Culture, health, and medicine intersect in various ways—and not always without friction. This paper examines how liberal multicultural states ought to interact with diverse communities which hold different health-related or medical beliefs and practices. The debate is fierce within the fields of medicine and bioethics as to how traditional medicines ought to be regarded. What this debate often misses is the relationship that medical traditions have with cultural identity and the value that these traditions can have beyond the confines of (...) the clinical setting. This paper will attempt to bring some clarity to the discussion. In so doing, it will delve into some controversial areas: (1) the debate around whether liberal states ought to embrace multiculturalism, (2) the existence and nature of group-differentiated rights, (3) the question of whether healthcare systems ought to embrace medical pluralism, and (4) what this would entail for policymakers, clinicians, and patients. Ultimately, I argue that liberal democratic states with multicultural populations ought to recognize medical pluralism as a matter of respecting group-differentiated and individual human rights. (shrink)

While Russian political parties appear to be institutionalizing to some degree at the national level, they are surprisingly absent at the regional level. This is a result of the dynamics of Russia's dual economic and political transition. Regional elites prefer a “partial reform equilibrium” in political institutional development so that they can avoid widening the sphere of accountability for their decisions in order to protect the gains they have made in the early stage of the economic transition. Strong political institutions—like (...) competitive political parties that penetrate the periphery—would render transitional winners more broadly accountable to wider societal interests as well as to national political actors. The argument suggests that the territorial penetration and further institutionalization of Russia's party system are not necessarily inevitable. Under the conditions of dual, simultaneous economic and political transitions, elites may prefer an equilibrium of political underinstitutionalization to preserve their early winnings from the economic transition. (shrink)

Though we agree with their argument that language is shaped by domain-general learning processes, Christiansen & Chater (C&C) neglect to detail how the development of these processes shapes language change. We discuss a number of examples that show how developmental processes at multiple levels and timescales are critical to understanding the origin of domain-general mechanisms that shape language evolution.

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

As one of the preeminent philosophers of the twentieth century, W. V. Quine made groundbreaking contributions to the philosophy of science, mathematical logic, and the philosophy of language. This collection of essays examines Quine's views, particularly his holism and naturalism, for their value to feminist theorizing today. Some contributors to this volume see Quine as severely challenging basic tenets of the logico-empiricist tradition in the philosophy of science—the analytic/synthetic distinction, verificationism, foundationalism—and accept various of his positions as potential resources for (...) feminist critique. Other contributors regard Quine as an unrepentant empiricist and, unlike feminists who seek to use or extend his arguments, they interpret his positions as far less radical and more problematic. In particular, critics and advocates of Quine's arguments that the philosophy of science should be "naturalized"—understood and pursued as an enterprise continuous with the sciences proper—disagree deeply about whether such a naturalized philosophy is "philosophy enough." Central issues at stake in these disagreements reflect current questions of special interest to feminists and also bridge the analytic and postmodern traditions. They include questions about whether and how the philosophy of science, as a form of practice, is or can be normative as well as questions concerning the implications of Quine's philosophy of language for the transparency and stability of meaning. In representing feminist philosophy centrally engaged with the analytic tradition, this volume is important not only for what it contributes to the understanding of Quine and naturalized epistemology but also for what it accomplishes in working against restrictive conceptions of the place of feminism within the discipline. Aside from the editors, the contributors are Kathryn Pyne Addelson, Louise M. Antony, Richmond Campbell, Lorraine Code, Jane Duran, Maureen Linker, Phyllis Rooney, and Paul A. Roth. (shrink)

The upcoming U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization has the potential to eliminate or severely restrict access to legal abortion care in the United States. We a...

