Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender (...) diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

We respond to a Letter to the Editor regarding "Principlism and contemporary ethical considerations for providers of transgender health care." We address criticisms by Castle & Klein (2024) of blatant fatphobia related to the ethical elements concerning BMI restrictions for gender-affirming surgery. Our response corrects several mischaracterizations of the article and clarifies our position. My co-authors and I remain focused on advocating for patient-centered, ethically sound, evidence-based, and equitable healthcare policies.

Feminist analyses of gender concepts must avoid the inclusion problem, the fault of marginalizing or excluding some prima facie women. Sally Haslanger’s ‘ameliorative’ analysis of gender concepts seeks to do so by defining woman by reference to subordination. I argue that Haslanger’s analysis problematically marginalizes trans women, thereby failing to avoid the inclusion problem. I propose an improved ameliorative analysis that ensures the inclusion of trans women. This analysis yields ‘twin’ target concepts of woman, one concerning gender as class and (...) the other concerning gender as identity, both of which I hold to be equally necessary for feminist aims. (shrink)

In this paper, I argue that there is a notion of 'counterfactual success' which stands to knowledge how as true belief stands to propositional knowledge. (I attempt to avoid the question of whether knowledge how is a type of propositional knowledge.).

You can trust your friends. You should trust your friends. Not all of your friends all of the time: you can reasonably trust different friends to different degrees, and in different domains. Still, we often trust our friends, and it is often reasonable to do so. Why is this? In this paper I explore how and whether friendship gives us reasons to trust our friends, reasons which may outstrip or conflict with our epistemic reasons. In the final section, I will (...) sketch some related questions concerning trust based on the trustee’s race, gender, or other social identity. (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)

When William of Ockham lectured on Lombard's "Sentences" in 1317-1319, he articulated a new theory of knowledge.

If you love someone, is it good to believe better of her than epistemic norms allow? The partiality view says that it is: love, on this view, issues norms of belief that clash with epistemic norms. The partiality view is supposedly supported by an analogy between beliefs and actions, by the phenomenology of love, and by the idea that love commits us to the loved one’s good character. I argue that the partiality view is false, and defend what I call (...) the epistemic view. On the epistemic view, love also issues norms of belief. But these say simply that you should adhere to epistemic norms in forming and maintaining beliefs about loved ones. I offer two arguments for the epistemic view. The first appeals to the emotional responses of love, which, when sensitive to what the loved one is really like, can make love great and be morally transformative. The second is a new argument for why caring for a loved one requires true beliefs about him. We see that there may be some boundaries, such as stuffy traditions, that love is right to defy, but that epistemic boundaries are not among them. (shrink)

In our interactions with science, we are often vulnerable; we do not have complete control of the situation and there is a risk that we, or those we love, might be harmed. This is not an emotionall...

How should we respond to extremist views that we know are false? This paper proposes that we should be intellectually humble, but not open-minded. We should own our intellectual limitations, but be unwilling to revise our beliefs in the falsity of the extremist views. The opening section makes a case for distinguishing the concept of intellectual humility from the concept of open-mindedness, arguing that open-mindedness requires both a willingness to revise extant beliefs and other-oriented engagement, whereas intellectual humility requires neither. (...) Building on virtue-consequentialism, the second section makes a start on arguing that intellectually virtuous people of a particular sort—people with ‘effects-virtues’—would be intellectually humble, but not open-minded, in responding to extremist views they knew were false. We suggest that while intellectual humility and open-mindedness often travel together, this is a place where they come apart. (shrink)

We start with an observation about implicit quantifier domain restriction: certain implicit restrictions (e.g., restricting objects by location and time) appear to be more natural and widely available than others (e.g., restricting objects by color, aesthetic, or historical properties). Our aim is to explain why this is. That is, we aim to explain why some implicit domain restriction possibilities are available by default. We argue that, regardless of their other explanatory virtues, extant pragmatic and metasemantic frameworks leave this question unanswered. (...) We then motivate a partially nativist account of domain restriction that involves a minimal view of joint planning around broad shared goals about navigating and influencing our environments augmented with cognitive heuristics that facilitate these. Finally, we sketch how the view can be extended to account for the ways non-default restriction possibilities become available when conversationalists have shared idiosyncratic goals. (shrink)

