One of the most pervasive messages in modern advertising, both public and private, is that good health is something to strive for. Thus, the condition of our bodies and how the medical fraternity can impact on us is never far from our thoughts. Central to this interaction between doctor, patient, and society is a core group of terms that frame our discussions of sickness and health. Of particular interest to philosophers of medicine, the way we use and recognise the differences (...) between these terms has implications for how we decode the medical encounter. In this essay, three terms, disease, illness, and symptoms will be analysed to develop an argument for the continued separation and appreciation of them as distinct, although imbricated, concepts crucial to the performance of modern medicine. (shrink)

When patients have progressive and incurable dementia, should their advance directives always be followed? Contra Dworkin, Dresser argues that when patients remain able to enjoy and participate in their lives, directives to hasten death should sometimes be disregarded.

It is unclear whether someone’s responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, if responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we indicate here (...) what paying more attention to the diachronic and dyadic aspects of responsibility might involve and what implications this could have for assessments of responsibility for health-related behaviour. (shrink)

I defend a novel view of how social kinds (e.g., money, women, permanent residents) depend on our mental states. In particular, I argue that social kinds depend on our mental states in the following sense: it is essential to them that they exist (partially) because certain mental states exist. This analysis is meant to capture the very general way in which all social kinds depend on our mental states. However, my view is that particular social kinds also depend on our (...) mental states in more specific ways—some of them causal, others metaphysical. I defend a minimal but metaphysically important notion of essence—one that takes as primary that the essential properties of a kind constitute its identity—and argue that this minimal notion of essence is all that is needed to vindicate my claim that social kinds are essentially mind-dependent. (shrink)

The goal of this paper is to give an account of the pragmatic and social function of slurs, taken as speech acts. I develop a theory of the distinctive illocutionary force and pragmatic structure of slurs. I argue that slurs help to produce subjects who occupy social identities carved out by pernicious ideologies, and that they do this whether or not anyone involved intends for the slur to work that way or has any particular feelings or conscious thoughts associated with (...) using or being targeted by the slur. I offer an Althusser‐inspired account of what an ideology is, as well as of the mechanisms by which slurs can serve to cue and strengthen ideologies. A slur, I argue, is a kind of interpellation, which reduces its target to a generic identity and derogates and subordinates its target. I explore how slurs and ideologies work in tandem to constitute and fortify one another. I end by applying my account to see how well it fits and helps illuminate three quite different, especially complex slurs. (shrink)

Mass Hysteria examines the medical and cultural practices surrounding pregnancy, new motherhood, and infant feeding. Late eighteenth century transformations in these practices reshaped mothers' bodies, and contemporary norms and routines of prenatal care and early motherhood have inherited the legacy of that era. As a result, mothers are socially positioned in ways that can make it difficult for them to establish and maintain healthy and safe boundaries and appropriate divisions between public and private space.

The principle of informed consent obligates physicians to explain possible side effects when prescribing medications. This disclosure may itself induce adverse effects through expectancy mechanisms known as nocebo effects, contradicting the principle of nonmaleficence. Rigorous research suggests that providing patients with a detailed enumeration of every possible adverse event—especially subjective self-appraised symptoms—can actually increase side effects. Describing one version of what might happen (clinical “facts”) may actually create outcomes that are different from what would have happened without this information (another (...) version of “facts”). This essay argues that the perceived tension between balancing informed consent with nonmaleficence might be resolved by recognizing that adverse effects have no clear black or white “truth.” This essay suggests a pragmatic approach for providers to minimize nocebo responses while still maintaining patient autonomy through “contextualized informed consent,” which takes into account possible side effects, the patient being treated, and the particular diagnosis involved. (shrink)

