Communication and Conflict Management Training for Clinical Bioethics Committees Content Type Journal Article Pages 341-349 DOI 10.1007/s10730-009-9116-7 Authors Lauren M. Edelstein, Johns Hopkins Medicine’s Howard County General Hospital 5755 Cedar Lane Columbia MD 21044 USA Evan G. DeRenzo, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Elizabeth Waetzig, Change Matrix Inc. 485 Maylin St. Pasadena CA 91105 USA Craig Zelizer, Georgetown University Department of Government 3240 Prospect St. Washington, D.C. NW 20057 USA (...) Nneka O. Mokwunye, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

Much of Western European history conditions us to see human differences in simplistic opposition to each other: dominant/subordinate, good/bad, up/down, superior/inferior. In a society where the good is defined in terms of profit rather than in terms of human need, there must always be some group of people who, through systematized oppression, can be made to feel surplus, to occupy the place of dehumanized inferior. Within this society, that group is made up of Black and Third World people, working-class people, (...) older people, and women. (Lorde, 1984: 114). (shrink)

In common treatments of deontic logic, the obligatory is what is true in all deontically ideal possible worlds. In this article, I offer a new semantics for Standard Deontic Logic with Leibnizian intensions rather than possible worlds. Even though the new semantics furnishes models that resemble Venn diagrams, the semantics captures the strong soundness and completeness of Standard Deontic Logic. Since, unlike possible worlds, many Leibnizian intensions are not maximally consistent entities, we can amend the semantics to invalidate the inference (...) rule which ensures that all tautologies are obligatory. I sketch this amended semantics to show how it invalidates the rule in a new way. (shrink)

The counterfactual mental state of negligent criminal activity invites skepticism from those who see mental states as essential to responsibility. Here, I offer a revision of the mental state of criminal negligence, one where the mental state at issue is actual and not merely counterfactual. This revision dissolves the worry raised by the skeptic and helps to explain negligence’s comparatively reduced culpability.

In On What Matters, Derek Parfit enters the debate between actualists and possibilists. This debate concerns mere possibilia, possible but non-actual things such as golden mountains and talking donkeys. Roughly, possibilism says that there are such things, and actualism says that there are not. Parfit not only argues for possibilism but also argues that some self-proclaimed actualists are, in fact, unwitting possibilists. -/- I argue that although Parfit’s arguments do not fully succeed, they do highlight a tension within the frameworks (...) of many actualists. Many actualists conscript abstract objects into the role of "possible worlds" to avoid quantifying over mere possibilia. But, in doing so, actualists must quantify over mere possibilia anyway. When we alleviate this tension, a Parfit-friendly form of actualism arguably remains. This form of actualism says that while everything that exists is actual, it is also true in some sense that there are mere possibilia. (shrink)

Various strands of religious thought distinguish veneration from worship. According to these traditions, believers ought to worship God alone. To worship anything else, they say, is idolatry. And yet many of these same believers also claim to venerate—but not worship—saints, angels, images, relics, tombs, and even each other. But what's the difference? Tim Bayne and Yujin Nagasawa (2006: 302) are correct that “it seems to be extremely difficult to distinguish veneration from worship.” Many have argued throughout history that veneration collapses (...) into worship and that those who venerate saints or icons are guilty of idolatry. In this essay, we distinguish worship from veneration in two stages. First, we give a formal account of their difference. Drawing from St. John of Damascus (c. 675-749 AD), we argue that worship is a determinate of the determinable veneration. Second, we give more substantive accounts of both that explain their differences and similarities. Drawing again from St John, we argue that acts of veneration and worship signify subordination. Their difference, however, lies in the fact that worship alone requires absolute subordination. (shrink)

As clinical trials end, little is understood about how participants exiting from clinical trials approach decisions related to the removal or post-trial use of investigational brain implants, such as deep brain stimulation (DBS) devices. This empirical bioethics study examines how research participants experience the process of exit from research at the end of clinical trials of implanted neural devices. Using a modified grounded theory study design, we conducted semi-structured, in-depth interviews with 16 former research participants from clinical trials of DBS (...) and responsive neurostimulation (RNS). Open-ended questions elicited motivations for joining the trial, understanding of study procedures at the time of initial informed consent, the process of exiting from research, and decisions about device removal or post-trial device use. Thematic analysis identified categories related to: limited preparedness for the end of research participation, straightforwardness of decisions to explant or keep the device, reconciling with the end of research participation, reconciling post-trial expectations, and achieving a sense of closure after exit from research. A preliminary theoretical model describes contextual factors influencing the process and experience of exit from research. Experiences of clinical trial participants should guide research practices to enhance the ethical design and conduct of clinical trials in DBS and other brain devices. (shrink)

