Vaccine mandates played a critical role in the success of New York City’s COVID-19 response. By relying on evidence as a substantive basis for the mandates and adhering to procedural requirements and precedent, New York City leveraged its position and expertise as a local governmental authority to devise mandatory vaccine policies that withstood numerous legal challenges. New York City’s experience highlights the role of municipal government in mounting a meaningful public health response, and the strategies adopted by NYC may provide (...) a blueprint for municipalities around the world facing the ongoing COVID-19 pandemic and the threat of future public health emergencies. (shrink)

Background The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit (...) staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. Methods A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. Results All 178 respondents (response rate: 25–32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to ‘team cooperation’, ‘team solidarity’ and ‘work ethic’. Lessons learned were mostly related to ‘quality of care’ and ‘professional qualities’. Conclusions Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals’ dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. Trial registration The trial was registered on The Netherlands Trial Register, number NL9177. (shrink)

Nurses working in correctional and forensic mental health settings face unique challenges in the provision of care to patients within custodial settings. The subjectivities of both patients and nurses are subject to the power relations, discourses and abjection encountered within these practice milieus. Using a poststructuralist approach using the work of Foucault, Kristeva, and Deleuze and Guattari, this paper explores how both patient and nurse subjectivities are produced within the carceral logic of this apparatus of capture. Recognizing that subjectivities are (...) fluid and dynamic, and capable of change, Deleuze and Guattari's concept of deterritorialization will illustrate opportunities for resistance, where nurses can begin to practice outside the dominant carceral logic (and restrictions) of the system. (shrink)

Recovery is a model of care in (forensic) mental health settings across Western nations that aims to move past the paternalistic and punitive models of institutional care of the 20th century and toward more patient‐centered approaches. But as we argue in this paper, the recovery‐oriented services that evolved out of the early stages of this liberating movement signaled a shift in nursing practices that cannot be viewed only as improvements. In effect, as “recovery” nursing practices became more established, more codified, (...) and more institutional(ized), a stasis developed. Recovery had been reterritorialized. The purpose of this paper is to examine some of the threads of recovery, from its early days of antipsychiatry activism to its codification into mental health—including forensic mental health—institutions through the lens of poststructuralist philosophers Gilles Deleuze and Felix Guattari. We believe that Deleuze and Guattari's scholarship provides the necessary, albeit uncomfortable, framework for this critical examination. From a conceptualization of recovery as an assemblage, we critically examine how we can go about creating something new, caught in a tension between stasis and change. (shrink)

Nurses working in forensic psychiatric settings face unique challenges in practice, where they take on a dual role of custody and caring. Patient resistance is widespread within these restrictive settings and can take many forms. Perhaps the most disturbing form of resistance entails a patient's weaponization of their bodily fluids, with nurses as their target. The tendency in assigning motive for this act is to relegate to the psychopathology of the patient. This paper will adopt a poststructuralist perspective to reexamine (...) this phenomenon as an act of resistance through the lens of Kristeva's concept of abjection. Patients confined in these settings have little sense of control, and in resistance may resort to the only thing available: their bodily fluids. By weaponizing the abject, patients actively violate and permeate the physical and psychological boundaries of nurses—the very boundaries considered crucial to safe and professional forensic psychiatric nursing practice. By recognizing this phenomenon as an act of resistance to confinement and loss of control, nurses may reorient their approach to care in forensic psychiatric settings. (shrink)

The susceptibility of online learning to cheating behavior remains a contentious and unresolved issue. A cross-sectional explanatory research design was utilized to test the hypothesized factors influencing academic cheating in online learning. Our study involved 562 participants, selected through a non-probability sampling technique, who were surveyed using online questionnaires designed to measure the identified factors. We tested the hypotheses by utilizing path analysis through the partial least square regression approach within the SMART-PLS software. The demographics such as gender and age (...) of the students, along with the roles of teachers and school administration significantly influenced the students’ instances of self-reported academic cheating. The students’ attitude toward academic cheating emerged as an important factor in predicting cheating behaviors. The paper concludes with recommendations for future research explorations into other potential factors that may contribute to academic dishonesty in online learning. (shrink)

We present a specific elaboration and partial defense of the claims that cognition is enactive, embodied, embedded, affective and (potentially) extended. According to the view we will defend, the enactivist claim that perception and cognition essentially depend upon the cognizer’s interactions with their environment is fundamental. If a particular instance of this kind of dependence obtains, we will argue, then it follows that cognition is essentially embodied and embedded, that the underpinnings of cognition are inextricable from those of affect, that (...) the phenomenon of cognition itself is essentially bound up with affect, and that the possibility of cognitive extension depends upon the instantiation of a specific mode of skillful interrelation between cognizer and environment. Thus, if cognition is enactive then it is also embodied, embedded, affective and potentially extended. (shrink)

This introduction to a special issue of Topoi introduces and summarises the relationship between three main varieties of 'enactivist' theorising about the mind: 'autopoietic', 'sensorimotor', and 'radical' enactivism. It includes a brief discussion of the philosophical and cognitive scientific precursors to enactivist theories, and the relationship of enactivism to other trends in embodied cognitive science and philosophy of mind.

