kim, pp. 223-232) -/- Chapter 20: The Role of the Moderator: Problems and Possibilities for Government-Run Online Discussion Forums (Scott Wright, pp. 233-242) -/- Chapter 21: Silencing the Clatter: Removing Anonymity from a Corporate Online Community (Gilly Leshed, pp. 243-251) -/- Chapter 22: Facilitation and Inclusive Deliberation (Matthias Trénel, pp. 253-257) -/- Chapter 23: Rethinking the ‘Informed’ Participant: Precautions and Recommendations for the Design of Online Deliberation (Kevin S. Ramsey and Matthew W. Wilson, pp. 259-267) -/- Chapter 24: PerlNomic: Rule Making and Enforcement in Digital Shared Spaces (Mark E. Phair and Adam Bliss, pp. 269-271) -/- Part VI - Design of Deliberation Tools -/- Chapter 25: An Online Environment for Democratic Deliberation: Motivations, Principles, and Design (Todd Davies, Brendan O’Connor, Alex Cochran, Jonathan J. Effrat, Andrew Parker, Benjamin Newman, and Aaron Tam, pp. 275-292) -/- Chapter 26: Online Civic Deliberation with E-Liberate (Douglas Schuler, pp. 293-302) -/- Chapter 27: Parliament: A Module for Parliamentary Procedure Software (Bayle Shanks and Dana Dahlstrom, pp. 303-307) -/- Chapter 28: Decision Structure: A New Approach to Three Problems in Deliberation (Raymond J. Pingree, pp. 309-316) -/- Chapter 29: Design Requirements of Argument Mapping Software for Teaching Deliberation (Matthew W. Easterday, Jordan S. Kanarek, and Maralee Harrell, pp. 317-323) -/- Chapter 30: Email-Embedded Voting with eVote/Clerk (Marilyn Davis, pp. 325-327) -/- Epilogue: Understanding Diversity in the Field of Online Deliberation (Seeta Peña Gangadharan, pp. 329-358). -/- For individual chapter downloads, go to odbook.stanford.edu. (shrink)

Helen Steward argues that determinism is incompatible with agency itself--not only the special human variety of agency, but also powers which can be accorded to animal agents. She offers a distinctive, non-dualistic version of libertarianism, rooted in a conception of what biological forms of organisation might make possible in the way of freedom.

In this article, I offer an account of an unjust epistemic practice―namely, epistemic appropriation―that harms marginalized knowers through the course of conceptual dissemination and intercommunal uptake. The harm of epistemic appropriation is twofold. First, while epistemic resources developed within the margins gain uptake with dominant audiences, those resources are overtly detached from the marginalized knowers responsible for their production. Second, epistemic resources developed within, but detached from, the margins are utilized in dominant discourses in ways that disproportionately benefit the powerful.

When it comes to cheating in higher education, business school students have often been accused of being the worst offenders; if true, this may be a contributing factor in the kinds of fraud that have plagued the business community in recent years. We examined the issue of cheating in the business school by surveying 268 students in business and other professional schools on their attitudes about, and experiences with, cheating. We found that while business school students actually cheated no more (...) or less than students in other professional schools, their attitudes on what constitutes cheating are more lax than those of other professional school students. Additionally, we found that serious cheaters across all professional schools were more likely to be younger and have a lower grade point average. (shrink)

Smart cities are now an established area of technological development and theoretical inquiry. Research on smart cities spans from investigations into its technological infrastructures and design scenarios, to critiques of its proposals for citizenship and sustainability. This article builds on this growing field, while at the same time accounting for expanded urban-sensing practices that take hold through citizen-sensing technologies. Detailing practice-based and participatory research that developed urban-sensing technologies for use in Southeast London, this article considers how the smart city as (...) a large-scale and monolithic version of urban systems breaks down in practice to reveal much different concretizations of sensors, cities, and people. By working through the specific instances where sensor technologies required inventive workarounds to be setup and continue to operate, as well as moments of breakdown and maintenance where sensors required fixes or adjustments, this article argues that urban sensing can produce much different encounters with urban technologies through lived experiences. Rather than propose a “grassroots” approach to the smart city, however, this article instead suggests that the smart city as a figure for urban development be contested and even surpassed by attending to workarounds that account more fully for digital urban practices and technologies as they are formed and situated within urban projects and community initiatives. (shrink)

