This article attempts to motivate a reorientation of ethical analysis of conscientious objection by physicians. First, it presents an illustrative case from a hospital emergency department for context. Then, it criticizes the standard pro- and anti-CO arguments. It proposes that the fault in standard approaches is to focus on the ethics of the physician’s behavior, and a better way forward on this issue is to ask how the party against whom the physician exercises the CO ought to respond. It connects (...) this question with recent trends in physician employment models, which suggest that CO may become a potential source of conflict in the future. The article then develops a relational account of CO that extends James Childress’ insights about the nature of CO in “Appeals to Conscience”. This relational account characterizes CO as a two-place relation between conscientious objector and expectant party, in which the conscientious objector makes a request of the expectant party, which has implications that will be welcome and unwelcome for both the pro- and anti-CO camps. Finally, the paper applies this relational account of CO to the case when the physician is an employee. This application demonstrates that it is highly context dependent whether or not an employer should accede to the CO requests of physician–employees. (shrink)

That Jehovah’s Witnesses may refuse lifesaving blood transfusions is a morally accepted feature of contemporary medical practice. The principle of respect for autonomy supports this, and there is seldom reason to interfere with this choice because it rarely harms another individual. Advances in surgical technique have made it possible for transplant surgeons to perform bloodless organ transplant, enabling Jehovah’s Witnesses to benefit from this treatment. When the transplant organ is a directed donation from a family member or friend, no ethical (...) dilemma arises. However, when a Jehovah’s Witness cannot identify a living donor and wishes to be listed for organ transplant, the transplant team may face an ethical dilemma. On the one hand, it wishes to provide care to the patient that is compatible with her or his preferences. On the other hand, the team may wonder if it is fair to other patients who need an organ and will accept blood transfusion to include the Jehovah’s Witness patient on a waiting list for a donated organ. If the Jehovah’s Witness patient is listed and receives an organ, then a patient who also needs an organ, and who is willing to accept all care to optimize the success of the transplant, may be denied an organ.To frame the ethical dilemma outlined above we present an anonymized case of a Jehovah’s Witness woman in urgent need of a kidney, who was referred to one of the authors’ institution’s transplant center. We review the evolution of the Jehovah’s Witness position on blood transfusion and the medical community’s efforts to provide care that accommodates this religious commitment. If Witnesses are to be denied transplant in the name of justice, there must be an ethically sound reason. We identify two rationales in the literature: (1) this allocation is unacceptable because it will cost lives; (2) resources should be allocated to patients who comply with the standard of care. We argue that neither apply to this dilemma. We also emphasize the importance of examining the data on outcomes of transplant with and without transfusion. Our interpretation of the published data on transplant without transfusion is that the outcomes are similar. We conclude that, in the absence of data that resources are risked, it is not ethical to refuse to include a Jehovah’s Witness patient on a waiting list for an organ. Finally, we reflect on the heterogeneity in transplant institutes’ polices for accepting Jehovah’s Witness patients. (shrink)

From February 2020, the COVID-19 pandemic led to closures of educational institutions to reduce the spread of infectious disease. This forced the U.S. education system into a massive experiment with online education. Despite conducting online bioethics education for nearly twenty years, our bioethics program, a joint endeavor of Clarkson University and Icahn School of Medicine at Mount Sinai, was not immune to this disruption because our curriculum features intensive, one-week onsite courses. Even in the face of historic disruptions, it is (...) vital to ensure minimal interruptions to teaching and assessing students to provide effective education. This paper reviews the steps we took to successfully convert the onsite components of our curriculum to a synchronous online format, and it focuses on how we preserved instruction and assessment of practical skills that comprise these courses’ core. It also explains how we fostered interactive classroom environments. (shrink)

Millikan [2000] has levelled a number of persuasive criticisms against Cummins's [1996] theory of mental representation. In this paper, I pave a middle path in the debate between Cummins [2000] and Millikan [2000] to answer two questions. How are representations applied to targets? How is the content of a representation determined? The result is a new theory of mental representation, which I call narrow structuralism.

The spatial organization of the genome is intimately linked to its biological function, yet our understanding of higher order genomic structure is coarse, fragmented and incomplete. In the nucleus of eukaryotic cells, interphase chromosomes occupy distinct.

Postulating the subcortical organization of human consciousness provides a critical link for the construal of pain in patients with impaired cortical function or cortical immaturity during early development. Practical implications of the centrencephalic proposal include the redefinition of pain, improved pain assessment in nonverbal humans, and benefits of adequate analgesia/anesthesia for these patients, which certainly justify the rigorous scientific efforts required. (Published Online May 1 2007).

