: This essay is a collection of my experiences of and reflections on being pregnant and choosing to place the child for open adoption. The piece was started late in the term of my pregnancy and completed about a week before the birth.

Cohen (2023) takes a fair and measured approach to the question of what ChatGPT means for bioethics. The hype cycles around AI often obscure the fact that ethicists have developed robust frameworks...

The prospective study follows college students after the 9/11 attacks. Based on evidence and trauma-related theories, and guided by reports on positive and negative reactions and meaning-related actions among Americans after 9/11, we explored the seemingly contradictory, yet meaning-related pathways to posttraumatic growth and posttraumatic stress disorder symptoms , indicating the sense of deep interconnectedness and deep conflict. The final model showed that 9/11 emotional turmoil triggered processes of assimilation, as indicated in pathways between prayer coping and perceived spiritual and (...) social support, and of accommodation, as indicated in the pathway of spiritual struggle. Both pathways were directly associated with PTG in the follow-up. Perceived spiritual and social support contributed to lower levels of PTSD symptoms, whereas spiritual struggle had an opposite impact on symptoms; both effects were mediated through optimism but in opposite directions. The study suggests the interplay of complex crisis-related phenomena following meaning-laden collective trauma that presented existential challenges, involving coping, optimism, deep conflict, and deep interconnectedness. (shrink)

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems on students' mental health and academic outcomes.Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across five (...) school districts. School clinicians are randomized to either MATCH or usual care treatment conditions. The target sample includes 168 youths referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health.Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board. We plan to publish the findings in peer-reviewed journals and present them at academic conferences.Clinical Trial Registration:ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016. (shrink)

Raymond Lemieux | Résumé : Entre le discours du maître et le discours magistériel, la proximité est évidente. Pourtant le magis formant leur élément commun peut aussi bien s’avérer un facteur d’abrutissement, un producteur d’esclave, qu’un porteur d’émancipation. Comment le discours magistériel, qui se veut émancipateur, peut-il gérer cette ambiguïté ? Comment le maître peut-il être un maître de liberté ? L’article interroge tour à tour les pratiques éducatives et les pratiques psychanalytiques qui affrontent le même type d’aporie. Il (...) met de l’avant l’importance de l’interdiction faite à l’éducateur tant qu’à l’analyste de jouir de l’élève ou de l’analysant, c’est-à-dire de faire de leur apparente position de sujet assujetti un profit personnel. Qu’est-ce qu’éduquer à la liberté ? Qu’en est-il du magistère, dont le discours se veut émancipateur ? |: The semantic closeness between the discourse of the master and the magisterial teaching of the Church is obvious. However, the common root magis may be displayed as an enslavement process as well as a liberating one. How can this ambiguousness be removed from the teaching of the Church ? How can this one be an education to liberty ? In order to find some practical way of answering this question, the paper briefly examines contemporary educational and psychoanalytic challenges which confront such a logical and practical deadlock. It stresses the importance of the interdiction, for the educator as well as the psychoanalyst, of taking any personal advantage, pleasure or profit from the apparent position of subject which is that of the other. What does mean to educate with the purpose of liberty ? How the magisterial discourse of the Church can be an emancipatory one ? (shrink)

Résumé Au point de départ, l’acte théologique se constitue par la lecture des Écritures. Mais cette lecture, par laquelle se produit un sujet théologien, ne peut elle-même se résoudre que dans une écriture par laquelle ce sujet fait trace, à son tour, de son expérience. Le présent article investigue ces rapports complexes de la théologie aux Écritures et à l’écriture pour tenter d’en définir l’acte théologique comme traversée des textes et production d’un sens. La théologie, argumente-t-il, suppose que le lecteur-écrivain (...) se situe dans l’axe de l’Autre, c’est-à-dire dans un rapport au texte et à l’ordre symbolique du monde qui consiste à ne pas se laisser arrêter par leurs valeurs acquises, à continuer sans relâche à interroger ce qu’ils laissent à désirer. Cet acte, dès lors, ne peut se réaliser que dans le lieu de son impossibilité même : donner figure à l’Autre en sachant que cet Autre lui échappe.The theological work starts by reading Scriptures. This reading, which produces the theological subject, yet needs a writing by which this subject traces his own experience. The present paper investigates the complex relations that the theologian must keep up with reading and writing in order to define the specific locus of his work. Theology, it argues, supposes that the reader-writer places himself in the axis of the Other, that means, in such a relation with texts and symbolic order of the word as he will not be stopped by actual value systems and he will keep inquiring what is left open to desire by them. This act, therefore, can take place only in the context of its own impossibility : it gives a representation of the Other while knowing that the Other cannot be represented. (shrink)

Un État idéal pourrait intervenir efficacement pour articuler l’interface entre les médias classiques et les médias sociaux. L’État réel, par contre, ne dispose pas de l’information nécessaire et ses acteurs ne sont pas soumis aux incitations requises. De plus, il n’existe pas d’intérêt public dont l’État puisse se réclamer. Il faut se demander si découlerait du laissez-faire une situation meilleure que celle que produit la coercition des processus politiques et bureaucratiques.

Baranova, J., Duoblienė, L., 2020. Filosofija vaikams ir multimodalus ugdymas. Vilnius: Vilniaus universiteto leidykla, 223 p. ISBN 978-609-07-0423-3 Recenzentė Kristina Petrošienė.

