Self‐trust is essential to the well‐being of people with chronic illnesses and those who care for them. In this exploratory essay, we draw on a trove of health narratives to catalyze examination of this important but often overlooked topic. We explore how self‐trust is impeded at both personal and structural levels, how it can best be nourished, and how it is related to self‐advocacy. Because people's ability to trust themselves is intrinsically linked to the trust others have in them, we (...) pay particular attention to the role that allies such as clinical professionals play in the development of self‐trust, highlighting the importance of eliciting patient narratives, of curious listening, and of compassionately raising questions. We also contrast the self‐trust paradigm with that of self‐management, which tends to replace the former's attention to patients’ experiences, abilities, qualities, or judgments with a professionally dominated discourse dedicated to addressing illness through behavior changes prescribed by clinicians. We close with a call to action, exhorting readers to focus on supporting self‐trust in health care settings and on creative research in this critical yet heretofore underrepresented domain. (shrink)

The authors explore whether the need for ethical reflection on the part of designing engineers is dependent on the type of design process. They use Vincenti's distinction between normal and radical design and different levels of design hierarchy. These two dimensions are coupled with the concept of ill-structured problems, which are problems in which possible solutions cannot be ordered on a scale from better to worse. Design problems are better structured at lower hierarchical levels and in cases of normal design. (...) Better structured design problems require less ethical reflection on the part of designing engineers if such situations are characterized by the existence of generally accepted normative frameworks. Engineers could then deal with moral problems within the bounds of such frameworks and without the need for further reflection. On the basis of a number of empirical cases, the authors explore whether these ideas hold water. They discuss four cases ranging from a high-level radical design process to a low-level normal design process. (shrink)

Different methods have been developed to address ethical issues during research. Most of these methods were developed at universities. In this article ethical parallel research within a Research and Technology Organization is described. Within a European project about perceived security, CPSI, the ethical issues were identified by ethicists cooperating in the project. The project CPSI was aimed at developing a research method that can be used by (local) government to monitor or assess perceived and actual security. Together with the researchers (...) a way was sought to address the ethical issues. Several issues could be addressed by choices with regard to the design of the validation study, in this case a survey. The ethical and legal reasons that were relevant for choices in the design of the validation study were made an integral part of these decisions. Some issues were already identified during the writing of the proposal others were only identified during the research. Participating in the research gave the ethicists access to all relevant information. It made it possible to address the ethical issues when they became relevant. Ethical reasons were part of some of the discussions on research method. It proved possible to address most ethical issues satisfactorily during the research project. (shrink)

Entry of new organizations, including multinational enterprises from emerging markets, raises the ethical question of will they benefit society. The concept of legitimacy answers this question because it is the overall assessment of the appropriateness of organizational ends and means. Moreover, gaining legitimacy enables EMNEs to succeed in new host countries. Past work examined collective level indicators of the legitimacy of MNEs, but recent research recognizes the importance of individuals’ perceptions as the micro-foundation of legitimacy. This study first uses new (...) pragmatism, deontology, and utilitarianism to demonstrate that legitimacy is fundamentally an ethical concept—a perspective that has been overlooked in management research. Second, this study uses a seven-step procedure to develop and validate a measure of individuals’ perceptions of the legitimacy of Chinese EMNEs operating in The Netherlands, a developed country. Six dimensions of legitimacy were identified. The study also finds support for this legitimacy judgment process linking the dimensions: validating knowledge → propriety judgments → generalized judgment. This work provides additional micro-foundations to research on legitimacy and contributes to the ongoing process of construct validation. Future research could use the validated measure in other settings and use specific ethical theories in depth to refine the concept of legitimacy. (shrink)

