The majority of midwives in the UK are employed within the NHS. They are legally bound to fulfil their contractual obligations to their employers. At the same time they are professionally mandated to interpret and act on the UKCC's Code of professional conduct. Midwives have always maintained that they are autonomous practitioners, and the Code is written in a way that endorses this belief. Underlying the Code is the assumption that midwives have moral and professional freedom to act on its (...) imperatives. However, midwives' claim to autonomy is flawed, and therefore the Code's claim to be a source of empowerment is also flawed. Underlying the difficulties is a conflict derived from the imposition of a deontologically-based professional Code on to a workforce that is constrained within and employed by the utilitarian-based NHS. (shrink)

The authors mark the twentieth anniversary of the classic study by Weitzman et al., which found considerable gender stereotyping in picture books for preschool children, by replicating and extending their study with an updated sample that includes books by Black illustrators. The authors find evidence that female characters and female relationships receive considerably more attention in recent books by both conventional illustrators and Black illustrators than they did in the late 1960s. They also find, consistent with the liberal feminist aims (...) of Weitzman et al., evidence that male and female characters are shown in a more egalitarian fashion than they were in the late 1960s in books by mainstream authors. Finally, they discover that, consistent with the aims of recent Black feminist theorists, Black illustrators are more apt than others to highlight women's involvement in an ethic of caring and an ethic of personal accountability. (shrink)

We read with interest the extended essay published from Riisfeldt and are encouraged by an empirical ethics article which attempts to ground theory and its claims in the real world. However, such attempts also have real-world consequences. We are concerned to read the paper’s conclusion that clinical evidence weakens the distinction between euthanasia and normal palliative care prescribing. This is important. Globally, the most significant barrier to adequate symptom control in people with life-limiting illness is poor access to opioid analgesia. (...) Opiophobia makes clinicians reluctant to prescribe and their patients reluctant to take opioids that might provide significant improvements in quality of life. We argue that the evidence base for the safety of opioid prescribing is broader than that presented, restricting the search to palliative care literature produces significant bias as safety experience and literature for opioids and sedatives exists in many fields. This is not acknowledged in the synthesis presented. By considering additional evidence, we reject the need for agnosticism and reaffirm that palliative opioid prescribing is safe. Second, palliative sedation in a clinical context is a poorly defined concept covering multiple interventions and treatment intentions. We detail these and show that continuous deep palliative sedation is a specific practice that remains controversial globally and is not considered routine practice. Rejecting agnosticism towards opioids and excluding CDPS from the definition of routine care allows the rejection of Riisfeldt’s headline conclusion. On these grounds, we reaffirm the important distinction between palliative care prescribing and euthanasia in practice. (shrink)

Previous studies examining EEG and LORETA in patients with chronic pain discovered an overactivation of high theta and low beta power in central regions. MEG studies with healthy subjects correlating evoked nociception ratings and source localization described delta and gamma changes according to two music interventions. Using similar music conditions with chronic pain patients, we examined EEG in response to two different music interventions for pain. To study this process in-depth we conducted a mixed-methods case study approach, based on three (...) clinical cases. Effectiveness of personalized music therapy improvisations versus preferred music on chronic pain was examined with 16 participants. Three patients were randomly selected for follow-up EEG sessions three months post-intervention, where they listened to recordings of the music from the interventions provided during the research. To test the difference of EM versus preferred music, recordings were presented in a block design: silence, their own composed EM, preferred music, and a non-participant’s EM as a control. Participants rated their pain before and after the EEG on a 1–10 scale. We conducted a detailed single case analysis to compare all conditions, as well as a group comparison of entrainment-healing condition versus preferred music condition. Power spectrum and according LORETA distributions focused on expected changes in delta, theta, beta, and gamma frequencies, particularly in sensory-motor and central regions. Intentional moment-by-moment attention on the sounds/music rather than on pain and decreased awareness of pain was experienced from one participant. Corresponding EEG analysis showed accompanying power changes in sensory-motor regions and LORETA projection pointed to insula-related changes during entrainment-pain music. LORETA also indicated involvement of visual-spatial, motor, and language/music improvisation processing in response to his personalized EM which may reflect active recollection of creating the EM. Group-wide analysis showed common brain responses to personalized entrainment-healing music in theta and low beta range in right pre- and post-central gyrus. We observed somatosensory changes consistent with processing pain during entrainment-healing music that were not seen during preferred music. These results may depict top–down neural processes associated with active coping for pain. (shrink)