As the field of clinical ethics consultation sets standards and moves forward with the Quality Attestation process, questions should be raised about what ethical issues really do arise in practice. There is limited data on the type and number of ethics consultations conducted across different settings. At Loyola University Medical Center, we conducted a retrospective review of our ethics consultations from 2008 through 2013. One hundred fifty-six cases met the eligibility criteria. We analyzed demographic data on these patients and conducted (...) a content analysis of the ethics consultation write-ups coding both the frequency of ethical issues and most significant, or key, ethical issue per case. Patients for whom ethics consultation was requested were typically male, white, between 50 and 69 years old, of non-Hispanic origin, and of Roman Catholic faith. Nearly half were in the intensive care unit and 44.2 % died in the hospital. The most frequent broad ethical categories were decision-making, goals of care/treatment, and end-of-life. More specifically, capacity, patient’s wishes/autonomy, and surrogate decision maker were the most frequent particular ethical issues. The most common key ethical issues were withdrawing/withholding treatment, patient wishes/autonomy, and capacity. Our findings provide additional data to inform the training of clinical ethics consultants regarding the ethical issues that arise in practice. A wider research agenda should be formed to collect and compare data across institutions to improve education and training in our field. (shrink)

In his 1763 Prize Essay, Kant is thought to endorse a version of formalism on which mathematical concepts need not apply to extramental objects. Against this reading, I argue that the Prize Essay has sufficient resources to explain how the objective reference of mathematical concepts is secured. This account of mathematical concepts’ objective reference employs material from Wolffian philosophy. On my reading, Kant's 1763 view still falls short of his Critical view in that it does not explain the universal, unconditional (...) applicability of mathematical concepts. (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)

In their article on the limited duty to reinterpret genetic variants, Watts and Newson argue that clinical labs are not morally obligated to conduct routine reinterpretation despite its potential clinical and personal value.1 We endorse the authors’ argument for a circumscribed duty to reclassify genomic variants in certain cases, including to promote diagnostic equity for racial and ethnic minority populations that have been historically excluded from and exploited by genomic research and medicine. However, given the history and resilience of scientific (...) racism, the use of socially constructed racial and ethnic categories to enhance diagnostic equity raises several ethical and practical challenges. In the short term, using socially constructed racial and ethnic categories to identify patients for variant reclassification is a practical approach for addressing concerns of diagnostic equity. In contrast, diagnostic accuracy depends on patients’ genetic similarity to reference genomes, rather than their socially determined race or ethnicity.2 Thus, in the long term, securing both diagnostic equity and diagnostic accuracy through targeted variant reclassification will require a shift away from relying on race and ethnicity and towards assessing genetic similarity. Critically, the identification of patients for genomic variant reclassification using socially constructed race or ethnicity runs the risk of perpetuating the harmful …. (shrink)

In his Material Beings, Peter van Inwagen distinguishes two questions about parthood. What are the conditions necessary and sufficient for some things jointly to compose a whole? What are the conditions necessary and sufficient for a thing to have proper parts? The first of these, the Special Composition Question (SCQ), has been widely discussed, and David Lewis has argued that an important constraint on any answer to the SCQ is that it should not permit borderline cases of composition. This is (...) a far-reaching claim, since many plausible-seeming accounts of composition do permit borderline cases. Ned Markosian has recently directed our attention to the second, the neglected Inverse Special Composition Question (ISCQ). I will argue that those who accept Lewis’s constraint on answers to the SCQ should accept an analogous constraint on answers to the ISCQ, and I will discuss the effects of such a constraint. (shrink)

In his paper in the same volume, Sider argues that, of maximalism and quantifier variance, the latter promises to let us make better sense of neo-Fregeanism. I argue that neo-Fregeans should, and seemingly do, reject quantifier variance. If they must choose between these two options, they should choose maximalism.

European Journal of Philosophy, Volume 29, Issue 4, Page 712-730, December 2021.

