This book contains articles on ignorance in the medical field and where the contributing researchers would like research directed.

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

Dominic Smith’s Exceptional Technologies has a specific project, a bridge it is hoping to build, between a philosophy of technology which has become too standardised and a continental tradition tha...

The way health is conceptualized determines the actions taken to protect and promote it and, in turn, the actors responsible for such actions in an increasingly inter-dependent world. This essay presents a brief description of health policies in Peru during the last ten years in order to analyze the implications of paradigms of medical ethics, human rights and quality of care. These paradigms offer distinct ways of formulating, applying and evaluating health policies and understanding the relationship among different actors at (...) various levels. Building upon other detailed analyses of sexual and reproductive health policy in Peru (Coe, 2004; Miranda and Yamin, 2004), as well as critical appraisals of health services models (Gericke, Kurowski, Ranson and Mills, 2005; Krieger, Northridge, Gruskin, Quinn, Kriebel, Davey Smith, Bassett, Rehkopf and Miller, 2003), this article advocates the importance of construing and promoting health as a human right. (shrink)

Fricker shows that virtue epistemology provides a general epistemological idiom in which these issues can be forcefully discussed.

When we hope to explain and perhaps vindicate a practice that is internally diverse, philosophy faces a methodological challenge. Such subject matters are likely to have explanatorily basic features that are not necessary conditions. This prompts a move away from analysis to some other kind of philosophical explanation. This paper proposes a paradigm based explanation of one such subject matter: blame. First, a paradigm form of blame is identified—‘Communicative Blame’—where this is understood as a candidate for an explanatorily basic form (...) of blame. Second, its point and purpose in our lives is investigated and found to reside in its power to increase the alignment of the blamer and the wrongdoer's moral understandings. Third, the hypothesis that Communicative Blame is an explanatorily basic form of blame is tested out by seeing how far other kinds of blame can reasonably be understood as derivative, especially in respect of blame's point and purpose. Finally, a new and quasi-political worry about blame is raised. (shrink)

In this paper I respond to three commentaries on Epistemic Injustice: Power and the Ethics of Knowing. In response to Alcoff, I primarily defend my conception of how an individual hearer might develop virtues of epistemic justice. I do this partly by drawing on empirical social psychological evidence supporting the possibility of reflective self-regulation for prejudice in our judgements. I also emphasize the fact that individual virtue is only part of the solution – structural mechanisms also have an essential role (...) in combating epistemic injustice. My response to Goldberg principally concerns my perceptual account of the epistemology of testimony, which I defend as being both well-motivated and best categorized as a species of non-inferentialism. I also explain its relation to the reductionism/non-reductionism contrast, and defend my resistance to casting it as any kind of default view. In response to Hookway, I contrast discriminatory with distributive forms of epistemic injustice, and defend the basic taxonomy I present in the book, which casts testimonial and hermeneutical injustice as the two fundamental discriminatory forms of epistemic injustice. (shrink)

There are two kinds of forgiveness that appear as radically different from one another: one presents forgiveness as essentially earned through remorseful apology; the other presents it as fundamentally non-earned—a gift. The first, which I label Moral Justice Forgiveness, adopts a stance of moral demand and conditionality; the second, which I label Gifted Forgiveness, adopts a stance of non-demand and un-conditionality. Each is real; yet how can two such different responses to wrongdoing be of one and the same kind? This (...) paper explains how, by showing that the basic role each plays in moral-social life is the same; and that one is conceptually and therefore historically prior to the other. The result is pluralism, with each kind of forgiveness represented as distinctive in both its psychology and its normativity; and yet an ordered pluralism—with Moral Justice Forgiveness revealed as the root kind, and Gifted Forgiveness a culturally contingent iteration. (shrink)

We have now reached the point at which cloud computing and other types of advanced infrastructure are bringing about a situation in which knowledge objects can be delivered in an efficient manner to hose who need to consume them. And just as highways were the infrastructure necessary for a manufacturing economy, serving as the arteries along which raw materials and manufactured goods coming in from all directions could flow, so we believe that ontologies will in the future provide an important (...) pillar in the infrastructure that is necessary for the accurate and safe delivery of all varieties of knowledge. (shrink)