Širším tématem tohoto článku je otázka kulturní relativity v metodologii antropologie a sociálních věd. Cílem textu je popsat anti-anti-relativistický postoj antropologa Clifforda Geertze, v němž se odráží jeho interpretace pozdního díla L. Wittgensteina a jeho pojmu „životní forma“. Geertzův anti-anti-relativismus je výsledkem odmítnutí zaujmout pozici relativisty nebo etnocentristy, a to z několika důvodů. Hlavním problémem obou táborů je podle něj mylná představa kultury jako nedynamického a uzavřeného celku, která vyplývá z filozofické představy „ideálních“ pojmů. Taková představa je podle něj zvlášť (...) neudržitelná v dnešním globalizovaném propojeném světě. Geertz taktéž upozorňuje na dynamický způsob formování identity (subjektu nebo kultury) prostřednictvím setkání se s cizím. Životní forma je pro Geertze metodologický nástroj, který umožňuje vyhnout se rozhodování mezi relativismem nebo anti-relativismem a který naopak poskytuje dynamickou střední cestu, jejíž pomocí jde zkoumat vzájemné prolínání identit kultur a sociálních skupin. (shrink)

Sous le thème de la « méthode », l’auteur se propose de formuler une éthique de la lecture à partir de Gilles Deleuze. L’analyse est fondée sur un dédoublement de la lecture : d’abord la lecture qu’a fait De-leuze de David Hume tel qu’exprimé dans Empirisme et subjectivité (1953) et celle de Henri Bergson dans Le bergsonisme (1966), ensuite par la lecture que l’auteur fait de ces deux livres de Deleuze. Par l’entremise de l’empirisme (Hume) et de l’intuition (Bergson), l’auteur (...) conclut que la lecture que Deleuze a faite est performative en ce sens qu’elle fait ce qu’elle énonce. Une éthique de la lecture correspondante se voudra donc, de même, performative : elle dépassera le donné à tra-vers le délire, s’ouvrira à l’inhumain et au surhumain à travers le vir-tuel. (shrink)

Traduit de l’anglais (É. U.) par François Jaquet -/- En révoquant l’arrêt Roe v. Wade le 24 juin 2022, la Cour suprême des États-Unis permettait à treize États conservateurs de voter immédiatement des lois interdisant l’interruption volontaire de grossesse, privant ainsi des millions d’Américaines d’un droit institué quelque cinquante ans plus tôt. Cet événement historique témoigne, s’il était besoin, du caractère toujours controversé de l’avortement. Faut-il en conclure que ce sujet ne peut susciter que des débats infructueux, sans espoir de (...) progrès ? -/- Une telle opinion est, selon Kristina Grob et Nathan Nobis, largement contestable, si l’on recourt à la pensée critique – en définissant minutieusement les termes du débat et en mettant à l’épreuve les définitions existantes, en rejetant les nombreuses « pétitions de principes », en énonçant la structure complète des arguments et en évaluant leurs forces et leurs faiblesses. -/- Les deux philosophes soutiennent, sur la base de considérations à la fois rationnelles et éthiques, que l’avortement n’est généralement pas immoral et qu’il doit donc demeurer un droit légal. -/- AVRIL 2023 10 € – 96 PAGES ISBN 9782493117199 13 x 19,5 cm. (shrink)

La critique de la métaphysique dans la Dialectique transcendantale de la Critique de la raison pure débouche sur la doctrine de l’usage régulateur des idées transcendantales de la raison pure. La théorie de l’usage régulateur de ces idées est relativement abstraite et demande à être clarifiée. Kant affirme que ces idées ont un usage dans les sciences empiriques. Cependant il ne spécifie pas quel usage les sciences peuvent faire de ces idées. Dans cet article je compare les caractéristiques des idées (...) transcendantales aux caractéristiques des modèles scientifiques. Ainsi la thèse principale de mon article est que la théorie kantienne de l’usage régulateur des idées est comparable à la modélisation en science. C’est ce que je nomme « l’approche modélisatrice des idées transcendantales chez Kant ». D’après cette interprétation, on trouve chez ce dernier une conception relativement élaborée de la modélisation que l’on peut comprendre comme signifiant que la métaphysique fournit aux sciences les formes les plus universelles de modèles qui peuvent être spécifiés pour des objectifs particuliers par les sciences. (shrink)

Une sourde appréhension hante aujourd’hui les consciences : « Le christianisme survivra-t-il à la modernité ? ». S’il a été un facteur historique de civilisation, sa pertinence est-elle caduque quand cette civilisation se transforme, comme cela est le cas dans le monde contemporain ? De quelles quêtes, de quelles souffrances, les regards portés sur lui, de l’intérieur comme de l’extérieur, sont-ils symptômes ? Quels en sont les dynamismes fondamentaux ? À quelles conversions l’expérience chrétienne est-elle appelée ?Pour baliser des pistes (...) de réponses à ces questions, nous questionnerons ici l’institution culturelle du christianisme, c’est-à-dire les modes selon lesquels, dans son histoire, il a soutenu du sens et se trouve, aujourd’hui, confronté à une conjoncture inédite. Cette institution culturelle comprend davantage que la vie interne et l’action des Églises qui à la fois la débordent et en dépendent. Des actes de foi l’animent, certes, sans s’y confiner non plus. Par christianisme, nous entendons donc saisir les modes variés par lesquels se sont inscrites, historiquement, « des nappes de produit relatives à des systèmes de production » en transactions constantes avec le « monde ». A vague apprehension haunts many minds today: “Will Christianity outlive modernity?” Although Christianity was a historical factor in the development of civilisation, will its pertinence be bypassed when this civilisation is transformed, as seems to be the case in the contemporary world? What is the re-examination applied to it from inside and out symptomatic of – of what searching and what suffering? What are the fundamental dynamics underlying this? What sorts of conversion is the Christian experience called upon to undertake?In order to outline some approached to responding to these questions, we shall examine the cultural institution of Christianity, that is, the ways in which it underwrote meaning and today stands at a new crossroads in its history. This cultural institution comprises more than its internal life and the action of the Churches, which both go beyond it and depend upon it. Acts of faith are vital to this process, obviously, but also reach beyond it. By “Christianity”, we mean discerning the various modes through which “the layers of products related to systems of production” in constant interplay with the “world” are inscribed in a historical process. (shrink)

