When our nearest and dearest experience medical crises, we may need to step into caregiving roles. But in doing so, we may find that our new caregiving relationship is actually in tension with the loving relationship that motivated us towards care. What we owe and are entitled to as friends, spouses, and family members, can be different from what we owe and are entitled to as caregivers. For this reason, caregiving carries with it the risk of a type of moral (...) distress that I call “role conflict distress.” Rather than view role conflict distress as a sign that we are falling short, I suggest that it actually speaks to the commitment that we have to the loving relationship that grounds our duty of care. (shrink)

Recent work on diachronic agency has challenged the predominantly structural or synchronic approach to agency that is characteristic of much of the literature in contemporary philosophical moral psychology. However, the embodied dimensions of diachronic agency continue to be neglected in the literature. This article draws on phenomenological perspectives on embodiment and narrative conceptions of the self to argue that diachronic agency and selfhood are anchored in embodiment. In doing so, the article also responds to Diana Meyers' recent work on corporeal (...) selfhood. (shrink)

In his recent book Reflective Democracy, Robert Goodin argues that 'external-collaborative' models of democratic deliberation procedures need to be supplemented by 'internal-reflective' deliberation. The exercise of the moral imagination plays a central role in Goodin's account of 'democratic deliberation within'. By imaginatively putting ourselves in the place of a range of others, he argues, including those who maybe not be able to represent their own interests, we can make their points of view 'communicatively present' in deliberation. Goodin's argument emphasizes the (...) role of art and other forms of cultural representation in helping to bring about this expansion of moral imagination. Drawing on debates in philosophy of mind concerning the scope and limits of our capacities to simulate other minds, I argue that Goodin's analysis of 'democratic deliberation within' conflates different kinds of imaginative project. In doing so, it underestimates both the difficulties of imaginatively putting ourselves in the place of others and the political risks in doing so. I argue, alternatively, that moral engagement with others involves the capacity for sympathy and that art and other forms of cultural representation can enlarge the scope of our sympathies, by assisting us to overcome imaginative resistance to alien points of view. In developing this argument, I provide a qualified defense of Iris Young's claim that respect for others involves 'asymmetrical reciprocity'. (shrink)

Powered by ‘big health data’ and enormous gains in computing power, artificial intelligence and related technologies are already changing the healthcare landscape. Harnessing the potential of these technologies will necessitate partnerships between health institutions and commercial companies, particularly as it relates to sharing health data. The need for commercial companies to be trustworthy users of data has been argued to be critical to the success of this endeavour. I argue that this approach is mistaken. Our interactions with commercial companies need (...) not, and should not, be based on trust. Rather, they should be based on confidence. I begin by elucidating the differences between trust, reliability, and confidence, and argue that trust is not the appropriate attitude to adopt when it comes to sharing data with commercial companies. I argue that what we really should want is confidence in a system of data sharing. I then provide an outline of what a confidence-worthy system of data sharing with commercial companies might look like, and conclude with some remarks about the role of trust within this system. (shrink)

Sugar, pork, beer, corn, cider, scrapple, and hoppin' John all became staples in the diet of colonial America. The ways Americans cultivated and prepared food and the values they attributed to it played an important role in shaping the identity of the newborn nation. In A Revolution in Eating, James E. McWilliams presents a colorful and spirited tour of culinary attitudes, tastes, and techniques throughout colonial America. Confronted by strange new animals, plants, and landscapes, settlers in the colonies and West (...) Indies found new ways to produce food. Integrating their British and European tastes with the demands and bounty of the rugged American environment, early Americans developed a range of regional cuisines. From the kitchen tables of typical Puritan families to Iroquois longhouses in the backcountry and slave kitchens on southern plantations, McWilliams portrays the grand variety and inventiveness that characterized colonial cuisine. As colonial America grew, so did its palate, as interactions among European settlers, Native Americans, and African slaves created new dishes and attitudes about food. McWilliams considers how Indian corn, once thought by the colonists as "fit for swine," became a fixture in the colonial diet. He also examines the ways in which African slaves influenced West Indian and American southern cuisine. While a mania for all things British was a unifying feature of eighteenth-century cuisine, the colonies discovered a national beverage in domestically brewed beer, which came to symbolize solidarity and loyalty to the patriotic cause in the Revolutionary era. The beer and alcohol industry also instigated unprecedented trade among the colonies and further integrated colonial habits and tastes. Victory in the American Revolution initiated a "culinary declaration of independence," prompting the antimonarchical habits of simplicity, frugality, and frontier ruggedness to define American cuisine. McWilliams demonstrates that this was a shift not so much in new ingredients or cooking methods, as in the way Americans imbued food and cuisine with values that continue to shape American attitudes to this day. (shrink)