Bernard Williams is a sceptic about the objectivity of moral value, embracing instead a qualified moral relativism—the ‘relativism of distance’. His attitude to blame too is in part sceptical. I will argue that the relativism of distance is unconvincing, even incoherent; but also that it is detachable from the rest of Williams's moral philosophy. I will then go on to propose an entirely localized thesis I call the relativism of blame, which says that when an agent's moral shortcomings by our (...) lights are a matter of their living according to the moral thinking of their day, judgements of blame are out of order. Finally, I will propose a form of moral judgement we may sometimes quite properly direct towards historically distant agents when blame is inappropriate—moral-epistemic disappointment. Together these two proposals may help release us from the grip of the idea that moral appraisal always involves the potential applicability of blame, and so from a key source of the relativist idea that moral appraisal is inappropriate over distance. (shrink)

I shall first briefly revisit the broad idea of ‘epistemic injustice’, explaining how it can take either distributive or discriminatory form, in order to put the concepts of ‘testimonial injustice’ and ‘hermeneutical injustice’ in place. In previous work I have explored how the wrong of both kinds of epistemic injustice has both an ethical and an epistemic significance—someone is wronged in their capacity as a knower. But my present aim is to show that this wrong can also have a political (...) significance in relation to non-domination, and so to freedom. While it is only the republican conception of political freedom that presents nondomination as constitutive of freedom, I shall argue that non-domination is best understood as a thoroughly generic liberal ideal of freedom to which even negative libertarians are implicitly committed, for non-domination is negative liberty as of right—secured non-interference. Crucially on this conception, non-domination requires that the citizen can contest interferences. Pettit specifies three conditions of contestation, each of which protects against a salient risk of the would-be contester not getting a ‘proper hearing’. But I shall argue that missing from this list is anything to protect against a fourth salient threat: the threat that either kind of epistemic injustice might disable contestation by way of an unjust deflation of either credibility or intelligibility. Thus we see that both testimonial and hermeneutical injustice can render a would-be contester dominated. Epistemic justice is thereby revealed as a constitutive condition of non-domination, and thus of a central liberal political ideal of freedom. (shrink)

Interpreting Bernard Williams’s ethical philosophy is not easy. His style is deceptively conversational; apparently direct, yet argumentatively inexplicit and allusive. He is moreover committed to evading ready-made philosophical “-isms.” All this reinforces the already distinct impression that the structure of his philosophy is a web of interrelated commitments where none has unique priority. Against this impression, however, I will venture that the contours of his philosophy become clearest if one considers that there is a single, unchanging root conviction from which (...) his ethical philosophy grows. Despite the perpetual motion of his philosophical thought—its erudition, originality, range, and unceasing forward momentum—still, I contend, there is something unchanging at the heart of it. I will show this by reference to three signature theses: internal reasons, the relativism of distance, and the porous borders of philosophy and history. I will argue that the root conviction of which these are the fruits is the conviction that the constraints of universal rationality seriously underdetermine how one should live. This, I believe, is the vision of the human ethical condition that constitutes the largely inexplicit yet utterly fundamental presupposition beneath Williams’s ethical philosophy taken as a whole. I label the object of this root conviction ethical freedom, and thus portray Williams as a philosopher of ethical freedom. (shrink)

The Truth That Never Hurts brings together for the first time more than two decades of literary criticism & political thought about gender, race, sexuality, power & social change. As one of the first writers in the United States to claim Black feminism for Black women in the early seventies, this authors works has been ground breaking in defining a Black women's literary tradition; in examining the sexual politics of the lives of Black & other women of color; in representing (...) the lives of Black lesbians & gay men; & in making connections between race, class, sexuality, & gender. Her essay "Toward a Black Feminist Criticism," is often cited as a major catalyst in opening the field of Black women's literature. This essay also presented the first serious discussion of Black lesbian writing. Essays about racism in the women's movement, Black & Jewish relations, & homophobia in the Black community have ignited dialogue about topics that few other writers address. The collection also brings together topical political commentaries that examine the 1968 Chicago convention demonstrations; attacks on the NEA; the Anita Hill/Clarence Thomas Senate hearings; & police brutality against Rodney King & Abner Louima. It also includes a never before published personal essay on racial violence, the day-to-day life of Kitchen Table Press, & the bonds between Black women that make it possible to survive. This authors writing offers a rare combination of intellectual challenge & an accessible personal voice. her commitment to telling the truth about difficult, even volatile issues, makes a unique contribution to American literature & social thought. (shrink)

