This essay shows how South African Pentecostal teachings about sexuality, particularly HIV prevention and divorce, constrain women’s real and imagined choices. Institutional Review Board–approved fieldwork revealed the prevalence of wives remaining faithful to unfaithful husbands despite high risks of physical abuse and HIV infection. Maintaining the “ideal” of abstinence and faithfulness, male pastors actively oppose condom use and emphasize that “God hates divorce”. In this essay I engage and resist such hermeneutics. Using scripture as source and norm, I construct an (...) A-B-C-D prevention strategy to enhance women’s freedom: Abstain, Be faithful, use Condoms, or Divorce. (shrink)

Although the principle of fair subject selection is a widely recognized requirement of ethical clinical research, it often yields conflicting imperatives, thus raising major ethical dilemmas regarding participant selection. In this paper, we diagnose the source of this problem, arguing that the principle of fair subject selection is best understood as a bundle of four distinct sub-principles, each with normative force and each yielding distinct imperatives: (1) fair inclusion; (2) fair burden sharing; (3) fair opportunity; and (4) fair distribution of (...) third-party risks. We first map out these distinct sub-principles, and then identify the ways in which they yield conflicting imperatives for the design of inclusion and exclusion criteria, and the recruitment of participants. We then offer guidance for how decision makers should navigate these conflicting imperatives to ensure that participants are selected fairly. (shrink)

Resolving religious disagreements is difficult, for beliefs about religion tend to come with strong biases against other views and the people who hold them. Evidence can help, but there is no agreed-upon policy for weighting it, and moreover bias affects the content of our evidence itself. Another complicating factor is that some biases are reliable and others unreliable. What we need is an evidence-weighting policy geared toward negotiating the effects of bias. I consider three evidence-weighting policies in the philosophy of (...) religion and advocate one of them as the best for promoting the resolution of religious disagreements. (shrink)

Analytic metaphysics is in resurgence; there is renewed and vigorous interest in topics such as time, causation, persistence, parthood and possible worlds. We who share this interest often pay lip-service to the idea that metaphysics should be informed by modern science; some take this duty very seriously.2 But there is also a widespread suspicion that science cannot really contribute to metaphysics, and that scientific findings grossly underdetermine metaphysical claims. For some, this prompts the thought ‘so much the worse for metaphysics’; (...) others mutter ‘so much the worse for science’. (shrink)

As concerns about the negative health effects of unhealthy eating, overweight and obesity have increased, so too have policy efforts to promote healthy eating. Federal, state, and local governments have proposed and implemented a variety of healthy eating policies. Many of these policies are controversial, facing objections that range from the practical (e.g., the policy won’t succeed at improving people’s diets) to the ethical (e.g., the policy is paternalistic or inequitable). Especially controversial have been policies limiting the options offered in (...) the marketplace, limiting access to certain options, or providing disincentives for the purchase of certain options. Examples of such policies include proposed .. (shrink)

The purpose of this article is to investigate how cultural meanings associated with the left ventricular assist device inform acceptance and experience of this innovative technology when it is used as a destination therapy. We conducted open-ended, semistructured interviews with family caregivers and patients who had undergone LVAD-DT procedures at six U.S. hospitals. A grounded theory approach was used for the analysis. Thirty-nine patients and 42 caregivers participated. Participants described a sense of obligation to undergo the procedure because of its (...) promise for salvation. However, once the device was implanted, patients described being placed into a liminal state of being neither sick nor healthy, with no culturally scripted role. Consideration of end-of-life decisions was complicated by the uncertainties about how patients with LVADs die. Pre-implantation communications among patient, family, and clinicians should take into account the impact of the technology on meaning, identity, and patient experience. (shrink)

Where there is trust, there is also vulnerability, and vulnerability can be exploited. Epistemic trust is no exception. This chapter maps the phenomenon of the exploitation of epistemic trust. I start with a discussion of how trust in general can be exploited; a key observation is that trust incurs vulnerabilities not just for the party doing the trusting, but also for the trustee (after all, trust can be burdensome), so either party can exploit the other. I apply these considerations to (...) epistemic trust, specifically in testimonial relationships. There, we standardly think of a hearer trusting a speaker. But we miss an important aspect of this relationship unless we consider too that the speaker standardly trusts the hearer. Given this mutual trust, and given that both trustees and trusters can exploit each other, we have four possibilities for exploitation in epistemic-trust relationships: a speaker exploiting a hearer (a) by accepting his trust or (b) by imposing her trust on him, and a hearer exploiting a speaker (c) by accepting her trust or (d) by imposing his trust on her. One result is that you do not need to betray someone to exploit him – you can exploit him just as easily by doing what he trusts you for. (shrink)

