When I say ‘pain’, it is clearly a singular phenomenon. Yet if I ask for an example, you can provide many varying instances that confound the idea of its singularity. How can a pinprick be of the same thing as depression or grief? This study maintains the singularity of pain by exploring the process and structure of its experience to account for its variance and its subjectivity. Heidegger’s Being and Time provides the pathway to achieving this, where we comprehend how (...) pain’s myriad manifestations, and their inherent subjectivity, relate to our way of Being – the meaningful horizon through which we encounter pain. The study comes to tie the process of encountering pain with a structure that suffering provides, which explains both the variance and the subjectivity of the pain experience. This can then be mapped onto individual experiences of a singular phenomenon to understand how they arose and what has conditioned them. (shrink)

Bioethics in a Liberal Societ By Max Charlesworth, Cambridge University Press, 1993. Pp. 172. ISBN 0?521?44952?9. £9.95 pbk. The Logical Universe: The Real Universe By Noel Curran Avebury, 1994. Pp. 158. ISBN 1?85628?863?3. £32.50. Beyond Postmodern Politics: Lyotard, Rorty, Foucault By Honi Fern Haber Routledge, 1994. Pp.viii + 160. ISBN 0?415?90823?X. $15.95. Baudrillard's Bestiary: Baudrillard and Culture By Mike Gane Routledge, 1991, Pp. 184. ISBN 0?415?06307?8. £10.99 pbk. Truth, Fiction and Literature: A Philosophical Perspective By Peter Lamarque and Stein Haugom (...) Olsen Clarendon Press, 1994. Pp. 456. ISBN 0?19?824082?1. £45.00. Milton and the Drama of History: Historical Vision, Iconoclasm, and the Literary Imagination By David Loewenstein Cambridge University Press, 1990. Pp. x + 197. ISBN 0?521?37253?4. £25.00. Philosophy and Knowledge: A Commentary on Plato's Theaetetus Ronald M. Polansky Associated University Presses, 1992. Pp. 260. ISBN 0?8387?5215?2. £29.95. Heidegger and French Philosophy: Humanism, Antihumanism and Being By Tom Rockmore Routledge, 1995. Pp. xx + 250. ISBN 0?415?11181?1. £14.99 pbk. Living Poetically: Kierkegaard's Existential Aesthetics By Sylvia Walsh The Pennsylvania State University Press, 1994. Pp. 294. ISBN 0?271?01328?1. (shrink)

It is plausible to think that practices of caring are partly constituted by a caregiver's commitment to a cared-for. However, discussions of caring often contain no explicit discussion of such commitments, and do not attempt to draw any philosophical conclusions from the nature of caring relations as committed. A discussion of caring practices that emphasizes the importance of commitment therefore has the potential to generate important new insights for our understanding of caring. This essay begins that project by arguing that (...) a commitment-centric conception of caring entails the truth of moral partialism. Although many care-ethicists are sympathetic to partialism, the arguments in its defense remain controversial. As I show in this article, however, partialism is necessarily true given the committed nature of caring. This is because the concept of commitment is itself a necessarily partial one: to say that we are equally committed to everyone or everything is equivalent to saying that we are not committed to anything. Thus, when viewed as a species of commitment, it is part of the concept of caring that it requires us to put the needs of those we care for before the needs of those unknown to us. (shrink)

Moral distress has been the subject of extensive research and debate in the nursing ethics literature since the mid-1980s, but the concept has received comparatively little attention from those working outside of applied ethics. In this article, I defend a care ethical account of moral distress, according to which the phenomenon is the product of an agent’s inability to live up to one of her caring commitments. This account has a number of attractions. First, it places a greater emphasis on (...) the importance of the relationship between the caregiver and her cared-for than that found in previous accounts. Second, it does not make problematic assumptions about the correctness of a caregiver’s moral judgments, as has been claimed in relation to previous accounts of moral distress. Finally, my account allows for a clear conceptual distinction to be drawn between moral distress and other forms of negative moral emotion such as guilt and regret. Earlier accounts draw this distinction by appealing to the causal aetiology of moral distress, but as I show here, such appeals are ultimately unsuccessful unless they are made from an explicitly care ethical starting point. One of the implications of my account is that moral distress has the potential to occur in the context of any caregiving relationship. This claim is explored in the final section of the paper, in relation to student-teacher and parent-child caregiving. (shrink)

According to agent-based approaches to virtue ethics, the rightness of an action is a function of the motives which prompted that action. If those motives were morally praiseworthy, then the action was right; if they were morally blameworthy, the action was wrong. Many critics find this approach problematically insensitive to an act’s consequences, and claim that agent-basing fails to preserve the intuitive distinction between agent- and act-evaluation. In this article I show how an agent-based account of right action can be (...) made sensitive to an act’s consequences. According to the approach which I defend, an action is right just in case it realizes an agent’s morally praiseworthy motive. Conversely, an action is wrong just in case it realizes a morally blameworthy motive. Specifying act-evaluation in terms of the realization, rather than the expression, of an agent’s motives allows an agent-based approach to distinguish between agent- and act-evaluation. This is because an agent may act from a morally praiseworthy motive, but fail to realize that motive. Her action will therefore not have been the right one, despite its being the expression of morally praiseworthy motives. (shrink)

