Ever since medical assistance in dying (MAID) became legal in Canada in 2016, controversy has enveloped the refusal by many faith‐based institutions to allow this service on their premises. In a recent article in this journal, Philip and Joshua Shadd have proposed ‘changing the conversation’ on this issue, reframing it as an exercise not of conscience but of an institutional right of self‐governance. This reframing, they claim, will serve to show how health‐care institutions may be justified in refusing (...) to provide MAID on moral or religious grounds. I argue that it will not make it easier to justify institutional refusal, and is likely to make it harder. (shrink)

Background: Ideas of patient involvement are related to notions of self-determination and autonomy, which are not always in alignment with complex interactions and communication in clinical practice. Aim: To illuminate and discuss patient involvement in routine clinical care situations in nursing practice from an ethical perspective. Method: A case study based on an anthropological field study among patients with advanced cancer in Denmark. Ethical considerations: Followed the principles of the Helsinki Declaration. Findings: Two cases illustrated situations where nurses refused patient (...) involvement in their own case. Discussion: Focus on two ethical issues, namely ‘including patients’ experiences in palliative nursing care’ and ‘relational distribution of power and knowledge’, inspired primarily by Hannah Arendt’s concept of thoughtlessness and a Foucauldian perspective on the medical clinic and power. The article discusses how patients’ palliative care needs and preferences, knowledge and statements become part of the less significant background of nursing practice, when nurses have a predefined agenda for acting with and involvement of patients. Both structurally conditioned ‘thoughtlessness’ of the nurses and distribution of power and knowledge between patients and nurses condition nurses to set the agenda and assess when and at what level it is relevant to take up patients’ invitations to involve them in their own case. Conclusion: The medical and institutional logic of the healthcare service sets the framework for the exchange between professional and patient, which has an embedded risk that ‘thoughtlessness’ appears among nurses. The consequences of neglecting the spontaneous nature of human action and refusing the invitations of the patients to be involved in their life situation call for ethical and practical reflection among nurses. The conditions for interaction with humans as unpredictable and variable challenge nurses’ ways of being ethically attentive to ensure that patients receive good palliative care, despite the structurally conditioned logic of healthcare. (shrink)

Freedom of Conscience and Freedom of Religion should be taken to protect two distinct sets of moral considerations. The former protects the ability of the agent to reflect critically upon the moral and political issues that arise in her society generally, and in her professional life more specifically. The latter protects the individual's ability to achieve secure membership in a set of practices and rituals that have as a moral function to inscribe her life in a temporally extended narrative. Once (...) these grounds are distinguished, it becomes more difficult to grant healthcare professionals' claims to religious exemptions on the basis of the latter than it is on the basis of the former. While both sets of considerations generate ‘internal reasons’ for rights to accommodation, the relevant ‘external’ reasons present in the case of claims of moral conscience do not possess analogues in the case of claims of religious conscience. However, the argument applies only to ‘irreducibly religious’ claims, that is to claims that cannot be translated into moral vocabulary. What's more, there may be reasons to grant the claims of religious persons to exemptions that have to do not with the nature of the claims, but with the beneficial effects that the presence of religious persons may have in the context of the healthcare institutions of multi-faith societies. (shrink)

In bioethics vaccine refusal is often discussed as an instance of free riding on the herd immunity of an infectious disease. However, the social science of vaccine refusal suggests that the reasoning behind refusal to vaccinate more often stems from previous negative experiences in healthcare practice as well as deeply felt distrust of healthcare institutions. Moreover, vaccine refusal often acts like an exit mechanism. Whilst free riding is often met with sanctions, exit, according to Albert Hirschman’s (...) theory of exit and voice is most efficiently met by addressing concerns and increasing the quality and number of feedback channels. If the legitimate grievances responsible for vaccine refusal are not heard or addressed by healthcare policy, further polarization of attitudes to vaccines is likely to ensue. Thus, there is a need in the bioethics of vaccine refusal to understand the diverse ethical questions of this inflammable issue in addition to those of individual responsibility to vaccinate. (shrink)

The Swedish solution to the legal handling of professional conscientious refusal in healthcare is described. No legal right to conscientious refusal for any profession or class of professional tasks exists in Sweden, regardless of the religious or moral background of the objection. The background of this can be found in strong convictions about the importance of public service provision and related civic duties, and ideals about rule of law, equality and non-discrimination. Employee's requests to change work tasks are (...) handled on a case-by-case basis within the frames of labour law, ensuring full voluntariness, and also employer's privilege regarding the organisation and direction of work, and duties of public institutions to provide services. Two complicating aspects of this solution related to the inclusion of ‘alternative medical’ service providers in a national health service, and professional insistence on conscientious refusal rights to accept legalised assisted dying are discussed. The latter is found to undermine the pragmatic reasons behind recent attempts by prolife groups to challenge the Swedish solution related to legal abortion in courts. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 44, no. 2. © 2018 by Feminist Studies, Inc. 333 Michelle V. Rowley, Elora Halim Chowdhury, and Isis Nusair Refusing to Account: Toward a Pedagogy of Tectonic Instability The increasing commoditization of knowledge and corporatization of the academy have led to a drastic restructuring of higher education, and in particular, of public institutions of learning. There is a striking similarity to the strategies enacted across institutions, each (...) governed by modes of efficiency and profitability. These moves have included a preference for larger classes, curriculum decisions that are governed by seats rather than pedagogical possibilities, an expansion of online offerings, tuition increases, and ramped-up bureaucratization, with the latter being accompanied by fewer faculty hires, a greater dependence on contingent faculty, and a swell in the ranks of senior administrative staff. This restructuring has held very specific consequences for women ’s studies programs. While larger classes are not inherently at odds with a student-centered feminist pedagogy, they do require adjustments in order to achieve similar results with our students, and they do exact greater physical and emotional labor from us as instructors. These restructuring strategies have also positioned the field in a Catch22 in that a number of issues that we have lobbied to have valued within the academy have now come into the university’s line of vision only to be redeployed as part of the university’s public relations branding agenda. There are numerous examples if we would but look: campuses that are spotted with banners portraying faculty and students of color —a visual map to the institution’s “embrace of diversity”; committees 334 Michelle V. Rowley, Elora Halim Chowdhury, and Isis Nusair that are convened to review the institution’s sexual harassment policy while simultaneously refusing the involvement of women’s studies academics in the process, for whom these are scholarly and intellectual areas of study; the introduction of multicultural general education curricula, where the study of “difference” amounts to a banal presence of one or more categories of “otherness” in syllabi. This list is not exhaustive but the similarity that threads through is the commodification and the PR-ization of issues that sit at the heart of the field of women’s studies. Such cooptation notwithstanding, in this economic climate of profit maximization, small, interdisciplinary programs and departments such as women’s studies, ethnic studies, and LGBT studies have become woefully vulnerable to mergers, downsizing, and elimination.1 Our own program, now defunct, attests to this growing reality.2 So what then is the story to be told for a program that no longer exists? As alumna of Clark University’s now defunct women’s studies doctoral program, we consider the ways in which Clark, under the guidance of Cynthia Enloe, worked to move the field toward a more transnational bent. While we begin with an engagement with Clark’s specific institutional vulnerabilities, we use Clark’s commitment to a transnational praxis as our comparative point of departure to note the ways in which the importance and acuity of a transnational feminist critique have seeped away from the field. At various points in the article, we discuss how our individual trajectories emerged out of a transnational feminist sensibility. We interrogate the ways that the dominant logics of the field continue to be complicit with the very inequities and modes of representation critiqued within transnational feminist discourses. We point to the role that our scholarly pursuits play in an ongoing effort to hold the field accountable to a transnational feminist critique. Finally, 1. See Miranda Joseph, Debt to Society: Accounting for Life under Capitalism (Minneapolis, MN: University of Minnesota Press, 2014); and Chandra Talpade Mohanty, “Privatized Citizens, Corporate Academies, and Feminist Projects,” in Feminism without Borders: Decolonizing Theory, Practicing Solidarity (Durham, NC: Duke University Press, 2003). 2. The doctoral program at Clark began in 1992 and closed in 2008, graduating twenty-six PhDs and training many more who have gone on to make significant contributions at NGOs among other locations. For example, Parissara Liewkeat and Barbara Schulman have held positions with the International Labor Organization and Amnesty International, respectively. Michelle V. Rowley, Elora Halim Chowdhury, and Isis Nusair 335 we look back at our own training... (shrink)