Background Moral resilience is the integrity and emotional strength to remain buoyant and achieve moral growth amid distressing situations. Evidence is still emerging on how to best cultivate moral resilience. Few studies have examined the predictive relationship of workplace well-being and of organizational factors with moral resilience. Research aims The aims are to examine associations of workplace well-being (i.e., compassion satisfaction, burnout, and secondary traumatic stress) and moral resilience, and to examine associations of workplace factors (i.e., authentic leadership and perceived (...) congruence of organizational mission and behaviors) and moral resilience. Research design This study uses a cross-sectional design. Participants and research context Nurses practicing in a hospital in the United States were surveyed using validated instruments (N = 147). Individual factors were measured using demographics and the Professional Quality of Life Scale. Organizational factors were measured using the Authentic Leadership Questionnaire and a single item measuring organizational mission/behavior congruence. Moral resilience was measured using the Rushton Moral Resilience Scale. Ethical considerations The study was approved by an institutional review board. Findings Resilience was noted to have significant small correlations with burnout, secondary traumatic stress, compassion satisfaction, and organizational mission/behavior congruence. Burnout and secondary traumatic stress predicted less resilience, whereas compassion satisfaction and perceived congruence between organizational mission and behaviors predicted higher resilience. Discussion Burnout and secondary traumatic stress, increasingly experienced by nurses and other health professionals, have negative effects on moral resilience. Compassion satisfaction can increase resilience, which is especially important in nursing. Organizational practices promoting integrity and confidence can have positive effects on resilience. Conclusions Continued work to confront workplace well-being issues, especially burnout, is needed as a way of increasing moral resilience. Studies of organizational and work environment factors to bolster resilience are likewise needed to assist organizational leaders in devising the best strategies. (shrink)

This paper argues for an interpretation of what Heidegger means by 'angst' in Being and Time that begins from the methodological role angst is supposed to play in Division I as that which disrupts falling. It argues that angst is a distinctive kind of ontological insight.

Gatekeeping, or determining membership of your group, is crucial to science: the moniker ‘scientific’ is a stamp of epistemic quality or even authority. But gatekeeping in science is fraught with dangers. Gatekeepers must exclude bad science, science fraud and pseudoscience, while including the disagreeing viewpoints on which science thrives. This is a difficult tightrope, not least because gatekeeping is a human matter and can be influenced by biases such as groupthink. After spelling out these general tensions around gatekeeping in science, (...) we shed light on them with a case study from psychology. This concerns whether academic psychologists rightly or wrongly classify the applied-psychology framework of NLP (‘neuro-linguistic programming’) as unscientific and even pseudoscientific. This example of gatekeeping is particularly instructive because both the NLP community and the psychology community, we argue, make legitimate but also illegitimate moves. This case gives rise to several general insights about gatekeeping in science more generally. (shrink)

Question: Do clinicians providing abortion practicing in states that restrict abortion experience more moral distress than those practicing in states that protect abortion? -/- Findings: In this national, purposive survey study of 310 clinicians providing abortion, moral distress was elevated among all clinicians, with those practicing in restrictive states reporting higher levels of moral distress compared with those practicing in protective states. -/- Meaning: The findings suggest that structural changes addressing bans on necessary health care, such as federal protection for (...) abortion, are needed at institutional, state, and federal policy levels to address clinician moral distress. (shrink)

This paper focuses on how experiences of trauma can lead to generalized fear of people, objects and places that are similar or contextually or conceptually related to those that produced the initial fear, causing epistemic, affective, and practical harms to those who are unduly feared and those who are intimates of the victim of trauma. We argue that cases of fear generalization that bring harm to other people constitute examples of injustice closely akin to testimonial injustice, specifically, mnemonic injustice. Mnemonic (...) injustice is a label that has been introduced to capture how injustice can occur via the operation of human memory systems when stereotypes shape what is remembered. Here we argue that injustices can also occur via memory systems when trauma leads to a generalized fear. We also argue that this calls for a reformulation of the notion of mnemonic injustice. (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)

As a forum for philosophical discourse of religious studies as related to the world's women, the "Annual Review of Women in World Religions" fails. The first three issues display an unfortunately limited approach. Certain articles are promising, but editorial intellectual constraints appear to have circumscribed the philosophical latitude provided to contributors. In spite of the potential of the journal's topic area, it is doubtful it will soon succeed in emerging as a publication with adequate inclusionary liberality and ideal discursive freedom.