This paper starts from the presupposition that moral codes often do not suffice to make agents understand their moral responsibility. We will illustrate this statement with a concrete example of engineers who design a truck’s trailer and who do not think traffic safety is part of their responsibility. This opinion clashes with a common supposition that designers in fact should do all that is in their power to ensure safety in traffic. In our opinion this shows the need for a (...) moral philosophy that helps engineers to interpret their responsibility and think more critically about it. For this purpose we will explore the moral philosophy of Alasdair MacIntyre, which is particularly interesting because he locates the beginning of moral thinking in the daily practice of a profession. This is consistent with the history of moral codes, for codes are also the product of moral reflection by professionals. We will use MacIntyre’s philosophy to (1) explain what is wrong with the designers’ understanding of their responsibility and (2) show a possible way to bring their reflection to a more self-critical level. We will also inspect MacIntyre’s proposal critically. (shrink)

In projects concerning big data, ethical questions need to be answered during the design process. In this paper the Value Sensitive Design method is applied in the context of data-driven health services aimed at disease prevention. It shows how Value Sensitive Design, with the use of a moral dialogue and an ethical matrix, can support the identification and operationalization of moral values that are at stake in the design of such services. It also shows that using this method can support (...) meeting the requirements of the General Data Protection Regulation. (shrink)

Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities in (...) New South Wales, Australia to elicit the views of well-informed community members on the acceptability and legitimacy of: making pathogen WGS and linked administrative data available for public health researchusing this information in concert with data linkage and machine learning to enhance communicable disease surveillance systems Fifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts. Results Almost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective systems. Conclusions Participants across all four events strongly supported the introduction of data linkage and pathogenomics to public health research under current research governance structures. Combining pathogen WGS with event-based data surveillance systems, however, is likely to be controversial because of a lack of public trust, even when the potential public health benefits are clear. Any suggestion of private sector involvement or commercialisation of WGS or surveillance data was unanimously rejected. (shrink)

How do we understand the agency and significance of material forces and their interface with human bodies? What does it mean to be human in these times, with bodies that are inextricably interconnected with our physical world? Bodily Natures considers these questions by grappling with powerful and pervasive material forces and their increasingly harmful effects on the human body. Drawing on feminist theory, environmental studies, and the sciences, Stacy Alaimo focuses on trans-corporeality, or movement across bodies and nature, which (...) has profoundly altered our sense of self. By looking at a broad range of creative and philosophical writings, Alaimo illuminates how science, politics, and culture collide, while considering the closeness of the human body to the environment. (shrink)

By insisting on the importance of materiality, this volume breaks new ground in philosophy, feminist theory, cultural studies, science studies, and other fields where the body and nature collide.

Journal of Global Ethics, Volume 9, Issue 3, Page 293-310, December 2013.

In Undomesticated Ground, Stacy Alaimo issues a bold call to reclaim nature as feminist space.

I argue that judgments of what is ‘true in a fiction’ presuppose the Reality Assumption: the assumption that everything that is true is fictionally the case, unless excluded by the work. By contrast with the more familiar Reality Principle, the Reality Assumption is not a rule for inferring implied content from what is explicit. Instead, it provides an array of real-world truths that can be used in such inferences. I claim that the Reality Assumption is essential to our ability to (...) understand stories, drawing on a range of empirical evidence that demonstrates our reliance on it in narrative comprehension. However, the Reality Assumption has several unintuitive consequences, not least that what is fictionally the case includes countless facts that neither authors nor readers could ever consider. I argue that such consequences provide no reason to reject the Reality Assumption. I conclude that we should take fictions, like non-fictions, to be about the real world. (shrink)

Human rights instruments exist to respond to serious dangers that human beings routinely face, what Henry Shue terms ‘standard threats.’ According to Shue’s influential account of the structure of a moral right, these threats are ‘the targets of the social guarantees for the enjoyment of … a right.’ They are ‘common, or ordinary, and serious but remediable.’ Yet for individuals who struggle daily against serious, remediable threats that are common to their peer group, but do not routinely threaten mainstream society, (...) this oversight has enormous implications for their security, subsistence, freedom, and dignity. This paper examines the three elements of Shue’s standard threat. It concludes by making the case that if we are to deploy this element of the structure of moral rights to justify social guarantees of protection, and to craft them in a way that takes proper account of human diversity, then we must ask: Standard for whom? (shrink)