The significance of big data for driving health research and improvements in patient care is well recognised. Along with these potential benefits, however, come significant challenges, including those concerning the sharing and linkage of health and social care records. Recently, there has been a shift in attention towards a paradigm of data sharing centred on the ‘trusted research environment’ (TRE). TREs are being widely adopted by the UK’s health data initiatives including Health Data Research UK (HDR UK),1 Our Future Health2 (...) and Genomics England.3 A recent review commissioned by the UK’s Department of Health and Social Care (hereafter referred to as the ‘Goldacre Review’) places TREs at the heart of its recommendations around the future of National Health Service (NHS) health data sharing for research, describing them as the ‘clear path forward’ to a health data system in which trust is ‘earned’ through ‘provable, credible steps to protect patient privacy, and by being transparent with everyone about everything that is done with their deepest medical secrets’.4 We argue that rather than building public trust, the TRE model actually reduces the need for trust in the use and sharing of patient health data. This is because trust is importantly connected to vulnerability and uncertainty; an essential part of trusting someone is accepting that one’s trust could be disappointed or betrayed. In attempting to provide assurances or guarantees of data privacy and security, TREs strive to remove this vulnerability, and so remove the need for trust. We do not see this as a problem and are broadly supportive of this kind of data sharing model because of the increased security and oversight it provides. However, having argued that TREs are not actually concerned with trust, we consider the importance of being precise about the words that we use …. (shrink)

Patients in the vegetative state are wholly unaware of themselves, or their surroundings. However, a minority of patients diagnosed as vegetative are actually aware. What is the well-being of these patients? How are their lives going, for them? It has been argued that on a reasonable conception of well-being, these patients are faring so poorly that it may be in their best interests not to continue existing. I argue against this claim. Standard conceptions of well-being do not clearly support the (...) conclusion that these patients would be better off having life-sustaining treatment withdrawn, and in fact, it may be possible for these patients to retain a passable level of well-being. I suggest that further research into the subjective experiences of these patients will allow us to better promote their well-being. (shrink)

Unresponsive wakefulness syndrome is a disorder of consciousness wherein a patient is awake, but completely non-responsive at the bedside. However, research has shown that a minority of these patients remain aware, and can demonstrate their awareness via functional neuroimaging; these patients are referred to as having ‘cognitive motor dissociation’. Unfortunately, we have little insight into the subjective experiences of these patients, making it difficult to determine how best to promote their well-being. In this paper, I argue that the capacity to (...) experience pain or pleasure is a key component of well-being for these patients. While patients with unresponsive wakefulness syndrome are believed to be incapable of experiencing pain or pleasure, I argue that there is evidence to support the notion that CMD patients likely can experience pain and pleasure. I analyze current neuroscientific research into the mechanisms of pain experience in patients with disorders of consciousness, and provide an explanation for why CMD patients likely can experience physical pain. I then do the same for physical pleasure. I conclude that providing these patients with pleasurable experiences, and avoiding subjecting them to pain, are viable means of promoting their well-being. (shrink)