Meeting appropriate ethical standards for research involving human participants, mean ensuring confidentiality. It is assumed that the research participant will accept the safeguarding protocols necessary to ensure confidentiality. This assumption however oversimplifies the variation of motivations that goes into participants’ decisions to participate in research. Drawing on reflections from my fieldwork experience in Ghana, I answer the questions: Why do research participants reject confidentiality? What ethical position can one take when the researcher and the researched have conflicting perspectives about confidentiality? (...) I contend that participants with personal stake refuse confidentiality when they want to be acknowledged for their data. Rejecting confidentiality is however, embedded in the individual perspective, cultural, and political context of the study area. The ethical concerns of such refusal can be ameliorated if confidentiality is nuanced to include six categorically distinct but mutually non-exclusive stages: research-planning, ongoing-information, writing-up, reality-after-research, differential-disseminations, and no-confidentiality-clause. The paper further argues that whilst maintaining institutional allegiance in this matter is crucial, employing confidentiality should lie at the intersection of participants’ motivation for taking part in the research, the socio-cultural-specific-context of the study location and the nature of the topic being explored. (shrink)

To address an ethics of refusal in higher education is to wager in the name of future possibles not already governed by the extractive politics of colonial progress and oppressive regimes of knowing and doing. In this essay, Petra Mikulan shows American pragmatism to have always been, in a certain sense, post-Anthropocene in its condition of emergence, bound up with settler colonialism and its extractive geopolitics. However, pragmatism in its speculative trust can also help engage education in thinking of (...) a future that does not belong to a presupposed humanity and its “nature” by dramatizing a certain insistence of educational institutions on maintaining comfort and trust in the “common good.” What is at stake in education facing planetary ecological devastation and intensified racial and social injustices, Mikulan contends, is an ethics of refusal of institutionalized learning, knowing, and doing tout court, particularly if these educational regimes continue to insist on governing what are deemed the only possible (and thus impossible) enactments of education. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Refusals of Treatment and Requests for DeathTom L. Beauchamp (bio)It would be hard to overestimate the importance of two decisions on physician-assisted suicide delivered recently by the Ninth and Second Circuit Courts (Compassion in Dying v. State of Washington, 79 F.3d 790 (9th Cir. 1996) (en banc), aff’g 850 F.Supp. 1454 (W.D. Wash. 1994), rev’g 49 F.3d 586 (9th Cir. 1995); Quill v. Vacco, 80 F.3d 716 (2nd Cir. (...) 1996). They are the highest courts yet to render an opinion on this subject, and their decisions have set the stage for the U.S. Supreme Court to take one of two paths: It will either say that (1) all citizens have a liberty interest in physician-assisted suicide, or that (2) each state may set its own policy on such matters. Whichever path is elected, a right to request physician-assisted suicide is a virtual certainty, at least in some states.These opinions are later segments of an evolving legal history in which courts have held that no criminal liability exists for withholding or withdrawing a life-sustaining treatment when physicians are directed to do so by a patient or an authorized surrogate (see Alan Meisel 1992). The decriminalization of suicide and the right to refuse a life-sustaining treatment now appear to be evolving into a rule that a patient has a legal right to control his or her death, or at least to obtain a lethal prescription. We are at a delicate point in this evolving history. Neither in law nor in bioethics is the justification of physician assistance in suicide the received opinion at the present time, but support for physician assistance in dying could soon become the received opinion in both disciplines.The leading edge of the wedge producing these changes has been widespread acceptance of an extensive right to refuse treatment. This right is today axiomatic in even conservative quarters of bioethics, but 20 years ago it was far from axiomatic that all patients have a right to refuse treatment. Few at that time judged that it would be both immoral and illegal for a physician not to forgo treatment in the face of a competent, authoritative refusal of any form of medical service or treatment.The justification for assistance in bringing about death in medicine is an extension of the justification for letting patients die. Letting a patient die by accepting a valid refusal to continue in life is directly analogous to helping a patient die by accepting a valid request for help. The high value we place on [End Page 371] rights of autonomy thereby spills over from the right to refuse to the underexplored right to request active assistance. 1 As the autonomy interest in this choice increases, denial of help to the patient becomes more burdensome.Those who defend the view that euthanasia and physician-assisted suicide are morally prohibited typically assume that assistance involves an act of killing, that acts of killing are impermissible, and that a defensible distinction exists between killing and letting die. However, this distinction has proved difficult to explicate, and the category of killing often seems distant from the problem at hand. For example, it is an eccentric view that a physician who prescribes a lethal medication to a patient thereby kills the patient (or, for that matter, lets the patient die) when the patient voluntarily ingests the medication and dies. So poor are the conceptual understandings of “killing” and “letting die” that conceptual confusion abounds as to which term to use in almost all morally difficult and controversial cases.A common view is that “letting die” is a matter of “ceasing useless treatments” after which patients die (Gaylin, Kass, Pellegrino, and Siegler 1988). This account is attractive, but too narrow. “Letting die” occurs in medicine under at least two circumstances: cessation of treatment because it is useless and cessation of treatment because it has been refused (which can occur even with useful treatments). Neither conceptually nor morally is “ceasing useless treatment” the proper way to state the condition under which many “letting-die” cases occur. It follows that the type of action—killing or letting... (shrink)

