Practical Reason and Norms focuses on three problems: In what way are rules normative, and how do they differ from ordinary reasons? What makes normative systems systematic? What distinguishes legal systems, and in what consists their normativity? All three questions are answered by taking reasons as the basic normative concept, and showing the distinctive role reasons have in every case, thus paving the way to a unified account of normativity. Rules are a structure of reasons to perform the required act (...) and an exclusionary reason not to follow some competing reasons. Exclusionary reasons are explained, and used to unlock the secrets of orders, promises, and decisions as well as rules. Games are used to exemplify normative systems. Inevitably, the analysis extends to some aspects of normative discourse, which is truth-apt, but with a diminished assertoric force. (shrink)

John McDowell and Hubert L. Dreyfus are philosophers of world renown, whose work has decisively shaped the fields of analytic philosophy and phenomenology respectively. Mind, Reason, and Being-in-the-World: The McDowell-Dreyfus Debate opens with their debate over one of the most important and controversial subjects of philosophy: is human experience pervaded by conceptual rationality, or does experience mark the limits of reason? Is all intelligibility rational, or is there a form of intelligibility at work in our skilful bodily rapport with the (...) world that eludes our intellectual capacities? McDowell and Dreyfus provide a fascinating insight into some fundamental differences between analytic philosophy and phenomenology, as well as areas where they may have something in common. Fifteen specially commissioned chapters by distinguished international contributors enrich the debate inaugurated by McDowell and Dreyfus, taking it in a number of different and important directions. Fundamental philosophical problems discussed include: the embodied mind, subjectivity and self-consciousness, intentionality, rationality, practical skills, human agency, and the history of philosophy from Kant to Hegel to Heidegger to Merleau-Ponty. With the addition of these outstanding contributions, Mind, Reason, and Being-in-the-World is essential reading for students and scholars of analytic philosophy and phenomenology. (shrink)

This book makes a significant contribution to the contemporary debate about multiculturalism and democratic theory. It reflects upon the ways in which claims about culture and identity are advanced by immigrants, national minorities, aboriginals, and other groups. It argues that liberal democrats should provide recognition and support for minority cultures and identities, and examines case studies from a number of different societies to show how theorists can learn about justice.

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)

"Although the task of formulating an appropriate policy response to the problem of anthropogenic climate change is one that raises a number of very difficult normative issues, environmental ethicists have not played an influential role in government deliberations. This is primarily due to their rejection of many of the assumptions that structure the debates over policy. This book offers a philosophical defense of these assumptions, in order to overcome the major conceptual barriers to the participation of philosophers in these debates. (...) There are five important barriers: First, the policy debate presupposes a stance of liberal neutrality, as a result of which it does not privilege any particular set of environmental values over other concerns. Second, it assumes ongoing economic growth, along with a commitment to what is sometimes called a weak sustainability framework when analyzing the value of the bequest being made to future generations. Third, it treats climate change as fundamentally a collective action problem, not an issue of distributive justice. Fourth, there is the acceptance of cost-benefit analysis, or more precisely, the view that a carbon pricing regime should be guided by our best estimate of the social cost of carbon. And finally, there is the view that when this calculation is undertaken, it is permissible to discount costs and benefits, depending on how far removed they are from the present. This book attempts to make explicit and defend these presuppositions, and in so doing offer philosophical foundations for the debate over climate change policy"--. (shrink)

As scholars envision a new regulatory or statutory neurorights schema it is important to imagine unintended consequences if reforms are implemented before their implications are fully understood. This paper critically evaluates provisions proposed for a new Chilean Constitution and evaluates this movement against efforts to improve the diagnosis of, and treatment for, individuals with disorders of consciousness within the broader context of disability law, international human rights, and a capabilities approach to health justice as advanced by Amartya Sen and Martha (...) Nussbaum. Framed in this way, any neurorights regime would need to satisfy several criteria. First it would be obliged to balance both positive and negative rights in the furtherance of human capabilities. Second, it would need to be future oriented and informed about the science it sought to regulate and not fall prey to science fiction fantasies that remain ungrounded in reality. Third, it would need to be specific and avoid generalizations that would lead to conceptual confusion and litigation that could delay scientific progress. Finally, it would need to harmonize novel neurorights with long-established norms in international disability and human rights law. A failure to meet these criteria will destine any novel neurorights regime to the periphery. At this juncture Chile’s nascent constitutional venture into neurorights fails to satisfy these criteria. While there yet may be a role for a more capacious and bivalent articulation of neurorights that account for capabilities and precedent, the current Chilean neurorights reforms are vague and premature. As such they should undergo additional scholarly scrutiny and should not be adopted by other jurisdictions. (shrink)

The nature of biological order.--The deployment of biological order.--The hierarchical continuity of biological order.--Bibliography (p. xvi-xvii).

