ABCP asset‐backed commercial paper ABS asset‐backed security ABX a source of price indices for MBSs and CDSs ARM adjustable‐rate mortgage B...

Katrina Karkazis, Fixing sex: Intersex, medical authority, and lived experience, Durham, N.C.: Duke University Press, 2008, reviewed by Ellen K. Feder Elizabeth Reis, Bodies in doubt: An American history of intersex, Baltimore: Johns Hopkins University Press, 2009, reviewed by Ellen K. Feder.

A concise, elegant, and thought-provoking exploration of the mystery of consciousness and the functioning of the brain. Despite decades of research, remarkable imagery, and insights from a range of scientific and medical disciplines, the human brain remains largely unexplored. Consciousness-the awareness of our own and others' existence-has eluded explanation. Nineteen Ways of Looking at Consciousness offers a brilliant overview of the state of modern consciousness research in twenty brief, revealing chapters. Neuroscientist and author Patrick House describes complex concepts in accessible (...) terms, weaving brain science, technology, gaming, analogy, and philosophy into a tapestry that illuminates how the brain works and what enables consciousness. This remarkable book fosters a sense of mystery and wonder about the strangeness of the relationship between our inner selves and our environment. (shrink)

The paper attempts to show that Aristotle's critique of Plato's teachings provides an exemplary model of sound, scientific, philosophical commentary. This view has been vigorously opposed by one of the most brilliant Platonist in our century. J.N. Findlay sharply distinguishes between the Aristotle whom he regards as a faithful recorder of his master's teachings, and the Aristotle whom he condemns as a thoroughly misguided and incompetent Platonic commentator. I join Findlay in giving first authority to Aristotle's evidence against Cherniss (...) and others, but maintain against Findlay that the most philosophically insightful and accurate exposition of Plato's philosophy is to be found in the works of Aristotle. In arguing this thesis I attempt to support J.A. Doull's account of the relation of Aristotle to Plato. (shrink)

Taking into account pragmatic considerations and recent linguistic and psychological studies, the author forges a new understanding of the relation between metaphoric and literal meaning. The argument is illustrated with analysis of metaphors from literature, philosophy, science, and everyday language.

Many formerly incarcerated people have civil legal needs that can imperil their successful re-entry to society and, consequently, their health. We categorize these needs and assess their association with cardiovascular disease risk factors in a sample of recently released people. We find that having legal needs related to debt, public benefits, housing, or healthcare access is associated with psychosocial stress, but not uncontrolled high blood pressure or high cholesterol, in the first three months after release.

Fabienne Blaise- F. Blaise, P. Judet de La Combe et Ph. Rousseau (éds.) : Le Métier du mythe. Lectures d'Hésiode (Villeneuve d'Ascq, PUS, 1996) - traduction chinoise à paraître aux éditions Huaxia Publishing House of China, Pékin, en 2005. Jean Bollack- La Muerte de Antigona. La tragedia de Creonte. Traduction en espagnol de La Mort d'Antigone (Paris, PUF, 1999) par Arnaud Pons et de Xavier Riu, Arena Libros, coll. Tempo al Tempo, Madrid 2004, 144 p. - Sentido contra sentido. ¿ (...) Como se lee.. (shrink)

The scientific, ethical, and policy issues raised by research involving the engraftment of human neural stem cells into the brains of nonhuman primates are explored by an interdisciplinary working group in this Policy Forum. The authors consider the possibility that this research might alter the cognitive capacities of recipient great apes and monkeys, with potential significance for their moral status.

This book's thirty essays explore philosophically the nature and morality of sexual perversion, cybersex, masturbation, homosexuality, contraception, same-sex marriage, promiscuity, pedophilia, date rape, sexual objectification, teacher-student relationships, pornography, and prostitution. Authors include Martha Nussbaum, Thomas Nagel, Alan Goldman, John Finnis, Sallie Tisdale, Robin West, Alan Wertheimer, John Corvino, Cheshire Calhoun, Jerome Neu, and Alan Soble, among others. A valuable resource for sex researchers as well as undergraduate courses in the philosophy of sex.

IntroductionDespite the need for trained physician ethicists, fellowships in clinical ethics are limited and primarily offered to thosewho have completed a graduate degree. The standardization of credentialing for clinical ethics consultants (CECs) and the restructuring of undergraduate medical education allow innovative models to train CECs that can provide an expanded opportunity for formal ethics training at an earlier stage.MethodsAt the University of Michigan Medical School we developed, implemented, and evaluated a pre-doctoral clinical ethics fellowship program from 2017 to 2019 for (...) senior medical students, designed to meet established competencies for CECs. Consultation notes from the beginning and end of the fellowship program were randomly selected for each fellow and independently rated by two faculty ethicists who used the validated Ethics Consultation Quality Assessment Tool (ECQAT).1 Inter rater reliability and trends in scores over time were calculated.ResultsThree students successfully completed the fellowship at the University of Michigan Medical School, conducted at least 50 formal ethics consultations, and spent approximately 40 hours a week on service for a minimum of six months. All students finished the fellowship with teaching and policy development experience, first-authored peer-reviewed manuscripts, and national presentations. The fellows demonstrated improvement in their ECQAT overall holistic rating score; all ended their fellowship with a holistic score of adequate or above. There was 92 percent agreement between raters withrespect to the acceptability of the fellows’ ethics consult notes. Two fellows have taken and passed the Healthcare Ethics Consultant-Certification (HEC-C) exam offered by the American Society for Bioethics and Humanities (ASBH).ConclusionsIntegration of a pre-doctoral fellowship model that meets professional certification standards for clinical ethics consultation creates an opportunity for medical students to become trained CECs early in their career. (shrink)

The conventional wisdom regarding the creation of federal housing programs during the Great Depression cites market failure as the key factor leading to government action. A review of the historical record regarding one program in particular, the Federal Housing Administration's insurance of real‐estate mortgages, suggests a more complex picture. Amortized loans were not created anew by the FHA but had been developed previously by various financial institutions; their use by national banks was restricted by law. What (...) market failure occurred seems to have been induced, at least in part, by the federal government. (shrink)

What comes to my mind is my house in the woods with no neighbor in sight, a home I have to defend not against real burglars or imaginary terrorists but against deer that eat my flowers and raccoons that break into my porch and all that at a 15-minute drive from a superb library. I see the peaceful emptiness of the land. I see myself driving or riding my motorcycle on, say, Interstate 70, somewhere in Arizona or New Mexico perhaps (...) along the legendary Santa Fe Railroad with barely a car on the magnificent highway. With some justification the USA is reproached for being the world's worst polluter yet it invented and maintains the most glorious National and State Parks. I recall the Natchez Trace running from Mississippi to Nashville Tennessee, a fine two-lane road with no buildings (not even a gas station) along its 443 miles (710 km), or the Appalachian Trail, a mountain footpath for hikers which extends over 2100 miles (3400 km). To those who equate America with New York it may sound surprising, but the overwhelming majority of the population of the United States leads a quiet, undisturbed life. One pays one's taxes - and is left alone in everything else. Years can pass without the need for any contact with the so-called ‘authorities’ to arise, and when it does - on city, state, or federal level - the contacts are usually pleasant. People elect their sheriffs, their judges, the employees of the court house, all of whom, to keep their jobs, try to be helpful. In the soup-kitchen where I have occasionally served, a good, appetizing meal is offered free of charge to anyone who comes in, with no questions asked about need or identity. Many who come could afford to buy themselves a meal. (shrink)

Under a policy first enacted in 1988 and expanded in 1996, federally funded public housing authorities (“PHAs”) and private landlords renting their properties to tenants receiving federal housing assistance have been required to include a provision in all leases under which drug-related criminal activity as well as criminal activity that in any way poses a threat to other tenants or nearby residents constitutes ground for initiating eviction proceedings. This strict liability eviction policy, which has become known as (...) the “One-Strike Rule,” was part of a broader congressional effort to combat the “reign of terror” that Congress believed drug dealers were imposing on public housing and assisted housing tenants. Like many of the crime-related policies enacted in the 1980s and 1990s, the One-Strike Rule has done little to reduce crime rates, but has been wildly successful in ensuring that the situation of poor households receiving federal assistance remains highly precarious. Calls for reform of the One-Strike Rule are almost as old as the policy itself, but given the political outlook of the current administration, the prospects for reform at the federal level are dim. While federal law and a combination of gridlock and unwillingness in the congressional and executive branches foreclose a range of possible strategies for reform, there is nonetheless room to mitigate the socially corrosive effects of the One-Strike Rule through legislative efforts at the state and local level. Courts in various jurisdictions have upheld state laws that protect vulnerable tenants despite the federal strict liability policy, and these holdings help to provide a framework for how state and local governments seeking to protect tenants can do so without their efforts necessarily falling prey to the Supremacy Clause. This article describes that framework and proposes three concrete measures that fit it. The article is structured as follows: after explaining the One-Strike Rule and the threat it poses to vulnerable tenants (Section II), the article discusses the burden the Rule imposes on tenants and the benefits it is supposed to bring to other parties, and argues that the resulting distribution of burdens and benefits is unjust (Section III). The article then lays out three concrete measures that state and local governments can enact to protect tenants who face eviction for criminal activity under the Rule without falling prey to a federal preemption challenge: requiring “good cause” for eviction, giving tenants the right to cure a breach of their lease, and providing tenants with free counsel in landlord-tenant court (Section IV). (shrink)