Catholic doctrine’s strict prohibition on abortion can lead clinicians or institutions to conscientiously refuse to provide abortion, although a legal duty to provide abortion would apply to anyone who refused. Conscientious refusals by clinicians to end a pregnancy can constitute murder or reckless homicide under American law if a woman dies as a result of such a refusal. Such refusals are not immunized from criminal liability by the constitutional right to the free exercise of religion or by statutes that (...) confer immunity from criminal homicide prosecution. Core principles of the rule of law require the state to protect the lives of all persons equally and to place the life and health of persons above any the interests of providers have in moral integrity or in respecting the moral status of prenatal humans. In some states criminal liability related to conscientious objection also applies to corporate hospital officials. (shrink)

Fritz argues that there is an “unjustified asymmetry” in legislation that allows physicians and health care institutions to refuse to provide elective abortions and other morally contested l...

The vignette described in the introduction of this symposium raises a number of ethical and legal problems for physicians who work for correctional institutions and death row inmates. They are not confined to correctional physicians, however, as states have requested aid from practicing physicians in the community, and even from other states, when conflicts have arisen in the treatment of death row inmates as they near the date of execution. As outlined, the case involves a 48-year-old man with a long (...) history of schizophrenia, initially diagnosed at age 19. Compliant with medication, he remained generally free from positive symptoms-delusions and hallucinations. Nonetheless, he committed two murders during a robbery and was sentenced to death. Since his incarceration, the defendant has consistently refused psychotropic medications and has been forcibly medicated on several occasions when he exhibited violent outbursts and was overtly psychotic. (shrink)

What consequences do poststructuralist theories of language have for feminist strategies addressing rape? In particular, what might be the fate of attempts to secure the meanings of certain words uttered by women in this context, such as ‘no’? Can we bracket off such statements from the agon of the juridico-linguistic domain in a manner that short-circuits all contest? In contrast, if we agree that such contest is an irrevocable component of the field in which feminist struggles take place, does this (...) mean we no longer need to attend to the destiny of women’s refusal before the law? This article will consider these questions in relation to the framing of refusal in a recent Australian sexual assault trial. I will suggest that a poststructuralist feminist strategy might turn to the political process of recontextualization that attends such utterances, in order to contest the institutional rewriting of rape as romance. (shrink)

Background Victoria was the first Australian state to legalize voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). Some institutions indicated they would not participate in voluntary assisted dying. The Victorian government issued policy approaches for institutions to consider Objective To describe and analyse publicly available policy documents articulating an institutional objection to voluntary assisted dying in Victoria. Methods Policies were identified using a range of strategies, and those disclosing and discussing the nature of an institutional objection (...) were thematically analysed using the framework method. Results The study identified fifteen policies from nine policymakers and developed four themes: (1) extent of refusal to participate in VAD, (2) justification for refusal to provide VAD, (3) responding to requests for VAD, and (4) appeals to state-sanctioned regulatory mechanisms. While institutional objections were stated clearly, there was very little practical detail in most documents to enable patients to effectively navigate objections in practice. Conclusion This study demonstrates that despite having clear governance pathways developed by centralized bodies (namely, the Victorian government and Catholic Health Australia), many institutions’ public-facing policies do not reflect this guidance. Since VAD is contentious, laws governing institutional objection could provide greater clarity and regulatory force than policies alone to better balance the interests of patients and non-participating institutions. (shrink)

One of the main contributions of A Feminist Theory of Refusal is its connection of everyday action and prefigurative practices with an explicit commitment to structural change. But how such change happens, and what kind of relations it implies between ‘the city’ (as the existing political community) and feminist heterotopias of refusal, remains unclear. Reading Honig’s work as a prefigurative theory, I argue that it links moments of doing-otherwise with moments of institutional politics, sparking questions about the (...) conditions of a successful return to the city. I then develop these conditions through a case study of the feminist activism of Women on Waves; and argue that feminist refusal can lead to political transformation if it durably connects practices inside and outside the city. (shrink)

This paper focuses on the possibility of sin as intellectual evil as operative in the contemporaneous culture in the debate over the essential nature of marriage and the accomplishment of the ends of marriage. It presents an account of theology as a science and the application of this understanding and its canons of operation to the issues presented in two recent documents—the Statement of the Wijngaards Institute for Catholic Research and the Affirmation of the Church’s Teaching on the Gift of (...) Sexuality, each of which addresses the encyclical Humanae vitae on the occasion of its 50th anniversary. The paper concludes with an examination of the essential nature of marriage to guide the fulfillment of its ends now described as intrinsic/essential and intrinsic/contingent. (shrink)

Contrary to the widespread opinion that in the Soviet period the Institute of Philosophy had been a mere citadel of ideological dogmatism, the author shows that even in the most oppressive periods of stagnation not only did the institute resist the imposition of this atmosphere, but it openly refused to take part in any campaign of condemnation or ideological reprisal against nonconformists, whether in philosophy, literature, economics, or politics. The reigning atmosphere in the institute at that time was one of (...) glasnost, open argument, and constructive discussion. And the mediator of such an environment was the institute's Communist Party chapter, which among other positive influences, provided the institute and its associates with real protection from Stalinism, hostility, and societal pressure. While in the country as a whole there had never been a civil society, the institute always possessed and actively displayed the key features of such an institution. The famous wall newspaper published at the institute was one sign of such its civic-social maturity. (shrink)