This article focuses on how solidarity is negotiated in interactions during medical visits between nurse practitioners and patients. Drawing on data from ethnographic field notes, audio-recorded interactions and interviews involving one NP and 20 patients, the article outlines ways in which the NP creates a sense of solidarity by lessening the social distance between herself and her patients. These attempts at solidarity do not correlate with what has been noted in previous studies of medical visits involving medical doctors and may (...) represent a difference in how both the NP and the patients view the NP as a mid-level provider. As NPs are taking on a more prominent role in the healthcare landscape, it is important to understand what the interactional norms are and how these may deviate from the norm set by MDs. (shrink)

Standard theories define fiction in terms of an invited response of imagining or make-believe. I argue that these theories are not only subject to numerous counterexamples, they also fail to explain why classification matters to our understanding and evaluation of works of fiction as well as non-fiction. I propose instead that we construe fiction and non-fiction as genres: categories whose membership is determined by a cluster of nonessential criteria, and which play a role in the appreciation of particular works. I (...) claim that this proposal captures the intuitions motivating alternative theories of fiction. (shrink)

Overdiagnosis is an emerging problem in health policy and practice: we address its definition and ethical implications. We argue that the definition of overdiagnosis should be expressed at the level of populations. Consider a condition prevalent in a population, customarily labelled with diagnosis A. We propose that overdiagnosis is occurring in respect of that condition in that population when the condition is being identified and labelled with diagnosis A in that population ; this identification and labelling would be accepted as (...) correct in a relevant professional community; but the resulting label and/or intervention carries an unfavourable balance between benefits and harms. We identify challenges in determining and weighting relevant harms, then propose three central ethical considerations in overdiagnosis: the extent of harm done, whether harm is avoidable and whether the primary goal of the actor/s concerned is to benefit themselves or the patient, citizen or society. This distinguishes predatory, misdirected and tragic overdiagnosis; the degree of harm moderates the justifiability of each type. We end with four normative challenges: methods for adjudicating between professional standards and identifying relevant harms and benefits should be procedurally just; individuals, organisations and states are differently responsible for addressing overdiagnosis; overdiagnosis is a matter for distributive justice: the burdens of both overdiagnosis and its prevention could fall on the least-well-off; and communicating about overdiagnosis risks harming those unaware that they may have been overdiagnosed. These challenges will need to be addressed as the field develops. (shrink)

Individuals with idiopathic environmental illness with attribution to electromagnetic fields (IEI-EMF) claim they experience adverse symptoms when exposed to electromagnetic fields (EMFs) from mobile telecommunication devices. However, research has consistently reported no relationship between exposure to EMFs and symptoms in IEI-EMF individuals. The current study investigated whether presence of symptoms in IEI-EMF individuals were associated with a nocebo effect. Data from two previous double-blind provocation studies were re-analyzed based on participants’ judgments as to whether or not they believed a telecommunication (...) base station was “on” or “off.” Experiment 1 examined data in which participants were exposed to EMFs from Global System for Mobile Communication, Universal Mobile Telecommunications System, and sham base station signals. In Experiment 2, participants were exposed to EMFs from Terrestrial Trunked Radio Telecommunications System and sham base station signals. Our measures of subjective well-being indicated IEI-EMF participants consistently reported significantly lower levels of well-being, when they believed the base station was “on” compared to “off.” Interestingly, control participants also reported experiencing more symptoms and greater symptom severity when they too believed the base station was “on” compared to “off.” Thus, a nocebo effect provides a reasonable explanation for the presence of symptoms in IEI-EMF and control participants. (shrink)