Social problems such as racism, sexism, and inequality are often cited as structural rather than individual in nature. What does it mean to invoke a social structural explanation, and how do such explanations relate to individualistic ones? This article explores recent philosophical debates concerning the nature and usages of social structural explanation. I distinguish between two central kinds of social structural explanation: those that are autonomous from psychology, and those that are not. This distinction will help clarify the explanatory power (...) that each type of SSE has, points of convergence with methodological traditions such as critical theory and rational choice theory, and the difficulties that each type of SSE faces. (shrink)

To what extent should we focus on implicit bias in order to eradicate persistent social injustice? Structural prioritizers argue that we should focus less on individual minds than on unjust social structures, while equal prioritizers think that both are equally important. This article introduces the framework of transactive memory into the debate to defend the equal priority view. The transactive memory framework helps us see how structure can emerge from individual interactions as an irreducibly social product. If this is right, (...) then debiasing interventions are structural interventions. One upshot is that the utility of the individual versus structural distinction is not apparent for the purposes of intervention. (shrink)

As of this writing, twenty‐one states have passed laws barring transgender youth‐athletes from competing on public‐school sports teams in accordance with their gender identity. Proponents of these regulations claim that transgender females in particular have inherent physiological advantages that threaten a “level playing field” for their cisgender competitors. Existing evidence is limited but does not support these restrictions. Gathering more robust data will require allowing transgender youth to compete (rather than preemptively barring them), but even if trans females are shown (...) to retain some advantage, this would not have greater moral significance than the many other “fair” physical and economic advantages found across sports. These regulations deprive transgender youth, an exceptionally vulnerable population, from the vast physical, mental, and social benefits of sports. While we advocate for transgender inclusion under our current, gender‐segregated model of sport, we propose changes to the overarching structure that would promote a more inclusive and fairer athletic environment. (shrink)

Patients with disorders of consciousness after severe brain injury need surrogate decision makers to guide treatment decisions on their behalf. Formal guidelines for surrogate decisionmaking generally instruct decision makers to first appeal to a patient’s written advance directive, followed by making a substituted judgment of what the patient would have chosen, and lastly, to make decisions according to what seems to be in the patient’s best medical interests. Substituted judgment is preferable because it is taken to preserve patient autonomy, by (...) using a patient’s past wishes and values to reconstruct what they would have chosen for themselves. In this paper, the author argues that for a certain population of patients, the standard interpretation of substituted judgment cannot ensure the preservation of patient autonomy. Patients with “covert awareness” may continue to have values and an authentic sense of self, which may differ from their past values and wishes. Accordingly, surrogate decision makers should make decisions based on how the patient is likely to experience their condition in the present, rather than their past wishes and values. (shrink)

When experienced in-person, engagement with art has been associated—in a growing body of evidence—with positive outcomes in wellbeing and mental health. This represents an exciting new field for psychology, curation, and health interventions, suggesting a widely-accessible, cost-effective, and non-pharmaceutical means of regulating factors such as mood or anxiety. However, can similar impacts be found with online presentations? If so, this would open up positive outcomes to an even-wider population—a trend accelerating due to the current COVID-19 pandemic. Despite its promise, this (...) question, and the underlying mechanisms of art interventions and impacts, has largely not been explored. Participants were asked to engage with one of two online exhibitions from Google Arts and Culture. With just 1–2 min exposure, both improved negative mood, state-anxiety, loneliness, and wellbeing. Stepdown analysis suggested the changes can be explained primarily via negative mood, while improvements in mood correlated with aesthetic appraisals and cognitive-emotional experience of the exhibition. However, no difference was found between exhibitions. We discuss the findings in terms of applications and targets for future research. (shrink)

Neuroimaging research regularly yields “incidental findings”: observations of potential clinical significance in healthy volunteers or patients, but which are unrelated to the purpose or variables of the study.

Philosophers are inclined to raise philosophical dust by asking such questions as, what relations must exist between two body occurrences for them to be body occurrences of the same body? or what relation among person-stages makes them stages of the same person? and then complain that they cannot see the answers. I want to argue that the reason they cannot see the answers is that these questions and others like them are misconceived.