Allegations of bias against senior judges have not been common in English courts, so the House of Lords had little material to draw on when the Pinochet case was decided. It is therefore worthwhile to compare their Lordships» approach with that of the Federal Constitutional Court in Germany. This court has been selected because: (a) it has a comparable number of judges to the House of Lords and its decisions are unappealable, and (b) its cases have a constitutional and (...) (often) political content—as did the Pinochet case. The Federal Constitutional Court case law is comparatively prolific, so this study has been limited to the last 15 years. The case law covers a wide variety of issues, for example provision of legal opinions or representation, membership of associations, holding of public offices, public statements of opinion. If the standards set in this case law were applied to Lord Hoffmann's position in the Pinochet case, there are grounds for saying that he might not have been excluded. (shrink)

The evidence reveals that young children are targeted by food and beverage advertisers but are unable to comprehend the commercial context and persuasive intent of marketing. Although the First Amendment protects commercial speech, it does not protect deceptive and misleading speech for profit. Marketing directed at children may fall into this category of unprotected speech. Further, children do not have the same First Amendment right to receive speech as adults. For the first time since the Federal Trade Commission's original (...) attempt to regulate marketing to children in the 1970s , the political, scientific, and legal climate coalesce to make the time well-suited to reevaluate the FTC's authority for action. This paper analyzes the constitutional authority for the FTC to regulate television food marketing directed at children as deceptive in light of the most robust public health evidence on the subject. (shrink)

This article is currently available as a free download on ingentaconnect.

In response to the obesity epidemic, much discussion in the public health and child advocacy communities has centered on restricting food and beverage marketing practices directed at children. A common retort to appeals for government regulation is that such advertising and marketing constitutes protected commercial speech under the First Amendment. This perception has allowed the industry to function largely unregulated since the Federal Trade Commission 's foray into the topic, termed KidVid, was terminated by an act of Congress in (...) 1981. The FTC has since focused on self-regulation as a potential solution to such concerns. However, this method of control has proven ineffective to protect children, and has led to growing recognition that federal regulation may be necessary.Since KidVid, the evidence has only mounted that children are uniquely vulnerable to the effects of advertising. Over the same time period, the exposition of commercial speech jurisprudence has plateaued, as the Supreme Court has not decided a pure commercial speech case since 2002. (shrink)

In this new publication, Cristina Cormos professionally addresses a sensitive issue, complex and difficult in the same time, and ambitiously manages to give us a picture of international migration viewed through identity change. Starting from the hypothesis that "migration is a change that simultaneously occurs in both physical and socio-cultural realms, which implies not only movement from one community to another, but also the disintegration of structural bonds in the departure area, paralleled by a cultural assimilation of the destination environment", (...) the author analyzes identity changes of the emigrants throughout the entire migration process, the factors underlying these changes, as well as the consequences and implications of these factors in the return migration. The issues addressed within this book also cover the changes occurred in the family and community of origin as a result of the absence of one of its members and of the manifestation of identity changes respectively. (shrink)

The Federal Trade Commission has an important role to play in the governmental oversight of mobile health apps, ensuring consumer protections from unfair and deceptive trade practices and curtailing anti-competitive methods. The FTC’s consumer protection structure and authority is outlined before reviewing the recent FTC enforcement activities taken on behalf of consumers and against developers of mhealth apps. The article concludes with identification of some challenges for the FTC and modest recommendations for strengthening the consumer protections it provides.

This note examines the British case of Broidy v. St Helen's andKnowsley Health Authority in which Margaret Broidy was unsuccessful in anegligence action against the defendant Health Authority following an emergency caesareanoperation in which a hysterectomy had been performed as `essential'. Of particularfeminist interest is the fact that Broidy's claim for, inter alia, the costs of asurrogacy arrangement to be carried out in California was refused on the basis that it wasnot reasonable – the chances of success of (...) the surrogacy arrangement being deemed tooremote. Set within the context of an increasingly prolific number ofworld-wide surrogacy stories, the Broidy decision is analysed as providing a recentillustration of some of the difficult implications of the reproductive option which surrogacyhas now become. (shrink)

Preparing for and responding to public health emergencies involving medical countermeasures raise often complex legal challenges and questions among response stakeholders at the local, state, and federal levels. This includes concerns about emergency legal authorities, liability, emergency use of regulated medical products, and regulations that might enhance or hinder public health response goals. In this article, lawyers from the U.S. Department of Health and Human Services’ Office of the General Counsel , Centers for Disease Control and Prevention , and (...) Food and Drug Administration discuss federal legal tools that are critical to enhancing MCM legal preparedness for public health emergencies, with an emphasis on the legal mechanisms that can be used to facilitate the emergency use of countermeasures. Specifically, the authors describe the Public Readiness and Emergency Preparedness Act and Emergency Use Authorization authority, outlining the conditions under which these tools can be utilized and providing examples of how they have supported both pre-event and intra-event activities. (shrink)

Law can greatly facilitate responses to public health emergencies, including naturally-occurring infectious disease outbreaks and intentional or accidental exposures to chemical, biological, radiological, or nuclear agents. At the federal level, the Secretary of the Department of Health and Human Services, as the lead for federal public health and medical responses to public health emergencies and incidents, has a range of authorities to support federal, state, tribal, local, and territorial responses. For example, under the Public Health Service Act, (...) the Secretary may provide temporary assistance to States to meet health emergency needs or deploy medicine and supplies from the Strategic National Stockpile. The Secretary also may determine that a disease or disorder presents a public health emergency, which may be the first step in triggering other critical legal authorities for response.Since the 2001 anthrax attacks, one focus of public health preparedness has been on developing, distributing, and rapidly dispensing medical countermeasures for CBRN emergencies and pandemics. (shrink)

Federal Indian law is the body of law that defines the rights, responsibilities, and relationships between three sovereigns, Tribes, states, and the federal government. This area of law has defined, oftentimes poorly, the contours of treaty rights, criminal and civil jurisdiction, economic development, among other issues. Much has been documented in terms of the implications of social, legal, political, and economic systems that perpetuate inequities amongst American Indian and Alaska Native populations. There has also been substantial research on (...) health inequalities. Yet, there has been less discussion on the role of law in perpetuating these adverse health outcomes in these populations. The social and structural determinants of health are the factors and conditions, such as housing, education, and politics, that create health disparities. For years, law has been described as a tool to promote health and even a determinant of health. And while research has explored Tribal health laws and federal Indian health policies, more needs to be analyzed in terms of the role of foundational principles of federal Indian law in perpetuating health disparities. This article argues that federal Indian law is a structural determinant of health by linking health disparities to the constructs of this body of law. (shrink)

In this text, our question is what is the current regulatory trend in countries that are not considered central in the development of artificial intelligence, such as Brazil: a preventive approach, or an experimental approach? We will analyze the bills (PL) that are being processed in legislative houses at the state level, and at the federal level, highlighting some elements, such as: Delimitation of the object (conceptualization), fundamental principles, ethical guidelines, relationship with human work, human supervision, and guidelines for (...) public authorities. Based on these elements, we identified how the issues that drive the contemporary debate on AI have been addressed in these legislative initiatives. The results indicate that the strongest national regulation proposal mentions risks, rights, governance, economic agents; these mentions dialogue with the concerns discussed by researchers around the world, regarding the mitigation and prevention of risks, regarding the preservation of individual and collective rights, the role of the State as a regulator and supervisor, and, as was to be expected, the maintenance of economic policies that possibly tend to protect the market; proposes that the foundations of the development, implementation and use of AI have values consistent with ‘human centered AI’ (Bingley et al. 2023), but also points to the neoliberal matrix; introduces human supervision as an effective element in the AI systems cycle; the trend that we can observe in Brazil is the configuration of a regulation that harmonizes articles that favor the preventive approach, with the presence of articles that favor the experimentation approach. (shrink)

The authors assess the collaboration between the University of California, Berkeley’s Community Assessment of Renewable Energy and Sustainability program and the Pinoleville Pomo Nation, a small Native American tribal nation in northern California. The collaboration focused on creating culturally inspired, environmentally sustainable housing for tribal citizens using a codesign methodology developed at the university. The housing design process is evaluated in terms of both its contribution to Native American “cultural sovereignty,” as elaborated by Coffey and Tsosie, and as (...) a potential example of the democratization of scientific practice. (shrink)

The authors examine the internal and external motivating factors behind the actions of the House Committee on Ethics members by looking at the procedural efficiency of the Committee on Ethics (or lack thereof), as a natural consequence of the committee members' implicit public policy actions.