The current model of adult neurogenesis in mammals suggests that adult‐born neurons are generated by stem cells that undergo long‐term self‐renewal, and that a lifetime supply of stem cells resides in the brain. In contrast, it has recently been demonstrated that adult‐born neurons in crayfish are generated by precursors originating in the immune system. This is particularly interesting because studies done many years ago suggest that a similar mechanism might exist in rodents and humans, with bone marrow providing stem cells (...) that can generate neurons. However, the relevance of these findings for natural mechanisms underlying adult neurogenesis in mammals is not clear, because of uncertainties at many levels. We argue here that the recent findings in crayfish send a strong signal to re‐examine existing data from rodents and humans, and to design new experiments that will directly test the contributions of the immune system to adult neurogenesis in mammals. (shrink)

L’heure est à la commémoration du mouvement de 1968, en Allemagne comme ailleurs. On considère que 1968 est à l’origine des nouveaux mouvements sociaux des années 1970 et 1980, dont le mouvement des femmes. Premier d’une série de mouvements sociaux, le « nouveau mouvement des femmes » émerge en Allemagne en 1971 au cours du processus de mobilisation contre la loi sur l’avortement (article 218 du code pénal). L’engagement des femmes est moins visible dans les mouvements protestataires de la f...

La conscience de soi a-t-elle été méconnue des hommes du Haut Moyen Âge? Se restreignant à l’époque de Charlemagne et parcourant les diverses sources théologiques – les commentaires exégétiques, les traités anti-adoptianistes, l’œuvre rédigée afin de réfuter l’adoration des icônes instaurée par le concile de Nicée II, les traités sur les vices et les vertus – la recherche permet de mieux percer la relation dialectique entre natura et persona ou encore entre commun et individuel et de détecter quelques modèles de (...) la perception de soi. Le « souci de soi » carolingien met en œuvre une stratégie : comment, en évitant la corruption de soi par les vices, on parvient à la perfection de la persona aux temps eschatologiques. (shrink)

Près d'une trentaine d'articles sur les idées politiques de Gérard Bergeron et sur la politique en général.

Difference and Disability in the Medieval Islamic World: Blighted Bodies. By Kristina L. Richardson. Edinburgh: Edinburgh University Press, 2012. Pp. ix + 158. $110, £65 ; $40, £24.99.

This article extends Lemieux’s concern for the interdisciplinary tension between philosophy and sociology to the intradisciplinary tension within psychology between approaches to the study of children focusing on universal principles and approaches adopting a contextual lens. This tension arises both in how development is defined and in the methods chosen for its study. This tension is exemplified in terms of the recent American preoccupation with the Word Gap (WG), a supposed difference of 30 million words heard by socioeconomically diverse (...) children by the age of 4 that is blamed for educational disparities throughout the school years. The article discusses the political implications of WG discourse as it gives rise to the erasure of language practices of diverse Americans and obscures the role that the educational system plays in fostering a ‘one-size-fits-all’ instructional model. The article concludes with a discussion of attempts to combat the deficit model that the WG discourse reproduces. (shrink)

This article employs a thumbs and thumbnails analysis to analyze the 85 most viewed Asian online porn thumbnails, videos, and their audiences’ comments to argue that cyberspace functions as a space of “affective simulation,” rather than simply as a space of representation. For these online viewers, the performativity of pain by Asian women porn stars functions as an entry point to access and externalize their affective excess.