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level (...) of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection. (shrink)

It is argued that the primary aim of institutional management is to protect the moral integrity of health professionals without significantly compromising other important values and interests. Institutional policies are recommended as a means to promote fair, consistent, and transparent management of conscience-based refusals. It is further recommended that those policies include the following four requirements: (1) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s/surrogate’s timely access to information, counseling, and referral. (...) (2) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s timely access to health care services offered within the institution. (3) Conscience-based refusals will be accommodated only if the accommodation will not impose excessive burdens on colleagues, supervisors, department heads, other administrators, or the institution. (4) Whenever feasible, health professionals should provide advance notification to department heads or supervisors. Formal review may not be required in all cases, but when it is appropriate, several recommendations are offered about standards and the review process. A key recommendation is that when reviewing an objector’s reasons, contrary to what some have proposed, it is not appropriate to adopt an adversarial approach modelled on military review boards’ assessments of requests for conscientious objector status. According to the approach recommended, the primary function of reviews of objectors’ reasons is to engage them in a process of reflecting on the nature and depth of their objections, with the objective of facilitating moral clarity on the part of objectors rather than enabling department heads, supervisors, or ethics committees to determine whether conscientious objections are sufficiently genuine. (shrink)

I argue in this essay that the phenomena we classify as "mental illness" result largely from the refusal of socially authorized "experts" to recognize - and thus to constitute - the Other as a subject. I suggest that Institutional Mental Health refuses to do this not merely because it seeks to aggrandize its own power but also because it fears to acknowledge that we are all participants in a process of historical development. It denies this because it is (...) historically conditioned by its own moment of origin in the project of the Enlightenment, It is conseqently wed to an ethos of rationalized order that does not accomodate, much less support, the unpredictable creative power of the Other and that sustains instead the project of mastery, of domination, of disovering eternal laws that will enable Reason to master history and to master the Other. For this reason Institutional Mental Health and its diverse ideologies, ranging from the pyschoanalytic to genetic defect models, constitute a major obstacle to the evolution of humanity. (shrink)

Since 1991, the Patient Self-Determination Act (PSDA) has required all health care institutions that receive Federal funds to inform patients upon admission of their rights to make decisions about medical care and to execute advance directives. Implementation of the PSDA presents a special challenge for state mental hospitals. The relevance and possible negative therapeutic impact of discussing end of life decisions at the time of an acute psychiatric admission has recently been raised in the literature. Other ethical dilemmas arising from (...) the interplay between mental illness and informed consent for medical treatment, particularly for older patients committed to state mental hospitals, have been highlighted by the PSDA. In this article we discuss some of the issues raised by implementation of the PSDA in this setting. (shrink)

Institutions, if unjust, ought to be reformed or even abolished. This radical Rawlsian thought leads to the question of whether the family ought to be abolished, given its negative impact on the very possibility of delivering equality of life chances. In this article, we address questions regarding the justice of the family, and of marriage, and reflect on rights, equality, and the provision of social goods by institutions. There is a temptation to justify our social institutions in terms which highlight (...) their universal accessibility and benefits. But we may best understand the claim of some of our most important institutions where we recognize that they are forms of social good which may legitimately benefit some without having to benefit all. Their abolition is unjustified where there is sufficient value in them given our collective needs that it is unreasonable for some to refuse the means to maintain and promote these goods. (shrink)

As a concept, affordance is integral to scholarly analysis across multiple fields—including media studies, science and technology studies, communication studies, ecological psychology, and design studies among others. Critics, however, rightly point to the following shortcomings: definitional confusion, a false binary in which artifacts either afford or do not, and failure to account for diverse subject-artifact relations. Addressing these critiques, this article demarcates the mechanisms of affordance—as artifacts request, demand, allow, encourage, discourage, and refuse—which take shape through interrelated conditions: perception, dexterity, (...) and cultural and institutional legitimacy. Together, the mechanisms and conditions constitute a dynamic and structurally situated model that addresses how artifacts afford, for whom and under what circumstances. (shrink)

Sometimes the mentally ill have sufficient mental capacity to refuse treatment competently, and others have a moral duty to respect their refusal. However, those with episodic mental disorders may wish to precommit themselves to treatment, using Ulysses contracts known as “mental health advance directives.” How can health care providers justify enforcing such contracts over an agent’s current, competent refusal? I argue that providers respect an agent’s autonomy not retrospectively—by reference to his or her past wishes—and not merely synchronically—so (...) that the agent gets what he or she wants right now—but diachronically and prospectively, acting so that the agent can shape his or her circumstances as the agent wishes over time, for the agent will experience the consequences of providers’ actions over time. Mental health directives accomplish this, so they are a way of respecting the agent’s autonomy even when providers override the agent’s current competent refusal. (shrink)

The Institutional Animal Care and Use Committee is entrusted with assessing the ethics of proposed projects prior to approval of animal research. The role of the IACUC is detailed in legislation and binding rules, which are in turn inspired by the Three Rs: the principles of Replacement, Reduction, and Refinement. However, these principles are poorly defined. Although this provides the IACUC leeway in assessing a proposed project, it also affords little guidance. Our goal is to provide procedural and philosophical (...) clarity to the IACUC without mandating a particular outcome. To do this, we analyze the underlying logic of the Three Rs and conclude that the Three Rs accord animals moral standing, though not necessarily “rights” in the philosophical sense. We suggest that the Rs are hierarchical, such that Replacement, which can totally eliminate harm, should be considered prior to Reduction, which decreases the number of animals harmed, with Refinement being considered last. We also identify the need for a hitherto implicit fourth R: Reject, which allows the IACUC to refuse permission for a project which does not promise sufficient benefit to offset the pain and distress likely to be caused by the proposed research. (shrink)

At the 2021 conference of the Society for the Study of Christian Ethics, Linda Woodhead presented a paper entitled ‘Truth and Deceit in Institutions’. Amra Bone was then invited to deliver a response to this paper drawing on her knowledge of Islamic traditions and culture. This article is her response. The article highlights the importance the Qur’anic scripture gives to justice and neither distorting nor refusing to give testimony. It then briefly explores the Arabic term Kufr found in the Qur’an. (...) Whilst more commonly interpreted to mean disbelief, this term literally means hiding or covering up truth. Dishonesty can therefore be equated to disbelief which makes it a very serious matter for Muslims. Therefore ethics determine that the road to greater institutional honesty must be adopted. In Islamic Law the end does not justify the means; rather the outcome rests with God alone and the responsibility given to men and women is to act honestly and ethically. For any institution or society to develop positively, every individual must play their part and take this responsibility seriously and not to rely on a few courageous individuals. (shrink)