This article appeared originally in L'EUROPE en formation, No. 238, Juillet-Aout 1980 and is here reprinted with the permission of the author and editor. Presses d'Europe, Paris.

A “Critical Perspectives” article in the Journal of Bioethical Inquiry on scientific integrity in Brazil summarizes several misconduct cases documented therein . To further reinforce the responsible conduct of research in developing countries and to fight against the unaccountability of many editors , we describe here a Mexican instance of alleged in-house plagiarism .In June 2011, we submitted a “Correspondence” note to a Nature group journal to expose what we claimed to be a breach of collegiality and inappropriate authorship in (...) a three-page mutation report just published in that journal. Our main complaints were two: the surreptitious way in which we believed that both displayed metaphases in that report had been obtained from our files by a local colleague and then published without our consent and the massive easy-on co-authorship: 14 out of 21 co-authors declared just to have “provided clinical material.” In c .. (shrink)

Following Rawls, many political liberals hold reasonableness in high regard. Reasonable citizens can disagree, however, and some may find their arguments routinely ignored in elections and legislatures. Should we be troubled by such failures of institutional responsiveness as a matter of justice? The author argues that the expectation of such failures would lead parties in an original position to favor certain classes of institutions over others: A Theory of Justice and Political Liberalism together suggest a particular federal structure to (...) a republic of reasons. (shrink)

Author of more than 80 studies and articles of theology and bibliotheconomy and of the book: Cenzurarea presei ortodoxe în comunism, but alsoPhD in philology and member of important associations and cultural institutions, Silviu-Constantin Nedelcu is already a name known in the Romanian cultural space. His recent book, entitled: O scurtă istorie a bibliotecilor byzantine, published by the acclaimed Lumen Publishing House from Iassy, comes to offer a new testimony of the quality of his investigations.

By analysing original sources and evaluating conceptual frameworks, this book discusses the idea proclaimed in the Preamble to the Constitution that Australia is a federal commonwealth. Taking careful account of the influence which the American, Canadian and Swiss Constitutions had upon the framers of the Australian Constitution, the author shows how the framers wrestled with the problem of integrating federal ideas with inherited British traditions and their own experiences of parliamentary government. In so doing, the book explains how (...) the Constitution came into being in the context of the groundswell of federal ideas then sweeping the English-speaking world. In advancing an original argument about the relationship between the formation of the Constitution, the representative institutions, configurations of power and amending formulas contained therein, fresh light is shed on the terms and structure of the Constitution and a range of problems associated with its interpretation and practical operation are addressed. (shrink)