This chapter explores the foundation and content of the duty to respect persons. The authors argue that it is best understood as a duty to recognize people’s rights. Respect for persons therefore has specific implications for how competent and non-competent persons ought to be treated in research. For competent persons it underlies the obligation to obtain consent to many research procedures. The chapter gives an analysis of the requirements for obtaining valid consent. It then considers respect for persons as it (...) relates to four common topics: the therapeutic misconception, research with children and adolescents, the use of deception in research, and research on competent adults without their consent. (shrink)

The drive to describe cultural history as an evolutionary process has two sources. One from within social theory is part of the impetus to convert social studies into "social sciences" providing them with the status accorded to the natural sciences. The other comes from within biology and biological anthropology in the belief that the theory of evolution must be universal in its application to all functions of all living organisms. The social scientific theory of cultural evolution is pre-Darwinian, employing a (...) developmental model of unfolding characterized by intrinsic directionality, by definable stages that succeed each other and by some criterion of progress. It is arbitrary in its definitions of progress and has had the political problem that a diachronic claim of cultural progress implies a synchronic differential valuation of present-day cultures. The biological scheme creates an isomorphism between the Darwinian mechanism of evolution and cultural history, postulating rules of cultural "mutation", cultural inheritance and some mechanism of natural selection among cultural alternatives. It uses simplistic ad hoc notions of individual acculturation and of the differential survival and reproduction of cultural elements. It is unclear what useful work is done by substituting the metaphor of evolution for history. (shrink)

_ Source: _Page Count 28 Recent debates over climate change policy have made it clear that the choice of a social discount rate has enormous consequences for the amount of mitigation that will be recommended. The social discount rate determines how future costs are to be compared to present costs. Philosophers, however, have been almost unanimous in endorsing the view that the only acceptable social rate of time preference is zero, a view that, taken literally, has either absurd or extremely (...) radical implications. The first goal of this paper is to show that the standard arguments against temporal preference are much less persuasive than they are usually taken to be. The second goal is to explore two different avenues of argument that could be adopted, in order to show that temporal discounting of welfare may be permissible. The first involves simply an application of the method of reflective equilibrium, while the second involves consideration of the way that our abstract moral commitments are institutionalized. (shrink)

Edward Feser defends the ‘Neo-Platonic proof ’ for the existence of the God of classical theism. After articulating the argument and a number of preliminaries, I first argue that premise three of Feser’s argument—the causal principle that every composite object requires a sustaining efficient cause to combine its parts—is both unjustified and dialectically ill-situated. I then argue that the Neo-Platonic proof fails to deliver the mindedness of the absolutely simple being and instead militates against its mindedness. Finally, I uncover two (...) tensions between Trinitarianism and the Neo-Platonic proof. (shrink)

"The patriarch of medical ethics explains why some accepted ethical values need to catch up with the science of human reproduction and why newer reproductive methods can be more "natural" and humane than those they replace." -- from Publisher's site.

Multifunctionality poses significant challenges for human brain mapping. Cathy Price and Karl Friston argue that brain regions perform many functions in one sense and a single function in another. Thus, neuroscientists must revise their “cognitive ontologies” to obtain systematic mappings. Colin Klein draws a different lesson from these findings: neuroscientists should abandon systematic mappings for context-sensitive ones. I claim that neither account succeeds as a general treatment of multifunctionality. I argue that brain areas, like genes or organs, are multifunctional in (...) different ways. I call this the “functional heterogeneity hypothesis.” I contend that different multifunctional parts require different mapping strategies. (shrink)

CONTEMPORARY ISSUES IN BUSINESS ETHICS, 6E introduces readers to business ethics by focusing on the influence of market mechanisms and social values on workplace norms. And because business is increasingly a global enterprise, this edition emphasizes the role of ethics both at home and abroad.