Temporariness has become the norm in contemporary refugee protection. Many refugees face extended periods of time waiting for permanent status, either in camps or living among citizens in their state of asylum. Whilst this practice of keeping refugees waiting is of benefit to states, I argue that not only is it harmful to refugees but it also constitutes an injustice. First, I outline the prevalence of temporary assistance in the refugee protection regime. Second, I outline the orthodox view on temporary (...) refugee protection – it is acceptable as long as it is not indefinite. I then spend the remainder of the article considering four arguments against temporary refugee protection: the plan argument, the reciprocity argument, the domination argument, and the compounding injustice argument. I contend that the first two arguments, which already feature in the literature, merely show that temporary protection is harmful to refugees. My own arguments on domination and compounding injustice show, instead, that giving refugees temporary protection constitutes an injustice. The domination argument allows us to critique the current practice of temporary refugee protection, whereas the compounding injustice argument shows that temporariness in any form constitutes an injustice. (shrink)

The standard bioethics account is that respecting patient autonomy means ensuring that patients make their own decisions, and that requires that they give informed consent. In fact, respecting autonomy often has more to do with the overall shape and meaning of their health care regimes. Ideally, patients will sometimes take control of their health care but sometimes defer to medical authority. The physician's task is, in part, to inculcate patients into the appropriate good health care regimes.

I develop and defend the following neo-Aristotelian account of supererogation: an action is supererogatory if and only if it is overall virtuous and either the omission of an overall virtuous action in that situation would not be overall vicious or there is some overall virtuous action that is less virtuous than it and whose performance in its place would not be overall vicious. I develop this account from within the virtue-ethical tradition. And I argue that it is intuitively defensible and (...) fully compatible with the doctrine of the mean. (shrink)

Questions of what a self-driving car ought to do if it encounters a situation analogous to the ‘trolley problem’ have dominated recent discussion of the ethics of self-driving cars. This paper argues that this interest is misplaced. If a trolley-style dilemma situation actually occurs, given the limits on what information will be available to the car, the dynamics of braking and tyre traction determine that, irrespective of outcome, it is always least risky for the car to brake in a straight (...) line rather than swerve. (shrink)

What role does audience uptake play in determining whether a speaker refuses or consents to sex? Proponents of constitution theories of uptake argue that which speech act someone performs is largely determined by their addressee’s uptake. However, this appears to entail a troubling result: a speaker might be made to perform a speech act of sexual consent against her will. In response, we develop a social constitution theory of uptake. We argue that addressee uptake can constitute a speaker’s utterance of (...) ‘no’ as a speech act of consent under some conditions, but that this does not prevent us from judging that an addressee committed rape. Second, we claim that addressee uptake is not the only form of uptake that matters—the uptake of other members of the discursive community matters too, and can override the addressee’s uptake, constituting the speaker’s utterance as the speech act it was intended to be. (shrink)

Epistemologists generally think that genuine warrant that is available to anyone must be available to everyone who is exposed to the relevant causal inputs and is able and willing to properly exercise her rationality. The motivating idea behind this requirement is roughly that an objective view is one that is not bound to a particular perspective. In this paper I ask whether the aperspectivality of our warrants is a precondition for securing the objectivity of our claims. I draw upon a (...) Sellarsian account of perception in order to argue that it is not; rather, inquirers can have contingent properties and perspectives that give them access to forms of rational warrant and objective knowledge that others do not have. The universal accessibility of reasons, on my account, is not a precondition for the legitimacy of any actual warrant, but rather a regulative ideal governing inquiry and communication. (shrink)

We consider the current debate between bioconservatives and their opponents—whom we dub bioliberals—about the moral acceptability of human enhancement and the policy implications of moral debates about enhancement. We argue that this debate has reached an impasse, largely because bioconservatives hold that we should honour intuitions about the special value of being human, even if we cannot identify reasons to ground those intuitions. We argue that although intuitions are often a reliable guide to belief and action, there are circumstances in (...) which they are not reliable. Intuitions—including intuitions about enhancement—are subject to various cognitive biases rendering them unreliable in some circumstances. We argue that many bioconservative intuitions about enhancement are examples of such unreliable intuitions. Given this, it is unrealistic of bioconservatives to expect others to rely on their unexamined intuitions. Furthermore, refusing to engage in debates about the reasons and values that underpin their intuitions about enhancement will have the effect of making bioconservative voices less relevant in policy debates about enhancement than they would otherwise be. (shrink)