In 1992, the United States Supreme Court, in Planned Parenthood of Southeastern Pennsylvania v. Casey, upheld the ruling in Roe v. Wade, namely that women have a right “to choose to have an abortion before viability and to obtain it without undue interference from the State.”1 However, since this ruling, some states have imposed regulations that greatly limit this right by restricting access. Texas is a recent example of this. Two proposed restrictions in House Bill 2, which will be discussed (...) in detail below, will force all but eight clinics that are located in metropolitan areas to shut down. The U.S. Supreme Court put the proposed restrictions on hold in October 2014, allowing several clinics to remain open while the restrictions are being appealed in the U.S. Court of Appeals for the Fifth Circuit. If the restrictions are passed, however, those clinics will be forced to shut down and, as a result, many women in Texas will be required to travel more than 100 miles in order to access a safe and legal abortion. Much of the focus of these restrictions has been on women and rightly so. However, I want to turn the attention to physicians. The requirements exacerbate unfair treatment of abortion providers compared with other physicians. Abortion providers face threats from the public—some of which turn into violent attacks—and they are often ostracized by their fellow medical practitioners. There are so few abortion providers to begin with and the proposed requirements limit these physicians’ opportunities to practice the branch of medicine of their choosing. Although the HB 2 requirements may not result in an unconstitutional undue burden on physicians, the challenges created by the bill limit physicians’ abilities to provide abortions. As a result of these limits, HB 2 creates an unconstitutional undue burden for women seeking abortions by creating barriers directed at abortion providers and clinic staff who are willing and able to provide abortions. The first of the two controversial HB 2 requirements is the admitting privileges requirement: “A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced.”2 The second requirement is the ambulatory surgical center requirement: “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under [Texas Health & Safety Code] [...] for ambulatory surgical centres.”3 In order to meet these state-mandated obligations, some abortion clinics would have to spend more than $1 million in upgrades if they wish to remain open. The District Court decided that the ambulatory surgical center requirement places an unconstitutional undue burden on women, and that the two requirements together place an undue burden on women in Texas and especially in the Rio Grande Valley where the nearest clinic is a couple hundred miles away.4 Later, the U.S. Court of Appeals for the Fifth Circuit reversed the District Court’s decision and argued, “the admitting privileges requirement is constitutional on its face.”5 While the regulations are being appealed, the Supreme Court granted a stay of injunction, allowing about twelve abortion clinics to reopen until a final decision regarding the regulations is made. The District Court ruled that the purpose of the two regulations was to create a substantial obstacle for women seeking abortions in Texas. While the defendants argued that the regulations were designed to make abortions safer and reduce risk, the Court decided that this was not the case. An abortion, especially a first-term abortion, is a very safe procedure and is safer than many other routine surgical procedures. As stated in Planned Parenthood v. Casey, “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”6 The undue burden in this case is imposed, not through restricting women’s access directly, but by restricting physicians’ freedom to perform abortions. The admitting privileges requirement has reduced the number of physicians who can perform abortions and the ambulatory surgical center requirement has reduced the number of clinics where abortions can be performed. The American Medical Association states, “[t]he Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.”7 This means that physicians are not required to perform abortions, except in emergency situations, but can as long as the procedure is done safely and does not violate the law. The new Texas regulations, however, are so restrictive that few abortion providers, limited to only four urban areas, can legally perform abortions. Physicians do not have an absolute right to perform abortions as opposed to women who have an absolute right to have access to an abortion. Physicians do face many challenges that other professionals face in terms of obtaining qualifications and finding work. Abortion providers, however, face challenges that most other physicians do not. The restrictions imposed by these regulations exacerbate unfair treatment toward abortion providers and place further obstacles in their path in terms of providing the service they want and are qualified to provide. Both abortion clinics and abortion providers are being treated differently from other medical clinics and physicians. For instance, “grandfathering of existing facilities and the granting of waivers from specific requirements is prohibited for abortion providers, although other types of ambulatory surgical facilities are frequently granted waivers or are grandfathered.”8 Many abortion clinics cannot afford the necessary upgrades. Furthermore, it is extremely expensive to open a brand new clinic that complies with the ambulatory surgical center requirements. Being grandfathered in would be the only option available to abortion clinics that cannot afford the upgrade. However, unfair treatment of abortion clinics and providers is preventing those clinics from being grandfathered into the new system. As a result, many abortion clinics may be forced to close. Admitting privileges are proving difficult or impossible for physicians both to obtain and, for those who have already been granted privileges, to keep. Dr. Sherwood Lynn, an obstetrician-gynecologist who has performed abortions for decades, describes the process of obtaining admitting privileges and the difficulties abortion providers face. After sending in an application a physician must wait for the hospital to send them the required materials, “but if the address of the practice on the application is of an abortion provider or clinic, [the hospital] won’t send [them] the package of materials required. [They] simply can’t apply.”9 Dr. Lynn and several other physicians have surmised that hospitals are only withholding privileges from qualified physicians who perform abortions and that other physicians do not face this discriminatory treatment. Hospitals have also revoked privileges granted to physicians after learning that the physicians perform abortions. For instance, in Texas two doctors, “received notices [...] informing them that their admitting privileges to the University General Hospital of Dallas have been revoked, with the hospital’s CEO claiming the hospital was unaware they were providing abortion care and that the hospital believed such care would damage its reputation.”10 What is curious about this revocation is that, “federal and state laws [...] forbid hospitals from discriminating against doctors who perform abortions,” and yet hospitals are clearly doing just that.11 Dr. Pamela Richter, another abortion provider in Texas, had her temporary admitting privileges revoked with no explanation and because of this, the clinic where she performed abortions, Reproductive Services, can no longer provide abortions at all.12 As the hospital gave no reason for the revocation, it not clear Dr. Richter’s privileges were revoked because she performs abortions. Dr. Richter, however, has performed over 17,000 abortions and her privileges were revoked soon after HB 2 was introduced.13 According to the Texas Hospital Association, giving admitting privileges to doctors who do not work for the hospital is expensive and time-consuming but this does not account for the fact that hospitals are revoking previously granted privileges from physicians whom they learn are providing abortion services.14 As mentioned previously, the District Court found that the admitting privileges requirement and the ambulatory surgical center requirement do not further ensure the health and safety of women undergoing an abortion. Several physicians have testified to this fact. Dr. Lynn stated in an interview: The admitting privileges requirements are [...] absolutely unnecessary. If you have a number of patients waiting for procedures, and something happens and a patient needs to be transferred to a hospital, you’re not going to leave everyone else and go to the hospital. That makes no sense. You’re going to refer that person to a gynecologist at the hospital. There is no safety issue involved here. If a patient shows up with an emergency, every hospital is required to admit that patient. They have to by law.15 It is rare that complications will arise from an abortion performed in a clinic. Dr. Richter, for example, has performed more than 17,000 abortions and not once had to send a patient to a hospital because of complications resulting from the procedure. According to Dr. Lynn even if abortion providers were granted privileges to hospitals, it is unlikely that they will exercise them. In essence, having admitting privileges at a hospital does nothing to further ensure the safety of an already safe procedure. The only result of the admitting privileges requirement is to limit certain physicians’ ability to perform legal abortions. Not only do the HB 2 requirements fail to further ensure the health and safety of women, the HB 2 requirements may actually create more health risks to women who cannot access the eight remaining clinics. The first risk is that the remaining clinics would have an influx of patients that they may not be able to handle, forcing women to wait longer for an appointment. As stated by the District Court, “[e]ven assuming every woman in Texas who wants an abortion [...] could travel to one of the four metropolitan areas where abortions will still be available, the cumulative results of HB 2 are that, at most, eight providers would have to handle the abortion demand of the entire state.”16 Furthermore, “[t]hat the State suggests that these seven or eight providers could meet the demand of the entire state stretches credulity.”17 Abortion is a time sensitive procedure. It is safest when performed early in a pregnancy. The increase in patients to these remaining clinics, assuming all women in Texas can access them, will increase wait times and may force women to have abortions later in pregnancy. In the worst-case scenario, a woman would not see an abortion provider at all before viability. Such instances may be rare, but they are possible. In such cases, women’s access to legal abortions becomes impossible and thereby violate the ruling in Roe. Clinics may be able to avoid the aforementioned problems if they hire more physicians. However, there are two barriers to hiring more physicians. First, as mentioned previously, admitting privileges to Texas hospitals are difficult, if not impossible, for abortion providers to obtain. Second, given the negative treatment of abortion providers by anti-abortion groups, many physicians are not willing to perform abortions. The harassment abortion providers face is unique to those physicians and many physicians will not perform abortions for that reason. In an article published in the Austin Chronicle, anti- abortion activist Abby Johnson, “discusses how her group investigated appraisal district records to find the new location of where an Austin abortion physician plans to work.”18 Johnson states, “These abortionists are feeling the pressure from the pro-life movement in Texas. I think they feel like they’re on the run. And that’s how we want to keep it.”19 If the HB 2 requirements are passed and there remain at most eight abortion providers in Texas, these activists will concentrate on those clinics and, “the dangerous impact of their intimidation tactics will be exacerbated.”20 Even if the number of physicians needed to meet the demand in Texas can obtain admitting privileges and work at one of the remaining clinics, they may choose not to do such work because they are putting themselves at risk. The harm abortion providers face from such anti-abortion groups is not unique to Texas. There are stories from all over the country and from other countries where abortion is legal of physicians receiving death threats. Dr. George Tiller, an abortion provider in Kansas, was killed outside his church and had received numerous death threats prior to this. The HB 2 requirements are making it so that abortion providers either cannot provide their services any longer or will face increased threats and increased danger to themselves. Physicians are allowed to conscientiously object to providing medical interventions in certain circumstances for moral and religious reasons. However, there are limits on this right. According to the American Congress of Obstetricians and Gynecologists, “[w]hen conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal.”21 I would argue fear for one’s safety in the face of immediate threats is perhaps a stronger ground on which to refuse to provide care than a personal belief that abortion is immoral or against one’s religion. ACOG also states, “[p]roviders with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide.”22 This responsibility has been largely disputed by the medical community but in cases of rape, incest, and health risks to women, referrals must be made without exception. However, under the requirements of HB 2, working in proximity to an abortion provider may not be possible because they are so geographically limited. Referrals are supposed to be made within reason. Some areas of Texas, such as the Rio Grande Valley, are up to 200 miles away from the nearest clinic that would remain open if HB 2 is passed. Referrals may simply not be feasible given the geographical distances and the decreasing number of available physicians. As mentioned above, there are two risks to the health and safety of women as a result of HB 2. The second of these is that if a woman cannot access one of the remaining clinics, she may seek out a more convenient but illegal and unsafe abortion, which is far more likely to result in a dangerous complication. Dr. Lynn states, “[b]ecause of the restrictions lawmakers impose, women will seek abortions illegally, and we’re going to see a rise in septic abortions.”23 Some areas of Texas might effectively revert back to a pre-Roe era where abortions were performed in unsanitary conditions by unqualified people resulting in dangerous medical complications far more often than legal abortion procedures do now. Physicians like Dr. Lynn who want to prevent this from happening generally cannot do so without facing legal sanction. Physicians have a duty to provide safe medical care and if they cannot obtain admitting privileges, they cannot exercise this duty. ACOG released a statement expressing their objections to the new requirements. They state that HB 2 is, “plainly intended to restrict the reproductive rights of women in Texas through a series of requirements that improperly regulate medical practice and interfere with the patient-physician relationship.”24 Executive Vice-President of ACOG, Hal C. Lawrence III stated: The Texas bills set a dangerous precedent of a legislature telling doctors how to practice medicine and how to care for individual patients. ACOG opposes legislative interference, and strongly believes that decisions about medical care must be based on scientific evidence and made by licensed medical professionals, not the state or federal government.25 Abortion is one of only a few areas of medicine where the legislature imposes so many regulations restricting particular physicians’ ability to practice medicine. Not only are abortions providers being regulated by the state, they are also facing clear discrimination from others within the medical community. The state is closing down clinics that do not meet the ambulatory surgical center requirements and hospitals are denying physicians admitting privileges because they perform abortions. In summary, abortion providers are being discriminated against both by the legislature and other members of the medical community. Other physicians who do not perform abortions are not denied admitting privileges on discriminatory grounds. Clinics that cannot afford upgrades to become an ambulatory surgical center are being grandfathered in, while abortion clinics are being forced to close down. Ob-Gyns who conscientiously object to performing abortions and who are not located in close proximity to at least one abortion provider cannot effectively fulfill their duty to refer patients. Lastly, given the barriers these regulations will create, there will likely be a rise in complications resulting from abortions provided under grossly unsafe conditions. Physicians, whose duty it is to provide safe and effective medical care, are being denied the right to exercise this duty. While this denial may not be unconstitutional, it is certainly unjust and discriminatory and creates obstacles that other physicians do not face. Most importantly, these obstacles are creating an undue burden for women. The HB 2 requirements do not increase the health and safety of abortions; all they do is create substantial obstacles for women. In light of these observations, the requirements seem to me to be in clear violation of Casey, in which it was decided that, “[u]nnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on that right.”26 These regulations do just what Casey was meant to prohibit and this is accomplished through limiting physicians’ ability to practice safe abortions across the state of Texas. Therefore, the HB 2 requirements may not impose an undue burden on doctors but they do impose an undue burden on women. PDF available: Rachel Hill, "Texas HB 2," Voices in Bioethics. References: 1 Planned Parenthood of Southeastern Pennsylvania v. Casey, pg. 2. 