Despite the importance of effective observational analysis in the technical aspects of climbing performance, limited research informs this aspect of climbing coach education. Thus, the purpose of the present research was to explore cognitive-perceptual mechanisms underpinning visual search strategies of expert and novice climbing coaches through the novel combination of eye-tracking technology and retrospective think-aloud methodology. Analysis of gaze data revealed expert climbing coaches to demonstrate fewer fixations of greater duration, and fixate on distinctly different areas of the visual display, (...) than their novice counterparts. Retrospective think-aloud interviews further demonstrated differences in the cognitive-perceptual mechanisms underpinning these visual search strategies, with expert coaches more cognisant of their visual search strategy. To expand, the gaze behaviour of expert climbing coaches was underpinned by hierarchical and complex knowledge structures relating to principles of climbing movement. This enabled expert coaches to actively focus on the most relevant aspects of a climber’s performance for analysis. Findings demonstrate the utility of combining eye tracking and retrospective think-aloud interviewing as a new, efficient methodology of capturing the cognitive-perceptual processes of climbing coaches to inform coaching education/strategies. (shrink)

How should accounts that stress the embodied, embedded and engaged character of human minds accommodate the role of rationality in human subjectivity? Drawing on Matthew Boyle’s contrast between ‘additive’ and ‘transformative’ conceptions of rationality, I argue that contemporary work on embodied cognition tends towards a problematic ‘additivism’ about the relationship between mature human capacities to think and act for reasons, and sensorimotor capacities to skillfully engage with salient features of the environment. Additivists view rational capacities to reason and reflect as (...) a distinct ‘layer’ or ‘storey’ of human cognition, with a normative structure that differs from that of the sensorimotor coping skills which support it. I argue that emphasizing the embodied and engaged character of human minds is better combined with a ‘transformative’ conception of rationality – one which holds that acquiring abilities to give and ask for reasons transforms the normative structure of our unreflective embodied dealings with the environment. And I argue that a transformative embodied cognitive science of human rationality is not only possible, but underway. Integrating existing work on embodied cognition with work on the cultural and developmental contexts that shape human minds suggests how human immersion in culture transforms the structure of sensorimotor engagements by bringing about the communicability and negotiability of the meanings to which those engagements attune us. (shrink)

What kind of symbiosis between archaeon and bacterium gave rise to their eventual merger at the origin of the eukaryotes? I hypothesize that conditions favouring bacterial uptake were based on exchange of intermediate carbohydrate metabolites required by recurring changes in availability and use of the two different terminal electron chain acceptors, the bacterial one being oxygen. Oxygen won, and definitive loss of the archaeal membrane potential allowed permanent establishment of the bacterial partner as the proto‐mitochondrion, further metabolic integration and highly (...) efficient ATP production. This represents initial symbiogenesis, when crucial eukaryotic traits arose in response to the archaeon‐bacterium merger. The attendant generation of internal reactive oxygen species (ROS) gave rise to a myriad of further eukaryotic adaptations, such as extreme mitochondrial genome reduction, nuclei, peroxisomes and meiotic sex. Eukaryotic origins could have started with shuffling intermediate metabolites as is still essential today. (shrink)

In this richly argued and provocative book, David Davies elaborates and defends a broad conceptual framework for thinking about the arts that reveals important continuities and discontinuities between traditional and modern art, and between different artistic disciplines. Elaborates and defends a broad conceptual framework for thinking about the arts. Offers a provocative view about the kinds of things that artworks are and how they are to be understood. Reveals important continuities and discontinuities between traditional and modern art. Highlights core topics (...) in aesthetics and art theory, including traditional theories about the nature of art, aesthetic appreciation, artistic intentions, performance, and artistic meaning. (shrink)