Photo ID 222412412 © US Navy Medicine | Dreamstime.com ABSTRACT In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. INTRODUCTION Medical resources in an austere environment without quick recourse for resupply or casualty evacuation are often (...) limited. The shortage extends not only to supplies like blood products and drugs, but physicians and other medical personnel. In the midst of a mass casualty scenario, such as a battle that includes intense ground fighting, the medical staff will stretch scarce resources and triage casualties according to specific criteria. Typically, they proceed by providing care for the most severely wounded first, referred to here as conventional triage. At times, though, the staff may reverse the triage so that soldiers with minor wounds can return to the fight. In a mass casualty situation, when medical personnel apply conventional triage and treat casualties from opposing forces, a dilemma may arise. We argue that it can be permissible for military physicians to prioritize their own soldiers over enemy combatants in a mass casualty triage, where reverse triage does not apply. The case we will focus on is as follows: Battlefield Triage: During combat operations on a remote island in the Pacific Ocean, a compatriot soldier and an enemy combatant arrive at the compatriot soldier country’s medical treatment facility. Both have similar gunshot wounds to the abdomen, and they arrive with similar conditions. Both have low oxygen saturation and excessive blood loss. The sole physician only has enough time to stabilize one person. The scenario is brief, and we are aware that medical rules of eligibility will most often dictate how the physician proceeds,[1] but this scenario is useful in setting up the question we focus on in this paper: would it be wrong to favor the stabilization of a soldier just because the soldier is the physician’s compatriot? In other words, can nationality serve as an ethically justified tiebreaker in a situation such as Battlefield Triage?[2] In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. The AMA’s Code of Medical Ethics asserts that physicians have “ethical obligations to place patients’ welfare above their self-interest and above obligations to other groups.”[3] The World Medical Association’s Declaration of Tokyo affirms that “no motive, whether personal, collective or political, shall prevail against this higher purpose” of alleviating distress.[4] Physicians are taught early on that triage decisions must be medically indicated and made without consideration of factors such as race, ethnicity, religion, social status, and nationality. They are taught that public trust and obligations of justice grounded in equality demand that only medical indications be considered. But military physicians in a military setting are beholden to obligations, duties, and responsibilities as members of the military, and when these obligations, duties, and responsibilities conflict, as they do in Battlefield Triage, which loyalties win out and why?[5] Critics of partiality on national grounds argue that partiality undermines public trust in medicine and justice because everyone should be treated equally regardless of nationality.[6] Proponents of partiality argue that military obligations supersede equality and that justice requires partiality in such cases.[7] Despite the critics’ disagreement, both agree that there is a morally right, perhaps even blameless, course of action. Drawing on insights from virtue ethics, we argue that Battlefield Triage is a moral tragedy in which justice is unattainable and there is no action without moral cost. The assumption that there is a morally right choice is flawed. We argue that while no decision in this scenario is free from moral blame, there are reasons to favor treating one’s soldiers over enemy combatants. I. The Case Against Partiality There is a common assumption that there is a morally right or just decision in Battlefield Triage. A number of organizations and scholars claim that it is wrong for military physicians to favor their own soldiers on the grounds of nationality or some form of ‘group membership.’ (In a conflict involving service members from multiple nations working as a coalition, a soldier from an allied country may receive the same priority as the US service member due to ‘group membership.’) The World Medical Association’s WMA Declaration of Lisbon on the Rights of the Patient, which was reaffirmed in 2015, posits that, “[i]n circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.”[8] This echoes what was set forth in Article 12 of the Geneva Conventions, which states that “[o]nly urgent medical reasons will authorize priority in the order of treatment to be administered.”[9] The argument for impartiality in Battlefield Triage is that every person is morally equal, and equality entails that medical distribution is, “based on a combination of medical need and urgency.”[10] This is in keeping with the bioethical principles that are generally applied.[11] II. The Case for Partiality On the other side, there are arguments that favoritism is the ethically right decision in Battlefield Triage.[12] The argument asserts that members of the military form a morally significant community of friends and participation in these relationships demands partiality. Just as parents have strong ethical duties to their children and not just any children, military personnel have ethical duties to their group, a group that involves an affirmation of mutual aid and support. Some have termed these ‘associative duties. According to Michael Gross, obligations of friendship, care, and solidarity “leave very little room for generally applicable principles of justice that would obligate a medic to treat enemy or non-compatriot wounded ahead of their compatriots.”[13] This is true in Battlefield Triage, but it may also be true even if the enemy’s soldier were more seriously wounded: “the ethics of small group cohesion, largely an ethics of care, mostly replaces the demands of impartial justice.”[14] In a more recent article, Gross explains that preferential treatment is ethically justified based on fighting capability and “the special obligations people owe friends, family, and, no less, comrades-in-arms.”[15] To not show partiality to the US soldier would be morally wrong on the grounds of friendship and mutual care.[16] III. The Moral Tragedy of Battlefield Triage Defenders and critics of Battlefield Triage favoritism based on nationality both frame their position as just or fair. For example, Justin List argues that physicians are “bound to practice medical neutrality,”[17] Marcus Adams denies that physicians “possess special ethical obligations” to enemy combatants because of their profession.[18] These perspectives assume that there is a morally right decision and that justice is attainable. The assumption that there is or can be a morally right Battlefield Triage decision, and we need to put our heads together to figure it out, remains strongly entrenched. However, the facts of the situation should give us pause; there are too many people and too few resources, and this demands a decision-making process that determines who will receive scarce resources. By its very nature, a battlefield triage decision has to be made based on some characteristic or value, a characteristic or value that will inevitably favor some at the expense of others. This is precisely why competing analyses “in the military context struggle to resolve these conflicts satisfactorily.”[19] Drawing on the insights of virtue ethics, we suggest that Battlefield Triage is a moral tragedy. Virtue ethics suggests that morality is about acting virtuously, which is to say that we should do what a virtuous person would do in the situation. Ethics is about figuring out how a just, wise, compassionate, loving, and fair person would act, and then doing that, as one grows in virtue. But life is not always clear cut, and it is possible that virtuous people may find themselves in a moral tragedy, a situation in which, through no fault of one’s own, a person must make a morally objectionable decision. After the action the virtuous person “emerges having done a terrible thing, the very sort of thing that the callous, dishonest, unjust, or in general vicious agent would characteristically do.”[20] Stated differently, a moral tragedy presents a virtuous person with two or more courses of action, all of which have a moral cost.[21] In Battlefield Triage, no matter how the physician goes about deciding, there is going to be defensible concern from those not saved. The fact that there are more people than can be helped fosters competing values in battlefield triage: maximize lives saved, treat people equally, treat the worse off, and support the war effort. Treating people equally may create tension between treating the worse off, maximizing lives saved, and supporting the war effort. Reverse triage is a case in point, as supporting the war effort conflicts with treating the worse off first, as is a fair lottery system since deploying a lottery may not maximize lives saved or support the war effort. There can be reasons why one person is selected over another, to be sure. Yet, there are reasons for making a decision, and that the decision is subject to legitimate moral concern is another. To recognize the moral tragedy of Battlefield Triage is to recognize the impossibility of acting blamelessly in the situation. In this situation, the virtuous military physician is going to have to sacrifice important values such as justice, compassion, and respect for others, even with a defensible criterion in hand. The physician will grieve this sacrifice accordingly. The physician may find her decision difficult or stressful, and rightly so, because of what her circumstances require of her. This kind of moral tragedy results “in actions which betray and violate the rights of persons to whom there may be a strong duty of care. When this happens, it properly triggers an appropriate moral emotion since our moral integrity has been violated and this affects how we think of ourselves and what we have become.”[22] Rather than view her triage decision as the morally superior choice, the virtuous military physician will view her decisions in these circumstances in a different light: it is the least bad option in a terrible situation, and she did something ethically problematic, something that is contrary to her moral character. She deeply regrets the circumstances in which she had to act. IV. Virtue Ethics A virtue ethicist has insight into how one should go about deciding what to do in a moral tragedy, although virtue ethics may not be as helpful as one may hope. The goal of the virtuous military physician in Battlefield Triage is to adopt the best course of action or the action that she feels she ought to do, all things considered. This does not make her choice devoid of serious wrongdoing—a decision must be made, but that does not make it just. The virtuous military physician will approach the situation with courage, responsibility, and insight. She will think about the decision carefully, wisely, and conscientiously; she will weigh the goods and harms of the choices before her, in conjunction with a proper conception of the good life, human worth, and understanding of her obligations to others—including chain of command, fellow soldiers, and the medical community. She is attuned to the value of human life and has a reasonable idea of the various ways her decisions will affect others. She recognizes that she is in this non-ideal situation through no fault of her own: she is not the one fighting in battles; she is serving her country as a physician, whose job it is to save lives, treat everyone justly, and promote military objectives. She regrets the decision she is forced to make in battlefield triage, acting “with immense regret and pain,” Hursthouse explains, “instead of indifferently or gladly.”[23] This is because, no matter what decision is made, the virtuous military physician “does something terrible or horrible,” something she otherwise would not do and is contrary to her values.[24] V. A Resolvable Moral Tragedy Instead of asking whether there is a morally right decision, in which a decision is morally blameless and above reproach, the virtue ethicist asks whether there is a decision with a convincing rationale, knowing that a decision can have a clear rationale but still be morally tragic. It is perfectly reasonable to think that different virtuous persons will arrive at different courses of action: “two virtuous agents, in the same situation,” Hursthouse writes, “may act differently” in irresolvable moral tragedies, in cases in which there is no clear course of action.[25] Because a person must act in a moral tragedy, one goal is to identify reasons for choosing the chosen action. Some decisions are clearly indefensible—treating neither the compatriot soldier nor the enemy combatant in Battlefield Triage would be wrong—and some decisions are more problematic than others. If the military physician selects to treat the soldier because she does not like the enemy combatant’s skin color, such a reason would be deeply problematic. But much of the debate over how to act in a moral tragedy is not over clearly indefensible or problematic criteria. Instead, the literature is largely about different standards or implementations of justice. Some scholars defend nation-impartial triage as right, while others defend nation-aware triage as right, and each argues that the other side is promoting an unjust or otherwise wrong solution to Battlefield Triage. We suggest that Battlefield Triage is a resolvable moral tragedy and that virtue ethics offers convincing reasons to prefer the treatment of the compatriot soldier rather than the enemy combatant on the grounds of national identity. Virtues are integral to living a good life, a flourishing life, but as Aristotle observed long ago, human beings are inherently social, interdependent and interconnected in profound ways.[26] This goes beyond the obvious fact that we need each other to survive day to day (one person makes clothes, another farms, and another makes tools); the claim is that a good or flourishing life depends in large part on one’s social network or community. This is why many of Aristotle’s moral virtues are other facing: justice, friendship, generosity, and magnanimity, to name a few. Courage, a typically self-facing virtue, is understood by Aristotle to be the virtue that regards one’s fear of death in battle, a battle fought on behalf of one’s city.