In this provocative book, a professor of philosophy examines the arguments for and against euthanasia, analyzes specific case studies, including those of Baby Jane Doe and Barney Clark, and offers an alternate theory on the morality of euthanasia. Various traditional distinctions--between "human" and "non-human," intentional and nonintentional, killing and "letting die"--are taken into account to determine whether euthanasia is permissible or not. Rachels presents a systematic argument against the traditional view, defending an alternative position based on the belief that there (...) is a profound difference between having a life and merely being alive. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume XX, Number 2, November 1994, pp. 179-194 Symposium A version of this paper was presented at the symposium on A Progress of Sentiments by Annette C. Baier, held at the Pacific Division Meetings of the American Philosophical Association, Los Angeles, March 1994. On an Unorthodox Account of Hume's Moral Psychology RACHEL COHON One can learn a great deal about Hume's Treatise from Annette Baier's fascinating (...) book, A Progress of Sentiments.1 It is in places dazzling, in others revelatory, occasionally puzzling, and everywhere interesting. Having said that, I proceed to criticize one aspect of it. Belief and the Passions My topic is Baier's interpretation of Hume's moral psychology. First I sketch out the striking differences between Baier's View of Hume's moral psychology and what I call the Standard View. Then I consider some of Baier's reasons for her unorthodox reading. I argue that Baier's View of Hume's moral psychology is motivated in part by a particular, unstated understanding of Hume's theory of the passions. As a consequence of this, I argue, Baier denies Hume the use of an especially strong argument against the moral rationalists' theory of motivation and morality, for that strong anti-rationalist argument (sometimes called the influence argument) depends upon a support that is incompatible with Hume's theory of the passions as Baier implicitly understands it. But without the influence argument, Hume's case against the moral rationalists would be much weaker. The relevant portion of the Standard View, on the other hand, makes better sense of Hume's campaign against Samuel Clarke and others, because it embraces the support Hume offers for the influence argument. So, in this one respect, I shall argue that a portion of the Rachel Cohon is at the Department of Philosophy, Stanford University, Stanford CA 94305 USA. 180 Rachel Cohon Standard View of Hume's moral psychology is superior to Baier's View. But whether we should reject Baier's View in favor of the relevant portion of the Standard View depends, of course, upon whether we can consistently reject the unstated interpretation of Hume's theory of the passions on which Baier's View seems to be based. Baier explicitly sees her version of Hume's moral psychology as shaped by the account of the passions in Book II. And Baier's discussion of the role of belief in the causation and individuation of the passions is illuminating. It helps guard against a common oversimplification of Hume's claim about the motivating power of reason. Baier reminds us that passions are impressions of reflection, and hence must be introduced in the mind by an impression or an idea; i.e., each passion is caused by certain ideas or impressions. Passions are "thought-caused" and "idea-mediated" (160). Anger, for example, "is always directed at someone for some perceived insult, injury or harm" (161). It has a "subject" or cause, the injury the person is thought to have done one. In one place Baier refers to the causes of passions as their "appropriate reasons" (164). The causes are "thoughts about what is or is likely to become the case" (161). For something to be a passion at all rather than a mere pleasure or pain, some idea must be present to cause it. Passions do, indeed, have their hedonic components, such as the two pleasures included in pride. But for pride to be the passion it is, rather than some other, "one must believe the fine thing to be one's own" (161). A particular belief is what identifies the passion. Even desire is influenced by a belief or idea, and subsequently is often called "preference " (164). Thus, since reason produces beliefs, and beliefs are the crucial, identifying causes of passions, reason has a thorough-going influence on passion. And since passions are what move us to act, reason provides indispensable causal input into volition and action. It is easy but inaccurate to describe Hume as saying that belief, or reason, does not cause action. Furthermore, besides having a characteristic cause, many passions have an intentional object distinct from their cause. For anger, this "object... (shrink)