The transparency of perceptual experience has been invoked in support of many views about perception. I argue that it supports a form of enactivism—the view that capacities for perceptual experience and for intentional agency are essentially interdependent. I clarify the perceptual phenomenon at issue, and argue that enactivists should expect to find a parallel instance of transparency in our agentive experience, and that the two forms of transparency are constitutively interdependent. I then argue that i) we do indeed find such (...) parallels: the way in which an action is directed towards its goal through our bodily movements parallels the way in which an experience is directed towards its object through our perceptual sensation, and ii) reflecting on sensorimotor skills shows why the two instances of transparency are constitutively interdependent. Section 4 gives reasons for generalizing beyond the cases considered so far by applying the enactive view to Kohler's landmark studies of perceptual adaptation. The final section clarifies the form of enactivism to which the previous sections point. The view that emerges is one whereby our perceptual and practical skills are interrelated aspects of a single capacity to have one's mind intentionally directed upon the world. The transparency of experience, on this view, is achieved in virtue of our capacities as agents as much as it is given in virtue of our capacities as perceivers. (shrink)

I argue that the phenomenal properties of conscious visual experiences are properties of the mind-independent objects to which the subject is perceptually related, mediated by the subject's practical understanding of their sensorimotor relation to those properties. This position conjoins two existing strategies for explaining the phenomenal character of perceptual experiences: accounts appealing to perceivers’ limited, non-inferential access to the details of their sensory relation to the environment, and the relationalist conception of phenomenal properties. Bringing these two positions together by emphasizing (...) their sensorimotor common ground allows each one to respond to damaging objections using the resources of the other. The resulting ‘sensorimotor relationalism’ about conscious vision provides a promising schema for explaining phenomenal properties of perceptual states, replacing ‘Hard’ questions with tractable ones about the perceptual relation and its sensorimotor underpinnings. (shrink)

Group sex among men who have sex with men may be understood as a ‘radical’ practice insofar as it transgresses dominant social discourses around appropriate sexual relations—prioritizing heteronormative, monogamous and risk‐averse sex. These practices are generally defined as steeped in risk, most commonly due to the potential for transmitting human immunodeficiency virus and sexually transmitted infections and accompanied by the possibility of legal and social repercussions. Our ethnographic research study explored the desires, practices and contexts of group sex participants (n (...) = 10) within a popular group sex party destination located in the United States. We employ a poststructuralist perspective (utilizing the work of Deleuze and Guattari) to understand group sex events with the pretext that bodies have no inherent ethics, meaning or essence: they are ‘bodies without organs’. We identify group sex as a form of boundary play, in which participants pursue new limits to what their bodies can do but within a carefully constructed environment that establishes norms of interaction meant to secure trust and safety between participants. A variety of risk reduction practices are shown to be promoted and honoured within these eventful sexual(ized) spaces. The application of poststructuralist concepts of ‘boundary play’ and ‘bodies without organs’ helped to depict the construction and navigation of pleasure, safety and risk among group sex participants. (shrink)

In this paper, we argue that nurses need to be aware of how the production of space in specific contexts – including health care systems and research institutions – perpetuates marginalized populations' state of social otherness. Lefebvre's idea regarding spatial triad is mobilized in this paper, as it pertains to two‐spirited, lesbian, gay, bisexual, trans and queer populations (2SLGBTQ*). We believe that nurses can create counter‐spaces within health care systems and research institutions that challenge normative discourses. Lefebvre's work provides us (...) the necessary tools to understand how various places or environments produce identities. In understanding Lefebvre's principles, we believe that nurses can play an essential role in creating counter‐spaces, thereby instigating counter‐institutional practices, for those who experience otherness. (shrink)

The problem of structure and agency has been the subject of intense debate in the social sciences for over 100 years. This book offers a solution. Using a critical realist version of the theory of emergence, Dave Elder-Vass argues that, instead of ascribing causal significance to an abstract notion of social structure or a monolithic concept of society, we must recognise that it is specific groups of people that have social structural power. Some of these groups are entities with (...) emergent causal powers, distinct from those of human individuals. Yet these powers also depend on the contributions of human individuals, and this book examines the mechanisms through which interactions between human individuals generate the causal powers of some types of social structures. The Causal Power of Social Structures makes particularly important contributions to the theory of human agency and to our understanding of normative institutions. (shrink)

Clinical research with adults who are unable to provide informed consent has the potential to improve understanding and care of a number of devastating conditions. This research also has the potential to exploit some of society's most vulnerable members. Recently, a number of task forces and individual writers have proposed guidelines to ensure that such research is both possible and ethical. Yet, there is widespread disagreement over which safeguards should be adopted. In the present paper, I consider to what extent (...) these disagreements can be resolved by appeal to a general account of the interests of subjects who are unable to consent and the conditions that must be satisfied for research enrollment to constitute exploitation of their inability to make their own decisions. (shrink)