We gain information from collective, often institutional bodies all the time—from the publications of committees, news teams, or research groups, from web sites such as Wikipedia, and so on—but do these bodies ever function as genuine group testifiers as opposed to mere group sources of information? In putting the question this way I invoke a distinction made, if briefly, by Edward Craig, which I believe to be of deep significance in thinking about the distinctiveness of the speech act of testimony. (...) The distinction is that between somebody’s functioning as a ‘good informant’ and their functioning merely as a ‘source of information’. The difference between these has, as he remarks, a crucial ethical aspect: What I have in mind is the special flavour of situations in which human beings treat each other as subjects with a common purpose, rather than as objects from which services, in this case true belief, can be extracted. In this paper I shall try to bring out the distinctive nature of the role of good informant in a way that helps to clarify what is at stake in asking whether there can be group testimony in the sense of genuinely collective testimony—that is to say, where the group testifier is a collective and not merely a sum of individuals testifying in one or another form of aggregated chorus. (shrink)

The dual aim of this article is to reveal and explain a certain phenomenon of epistemic injustice as manifested in testimonial practice, and to arrive at a characterisation of the anti–prejudicial intellectual virtue that is such as to counteract it. This sort of injustice occurs when prejudice on the part of the hearer leads to the speaker receiving less credibility than he or she deserves. It is suggested that where this phenomenon is systematic it constitutes an important form of oppression. (...) [ABSTRACT FROM AUTHOR]. (shrink)

This paper explores the relation between rational authority and social power, proceeding by way of a philosophical genealogy derived from Edward Craig's Knowledge and the State of Nature. The position advocated avoids the errors both of the 'traditionalist' (who regards the socio-political as irrelevant to epistemology) and of the 'reductivist' (who regards reason as just another form of social power). The argument is that a norm of credibility governs epistemic practice in the state of nature, which, when socially manifested, is (...) likely to imitate the structures of social power. A phenomenon of epistemic injustice is explained, and the politicizing implication for epistemology educed. (shrink)

[T]he dominated live in a world structured by others for their purposes — purposes that at the very least are not our own and that are in various degrees inimical to our development and even existence.We are perhaps used to the idea that there are various species of oppression: political, economic, or sexual, for instance. But where there is the phenomenon that Nancy Hartsock picks out in saying that the world is “structured” by the powerful to the detriment of the (...) powerless, there is another species of oppression at work, one that has not been registered in mainstream epistemology: epistemic oppression. The word ‘structured’ may be read materially, so as to imply that social institutions and practices favour the powerful, or ontologically, so as to imply that the powerful somehow constitute the world. But for present purposes I am interested only in an epistemological reading, which implies that the powerful have some sort of unfair advantage in “structuring” our understandings of the social world. I will try to present an account of what this initially vague idea involves. I hope thereby to explain an exact sense in which the powerful can have a kind of epistemic advantage that means the powerless are epistemically oppressed. (shrink)

The thirteen specially-commissioned essays in this volume are written by philosophers at the forefront of feminist scholarship, and are designed to provide an accessible and stimulating guide to a philosophical literature that has seen massive expansion in recent years. Ranging from history of philosophy through metaphysics to philosophy of science, they encompass all the core subject areas commonly taught in anglophone undergraduate and graduate philosophy courses, offering both an overview of and a contribution to the relevant debates. Together they testify (...) to the intellectual value of feminism as a radicalizing energy internal to philosophical inquiry. This volume will be essential reading for any student or teacher of philosophy who is curious about the place of feminism in their subject. (shrink)

I consider Katherine Hawley's commitment account of interpersonal trustworthiness alongside her sceptical challenge regarding the value of philosophically modelling institutional trustworthiness as distinct from reliability. I argue, pace Hawley's challenge, that there would be significant diagnostic and explanatory loss if we were to content ourselves with ideas of institutional (un)reliability alone; and I offer an illustrative case where institutional unreliability is only the half of it, indicating that when it comes to certain kinds of institutional dysfunction, we do need philosophical (...) models of institutional ‘distrustworthiness’ if we are to achieve a proper diagnosis. (shrink)

She was to a degree the tool of her husband. However, despite the fact she was under his influence to a degree she cannot escape if the Bank took all reasonable steps to ensure that she had appreciated and understood what she was signing. It may be that Mrs Wright-Bailey did not have an adequate comprehension of the nature of the charge... [E]ven if she did not, the Bank did take all reasonable steps.

We present a novel methodology for calculating the improvements obtained in successive versions of biomedical ontologies. The theory takes into account changes both in reality itself and in our understanding of this reality. The successful application of the theory rests on the willingness of ontology authors to document changes they make by following a number of simple rules. The theory provides a pathway by which ontology authoring can become a science rather than an art, following principles analogous to those that (...) have fostered the growth of modern evidence-based medicine. Although in this paper we focus on ontologies, the methodology can be generalized to other sorts of terminology-based artifacts, including Electronic Patient Records. (shrink)

Our understanding of social experiences is central to our social understanding more generally. But this sphere of epistemic practice can be structurally prejudiced by unequal relations of power, so that some groups suffer a distinctive kind of epistemic injustice—hermeneutical injustice. I aim to achieve a clear conception of this epistemicethical phenomenon, so that we have a workable definition and a proper understanding of the wrong that it inflicts.