Biomedicine has opened up new possibilities for parenthood. Once resigned to remaining childless or pursuing adoption, infertile couples can now pursue options such as gamete donation, in-vitro fer...

Findings from the cognitive sciences suggest that the cognitive mechanisms responsible for some memory errors are adaptive, bringing benefits to the organism. In this paper we argue that the same cognitive mechanisms also bring a suite of significant epistemic benefits, increasing the chance of an agent obtaining epistemic goods like true belief and knowledge. This result provides a significant challenge to the folk conception of memory beliefs that are false, according to which they are a sign of cognitive frailty, indicating (...) that a person is less reliable than others or their former self. Evidence of memory errors can undermine a person’s view of themselves as a competent epistemic agent, but we show that false memory beliefs can be the result of the ordinary operation of cognitive mechanisms found across the species, which bring substantial epistemic benefits. This challenge to the folk conception is not adequately captured by existing epistemological theories. However, it can be captured by the notion of epistemic innocence, which has previously been deployed to highlight how beliefs which have epistemic costs can also bring significant epistemic benefits. We therefore argue that the notion of epistemic innocence should be expanded so that it applies not just to beliefs but also to cognitive mechanisms. (shrink)

Faith is often regarded as having a fraught relationship with evidence. Lara Buchak even argues that it entails foregoing evidence, at least when this evidence would influence your decision to act on the proposition in which you have faith. I present a counterexample inspired by the book of Job, in which seeking evidence for the sake of deciding whether to worship God is not only compatible with faith, but is in fact an expression of great faith. One might still think (...) that foregoing evidence may make faith more praiseworthy than otherwise. But I argue against this claim too, once more drawing on Job. A faith that expresses itself by a search for evidence can be more praiseworthy than a faith that sits passively in the face of epistemic adversity. (shrink)

Religious communities often discourage disagreement with religious authorities, on the grounds that allowing it would be epistemically detrimental. I argue that this attitude is mistaken, because any social position in a community—including religious authority—comes with epistemic advantages as well as epistemic limitations. I argue that religious communities stand to benefit epistemically by engaging in disagreement with people occupying other social positions. I focus on those at the community’s margins and argue that religious marginalization is apt to yield religiously important insights; (...) so their disagreement with religious authorities should be encouraged. (shrink)

The American Society for Bioethics and Humanities has created a quality attestation process for clinical ethics consultants; the pilot phase of reviewing portfolios has begun. One aspect of the QA process which is particularly challenging is assessing the interpersonal skills of individual clinical ethics consultants. We propose that using case simulation to evaluate clinical ethics consultants is an approach that can meet this need provided clear standards for assessment are identified. To this end, we developed the Assessing Clinical Ethics Skills (...) tool, which identifies and specifies specific behaviors that a clinical ethics consultant should demonstrate in an ethics case simulation. The aim is for the clinical ethics consultant or student to use a videotaped case simulation, along with the ACES tool scored by a trained rater, to demonstrate their competence as part of their QA portfolio. The development and piloting of the tool is described. (shrink)

I give an overview of the trust literature and then of six central issues concerning epistemic trust. The survey of trust zeroes in on the kinds of expectations that trust involves, trust’s characteristic psychology, and what makes trust rational. The discussion of epistemic trust focuses on its role in testimony, the epistemic goods that we trust for, the significance of epistemic trust in contrast to reliance, what makes epistemic trust rational, and epistemic self-trust.

In this chapter I explore how epistemic injustice (as discussed by Miranda Fricker) can arise in connection with knowledge how. I attempt to bypass the question of whether knowledge how is a type of propositional knowledge, and instead focus on some distinctive ways in which knowledge how is sometimes sought, identified or ignored.