The philosophical literature would have us believe that the conservative view on abortion is based on the claim that the fetus is a person from the time of conception. Given the widespread acceptance of this analysis, it comes as something of a surprise to learn that it conflicts with a number of major arguments offered in support of the conservative view. I argue, in the present paper, that a careful examination of these inconsistencies establishes that the personhood analysis is mistaken: (...) the conservative view is based on the natural process of fetal development, not the personhood of the fetus. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Rhetoric and Power: An Inquiry into Foucault’s Critique of ConfessionDave TellOn October 10, 1979, Michel Foucault revised his thesis on confession. On that day, some three years after the publication of his magisterial treatment of confession in the first volume of The History of Sexuality, Foucault argued that the Pythagoreans, Stoics, and Epicureans had, before the advent of Christianity, their own practices of confession. Yet these practices, unlike their (...) Christian variants, were not complicit with practices of domination (OS 310, 312). In the context of Foucault’s thought theretofore, in which the confession consistently figured as an essential component in the exercise of modern power, this is a radical shift. In lectures given at both Berkeley and Dartmouth in the fall of 1980, Foucault made similar arguments. On these occasions he argued that Seneca’s De ira constituted a “stoic confession,” the object of which was to enable the subject to “live differently, better, more happily, than other people” (AB 210, 205). Judith Butler captures the gravity of the shift: “In the last years of his life, Foucault returned to the question of confession, reversing his earlier critique in the first volume of the History of Sexuality, where he indicts confession as a forcible extraction of sexual truth, a practice in the service of a regulatory power” (2005, 112).This reversal was short lived. Although Foucault would celebrate ancient Greek techniques of the self for the rest of his life, he would not [End Page 95] long refer to these techniques in terms of confession. Thus, in another reading of De ira, this one in March 1982, Foucault again noted that the Stoics have “confessional practices” that are “very close to what is found in Christianity” (Herm 482). This time, however, he insisted that the Stoic practices were fundamentally different: “However, all these elements seem to me to be profoundly different from what we should call ‘confession’ in the strict, or anyway, spiritual sense of the word” (Herm 365). In The Care of the Self, Foucault again conceded that De ira—what he now called “the most detailed description” of antique practices of the self—looked “at first glance” like a Christian confession, but he again maintained that it is something quite different: “The purpose of the examination is not therefore to discover one’s own guilt, down to its most trifling forms” (CS 61–62). Foucault concluded that the various “discourses of the self”—the confession and the Greek techniques of the self—could not be placed into a single category (see GE 250). Indeed, the “profound difference” (Herm 299) between these two discourses of the self was perhaps Foucault’s most repeated claim of the 1980s (see Herm 222, 237–44, 299, 308; GE 247–48; WS 237; AB 207–8; RFT 27; UP 89; CS 239; SS 5; FI 5, 12; FS 30, 35, 44, 87, 96, 97, 143–45, 147).It is worth asking why Foucault returned so consistently to the distinction between these two discursive forms. This question gains even more relevance for readers of this journal when we remember that, on at least two occasions, Foucault defined one of these forms, the ancient techniques of the self, in terms of its opposition to rhetoric: the techniques of the self, he claimed, are “nonrhetorical” (Herm 368; FS 20). Thus the question that drives this essay is not so much why Foucault attached such importance to the distinction but rather how rhetoric itself might differentiate the confession from the techniques of the self. Stated differently, Foucault’s work on the confession vis-à-vis the technologies of the self provides a valuable opportunity to study the role of rhetoric in Foucault’s thought—not because they are both rhetorical forms but, curiously, because Foucault insists that one is not.In order to foreground the work of rhetoric in Foucault’s thought, I situate his discourses of the self in the context of Nietzsche’s critique of metonymy. Although this may seem arbitrary, it gains initial plausibility from three facts. First, we know that Foucault understood rhetoric in terms of tropes (OT 84; Cooper 1988, 4). Second, we know too that Foucault had a deep... (shrink)

Although inquiry-based instruction has been a centerpiece of progressive visions of social studies education almost since its inception as a school subject a century ago, teachers often struggle to conceptualize it in ways that make true inquiry possible for their students. In this essay I suggest that social educators strengthen their connection with John Dewey’s pragmatic epistemology as the foundation of inquiry-based teaching in social studies, arguing in support of an approach that holds the promise of advancing goals associated with (...) meaningful democratic citizenship education. (shrink)

Susan Hurley (1998a, 2003a, 2008) argues that our capacities for perception, agency and thought are essentially interdependent and co-emerge from a tangle of sensorimotor processes that are both cause and effect of the web of interactive and communicative practices they weave us into. In this paper, I reconstruct this view and its main motivations, with a particular focus on three important aspects. First, Hurley argues that an essential aspect of conscious perception – its perspectival unity – constitutively depends on agency. (...) That is, agency is a transcendental condition on the possibility of perception (§3). Second, understanding why this dependence obtains involves understanding why perception and agency emerge together, and how they do so on the basis of a web of interrelated capacities for sensorimotor control (§2, §4). Third, understanding these first two aspects of Hurley’s view is the key to understanding the sophisticated interplay between i) her arguments for the causal interdependence of sensory input and motor output, and ii) her arguments for the essential interdependence of perception and agency. (shrink)