The notion of recognition is an ethically potent resource for understanding human relational needs; and its negative counterpart, misrecognition, an equally potent resource for critique. Axel Honneth’s rich account focuses our attention on recognition’s role in securing basic self-confidence, moral self-respect, and self-esteem. With these loci of recognition in place, we are enabled to raise the intriguing question whether each of these may be extended to apply specifically to the epistemic dimension of our agency and selfhood. Might we talk intelligibly—while (...) staying in tune with Honneth’s concepts and their Hegelian key—of a generic idea of epistemic recognition? Such an idea might itself be seen to apply at the same three levels to indicate: first, basic epistemic self-confidence; second, our status as epistemically responsible; and third, a certain epistemic self-esteem that reflects the epistemic esteem we receive from others. The papers in this volume surely sound a chord in the affirmative, and together they steer us towards a multifaceted conception of how epistemic injustice is related to epistemic misrecognition, and indeed how we might construe a positive relation of epistemic recognition. (shrink)

My overarching purpose is to illustrate the philosophical fruitfulness of expanding epistemology not only laterally across the social space of other epistemic subjects, but at the same time vertically in the temporal dimension. I set about this by first presenting central strands of Michael Williams' diagnostic engagement with scepticism, in which he crucially employs a Default and Challenge model of justification. I then develop three key aspects of Edward Craig's ‘practical explication' of the concept of knowledge so that they may (...) be seen to resonate positively with Williams's epistemological picture: the admixture of internalist and externalist features; the proto-contextualism; and, finally, the distinctively genealogical antisceptical impetus. In this way I aim to support and augment the socialized anti-sceptical case mounted by Williams, and so to show that expanding epistemology in the temporal dimension can be a productive move in central debates in epistemology. Philosophical Papers Vol. 37 (1) 2008: pp. 27-50. (shrink)

Our ideas about forgiveness seem to oscillate between idealization and scepticism. How should we make sense of this apparent conflict? This paper argues that we should learn something from each, seeing these views as representing opposing moments in a perennial and well-grounded moral ambivalence towards forgiveness. Once we are correctly positioned, we shall see an aspect of forgiveness that recommends precisely this ambivalence. For what will come into view will be certain key psychological mechanisms of moral-epistemic influence – other-addressed and (...) self-addressed mechanisms of moral social construction – that enable forgiveness to function well when it is well-functioning, but which are also intrinsically prone to deterioration into one or another form of bad faith. Thus forgiveness is revealed as necessarily containing seeds of its own corruption, showing ambivalence to be a generically appropriate attitude. Moreover, it is emphasized that where forgiver and forgiven are relating to one another in the context of asymmetries of social power, the practice of forgiveness is likely to be further compromised, notably increasing the risk of negative influence on the moral-epistemic states of either the forgiver or the forgiven, or both. (shrink)

Taking on topics from pornography and prostitution to female genital mutilation, from womens magazines and marriage to sexual violence, contributors in this collection argue that the kind of liberal feminism currently rising to prominence does little to challenge the status quo.

In both social science and medicine, research on reproduction generally focuses on women. In this article, we examine how men’s reproductive contributions are understood. We develop an analytic framework that brings together Cynthia Daniels’ conceptualization of reproductive masculinity with a staged view of reproduction, where the stages include the period before conception, conception, gestation, and birth. Drawing on data from two medical sites that are oriented to the period before pregnancy, we examine how gendered knowledge about reproduction produces different reproductive (...) equations in different stages of the reproductive process. We conclude with a new research agenda that emerges from rethinking the role of men and masculinity in reproduction. (shrink)

Insight into animal biology and development provided by classical genetic analysis of the model organism Drosophila melanogaster was an incentive to develop advanced genetic tools for this insect. But genetic systems for the over one million other known insect species are largely undeveloped. With increasing information about insect genomes resulting from next generation sequencing, RNA interference is now the method of choice for reverse genetics, although it is constrained by the means of delivery of interfering RNA. A recent advance to (...) ensure sustained delivery with minimal experimental intervention or trauma to the insect is to exploit commensal bacteria for symbiont‐mediated RNA interference. This technology not only offers an efficient means for RNA interference in insects in laboratory conditions, but also has potential for use in the control of human disease vectors, agricultural pests and pathogens of beneficial insects. (shrink)