Moral realists often assume that folk intuitions are predominantly realist, and they argue that this places the burden of proof on antirealists. More broadly, appeals to intuition in metaethics typically assume that folk judgments are generally consistent across individuals, such that they are at least predominantly something, if not realist. A substantial body of empirical work on moral objectivism has investigated these assumptions, but findings remain inconclusive due to methodological limitations. Objectivist judgments classify individuals into broad categories of realism and (...) antirealism, but they do not address more specific conflicts in the metaethical literature between different types of realism and antirealism, such as between nonnaturalism and divine command theory, or between noncognitivism and error theory. Further, the data currently show that the folk are objectivists about some moral claims but not others, raising questions that have not been addressed in previous studies about how much of the moral domain is judged to be objective, and about how endorsements of different types of realism and antirealism are distributed among different types of moral claims. Here, I present a new survey that addresses these limitations. The results challenge both of the empirical assumptions identified above, with important implications for metaethical methodology. (shrink)

The paper argues that the reconciliation of the Causal Theory of Perception with Disjunctivism requires the rejection of causal particularism – the idea that the ontology of causation is always and everywhere an ontology of particulars (e.g., events). The so-called ‘Humean Principle’ that causes must be distinct from their effects is argued to be a genuine barrier to any purported reconciliation, provided causal particularism is retained; but extensive arguments are provided for the rejection of causal particularism. It is then explained (...) how the reconciliation of the causal theory with disjunctivism can proceed on the basis of an ontology of facts. (shrink)

The reductivist view of war holds that the moral rules of killing in war can be reduced to the moral rules that govern killing between individuals. Noam Zohar objects to reductivism on the grounds that the account of individual self-defence that best supports the rules of war will inadvertently sanction terrorist killings of non-combatants. I argue that even an extended account of self-defence—that is, an account that permits killing at least some innocent people to save one's own life—can support a (...) prohibition on terrorism, provided that it distinguishes between direct and indirect threats. What such an account cannot support is the blanket immunity of non-combatants to defensive killing. If a non-combatant is morally responsible for indirectly threatening in an unjust war, she can be liable to defensive killing. However, this gives us reason to revise our account of permissible killing in war, rather than to reject the reductivist account. (shrink)

The practice of nursing involves ongoing interactions between nurses' and clients' lived bodies. Despite this, several scholars have suggested that the “lived body” (Merleau‐Ponty, 1962) has not been given its due place in nursing practice, education or research (Draper, J Adv Nurs, 70, 2014, 2235). With the advent of electronic health records and increased use of technology, face‐to‐face assessment and embodied understanding of clients' lived bodies may be on the decline. Furthermore, staffing levels may not afford the time nurses need (...) to be as “present” with their clients in embodied ways. The failure to attend to the lived body may contribute to missed opportunities for care and decreased quality of life for both clients and healthcare practitioners. In this paper, we undertake an analysis of selected aspects of the work of Maurice Merleau‐Ponty. The aim is to advance understanding of the affordances this work may offer to enhancing client–nurse interactions within the practice of nursing. Merleau‐Ponty's notions of embodiment, intersubjectivity and intercorporeality as articulated in his seminal texts The Phenomenology of Perception (New York, NY: Routledge, 2012) and The Visible and the Invisible (Evanston, IL: Northwestern University Press, 1968) are examined. These three constructs are discussed as they relate to the lived body in client–nurse interactions in nursing practice and education. Finally, implications of how attention to “the lived body” could shape interactions and have the potential to foster increased quality of life of clients and nurses are considered. (shrink)

Preference utilitarians are concerned to maximize the autonomous choices of individuals; for this reason, they argue that nurses ought to advocate for those patients who desire assistance with ending their lives. This approach prompts us to consider, then, the moral validity of nursing involvement in measures intended to end the lives of patients. In this article, the terms of preference utilitarianism are set out and considered in order to determine whether this approach offers sufficient philosophical support for sanctioning a role (...) for nursing in euthanasia. Ultimately, it is found that preference utilitarianism is lacking in this respect, as well as in its fitness for guiding nursing activity in general. In particular, it is found that nurses are required to exchange a handmaiden relationship with the medical profession for an equally undignified relationship with patients. If nursing involvement in measures intended to end the lives of patients is to find sufficient philosophical support, then we need to look elsewhere. (shrink)

Stocks and flows are building blocks of dynamic systems: Stocks change through inflows and outflows, such as our bank balance changing with withdrawals and deposits, or atmospheric CO2 with absorptions and emissions. However, people make systematic errors when trying to infer the behavior of dynamic systems, termed SF failure, whose cognitive explanations are yet unknown. We argue that SF failure appears when people focus on specific system elements, rather than on the system structure and gestalt. Using a standard SF task, (...) SF failure decreased by a global as opposed to local task format; individual global as opposed to local processing styles; and global as opposed to local perceptual priming. These results converge toward local processing as an explanation for SF failure. We discuss theoretical and practical implications on the connections between the scope of attention and understanding of dynamic systems. (shrink)

Journal of Applied Philosophy, EarlyView.