Circumcision of a male child was recently ruled illegal by a court in Germany on the grounds that it violates the child's rights to bodily integrity and self-determination. This paper begins by challenging the applicability of these rights to the circumcision debate. It argues that, rather than a sweeping appeal to rights, a moral analysis of the practice of circumcision will require a careful examination of the interests of the child. I consider three of these interests in some detail. The (...) first is the interest in avoiding a moderate decrease in expected future sexual pleasure. I argue that even if such a decrease were to occur, it is not wholly unreasonable to think that this might actually be a good thing for the child. Second, I consider the interest in self-determination. I argue that this interest is not as strong as it might appear because the adult's circumcision decision is subject to a variety of biases and a significant lack of information. Finally, I consider the child's interest in avoiding the future costs of adult circumcision. I argue that this interest becomes much stronger in the religious case because the child is quite likely to choose to become circumcised as an adult. The likelihood of the child choosing circumcision in the religious case also reduces the extent to which infant circumcision violates his interest in self-determination. I conclude that male infant circumcision falls within the prerogative of parental decision-making in the secular case and even more clearly so in the religious case. Finally, I distinguish male circumcision from female genital cutting in several important respects and argue that we can coherently hold that male circumcision is permissible without also endorsing all forms of female genital cutting. (shrink)

This paper seeks to give an account of what it is for an individual to instantiate thisness (i.e. primitive individual essence). Thisnesses are peculiar entities, and even those who endorse their existence and instantiation by objects/entities, have said very little about how an individual and its thisness are related. My approach will be to seek out a model for the instantiation of thisness by canvassing broadly Aristotelian accounts of the substance/attribute relation, and then by making appropriate modifications to the most (...) likely candidates in order to accommodate an individual's instantiation of thisness. What will emerge is that the model with the most utility makes thisness redundant in the case of material substances. Nonetheless, I will suggest that a version of the model can be appropriately applied in the case of other individuals which might instantiate thisness: for example, events (where these are conceived as a fundamental category of ontology distinct from material substances). (shrink)

If ever I summon before me my highest ideals of men and medicine, I find them sprung from the spirit of Osler. —Wilder Penfield, M.D. Neuroethics is a recently coined term that is shaping our cultu...

Adaptationists explain the evolution of religion from the cooperative effects of religious commitments, but which cooperation problem does religion evolve to solve? I focus on a class of symmetrical coordination problems for which there are two pure Nash equilibriums: (1) ALL COOPERATE, which is efficient but relies on full cooperation; (2) ALL DEFECT, which is inefficient but pays regardless of what others choose. Formal and experimental studies reveal that for such risky coordination problems, only the defection equilibrium is evolutionarily stable. (...) The following makes sense of otherwise puzzling properties of religious cognition and cultures as features of cooperative designs that evolve to stabilise such risky exchange. The model is interesting because it explains lingering puzzles in the data on religion, and better integrates evolutionary theories of religion with recent, well-motivated models of cooperative niche construction. (shrink)

In our papers on the rationality of magic, we distinghuished, for purposes of analysis, three levels of rationality. First and lowest (rationalitYl) the goal directed action of an agent with given aims and circumstances, where among his circumstances we included his knowledge and opinions. On this level the magician's treatment of illness by incantation is as rational as any traditional doctor's blood-letting or any modern one's use of anti-biotics. At the second level (rationalitY2) we add the element of rational thinking (...) or thinking which obeys some set of explicit rules, a level which is not found in magic in general, though it is sometimes given to specific details of magical thinking within the magical thought-system. It was the late Sir Edward E. Evans-Pritchard who observed that when considering magic in detail the magician may be as consistent or critical as anyone else; but when considering magic in general, or any system of thought in general, the magician could not be critical or even comprehend the criticism. Evans-Pritchard went even further: he was sceptical as to whether it could be done in a truly consistent manner: one cannot be critical of one's own system, he thought. On this level (rationalitY2) of discussion we have explained (earlier) why we prefer to wed Evans Pritchard's view of the magician's capacity for piece-meal rationality to Sir James Frazer's view that magic in general is pseudo-rational because it lacks standards of rational thinking. (shrink)