Pierre Duhem’s philosophy of science has influenced many philosophers in the twentieth century, and even today. Many of the subjects he addressed are still highly discussed today, especially the distinction between science and metaphysics. My aim in this paper will be to motivate a naturalistic approach where the difference between physics and metaphysics is only a matter of degree. I focus on whether it would be possible to articulate this gradual distinction from a duhemian point of view. Although Duhem thought (...) that metaphysics is an entirely different and more excellent activity than physics, I believe that Duhem’s philosophy of science also supports a naturalistic distinction in terms of degrees. I offer three reasons to justify this conclusion: Duhem’s notion of common sense; Duhem’s holism and his views on the generality of our theories, and Duhem’s notion of natural classification. At the end of the paper I will argue that a naturalistic approach accomplishes must of what Duhem wanted to achieve with his distinction. (shrink)

The current literature on the value of knowledge is marred by two unwarranted presumptions, which together distort the debate and conceal what is perhaps the most basic value of knowledge, as distinct from mere true belief. These presumptions are the Synchronic Presumption, which confines philosophical attention to the present snapshot in time; and the Analytical Presumption, which has people look for the value of knowledge in some kind of warrant. Together these presumptions conceal that the value of knowledge might inhere (...) not in a necessary condition, but simply in a property that most knowledge possesses; and, in particular, that it might inhere, as I argue it does, in a certain property of 'resilience': the tendency to survive misleading counter-evidence over time owing to the subject's being in a position to weight it against evidence already possessed. (shrink)

My overarching purpose is to illustrate the philosophical fruitfulness of expanding epistemology not only laterally across the social space of other epistemic subjects, but at the same time vertically in the temporal dimension. I set about this by first presenting central strands of Michael Williams' diagnostic engagement with scepticism, in which he crucially employs a Default and Challenge model of justification. I then develop three key aspects of Edward Craig's ‘practical explication' of the concept of knowledge so that they may (...) be seen to resonate positively with Williams's epistemological picture: the admixture of internalist and externalist features; the proto-contextualism; and, finally, the distinctively genealogical antisceptical impetus. In this way I aim to support and augment the socialized anti-sceptical case mounted by Williams, and so to show that expanding epistemology in the temporal dimension can be a productive move in central debates in epistemology. (shrink)

Over the centuries, many philosophers have written about injustice. More recently, attention has turned to a previously little-recognized form of injustice – epistemic injustice. The philosopher Miranda Fricker coined the phrase ‘epistemic injustice’ – an example being when your credibility as a source of knowledge is unjustly downgraded (perhaps because you are ‘just a woman’ of the ‘wrong’ race). This interview with Miranda explores what epistemic injustice is, and why it is important.

Being compassionate and empathic while making rational decisions is expected from healthcare workers across different contexts. But the daily challenges that these workers face, aggravated by the recent COVID-19 crisis, can give rise to compassion and decision fatigue, which affects not only their ability to meet these expectations but has a significant negative impact on their wellbeing. Hence, it is vital to identify factors associated to their exhaustion. Here, we sought to describe levels of compassion and decision fatigue during the (...) pandemic, and to identify factors related to these forms of exhaustion. We collected data using self-reported questionnaires to measure compassion fatigue, decision fatigue, and grit in five intervals from April to November, 2020 (N = 856). Our results showed a negative correlation between grit and compassion and decision fatigue. We also found that under the circumstances studied grit tends to be higher in technicians, nurses, other professionals (psychologists, social workers), and workers at the Emergency Room (ER), and lower in general practitioners. Compassion fatigue tend to be higher for technicians, whereas decision fatigue was lower for specialists, general practitioners, and technicians, and higher for those working at private hospitals. (shrink)

We hypothesise that the sarcolemma of an actively growing myofibre has different properties to the sarcolemma of a mature adult myofibre. Such fundamentally different properties have clinical consequences for the onset, and potential therapeutic targets, of various skeletal muscle diseases that first manifest either during childhood (e.g. Duchenne muscular dystrophy, DMD) or after cessation of the main growth phase (e.g. dysferlinopathies). These characteristics are also relevant to the selection of both tissue culture and in vivo models employed to study such (...) myopathies and the molecular regulation of adult myofibres. During growth, multinucleated myofibres increase enormously in size and volume with dramatic increases in length (up to ∼600 mm). This is in striking contrast with most mononucleated cells such as fibroblasts, that remain at a relatively small size (∼10–20 µm diameter). The consequences of a dynamic, expanding sarcolemma during growth, compared with that of an adult myofibre of a fixed length, are discussed with respect to various aspects of muscle biology. (shrink)