Philosopher Davis argues that Christian belief in the resurrection is rational on historical, philosophical, and theological grounds. Each of the book's ten chapters takes up a different aspect of the Christian concept of bodily resurrection and subsequently deals with such matters as perservation of personal identity and soul-body dualism, issues in biblical scholarship, and the reliability of New Testament accounts.

This work is an essay in Peirce's epistemology, with about an equal emphasis on the "epistemology" as on the "Peirce's." In other words our intention has not been to write exclusively a piece of Peirce scholarshiJ> hence, the reader will find no elaborate tying in of Peirce's epistemology to other portions of his thought, no great emphasis on the chronology of his thought, etc. Peirce scholarship is a painstaking business. His mind was Labyrinthine, his terminology intricate, and his writings are, (...) as he himself confessed, "a snarl of twine." This book rather is intended perhaps even primarily as an essay in epistemology, taking Peirce's as the focal point. The book thus addresses a general philosophical audience and bears as much on the wider issue as on the man. I hope therefore that readers will give their critical attention to the problem of knowledge and the sugges tions we have developed around that problem and will not look here in the hope of finding an exhaustive piece of Peirce scholarship. (shrink)

Global ignorance about Africa continues to sustain inappropriate global interventions to resolve public health crises, often with disastrous consequences. To explain why this continues to happen, I marshal two theorems that predict basic statistical properties, called ‘the doctrinal paradox’ and ‘the discursive dilemma’, which underlie scientific consensus formation and evidence-based decision making on a global scale. These mathematical results illuminate the epistemic and material injustices committed by the protocols of medical research conducted at the highest level of global knowledge production (...) in the service of international humanitarian aid for Africans. These social choice theorems reveal that a global scientific consensus projecting claims and proposing policies about Africa’s disease burden is likely to yield a low degree of reliability, in that the probability of its accuracy is less than chance. The solution to this anomaly is to remove from the global scientific agenda the statistically unrealisable demand of satisfying too many multinational corporate and foreign governments’ priorities as equally entitled to benefit from the knowledge produced to improve Africa’s public health sector. Instead, foreign funding targeted to support medical science and policy in Africa should be directed by those specialists in situ who are most familiar with their own national health challenges and potential solutions, rather than relying upon foreign decision makers to interpret Africa’s emergency public health care needs. Keywords Doctrinal paradox, discursive dilemma, scientific consensus, epistemic trust, global health ethics, group agency. (shrink)

IT WAS an outlandish, ethically questionable experiment, but this was the 1960s after all. Psychiatrist Robert Heath of Tulane University in New Orleans hoped to cure his patients' depression, intractable pain, schizophrenia, suicidal feelings, addiction, and even homosexuality - which in those days was considered a psychiatric disorder - by drowning them out with pleasure, induced by an electrode implanted deep in their brains.

Physicians place significant weight on the distinction between acts and omissions. Most believe that autonomous refusals for procedures, such as blood transfusions and resuscitation, ought to be respected, but they feel no similar obligation to accede to requests for treatment that will, in the physician’s opinion, harm the patient (e.g., assisted death). Thus, there is an asymmetry. In this paper, we challenge the strength of this distinction by arguing that the ordering of values should be the same in both cases. (...) The reason for respecting refusals is that, in such cases, autonomy outweighs well-being. We argue that the same should be true in request cases, which means that requests should not be denied only due to the treatment being too harmful in the physician’s opinion. Our strategy is to consider and reject a number of arguments for the asymmetrical view, including an appeal to the doing–allowing distinction and positive and negative rights. The duty to respect refusals is still greater than the duty to grant requests on our view, but, by arguing that the ordering of values is the same in both cases, we show that there is less of a distinction in healthcare between requests and refusals than many currently believe. (shrink)