In the last two decades few topics in philosophy of science have received as much attention as mechanistic explanation. A significant motivation for these accounts is that scientists frequently use the term “mechanism” in their explanations of biological phenomena. While scientists appeal to a variety of causal concepts in their explanations, many philosophers argue or assume that all of these concepts are well understood with the single notion of mechanism. This reveals a significant problem with mainstream mechanistic accounts– although philosophers (...) use the term “mechanism” interchangeably with other causal concepts, this is not something that scientists always do. This paper analyses two causal concepts in biology–the notions of “mechanism” and “pathway”–and how they figure in biological explanation. I argue that these concepts have unique features, that they are associated with distinct strategies of causal investigation, and that they figure in importantly different types of explanation. (shrink)

Life sciences and emerging technologies raise a plethora of issues. Besides practical, bioethical and policy issues, they have broader, cultural implications as well, affecting and reflecting our zeitgeist and world-view, challenging our understanding of life, nature and ourselves as human beings, and reframing the human condition on a planetary scale. In accordance with the aims and scope of the journal, LSSP aims to foster engaged scholarship into the societal dimensions of emerging life sciences (Chadwick and Zwart 2013) and via this (...) thematic series, the journal provides a podium for authors who intend to address concrete issues from a ‘continental philosophical’ perspective, which may in- clude (post)phenomenology, hermeneutics, dialectics, (post)structuralism, psychoanalysis, critical theory and similar approaches. The series aims to contribute to a diagnostics of the present and a prognostics of the future, focusing on critical normative challenges (such as embodiment, intimate technologies, social justice, biopower, nanomedicine, human enhancement and the anthropocene) and building on the work of key authors such as Hegel (1830), Heidegger (1953, 1953/1954), Bachelard (1938), Canguilhem (1975), Lacan (1966, 1969-1970/1991), Habermas (1968), Serres (1972), Foucault (1969), Žižek (2006/2009), Stiegler (2010), Sloterdijk (2001, 2009) and others, but targeting con- crete up-to-date events and case studies against the backdrop of broader developments within the techno-scientific culture. (shrink)

The role of emotions in mental life is the subject of longstanding controversy, spanning the history of ethics, moral psychology, and educational theory. This paper defends an account of love’s cognitive power. My starting point is Plato’s dialogue, the Symposium, in which we find the surprising claim that love aims at engendering moral virtue. I argue that this understanding affords love a crucial place in educational curricula, as engaging the emotions can motivate both cognitive achievement and moral development. I first (...) outline the state of the challenge between dominant rival theories regarding emotions in learning. Next, I demonstrate how Platonic virtue ethics offers the most tenable prospect for an education of reason and emotion. Third, I sketch three practical ways educators might constructively engage emotions in the classroom. I conclude that love’s virtue is its peerless power to motivate the creative and lateral thinking which leads to moral development. (shrink)

Every living entity requires the capacity to defend against viruses in some form. From bacteria to plants to arthropods, cells retain the capacity to capture genetic material, process it in a variety of ways, and subsequently use it to generate pathogen-specific small RNAs. These small RNAs can then be used to provide specificity to an otherwise non-specific nuclease, generating a potent antiviral system. While small RNA-based defenses in chordates are less utilized, the protein-based antiviral invention in this phylum appears to (...) have derived from components of the same ancestral small RNA machinery. Based on recent evidence, it would seem that RNase III nucleases have been reiteratively repurposed over billions of years to provide cells with the capacity to recognize and destroy unwanted genetic material. Here we describe an overview of what is known on this subject and provide a model for how these defenses may have evolved. RNase III nuclease domains are widely used in an array of RNA metabolic functions as well as antiviral defenses. Here, we review their current usage as well as provide insight into how these domains may have shaped all major antiviral pathways over the course of evolution. (shrink)