In 2016, when #NODAPL first appeared in the mainstream media, many nonnative people approached me about how to support the water protectors. This question can be answered in a couple of ways: first, I might address the specific issue, or second, I might respond more generally about how to be an ally to native people. The two responses highlight a current issue in Indian Country: should nonnatives serve as active bystanders—or should they be allies to native peoples? Being an ally (...) has come under scrutiny, especially given its propensity for epistemic injustice. Some philosophers—such as Rachel McKinnon—argue for dismissing the concept altogether, requiring that individuals serve as active bystanders. Although this may be necessary to support individuals in the transgender community, it lacks the resources to fully address the needs of colonized peoples. In this article, I argue for the operationalization of “ally” in Indian Country insofar as it is subject to decolonizing treatment. Although there is a need for both bystanders and allies in Indian Country, the Indigenous people must define the concepts that are intended to serve them. (shrink)

This paper aims to identify the key characteristics of model organisms that make them a specific type of model within the contemporary life sciences: in particular, we argue that the term “model organism” does not apply to all organisms used for the purposes of experimental research. We explore the differences between experimental and model organisms in terms of their material and epistemic features, and argue that it is essential to distinguish between their representational scope and representational target. We also examine (...) the characteristics of the communities who use these two types of models, including their research goals, disciplinary affiliations, and preferred practices to show how these have contributed to the conceptualization of a model organism. We conclude that model organisms are a specific subgroup of organisms that have been standardized to fit an integrative and comparative mode of research, and that it must be clearly distinguished from the broader class of experimental organisms. In addition, we argue that model organisms are the key components of a unique and distinctively biological way of doing research using models.Keywords: Experimental organism; Genetics; Model organism; Modeling; Philosophy of biology; Representation. (shrink)

In this paper, we explore the recent creation of “iBlastoids,” which are 3-D structures that resemble early human embryos prior to implantation which formed via self-organization of reprogrammed ad...

The biological sciences have become increasingly reliant on so-called 'model organisms'. I argue that in this domain, the concept of a descriptive model is essential for understanding scientific practice. Using a case study, I show how such a model was formulated in a preexplanatory context for subsequent use as a prototype from which explanations ultimately may be generated both within the immediate domain of the original model and in additional, related domains. To develop this concept of a descriptive model, I (...) focus on use of the nematode worm Caenorhabditis elegans and the wiring diagrams that were developed as models of its neural structure. In addition, implications of the concept of a descriptive model, particularly its relevance for the data-phenomena distinction as well as its relation to long-standing debates on realism, are briefly examined. (shrink)

Through an examination of the actual research strategies and assumptions underlying the Human Genome Project (HGP), it is argued that the epistemic basis of the initial model organism programs is not best understood as reasoning via causal analog models (CAMs). In order to answer a series of questions about what is being modeled and what claims about the models are warranted, a descriptive epistemological method is employed that uses historical techniques to develop detailed accounts which, in turn, help to reveal (...) forms of reasoning that are explicit, or more often implicit, in the practice of a particular field of scientific study. It is suggested that a more valid characterization of the reasoning structure at work here is a form of case-based reasoning. This conceptualization of the role of model organisms can guide our understanding and assessment of these research programs, their knowledge claims and progress, and their limitations, as well as how we educate the public about this type of biomedical research. (shrink)

Through an examination of the actual research strategies and assumptions underlying the Human Genome Project, it is argued that the epistemic basis of the initial model organism programs is not best understood as reasoning via causal analog models. In order to answer a series of questions about what is being modeled and what claims about the models are warranted, a descriptive epistemological method is employed that uses historical techniques to develop detailed accounts which, in turn, help to reveal forms of (...) reasoning that are explicit, or more often implicit, in the practice of a particular field of scientific study. It is suggested that a more valid characterization of the reasoning structure at work here is a form of case-based reasoning. This conceptualization of the role of model organisms can guide our understanding and assessment of these research programs, their knowledge claims and progress, and their limitations, as well as how we educate the public about this type of biomedical research. (shrink)