Caregiving relationships are often characterized by an imbalance of power between the caregiver and her cared-for. The danger that this power will be abused is a source of serious moral concern. In this article, I argue that the risk of an abuse of power sometimes stems not from the possession of power itself, but from the very nature of caring relationships. This is because carers must be prepared to exercise non-minimal amounts of power over their cared-fors, even if doing so (...) is likely to cause the cared-for distress or even pain. This means that caring itself, rather than the malign influence of power dynamics, generates a risk of unintentional abuse. One of the ways in which this risk can be reduced, I argue, is by trying to avoid an exclusive focus on the outcomes of care, and by paying more attention to the way in which that care is delivered. (shrink)

In this paper, I argue that care ethics should be understood as a form of value pluralism. Writers on the ethics of care tend not explicitly to address issues in the theory of value, although much of what has been written about care ethics may be taken to suggest that it endorses some form of value monism. I argue against this conception of care ethics by showing that the practical reality of caregiving is more accurately represented by a pluralist account (...) of value. Practices of care are plausibly guided by a number of distinct and potentially conflicting values. These include quality of life, autonomy, dignity, personal development, and the value of nurturant relationships. Whilst caring takes each of these values to be important in its own right, they are not always jointly realisable, and carers are sometimes forced to promote one such value at the expense of another. The possibility of conflict between values is, of course, precisely what a pluralist conception of value tells us to expect. In this respect, then, value pluralism more faithfully reflects the reality of caregiving than does value monism, and care ethicists ought for this reason to endorse it. (shrink)

Horizontal transfer (HT) is the transmission of genetic material between non‐mating species, a phenomenon thought to occur rarely in multicellular eukaryotes. However, many transposable elements (TEs) are not only capable of HT, but have frequently jumped between widely divergent species. Here we review and integrate reported cases of HT in retrotransposons of the BovB family, and DNA transposons, over a broad range of animals spanning all continents. Our conclusions challenge the paradigm that HT in vertebrates is restricted to infective long (...) terminal repeat (LTR) retrotransposons or retroviruses. This raises the possibility that other non‐LTR retrotransposons, such as L1 or CR1 elements, believed to be only vertically transmitted, can horizontally transfer between species. Growing evidence indicates that the process of HT is much more general across different TEs and species than previously believed, and that it likely shapes eukaryotic genomes and catalyses genome evolution. (shrink)

Lévy's Upward Theorem says that the conditional expectation of an integrable random variable converges with probability one to its true value with increasing information. In this paper, we use methods from effective probability theory to characterise the probability one set along which convergence to the truth occurs, and the rate at which the convergence occurs. We work within the setting of computable probability measures defined on computable Polish spaces and introduce a new general theory of effective disintegrations. We use this (...) machinery to prove our main results, which (1) identify the points along which certain classes of effective random variables converge to the truth in terms of certain classes of algorithmically random points, and which further (2) identify when computable rates of convergence exist. Our convergence results significantly generalize earlier results within a unifying novel abstract framework, and there are no precursors of our results on computable rates of convergence. Finally, we make a case for the importance of our work for the foundations of Bayesian probability theory. (shrink)

It is commonly thought that disability is a harm or “bad difference” because having a disability restricts valuable options in life. In his recent essay “Disability, Options and Well-Being,” Thomas Crawley offers a novel defense of this style of reasoning and argues that we and like-minded critics of this brand of argument are guilty of an inconsistency. Our aim in this article is to explain why our view avoids inconsistency, to challenge Crawley's positive defense of the Options Argument, and to (...) suggest that this general line of reasoning employs a double standard. (shrink)

Activists’ investigations of animal cruelty expose the public to suffering that they may otherwise be unaware of, via an increasingly broad-ranging media. This may result in ethical dilemmas and a wide range of emotions and reactions. Our hypothesis was that media broadcasts of cruelty to cattle in Indonesian abattoirs would result in an emotional response by the public that would drive their actions towards live animal export. A survey of the public in Australia was undertaken to investigate their reactions and (...) responses to. The most common immediate reaction was feeling pity for the cattle. Women were more likely than men to feel sad or angry. Most people discussed the media coverage with others afterwards but fewer than 10 % contacted politicians or wrote to newspapers. We conclude that the public were emotionally affected by the media coverage of cruelty to cattle but that this did not translate into significant behavioral change. We recommend that future broadcasts of animal cruelty should advise the public of contact details for counseling and that mental health support contacts, and information should be included on the websites of animal advocacy groups to acknowledge the disturbing effect animal cruelty exposes can have on the public. (shrink)