This history of philosophy is a history of men. Or at least, that’s how it has been told over the past several hundred years. But, over the last few decades, we’ve begun to see more and more recognition of women philosophers and the huge impact that they have had on the course of our discipline. There have always been philosophers who happened to be women. Hypatia of Alexandria was known by her contemporaries simply as The Philosopher, and hundreds of young (...) men travelled from throughout the region to attend her public lectures. Philosophers who happen to be women, then, are nothing new. But our failure to recognise them as full contributors to the subject makes them appear to us as something of a surprise. A result of this is that women are often remembered as women first: they are seen more as women than they’re seen as philosophers. (shrink)

Many people are worried about developing dementia, fearing the losses and burdens that accompany the condition. Dementia‐specific advance directives are intended to address dementia's progressive effects, allowing individuals to express their treatment preferences for different stages of the condition. But enthusiasm for dementia‐specific advance directives should be tempered by recognition of the legal, ethical, and practical issues they raise. Dementia‐specific advance directives are a simplistic response to a complicated situation. Although they enable people to register their future care preferences, in (...) many cases, those preferences will not, and should not, determine their later care. (shrink)

Most of us have moral heroes--people such as Mother Teresa or Gandhi--who have dedicated their lives to making the world a better place. We admire such people, and may even seek to become more like them. But at the same time, we don't believe that anyone who falls short of their example is thereby bad or evil. We believe, in other words, both in the importance of moral ideals and exemplars and in the possibility of goodness short of perfection. This (...) book aims to give a rigorous philosophical account and defense of these claims from within a broadly Neo-Aristotelian perspective. (shrink)

The Principle of Procreative Beneficence claims that we have a moral obligation, where choice is possible, to choose to create the best child we can. The existence of this moral obligation has been proposed by John Harris and Julian Savulescu and has proved controversial on many levels, not least that it is eugenics, asking us to produce the best children we can, not for the sake of that child's welfare, but in order to make a better society. These are strong (...) claims that require robust justification that can be open to scrutiny and debate. This article argues that robust justifications are currently lacking in the work of Savulescu and Harris. The justifications provided for their conclusions about this obligation to have the best child possible rely heavily on Derek Parfit's Non-Identity Problem and the intuitive response this provokes in many of us. Unfortunately Harris and Savulescu do not embrace the entirety of the Non-Identity Problem and the puzzle that it presents. The Non-Identity Problem actually provides a refutation of PPB. In order to establish PPB as a credible and defendable principle, Harris and Savulescu need to find what has eluded Parfit and many others: a solution to the Non-Identity Problem and thus an overturning of the refutation it provides for PPB. While Harris and Savulescu do hint at possible but highly problematic solutions to the Non-Identity Problem, these are not developed or defended. As a result their controversial is left supported by little more than intuition. (shrink)

Our society currently faces many complex and perplexing issues related to biotechnology, including the need to define the outer boundaries of genetic research on human beings and the need to protect individual and group rights to human tissue and the knowledge gained from the study of that tissue. Scientists have increasingly become interested in studying so-called “population isolates” to discover the nature and location of genes that are unique to particular groups. Indigenous peoples are often targeted by scientists because “the (...) relative isolation of the communities ensures minimal gene flow.” Such studies raise a number of issues related to privacy rights, property rights, informed consent, and group rights versus individual rights. These issues recently came to light in a case brought by the Havasupai Tribe and its members over the use of blood samples, handprints, and genealogy information initially taken by researchers at Arizona State University for a diabetes project. These materials were then allegedly used by researchers at ASU and other institutions for a multitude of unauthorized purposes, including research into the frequency of mental health disorders and the origin of human populations. Consequently, the affected members sued for damages under several legal theories. However, underlying all of these claims was the allegation that this unauthorized use of genetic resources and data not only injured the individuals who gave samples, but also caused a collective harm to the Havasupai Tribe and the cultural and spiritual beliefs of its members. (shrink)

Lynne Rudder Baker, Saving Belief: A Critique of Physicalism Princeton: Princeton University Press, 1987, xii + 177 pp. Daniel C. Dennett, The Intentional Stance Cambridge: MIT Press, 1987, xi + 388 pp. Paul M. Churchland, Matter and Consciousness Cambridge: MIT Press, revised edition, 1988, xii + 184 pp.