Background: The concept of moral distress has been the subject of nursing research for the past 30 years. Recently, there has been a call to move from developing an understanding of the concept to developing interventions to help ameliorate the experience. At the same time, the use of the term moral distress has been critiqued for a lack of clarity about the concepts that underpin the experience. Discussion: Some researchers suggest that a closer examination of how socio-political structures influence healthcare (...) delivery will move moral distress from being seen as located in the individual to an experience that is also located in broader healthcare structures. Informed by new thinking in relational ethics, we draw on research findings from neuroscience and attachment literature to examine the reciprocal relationship between structures and agents and frame the experience of moral distress. Conclusion: We posit moral distress as a form of relational trauma and subsequently point to the need to better understand how nurses as moral agents are influenced by—and influence—the complex socio-political structures they inhabit. In so doing, we identify this reciprocity as a framework for interventions. (shrink)

Imprecise definition of key terms in the “public participation” domain have hindered the conduct of good research and militated against the development and implementation of effective participation practices. In this article, we define key concepts in the domain: public communication, public consultation, and public participation. These concepts are differentiated according to the nature and flow of information between exercise sponsors and participants. According to such an information flow perspective, an exercise’s effectiveness may be ascertained by the efficiency with which full, (...) relevant information is elicited from all appropriate sources, transferred to all appropriate recipients, and combined to give an aggregate/consensual response. Key variables that may theoretically affect effectiveness—and on which engagement mechanisms differ—are identified and used to develop a typology of mechanisms. The resultant typology reveals four communication, six consultation, and four participation mechanism classes. Limitations to the typology are discussed, and future research needs identified. (shrink)

Feminism, Science, and the Philosophy of Science brings together original essays by both feminist and mainstream philosophers of science that examine issues at the intersections of feminism, science, and the philosophy of science. Contributors explore parallels and tensions between feminist approaches to science and other approaches in the philosophy of science and more general science studies. In so doing, they explore notions at the heart of the philosophy of science, including the nature of objectivity, truth, evidence, cognitive agency, scientific method, (...) and the relationship between science and values. (shrink)

“The Role of the Individual in Evolution” is a prescient yet neglected 1941 work by the 20th century’s most important paleontologist, George Gaylord Simpson. In a curious intermingling of explanation and critique, Simpson engages questions that would become increasingly fundamental in modern biological theory and philosophy. Did individuality, adaptation, and evolutionary causation reside at more than one level: the cell, the organism, the genetically coherent reproductive group, the social group, or some combination thereof? What was an individual, anyway? In this (...) introduction, we highlight two points in a wider historical context. First, recognizing the political context of Simpson’s writing profoundly deepens our understanding of the development of his science as the Modern Evolutionary Synthesis infused biology. Second, this story illuminates the emergence of debates around what would eventually come to be called multilevel selection theory. The organism-centered concept of biological individuality defended by Simpson is situated in relation to the then-emerging Synthesis, in which he was a renowned player, and also in relation to the views he opposed: the “metaphysical” ideas of paleontologists such as Henry Fairfield Osborn, who claimed that some evolutionary trends derived from potentialities already implanted in the germplasm; and the organicist ideas of Ralph W. Gerard and the Chicago School of ecologists, which he derided as all too congenial to totalitarianism. We find parallels between the ways that Simpson thought then about human individuality under totalitarianism and the way he thought about individuality in evolution; not that any causal relationship linked the two, but that commonalities of hierarchical structure exist between single entities and groups in both instances. We then trace the subsequent development of Simpson’s political and philosophical takes on the role of the individual in evolution through the 1960s and lightly sketch out the later fate of the organicist ideas of the Chicago School. Simpson’s paper, originally published in the Journal of the Washington Academy of Sciences, is available as supplementary material in the online version of this article, as part of the "Classics in Biological Theory" collection. (shrink)

This paper argues that moral thinking is an essential management capability which strengthens organizations and contributes to theirperformance in the marketplace. The paper explains what moral thinking is, and addresses the most common reasons for considering it inappropriate or irrelevant to managerial practice. The argument provides a compelling rationale for the corporate ethics initiatives undertaken in recent years.