[27] All of this remains true today. Namely, there is an important sense in which our community matters to our lives: it is easier to live a good, flourishing life if one is part of a good, flourishing community. Our community is made up of smaller groups, and it is more accurate to say that we are simultaneous members of different groups within a broader community. A person may be part of a family, friend group, research team, large state university, city, state, and nation. Groups can function well or not, as we all have experienced, and this suggests that there are virtues or excellences that groups can instantiate. Good groups are unified in purpose, with each member doing their duty alongside others for the attainment of that purpose. Good groups manifest solidarity among their members. Although Aristotle does not list solidarity as a virtue, a number of modern-day virtue ethicists have begun examining how group solidarity can be a virtue that contributes to a good or flourishing life.[28] Solidarity is not conceptualized as an individual virtue, a virtue possessed by a person in isolation of others; instead, it is a collective virtue, a virtue that is shared among members of a defined group with particular ends.[29] “A group has solidarity to the extent that its members are disposed to: (1) share values, aims, or goals; (2) care about those values, aims, or goals; (3) act in accordance with those values, aims, or goals; (4) trust the testimony of other group members with respect to those values, aims, and goals; and (5) feel a sense of belonging to the group.”[30] The virtue of collective or group solidarity involves individuals having special concern for each other, shared aims and values, trust, loyalty, and a sense of belonging with these specific others. There is a oneness to the group in the pursuit of a definite goal or purpose, involving mutual support and affirmation of each member. As such, the group has ends and goods above and beyond the good of each individual person. Sometimes solidarity requires personal sacrifice for the collective (for example, a father sacrificing food so his child can eat). The virtue of collective or group solidarity is important to the military and medical community at every level, and for clear reasons. In the military, there is a clear hierarchy of command, unity of purpose and end, mutual trust and support in complex settings, and so on. Soldiers need to know they can count on one another, and solidarity grounds a soldier’s ability to trust others and be assured of mutual aid. In medicine, solidarity maintains self-regulation of the profession, shared values and goals, as well as public support, not to mention that day-to-day operations require physician trust, engagement, and effort toward the ends of clinical care. Physicians need to work together, along with others, in pursuit of health, and disunity is sowed when there is mistrust, selfishness, or disengagement among the healthcare team and organization. Importantly, just as we are all members of various groups and hence may manifest group solidarity in different settings, the virtuous military physician instantiates collective solidarity with both the medical profession and the military. Her dual loyalty contributes to the moral difficulty of acting in Battlefield Triage. The military physician has competing obligations to distinct groups and cannot satisfy all obligations in Battlefield Triage. Solidarity with the military supports the consideration of favoring the soldier for reasons of national identity, whereas solidarity with the medical community does not. Something has to give, which is why it is a moral tragedy. The virtuous military physician, therefore, must weigh the costs of each course of action. To fulfill her obligations to the medical community would require that she does not use nationality and other non-medical considerations in Battlefield Triage. Since the soldier and enemy combatant are equally injured, justice would demand a random process, perhaps a flip of the coin. Although this may satisfy obligations the military physician has to the medical community, this would be costly to the physician’s military group. If word gets out that the physician decides who to treat based on a coin toss, soldiers, families, and citizens may become frustrated and angry. Soldier morale may go down if it becomes known that a coin flip led to the preventable death of a soldier and the saving of an enemy combatant who had killed (or attempted to kill) other soldiers. As Gross highlights, military solidarity involves a mutual aid promise that military personnel promise to help one another.[31] A military physician is part of the military and, as such, is part of the mutual aid promise, which would appear to be violated if the physician flips a coin. Treating a member of one’s own team may be psychologically more beneficial than treating an enemy combatant and may lead to less moral distress.[32] Finally, treating soldiers rather than enemy combatants promotes broader military and social aims, including returning soldiers to health, maintaining unity of purpose, and minimizing community suffering from a soldier’s death. Favoring members of one’s group, that is, triage based on nationality in Battlefield Triage, would fulfill obligations of military group loyalty, which is contrary to the values and duties of medicine. It does not seem as though showing favoritism in this particular situation is very costly to the medical community or general public, but this is because there is recognition that the physician is in the military. Medicine is impartial to non-medical indications partly because of fairness and to promote public trust in medicine. However, Battlefield Triage is unique, as medicine is being practiced in a non-public, wartime setting. In ordinary circumstances, a patient’s identity is irrelevant, and physicians ought not play favorites. Since Battlefield Triage is not an ordinary circumstance, decisions based on patient identity may not undermine public trust in medicine. In addition, it is contestable that fairness in Battlefield Triage requires that no consideration be paid to one’s nationality. Fairness is about giving each person their due, what is owed to them, and the case can be made that soldiers who place themselves in danger for the sake of the common good or a just cause are owed special attention when they suffer harm in the line of duty. In other words, soldiers voluntarily undergo risk to themselves for the greater good, and society owes them for this sacrifice. This plausibly includes preferential treatment in a situation such as Battlefield Triage. So, while the medical community affirms justice demands non-preferential treatment, the military community can affirm the opposite. The demands of fairness are unclear at best or in conflict in this situation: demands of physician justice decry favoritism, while demands of military justice support favoritism. Triage not based on nationality is arguably unfair and triage based on nationality may not undermine public trust, after all. All things considered, there is a clear rationale for favoring nationality-based preferential treatment in Battlefield Triage. Adopting a nationality-based preference in this situation is more defensible than not. This does not make such a decision ethically right or just. Preference based on nationality is the least bad decision, but it is not morally blameless. It involves one in a serious moral wrong, a wrong otherwise avoided and contrary to one’s character. The virtuous military physician is in a situation in which obligations conflict, and we disagree with Gross, who posits that care of fellow soldiers “is important to the near exclusion of all else.”[33] Gross fails to appreciate the collective virtue of solidarity as applied to those in medicine. The military physician has duties to fellow soldiers but also to fellow physicians, to the medical community, and humanity. To favor a soldier on grounds of nationality violates her duties and responsibilities to this latter group. She is involved in a moral tragedy and can only seek the most just action given the circumstances, yet, at least in virtue ethics, the action remains far from blameless. CONCLUSION We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. As such, the virtuous military physician incurs a moral cost to acting as she does—there is a moral residue. However, despite being a moral tragedy, there are clear reasons to act in favor of treating one’s own, considering group solidarity. As such, these kinds of tragedies are resolvable: virtuous military physicians should favor treatment of their own, although they would do so with sorrow. - [1] Militaries set forth medical rules of eligibility or guidelines used to determine whether a person qualifies for specific medical interventions or treatments in certain circumstances, and these guidelines are binding for a military physician. For example, despite opposition from medical organizations, militaries have adopted reverse triage guidelines for military physicians to follow. For ethical discussion, see Falzone, Elisabeth, P. Pasquier, C. Hoffmann, O. Barbier, M. Boutonnet, A. Salvadori, A. Jarrassier, J. Renner, B. Malgras, and S. Mérat. "Triage in military settings." Anaesthesia Critical Care & Pain Medicine 36, no. 1 (2017): 43-51. https://doi.org/10.1016/j.accpm.2016.05.004 [2] There are issues that are related to this, including the triage of civilians and allied soldiers. We set related issues aside for purposes of this paper [3] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [4] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [5] This is termed the “dual loyalty” dilemma in military medicine and has been described at length elsewhere: Institute of Medicine (US) Board on Health Sciences Policy. Military Medical Ethics: Issues regarding Dual Loyalties: Workshop Summary. Washington (DC): National Academies Press (US); 2008. Toward a Framework for Resolving Dual Loyalties. Available from: https://www.ncbi.nlm.nih.gov/books/NBK214853/ [6] See Kenneth G. Swan and K.G. Swan, Jr., “Triage: The Past Revisited,” Military Medicine 161:8 (1996): 448–452. https://doi.org/10.1093/milmed/161.8.448; Jerome A. Singh, “American Physicians and dual loyalty obligations in the ‘war on terror,’” BMC Medical Ethics 4.4 (2003): 1–10. https://doi.org/10.1186/1472-6939-4-4; Beam, Thomas E. "Medical Ethics on the Battlefield." Military Medical Ethics: Sect. IV. Medical ethics in the military. Medical ethics on the battlefield: the crucible of military medical ethics 2 (2003): 369-402; Hereth, Blake. "Health justice for unjust combatants." Journal of Military Ethics 20, no. 1 (2021): 67-81. https://doi.org/10.1080/15027570.2021.1949782. [7] See Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. Gross, Michael L. "Comradery, community, and care in military medical ethics." Theoretical medicine and bioethics 32 (2011): 337-350. https://doi.org/10.1007/s11017-011-9189-6. Gross, Michael L. "The limits of impartial medical treatment during armed conflict." In Military medical ethics for the 21st century, pp. 71-84. Routledge, 2016. [8] World Medical Association, WMA Declaration of Lisbon on the Rights of the Patient. 5 December 2022, https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/ [9] Geneva Convention for the Amelioration of the Condition of Wounded, Sick in Armed Forces in the Field. 12 August 1949. https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.30_GC-I-EN.pdf. [10] List, Justin M. "Medical neutrality and political activism: physicians' roles in conflict situations." In Physicians at war: The dual-loyalties challenge, pp. 237-253. Dordrecht: Springer Netherlands, 2008. 240 [11] Beauchamp, T., and J. Childress. 2013. Principles of Biomedical Ethics, 7th ed. Oxford, United Kingdom: Oxford University Press. [12] Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. [13] Gross, "Comradery, community, and care in military medical ethics," 347. [14] Gross, “Comradery, community, and care in military medical ethics,” 349. [15] Gross, Michael L. "When medical ethics and military ethics collide." Narrative inquiry in bioethics 13, no. 3 (2023): 199-204. 202 https://dx.doi.org/10.1353/nib.2023.a924191 [16] Our argument draws on virtue ethics, from which care ethics derives, and it is worth clarifying how our argument relates to Gross’s. We do not think that the virtue of friendship grounds triage decisions, for we think it is unlikely that the physician and wounded soldier are friends. Instead, as explained below, we think the collective virtue of group solidarity better captures the moral significance of group loyalty and that Gross would agree with us. But since military physicians are part of distinct groups, with competing obligations, the military physician will be forced to sacrifice a value in battlefield triage cases. In other words, we think Gross downplays the dual group membership of a military physician. [17] List,”Medical neutrality and political activism,” 250. [18] Adams,”Triage priorities and military physicians,” 235. [19] London, Leslie, Leonard S. Rubenstein, Laurel Baldwin-Ragaven, and Adriaan Van Es. "Dual loyalty among military health professionals: human rights and ethics in times of armed conflict." Cambridge Quarterly of Healthcare Ethics 15, no. 4 (2006): 381-391. 383. [20] Hursthouse, R. On Virtue Ethics. OUP 1999. 74 [21] Nussbaum, Martha C. "The costs of tragedy: Some moral limits of cost-benefit analysis." The Journal of Legal Studies 29, no. S2 (2000): 1005-1036, 1007. [22] De Wijze, S. (2005). Tragic-remorse–the anguish of dirty hands. Ethical theory and moral practice, 7(5), 453-471, 457. https://doi.org/10.1007/s10677-005-6836-x [23] Hursthouse, 73 [24] Hursthouse, 81 [25] Hursthouse, 72 [26] Aristotle, Politics 1253a8. Reeve, C. D. C., Indianapolis: Hackett Publishing Co., 2017 [27] Aristotle, Nicomachean Ethics. III.6.114a, 34-35. 2002, Nicomachean Ethics, Christopher Rowe (trans.), Oxford: Oxford University Press [28] Byerly, T. Ryan, and Meghan Byerly. "Collective virtue." The Journal of Value Inquiry 50, no. 1 (2016): 33-50. https://doi.org/10.1007/s10790-015-9484-y; Federico, Veronica. "Conclusion: solidarity as a public virtue." Solidarity as a Public Virtue (2018): 495-542. https://doi.org/10.5771/9783845290058. Rehg, William. "Solidarity and the common good: An analytic framework." Journal of Social Philosophy 38, no. 1 (2007): 7-21. https://doi.org/10.1111/j.1467-9833.2007.00363.x [29] Byerly and Byerly. "Collective virtue." 43 [30] Battaly, Heather. "Solidarity: Virtue or vice?." In Social virtue epistemology, pp. 303-324. Routledge, 2022. 304 [31] Ibid., 2011: 341 [32] It might be thought that displaying altruism by helping an enemy combatant at the expense of one’s fellow soldier may be psychologically satisfiying. For evidence that military physicians find it difficult to treat enemy combatants, see Lundberg, Kristina, Sofia Kjellström, Anders Jonsson, and Lars Sandman. "Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties." Military medicine 179, no. 8 (2014): 821-826. https://doi.org/10.7205/MILMED-D-14-00038. Lamblin, Antoine, Clément Derkenne, Marion Trousselard, and Marie-Ange Einaudi. "Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study." BMC Medical Ethics 22 (2021): 1-13. https://doi.org/10.1186/s12910-021-00723-2 [33] Ibid., 2011: 344. (shrink)