2 Whole Women’s Health v. Lakey, pg. 2. 3 Ibid. 4 Ibid., 4. 5 Ibid., 2. 6 Planned Parenthood v. Casey, pg. 16 7 AMA Code of Medical Ethics, “Opinion 2.01 – Abortion,” American Medical Association. 8 Whole Women’s Health v. Lakey, pg. 10. 9 Dr. Sherwood Lynn, “A Texas Ob-Gyn Details the Horrific Consequences of Abortion Restrictions,” Cosmopolitan. 10 Feminist Newswire, “Texas Hospitals Revoke Admitting Privileges to Abortion Providers,” Feminist Majority Foundation Blog. 11 Ibid. 12 Ibid. 13 Ibid. 14 Glenn Hegar, “Texas Hospital Association’s Statement of Opposition to Section 2 of the Committee Substitute for Senate Bill 5,” Texas Hospital Association. 15 Dr. Lynn, “A Texas Ob-Gyn.” 16 Whole Women’s Health v. Lakey, pg. 10. 17 Ibid. 18 Mary Tuma, “Undercover Audio Reveals Anti-Abortion Tactics: Anti-abortion activists monitor and track providers, patients,” Austin Chronicle. 19 Ibid. 20 Ibid. 21 Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” The American Congress of Obstetricians and Gynecologists. 22 Ibid. 23 Dr. Lynn, “A Texas Ob-Gyn.” 24 “Ob-Gyns Denounce Texas Abortion Legislation: Senate Bill 1 and House Bill 2 Set Dangerous Precedent,” The American Congress of Obstetricians and Gynecologists. 25 Ibid. 26 Planned Parenthood v. Casey, pg. 16. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Michelet and Social Romanticism: Religion, Revolution, NatureArthur MitzmanIn 1851, shortly before his second and definitive suspension from his teaching at the Collège de France, Jules Michelet told a young friend of his dissatisfaction with the meager political impact of the Republican professors of the time: “Our present propaganda... has resembled strongly that which might be made by a man enclosed in a crystal glass. He finds his voice to (...) be resounding and very strong: that’s because it breaks against the inner surface. But those who are outside, the men of the people, hear nothing.” 1Michelet had become painfully aware of how little his voice had been heard outside the crystal in June 1848, when barricade-builders outside his house on the Rue des Postes responded to his son-in-law’s appeal not to expose the dwelling of the great historian to artillery fire by asking, “Who is Michelet?” 2 This occurred two years after the publication of Le Peuple and only months after the appearance of his celebration of the commoners’ festivals of federation in 1790, both texts being landmarks in the social romantic anticipation of 1848. In fact it was the 1848 Revolution itself that had diminished the resonance of Michelet’s ideas, by polarizing the country in a way that made it impervious to his message of social harmony.Before 1848, Michelet was a central figure in the intellectual disaffection that delegitimized the July Monarchy. His work in the 1840s had shifted from the historical erudition of his many-volumed Histoire de France to contemporary polemics against the clergy and the government: attacks on the Jesuits and the Church 3 swiftly broadened to a conflict with the intellectual and political establishment of the period. In Le Peuple (1846), Michelet combined an analysis of the profound social divisions within the French nation with a remarkable sketch of the relation between civilization and nature, a Rousseauian appeal to the natural qualities of the common people and an [End Page 659] invocation of the genius of the future, who would be gifted with “the two sexes of the spirit.”Le Peuple was the first of a series of works on nature, women, and the common people, those three “others” of nineteenth-century high culture, that have throughout this century fascinated cultural historians. In the historiographical tradition, its author has been celebrated by those who viewed him as their predecessor in the broadening of history-writing to include culture and mentalities, such as Lucien Febvre and Jacques Le Goff, and denigrated by those, like Pieter Geyl, who have been outraged by his nationalistic pathos and his blatant subjectivity. 4 I shall suggest in this essay that all of these aspects of Michelet’s work are rooted in his significance in the 1840s as a social romantic, the contemporary and friend of George Sand, Lamennais, Pierre Leroux, and others.For apart from what Michelet has come to mean, as totem or as scarecrow, to the scholarship of the twentieth century, he was enmeshed in the ideological conflicts of his own time. Without an understanding of those conflicts, an important perspective on his place in the history of ideas will be missing, a perspective which, moreover, may shed some light on the broader historical significance of the social romanticism he represented. For example, the “ideological” Michelet was best known in his own time as an anti-clerical. 5 Indeed, his version of the Romantic évangile éternel, which he developed in the 1840s, takes a privileged place among the efforts of intellectuals in the first half of the nineteenth century to work out new religious conceptions to replace a moribund Catholicism. 6 Yet the principal framework of his polemical activity was not the Church but the liberal academic establishment, with which he was at war from his 1843 lectures on the Jesuits to his dismissal from his official functions at the beginning of the Second Empire.Michelet and the July Monarchy: From Liberalism to Social RomanticismSeen from the standpoint of the early years of his career, roughly 1825 to 1835, Michelet would seem an improbable candidate for any kind of romanticism. Given his impoverished, artisan background as well... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:An Egg Takes Flight: The Once and Future Life of the National Bioethics Advisory Commission*Alexander Morgan Capron (bio)Attempting to describe the National Bioethics Advisory Commission (NBAC) is comparable to the surreal feat performed by the artist in a famous painting by René Magritte. The artist (Magritte himself) sits with his back to the viewer, a palette in his left hand. The brush in his right hand is raised to (...) a canvas, blank except for a bird in flight that he is in the process of painting. The artist is looking to his left at a tabletop, bare except for a single, plain egg.Having held its second formal meeting in mid-January, NBAC is certainly still embryonic, its future mysterious within its shell. Yet answers to four major questions that will determine not just what kind of bird the Commission turns out to be but the heights to which it will fly should be evident by April or May 1997. First, will the White House take the sort of interest in NBAC that is needed if it is to succeed? Second, will the Commission’s term be extended beyond October 1997—and will the decision come early enough to allow it to start soon on projects that will take more than a single year to complete? Third, will the Commission take a broad view of the issues it addresses, reexamining widely accepted assumptions and going back to basic premises, or will it respond primarily in bureaucratic terms, guided by its charter’s focus on improving the policies and practices of federal departments and agencies? Fourth, will the Commission move beyond its initially mandated topics—the rights and welfare of human research subjects and the management and use of genetic information—and become what its name promises, the nation’s advisory body on the full range of bioethical issues that arise in the organization and management of health services and research?The Origins of the Egg: NBAC’s PredecessorsThe creation of a national bioethics commission has been demanded for years, at the least since its most recent predecessor, the Biomedical Ethics [End Page 63] Advisory Committee (BEAC) finally expired in 1990. BEAC’s statutory authority lapsed after the hapless committee had spent several years itself like an in vitro embryo in a vat of liquid nitrogen. BEAC’s opponents in Congress froze its appropriation and forbad it to meet until the Biomedical Ethics Board of six senators and six representatives to which it was supposed to report resolved the chaos resulting from the Board members’ ideological differences and personal distrust; this never occurred, and the Board proved unable even to choose its chairman. 1 BEAC, which met only twice, had laid preliminary plans to study the issues raised by the new genetics, but the politics of abortion—which had greatly complicated and slowed the Board’s naming of the BEAC members—was strong enough to interfere even with the topic of genetics, on which the difference among committee members actually gave no sign of dividing on pro-life/pro-choice grounds.The disappearance of BEAC left the nation without a mechanism for “public bioethics,” and several efforts were undertaken in the early 1990s to generate a new commission that could carry on in the tradition of the two previous, successful bioethics commissions. (The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research operated under a Congressional mandate in the Department of Health, Education, and Welfare from 1974 to 1978, and the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, which had been authorized by Congress in 1978, actually operated as an independent body with government-wide purview from January 1980 to March 1983.) The Institute of Medicine established a committee to assess the mechanisms available not only to the federal government but also to states, professional bodies, and the public for deliberating about and resolving ethical issues stemming from developments in biomedicine (Bulger, Bobby, and Fineberg 1995). In September 1992, Senators Mark O. Hatfield (R-OR), Edward M. Kennedy (D-MA), and Dennis DeConcini (D-AZ) requested that the Office of Technology Assessment (OTA) evaluate the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Popular Culture in the Houses of Poe and CortázarDaniel Bautista (bio)"[…]at the age of nine I read Edgar Allan Poe for the first time. That book I stole to read because my mother didn't want me to read it, she thought I was too young and she was right. The book scared me and I was ill for three months, because I believed in it."…—Julio Cortázar1In interviews and essays, (...) Julio Cortázar, the famous Argentine author, often expressed a lifelong fascination with Edgar Allan Poe (Berg 227–32). Moreover, as a young man Cortázar spent two years translating the American author's prose into Spanish, making irresistible the search for traces of Poe in his own work. His description of Poe as a youthful and guilty pleasure reflects a common reaction to the American author that has led some critics to rue Poe's influence. Jonathan Elmer points out that "Poe's connection with juvenile tastes, and hence with a time when reading and acquiring 'culture' were actually enjoyable […] has been insistently and disapprovingly stressed by the Anglo-American literary-historical tradition" (3). Although Poe himself often liked to "advertise [his work] as ethereal and otherworldly, or avowedly timeless," critics who found elements of the vulgarly popular in his writing regarded the author as a true "stumbling block" in the American literary landscape (Rosenheim and Rachman xii; Eliot 205). In a similar vein, Elmer observes,It has puzzled many critics, sometimes to the point of vituperation, that Poe stands simultaneously as the germinal figure of a central modernist trajectory (leading via Baudelaire to French Symbolism and thence to the high modernism of Eliot and others) and as the much-acknowledged pioneer of several durable mass-cultural genres: detective fiction and science fiction, as well as certain modes of sensational or gothic horror, which are today, to use one of Poe's coinages, "omniprevalent."(2)In the past, such critics tended to dismiss Poe to the fringes of the American canon for what they saw as his highbrow pretensions and lowbrow taste. More recently, critics like Elmer and others have argued that Poe's ability to straddle the high/low cultural divide is precisely what makes him such a perennially fascinating writer and one of the most revealing about American culture in general.Considering Poe's high standing in Latin America, one might assume that the question of his low or popular status was not as much of a stumbling block there.2 Cortázar himself blamed American discomfort with Poe on his use of "baroque" language, an issue that Cortázar's own background as a native Spanish speaker allowed him to ignore: [End Page 1] "since I'm neither English nor American, I see it with another perspective. I know there are aspects which have aged a lot, that are exaggerated, but that hasn't the slightest importance next to his genius" (Weiss 73). The idea that an author's "genius" could rise above the demands of his countrymen was important to Cortázar. Questions about his own cultural status also significantly affected the reception of Cortázar's work, though in many ways he suffered from just the opposite charges made against Poe. The style and themes of his work, and the political context in Argentina during the early part of his career (characterized most conspicuously by the rise of Perónism), led some in the literary establishment of his own country to accuse Cortázar of being too European or elitist.3 Looking at Poe and Cortázar together, this essay compares how both authors negotiated such cultural issues in their writing and the way that Cortázar reworks some of Poe's particular strategies in a modern Argentine setting. Focusing on two of these authors' most well-known stories, "The Fall of the House of Usher" (published in 1839) and "Casa tomada" ("House Taken Over") (published in 1946), I argue that they both reflect some of the ways that Poe and Cortázar grappled with the rise and attraction of a popular culture that threatened to reconfigure their particular literary landscapes.In Keywords, Raymond Williams traces the... (shrink)