The concept of public participation is one of growing interest in the UK and elsewhere, with a commensurate growth in mechanisms to enable this. The merits of participation, however, are difficult to ascertain, as there are relatively few cases in which the effectiveness of participation exercises have been studied in a structured manner. This seems to stem largely from uncertainty in the research community as to how to conduct evaluations. In this article, one agenda for conducting evaluation research that might (...) lead to the systematic acquisition of knowledge is presented. This agenda identifies the importance of defining effectiveness and of operationalizing one’s definition. The article includes analysis of the nature of past evaluations, discussion of potential difficulties in the enactment of the proposed agenda, and discussion of some potential solutions. (shrink)

Unrealistic optimism is a bias that leads people to believe, with respect to a specific event or hazard, that they are more likely to experience positive outcomes and/or less likely to experience negative outcomes than similar others. The phenomenon has been seen in a range of health-related contexts—including when prospective participants are presented with the risks and benefits of participating in a clinical trial. In order to test for the prevalence of unrealistic optimism among participants of early-phase oncology trials, we (...) conducted a survey with patients over 18 years of age who were enrolled in a phase I, phase I/II, or phase II clinical cancer trial in the New York City area between August 2008 and October 2009. Participants in our study were asked to compare their own chances of experiencing a range of risks and benefits related to the trial they were enrolled in with the chances of the other trial participants. We found a significant optimistic bias in their responses. Respondents tended to overestimate the benefits of the trial they were enrolled in and underestimate its risks. In addition, we found no significant relationship between respondents’ understanding of the trial’s purpose and how susceptible they were to unrealistic optimism. Our findings suggest that improving the consent process for oncology studies requires more than addressing deficits in understanding. (shrink)

The concept of “public participation” is currently one of great interest to researchers and policy makers. In response to a perceived need for greater public involvement in decision making and policy formation processes on the part of both policymakers and the general public, a variety of novel mechanisms have been developed, such as the consensus conference and citizens jury, to complement traditional mechanisms, such as the public meeting. However, the relative effectiveness of the various mechanisms is unclear, as efforts at (...) evaluation have been sparse. In this article, the authors describe an evaluation of a two-day “deliberative conference” on the topic of radiation dose assessment. The authors detail the evaluation framework that they adopt and describe the instruments that they have developed to determine the attainment of the evaluationcriteria stipulated in that framework. They then describe the participation exercise that they have evaluated. Finally, they apply the instruments to assess the effectiveness of the exercise, and discuss the results and their implications for the conduct of evaluations and the use of this particular participation mechanism. (shrink)

If people sometimes participate in research because of altruism—because they want to help in the search for treatments—should we revise our views about what kinds of experiments are ethical? If participants act out of altruism, we might let them accept greater risks than we would if they are motivated only by a desire for personal gain. But how can we know when participants are genuinely altruistic?

The allocation of vaccines and therapeutics for Covid‐19 obviously raises ethical questions, and physicians and ethicists have begun to address them. Writers have identified various criteria that should guide allocation decisions, but the criteria often conflict and need to be balanced against one another. This article proposes a model for thinking about how different considerations that are relevant to the distribution of vaccines and scarce treatments for Covid‐19 could be integrated into an allocation procedure. The model employs the construct of (...) a weighted lottery, which is a construct that has been employed in other contexts that involve the distribution of scarce resources. The article highlights the advantages of applying a weighted lottery to the Covid‐19 context and offers an illustration for how it might work in practice. The primary aim of the article is to articulate the structural features of a weighted lottery for this context and to bring out its advantages over other methods for allocating Covid‐19 medications. (shrink)

Recent years have witnessed a growing concern that terminally illpatients are needlessly suffering in the dying process. This has ledto demands that physicians become more attentive in the assessment ofsuffering and that they treat their patients as `whole persons.'' Forthe most part, these demands have not fallen on deaf ears. It is nowwidely accepted that the relief of suffering is one of the fundamentalgoals of medicine. Without question this is a positive development.However, while the importance of treating suffering has generally (...) beenacknowledged, insufficient attention has been paid to the question ofwhether different types of terminal suffering require differnt responsesfrom health care professionals. In this paper we introduce a distinctionbetween two types of suffering likely to be present at the end of life,and we argue that physicians must distinguish between these types if theyare to respond appropriately to the suffering of their terminally illpatients. After introducing this distinction and explaining its basis,we further argue that the distinction informs a (novel) principle ofproportionality, one that should guide physicians in balancing theircompeting obligations in responding to terminal suffering. As weexplain, this principle is justified by reference to the intereststerminally ill patients have in restoration, as well as in therelief of suffering, at the end of life. (shrink)