Objective: Even when critically ill patients are almost certain to die from their illnesses, there is generally an element of prognostic uncertainty. Little is known about how physicians handle this uncertainty in conversations with surrogate decision makers. We sought to evaluate whether and how physicians discuss prognostic uncertainty with surrogate decision makers of patients who are highly likely, but not certain, to die. Design: We audiotaped and transcribed discussions between clinicians and surrogate decision makers at two major California teaching hospitals (...) from 2006 through 2008. Physicians completed a questionnaire addressing their prognostic estimates for patients' survival to hospital discharge. Participants: We included physicians and surrogates of 12 incapacitated, critically ill patients. Measurements: We analyzed transcripts of discussions in which physicians' estimates of patients' chances of hospital survival were 1% to 5%; we coded whether physicians disclosed the prognostic uncertainty and, if so, how they conveyed that death was highly likely but not certain. Results: Physicians' estimates of short-term survival were 1% to 5% for 12 of the 70 patients enrolled in the original study. In 8 of 12 cases, physicians conveyed prognostic uncertainty by using probabilistic language or by an explicit mention of uncertainty. In four cases, physicians made at least one statement that either implied or was ambiguous about whether death was certain. Conclusion: We observed variability in how physicians handle prognostic uncertainty in their discussions with surrogates of patients who are highly likely, but not certain, to die, including some circumstances in which physicians stated or implied that death was certain. (shrink)

Although cases are central to the epistemic practices utilized within clinical medicine, they appear to be limited in their ability to provide evidence about causal relations because they provide detailed accounts of particular patients without explicit filtering of those attributes most likely to be relevant for explaining the phenomena observed. This paper uses a series of recent case reports to explore the role of cases in casual attribution in medical diagnosis. It is argued that cases are brought together by practitioners (...) to generate causal attributions and testable predictions using a manipulability view of causation. (shrink)

Many consumers are motivated to attend Farmers’ Markets because of the opportunity to purchase fresh and local products. The subsequent interactions at FMs provide an important pathway for the direct exchange of information. While previous research suggests that people value local food and the FM shopping experience and that purchasing directly from producers can lead to transformative learning, little is known about exactly how the shopping experience at FMs can influence consumer purchasing behavior. This study examines the extent of and (...) mechanism for such “influencing.” Using data from surveys, observations, and interviews gathered at six FMs, we analyze the interactions between consumers and vendors, including the motivations and values of both parties. We explore the question, “How do farmers’ markets facilitate change in consumer purchasing behavior?” We propose that the dynamic of change in consumer purchasing behavior at FMs takes root in the exchange of information between consumers and vendors during interactions. Our results suggest that there are three specific characteristics shared by FM consumers and vendors that lead to these meaningful interactions at FMs: symmetry of motivations to attend FMs, shared values, and mutual dependence on interactions. Then, when a consumer learns new information from a FM vendor during an interaction, the consumer is more likely to make a change in their immediate purchase. Information about the products for sale and the modes of production of those items can especially impact consumers’ immediate purchases at FMs. We found that FM interactions can also impact long-term purchasing behavior, such as purchasing more organic or locally produced foods. Our results suggest that FM interactions may have significant implications for consumer health, local economies, and the environment. (shrink)

ArgumentWe examine the criteria used to validate the use of nonhuman organisms in North-American alcohol addiction research from the 1950s to the present day. We argue that this field, where the similarities between behaviors in humans and non-humans are particularly difficult to assess, has addressed questions of model validity by transforming the situatedness of non-human organisms into an experimental tool. We demonstrate that model validity does not hinge on the standardization of one type of organism in isolation, as often the (...) case with genetic model organisms. Rather, organisms are viewed as necessarily situated: they cannot be understood as a model for human behavior in isolation from their environmental conditions. Hence the environment itself is standardized as part of the modeling process; and model validity is assessed with reference to the environmental conditions under which organisms are studied. (shrink)

What consciousness exactly is remains an unsettled issue among both philosophers and biologists. Three aspects of consciousness are generally recognized: awareness consciousness (through connection...