Most bioethicists who address questions to which global justice matters have not considered the significance of the disputes over the correct theory of global justice. Consequently, the significance of the differences between theories of global justice for bioethics has been obscured. In this paper, I consider when and how these differences are important. I argue that certain bioethical problems can be resolved without addressing disagreements about global justice. People with very different views about global justice can converge on the existence (...) of a duty to aid the very badly off — those in absolute poverty — wherever they may be. However, despite agreement on extreme cases, there should be disagreement over the extent of international obligations to those who are only relatively poor. Consequently, different theories of justice will diverge in their implications for a number of important problems in contemporary bioethics. I close by sketching in more detail two contemporary bioethical issues —concerning pharmaceutical patents and the health worker brain drain —and show how responses to them might be developed by cosmopolitan and statist liberals. (shrink)

Neuron diagrams are heavily employed in academic discussions of causation. Stephen Mumford and Rani Lill Anjum, however, offer an alternative approach employing vector diagrams, which this paper attempts to develop further. I identify three ways in which dispositionalists have taken the activities of powers to be related: stimulation, mutual manifestation, and contribution combination. While Mumford and Anjum do provide resources for representing contribution combination, which might be sufficient for their particular brand of dispositionalism, I argue that those resources are not (...) flexible enough to further accommodate either stimulation or mutual manifestation. Representational tools are provided to address these limitations, improving the general value of the vector model for dispositionalist approaches to causation. (shrink)

BackgroundGenetics and genomics research (GGR) is increasingly being conducted around the world; yet, researchers and research oversight entities in many countries have struggled with ethical challenges. A range of ethics and regulatory issues need to be addressed through comprehensive policy frameworks that integrate with local environments. While important efforts have been made to enhance understanding and awareness of ethical dimensions of GGR in Africa, including through the H3Africa initiative, there remains a need for in-depth policy review, at a country-level, to (...) inform and stimulate local policy development and revision on the continent.MethodsTo identify and characterize existing ethics-related guidelines and laws applicable to GGR across much of Africa, we conducted a scoping review of English language policy documents identified through databases, repositories, and web searches. Thirty-six documents were included and coded using a framework that contained a range of themes across five analytical categories: (1) respect, (2) beneficence, (3) justice, (4) independent oversight, and (5) bans and prohibitions. Data analysis software (NVivo 12) was used to organize, code, and tabulate information according to document characteristics and topics. Illustrative examples of policy requirements were selected for inclusion.ResultsDocuments that met inclusion criteria spanned 20 years; published between 1996 and 2018, with the majority (58%) published after 2009. About two-thirds were denoted as “guidelines,” and slightly more than half were non-exclusive to GGR. Very few (six) country-level documents identified were specific to GGR. Requirements related to the principle of “respect” appeared most often across all documents, relative to other principles and processes. The most commonly stated ban was on reproductive cloning. Other prohibitions applied to germline editing, undue inducements in research, sample use for commercial purposes, employee mandatory DNA testing, fetal sex selection, stem cell use, eugenics, and research without public health benefits.ConclusionsEnforceable policies that are indispensable to the ethical conduct and review of GGR are either deficient or missing in many African countries. Existing international, GGR-specific ethics guidelines can be used to inform GGR policy development at a country-level, in conjunction with insight from country specific ethics committees and other local stakeholders. (shrink)

Life Without Principles d adds a fourth volume to the trilogy published under the general title The Persistence of Reality d. I demonstrates why theoretical and practical questions cannot be disjoined.