The policy adopted by housing authorities of denying prospective tenants with a criminal record access to housing is an important barrier to ex-offenders seeking somewhere to live. The policy is legal, but are there any good reasons in favor of it when we know that having no, or limited, access to secure and affordable housing increases the probability of recidivism? The primary aim of this article is to critically discuss two central reasons that have been given for (...) denying people with criminal records access to housing: that doing so will prevent crime, and that the policy reduces fear of crime. We also try to evaluate an argument for the conclusion that current law, and the policies that follows wrongfully discriminate against people with criminal records. The general thrust of the article is that arguments for this practice turning on its crime preventive effect, and its role in reducing or preventing fear of crime, are unpersuasive. We then explained why, in our view, excluding ex-offenders from housing amounts to wrongful discrimination against them. Our analysis suggests that ex-offenders, apart from a few excemptions, ought to be allowed access to housing to the same extent as other people. (shrink)

Photo ID 72893750 © Rawpixelimages|Dreamstime.com ABSTRACT Solidarity is a concept increasingly employed in bioethics whose application merits further clarity and explanation. Given how vital cooperation and community-level care are to mitigating communicable disease transmission, we use lessons from the COVID-19 pandemic to reveal how solidarity is a useful descriptive and analytical tool for public health scholars, practitioners, and policymakers. Drawing upon an influential framework of solidarity that highlights how solidarity arises from the ground up, we reveal how structural forces can (...) impact the cultivation of solidarity from the top down, particularly through ensuring robust access to important social determinants of health. Public health institutions can support solidarity movements among individuals and communities by adopting a lens of social justice when considering public health priorities and, in turn, promote health equity. INTRODUCTION Over the past two decades, scholars have invoked the concept of solidarity when assessing a wide range of topics in bioethics, from CRISPR-Cas9 technology to organ donation to structural racism.[1] However, the growing literature on solidarity has not fully examined the roles and responsibilities of institutions and governments in fostering solidarity, especially regarding public health measures that implicate entire populations. We argue that it remains unclear how public health institutions should engage with solidarity and how their engagement will affect public health and its ethics. We first take Prainsack and Buyx’ three-tiered framework as an analytical starting point.[2] We then explore how public health institutions can foster solidarity by carefully considering factors that may bolster it on an interpersonal, community, and national scale. We conclude that public health institutions should adopt a lens of social justice to promote solidarity at the interpersonal and community levels, thereby promoting equity in future public health efforts. BACKGROUND Calls for solidarity in bioethics raise longstanding normative questions about the nature and limits of our duties to one another and how to weigh autonomy over considerations of justice.[3] Though the term is diversely applied, Prainsack and Buyx propose a potentially unifying definition in the 2011 Nuffield Council report, “Solidarity: Reflections On An Emerging Concept in Bioethics.” The report defines solidarity as an activity involving “shared practices reflecting a collective commitment to carry financial, social, emotional, and or other ‘costs’ to assist others.” Their conceptualization also includes important features that distinguish solidarity from other values like empathy or altruism: solidarity emphasizes action rather than mere internal feeling and recognition of connection as motivation.[4] Bioethicists have since applied this conceptualization when analyzing issues in public and global health, given that population-level efforts need cooperation from individuals and communities. Prainsack and Buyx further note that solidarity is relevant in bioethics discourses about justice and equity, in support of providing aid to low- and middle-income countries, and as a value exemplified by European welfare states.[5] Other bioethicists have argued that promoting solidarity can contribute to community engagement, partnership with Tribal communities, and global health equity.[6] Most recently, scholars have applied solidarity as a lens to assess the COVID-19 pandemic, highlighting the pitfalls of national mitigation efforts and global disparities in disease outcomes.[7] I. Solidarity at Three Levels It seems impossible to foster solidarity in public health if we cannot identify it in general contexts. Prainsack and Buyx articulate three levels of solidarity: interpersonal solidarity, group solidarity, and legal or contractual codifications of solidarity.[8] They argue that each level inherently informs the one ‘above’ it in a unilateral direction. In other words, solidarity is fundamentally a bottom-up phenomenon. Solidarity among individuals influences group norms, which then have the potential to shape policy and institutional practice.[9] Within the Prainsack and Buyx framework, it would seem nonsensical to posit how solidarity might be expressed vertically or from the “top down.” It appears intuitively odd to imagine how a government entity might ‘be’ in solidarity with a person or group if solidarity requires some cognition about their condition per Prainsack and Buyx’ definition. Some have argued that solidarity does not seem like something that one can impose, as instances of it arise from agents recognizing and acting upon some bond rather than in response to a command. Indeed, people may be rightfully hesitant to engage in solidarity if the official messaging is overly paternalistic or coercive.[10] However, some authors have countered that governments can express solidarity through enacting structural and policy changes, though it is ambiguous how these actions are distinct from a justice-driven approach.[11] If a bottom-up approach is thus the most practical means of achieving policy that reflects solidarity, then it does not add much to public health. Institutions would be ineffective without the population’s initiation of the corresponding social norms. However, we find this conclusion overly pessimistic. Fostering a culture of solidarity to improve public health has potential merit. Prainsack and Buyx’ framework overlooks how public health actors can influence solidarity between individuals and across communities. To clarify, we agree with the view that solidarity is a bottom-up phenomenon. Solidarity may not be able to originate in a top-down fashion, but we suggest that public health institutions can take a more active role in providing the public with accurate information, promoting social justice, and intervening in the social determinants of health. II. The COVID-19 Pandemic as a Case Study Lessons learned from the ongoing COVID-19 pandemic support our argument. The pandemic deepened socioeconomic disparities in the US and hindered access to vital resources such as food, housing, and healthcare.[12] Prainsack recently noted: “[n]ext to the immediate health effects of the virus, poverty and grave inequalities have been the root causes of human suffering during the pandemic.”[13] Prior to the pandemic, many rural and low-income populations lacked reliable access to the internet and devices like laptops or smartphones. This continued lack of access restricts the flow of information and prevents people from accessing telemedicine services.[14] Preexisting social, political, and health inequities worsened health outcomes among many marginalized racial and ethnic groups. It is well-documented that communities of color, including Black, American Indian or Alaska Native, and Latinx populations, had greater COVID-related mortality and morbidity due to the effects of structural racism.[15] Although federal US agencies such as the Centers for Disease Control and Prevention enacted laws that provided safety nets (e.g., the Federal Eviction Moratorium), the majority of such programs have ended, leaving many with little assistance and the threat of further hardship.[16] These disparities are relevant because Prainsack, Buyx, and others note that solidarity arises from agents recognizing and acting on some perceived attainable collective goal(s). Income inequality and disparate access to food, education, and health care may lead people to consider public health goals unattainable. This could limit the desire to work toward those goals collectively.[17] The existing literature on collective action theory supports this intuition. It emphasizes that structural conditions, such as an absence of perceived hope for social change among a group, can lead to low ‘group efficacy’ and little willingness to cooperate, both within and across socioeconomic strata.[18] The pandemic spurred countless messages from public health agencies. The messaging did not recognize or attend to the different material realities and circumstances of the US population. How can people feel comfortable getting vaccinated if they deeply distrust the government, including public health institutions? How can people remain motivated to wear masks and distance themselves if they cannot afford basic necessities and work jobs without adequate pay and leave policies? We ask these questions to illustrate how socioeconomic disparities can marginalize people if they feel ignored, apathetic, or resentful of those better off or those in power whom they perceive to “not be doing enough.” This marginalization precludes the formation of solidarity. There are instances when a population has disparate access to resources and social capital, but solidarity may still emerge from a shared goal or vision for the future. For example, a heterogeneous population living in the same town may come together to protest an environmental injustice that impacts their water supply with the common goal of securing access to safe drinking water. However, many populations in the US failed to recognize shared goals of this kind during the COVID-19 pandemic. A significant minority of the US population was reluctant to acknowledge the severity of COVID-19 infection and thus refused to participate in efforts to mitigate its spread. Even between groups who shared the goal of slowing COVID-19 transmission, the methods were widely debated. Approximately 20 percent of the adult population eligible for vaccination remains unvaccinated.