The so-called "biometric-Mendelian controversy" has received much attention from science studies scholars. This paper focuses on one scientist involved in this debate, Arthur Dukinfield Darbishire, who performed a series of hybridization experiments with mice beginning in 1901. Previous historical work on Darbishire's experiments and his later attempt to reconcile Mendelian and biometric views describe Darbishire as eventually being "converted" to Mendelism. I provide a new analysis of this episode in the context of Darbishire's experimental results, his underlying epistemology, and his (...) influence on the broader debate surrounding the rediscovery and acceptance of Mendelism. I investigate various historiographical issues raised by this episode in order to reflect on the idea of "conversion" to a scientific theory. Darbishire was an influential figure who resisted strong forces compelling him to convert prematurely due to his requirements that the new theory account for particularly important anomalous facts and answer the most pressing questions in the field. (shrink)

This article unpacks a particular use of ‘cases’ within developmental biology, namely as a means of describing the typical or canonical patterns of phenomena. The article explores how certain cases have come to be established within the field and argues that although they were initially selected for reasons of convenience or ease of experimental manipulation, these cases come to serve as key reference points within the field because of the epistemological structures imposed on them by the scientists using them and, (...) hence, become usable in a wider variety of circumstances including future theory development. (shrink)

Bioethics has entered a new era: as many commentators have noted, the familiar mantra of autonomy, beneficence, nonmaleficence, and justice has proven to be an overly simplistic framework for understanding problems that arise in modern medicine, particularly at the intersection of public policy and individual preferences. A tradition of liberal pluralism grounds respect for individual preferences and affirmation of competing conceptions of the good. But we struggle to maintain (or at times explicitly reject) this tradition in the face of individual (...) preferences that we find distasteful, suspect, or even repugnant, especially where the broader social good or respect for equality is at stake. Directed donation presents us with such a dilemma: can we uphold the right of self-determination through respect of individual preferences regarding disposition of transplantable organs while at the same time maintaining an allocation system that reflects values of equity and justice claimed to underlie the socially negotiated practice of transplantation? Or are some preferences simply to be deemed unethical and not respected, even if that leads to a reduction in the number of transplantable organs available and to an apparent disregard for the autonomous decisions of the recently deceased? (shrink)

Prior to the genomic sequencing era, the bible for those working in clinical genetics was McKusick’s Mendelian Inheritance in Man, which appeared in multiple editions between the 1960s and the late 1990s. This catalogue was organized according to general patterns of inheritance and focused on phenotypes. Beginning in the mid-1980s, it was replaced by Online Mendelian Inheritance in Man, a continuously updated catalogue documenting molecular relationships between genetic variation and phenotypic expression. This paper explores this resource’s evolution with attention to (...) how disease is distinguished from clinically irrelevant variation and how phenotypic similarities are captured in cases where there is no obvious genotypic association. It is argued that hybrid compromises are encoded into OMIM®; in addition to serving its key original purpose of being a diagnostic catalogue, it also began to record detectable variations in the genome even if they were not known to be associated with phenotypically visible disorders or even phenotypic variations. Although the impacts of geneticization have been well recognized, particularly in popular media, this example allows exploration of some of the historic, epistemic, and methodological causes that underlie tendencies toward disease geneticization in contemporary medicine, while highlighting that such gene-focused strategies may in fact be warranted in some contexts. (shrink)

Background: Falls in older adults are a major public health problem. White matter hyperintensities are highly prevalent in older adults and are a risk factor for falls. In the absence of a cure for WMHs, identifying potential strategies to counteract the risk of WMHs on falls are of great importance. Physical activity is a promising countermeasure to reduce both WMHs and falls risk. However, no study has yet investigated whether PA attenuates the association of WMHs with falls risk. We hypothesized (...) that PA moderates the association between WMHs and falls risk.Methods: Seventy-six community-dwelling older adults aged 70–80 years old were included in this cross-sectional study. We indexed PA using the Physical Activity Score for the Elderly Questionnaire. Falls risk was assessed using the Physiological Profile Assessment, and WMH volume was determined by an experienced radiologist on T2-weighted and PD-weighted MRI scans. We first examined the independent associations of WMH volume and PASE score with PPA. Subsequently, we examined whether PASE moderated the relationship between WMH volume and PPA. We plotted simple slopes to interpret the interaction effects. Age, sex, and Montreal Cognitive Assessment score were included as covariates in all models.Results: Participants had a mean age of 74 years and 54 were female. Forty-nine participants had a Fazekas score of 1, 19 had a score of 2, and 6 a score of 3. Both PASE and WMH volume were each independently associated with PPA score. The interaction model indicated that PASE score moderated the association between WMH volume and PPA, whereby higher PASE score attenuated the association between WMHs and falls risk.Conclusion: PA is an important moderator of falls risk. Importantly, older adults with WMH can reduce their risk of falls by increasing their PA. (shrink)