We show that for random bit strings, Up, with probability, image, the first order quantifier depth D) needed to distinguish non-isomorphic structures is Θ, with high probability. Further, we show that, with high probability, for random ordered graphs, G≤,p with edge probability image, D)=Θ, contrasting with the results for random graphs, Gp, given by Kim et al. [J.H. Kim, O. Pikhurko, J. Spencer, O. Verbitsky, How complex are random graphs in first order logic? Random Structures and Algorithms 26 119–145] of (...) D)=log1/pn+O. (shrink)

Critical Notice on Organizations as Wrongdoers By Stephanie Collins Oxford University Press, 2023. -/- Extract: What, if any, role does metaphysics have to play in addressing moral questions? When answering questions about moral responsibility, many theories rely on answers to questions about the nature of agency and agents, the persistence of persons and the existence and nature of free will. In recent work in social ontology, philosophers have argued for views of social categories or identities that take ethical and social–political (...) desiderata into consideration in several ways. Some argue for views of gender identities that depend on epistemic and ethical considerations (Bettcher, 2009). Others develop views of gender categories in ways they take to be metaphysically realist, tracking robust explanatory patterns in the world. For instance, Barnes (2017) argues for this interpretation of Haslanger’s views of racial and gender categories. Others argue that injustice and oppression are reflected in the nature of social categories. For instance, while it ought not to be this way, some gender categories are, for instance, trans-exclusionary (Ásta 2018). Indeed, one might even argue that social categories can involve a distinctively metaphysical form of oppression (Jenkins 2020, 2023). It is clear that many philosophers argue in ways that draw close connections between metaphysical and moral theorizing. ... (shrink)

Are animals not ours to use? According to proponents of veganism such as Gary Francione, any and all use of animals by humans is exploitative and wrong. It is wrong because animals have intrinsic worth and humans' use of animals fails to respect that worth. Contra Francione, I argue that that there are conditions under which it may be morally appropriate to collect, consume, sell, or otherwise use animal products. Francione is mistaken in his belief that assigning intrinsic worth to (...) a being is impossible if said being is also conceived as a resource. Using and (non-instrumental) valuing are not mutually exclusive; if they were, many if not most human relationships would be deemed morally unacceptable. Through a series of thought experiments involving intra-human relationships, I suggest that moral condemnation of relationships within which a less dependent party regularly takes from a more dependent party is indefensible. In fact, relationships of use between asymmetrically dependent parties are essential to the functioning of cooperative society, and are therefore desirable. My aims with this article are to convince readers of the need to reject principled veganism, and to garner support for new philosophical accounts of morally appropriate human-nonhuman animal relationships. (shrink)

This paper will examine universality spectra for relational theories which cannot be described in first-order logic. We will give a method using functors to show that two types of structures have the same universality spectrum. A combination of methods will be used to show universality results for certain ordered structures and graphs. In some cases, a universal spectrum under GCH will be obtained. Since the theories are not first-order, the classic model theory result under GCH does not hold.

The timing of the origin of flowering plants (Angiosperm) is hotly debated. It has been suggested that the disagreement between the fossil record of angiosperm origin strongly conflicts with the origin estimates generated by molecular clocks. I argue that this conflict reveals lessons about whether or under what conditions scientific disagreement is likely to bear fruit. Specifically, I point to issues of evidence quality and social epistemic structures which deserve more attention in understanding the productivity of disagreement.

Research has consistently revealed gender differences in attitudes toward science and technology. One explanation is that women are more personally affected by particular technologies, so they consider them differently. However, not all women universally experience biomedical technologies. We use the concept of technological salience to address how differences in subjective implications of a technology might explain differences in women’s attitudes toward biotechnology. In a sample of U.S. women from the National Survey of Fertility Barriers, we examine how women with and (...) without a biomedical barrier to fertility evaluate biotechnology for infertility, which, we argue, reflects differences in technological salience. For women with a biomedical barrier, various experiences, beliefs, and values impacted their attitudes; yet, most of these did not affect attitudes if women had not experienced a fertility barrier. Results suggest that technological salience contextualizes women’s attitudes toward these biotechnologies and may also have broader implications for other biotechnologies. (shrink)

1Department of Moral Philosophy, University of St Andrews, Fife KY16 9AL, Scotland, UKTolstoy on Aesthetics: What is Art? H.O. Mounce Aldershot, UK Ashgate 2001 v + 115 Hardback£35.00, $59.95.

https://plato.stanford.edu/entries/digital-art/.