Applying the tools and methods of analytic philosophy, analytic feminism is an approach adopted in discussions of sexism, classism and racism. The Bloomsbury Companion to Analytic Feminism presents the first comprehensive reference resource to the nature, history and significance of this growing tradition and the forms of social discrimination widely covered in feminist writings. Through individual sections on metaphysics, epistemology, and value theory, a team of esteemed philosophers examine the relationship between analytic feminism and the main areas of philosophical reflection. (...) Their engaging and original contributions explore how analytic feminists define their concepts and use logic to support their claims. Each section provides concise overviews of the main debates in feminist literature within that particular area of research, as well as introductions to each of the chapters. Together with a glossary and an annotated bibliography, this companion features an overview of the basic tools used in reading analytic philosophy. The result is an in-depth and authoritative guide to understanding analytic feminist's characteristic methods. Table of contents List of Contributors Acknowledgments Editor's Preface Part 1: Introduction 1. Introduction: What Is Analytic Feminism? Pieranna Garavaso, (University of Minnesota Morris, USA) 2. Introduction: Why Analytic Feminism? Ann Garry, (California State University, Los Angeles, USA) 3. Introduction: The Society for Analytical Feminism: Our Founding Twenty-Five Years Ago, Ann E. Cudd (College of Arts and Sciences at Boston University, USA)and Kathryn J. Norlock (Trent University, USA) Part 2: Metaphysics 4. Introduction to Feminist Metaphysics, Katharine Jenkins (The University of Nottingham, UK) and Pieranna Garavaso (University of Minnesota Morris, USA) 5. Feminist Metaphysics: Can This Marriage be Saved? Jennifer McKitrick, (University of Nebraska-Lincoln, USA) 6. Feminist Metaphysics as Non-Ideal Metaphysics, Mari Mikkola (Humboldt University, Germany) 7. Kinds of Social Construction, Esa Diaz-Leon (University of Barcelona, Spain) 8. Gender and the Unthinkable, Natalie Stoljar (McGill University, Canada) 9. Who's Afraid of Andrea Dworkin? Feminism and the Analytic Philosophy of Sex Katharine Jenkins, (The University of Nottingham, UK) Part 3: Epistemology 10. Introduction to Feminist Epistemology, Pieranna Garavaso (University of Minnesota Morris, USA) 11. Contemporary Standpoint Theory: Tensions, Integrations, and Extensions, Sharon Crasnow (Norco College, USA) 12. Objectivity in Science: The Impact of Feminist Accounts, Evelyn Brister (Rochester Institute of Technology, USA) 13. Feminist Philosophies of Science: The Social and Contextual Nature of Science, Lynn Hankinson Nelson (University of Washington, USA) 14. Reasonableness as an Epistemic Virtue, Deborah K. Heikes (University of Alabama, USA) 15. Agnotology, Feminism, and Philosophy: Potentially the Closest of Allies, Janet A. Kourany (University of Notre Dame, USA) 16. Say Her Name: Maladjusted Epistemic Salience in the Fight Against Anti-Black Police Brutality, Ayanna De'Vante Spencer (Michigan State University, USA) 17. The Epistemology of (Compulsory) Heterosexuality, Rachel Fraser (University of Cambridge, UK) Part 4: Value Theory 18. Introduction to Value Theory, Amanda Roth (State University of New York at Geneseo, USA) and Pieranna Garavaso (University of Minnesota Morris, USA) 19. Relational Autonomy and Practical Authority, Andrea C. Westlund, (University of Wisconsin-Milwaukee, USA) 20. (Feminist) Abortion Ethics and Fetal Moral Status, Amanda Roth (State University of New York at Geneseo, USA) 21. Feminist Approaches to Advance Directives, Hilde Lindemann (Michigan State University, USA) 22. What is Sex Stereotyping and What Could Be Wrong with It? Adam Omar Hosein (University of Colorado, Boulder, USA) 23. Kant's Moral Theory and Feminist Ethics-Women, Embodiment, Care Relations, and Systemic Injustice, Helga Varden (University of Illinois, USA) 24. Resisting Oppression Revisited, Carol Hay (University of Massachusetts Lowell, USA) 25. Women and Global Injustice: Institutionalism, Capabilities, or Care? Angie Pepper (University of York, UK) 26. Feminism, Nationalism, and Transnationalism: Reconceptualizing the Contested Relationship, Ranjoo Seodu Herr (Bentley University, USA) Part 5 Basic Logical Notions Pieranna Garavaso (University of Minnesota Morris, USA) and Lory Lemke (University of Minnesota Morris, USA) A–Z of Key Terms and Concepts Pieranna Garavaso (University of Minnesota Morris, USA) . (shrink)