Social and linguistic perceptions are linked. On one hand, talker identity affects speech perception. On the other hand, speech itself provides information about a talker's identity. Here, we propose that the same probabilistic knowledge might underlie both socially conditioned linguistic inferences and linguistically conditioned social inferences. Our computational–level approach—the ideal adapter—starts from the idea that listeners use probabilistic knowledge of covariation between social, linguistic, and acoustic cues in order to infer the most likely explanation of the speech signals they hear. (...) As a first step toward understanding social inferences in this framework, we use a simple ideal observer model to show that it would be possible to infer aspects of a talker's identity using cue distributions based on actual speech production data. This suggests the possibility of a single formal framework for social and linguistic inferences and the interactions between them. (shrink)

Of two contending models for eukaryotic evolution the “archezoan“ has an amitochondriate eukaryote take up an endosymbiont, while “symbiogenesis“ states that an Archaeon became a eukaryote as the result of this uptake. If so, organelle formation resulting from new engulfments is simplified by the primordial symbiogenesis, and less informative regarding the bacterium‐to‐mitochondrion conversion. Gradualist archezoan visions still permeate evolutionary thinking, but are much less likely than symbiogenesis. Genuine amitochondriate eukaryotes have never been found and rapid, explosive adaptive periods characteristic of (...) symbiogenetic models explain this. Mitochondrial proteomes, encoded by genes of “eukaryotic origin“ not easily linked to host or endosymbiont, can be understood in light of rapid adjustments to new evolutionary pressures. Symbiogenesis allows “expensive” eukaryotic inventions via efficient ATP generation by nascent mitochondria. However, efficient ATP production equals enhanced toxic internal ROS formation. The synergistic combination of these two driving forces gave rise to the rapid evolution of eukaryotes.Also watch the Video Abstract. (shrink)

How do questions concerning consciousness and phenomenal experience relate to, or interface with, questions concerning plans, knowledge and intentions? At least in the case of visual experience the relation, we shall argue, is tight. Visual perceptual experience, we shall argue, is fixed by an agent’s direct unmediated knowledge concerning her poise (or apparent poise) over a currently enabled action space. An action space, in this specific sense, is to be understood not as a fine-grained matrix of possibilities for bodily movement, (...) but as a matrix of possibilities for pursuing and accomplishing one’s intentional actions, goals and projects. If this is correct, the links between planning, intention and perceptual experience are tight, while (contrary to some recent accounts invoking the notion of ‘sensorimotor expectations’) the links between embodied activity and perceptual experience, though real, are indirect. What matters is not bodily activity itself, but our practical knowledge (which need not be verbalized or in any way explicit) of our own possibilities for action. Such knowledge, selected, shaped and filtered by the grid of plans, goals, and intentions, plays, we argue, a constitutive role in explaining the content and character of visual perceptual experience. (shrink)

I consider whether there is a plausible conception of personal identity that can accommodate the ‘Multiplicity Thesis’ (MT), the thesis that some ways of creating and deploying multiple distinct online personae can bring about the existence of multiple persons where before there was only one. I argue that an influential Kantian line of thought, according to which a person is a unified locus of rational agency, is well placed to accommodate the thesis. I set out such a line of thought (...) as developed by Carol Rovane, and consider the conditions that would have to be in place for the possibility identified by MT to be realised. Finally I briefly consider the prospects for MT according to neo-Lockean and animalist views of personhood. (shrink)

An eye-opening tour of the political tricks that subvert scientific progress. The Butter-Up and Undercut. The Certain Uncertainty. The Straight-Up Fabrication. Dave Levitan dismantles all of these deceptive arguments, and many more, in this probing and hilarious examination of the ways our elected officials attack scientific findings that conflict with their political agendas. The next time you hear a politician say, "Well, I’m not a scientist, but…," you’ll be ready.