We can enrich the explanation of how we should treat kid wrongdoers by recognizing that it matters who does the blaming and punishing. That we should think about who does the blaming and punishing is perhaps unsurprising, but it is nonetheless often underappreciated. Here, I offer two lessons about blame and punishment by thinking about who judges kids. First, the right account of moral and legal responsibility should allow that kids may rightly blame each other, and I argue that we (...) can best accommodate this by relativizing the threshold of competence needed for responsibility. Second, although each kid is an individual and, as a result, the implications of immaturity vary signifi- cantly from kid to kid, we should give kids a break as kids, that is, based on our categorizing them as kids. That we should and do categorize in that way reflects the nature of the criminal justice system as an institution and the nature of us as social beings. (shrink)

The year 2020 has yielded twin crises in the United States: a global pandemic and a public reckoning with racism brought about by a series of publicized instances of police violence toward Black men and women. Current data indicate that nationally, Black Americans are three times more likely than White Americans to contract Covid-19, a pattern that underscores the more general phenomenon of health disparity among Black and White Americans. Once exposed, Black Americans are twice as likely to die of (...) the virus. Unsurprisingly, Black Americans report higher levels of fear of Covid-19 than their White peers, but they also report higher levels of hesitancy toward a Covid-19 vaccine. This paper explores why this apparent discrepancy exists. It also provides practical recommendations for how government and public health leaders might address vaccine hesitancy in the context of the twin crises of 2020. (shrink)

This grounded study investigated the negotiation of authorship by faculty members, graduate student mentors, and their undergraduate protégés in undergraduate research experiences at a private research university in the northeastern United States. Semi-structured interviews using complementary scripts were conducted separately with 42 participants over a 3 year period to probe their knowledge and understanding of responsible authorship and publication practices and learn how faculty and students entered into authorship decision-making intended to lead to the publication of peer-reviewed technical papers. Herein (...) the theoretical model for the negotiation of authorship developed through the analysis of these interviews is reported. The model identifies critical causal and intervening conditions responsible for the coping strategies faculty and students employ, which, in our study, appear to often produce unfortunate consequences for all involved. The undergraduate student researchers and their graduate student mentors interviewed in this study exhibited a limited understanding of authorship and the requirements for authorship in their research groups. The power differential between faculty and students, the students’ limited epistemic development, the busy-ness of the faculty, and the faculty’s failure to prioritize authorship have been identified as key factors inhibiting both undergraduate and graduate students from developing a deeper understanding of responsible authorship and publication practices. Implications for graduate education and undergraduate research are discussed, and strategies for helping all students to develop a deeper understanding of authorship are identified. (shrink)

In this paper, I identify a form of epistemic insensitivity that occurs when someone fails to make proper use of the epistemic tools at their disposal in order to bring their beliefs in line with epistemically relevant evidence that is available to them. I call this kind of insensitivity agential insensitivity because it stems from the epistemic behavior of an individual agent. Agential insensitivity can manifest as a failure to either attend to relevant and available evidence, or appropriately interpret evidence (...) that is attended to. The concept of agential insensitivity allows us to conceptualize the kind of not-knowing involved in forms of ignorance that are cultivated and maintained by individual agents, especially when this ignorance is enabled or encouraged by social structures. I use the skepticism about racial disparities in policing practices that is displayed by many white Americans as a lens for exploring this connection. Understanding agential insensitivity thus provides insight into both social and epistemic phenomena. (shrink)

Two decades ago, in 1994, in the context of the 4th EU Framework Programme, ELSA was introduced as a label for developing and funding research into the ethical, legal and social aspects of emerging sciences and technologies. Currently, particularly in the context of EU funding initiatives such as Horizon2020, a new label has been forged, namely Responsible Research and Innovation. What is implied in this metonymy, this semantic shift? What is so new about RRI in comparison to ELSA? First of (...) all, for both labels, the signifier was introduced in a top-down manner, well before the concept that was signified by it had acquired a clear and stable profile. In other words, the signifier preceded the research strategies actually covered by these labels. Moreover, the newness of RRI does not reside in its interactive and anticipatory orientation, as is suggested by authors who introduced the term, but rather in its emphases on social-economic impacts. (shrink)

Kaplan and Craver claim that all explanations in neuroscience appeal to mechanisms. They extend this view to the use of mathematical models in neuroscience and propose a constraint such models must meet in order to be explanatory. I analyze a mathematical model used to provide explanations in dynamical systems neuroscience and indicate how this explanation cannot be accommodated by the mechanist framework. I argue that this explanation is well characterized by Batterman’s account of minimal model explanations and that it demonstrates (...) how relationships between explanatory models in neuroscience and the systems they represent is more complex than has been appreciated. (shrink)