When two people move in synchrony, they become more social. Yet it is not clear how this effect scales up to larger numbers of people. Does a group need to move in unison to affiliate, in what we term unitary synchrony; or does affiliation arise from distributed coordination, patterns of coupled movements between individual members of a group? We developed choreographic tasks that manipulated movement synchrony without explicitly instructing groups to move in unison. Wrist accelerometers measured group movement dynamics and (...) we applied cross-recurrence analysis to distinguish the temporal features of emergent unitary synchrony and distributed coordination. Participants’ unitary synchrony did not predict pro-social behavior, but their distributed coordination predicted how much they liked each other, how they felt toward their group, and how much they conformed to each other's opinions. The choreography of affiliation arises from distributed coordination of group movement dynamics. (shrink)

In their forthcoming article, ‘What makes a medical intervention invasive?’ De Marco, Simons, and colleagues explore the meaning and usage of the term ‘invasive’ in medical contexts. They describe a ‘Standard Account’, drawn from dictionary definitions, which defines invasiveness as ‘incision of the skin or insertion of an object into the body’. They then highlight cases wherein invasiveness is employed in a manner that is inconsistent with this account (eg, in describing psychotherapy) to argue that the term invasiveness is often (...) used to explicitly or implicitly reference interventions that do not fall under the standard account. The authors offer an alternative ‘schematic’ definition of invasiveness, whereby medical interventions entail an underlying context-independent property of ‘basic invasiveness’ and may be understood both relative to each other and to a context-specific threshold of what is ‘invasive’.1 We propose that the meaning of terms such as ‘invasiveness’ is necessarily heterogeneous, and that what is implied by its usage will certainly depend on context, particularly in medical settings. Hence, the creation of a unifying definition is less critical than clarification of the implied and intended meanings of each instance of the term’s use. We further argue that interpreting the use of terms like ‘invasiveness’ in medical practice is complicated by the embedding of each use of this term in a different ‘language game’, whereby words and their meanings are understood by an in-group familiar with …. (shrink)

If there are no fictional characters, how do we explain thought and discourse apparently about them? If there are, what are they like? A growing number of philosophers claim that fictional characters are abstract objects akin to novels or plots. They argue that postulating characters provides the most straightforward explanation of our literary practices as well as a uniform account of discourse and thought about fiction. Anti-realists counter that postulation is neither necessary nor straightforward, and that the invocation of pretense (...) provides a better account of the same phenomena. I outline and assess these competing theories. (shrink)

The empirical turn in bioethics and the deliberative turn in democracy theory occurred at around the same time, one at the intersection of bioethics and social science,1 2 the other at the intersection of political philosophy and political science.3–5 Empirical bioethics and deliberative democratic approaches both engage with immediate problems in policy and practice with normative intent, so it was perhaps inevitable that they would eventually find one another,6–8 and that deliberative research would become more common in bioethics.9 This commentary (...) responds to a paper by Ford et al, who ran a single jury of 18 people in Brighton in the UK in June 2018.10 The jury were asked to consider whether secondary research use of non-structured, free-text data from medical records should be permitted. I will consider three issues: the effort required in deliberative work, the challenge of sampling and selection of jurors and the basis for drawing normative conclusions from deliberative research. First: this report makes clear the effort involved in running a jury. These researchers contracted an external agency experienced in the method, established an oversight committee of policy-makers with power to act, developed expert witness briefs, selected witnesses and coordinated their testimony, and created a questionnaire to measure participants’ views, activities to support their understanding, and a scenario for consideration. …. (shrink)

Statements about fictional characters, such as “Gregor Samsa has been changed into a beetle,” pose the problem of how we can say something true (or false) using empty names. I propose an original solution to this problem that construes such utterances as reports of the “prescriptions to imagine” generated by works of fiction. In particular, I argue that we should construe these utterances as specifying, not what we are supposed to imagine—the propositional object of the imagining—but how we are supposed (...) to imagine. Most other theories of thought and discourse about fictional characters either fail to capture the intentionality of our imaginings, or else obscure the differences between imaginings directed toward fictional characters and those directed toward real individuals. I argue that once we have an account of prescriptions to imagine about real individuals, we can adapt the same framework to specify the contents of prescriptions to imagine about fictional characters, and thereby to account for the truth (or falsity) of statements about fictional characters. (shrink)