The 2015 judgment of the Namibia Supreme Court in Government of the Republic of Namibia v LM and Others set an important precedent on informed consent in a case involving the coercive sterilisation of HIV-positive women. This article analyses the reasoning and factual narratives of the judgment by applying Neil Manson and Onora O’Neill’s approach to informed consent as a communicative process. This is done in an effort to understand the practical import of the judgment in the particular context of (...) resource constrained public healthcare facilities through which many women in southern Africa access reproductive healthcare. While the judgment affirms certain established tenets in informed consent to surgical procedures, aspects of the reasoning in context demand more particularised applications of what it means for a patient to have capacity and to be informed, and to appropriately accommodate the disruptive role of power dynamics in the communicative process. (shrink)

This book presents an interpretive analysis of the major themes and purpose of Alexis de Tocqueville’s and Gustave de Beaumont’s first work, On the Penitentiary System, thereby offering new insights into Tocqueville as a moderate liberal statesman. The book explores Tocqueville’s thinking on penitentiaries as the best possible solution to recidivism, his approach to colonial imperialism, and his arguments on moral reformation of prisoners through a close reading of Tocqueville’s first published text. The unifying political concept of all three discussions (...) is Tocqueville’s underlying concern to pursue moderation between institutional and imaginative extremes in order to maintain liberal values. In both thinking moderately and advocating for moderate political action, Tocqueville’s On the Penitentiary System renews an emphasis on the importance of civic engagement and the balance between philosophy and praxis. (shrink)

Individuals with substance use disorders exhibit risk-taking behaviors, potentially leading to negative consequences and difficulty maintaining recovery. Non-invasive brain stimulation techniques such as transcranial direct current stimulation have yielded mixed effects on risk-taking among healthy controls. Given the importance of risk-taking behaviors among substance-using samples, this study aimed to examine the effects of tDCS on risk-taking among a sample of adults using cannabis. Using a double-blind design, 27 cannabis users [M age = 32.48, 41% female] were randomized, receiving one session (...) of active or sham tDCS over the bilateral dorsolateral prefrontal cortex. Stimulation parameters closely followed prior studies with anodal right dlPFC and cathodal left dlPFC stimulation. Risk-taking—assessed via a modified Cambridge Gambling Task—was measured before and during tDCS. Delay and probability discounting tasks were assessed before and after stimulation. No significant effects of stimulation on risk-taking behavior were found. However, participants chose the less risky option ∼86% of the trials before stimulation which potentially contributed to ceiling effects. These results contradict one prior study showing increased risk-taking among cannabis users following tDCS. There was a significant increase in delay discounting of a $1000 delayed reward during stimulation for the sham group only, but no significant effects for probability discounting. The current study adds to conflicting and inconclusive literature on tDCS and cognition among substance-using samples. In conclusion, results suggest the ineffectiveness of single session dlPFC tDCS using an established stimulation protocol on risk-taking, although ceiling effects at baseline may have also prevented behavior change following tDCS. (shrink)

The ancient Greek philosopher and teacher Aristotle was the founder of the Lyceum, a school in Athens dedicated to the study of nature and philosophical inquiry for over a hundred years. In opposition to his own teacher, Plato, Aristotle developed a metaphysical and ethical theory based on the view that human beings are embodied creatures, not merely thinking things. In doing so, he clarified and expanded the concept of virtue, developing a theory of virtue that has impacted how we think (...) about mental states, states of wellbeing, and states of moral character. In Book II of his Nicomachean Ethics, Aristotle explains how we learn good (or bad) habits through experience, education, and training. Pleasure and pain provide starting points for us, because they help orient us toward the good, but eventually our primary motivation should be to do good because it is good. Excellent habits are those that cause us to react in neither excessive nor deficient ways to the things around us. Once we have the right motivation to do good because it is good, and once our habitual righteous action exemplifies our stable character, we are virtuous and thriving people. (shrink)