In lieu of an abstract, here is a brief excerpt of the content:Rhetoric and Power: An Inquiry into Foucault’s Critique of ConfessionDave TellOn October 10, 1979, Michel Foucault revised his thesis on confession. On that day, some three years after the publication of his magisterial treatment of confession in the first volume of The History of Sexuality, Foucault argued that the Pythagoreans, Stoics, and Epicureans had, before the advent of Christianity, their own practices of confession. Yet these practices, unlike their (...) Christian variants, were not complicit with practices of domination (OS 310, 312). In the context of Foucault’s thought theretofore, in which the confession consistently figured as an essential component in the exercise of modern power, this is a radical shift. In lectures given at both Berkeley and Dartmouth in the fall of 1980, Foucault made similar arguments. On these occasions he argued that Seneca’s De ira constituted a “stoic confession,” the object of which was to enable the subject to “live differently, better, more happily, than other people” (AB 210, 205). Judith Butler captures the gravity of the shift: “In the last years of his life, Foucault returned to the question of confession, reversing his earlier critique in the first volume of the History of Sexuality, where he indicts confession as a forcible extraction of sexual truth, a practice in the service of a regulatory power” (2005, 112).This reversal was short lived. Although Foucault would celebrate ancient Greek techniques of the self for the rest of his life, he would not [End Page 95] long refer to these techniques in terms of confession. Thus, in another reading of De ira, this one in March 1982, Foucault again noted that the Stoics have “confessional practices” that are “very close to what is found in Christianity” (Herm 482). This time, however, he insisted that the Stoic practices were fundamentally different: “However, all these elements seem to me to be profoundly different from what we should call ‘confession’ in the strict, or anyway, spiritual sense of the word” (Herm 365). In The Care of the Self, Foucault again conceded that De ira—what he now called “the most detailed description” of antique practices of the self—looked “at first glance” like a Christian confession, but he again maintained that it is something quite different: “The purpose of the examination is not therefore to discover one’s own guilt, down to its most trifling forms” (CS 61–62). Foucault concluded that the various “discourses of the self”—the confession and the Greek techniques of the self—could not be placed into a single category (see GE 250). Indeed, the “profound difference” (Herm 299) between these two discourses of the self was perhaps Foucault’s most repeated claim of the 1980s (see Herm 222, 237–44, 299, 308; GE 247–48; WS 237; AB 207–8; RFT 27; UP 89; CS 239; SS 5; FI 5, 12; FS 30, 35, 44, 87, 96, 97, 143–45, 147).It is worth asking why Foucault returned so consistently to the distinction between these two discursive forms. This question gains even more relevance for readers of this journal when we remember that, on at least two occasions, Foucault defined one of these forms, the ancient techniques of the self, in terms of its opposition to rhetoric: the techniques of the self, he claimed, are “nonrhetorical” (Herm 368; FS 20). Thus the question that drives this essay is not so much why Foucault attached such importance to the distinction but rather how rhetoric itself might differentiate the confession from the techniques of the self. Stated differently, Foucault’s work on the confession vis-à-vis the technologies of the self provides a valuable opportunity to study the role of rhetoric in Foucault’s thought—not because they are both rhetorical forms but, curiously, because Foucault insists that one is not.In order to foreground the work of rhetoric in Foucault’s thought, I situate his discourses of the self in the context of Nietzsche’s critique of metonymy. Although this may seem arbitrary, it gains initial plausibility from three facts. First, we know that Foucault understood rhetoric in terms of tropes (OT 84; Cooper 1988, 4). Second, we know too that Foucault had a deep... (shrink)

Our team at the Centre for Clinical Ethics has long been engaged in internal discussion about the purpose and value of ethics debriefs and their purported role in reducing moral distress (Morley an...

Reasons.js is an open-source, loosely-coupled, web-based argument mapping library that can be integrated into a range of online coursewares and websites. The javascript library can be embedded into any HTML page and allows users to create, edit, share, and export argument maps . The API is designed to permit the integration of the three stages of informal logical analysis — identification of truth claims within arguments, the analysis of logical structure, and synthesis of logical structure into written form.