There has been growing global interest in livestock animal welfare. Previous research into attitudes towards animal welfare has focused on Europe and the United States, with comparatively little focus on Australia, which is an important location due to the prominent position of agriculture economically and culturally. In this article, we present results from qualitative research on how Australian meat consumers conceptualise sheep and beef cattle welfare. The study was conducted in two capital cities (Melbourne, Victoria and Adelaide, South Australia) and (...) a much smaller rural centre (Toowoomba, Queensland) using focus groups (involving 40.9% of participants) and mall-intercept interviews (59.1% of participants), totalling 66 participants. Qualitative analysis highlights that participants had clear ideas of what it means for an animal to live a ‘good life’ and experience a ‘good death,’ with their beliefs strongly tied to their expectations and cultural understandings of what Australian agriculture ‘should be.’ In response to open-ended questions, participants expressed attitudes that relied on romanticised visions of the ‘rural idyll’ as seen in frequent discussions about what is ‘normal’ for sheep meat and beef production, and relatedly, what count as ‘natural behaviours.’ Many participants rejected anything associated with the ‘other,’ classifying it as not ‘normal’: we argue that which is not considered normal, including intensive production, foreign ownership, and halal slaughter practices, appear to place participants’ conceptualizations of an animal’s ‘good death,’ and in turn the potential for a ‘good life,’ at risk. (shrink)

ABSTRACT Drawing inspiration from Fred Dretske, L. S. Carrier, John A. Barker, and Robert Nozick, we develop a tracking analysis of knowing according to which a true belief constitutes knowledge if and only if it is based on reasons that are sensitive to the fact that makes it true, that is, reasons that wouldn’t obtain if the belief weren’t true. We show that our sensitivity analysis handles numerous Gettier-type cases and lottery problems, blocks pathways leading to skepticism, and validates the (...) epistemic closure thesis that correct inferences from known premises yield knowledge of the conclusions. We discuss the plausible views of Ted Warfield and Branden Fitelson regarding cases of knowledge acquired via inference from false premises, and we show how our sensitivity analysis can account for such cases. We present arguments designed to discredit putative counterexamples to sensitivity analyses recently proffered by Tristan Haze, John Williams and Neil Sinhababu, which involve true statements made by untrustworthy informants and strange clocks that sometimes display the correct time while running backwards. Finally, we show that in virtue of employing the paradox-free subjunctive conditionals codified by Relevance Logic theorists instead of the paradox-laden subjunctive conditionals codified by Robert Stalnaker and David Lewis. (shrink)

In a recent very interesting and important challenge to tracking theories of knowledge, Williams & Sinhababu claim to have devised a counter-example to tracking theories of knowledge of a sort that escapes the defense of those theories by Adams & Clarke. In this paper we will explain why this is not true. Tracking theories are not undermined by the example of the backward clock, as interesting as the case is.

The prelims comprise: Why Is Reproductive Choice Important? Is There a Right to Reproduce? Is There a Duty to Reproduce? Are There Duties Not to Reproduce? Responsibilities in Reproductive Decisions Are There Rights to Rear Children? Conclusions References.

I’m sick of being treated like a dumb Mum who doesn’t understand the science. As far as I’m concerned, my family’s health is just too important. … If the government can’t protect the safety of my family, then I will.Recent Greenpeace activism in Australia resulted in the destruction of a field trial of a line of wheat “designed” to improve human nutrition. This incident demonstrates that, while there is significant ongoing public and private investment in genetically modified crop research and (...) development in Australia, many people continue to oppose GM foods strongly. We noted with interest that Greenpeace described this activism with language that explicitly connected the actions to the gender.. (shrink)

In recent years, there has been a distinct shift in the relationship between science and society. We have moved away from the classic unidirectional “deficit” model (Simis et al. 2016) focused on t...

The American Journal of Bioethics, Volume 11, Issue 10, Page 22-24, October 2011.