Do the conditions under which promises are made determine whether they ought to be kept? Philosophers have placed a number of conditions on promising which, they hold, must be met in order to make promise‐keeping obligatory. In so doing, they have distinguished valid promises from invalid promises and justified promises from promises that are not justified. Considering such conditions, one by one, we argue that they are mistaken. In the first place, the conditions they lay down are not necessary for (...) either valid or justified promise‐making. In the second place, promises need not meet such conditions in order to create moral obligations. In general, such analyses of promising fail because they suffer from a confusion between promise‐making and promise‐keeping. Philosophers have wrongly supposed that obligations to keep promises are dependent upon, or derivable from, the quality of the promises themselves, at the time they are made, instead of focusing on conditions that must be satisfied at the time when promises are supposed to be kept. It is not the quality of a promise that determines an obligation to keep it but the rightness or wrongness of performing the promised act. (shrink)

It is widely assumed that disability is typically a bad thing for those who are disabled. Our purpose in this essay is to critique this view and defend a more nuanced picture of the relationship between disability and well-being. We first examine four interpretations of the above view and argue that it is false on each interpretation. We then ask whether disability is thereby a neutral trait. Our view is that most disabilities are neutral in one sense, though we cannot (...) make simple generalizations about disability's relationship to well-being in other important senses. After defending this view, we discuss its practical implications for selective abortion for disability, nondisabled people's interactions with disabled people, and the use of QALYs in health policy. (shrink)

Waiting time is widely used in health and social policy to make resource allocation decisions, yet no general account of the moral significance of waiting time exists. We provide such an account. We argue that waiting time is not intrinsically morally significant, and that the first person in a queue for a resource does not ipso facto have a right to receive that resource first. However, waiting time can and sometimes should play a role in justifying allocation decisions. First, there (...) is a duty of fairness prohibiting line-cutting where a sufficiently just queue exists. Second, waiting time has several morally attractive features that can justify its incorporation into allocation schemes. Where candidates are in relevantly similar circumstances, allocating by waiting time is relatively efficient, maximizes distribution equality relative to other Pareto efficient distributions, and treats candidates fairly. The claim that allocation using waiting time is fair is controversial. Some have claimed that formal lotteries are a fairer way to select among equal beneficiaries. We argue that lotteries are no fairer than allocation based on waiting time when it is equiprobable how a prospective queue will be ordered. In practice, lotteries share many of the disadvantages of queues; which is fairer will depend on contingent features of the allocation scenario. The upshot is that first-come, first-served is in fact a just way to allocate resources in many of the cases where it seems pre-theoretically compelling, and waiting time has unique normative properties which frequently justify its incorporation into resource allocation schemes. (shrink)

Pavlovian cues predict the occurrence of motivationally salient outcomes, thus serving as an important trigger of approach and avoidance behavior. The amygdala is a key substrate of Pavlovian conditioning, and the nature of its contribution varies by the motivational valence of unconditioned stimuli. The literature on aversive Pavlovian learning supports a serial-processing model of amygdalar function, while appetitive studies suggest that Pavlovian associations are processed through parallel circuits in the amygdala. It is proposed that serial and parallel forms of information (...) processing can be attributed to differential recruitment of amygdalar nuclei, with emphasis placed on the lateral amygdala. (shrink)

The COVID-19 pandemic that struck New York City in the spring of 2020 was a natural experiment for the clinical ethics services of NewYork-Presbyterian (NYP). Two distinct teams at NYP’s flagship academic medical centers—at NYP/ Columbia University Medical Center (Columbia) and NYP/ Weill Cornell Medical Center (Weill Cornell)—were faced with the same pandemic and operated under the same institutional rules. Each campus used time as an heuristic to analyze our collective response. The Columbia team compares consults during the pandemic with (...) the same period during the year prior. The Weill Cornell service describes the phases of the pandemic to depict its temporal evolution and subsequent ethical challenges. Both sites report that the predominant ethical challenges centered around end-of-life decision making, setting goals of care, and medical futility, all complicated by resource allocation questions and the ambiguity of state law under crisis standards of care. The Columbia campus saw a statistically significant increase in ethics consultations provided to Hispanic patients, perhaps reflective of the disproportionate burden of COVID-19 suffered by this demographic. While Weill Cornell and Columbia saw a surge in clinical ethics consultations, the two services assumed a more expansive role than one normally played in institutional life. Serving as intermediaries between frontline clinicians and senior hospital administrators, consultants provided critical intelligence to hospital leadership about the evolution of the pandemic, disseminated information to clinicians, and attended to the moral distress of colleagues who were asked to provide care under truly extraordinary circumstances. The COVID-19 surge in New York City revealed latent capabilities in ethics consultation that may prove useful to the broader clinical ethics community as it responds to the current pandemic and reconceptualizes its potential for future service. (shrink)

This volume brings together some of the most distinguished thinkers in the field of theology to consider the question of the meaning of life in the various global religions.

One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the ’QALY trap’: we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all (...) are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination. (shrink)