It is commonly accepted that what we ought to do collectively does not imply anything about what each of us ought to do individually. According to this line of reasoning, if cooperating will make no difference to an outcome, then you are not morally required to do it. And if cooperating will be personally costly to you as well, this is an even stronger reason to not do it. However, this reasoning results in a self-defeating, yet entirely predictable outcome. If (...) everyone is rational, no one will cooperate, resulting in an aggregate outcome that is devastating for everyone. This dismal analysis explains why climate change and other collective action problems are so difficult to ameliorate. The goal of this paper is to provide a different, exploratory framework for thinking about individual reasons for action in collective action problems. I argue that the concept of commitment gives us a new perspective on collective action problems. Once we take the structure of commitment into account, this activates requirements of diachronic rationality that give individuals instrumental reasons to cooperate in collective action problems. (shrink)

The article explores the place of affect in community relations with respect to trauma following the closure of a steelworks for a working-class community in the South Wales valleys in 2002. A review of sociological approaches to community demonstrates the poor handling of relational and affective aspects which, it is argued, are central to the way in which community relations were formed and provided a safe and containing skin against the uncertainty of industrial production. Using psychoanalytic approaches to affect which (...) stress the importance of skin, particularly the work of Bick, Tustin, Winnicott and Anzieu, the article explores how a sense of a containing skin provides a feeling of ontological security for a community beset by uncertainty and insecurity. It is argued that, following the closure of the steelworks in 2002, this skin is ruptured and that it is difficult for the members of the community to find a way forward. Using examples taken from psychosocial interviews with community members, the case is made for a range of affective relations and practices through which the skin is created. The absence of these practices and relations creates a profound sense of lack of safety and fear of death within the inhabitants, which needs to be addressed, but is rarely discussed in approaches to community or regeneration. (shrink)

The ethical debate about neurotechnologies—including both drugs and implanted devices—has been largely framed around the questions of whether and when these technologies could damage or promote authenticity. Patients can experience changes in mood, behavior, emotion, or preferences—seemingly, changes in character or personality. Some describe such changes by saying they feel like different people; that they have become either more or less themselves; or that they feel as though some of their moods, behaviors, emotions or preferences are not their own. These (...) kinds of statements are used to describe both changes that a drug or device is... (shrink)

The aim of this article is to give an account of a methodological link between drama and political theory. This account is drawn primarily from the early philosophical work of Deleuze. Following Deleuze, we will refer to it as ‘the method of dramatization’. We will argue that dramatization is a method aimed at determining the quality of political concepts by ‘bringing them to life’, in the way that dramatic performances bring to life the characters and themes of a play-script. We (...) demonstrate that this can be specified in relation to the development of this method in Deleuze's early philosophical work as a practical, critical and artistic method and, in relation to the ontological assumptions he articulated and defended in Difference and Repetition, as a process of intensification of the Idea of the political. By way of example, we discuss how the dramatization of the concept of ideology functions in Deleuze and Guattari's Anti-Oedipus and A Thousand Plateaus. We conclude with some lines of inquiry that could be pursued by political theorists looking to investigate further the dramatic nature of method in political theory. (shrink)

Just war thinking serves a social and psychological role that international law cannot fill. Law is dispassionate and objective, while just war thinking accounts for emotions and the situatedness of individuals. While law works on us externally, making us accountable to certain people and institutions, just war thinking affects us internally, making us accountable to ourselves. Psychologically, an external focus leads to feelings of shame, while an inward focus generates feelings of guilt. Philosophers have long recognized the importance of these (...) two moral emotions. Recently, psychologists have found that feelings of guilt are linked to positive social outcomes, such as the desire for reconciliation and reparation, while shame generates anger and hostility. Just war thinking, as an inward-looking tradition, has a special relationship with guilt. By focusing on moral emotions, just war thinking can move beyond the law in four ways, by developing an ethic of accountability, by providing a foundation for addressing moral injury, by providing a common language for discussing the costs of war, and for identifying ethical problems in radically new contexts. (shrink)