[19] Governmental bodies responsible for disseminating information, coordinating the allocation of resources, and establishing guidelines have a large role in mediating these disagreements and intervening in socioeconomic conditions that impact people's ability and willingness to engage in solidarity. III. Solidarity, Social Justice, and the Role of Public Health Institutions Adopting a lens of social justice provides further insights into how public health actors impact solidarity. Powers and Faden argue that the “foundational moral justification for the social institution of public health is social justice.”[20] Their theory of social justice has two aims. First, it ensures that everyone has a sufficient amount of the six core elements of well-being and that public health institutions are responsible for “adopting policies and creating environments” where all can flourish.[21] Second, public health institutions should distribute resources meant to promote well-being and focus on the “needs of those who are the most disadvantaged.”[22] Public health institutions should enact policies that address injustice. In doing so, public health institutions can seed the opportunity to build solidarity from the bottom up. Equipping individuals and communities with resources will foster cooperation and adherence to policies that require solidarity, such as masking and vaccination. This is consistent with arguments illustrating how institutions such as Tribal governments promote the conditions needed for their group, and especially its most vulnerable members, to flourish.[23] Addressing social determinants of health with a social justice lens will create the circumstances under which more individuals and groups can find common causes and foster solidarity. In the long run, such efforts may result in the establishment of values and practices from the bottom up. There are societal and public health preconditions required before institutions can expect their audience to act in solidarity with one another. Through their great influence over information and resources, public institutions do have the power to impact what values are most widespread. Furthermore, public health may foster trust and hope, which are important psychosocial factors that influence collective action,[24] if policies increase access to resources that promote well-being. Messaging efficacy also depends on the context of public trust, education, and whether the institutions meet one’s basic needs. Disparate messaging across different public institutions may confuse or disillusion individuals. To apply our theory of solidarity to the decision to vaccinate, a policy would be to foster conditions that facilitate access to vaccines and information about vaccine efficacy instead of imposing a top-down mandate without first eliciting public trust. IV. Counterargument Some argue that discordant public health messaging, ineffective government, and inadequate social programs can also bring people together under pressure and foster solidarity. One may argue that the most powerful motivators towards solidarity are strife and disparity, as evidenced throughout history. During the pandemic alone, political struggle and personal hardship inspired solidarity in the US, from individual neighbors helping each other to mutual aid groups forming across communities. We thus do not claim that solidarity is possible only when our government programs and public health institutions are most effective. We instead point out that solidarity can be further hindered when people feel alienated, hopeless, and pitted against each other. CONCLUSION Many competing conceptualizations of solidarity persist in the bioethics literature, and Prainsack and Buyx offer one compelling framework that public health ethicists continue to draw upon.[25] However, their framework fails to acknowledge how public health institutions impact interpersonal and group solidarity. Public health institutions can foster solidarity through actions other than mere messaging, invoking catchphrases like “we are all in this together.” Efforts to address socioeconomic preconditions and alleviate health disparities can cultivate group solidarity. As we saw during the pandemic, cooperation and solidarity go hand-in-hand with disease mitigation efforts; solidarity has clear intrinsic value.[26] As this relationship becomes more apparent, we will continue to see attempts from public health institutions to foster or invoke solidarity. Therefore, public health institutions would be remiss to ignore their role in addressing the social determinants of health. Adopting a social justice lens when planning public health interventions will clarify and strengthen their role in facilitating solidarity. Ultimately, if health disparities continue to persist or widen, it is very hard to imagine how group solidarity can ever be achieved. The widescale adoption of many public health measures needed to promote health and well-being would be conducive to solidarity. - Disclaimer: The opinions expressed are the authors’ and do not represent the views of the NIH, DHHS, or the U.S. government. Funding Disclosure: This work was supported in part by the Intramural Program of the National Institutes of Health Clinical Center. - [1] John J Mulvihill et al., “Ethical Issues of CRISPR Technology and Gene Editing through the Lens of Solidarity,” British Medical Bulletin 122 (2017): 17–29, https://doi.org/10.1093/bmb/ldx002; Ben Saunders, “Altruism or Solidarity? The Motives for Organ Donation and Two Proposals,” Bioethics 26, no. 7 (September 2012): 376–81, https://doi.org/10.1111/j.1467-8519.2012.01989.x; -Vanessa Y Hiratsuka, “SPECIAL REPORT: A Critical Moment in Bioethics: Reckoning with Anti-Black Racism through Intergenerational Dialogue A Call for Solidarity in Bioethics: Confronting Anti-Black Racism Together,” 2022, https://doi.org/10.1002/hast.1380. [2] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [3] Bob Simpson, “A ‘We’ Problem for Bioethics and the Social Sciences: A Response to Barbara Prainsack,” Science, Technology, & Human Values 43, no. 1 (January 12, 2018): 45–55, https://doi.org/10.1177/0162243917735899. [4] Barbara Prainsack and Alena Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics (London: Nuffield Council on Bioethics, 2011). [5] Barbara Prainsack and Alena Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach,” Bioethics 26, no. 7 (September 2012): 343–50, https://doi.org/10.1111/J.1467-8519.2012.01987.X. [6] Bridget Pratt, Phaik Yeong Cheah, and Vicki Marsh, “Solidarity and Community Engagement in Global Health Research,” The American Journal of Bioethics : AJOB 20, no. 5 (May 3, 2020): 43–56, https://doi.org/10.1080/15265161.2020.1745930; Sara Chandros Hull, F. Leah Nez (Diné), and Juliana M. Blome, “Solidarity as an Aspirational Basis for Partnership with Tribal Communities,” The American Journal of Bioethics 21, no. 10 (October 3, 2021): 14–17, https://doi.org/10.1080/15265161.2021.1965258; Mbih J. Tosam et al., “Global Health Inequalities and the Need for Solidarity: A View from the Global South,” Developing World Bioethics 18, no. 3 (September 1, 2018): 241–49, https://doi.org/10.1111/DEWB.12182. [7] Peter West-Oram, “Solidarity Is for Other People: Identifying Derelictions of Solidarity in Responses to COVID-19,” Journal of Medical Ethics 47, no. 2 (February 1, 2021): 65–68, https://doi.org/10.1136/MEDETHICS-2020-106522; Barbara Prainsack, “Solidarity in Times of Pandemics,” Democratic Theory 7, no. 2 (December 1, 2020): 124–33, https://doi.org/10.3167/DT.2020.070215; F. Marijn Stok et al., “Social Inequality and Solidarity in Times of COVID-19,” International Journal of Environmental Research and Public Health 18, no. 12 (June 2, 2021), https://doi.org/10.3390/IJERPH18126339; Ming Jui Yeh, “Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics,” American Journal of Public Health 112, no. 2 (February 1, 2022): 255–61, https://doi.org/10.2105/AJPH.2021.306578; Barbara Prainsack, “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.,” Am J Public Health 112, no. 2 (February 1, 2022): 232–33, https://doi.org/10.2105/AJPH.2021.306619. [8] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [9] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [10] Yeh, “Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics”; Prainsack, “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.” [11] Ho, Anita, and Iulia Dascalu. "Relational solidarity and COVID-19: an ethical approach to disrupt the global health disparity pathway." Global Bioethics 32, no. 1 (2021): 34-50; West-Oram, Peter. "Solidarity is for other people: identifying derelictions of solidarity in responses to COVID-19." Journal of Medical Ethics 47, no. 2 (2021): 65-68. [12] Monica Webb Hooper, Anna María Nápoles, and Eliseo J. Pérez-Stable, “COVID-19 and Racial/Ethnic Disparities,” JAMA 323, no. 24 (June 23, 2020): 2466, https://doi.org/10.1001/jama.2020.8598. [13] Prainsack, Barbara. “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.” Am J Public Health 112, no. 2 (February 1, 2022): 232–33. https://doi.org/10.2105/AJPH.2021.306619. [14] Camille A Clare, “Telehealth and the Digital Divide as a Social Determinant of Health during the COVID-19 Pandemic,” Network Modeling Analysis in Health Informatics and Bioinformatics 10 (2021): 26, https://doi.org/10.1007/s13721-021-00300-y. [15] Patrick Nana-Sinkam et al., “Health Disparities and Equity in the Era of COVID-19,” Journal of Clinical and Translational Science 5, no. 1 (March 16, 2021): e99, https://doi.org/10.1017/cts.2021.23. 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New York: Oxford Press, 2006, p. 9 and Chapter 4 [21] Powers and Faden, Social Justice: The Moral Foundation of Public Health and Health Policy; Madison Powers and Ruth Faden, Structural Injustice: Power, Advantage, and Human Rights (New York: Oxford University Press, 2019). [22] Powers, Madison, and Ruth Faden. Social Justice: The Moral Foundation of Public Health and Health Policy. 1st editio. New York: Oxford Press, 2006, p. 10 [23] Bobby Saunkeah et al., “Extending Research Protections to Tribal Communities,” The American Journal of Bioethics 21, no. 10 (October 3, 2021): 5–12, https://doi.org/10.1080/15265161.2020.1865477. [24] Agostini and van Zomeren, “Toward a Comprehensive and Potentially Cross-Cultural Model of Why People Engage in Collective Action: A Quantitative Research Synthesis of Four Motivations and Structural Constraints.” [25] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics. [26] Ruth Chadwick, “COVID‐19 and the Possibility of Solidarity,” Bioethics 34, no. 7 (September 8, 2020): 637–637, https://doi.org/10.1111/bioe.12813. (shrink)