Suppose libertarians could prove that durable, unqualified private property rights could be created through 'original acquisition' of unowned resources in a state of nature. Such a proof would cast serious doubt on the legitimacy of the modern state. It could also render the approach to property rights that I favour irrelevant. I argue here that none of the familiar Lockean-libertarian arguments for a strong natural right to acquisition succeed, and that any successful argument for grounding a right to acquire would (...) have to use my favoured approach to property rights - the 'vector-sum' approach. I conclude with some doubts about original acquisition theory and natural property rights. (shrink)

Disorders of Consciousness (DoCs) raise difficult and complex questions about the value of life for persons with impaired consciousness, the rights of persons unable to make medical decisions, and our social, medical, and ethical obligations to patients whose personhood has frequently been challenged and neglected. Recent neuroscientific discoveries have led to enhanced understanding of the heterogeneity of these disorders, and focused renewed attention on the medical and ethical problem of misdiagnosis. -/- This book examines the entanglement of epistemic and ethical (...) uncertainty in DoCs and other medical contexts, and how they interact to create both epistemic and ethical risks. Philosopher and bioethicist L. Syd M Johnson pulls together multiple threads in this work: the ontological mysteries of consciousness, medical uncertainty about unconsciousness, ableist bias, withdrawal of treatment in neurointensive care, and the rarely questioned view that consciousness is essential to personhood and moral status. Johnson challenges longstanding bioethical dogmas about DoC patients, and argues for an ethics of uncertainty for contexts where there is a need for decisive action in the presence of unavoidable uncertainty. The ethics of uncertainty refocuses ethical inquiry concerning persons with DoCs, placing less emphasis on their contested personhood, and more on inductive risk and uncertainty, on respect for autonomy, and especially on epistemic justice. With applications to various decisional contexts where uncertainty and ethical risk interact, this ethical approach enables surrogate decision makers facing fraught and risky choices to fulfill their obligations as moral and epistemic agents. (shrink)