BackgroundAlthough animal research ethics committees are well established in Western countries, this field is weakly developed and its concept is poorly understood in the Middle East and North Africa region.ObjectiveOur main objective was to introduce the concept and requirements of ethical approaches in dealing with experimental animal in research and teaching in Egypt.MethodsDue to its very recent inception, Cairo University, Faculty of Science IACUC decided to operate in accordance with Guide for the Care and Use of Laboratory Animals 8th Edition (...) 2011 since Egypt has not yet compiled its own guide.ResultsFifty protocols were reviewed in 2013–2014. Only ten protocols were reviewed in 2013, but in 2014, forty protocols were reviewed. In 2013 all protocols were approved and in 2014, number of approvals were 35, the number of deferrals were 4, and one refused protocol. Master’s theses research protocols constituted the majority of the total reviewed protocols. This is attributed to the decision of the Board of the Faculty of Science, Cairo University in September, 2013 that the approval of the IACUC is mandatory before conducting any research involving animals or theses registration.ConclusionThe first IACUC was established in the Cairo University, Faculty of Science, since 2012. The challenges encountered by the committee were diverse, such as the absence of laws that control the use of animal models in scientific research, lack of guidelines and, mandatory ethical approval for any experimental animal research. (shrink)

Much debate has occurred as to whether or not moral responsibility should be ascribed to corporate entities. The present study advances the theory that moral responsibility is a self-imposed or attributable aspect of corporate operations which extends beyond the parameters established by law.In this context, the corporation must consciously endeavor to discharge its moral responsibility to avoid, minimize, eliminate and compensate for the potential or actual harm which its operations cause. To achieve this objective, consideration is given to the establishment (...) of a Moral Audit Committee, an internal monitoring mechanism, with a proposed generic structure. The corporate Mission Statement and Code of Ethics play a vital role as well in building an institutional environment which supports this self-appraisal process. With this system in place, the ambit of a Moral Audit is then examined. This study concludes with a case analysis, which partly depicts the Moral Audit process. (shrink)

A dogma accepted in many ethical, religious, and legal frameworks is that the reasons behind conscientious objection (CO) in healthcare cannot be evaluated or judged by any institution because conscience is individual and autonomous. This paper shows that this background view is mistaken: the requirement to reveal and explain the reasons for conscientious objection in healthcare is ethically justified and legally desirable. Referring to real healthcare cases and legal regulations, this paper argues that these reasons should be evaluated either ex (...) ante or ex post and defends novel conceptual claims that have not been analyzed in the debates on CO. First, a moral threshold requirement: CO is only justified if the reasons behind a refusal are of a moral nature and meet a certain threshold of moral importance. Second, this paper considers the rarely discussed conceptual similarities between CO in healthcare and the legal regulations concerning military refusals that place the burden of proof on conscientious objectors. This paper concludes that conscientious objection in healthcare can be accommodated only in some cases of destroying or killing human organisms. (shrink)

The aim of this article is to follow Honig's intention of thinking inoperativity as a form of refusal. It demonstrates that Agamben's inoperativity entails an intensification of use that can circumvent the pitfalls associated with the language of 'demands,' or the need to rescue the city as the space of the political par excellence, all while preserving its potential for instituting change. I claim that all destitution entails instituting practices and forms of experimentation that modify the subject, and that, (...) with the help of Agamben, subjects are nothing other than these modifications. The wager of this short intervention, therefore, is that a form of refusal that pays critical attention not only to the suspension but also to the intensification of use that this suspension inherently entails is attainable, all while acknowledging that the city is shaped by anti-blackness. (shrink)

Economic crisis emerges as a central feature of globalization and, in particular, of the structural instability of transnational capital circulation since the 1970s. The strategies of neoliberalism––deregulation, privatization, and expropriation of wealth toward the richer nations––redoubled the indebtedness of the global South and helped provoke debt crises in nations from Mexico in the 1980s and East Asia in the 1990s to Argentina, Iceland and Greece in the 2000s. Embedded as it almost always is within the global circuits of capitalist culture, (...) cinema has a particularly complex relationship to globalization: these economic shifts affect film funding, modes of production, and the institutions of international .. (shrink)

Background In June 2016, Canada legalized medical assistance in dying (MAiD). From the outset, some healthcare institutions (including faith-based and non-faith-based hospitals, hospices, and residential aged care facilities) have refused to allow aspects of MAiD onsite, resulting in patient transfers for MAiD assessments and provision. There have been media reports highlighting the negative consequences of these “institutional objections”, however, very little research has examined their nature and impact. Methods This study reports on findings from 48 semi-structured qualitative interviews conducted (...) with MAiD assessors and providers, MAiD team members (working to coordinate care and lead MAiD programs in institutions and health authorities), and family caregivers on their experiences with institutional objection. Participants were recruited from the Canadian provinces of British Columbia, Ontario, and Nova Scotia. Data were analyzed using inductive thematic analysis. Results Themes identified were: (1) basis for institutional objection (with objections commonly rooted in religious values and a particular philosophy of palliative care); (2) scope of objection (demonstrating a wide range of practices objected to); (3) lack of transparency regarding institutional position; (4) impacts on patients; (5) impacts on health practitioners; and (6) catalysts for change. Participants reported that many institutions’ objections had softened over time, lessening barriers to MAiD access and adverse impacts on patients and health practitioners. Participants attributed this positive change to a range of catalysts including advocacy by health practitioners and family members, policymaking by local health authorities, education, and relationship building. Nevertheless, some institutions, particularly faith-based ones, retained strong objections to MAiD, resulting in forced transfers and negative emotional and psychological impacts on patients, family members, and health practitioners. Conclusions This paper adds to the limited evidence base about the impacts of institutional objection and can inform practical and regulatory solutions in Canada and abroad. Reform is needed to minimize the negative impacts on patients, their caregivers, and health practitioners involved in MAiD practice. (shrink)