Deliberative democracy harbors a recurrent tension between full inclusion and intelligible speech. People with profound cognitive disabilities often signify this tension. While liberal deliberative theorists sacrifice inclusion for intelligibility, this exclusion is unnecessary. Instead, by analyzing deliberative locations that already include people with disabilities, I offer two ways to revise deliberative norms. First, the physical presence of disabled bodies expands the value of publicity in deliberative democracy, demonstrating that the publicity of bodies provokes new conversations similar to rational speech acts. (...) Second, the inclusion of people with profound disabilities necessitates a form of collaborative speech in which individuals make claims collaboratively. Habermas offers an ideal site to pursue this analysis because he recognizes the theoretical tension between inclusion and intelligibility and because his personal testimony reveals important insight into the lived experience of disability. (shrink)

The purpose of the current study was to examine the reliability and validity of the RESTQ-Sport-36 for use in the collegiate student-athlete population. A total of 494 collegiate student-athletes competing in National Collegiate Athletic Association Division I, II, or III sanctioned sport completed the RESTQ-Sport-36 and Brief Profile of Mood States. Structural equation modeling procedures were used to compare first order to hierarchical model structures. Results of a confirmatory factor analysis and exploratory structural equation modeling analysis indicated that the first (...) order 12-factor structure demonstrated the best fit of all models tested. Support was not observed for the fit of any hierarchical model. Moderate to strong correlations were observed between stress and recovery subscales and mood states, thus supporting the construct validity of the abbreviated RESTQ measurement model. The current findings provide support for the measure’s use in this population and give pause as it relates to the scoring and interpretation of hierarchical factors such as Total Stress and Total Recovery. Overall, the current results indicate that the RESTQ-Sport-36 may be a useful tool for collegiate student-athlete training load and competition monitoring. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:277 HUME'S IMPRESSIONS OF BELIEF Introduction Hume's theory of belief is often taken to be fully stated in his opening remarks on the subject in A Treatise of Human Nature, Book I, Part III, Section VII: "An opinion, therefore, or belief may be most accurately defin'd, A LIVELY IDEA RELATED TO OR ASSOCIATED WITH A PRESENT IMPRESSION."1 Taking this definition as Hume's final account leaves the reader with many (...) problems. What is it for an idea to be lively? How is an idea related to or associated with an impression? Is belief really so simple a phenomenon? I argue that Hume's theory of belief is much more complex than this, and that the Treatise contains only a rough, preliminary account of belief. By the time he wrote An Enquiry Concerning the Human Understanding, Hume had developed his theory in full detail. As I show, in this latter account a belief is an intentional state involving a combination of Humean ideas and impressions. The nature of these ideas and impressions allows the mind to take note of a belief as something quite different from its other perceptions. In the Treatise, however, Hume did not have a clear understanding of how the mind could distinguish beliefs from other perceptions. He could only go so far as to say that an idea believed is livelier than other ideas. He argued that a present impression is capable of calling to mind an idea of something that has been associated with that impression in the past, and of transferring some of its own vivacity to that idea. As we look at the account of belief in the Treatise, we will see how the preliminary concepts of force and liveliness and a transference of vivacity lay the foundation for his 278 final account, yet point to a need for a fuller explication of the difference the mind notes between beliefs and other perceptions. We will see that in the Appendix to the Treatise Hume tried to work out this difference in terms of 'feeling' but this was unsuccessful without the notion of an intentional act. Finally, we will see that Hume concluded in the Enquiry that a belief is an intentional state in which a new impression of reflection arises about the idea believed. This new impression is the feeling of belief by which beliefs are distinguished from other 2 perceptions of the mind. The Account in the Treatise We begin our explication of Hume's theory of belief by looking at the account in A Treatise of Human Nature. Here Hume maintains that it is ideas which are believed, and that these beliefs differ from other ideas only in their "force and vivacity" (T 96). This force and vivacity is a result of the believed idea's relation to an impression. These theses lead us to the familiar Treatise definition of belief as "A LIVELY IDEA RELATED TO OR ASSOCIATED WITH A PRESENT IMPRESSION" (T 96). Hume begins his analysis of belief in Section VII of the Treatise by stating that "the idea of an object is an essential part of the belief of it, but not the whole" (T 94). The suggestion is that there is more to being in a state of belief than merely entertaining the idea believed. The simple phrase "belief o_f_ an object" leads us to presume that it is ideas that are believed, or that we have beliefs o_f ideas. We will need to examine Hume's meaning of 'idea' in enough depth to understand the role it plays in the theory of belief. 279 Hume gives some examples of the way we may conceive ideas without believing them: Suppose a person present with me, who advances propositions, to which I do not assent, that Caesar dy'd in his bed, that silver is more fusible than lead, or mercury heavier than gold; 'tis evident, that notwithstanding my incredulity, I clearly understand his meaning, and form all the same ideas, which he forms (T 95). Note that Hume says one may form all the same ideas as another. Yet the ideas one forms are just what Hume had earlier called the propositions one... (shrink)