This investigation addresses the hypothesis that negative affect is associated with decreased ability to shift attention to a new focus. Thirty-nine participants completed a covert attentional orienting task and then viewed a distressing film clip. Mood was measured by self-report at the beginning and end of the session. Correlations between attentional orienting performance and self-reported mood indicated that participants with greater response time costs on invalidly cued trials reported more negative affect in response to the film. These results support the (...) hypothesis that negative affect is associated with a slowness to disengage attention. (shrink)

When Sandra Harding called for an epistemology of science whose systematic attention to the gendered Status of epistemic agents renders it ‘less partial and distorted’ than ‘traditional’ epistemologies, some commentators recoiled in horror. Propelled by ‘a mad form of the genetic fallacy’ they said, she descends ‘the slide to an arational account of science.’ On a less melodramatic reading, feminist epistemologies such as Harding's advocate not irrationalism, but senses of rationality more expanded than those which they associate with ‘traditional’ epistemology.

: The way patients make health care decisions is much more complicated than is often recognized. Patient autonomy allows both that patients will sometimes defer to clinicians and that they should sometimes be active inquirers, ready to question their clinicians and do some independent research. At the same time, patients' active inquiry requires clinicians' support.

Thomas Reid draws a distinction between the social and solitary operations of mind—acts of mind that require other intelligent beings versus those that may performed on one’s own. Yet his distinction obscures the irreducibly social character of the solitary operations. This paper preserves Reid’s distinction while accommodating the social character of the solitary operations. According to Reid, the solitary operations presuppose the social operations, expressed in what he calls the ‘natural language’ of mankind—a language that communicates the intentions that give (...) rise to the agreements by which the conventions of artificial languages are developed. Using artificial languages, we begin to sort the world into kinds and to anticipate the regular events that make a practical difference in our lives, providing the general conceptions that give our trains of thought the order and regularity required to form the solitary operations. By using artificial languages, we adapt social operations to solitary ends, to think alone and in silence. (shrink)

An important branch of environmental theory frames the climate crisis as a moral problem in need of a moral solution: human hubris is responsible for environmental degradation and must be atoned for through humility. Politically indeterminate, however, such argumentation is vulnerable to de-politicizing and mal-politicizing capture. In an effort to fend off the threat of either, this paper turns to the history of political thought and Jean-Jacques Rousseau, who theorized the environment as both a moral and a political domain. I (...) examine how Rousseau understood the availability of republican self-rule to be contingent both on the natural environment and on the relationship we construct with it such that freedom, in his words, is not automatically ‘a fruit of every Clime.’ This is the case, he suggests, because of the environment’s intersection with political economy and political culture. At the same time, Rousseau contends, republican self-rule is also a moral practice; republican polities afford citizens a public means of achieving and exercising moral agency. Triangulating the relationship between polity, morality, and environment, Rousseau’s thought offers an integrative logic through which to imbue the environment with both moral and political salience, thereby circumventing the dangers of mere moralization alone. (shrink)

: The principle of equipoise traditionally is grounded in the special obligations of physician-investigators to provide research participants with optimal care. This grounding makes the principle hard to apply in contexts with limited health resources, to research that is not directed by physicians, or to non-therapeutic research. I propose a different version of the principle of equipoise that does not depend upon an appeal to the Hippocratic duties of physicians and that is designed to be applicable within a wider range (...) of research contexts and types—including health services research and research on social interventions. I consider three examples of ethically contentious research trials conducted in three different social settings. I argue that in each case my version of the principle of equipoise provides more plausible and helpful guidance than does the traditional version of the principle. (shrink)