The central role played by Darwin's analogy between selection under domestication and that under nature has been adequately appreciated, but I have indicated how important the domesticated organisms also were to other elements of Darwin's theory of evolution-his recognition of “the constant principle of change,” for instance, of the imperfection of adaptation, and of the extent of variation in nature. The further development of his theory and its presentation to the public likewise hinged on frequent reference to domesticates.We have seen (...) that Darwin's reliance on the analogy between domesticated varieties and wild species was a bold and original step, in light of contemporary views on the nature of domesticates. However, as Darwin undoubtedly foresaw, his reliance on the analogy created difficulties as well as solving problems, and these began with his Malthusian codiscoverer of the principle of natural selection, Alfred Russel Wallace. Wallace's paper “On the Tendency of Varieties to Depart Indefinitely from the Original Type,” presented to the Linnean Scoiety along with the first public unveiling of Darwin's theory, states: We see, then, that no inferences as to varieties in a state of nature can be deduced from the observation of those occurring among domestic animals. The two are so much opposed to each other in every circumstance of their existence, that what applies to the one is almost sure not to apply to the other. Domestic animals are abnormal, irregular, artificial; they are subject to varieties which never occur and never can occur in a state of nature.62Much has been made of the similarity of views of Darwin and Wallace, but this quotation surely reveals how utterly different their views were on what to Darwin was an important matter. Several critics of the Origin saw Darwin's reliance on the domesticates as his Achilles heel. As Young has pointed out, Samuel Wilberforce included the following passage in his attack on the Origin: Nor must we pass over unnoticed the transference of the argument from the domesticated to the untamed animals. Assuming that man as the selector can do much in a limited time, Mr. Darwin argues that Nature, a more powerful, a more continuous power, working over vastly extended ranges of time, can do more. But why should Nature, so uniform and persistent in all her operations, tend in this instance to change? Why should she become a selector of varieties?63Another critic, Fleeming Jenkin, found the analogy a weakness in Darwin's theory because of the limited extent of variation in any one direction in domestic animals and plants.64 We have already seen that Darwin had confided a similar view to his notebook thirty years earlier, but changed his mind as a result of his profound study of domesticates. De Beer's reference to “an English country gentleman's knowledge of domestic plants and animals and their breeding”65 fails totally to recognize the originality and depth of Darwin's knowledge of domesticates.Why did Darwin, against the currents of his time, rely so heavily on mankind's experience with domesticated organisms to shape his theory about species in nature? On reason is that only with domesticates was an approach that came close to experimental verification possible. Darwin fully realized the inadequacies of the experiment, as is emphasized by his repeated contrasting of selection under nature and selection by man. Yet the extensive experience and data of plant and animal breeders offered the only reliable base against which Darwin could continually challenge his views. As he wrote in the introduction to Variation, with domestication, “man ... may be said to have been trying an experiment on a gigantic scale.”66 Given Darwin's high opinion of the quantitative work of Malthus and Quetelet (as emphasized by Schweber),67 and his unremitting efforts to secure data by which to test his theories, it was inevitable that he should attach high significance to domesticated varieties. John Tyndall, in his Belfast address of 1874, said: “The strength of the doctrine of Evolution consists, not in experimental demonstration (for the subject is hardly accessible to this mode of proof), but in its general harmony with scientific thought.”68 Darwin would have agreed with the latter thought, but I think he would have challenged the preceding one on the grounds that long experience with domesticated varieties did provide an element of experimental demonstration. It gave him confidence in his theory, and he used his vast knowledge of artificial selection boldly and creatively. (shrink)