BackgroundNational Ethics Committees (NECs) offer important oversight and guidance functions and facilitate public debate on bioethical issues. In an increasingly globalized world where technological advances, multi-national research collaborations, and pandemics are creating ethical dilemmas that transcend national borders, coordination and the joining of efforts among NECs are key. The purpose of this study is to take stock of the current NEC landscape, their varying roles and missions, and the range of bioethical topics on which they deliberated since their inception.MethodsData on (...) the availability, functions, and ethical deliberations (publications) of NECs globally were gathered through a systematic search of NEC websites and through contacts known to the authors. The search was conducted in English, French, and Spanish. The data abstraction was done in Excel and included the NEC’s country, region, functions, and deliberations on bioethical issues. Deliberation topics were classified into thematic categories through an iterative process of regrouping to arrive at the main set of themes.Results124 NECs in 100 countries were identified. 44% of the NECs are in Europe and 47% are in high-income countries. Out of the 1108 retrieved publications, 40% were on bioethics in the context of research, followed by the clinic (28%) and public health issues (22%). The top five topics of these publications were: research ethics (124; 9%), genetics and genomics (62; 6%), organ transplantation (58; 5%), assisted reproductive technology (49; 4%), and end of life (36; 3%).ConclusionOur study makes an important contribution to understanding the current interests and functions of NECs and the range of their bioethics deliberations. By making the data publicly available through this publication, it allows users to conduct tailored analyses and queries based on their interests, and to seek and strengthen collaboration and exchange. It also makes the case for the fruitfulness of developing and maintaining a global repository of current and new deliberations to more effectively advance this field for the greater good of humanity, research, and public health. (shrink)

A novel introduction to Jean-Paul Sartre’s existentialist phenomenology. Draws parallels between Sartre’s work and the work of Wittgenstein Stresses continuities rather than conflict between Sartre and Merleau-Ponty, and between Sartre and post-structuralist/post-modernist thinkers, thus corroborating ‘new Sartre’ readings Exhibits the influence of Gestalt psychology in Sartre’s descriptions of the life-world Forms part of the _Blackwell Great Minds_ series, which outlines the views of the great western thinkers and captures the relevance of these figures to the way we think and live (...) today. (shrink)

The authors of this article are previous or current members of the Clinical Ethics Consultation Affairs (CECA) Committee, a standing committee of the American Society for Bioethics and Humanities (ASBH). The committee is composed of seasoned healthcare ethics consultants (HCECs), and it is charged with developing and disseminating education materials for HCECs and ethics committees. The purpose of this article is to describe the educational research and development processes behind our teaching materials, which culminated in a case studies book called (...) A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care (hereafter, the Study Guide). In this article, we also enumerate how the Study Guide could be used in teaching and learning, and we identify areas that are ripe for future work. (shrink)

Several prominent debates in biology, such as those surrounding adaptationism, group selection, and punctuated equilibrium, have focused on disagreements about the relative importance of a cause in producing a phenomenon of interest. Some philosophers, such as John Beatty have expressed scepticism about the scientific value of engaging in these controversies, and Karen Kovaka has suggested that their value might be limited. In this paper, I challenge that scepticism by giving a novel analysis of relative significance controversies, showing that there are (...) three forms they can take. I argue that these controversies can have significant epistemic upshots, in that they help scientists form predictions about new instances of the phenomenon of interest. Finally, using two historical examples, I show how engaging in these controversies can improve our understanding of causal relationships. (shrink)

Ciudad Cayalá in Guatemala brands itself as the country’s first private city. I turn to Hannah Arendt to show how and why Cayalá does not and cannot provide the space of appearance she argues is needed to support the possibility of political action. I show how Arendt provides two apparently distinct phenomenological accounts in The Human Condition—one historically-oriented and the other politically-oriented—that articulate how Cayalá fails in its aspiration to privatize the political. Yet the apparent divergence between her accounts raises (...) concern about her relevance for liberatory feminist projects. To demonstrate how and why Arendt’s political phenomenology is aligned with certain feminist aims, I also generate a Cayaláian reading of Arendt to demonstrate the coherence of her two phenomenological accounts through interpreting her thinking by way of Cayalá’s architecture. This article enacts a dialogue between Arendt and Cayalá, mediated by feminist and architectural theory, concerning why efforts toward the privatization of cities will fail. (shrink)