The World Trade Organisation, and the international trade regime within which it operates, is regularly evaluated in terms of distributive outcomes or opportunities. A less-established concern is the extent to which the institutional structure of the trade regime enables agents to exert control over the economic forces to which they’re subject. This oversight is surprising, as trade negotiations amongst states have profound impacts upon what options remain open to those states and their citizens in regulating their economies. This article (...) contributes to filling this lacuna in the literature. Following on from recent neo-republican work on global and international justice, it argues that a major problem with the WTO is that it fails to effectively mitigate the domination of some states by others within its negotiations. Such domination prevails despite the employment of negative consensus as a decision-making procedure. (shrink)

Conscientious refusal is distinguished by its peculiar attitude towards the obligations that the objector refuses: the objector accepts the authority of the institution in general, but claims a right of conscience to refuse some particular directive. An adequate ethics of conscientious objection will, then, require an account of the institutional obligations that the objector claims a right to refuse. Yet such an account must avoid two extremes: ‘anarchism,’ where obligations apply only insofar as they match individual conscience; and (...) ‘totalitarianism,’ where even immoral obligations bind us. The challenge is to explain institutional obligations in such a way that an agent can be obligated to act against conscience, yet can object if the institution's orders go too far. Standard accounts of institutional obligations rely on individual autonomy, expressed through consent. This paper rejects the Consent model; a better understanding of institutional obligations emerges from reflecting on the intersecting goods produced by institutions and the intersecting autonomy of numerous distinct agents rather than only one. The paper defends ‘Professionalism’ as a grounding of professional obligations. The professional context can justify acting against conscience but more often that context partly shapes the professional conscience. Yet Professionalism avoids totalitarianism by distinguishing between (mere) injustice and abuse. When institutions are – or we conscientiously believe them to be – merely unjust, their directives still obligate us; when they are abusive, however, they do not. Finally, the paper applies these results to the problem of conscientious refusal in general and specifically to controversial reproduction cases. (shrink)

The book provides a detailed introduction to a major debate in bioethics, as well as a rigorous account of the role of conscience in professional decision-making. Exploring the role of conscience in healthcare practice, this book offers fresh counterpoints to recent calls to ban or severely restrict conscience objection. It provides a detailed philosophical account of the nature and moral import of conscience, and defends a prima facie right to conscientious objection for healthcare professionals. The book also has relevance to (...) broader debates about religious liberty and civil rights, such as debates about the rights and duties of persons and institutions who refuse services to clients on the basis of a religious objection. The book concludes with a discussion of how to regulate individual and institutional conscientious objection, and presents general principles for the accommodation of individual conscientious objectors in the healthcare system. This book will be of value to students and scholars in the fields of moral philosophy, bioethics and health law. (shrink)

The notions of duty and obligation constitute the central focus of Rawls's account of political authority. This chapter examines Rawls's accounts of (1) the justification of political authority; (2) the essential elements of a just constitutional regime; (3) the conditions under which resistance to just institutions is permissible or required; and (4) the conditions under which institutions cease to deserve fidelity and obedience. It commences with Rawls's accounts of duty and obligation, focusing on his accounts of (1) the duties and (...) obligation of citizens; and (2) the duty to obey unjust laws. Rawls discusses two instances in which certain forms of resistance are justifiable: civil disobedience; and conscientious refusal. Rawls's account continues to be oriented by the underlying notion that the legitimate exercise of coercive political power must be justifiable on terms that persons subject to that power can affirm on due reflection. (shrink)

Modern transformation of religious institutions and religion in general, affect the livelihoods of the western society. Today there are so many religious movements that offer a solution to secularized man's material and spiritual problems. Some came from the East, the other formed under the influence of modern culture and media. There are two main areas: first representatives insist on religious adaptation to social norms, the latter require preservation of authentic religious forms and principles. Some researchers emphasize the possibility of combining (...) scientific and religious worldviews - this compromise position will allow to reconcile the two camps, whose representatives are in a state of confrontation. Virtualization social life leads to changes within the religious organizations and the emergence of new trends, which focus on the development of communication technologies and the creation of new philosophical approaches. Traditional religious systems use virtual space as a tool for data transfer, but refuse to implement religious practices in the virtual space. The third kind of organizations - conformists, appealing to tradition, but using modern science. Technological process leads to a change in the nature of the human person, which adapts to the new conditions and accepts new cultural, religious, and ideological positions. This leads to both personal and social changes, which are the subject of this article. (shrink)

The National Institute of Science and the Arts, founded in 1795, consists of parallel academies, concerned with science, literature, the visual arts and so on. In the nineteenth century it represented a unique government-sponsored intellectual authority and a supreme court judgement, a power which came to be resented by innovators of all kinds. The Académie des sciences held a virtual monopoly in representing French science but soon this came to be challenged. In the period of the Second Empire we find (...) a group of men carving out a new career for themselves as professional popularizers of science, commissioned to write regular articles in newspapers and journals. Although they had begun by simply reporting the meetings of the Académie des sciences, they soon widened their scope and even began criticizing the august Académie. Thus they represented the alternative voice of science, distinct from ‘official science’. These independent writers had their counterpart in painting and literature, both of which were developing radical new approaches in mid-century. When the very traditional Fine Art Academy refused to consider their paintings, painters like Cézanne and Manet found an alternative outlet. Writers too asserted their independence from the Académie française. There were not only many parallels between the independent practitioners in science, painting and literature but also new schools of ‘naturalism’ in painting and literature which looked to science as a model. (shrink)

Greenblum and Hubbard argue that physicians are duty-bound by the constraints of Rawlsian ‘public reason’ to avoid engaging their patients’ religious considerations in medical decision-making.1 This position offers a number of appealing benefits to physicians. It will appear plausible because Rawls’s philosophical tradition of Political Liberalism enjoys the status of ideological orthodoxy in institutions tasked with forming the moral imaginations of physicians and other elites.2 3 It casts the physician in the role of a ‘reasonable person’ occupying the space of (...) public reason whose medical and ethical judgments are opposed by ‘sectarian’ religious patients who refuse to be reasonable. This narrative authorises the exclusion of patient religious considerations from medical decision making when they do not ‘translate’ into reasons recognised by ‘reasonable’ medical professionals and manages the trauma of overwhelmed physicians by legitimising disengagement from difficult interactions with religious patients. The authors’ arguments depend on concepts from Rawls’s Political Liberalism 4 and are presented as if the premises of Liberal theory are incontestable—despite the fact that a large body of philosophical literature challenging its premises and core concepts has existed for decades.3 5–7 This ‘nothing to see here, move along’ approach saves more space for anecdotes about religious people, at which …. (shrink)