According to mainstream philosophical views causal explanation in biology and neuroscience is mechanistic. As the term ‘mechanism’ gets regular use in these fields it is unsurprising that philosophers consider it important to scientific explanation. What is surprising is that they consider it the only causal term of importance. This paper provides an analysis of a new causal concept—it examines the cascade concept in science and the causal structure it refers to. I argue that this concept is importantly different from the (...) notion of mechanism and that this difference matters for our understanding of causation and explanation in science. (shrink)

This book draws on the hermeneutics of Hans-Georg Gadamer to inform a feminist perspective of social identities. Lauren Swayne Barthold moves beyond answers that either defend the objective nature of identities or dismiss their significance altogether. Building on the work of both hermeneutic and non-hermeneutic feminist theorists of identity, she asserts the relevance of concepts like horizon, coherence, dialogue, play, application, and festival for developing a theory of identity. This volume argues that as intersubjective interpretations, social identities are vital (...) ways of fostering meaning and connection with others. Barthold also demonstrates how a hermeneutic approach to social identities can provide critiques of and resistance to identity-based oppression. (shrink)

What is the connection between philosophy as studied in universities and those general views of man and reality which are commonly considered "philosophy"? Through his attempt to rediscover this connection, Craig offers a view of philosophy and its history since the early 17th century. Craig discusses the two contrary visions of man's essential nature that dominated this period--one portraying man as made in the image of God and required to resemble him as closely as possible, the other depicting (...) man as the autonomous creator of his own environment and values--and uses this context to clarify previously opaque textual detail. Illustrating how general concepts embodied by philosophical thought can be embodied in other media--especially literary--the author brings together disparate disciplines; he also reveals striking similarities between Anglo-American and certain 20th-century continental European lines of thought. (shrink)

While there is now considerable anxiety about whether the psychological theory presupposed by virtue ethics is empirically sustainable, analogous issues have received little attention in the virtue epistemology literature. This paper argues that virtue epistemology encounters challenges reminiscent of those recently encountered by virtue ethics: just as seemingly trivial variation in context provokes unsettling variation in patterns of moral behavior, trivial variation in context elicits unsettling variation in patterns of cognitive functioning. Insofar as reliability is a condition on epistemic virtue, (...) we have reason to doubt that human beings possess the cognitive materials required for epistemic virtue, and thereby reason to think that virtue epistemology is threatened by skepticism. We conclude that while virtue epistemology has resources for addressing this challenge, exploiting these resources forces tradeoffs between empirical and normative adequacy. (shrink)

Causal selection has to do with the distinction we make between background conditions and “the” true cause or causes of some outcome of interest. A longstanding consensus in philosophy views causal selection as lacking any objective rationale and as guided, instead, by arbitrary, pragmatic, and non-scientific considerations. I argue against this position in the context of causal selection for disease traits. In this domain, causes are selected on the basis of the type of causal control they exhibit over a disease (...) of interest. My analysis clarifies the principled rationale that guides this selection and how it involves both pragmatic and objective considerations, which have been overlooked in the extant literature. (shrink)

States began passing legislation mandating the collection of genetic material from certain convicted offenders in 1988. By 1998, all 50 states had passed laws allowing DNA databases for convicted sexual offenders, and some states collected DNA from all those convicted of a felony. A survey of 416 persons in Maryland revealed wide support for the inclusion of convicted violent offenders (89%) in DNA databases, in sync with most states’ policies. Between two thirds and three quarters of respondents also supported expanding (...) DNA databases to include those suspected of a violent offense, any convicted felon, as well as all convicted offenders, minor and major. Support for collecting the DNA of those suspected of any crime and for all newborns was considerably less (44% to 45%). Although a comprehensive database is most effective for solving and deterring crimes, vigorously enforced protections against abuse of this technology must be in place. (shrink)

This paper explores a distinction among causal relationships that has yet to receive attention in the philosophical literature, namely, whether causal relationships are reversible or irreversible. We provide an analysis of this distinction and show how it has important implications for causal inference and modeling. This work also clarifies how various familiar puzzles involving preemption and over-determination play out differently depending on whether the causation involved is reversible.