As knowledge increases about the human genome,prenatal genetic testing will become cheaper,safer and more comprehensive. It is likelythat there will be a great deal of support formaking prenatal testing for a wide range ofgenetic disorders a routine part of antenatalcare. Such routine testing is necessarilycoercive in nature and does not involve thesame standard of consent as is required inother health care settings. This paper askswhether this level of coercion is ethicallyjustifiable in this case, or whether pregnantwomen have a right to (...) remain in ignorance ofthe genetic make-up of the fetus they arecarrying. While information gained by genetictesting may be useful for pregnant women whenmaking decisions about their pregnancy, it doesnot prevent harm to future children. It isargued that as this kind of testing providesinformation in the interests of the pregnantwomen and not in the interests of any futurechild, the same standards of consent that arenormally required for genetic testing should berequired in this instance. (shrink)

Is it conceptually possible for an event, L, to be the cause of an earlier event, E? Some writers have employed the so-called bilking argument to attempt to show that the idea of such backwards causation is incoherent . According to this argument, if we are presented with what someone claims to be a case of backwards causation, it would be possible in principle to wait for E to occur, and then intervene to prevent the occurrence of L, thus demonstrating (...) that E could not have been caused by L after all. Moreover, if our attempts to bilk L-type events having observed E-type events always fail, we have grounds to argue that any causal relationship between the two is not one of backwards causation, but of ordinary, forwards, earlier-to-later causation.Does the bilking argument succeed in showing backwards causation to be incoherent? Before answering this question, let us deal with a far simpler reason for deeming backwards causation incoherent, whose elucidation now will be useful later. To those attracted to the view that temporal order is determined by causal order, 1 backwards causation may seem incoherent because on this view a cause is by definition earlier than its effect. I do not take issue with this view, and wish my conception of backwards causation to be compatible with it. 2 By ‘backwards causation’, I mean causation that runs in the opposite direction to some other causal processes, such that the temporal order entailed by such backwards causation is the reverse of that entailed by those other causal processes. In most philosophical discussions of backwards causation, we are at least implicitly given reasons to believe that these other causal processes dictate the …. (shrink)

Luce Irigaray's project elaborates an original concept of sexual difference. While this concept is widely discussed in feminist philosophy, there are multiple readings of sexual difference and some of these are contradictory. This essay surveys the various readings of sexual difference in English. Foci include the debate over the status of essentialism, ontology, and the controversy over the primacy of sexual difference, including discussion of whether her oeuvre marginalizes differences of race and sexuality. I conclude by arguing that her thinking (...) of difference is open to the future and non-totalisable in principle. This means that, difference, the concept at the heart of her thinking of sexual difference, cannot be primarily oriented toward engendering sexual difference because it is necessarily open to engendering relations that cannot be predicted. (shrink)

Some research is too risky to be conducted on anyone whose life expectancy is more than a few hours. Yet sometimes, the research can still be carried out using subjects who are brain dead or are soon to undergo a terminal wean, and who have articulated values that inclusion in the study can honor. So argues a team of ethicists and researchers at M.D. Anderson Cancer Center, where such research was recently undertaken.

Heidegger’s engagement with the poet Friedrich Hölderlin often dwells on the issue of temporality. For Heidegger, Hölderlin is the most futural thinker (zukünftigster Denker) whose poetry is necessary for us now and must be wrested from being buried in the past. Heidegger frames his reading of Hölderlin in terms of past, present, and future and, more importantly, describes him as being able to poetize time. This paper examines what it means to poetize time and why Hölderlin’s poetry in particular allows (...) us to understand temporality as the interplay of presence and non-presence. (shrink)

Charles S. Peirce’s and Sigmund Freud’s theories may be used to interpret Jean Cocteau’s film La Belle et la Bête (1946). This film has a specific set of codes which connote its filmic language. Cocteau uses fetishistic objects as symbols and icons to reflect the psychological meaning of the film’s narrative. Peirce’s icons and symbols include the connection a person may make through the conventions and expressions of language a person links with the object or idea being observed. Peirce’s semiotic (...) theory functions as a theory of communication. His theory refocuses on culture. Freud’s theories can be linked with ideas produced by Peirce in forming sign relations with the interpretation of the film and the role of imagination in the film. Especially important are Freud’s ideas of repression, conscious and unconscious as they relate to Cocteau’s filmic narrative and the film’s main character Belle. (shrink)

The girl under the age of 16 is said to have been left distraught after her avatar - her digital character - was gang raped by the online strangers.