Many studies have addressed the justice of public land acquisition, but few studies have addressed the question of what landowners perceive as just. Individual perceptions drive an important part of the social and scientific debates on legitimate and just land acquisition. This article addresses this gap by studying landowners’ and land purchasers’ perceptions of just land acquisition. We did this by uncovering the prevailing discourse on just land acquisition and studying the values that shaped people’s perceptions of just land acquisition. (...) The results showed that perceptions of justice are based on the values of lawfulness, decentness and equality. These values were translated into different norms that resulted in expectations pertaining to just land acquisition. Insight into the different perceptions and the prevailing discourse of just land acquisition and their underlying values increases the understanding of land acquisition processes and land policy strategies. First, it becomes apparent that land acquisition has an essential element of injustice that cannot be avoided by a good process or a just compensation fee. Second, insight in different discourses provides valuable input for debates on just land acquisition. Third, such insight shows that money is not always a sufficient means of indemnification. The combination of sufficient financial compensation, the opportunity of a new location, attractive selling conditions and accurate and open process are all important requisites to ensure that public land acquisition is perceived by the majority of landowners as just. (shrink)

The concept of fitness is central to evolutionary biology. Models of evolutionary change typically use some quantity called “fitness” which measures an organism’s reproductive success. But what exactly does it mean that fitness is such a measure? In what follows, we look at the interplay between abstract evolutionary models and quantitative measures of fitness and develop a measurement-theoretic perspective on fitness in order to explore what makes certain measures of fitness significant.

The present study analyses the relationship between human beings, society and nature from the thought of Jean-Jacques Rousseau; European thinker inserted in a vast political-anthropological tradition that seeks to understand human existence, both in its essential and relational dimensions. In this sense, Rousseau highlights a contradiction: technical and cultural development, although necessary, can also lead to the degradation of nature and the human essence. Works such as Discourse on the Sciences and Arts, Discourse on the Origin and Foundation of Inequality (...) and Reveries of a Solitary Stroller were chosen, precisely because they allow us to examine the consequences of human alienation about its relationship with the world, also demonstrating the search for harmony as the ultimate horizon of satisfaction. A critical position in the face of social relations and the need for esteem and recognition from others. In Reveries, for example, Rousseau reflects on happiness and the relationship with nature, which, if preserved, enables a refuge from social pressures and an encounter with the true “I”. It is a criticism of itself-love (amour-propre) like the search for possessions and honours; aspects that distance humanity from self-love (amour de soi) and pity for others. (shrink)

This comprehensive and important volume includes contributions by activists, journalists, lawyers and scholars from twenty-one countries. The essays map the directions the movement for women's rights is taking--and will take in the coming decades--and the concomittant transformation of prevailing notions of rights and issues. They address topics such as the rapes in former Yugoslavia and efforts to see that a War Crimes Tribunal responds; domestic violence; trafficking of women into the sex trade; the persecution of lesbians; female genital mutilation; and (...) reproductive rights. (shrink)

This paper argues that for the purposes of any sort of serious discussion about immoral conduct in sport very little is illuminated by claiming that the conduct in question is cheating. In fact, describing some behavior as cheating is typically little more than expressing strong, but thoroughly vague and imprecise, moral disapproval or condemnation of another person or institution about a wide and ill-defined range of improper advantage-seeking behavior. Such expressions of disapproval fail to distinguish cheating from many other types (...) of immoral conduct. The discussion shows that we should set the concept aside and assess the moral disapproval implied by claims of cheating by reference to the moral and other principles that underlie the practice of sport. This allows us to consider carefully the complexity of the issues that are raised when allegations of cheating are made and not be distracted by the emotionally loaded, conversation-stopping tendency of the concept. This means that some types of disputes in sport will be messy and demand more effort to resolve, but the payoff will be better informed and more thoughtful discussions and greater awareness of the moral complexity of sport and of its principled underpinnings. (shrink)

This essay argues that idleness as play and leisure would be recognised as an ideal over game playing in Bernard Suits’ Utopia. Idleness is unaccountably overlooked as an ideal by Suits, as is the problem that his description of game playing is an anachronism, pushing his Utopians into a pre-Utopian condition. There is room for playing games in an idle Utopia but in a less prominent and more restricted role. Idleness as play and leisure is not defended as the sole (...) ideal of Utopian existence though it is possibly that. Rather, it is presented as a compelling and preferable ideal for Suits’ Utopians, thus refuting his claim that game playing is ‘the only possible’ ideal of human existence in Utopia. (shrink)

An important book is always a beginning, a new way of looking at and thinking about things, sometimes including familiar things. C. Thi Nguyen’s Games: Agency as Art is one of those books. I...