Damon Tweedy is a psychiatrist, lawyer, and writer. He's also Black. While in his first year as a medical student at Duke University, one of his professors approached him in the classroom and asked why the light bulb in the room hadn't been changed, as requested. Tweedy realized that his professor assumed he was a maintenance worker, not a student. Tweedy never took up this incident with the professor, nor did the professor ever apologize. Tweedy recounts that his best "revenge" (...) would be to excel in the class, which he ultimately did. At the end of the semester, upon learning that Tweedy received the second highest grade of over one hundred students, this professor invited him to work as a research assistant in his... (shrink)

A framework for pragmatic analysis is proposed which treats discourse as a game, with context as a scoreboard organized around the questions under discussion by the interlocutors. The framework is intended to be coordinated with a dynamic compositional semantics. Accordingly, the context of utterance is modeled as a tuple of different types of information, and the questions therein — modeled, as is usual in formal semantics, as alternative sets of propositions — constrain the felicitous flow of discourse. A requirement of (...) Relevance is satisfied by an utterance (whether an assertion, a question or a suggestion) iff it addresses the question under discussion. Finally, it is argued that the prosodic focus of an utterance canonically serves to reflect the question under discussion (at least in English), placing additional constraints on felicity in context. (shrink)

Social scientists appeal to various “structures” in their explanations including public policies, economic systems, and social hierarchies. Significant debate surrounds the explanatory relevance of these factors for various outcomes such as health, behavioral, and economic patterns. This paper provides a causal account of social structural explanation that is motivated by Haslanger (2016). This account suggests that social structure can be explanatory in virtue of operating as a causal constraint, which is a causal factor with unique characteristics. A novel causal framework (...) is provided for understanding these explanations–this framework addresses puzzles regarding the mysterious causal influence of social structure, how to understand its relation to individual choice, and what makes it the main explanatory (and causally responsible) factor for various outcomes. (shrink)

In 2003 and 2004, Aotearoa New Zealand enacted two key laws that regulate two very different ways in which the female body may be commodified. The Prostitution Reform Act 2003 (PRA) decriminalized prostitution, removing legal barriers to the buying and selling of commercial sexual services. The Human Assisted Reproductive Technology Act 2004 (HART Act), on the other hand, put a prohibition on commercial surrogacy agreements. This paper undertakes a comparative analysis of the ethical arguments underlying New Zealand’s legislative solutions to (...) prostitution and commercial surrogacy. While the regulation of prostitution is approached with a Marxist feminist lens with the aim to ensure the health and safety of sex workers, commercial surrogacy is prohibited outright for concerns of negative impacts on present and future persons. I ground the principles of each Act in their ethical foundations and compare these two against one another. I conclude that New Zealand’s legislative approach to regulating the commodification of the female body is ethically inconsistent. (shrink)

Recent philosophical work has explored the distinction between causal and non-causal forms of explanation. In this literature, topological explanation is viewed as a clear example of the non-causal variety–it is claimed that topology lacks temporal information, which is necessary for causal structure. This paper explores the distinction between topological and causal forms of explanation and argues that this distinction is not as clear cut as the literature suggests. One reason for this is that some explanations involve both topological and causal (...) information. In these “borderline” cases scientists explain some outcome by appealing to the causal topology of the system of interest. These cases help clarify a type of topological explanation that is genuinely causal, but that differs from standard topological and interventionist accounts of explanation. (shrink)

This article examines the multiple realizability thesis within a causal framework. The beginnings of this framework are found in Elliott Sober’s “Multiple Realizability Argument against Reduction,”...

Gadamer's Dialectical Hermeneutics affirms the continuity between Gadamer's interest in Plato and his hermeneutics by focusing on the role of dialectic for Gadamer's own conception of understanding. Highlighting the productive and on-going nature of the dialectical tension at the heart of hermeneutics clarifies the roles that truth, good, practice, theory, and dialogue play in Gadamer's thought and emphasizes his desire to recover the practical nature of philosophy.