In the March 2010 edition of Mayo Clinic Proceedings, Drs. Rose and Curry declared that resident physicians have an ethical duty to reduce error during periods of fatigue. Problematically, however, they argued this means ingesting a stimulant for performance enhancement and sleep avoidance during a shift when a resident physician is experiencing fatigue as the more ethical choice than forgoing ingesting a stimulant. Rather than accepting enhancement as an unstoppable technological imperative, this article will examine the underlying motivations for enhancement (...) embedded in our culture and the corresponding legal framework relating to stimulant drugs. Although our society seems to be engaged in a pharmacological arms race of efficiency, competition, and self “betterment,” the FDA has not approved stimulant drugs such as modafinil for PESA. As a result, the off-label use of modafinil for PESA means these individuals are part of a large-scale experiment that poses serious immediate and long-term side effects to the individual user as well as society. (shrink)

Through a reading of Heidegger's interpretation of Aristotle on the pathe, this paper develops an account of what it is for finding or attunement to be authentic or owned.

Personal narratives can let us in on aspects of reality which we have not experienced for ourselves, and are thus important sources for philosophical reflection. Yet a venerable tradition in mainstream philosophy has little room for arguments which rely on personal narrative, on the grounds that narratives are particular and testimonial, whereas philosophical arguments should be systematic and transparent. I argue that narrative arguments are an important form of philosophical argument. Their testimonial aspects witness to novel facets of reality, but (...) their argumentative aspects help us to understand those facets for ourselves. My argument takes the form of a case study of the exemplary narrative argument penned by Rachel Moran, a former prostitute who uses her experiences to argue that prostitution amounts to sexual abuse. We’ll see that narrative arguments can enjoy expository Advantages over analytic ones. (shrink)

Some religious communities argue that public policy is best decided by their own members, on the grounds that collaborating with those reasoning from secular or “worldly” perspectives will only foment error about how society should be run. But I argue that epistemology instead recommends fostering disagreement among a plurality of religious and secular worldviews. Inter-worldview disagreement over public policy can challenge our unquestioned assumptions, deliver evidence we would likely have missed, and expose us to new epistemic alternatives; when done respectfully, (...) it can also combat epistemically problematic biases and groupthink. I address two objections that members of a politically active religious community might raise: one that inter-worldview disagreement about public policy is not needed because one’s own beliefs are already true, and another that it is not needed because one’s own beliefforming processes are divinely guided. (shrink)

Should religious believers proportion their religious beliefs to their evidence? They should: Religious faith is better, ceteris paribus, when the beliefs accompanying it are evidence-proportioned. I offer two philosophical arguments and a biblical argument. The philosophical arguments conclude that love and trust, two attitudes belonging to faith, are better, ceteris paribus, when accompanied by evidence-proportioned belief, and that so too is the faith in question. The biblical argument concludes that beliefs associated with faith, portrayed in the Hebrew Bible and the (...) New Testament, are typically, and normatively, exhorted on the basis of evidence. I hope to convince religious believers and nonbelievers alike that religious beliefs should be evidence-proportioned. (shrink)

Addressing religion and feminism on a global scale, this unprecedented book contains a nuanced and fine-tuned treatment of seven of the world's religions from a feminist perspective by leading women scholars. The fact that these authors share a dual but undivided commitment both to themselves as women and to their traditions as adherents imparts to their voices a prophetic quality, and if Mahatma Gandhi is to be believed, even scriptural value.

In July 2018, the Nuffield Council on Bioethics released the report Genome editing and human reproduction: Social and ethical issues, concluding that human germline modification of human embryos for implantation is not ‘morally unacceptable in itself’ and could be ethically permissible in certain circumstances once the risks of adverse outcomes have been assessed and the procedure appears ‘reasonably safe’. The Nuffield Council set forth two main principles governing anticipated uses and envisions applications that may include health enhancements as a public (...) health measure. This essay provides a critique of three aspects in the Nuffield Council’s Report: its presumption of therapeutic efficacy, its inflation of parental rights to create a certain type of child, and its reliance on a specially commissioned report that appears to distort key definitions in international law. (shrink)

We welcome Ballantyne & Schaefer’s discussion of the issues concerning consent and use of health data for research. In response to their acknowledgement of the need for public debate and discussion, we provide evidence from our own public consultation on this topic.