Purpose: We sought to examine the ethical, legal, and social implications (ELSI) literature research and scholarship types, topics, and contributing community fields of training as a first step to charting the broader ELSI community’s future priorities and goals. Methods: We categorized 642 articles and book chapters meeting inclusion criteria for content in both human genetics or genomics and ethics or ELSI during a 5-year period (2003–2008) according to research and scholarship types, topics, and the area of advanced training of the (...) first-listed author. Research and scholarship type categories were developed and characterized through in-depth review of 95 randomly sampled publications from the larger group. Results: There is a single dominant approach to ELSI, which focuses on ethical and other social issues “downstream” of advances in genomics, the contributors to which predominately have advanced training in medicine or science fields other than social science. A comparatively low percentage of publications primarily offer policy recommendations, and these are much more likely to be written by those with advanced training in law than is the case for the literature as a whole. Social science studies predominately employ qualitative methods and vary significantly with respect to the extent and types of recommendations offered. Two further types of ELSI research and scholarship offer alternative models for so-called “normative” work in this field. Conclusion: Considering topics, training, and types of ELSI research and scholarship from the most recent past allows for a baseline perspective that is sorely needed in charting this field’s future course. (shrink)

This paper will consider the extent to which patients' dependence on clinical expertise when making medical decisions threatens patient autonomy. I start by discussing whether or not dependence on experts isprima facietroubling for autonomy and suggest that it is not. I then go on to consider doctors' and other healthcare professionals' status as ‘medical experts’ of the relevant sort and highlight a number of ways in which their expertise is likely to be deficient. I then consider how this revised picture (...) of medical expertise should lead us to view the potential threat to patient autonomy that results from depending on such ‘experts’. I argue that, whether or not patients are aware of the limitations of medical expertise, in practice it is difficult to do other than defer to medical advice, and this presents a threat to patient autonomy that should be addressed. I conclude by suggesting some ways in which this threat to autonomy might be mitigated. (shrink)

Returning genetic research results to relatives raises complex issues. In order to inform the U.S. debate, this paper analyzes international law and policies governing the sharing of genetic research results with relatives and identifies key themes and lessons. The laws and policies from other countries demonstrate a range of approaches to balancing individual privacy and autonomy with family access for health benefit, offering important lessons for further development of approaches in the United States.

Who is it that can tell me who I am?The often-complex interplay between self and others characterizes educational undertakings. Considerations of how we gain knowledge involve, at least implicitly, an understanding of the relationship between self, others, and the material environment in which learning occurs. The Academy-Award-winning 1987 film Babette’s Feast, based on the 1950 short story by Isak Dine-sen, while not formally a story of education, presents through its protagonist a pedagogy that highlights learning through encounter as complementary and (...) integral to enhanced and mature knowledge. In this article, I engage closely with the film version of Babette’s Feast to elucidate its educational... (shrink)

In this paper, I argue that although it is important to attend to injustices surrounding women's epistemic exclusions, it is equally important to attend to injustices surrounding women's epistemic inclusions. Partly in response to the historical exclusion of women's knowledge, there has been increasing effort among first-world actors to seek out women's knowledge. This trend is apparent in efforts to mainstream gender in climate change negotiation. Here, one is told that women's superior knowledge about how to adapt to climate change (...) makes them “poised to help solve and overcome this daunting challenge.” Pulling from the work of Miranda Fricker, I argue that such claims risk epistemically objectifying women. To illuminate the risk of women's epistemic objectification in climate change discourse, I offer a feminist analysis of current efforts to seek women's environmental knowledge, cautioning throughout that such efforts must reflect just epistemic relations. (shrink)