Patients with severe disorders of consciousness are thought to be unaware of themselves or their environment. However, research suggests that a minority of patients diagnosed as having a disorder of consciousness remain aware. These patients, designated as having “cognitive motor dissociation”, can demonstrate awareness by imagining specific tasks, which generates brain activity detectable via functional neuroimaging. The discovery of consciousness in these patients raises difficult questions about their well-being, and it has been argued that it would be better for these (...) patients if they were allowed to die. Conversely, I argue that CMD patients may have a much higher level of well-being than is generally acknowledged. It is far from clear that their lives are not worth living, because there are still significant gaps in our understanding of how these patients experience the world. I attempt to fill these gaps, by analyzing the neuroscientific research that has taken place with these patients to date. Having generated as comprehensive a picture as possible of the capacities of CMD patients, I examine this picture through the lens of traditional philosophical theories of well-being. I conclude that the presumption that CMD patients do not have lives worth living is not adequately supported. (shrink)

Based upon the Decision Field Theory (Busemeyer and Townsend 1993), we tested a model of dynamic reasoning to predict the effect of time pressure on analytical and experiential processing during decision-making. Forty-six participants were required to make investment decisions under four levels of time pressure. In each decision, participants were presented with experiential cues which were either congruent or incongruent with the analytical information. The congruent/incongruent conditions allowed us to examine how many decisions were based upon the experiential versus the (...) analytical information, and to see if this was affected by the varying degrees of time pressure. As expected, the overall accuracy was reduced with greater time pressure and accuracy was higher when the experiential and analytical cues were congruent than when they were incongruent. Of great interest was the data showing that under high time pressure participants used more experiential cues than at other time pressures. We suggest that the dynamic reasoning paradigm has some future potential for predicting the effects of experiential biases in general, and specifically under time pressure. (shrink)

Prognosis after severe brain injury is highly uncertain, and decisions to withhold or withdraw life‐sustaining treatment are often made prematurely. These decisions are often driven by a desire to avoid a situation where the patient becomes ‘trapped’ in a condition they would find unacceptable. However, this means that a proportion of patients who would have gone on to make a good recovery, are allowed to die. I propose a shift in practice towards the routine provision of aggressive care, even in (...) cases where the probability of survival and acceptable recovery is thought to be low. In conjunction with this shift, I argue in favour of a presumption towards withdrawing life‐sustaining treatment, including artificial nutrition and hydration, when it becomes clear that a patient will not recover to a level that would be acceptable to them. I then respond to three potential objections to this proposal. (shrink)

(2014). Tin Men: Ethics, Cybernetics and the Importance of Soul. Journal of Military Ethics: Vol. 13, No. 1, pp. 3-19. doi: 10.1080/15027570.2014.908011.

How should you live? Should you devote yourself to perfecting a single talent or try to live a balanced life? Should you lighten up and have more fun, or buckle down and try to achieve greatness? Should you try to be a better friend? Should you be self-critical or self-accepting? And how should you decide among the possibilities open to you? Should you consult experts, listen to your parents, or should you do lots of research? Should you make lists of (...) pros and cons, or go with your gut? These are not questions that can be answered in general or in the abstract. Rather, these questions are addressed to the first person point of view, to the perspective each of us occupies when we reflect on how to live without knowing exactly what we're aiming for. To answer them, this book focuses on the process of living one's life from the inside, rather than on defining goals from the outside. Drawing on traditional philosophical sources as well as literature and recent work in social psychology, this book argues that to live well, we need to develop reflective wisdom: to care about things that will sustain us and give us good experiences, to have perspective on our successes and failures, and to be moderately self-aware and cautiously optimistic about human nature. Further, we need to know when to think about our values, character, and choices, and when not to. A crucial part of wisdom, the book maintains, is being able to shift perspectives: to be self-critical; to be realistic; to examine life when reflection is appropriate, but not when we should lose ourselves in experience. (shrink)