COVID-19 severity and mortality risk are greater for older adults whereas economic impact is deeper for younger adults. Using the Health Belief Model as a framework, this study used a web-based survey to examine how perceived COVID-19 susceptibility and severity and perceived efficacy of recommended health behaviors varied by age group and were related to the adoption of health behaviors. Proportional odds logistic regression was used to examine the relationship between age group and perceived COVID-19 susceptibility, severity, impact, and health (...) behavior efficacy and adoption. Structural equation modeling based on HBM constructs examined the relationships between health beliefs and behaviors. Data from 820 participants were analyzed. Middle-aged and older adults reported greater concerns about the personal risk of hospitalization and mortality, economic impact, and social impact of COVID-19 than young adults. Middle-aged adults also reported greatest concern for other age groups. Adoption and perceived efficacy of health behaviors was similar across age groups with few exceptions. Both middle-aged and older-adults were more likely to perceive their own and each other's age groups as responding adequately to COVID-19 compared to young adults. Structural equation modeling indicated perceived benefits of health behaviors were the primary driver of behavior uptake, with socioeconomic factors and perceived severity and susceptibility indirectly associated with uptake through their influence on perceived benefits. Overall, these results suggest adoption of health behaviors is very high with few differences between age groups, despite differences in perceived impact of COVID-19. Public health communications should focus on the benefits of health behaviors to drive adoption. (shrink)

Many want to know what bitcoin is and how it works. But bitcoin is as complex as it is controversial, and relatively few have the technical background to understand it. In this paper, I offer an accessible on-ramp for understanding bitcoin in the form of a model. My model reveals both what bitcoin is and how it works. More specifically, it reveals that bitcoin is a fictional substance in a massively coauthored story on a network that automates and distributes jobs (...) normally entrusted to centralized publishing institutions. My model therefore falsifies a popular view according to which each bitcoin is a chunk of code. (shrink)

Eating disorders are debilitating diseases that have twin impacts on the body and mind and are associated with a number of physiological and psychological comorbidities (Blinder, Cumella, and Sanathara 2006; Casiero and Frishman 2006), including increased suicide risk (Arcelus et al. 2011; Lipson and Sonneville 2020). In addition, eating disorders are growing in prevalence (Gilmache et al. 2019) and impact women at much higher rates than men (Bearman, Martinez, and Stice 2006), especially in adolescence (Spriggs, Kettner, and Carhart-Harris 2021). Anorexia (...) nervosa (AN) is a particularly devastating eating disorder, with one of the highest mortality rates of any psychiatric disorder (Sullivan 1995). Despite the severity of the condition, current treatments for AN are limited in their efficacy (Khalsa et al. 2017). Based on the growing body of evidence demonstrating the short-term and long-term efficacy of psychedelic-assisted psychotherapy for the treatment of other mental illnesses, I argue that research into psychedelic-assisted psychotherapy for AN should be funded. (shrink)

In a letter to an imagined future reader a century from now – at the 2121 bicentennial of the birth of Paulo Freire, I argue for the potential of a framework of timescapes and a feminist, Freirean praxis of letter-writing to enrich Freirean studies. In the context of analysis of Freire’s other letter-writing praxes across his life, I reflect on my recent interviews with two of Freire’s family correspondents, both women, whose letters with him have been published: the first to (...) be granted by his niece Cristina Bruno Freire and the first interview for an English-language publication (this journal) with his cousin Nathercia Lacerda. I aim to center their voices on the occasion of this current centennial and highlight the continuing need for critical translation and archiving of this work within Freirean studies, as well as for these creative forms of resistance and modes and areas of inquiry. (shrink)

We argue that Koch’s postulates are best understood within an interventionist account of causation, in the sense described in Woodward. We show how this treatment helps to resolve interpretive puzzles associated with Koch’s work and how it clarifies the different roles the postulates play in providing useful, yet not universal criteria for disease causation. Our paper is an effort at rational reconstruction; we attempt to show how Koch’s postulates and reasoning make sense and are normatively justified within an interventionist framework (...) and more difficult to understand within alternative frameworks for thinking about causation. (shrink)

Slurring language has had a lot of recent interest, but the focus has been almost exclusively on racial slurs. Gendered pejoratives, on the other hand—terms like “slut,” “bitch,” or “sissy”—do not fit into existing accounts of slurring terms, as these accounts require the existence of neutral correlates, which, I argue, these gendered pejoratives lack. Rather than showing that these terms are not slurs, I argue that this challenges the assumption that slurs must have neutral correlates, and so that a new (...) approach to thinking about the meaning of slurring terms is required. (shrink)

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; there are additional equity-based reasons to offer OPS to non-binary adults as a group; and the ethical defensibility (...) of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results. (shrink)