In this paper, we defend the ethics of clinical research against the charge of paternalism. We do so not by denying that the ethics of clinical research is paternalistic, but rather by defending the legitimacy of paternalism in this context. Our aim is not to defend any particular set of paternalistic restrictions, but rather to make a general case for the permissibility of paternalistic restrictions in this context. Specifically, we argue that there is no basic liberty-right to participate in clinical (...) research and that considerations of distributive fairness justify some paternalistic protections of research subjects. (shrink)

: "Clinical pragmatism" is an important new method of moral problem solving in clinical practice. This method draws on the pragmatic philosophy of John Dewey and recommends an experimental approach to solving moral problems in clinical practice. Although the method may shed some light on how clinicians and their patients ought to interact when moral problems are at hand, it nonetheless is deficient in a number of respects. Clinical pragmatism fails to explain adequately how moral problems can be solved experimentally, (...) it underestimates the relevance and importance of judgment in clinical ethics, and it presents a questionable account of the role that moral principles should play in moral problem solving. (shrink)

The Gendered Cyborg brings together material from a variety of disciplines that analyze the relationship between gender and technoscience, and the way that this relationship is represented through ideas, language and visual imagery. The book opens with key feminist articles from the history and philosophy of science. They look at the ways that modern scientific thinking has constructed oppositional dualities such as objectivity/subjectivity, human/machine, nature/science, and male/female, and how these have constrained who can engage in science/technology and how they have (...) limited our ideas of the possibilities for both humanity and science. Later sections contain readings that present key feminist theories about representation to examine how gender and technoscience are represented in areas of particular contemporary interest: the new human reproductive technologies, science fiction, film and the Internet. The readings constantly ask "Is this for women, for human beings?" Contributors: Alison Adam, Anne Balsamo, Lynda K. Bundtzen, Barbara Creed, Mary Ann Doane, Dion Farquhar, Jennifer González, Evelynn M. Hammonds, Donna Haraway, Fiona Hovenden, Luce Irigaray, Linda Janes, Gill Kirkup, Nina Lykke, Sadie Plant, Rosalind Pollack Perchesky, Londa Schiebinger, Vivian Sobchack, Deborah Lynn Steinberg, Nancy Leys Stepan, Nina Wakeford, Kathryn Woodward. (shrink)

This article critically analyzes the principle of beneficence and the principle of nonmaleficence in clinical medical ethics. It resists some recent skepticism about the principle of nonmaleficence, and then seeks to explain its role in medicine. The article proposes that the two principles are informed by different accounts of what is in the patient’s best interests. The principle of beneficence is tied to the patient’s best overall interests, whereas the principle of nonmaleficence is tied to the patient’s best medical interests (...) only. The article argues that the principle of nonmaleficence takes priority over the principle of beneficence in that it filters the treatment options that are appropriately subject to the principle of beneficence. Understanding how both principles can play an important role in medical practice, and how they relate when they come into conflict, can help clinicians to avoid certain mistakes in thinking about their duties to their patients. (shrink)