Since April 1996, the National Science and Technology Council (NSTC), in collaboration with the Office of Science and Technology Policy (OSTP) in the Executive Office of the President, has been leading the development of a government-wide Federal policy for research misconduct. The author is a Senior Policy Analyst in the Office of Science and Technology Policy and a participant in this process. This paper places the NSTC/OSTP effort in historical context, outlines the process by which the policy will be (...) finalized, and discusses the principal issues raised during the policy development process. (shrink)

A scholarly, clearly written interpretation of the Oresteia, interweaving the aesthetic, moral, political and cosmic elements in the drama. The author gives a valuable assessment of Aeschylus' reaction to the then current ideas of Plato and Aristotle. In an excellent chapter on the meanings of catharsis, he shows how Aeschylus interpreted Aristotle's theory of tragedy.--A. B. D.

The purpose of the article is to demonstrate how Heidegger's statement, "Language is the House of Being," claims to represent the essence of all Western European philosophy, namely, as an outline of the unity of indirect identities - being, form and name. The author raises a number of questions in his research. Can we identify "beginning" and "consequence" by exploring the phenomenon of language? Is there anything in the language between beginning and effect? What is a language? And why does (...) Heidegger call language home? Is it possible to identify philosophically what makes language possible regardless of cultural contexts and historical eras? Does the question "What is language?" at the same time lead us to the question "What is a person?" and then "What does it mean to be?" The article focuses on the connection of Heidegger's philosophy with Plato's philosophy, and therefore on the constancy of fundamental philosophical problems, which finds different ways of expression (mythological, metaphysical, phenomenological...). The second part of the article is devoted to the actual analysis of the concept of "house of being" through the comprehension of the speech (communicative) dimension of one's being. The author also explores the concept of Heidegger's philosophy of openness, distance, speech: existence is Dasein's relation to being, that is, to one's own making; speech (Rede) as a mode of openness (Dasein) is an existential phenomenon; language (Sprache) is an implementation of self-projecting (entwerfen) speech (Rede) into the "world". Given that a language contains a plurality of certain elements and relationships, the essential unity of the language should be sought at the discontinuity. The gap means openness and freedom of speech. That is, the existential condition of the possibility of language, called in the early Heidegger openness, in his later work appears as a gap, but here and there it is the essential language, which is at the same time the essence of man. (shrink)

In the study of the reproduction of state power through urban space, more attention has been paid to how states organize urban space to construct the disciplined subject than the converse of how states cultivate subjects who reproduce the material and symbolic significance of the built environment. Using the case study of public housing in the developmental state of Singapore, I argue that states attempt to shape how inhabitants navigate and interpret the built environment by constructing spatial-political subjects who (...) reproduce state hegemony through internalized mental and emotional schemas towards urban space. I analyze fifty years (1972—2021) and nearly 700 issues of periodicals by Singaporean housing authorities to illustrate two distinct phases of spatial-political subject formation which corresponded to deliberate shifts in the physical sites of state legitimacy. In the two decades following independence, the ruling People’s Action Party sought legitimacy for its program of slum clearance and public housing “New Town” construction, and accordingly cultivated the modern urban resident oriented towards the rationally-planned New Town and the high-rise apartment. Faced with political opposition in the mid-eighties but having already housed 80% of Singapore, the PAP then shifted the stakes of legitimacy towards the maintenance of existing common areas and cultivated the sociable urban citizen who equated ongoing municipal maintenance with ruling party provision while actively participating in state-sanctioned neighborhood activities. The following findings will illuminate an overlooked strategy in the state’s toolkit for reproducing its hegemony through urban space. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:IRBs Under the MicroscopeJonathan D. Moreno (bio)The spring and summer of 1998 were seasons in the sun for institutional review board (IRB) aficionados. Rarely have the arcana of the local human subjects review panels been treated to so much attention in both the executive and the legislative branches of government, not only at the federal but also at the state level. And it looks as if the attention (...) will continue for some time. The spate of interest is due to a series of coincidences: a powerful House of Representatives subcommittee held hearings after its chairman learned about the IRB system during a previous session on research in underdeveloped communities; the Department of Health and Human Services’s Inspector General (DHHS-IG) released a report on IRBs; the National Institutes of Health (NIH) Office of Extramural Research completed a report on clinical trial monitoring; the National Bioethics Advisory Commission (NBAC) readied a report on research involving persons with mental disorders; the states of Maryland and New York completed studies of research with subjects who lack decision-making capacity; and advocacy groups protested a psychiatric research project involving inner city children.Underlying these proximate causes for the IRB blitz is a growing realization that the already considerable clinical trial enterprise will expand significantly over the next few years. Congress is talking about giving the politically popular NIH half again the budget it currently receives, which in turn will stimulate more commercially supported research. The director of the National Cancer Institute is considering a five-fold increase in the number of subjects enrolled in oncology studies over the next several years. Phase I cancer studies are among the most ethically sensitive, so IRBs will have more work cut out for them if this goal is reached. Adding to the rush of interest in IRBs are the government’s recent apology to the survivors of the syphilis study in Tuskegee, continuing congressional dissatisfaction with the way the Pentagon handled its vaccine distribution during the Gulf War, and the controversy about AZT trials in developing countries.On the HillCongressman Christopher Shays, the moderate Connecticut Republican who has developed an interest in human research issues, convened hearings on human [End Page 329] subjects research and the IRB system on 11 June 1998. Shays chairs the House Government Reform/Human Resources Subcommittee. The committee’s ranking minority member is Edolphus Towns of Brooklyn, NY, who shares Shays’s interest in this area.The immediate rationale for the hearings was the release that day of the DHHS-IG report, Institutional Review Boards: A Time for Reform. The subtitle was changed from A System in Jeopardy apparently after some people in DHHS expressed reservations about its seemingly alarmist tone, but the IG staffers who testified before Shays’s subcommittee insisted that they stood behind the message that the IRB system is in trouble if considerable reforms are not undertaken. Among the factors in the research environment cited as support for the bleak forecast: managed care, commercialization, multi-site trials, high IRB workloads, minimal IRB oversight of approved studies, conflicts of interest, insufficient training of IRB members and investigators, and lack of IRB self-studies (DHHS-IG 1998).As is normally the case for congressional oversight hearings, the first panel of witnesses consisted of executive branch officials, including Eric Meslin, Executive Director of the National Bioethics Advisory Commission, and Gary Ellis, Director of the Office for Protection from Research Risks (OPRR). Shays pressed Ellis on the extent to which OPRR conducts on-site investigations of complaints about abuse of human subjects. Admitting that on-site investigations are rare, Ellis suggested that the agency is inadequately staffed to follow up on complaints as quickly as it might wish. The members of Congress who were present at the hearings generally expressed concern about the DHHS-IG’s findings.The second panel that day, which Shays was unable to attend, set a different tone. Four of the panelists—Paul Appelbaum of the University of Massachusetts at Worcester, Robert Levine of Yale University, Angela Bowen of the Western IRB (a private clinical trials review firm), and I—were invited as authorities on the current condition of the IRB system. Bert Spilker... (shrink)

Presidential power has provoked increasingly vigorous debate since the turn of this century, and this paper explores the scope and limits of a president's ability to invoke his executive authority to reform health care. Specifically, it identifies ways the Obama Administration can use directives to: expand Medicaid and SCHIP coverage through section 1115 waivers; test quality initiatives through Medicare demonstration authority; expand health information technology; allow drug reimportation and experiment with contracting power under Medicare; enhance patient protections and (...) private coverage requirements; lift coverage restrictions on Medicaid and SCHIP; and build on the health insurance program for federal employees. (shrink)

Presidential power has provoked increasingly vigorous debate since the turn of this century. In recent years, scholars and lawyers have been grappling with how Congress’s dictates may limit the president’s Commander-in-Chief power to detain enemy combatants at Guantanamo Bay, to fight wars abroad, and to conduct intelligence activities at home. But policymakers have not yet explored the many possibilities for invoking the president’s “Take Care” power to change health care policy.This article explores the scope and limits of President Barack Obama’s (...) ability to invoke his executive authority to reform health care. Specifically, it identifies ways the Obama Administration can use directives to: expand Medicaid and State Children’s Health Insurance Program coverage through section 1115 waivers; test quality initiatives through Medicare demonstration authority; expand health information technology; allow drug reimportation and experiment with contracting power under Medicare; enhance patient protections and private coverage requirements; lift coverage restrictions on Medicaid and SCHIP; and build on the health insurance program for federal employees. Consistent with the mission of the Legal Solutions in Health Reform project, this article does not endorse a particular policy. Instead of recommending “what,” it explains “how.”. (shrink)