I discuss the three distinctions “absolute and relative”, “true and apparent”, and “mathematical and common”, for the specific case of time in Newton’s Principia. I argue that all three distinctions are needed for the project of the Principia and can be understood within the context of that project without appeal to Newton’s wider metaphysical and theological commitments. I argue that, within the context of the Principia, the three claims that time is absolute rather than relative, true rather than apparent, and (...) mathematical rather than common, are to be evaluated with respect to the needs of, and relative to the success of, the project of the Principia. I claim that Newton is thereby offering a new, and empirical, philosophy of time. (shrink)

The main goal of part 1 is to challenge the widely held view that Poincaré orders the sciences in a hierarchy of dependence, such that all others presuppose arithmetic. Commentators have suggested that the intuition that grounds the use of induction in arithmetic also underlies the conception of a continuum, that the consistency of geometrical axioms must be proved through arithmetical induction, and that arithmetical induction licenses the supposition that certain operations form a group. I criticize each of these readings. (...) More fully, I argue that the justification Poincaré offers for the use of the group notion in geometry appears to extend to set-theoretic notions that would suffice to put arithmetic on a logical foundation, thus undermining his own case for the necessity of intuition in arithmetic. In part 2, I offer an interpretation of intuition’s role on which it justifies the use of group-theoretic, but not set-theoretic, notions. (shrink)

Moral pluralism is the norm in contemporary society. Even the best philosophical arguments rarely persuade moral opponents who differ at a foundational level. This has been vividly illustrated in contemporary debates in bioethics surrounding contentious issues such as abortion and euthanasia. It is readily apparent that bioethics discourse lacks an empirical explanation for the broad differences about various topics in bioethics and health policy. In recent years, social and cognitive psychology has generated novel approaches for defining basic differences in moral (...) intuitions generally. We propose that if empirical research using social intuitionist theory explains why people disagree with one another over moral issues, then the results of such research might help people debate their moral differences in a more constructive and civil manner. We illustrate the utility of social intuitionism with data from a national physician survey. (shrink)

Although a second-person neuroscience has high ecological validity, the extent to which a second- versus third-person neuroscience approach fundamentally alters neural patterns of activation requires more careful investigation. Nonetheless, we are hopeful that this new avenue will prove fruitful in significantly advancing our understanding of typical and atypical social cognition.

The success of business firms and other organizations relies on the trustworthiness of reports and other documents prepared by management accountants. This study examines the personal ethical values and ethical value types of management accountants. Data were obtained from a survey of members of the Institute of Management Accountants (IMA). The survey, composed of the Rokeach Values Survey and demographic questions, was delivered by the IMA Research Lab to membership samples. Importantly, the results indicated that the highest-ranked values were consistent (...) with values included in the IMA’s Statement of Ethical Professional Practice. That management accountants hold high ethical values better enables them to provide reliable and meaningful work to business firms and other organizations. Another important finding is that older management accountants are more concerned with moral values than their younger colleagues. This finding has notable implications for the future of the profession. (shrink)

Kant’s Mathematical World (KMW) is a strikingly original, richly detailed account of Kant’s philosophy of mathematics as a reckoning with the long-held understa.

Initial writings and moral distress research focused on nursing, however, it soon became clear that others in healthcare also experienced moral distress. The narratives discussed in this commentary show this variation not only in the authors’ multiplicity of disciplines (psychologists, nurses, an ethicist, and physicians), but also in their workplace environments (prisons, hospitals, and homecare) and their roles, from students to well accomplished professionals. In other words no one is immune. By looking through the lens of time the author shows (...) that the experience of moral distress is not isolated in time, but in fact continues to be lived over time. Other important themes drawn out here are: isolation, powerlessness, failure, regret, undermined potential and the way feelings are experienced. It is also noted that despite the pain and angst, there is a sense of gratitude in these stories. They touch our own woundedness, remind us of our own resiliency and give us hope for the redemptive power of the experience and reflection. (shrink)