In theory, HREC members should use the ethical guidelines in the National Statement on the Ethical Conduct of Research Involving Humans as the basis for their decisions, and researchers should design their research in accordance with these guidelines However, very little is known about what researchers and HREC members actually do in practice. In this paper, we report some of the key findings of the study “Human Research Ethics in Practice”, a qualitative interview-based study of health researchers and HREC members (...) in Victoria. The findings shed light on how researchers and HREC members conceptualise ethics, how they use the National Statement, and what deliberative strategies they employ to assess the ethical appropriateness of research studies. The findings also reveal differences and similarities between health researchers’ and HREC members’ perceptions of the roles of HRECs, and point to some sources of misunderstanding and tension. We examine the implications of some of these findings for the ways in which HRECs carry out their task, and research institutions support and promote ethical conduct in research amongst their staff and students. The focus of this study is on health research, but we suggest that the findings are highly relevant to all other research areas where human participants are involved. (shrink)

ABSTRACT When applying moral principles to concrete cases, we assume a background shared understanding of the boundaries of the persons to whom the principles apply. In most contexts, this assumption is unproblematic. However, in end‐of‐life contexts, when patients are receiving ‘artificial’ life‐support, judgments about where a person's self begins and ends can become controversial. To illustrate this possibility, this paper presents a case in which a decision must be made whether to deactivate a patient's pacemaker as a means to hasten (...) his death. After discussing some common moral principles that are often applied to resolve ethical problems at the end of life and after explaining why they are of no help here, the paper argues that the correct analysis of this case, and of cases of this sort, turns on considerations that relate to the constitution of the self. These considerations, the paper further argues, sometimes resist resolution. The constitution of the self is fixed in large measure by our concepts and social conventions, and these do not always provide determinate grounds for delimiting the boundaries of the self. (shrink)

In the debate over fetal tissue use, an analogy is often drawn between removing organs from the body of a person who has been murdered to use for transplantation, and collecting tissue from an aborted fetus to use for the same purpose. The murder victim analogy is taken by its proponents to show that even if abortion is the moral equivalent of murder, there is still no good reason to refrain from using the fetal tissue, since as a society we (...) do not see any problem about using organs from murder victims. However, I argue that the analogy between murder victims and aborted fetuses does not hold -- the two situations are not the same in all morally relevant respects. Thus the murder victim analogy does not provide an argument in favour of fetal tissue transplant. In conclusion, I point to some of the potential pitfalls of using analogies in ethical argument. (shrink)

Ethical research on human subjects requires that subjects, if they have the capacity to do so, give free and informed consent to participate in the trials in which they are enrolled. This requirement, which is commonly referred to as the principle of informed consent, was prominently endorsed by the authors of the Belmont Report in 1978, and it remains widely accepted today. Yet while the principle of informed consent is by now almost universally accepted, the responsibilities that it imposes on (...) those who conduct research on human subjects is a more contentious matter. New challenges to securing informed consent have emerged since the publication of the Belmont Report, and responding to these challenges requires... (shrink)

The ethical standards that regulate clinical research have multiple rationales. Among them is the need to protect potential subjects from making imprudent decisions, which extends beyond the soft paternalistic concern to protect people from making uninformed decisions to participate in trials. This article argues that a plausible risk/benefit restriction on clinical trials is presumptively justified by hard paternalism, which in turn is supported by a deeper fairness-based rationale. This presumptive case for hard paternalism in research is not defeated by the (...) alleged right to participate in clinical trials, by concerns about insult or status, by the need to conduct early phase trials that promise little to no benefit to participants, or by the recognition that some potential subjects are altruistically motivated. (shrink)

Presented as a retrospective speech by the president of the History of Science Society in 2038, this essay imagines a future for the profession of the history of science in the United States. Acknowledging that self-described historians of science do not fully control the subject, it considers the place of the history of science in a future university landscape in which interdisciplinary “studies” have supplanted disciplines as the fundamental organizing structure. It then situates this academic scene within a broader professional (...) landscape in which nonuniversity institutions play an expanded role in bringing the history of science directly to the public. Here the essay focuses on an imagined Science Heritage Center that blends commitments to innovative scholarly research, public history techniques of experiential learning, and updated technologies of virtual reality. It further suggests an unexpected direction for developing a collaborative “citizen history of science.”. (shrink)