This study explores how financial executives retrospectively account for their crossing the line into financial statement fraud while acting within or reacting to a financialized corporate environment. We conduct our investigation through face-to-face interviews with 13 former C-suite financial executives who were involved in and indicted for major cases of accounting fraud. Five different themes of accounts emerged from the narratives, characterizing executives’ fraud immersion as a meaning-making process by which the particulars of the proximal social context and individual motivations (...) collectively molded executives’ vocabularies of fraud immersion. Our executives’ narratives portray their fraud entanglement as typically occurring in small, incremental steps. Their accounts expand our understanding of the influence of socialization on executive-level financial fraud beyond the individualized focus of the fraud triangle model. (shrink)

Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the (...) informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

Recent work in the ontology of music suggests that we will avoid confusion if we distinguish between two kinds of question that are typically posed in music ontology. Thus, a distinction has been made between fundamental ontology and higher-order ontology. The former addresses questions about the basic metaphysical options from which ontologists choose. For instance, are musical works types, indicated types, classes of particulars, or some other kind of entity? Higher-order ontology addresses the question of what lies ‘at the centre’ (...) of a specific form of music, such as rock or jazz—or perhaps classical music. The argument of this essay is, first, that a close examination of the best efforts in two of these territories shows that they have the effect of pressing the music in each sphere into implausible Procrustean beds. Second, it is argued that the general question that higher-order ontologies pose, that is, ‘What work-kind is it that lies at the centre of a given kind of music, F?’ is a question based on a mistaken but seductive assumption, namely that the concept of the work of F has actual application. In fact, these concepts—upon which higher-order ontology depends—are mere artefacts of philosophy. The question is also addressed why the assumption is so seductive. Finally, the question finally is posed about what, if anything, is implied from the foregoing about the traditional ontology of classical music. (shrink)