The tendency to test outcomes that are predicted by our current theory (the confirmation bias) is one of the best-known biases of human decision making. We prove that the confirmation bias is an optimal strategy for testing hypotheses when those hypotheses are deterministic, each making a single prediction about the next event in a sequence. Our proof applies for two normative standards commonly used for evaluating hypothesis testing: maximizing expected information gain and maximizing the probability of falsifying the current hypothesis. (...) This analysis rests on two assumptions: (a) that people predict the next event in a sequence in a way that is consistent with Bayesian inference; and (b) when testing hypotheses, people test the hypothesis to which they assign highest posterior probability. We present four behavioral experiments that support these assumptions, showing that a simple Bayesian model can capture people's predictions about numerical sequences (Experiments 1 and 2), and that we can alter the hypotheses that people choose to test by manipulating the prior probability of those hypotheses (Experiments 3 and 4). (shrink)

Much of what we know results from information sources on which we epistemically rely. This fact about epistemic reliance, however, stands in tension with a very powerful intuition governing knowledge, an intuition that Pritchard (e.g., 2010) has termed the “ability intuition,” the idea that a believer's “reliable cognitive faculties are the most salient part of the total set of causal factors that give rise to [their] believing the truth” (Vaesen, 2011, p. 518; compare Greco, 2003; 2009; 2010). In this paper (...) I suggest that this tension may indeed be ineliminable. I proceed by canvassing some representative attempts to reconcile epistemic reliance and the ability intuition. In doing so, I suggest that all of these attempts founder on one or the other of two elements of what I've previously described (Shieber, 2013, 2015) as a “personalist presumption” in discussions of social epistemology: an excessive focus on (i) reliability filters within the persons who are the recipients of information or (ii) on reliable truth‐tracking and ‐conveying abilities in the persons who are the transmitters of information. In conclusion, I suggest how best to resolve the tension: by abandoning the ability intuition. (shrink)

In this article I argue that the conception of discourse ethics that Jürgen Habermas advances in his seminar paper, ‘Discourse Ethics: Notes on a Program of Philosophical Justification’, is subject to significant revision in later work. The central difference has to do with the status of the universalization principle and its relationship to the ‘rightness’ validity claim. The earlier view is structured by a desire to provide a weak-transcendental defense of the universalization principle. The later revision, however, essentially undercuts the (...) basis of this argument, because it severs the conception of practical discourse from the analysis of speech acts. As a way of responding to the difficulties this creates, I propose a ‘reboot’ of the discourse ethics program. This involves reverting to the earlier, more Durkheimian and less Kantian, formulation of the theory. The result is a program that is no longer encumbered by sterile debates about the correct formulation of the universalization principle, but can plausibly claim to provide insight into the role that language-dependence plays in the development and entrenchment of increasingly pro-social behavior patterns within our institutions. (shrink)

Consciousness is currently a thriving area of research in psychology and neuroscience. While this is often attributed to events that took place in the early 1990s, consciousness studies today are a continuation of research that started in the late 19th century and that continued throughout the 20th century. From the beginning, the effort built on studies of animals to reveal basic principles of brain organization and function, and of human patients to gain clues about consciousness itself. Particularly important and our (...) focus here is research in the 1950s, 1960s, and 1970s involving three groups of patients—amnesia, split brain, and blindsight. Across all three groups, a similar pattern of results was found—the patients could respond appropriately to stimuli that they denied seeing (or in the case of amnesiacs, having seen before). These studies paved the way for the current wave of research on consciousness. The field is, in fact, still grappling with the implications of the findings showing that the ability to consciously know and report the identity of a visual stimulus can be dissociated in the brain from the mechanisms that underlie the ability to behave in a meaningful way to the same stimulus. (shrink)

One of the most troubling features of international trade is that it often involves exchange between individuals facing dramatically different life circumstances, who therefore derive different levels of benefit from the exchange. Most obviously, wages are extremely low in underdeveloped countries. However, the principle underlying these wages is the same as the one the dictates wage levels in wealthy countries. It is, therefore, difficult to criticize the wages paid to ?pauper labor? without at the same time criticizing the way that (...) capitalism functions as a whole. For those who would like to question aspects of globalization, without simply repeating the standard moralizing critique of capitalism, this poses particular difficulties. This paper offers some suggestions on how egalitarians can approach this issue. The central piece of conceptual apparatus introduced, in the service of this aim, is the distinction between a ?first-best?, a ?second-best?, and an ?nth best? set of normative principles. It is then suggested, first, that capitalism is acceptable to egalitarians only within a third-best framework, and second, that this low level of idealization imposes real constraints on how far one can go in criticizing trade practices at the global level. (shrink)