In December 2017, Law 219/2017, ‘Provisions for informed consent and advance directives’, was approved in Italy. The law is the culmination of a year-long process and the subject of heated debate throughout Italian society. Contentious issues are addressed in the law. What emerges clearly are concepts such as quality of life, autonomy, and the right to accept or refuse any medical treatment – concepts that should be part of an optimal relationship between the patient and healthcare professionals. The law maximizes (...) the value of the patient’s time to decide. Every patient is allowed to make choices for the present as well as for the future, conceived as a continuation of the present, and to decide what comes next, based on what he/she already knows. The law identifies three distinct but converging paths towards the affirmation of a care relationship based on reciprocal trust and respect: the possibility to consent to or refuse treatment, the shared care planning, and advance directives. The fundamental point to emerge from the new Italian law is that consensus is an essential connotation of the treatment relationship. Consensus is not limited to the acceptance/rejection of medical treatment but is ongoing. It is projected into the future through shared care planning and advance directives which act as tools for self-determination and the manifestation of the beliefs and preferences of persons unable to express their will. These principles are in line with the idea of appropriate care as evaluated from two different perspectives, one of scientific adequacy and the other commensurate with the individual’s resources, fragility, values, and beliefs. Surely, however, the new law is not the end of the matter on issues such as conscientious objection, which is deeply rooted within the Italian cultural and political debate. In this regard, healthcare institutions and policymakers will be called upon to develop and implement organizational policies aimed at the management of foreseeable conscientious objection in this field. (shrink)

Objectivity has a history, and it is full of surprises. In Objectivity, Lorraine Daston and Peter Galison chart the emergence of objectivity in the mid-nineteenth-century sciences--and show how the concept differs from its alternatives, truth-to-nature and trained judgment. This is a story of lofty epistemic ideals fused with workaday practices in the making of scientific images. From the eighteenth through the early twenty-first centuries, the images that reveal the deepest commitments of the empirical sciences--from anatomy to crystallography--are those featured in (...) scientific atlases, the compendia that teach practitioners what is worth looking at and how to look at it. Galison and Daston use atlas images to uncover a hidden history of scientific objectivity and its rivals. Whether an atlas maker idealizes an image to capture the essentials in the name of truth-to-nature or refuses to erase even the most incidental detail in the name of objectivity or highlights patterns in the name of trained judgment is a decision enforced by an ethos as well as by an epistemology. As Daston and Galison argue, atlases shape the subjects as well as the objects of science. To pursue objectivity--or truth-to-nature or trained judgment--is simultaneously to cultivate a distinctive scientific self wherein knowing and knower converge. Moreover, the very point at which they visibly converge is in the very act of seeing not as a separate individual but as a member of a particular scientific community. Embedded in the atlas image, therefore, are the traces of consequential choices about knowledge, persona, and collective sight. Objectivity is a book addressed to anyone interested in the elusive and crucial notion of objectivity-- and in what it means to peer into the world scientifically. Lorraine Daston is Director at the Max Planck Institute for the History of Science in Berlin, Germany. She is the coauthor of Wonders and the Order of Nature, 1150-1750 and the editor of Things That Talk: Object Lessons from Art and Science. Peter Galison is Pellegrino University Professor of the History of Science and of Physics at Harvard University. He is the author of Einstein's Clocks, Poincaré's Maps: Empires of Time, How Experiments End, and Image and Logic: A Material Culture of Microphysics, and other books, and coeditor of The Architecture of Science. (shrink)

This book argues that a conscientiously objecting medical professional should receive an exemption only if the grounds of an objector's refusal are reasonable. It defends a detailed, contextual account of public reasonability suited for healthcare, which builds from the overarching concept of Rawlsian public reason. The author analyzes the main competing positions and maintains that these other views fail precisely due to their systematic inattention to the grounding reasons behind a conscientious objection; he argues that any such view is (...) plausible to the extent that it mimics the 'reason-giving requirement' for conscience objections defended in this work. Only reasonable objections can defeat the prior professional obligation to assign primacy to patient well-being, therefore one who refuses a patient's request for a legally available, medically indicated, and safe service must be able to explain the grounds of their objection in terms understandable to other citizens within the public institutional structure of medicine. The book further offers a novel policy proposal to deploy the Reasonability View: establishing conscientious objector status in medicine. It concludes that the Reasonability View is a viable and attractive position in this debate. A New Theory of Conscientious Objection in Medicine: Justification and Reasonability will be of interest to researchers and advanced students working in bioethics, medical ethics, and philosophy of medicine, as well as thinkers interested in the intersections between law, medical humanities, and philosophy. (shrink)

APPRENDRE A PHILOSOPHER AUJOURD'HUI : LE POIDS D'UN HERITAGE MYTHOLOGIQUE. Situation de l'enseignement de la philosophie. Fin de siècle : la possibilité d'une ouverture?. QUI EST CONCERNE PAR LA PHILOSOPHIE? DU PUBLIC IMAGINAIRE AU PUBLIC REEL. Le public (imaginaire) de l'humanisme abstrait. Que peut nous apprendre le refus d'enseigner la philosophie au deuxième sexe?. A QUOI JOUE L'ENSEIGNEMENT DE LA PHILOSOPHIE? MODES PEDAGOGIQUES DE L'ESPRIT DE SERIEUX. Quelles sont les impasses de l'idée de "jeu sérieux"?. Comment les modes pédagogiques se (...) sont-ils (elles) succédé?. LA PHILOSOPHIE PEUT-ELLE DEMEURER CRITIQUE DANS L'INSTITUTION SCOLAIRE?. Comment mettre une note à la liberté?. D'où viennent les amours philosophiques? (shrink)

Research ethics committees and institutional review boards spend considerable time developing, scrutinising, and revising specific consent processes and materials for survey-based studies conducted on crowdsourcing and online recruitment platforms such as MTurk and Prolific. However, there is evidence to suggest that many users of ICT services do not read the information provided as part of the consent process and they habitually provide or refuse their consent without adequate reflection. In principle, these practices call into question the validity of their (...) consent. In this paper we argue that although the ‘no read problem’ and the routinisation of consent may apply to research participants’ consent practices for studies on crowdsourcing platforms, this is not a serious problem. Furthermore, given that the informational requirements for informed consent in these contexts are minimal, we argue that these participants are, nevertheless, sufficiently informed to give valid consent. We conclude that research ethics committees and institutional review boards should only agonise over the precise details of the informed consent process and materials in those rare cases where appreciable risks to research participants need to be managed. (shrink)