Where do you begin the important conversation about professionalizing early childhood education (ECE) as a field of practice? This book is the tool you need to advance the conversation and shape the future of ECE. Professionalizing Early Childhood Education As a Field of Practice provides an overview of the topic, a participant guide, a conversation workbook, and a facilitator guide to move the conversation forward. Each section supports deep thought and creative discussions to make the overall conversation meaningful and productive (...) for the entire profession. Don't just sit back and listen; be a part of this important conversation.Stacie Goffin is a widely recognized authority in early childhood education with a passion for raising the competence of ECE as a field of practice. She received a degree in child development from the University of Massachusetts Amherst, followed by her master's in early childhood from George Washington University and her executive education certification from Harvard. Stacie currently serves as Principal of the Goffin Strategies Group, where she uses her experience consulting with educational programs to improve effectiveness and services for young children. (shrink)

Book synopsis: New work on a hot topic by an outstanding team of authors At the intersection of several central areas of philosophy It is the linguistic job of singular terms to pick out the objects that we think or talk about. But what about singular terms that seem to fail to designate anything, because the objects they refer to don't exist? We can employ these terms in meaningful thought and talk, which suggests that they are succeeding in fulfilling their (...) representational task. A team of leading experts presents new essays on the much-debated problem of empty reference and thought. In the 1960s and 1970s Keith Donnellan, David Kaplan, Saul Kripke and Hilary Putnam initiated a revolution in the then standard conception of reference—a concept at the core of philosophical inquiry. The repercussions of the revolution, particularly felt in metaphysics and epistemology, were soon refined by other influential writers such as Tyler Burge, Gareth Evans, and John Perry. They argued that some linguistic and mental representations have contents individuated by what they are about—by ordinary referents of expressions such as proper names, indexicals, definite descriptions and common nouns, i.e. by planets, people or natural kinds. The view was at odds with a central philosophical presumption at that time: that cognitive and linguistic access to objective reality is indirect and accidental, mediated by general descriptive characterizations, the only constitutive semantic feature of the expressions; hence its ontological and epistemological repercussions. A turning-point in the debate about how linguistic and mental representation reach external contents concerned the nature of empty mental and linguistic representations, framed by means of the very same expressions crucially invoked in the Donnellan-Kaplan-Kripke-Putnam arguments. The papers in this volume address different aspects of reference and thought about the non-existent. (shrink)

A lack of transparency and concerns over patients costs at the pharmacy counter have increased Congressional focus on pharmacy benefits management practices. However, applying regulations without transparency into pharmacy benefits managers practices could do more harm than good.