In previous writings, I joined those who take the view that action with an intention is an action for a reason, where whatever value there is in the action is a reason for it. This paper sketches the role of reasons and intentions in leading to action with an intention. Section 1 explains that though belief in the value of the intended action is not an essential constituent of intentions, nevertheless when humans act with an intention they act in the (...) belief that there is value in the action. Section 2 explains the relative role of value and intention in “producing” the action, and relates their role to that of motivation. (shrink)

Halakhic Man--originally published in Hebrew in 1944 and appearing for the first time in English translation--is considered to be Rabbi Soloveitchik's most important statement. A unique, almost unclassifiable work, its pages include a brilliant exposition of Mitnaggedism, of Lithuanian religiosity, with its emphasis on Talmudism; a profound excursion into religious psychology and phenomenology; a pioneering attempt at a philosophy of Halakhah; a stringent critique of mysticism and romantic religion--all held together by the force of the author's highly personal vision. Exuding (...) intellectual sophistication and touching upon issues fundamental to religious life, Rabbi Soloveitchik's exploration, in sum, seeks to explain the inner world of the Talmudist--or as he is referred to typologically, halakhic man--in terms drawn from Western culture. This book brings to the English-reading world a significant work by one of the most profound Jewish thinkers of this century. (shrink)

The problem of act individuation is a debate about the identity conditions of human acts. The fundamental question about act individuation is: how do we distinguish between actions? Three views of act individuation have dominated the literature. First, Donald Davidson and G.E.M. Anscombe have argued that a number of different descriptions refer to a single act. Second, Alvin Goldman and Jaegwon Kim have argued that each description designates a distinct act. Finally, Irving Thalberg and Judith Jarvis Thomson have averred that (...) some acts are sequences of causally related events, which include both a primitive bodily action and some of its effects. All of these accounts have assumed that a simple invariantist account of act individuation captures how ordinary people distinguish between acts. For my dissertation, I devised an experiment to test the action theorists' assumptions. My data show that people's intuitions seem to depend on the valence of the consequences of the action under consideration. So, an invariantist account is not possible. In light of the empirical results, I argue that if we seek a folk account of act individuation, then that account should be able to explain the variability that seems to be present in people's intuitions about different cases. (shrink)

Kripke's Pierre puzzle undermines some of the central epistemic intuitions that underlie traditional defences of the Fregean assumption that sentences'S believes that Fa ‘and'S believes that Fb’ can differ in truth value, even though a = b. Millian theorists have seized on this and employed the puzzle to reject the Fregean assumption itself. I argue that Millians are correct in rejecting traditional defences of the Fregean assumption, but they are wrong in rejecting the Fregean assumption itself. To this end, I (...) offer a different argument kr the assumption, one that is not open to Kripkean/millian objections. (shrink)

Gabriele Contessa has recently introduced and defended a view he calls ‘non-eliminative nihilism’. Non-eliminative nihilism is the conjunction of mereological nihilism and non-eliminativism about ordinary objects. Mereological nihilism is the thesis that composite objects do not exist, where something is a composite object just in case it has proper parts. Eliminativism about ordinary objects denies that ordinary objects exist. Eliminativism thus implies, for example, that there are no galaxies, planets, stars, ships, tables, books, organisms, cells, molecules, or atoms. Non-eliminativism is (...) the denial of eliminativism. Thus, NEN is the intriguing thesis that although composite objects do not exist, ordinary objects do. In this essay, I, first, summarize Contessa’s core support for NEN. Second, I describe two flaws in that support when it comes to organismic terms. Third, I consider and reject two possible responses on behalf of NEN’s defenders. Fourth, I show how the flaws cast doubt upon NEN itself. Finally, I offer reasons to think that if nihilism is true, then the folk have probably been trying to fix the reference of organismic terms to apparent objects within illusions. (shrink)

When addressing cultural and religious differences in the clinical setting we need to be realists. Despite our public homage to pluralism and good intentions, it is just not possible to overcome all the differences that might exist and achieve perfect understanding of others. Try as we may, we will never be able to see perfectly the world through another's eyes. Instead of reaching for such perfection, we should instead reach for an approximation of shared understanding that will promote discourse and (...) civility when peoples of different races, genders, cultures, religions, and sexual preferences interact in the clinic. (shrink)