Clinical research with adults who are unable to provide informed consent has the potential to improve understanding and care of a number of devasting conditions. This research also has the potential to exploit some of society's most vulnerable members. Recently, a number of task forces and individual writers have proposed guidelines to ensure that such research is both possible and ethical. Yet, there is widespread disagreement over which safeguards should be adopted. In the present paper, I consider to what extent (...) these disagreements can be resolved by appeal to a general account of the interests of subjects who are unable to consent and the conditions that must be satisfied for research enrollment to constitute exploitation of their inability to make their own decisions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:When Should “Riskier” Subjects Be Excluded from Research Participation?*Dave Wendler** (bio)AbstractThe exclusion of potential subjects based on increased risks is a common practice in human subjects research. However, there are no guidelines to ensure that this practice is conducted in a systematic and fair way. This gap in the literature and regulations is addressed by a specific account of a “condition on inclusion risks” (CIR), a condition under (...) which potential subjects should be excluded from research on the basis of increased risks. This account provides a general framework for assessing standard exclusions as well as more controversial ones such as the exclusion of pregnant women and women of childbearing potential from certain types of research.The exclusion of potential subjects on the basis of increased risks is a common and, in most instances, noncontroversial practice in human subjects research. Investigators routinely exclude potential subjects with reduced kidney function, bleeding disorders, and allergies to the drugs under investigation. Surprisingly, this use of exclusion criteria takes place in the absence of any explicit guidelines. In the present paper, I attempt to fill this gap in the literature and regulations by offering a specific account of the conditions under which potential subjects should be excluded from research on the basis of increased risk. This account serves two purposes.First, subjects who are excluded on the basis of increased risk are prevented from making their own enrollment decisions. Therefore, it is important to ensure, in spite of the broad range of potential subjects and the varied reasons for excluding them, that potential subjects are excluded in [End Page 307] a systematic and fair way. Second, certain instances of subject exclusion, most notably the exclusion of pregnant women and women of childbearing potential, raise more difficult issues. By providing a general framework for assessing the exclusion of potential subjects based on increased risks, the present analysis covers these cases as well and, thus, offers a solution to one of the thornier ethical dilemmas facing investigators and IRBs today.Briefly, I argue that standard exclusion practices suggest that whenever two groups of potential research subjects offer the same opportunity for scientific and individual benefit, but different levels of risk, the group that would introduce greater risks should be excluded. With this framework in place, I consider potential subjects, such as men and women of child-parenting potential, whose research participation introduces increased risks to third parties. I argue that the present approach is justified, not because it reduces harms to specific individuals, but because it reduces aggregate harms. Therefore, it should be applied to all riskier potential subjects regardless of who faces the risks in question. After defending this approach, I consider several objections.First, I argue that the present approach is not paternalistic; the exclusions it calls for are not justified by what is thought to be in the best interests of the individuals excluded. Rather, the argument is that these exclusions minimize the aggregate harm of human subjects research. In addition, the present approach does not violate the obligation of researchers to respect subject autonomy because it does not reduce the number of potential subjects who are given the opportunity to enroll in a particular protocol. Finally, the exclusions are consistent with reasonable side constraints on attaining the goals of research.“Riskier” SubjectsWhen it comes to evaluating risks, most guidelines on human subjects research stipulate simply that the risks entailed must be reasonable given the potential for benefit. The Australian National Health and Medical Research Council’s guidelines, for instance, require only that “the investigator... must be satisfied that the possible advantage to be gained from the work justifies any discomfort or risk involved” (ANMRC 1992, Clause 3). To determine whether the risks of a protocol are justified, one sums the risks of the various procedures in the protocol, whatever those procedures may be, and compares the result to the procedures’ potential for benefit. This evaluation of risks assumes that the aggregate risks of a [End Page 308] given protocol are fixed and thus will not help to determine whether and when the risks of particular protocols should be reduced by excluding riskier subjects. The United States Department of Health... (shrink)

Skepticism about the limits of online learning is as old as online learning itself. As with other technologically-driven innovations in pedagogy, there are deep-seated worries that important educational goods might be effaced or obscured by the ways of teaching and learning that online methods allow. One family of such worries is inspired by reflections on the bodily basis of an important kind of understanding, and skepticism over whether this bodily basis can be inculcated in the absence of actual, flesh-and-blood, classroom (...) interactions. This paper focuses on the ways in which such worries arise in the influential work of Hubert Dreyfus. The negative conclusion for which I argue is that endorsing Dreyfus's Merleau-Pontian picture of the relationship between bodily skill and understanding does not commit us to his general pessimism concerning online learning—bodily, emotional, and interactive dimensions might be essential to learning, but we lack reasons to think that online learning necessarily lacks these dimensions. The negative argument motivates a positive claim: rather than giving up on online learning we should focus on designing courses and pedagogies that scaffold the bodily, affective and interactive dynamics constitutive of understanding in a particular domain. (shrink)