In 2015, the Israeli Knesset passed the force-feeding act that permits the director of the Israeli prison authority to appeal to the district court with a request to force-feed a prisoner against his expressed will. A recent position paper by top Israeli clinicians and bioethicists, published in Hebrew, advocates for force-feeding by medical professionals and presents several arguments that this would be appropriate. Here, we first posit three interrelated questions: 1. Do prisoners have a right to hunger-strike? 2. Should governing (...) institutions force-feed prisoners and/or is it ethical to force-feed prisoners? 3. Should healthcare professionals force-feed prisoners? We then focus on the first and third questions. We first briefly provide several arguments to support the right of prisoners to refuse treatment. Next, we critically review the arguments presented in the Israeli position paper, demonstrating that they are all misguided at best. Lastly, we briefly present arguments against force-feeding by medical professionals. We conclude that healthcare providers should not participate in the force-feeding of prisoners. (shrink)

§ . As a corollary to the proposition that all institutions must be subordinated to the law of equal freedom, we cannot choose but admit the right of the citizen to adopt a condition of voluntary outlawry. If every man has freedom to do all that he wills, provided he infringes not the equal freedom of any other man, then he is free to drop connection with the state - to relinquish its protection and to refuse paying toward its support. (...) It is self evident that in so behaving he in no way trenches upon the liberty of others, for his position is a passive one, and while passive he cannot become an aggressor. It is equally self evident that he cannot be compelled to continue one of a political corporation without a breach of the moral law, seeing that citizenship involves payment of taxes; and the taking away of a man's property against his will is an infringement of his rights. Government being simply an agent employed in common by a number of individuals to secure to them certain advantages, the very nature of the connection implies that it is for each to say whether he will employ such an agent or not. If anyone of them determines to ignore this mutual safety confederation, nothing can be said except that he loses all claim to its good offices and exposes himself to the danger of maltreatment - a thing he is quite at liberty to do if he likes. He cannot be coerced into political combination without a breach of the law of equal freedom; he can withdraw from it without committing any such breach, and he has therefore a right so to withdraw. (shrink)

Introduction: Healthcare practitioners have a legal, ethical and professional obligation to obtain patient consent for all healthcare treatments. There is increasing evidence which suggests dissonance and variation in practice in assessment of decision-making capacity and consent processes. Aims: This study explores healthcare practitioners’ knowledge and practices of assessing decision-making capacity and obtaining patient consent to treatment in the acute generalist setting. Methods: An exploratory descriptive cross-sectional survey design, using an online questionnaire, method was employed with all professional groups invited via (...) email to participate. Data were collected over 3 months from July to September 2015. Survey content and format was reviewed by the liaison psychiatry team and subsequently contained five sections (demographics, general knowledge and practice, delirium context, legal aspects and education/training). Descriptive, univariate and bivariate analysis of quantitative data and qualitative content analysis of qualitative data were undertaken. Ethical considerations: The study was approved by the institutional Human Research and Ethics Committee and informed consent was taken to be provided by participants upon completion and submission of the de-identified survey. Results: In total, 86 participants engaged the survey with n = 24, exiting at the first consent question. Almost two-thirds of respondents indicated that all treatments required patient consent. Knowledge of consent and decision-making capacity as legal constructs was deficient. Decision-making capacity was primarily assessed using professional judgement and perceived predominantly as the responsibility of medical and psychology staff. A range of patient psychological and behavioural symptoms were identified as indicators requiring assessment of decision-making capacity. Despite this, many patients with delirium have their decision-making capacity assessed and documented only sometimes. Uncertain knowledge and inconsistent application of legislative frameworks are evident. Many participants were unsure of the legal mechanisms for obtaining substitute consent in patients with impaired decision-making capacity and refusing treatment. Conclusion: The legal context of decision-making capacity and consent to treatment appears complex for healthcare practitioners. Professional, ethical and legal standards of care in this context can benefit from structured education programmes and supportive governance processes. An understanding of why ‘duty of care’ is being used as a framework within the context of impaired decision-making capacity is warranted, alongside a review of the context of Duty of Care within health policy, guidance and faculty teaching. (shrink)

By way of comment, I suggest: 1) That the definitions of 'competence' and 'rationality' require some modification. 2) That Professor Sherlock is right to argue that a competent but irrational decision to refuse beneficial treatment ought to be overruled; but in practice it is extremely difficult to be sufficiently sure that the decision is really irrational and the treatment really will be beneficial, except when the patient's life is in danger or he is refusing basic necessities. 3) That in practice (...) the issue is further complicated by such questions as whether there are alternative treatments, whether persuasion is possible, what the doctor's or institution's legal obligations are, and what resources are available. 4) That the presumption should be against coercion, and the patient--however irritating this may be to some doctors--should be considered 'rational until proved irrational'. (shrink)

The terms “politics” and “political” have become so overdetermined that it is difficult to use them in any effective manner. We argue that this has dangerous political consequences, and that this could be addressed by providing a new, sounder, notion of politics. This paper argues that defining politics in relation to the notion of play can provide a notion both intuitively appealing and able to withstand the problematic overdeterminations. We argue that politics is the set of practices through which the (...) indeterminate of Spielraum is made more determinate. This suggests that politics is always partly a matter of play: it is about instituting values without making any claims about the legitimacy of this instituting act. With reference to Huizinga and Nietzsche’s analyses of play, we define play as the living unity of seriousness and frivolity, and non-play as either seriousness without frivolity or frivolity without seriousness. In order to illustrate this, we comparatively analyse the attitudes of Barack Obama and Donald Trump in the single context of the well-known yearly White House Correspondent’s Dinner. There, we see two opposed attitudes to playfulness. Our analysis allows us to apply our _Spielraum_ model of politics to show that the thrust of Obama’s attitude involves an embrace of the non-foundational nature of politics as play, whereas Trump’s attitude is politicidal: it is animated by a refusal to acknowledge its own lack of foundation, leading to an oscillation between over-seriousness and over-frivolity. (shrink)