The first complete history of Minneapolis and St Paul published in two decades. The book spans their ramshackle beginnings as cross-river rivals to their thriving metropolitan partnership today.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Nature of Space by Milton SantosDave McLaughlinThe Nature of Spaceby milton santos (trans. by brenda baletti) Durham, N.C.: Duke University Press, 2021When asked to review Milton Santos’s The Nature of Space, I was interested mostly in the book’s core theme. As a literary geographer, my own research focuses heavily on space as an analytical concept and a lived experience; I was keen to read and understand a (...) fresh perspective on this topic. Little did I know that opening this book would connect me to a world of geography scholarship for the most part ignored, actively or otherwise, in the Anglophone academy. For my sins, I was not alone in this ignorance. In 2017, for example, one scholar felt confident in writing that:The English-speaking geographical community knows very little about the theoretical work in geography being produced in the so-called [End Page 147] “global South.” They are unaware, for example, of the work of Brazilian geographer Milton Santos.1It is not my place here to write about the reasons why this is such a mistake. Others, better qualified than me, have already done so.2 My aim here is to do three things. First, to put Santos’s arrival into English-language geography in context; second, to consider briefly his key contribution to defining the nature of space; and finally, to touch on what Santos’s book offers us more broadly.Published in 2021, Brenda Baletti’s translation of Santos’s great work arrived on the crest of a wave of discussions, debates, and scholarly interventions around decoloniality in Western geography. This movement emphasizes uncovering “still colonising frames of knowledge”3—frames “through which the world is apprehended and explained and modelled for the future”—and “craft[ing] ways of thinking harder about and against them.”4 Others have argued that the long wait for an English translation of Santos’s The Nature of Space is evidence of just such modes of thought continuing, unreflectively, among Anglophone academia. In 2019, an English-language translation of Santos’s For a New Geography was published by the University of Minnesota Press, followed by The Nature of Space in 2021. Hopefully, publications indicate that some publishers, at least, are following Stephen Legg’s call to think hard against certain predominant Western frames.The Nature of Space, despite its mere 280 pages, is an opus of sorts. Santos’s style eschews narrow conceptualization in favor of building a solid theory of space on a remarkably broad foundation of thinkers, including Braudel, Merleau-Ponty, Habermas, Latour, and many, many others. This broad foundation is a result not only of his long career and his own widely travelled life; it is necessary due to the slippery and almost-undefinable nature of space itself. In a wonderful section of For a New Geography, Santos lays out the problem facing geographers in defining this concept around which our discipline revolves:I understand why geographers have spent more time defining geography than space as the latter is extremely hard to do. The same could be said of space as Saint Augustine said of time: “if I ask myself if I know [End Page 148] what it is, I respond that I do; but, if I ask myself to define it, I respond that I do not know how.”5Part of this complication, recognized by Santos, is that “space” is a word with many meanings outside academia.6 Yet, geographers also face no simple task in defining this core concept for our own needs. Doreen Massey’s definition from For Space is one of my favorites, not only because it well illustrates the complexity of the term “space,” but also due to the range of reactions it produces in my first-year undergraduate students when I introduce it: Space is the sphere of the possibility of the existence of multiplicity in the sense of contemporaneous plurality.7 This is a very crunchy sentence! But it gets to the heart of a conceptually complex truth: that space is the dimension in which things happen, a dimension in which we must live at all times, as well as... (shrink)

The aim of this article is to bring to the attention of the international nursing community the discrepancy between a pervasive ‘caring’ nursing discourse and a most unethical nursing practice in the United States. In this article, we present a duality: the conflict in American prisons between nursing ethics and the killing machinery. The US penal system is a setting in which trained healthcare personnel practice the extermination of life. We look upon the sanitization of deathwork as an application of (...) healthcare professionals’ skills and knowledge and their appropriation by the state to serve its ends. A review of the states’ death penalty statutes shows that healthcare workers are involved in the capital punishment process and shielded by American laws (and to a certain extent by professional boards through their inaction). We also argue that the law's language often masks that involvement; and explain how states further that duplicity behind legal formalisms. In considering the important role healthcare providers, namely nurses and physicians, play in administering death to the condemned, we assert that nurses and physicians are part of the states’ penal machinery in America. Nurses and physicians (as carriers of scientific knowledge, and also as agents of care) are intrinsic to the American killing enterprise. Healthcare professionals who take part in execution protocols are state functionaries who approach the condemned body as angels of death: they constitute an extension of the state which exercises its sovereign power over captive prisoners. (shrink)

Police and pastoral power: governmentality and correctional forensic psychiatric nursing Since 1978, the federal inmates of Canada have had access to a full range of psychiatric care within the penitentiary system. Several psychiatric units are now integrated into the correctional services of Canada. This paper presents the results of a grounded theory doctoral study undertaken in a multilevel secured psychiatric ward within the Canadian federal penitentiary system. The author describes and discusses the results of qualitative data that emerged from his (...) fieldwork. The concept of governmentality, as defined by the late French philosopher Michel Foucault, constitutes one of the major theoretical tools that were helpful in analyzing these data. Police and pastoral power, two dimensions of the security apparatus of governmentality, were found to be useful in understanding and characterizing nursing practice caught between the penal and the psychiatric dispositifs. A Foucauldian perspective allows one to understand the manner in which forensic psychiatric nursing is involved in the governance of mentally ill inmates through three forms of power — sovereign, disciplinary and pastoral — which have posited nursing practice as a strategic tool of the correctional services. This research consists of a study of nursing practice in an extreme setting that deserves a radical analysis. (shrink)