Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities.

Medical decision making when a patient cannot participate is complicated by the question of whose voice should be heard. The most common answer to this question is that “autonomy” is paramount, and therefore it is the voice of the unwell person that should be given priority. Advance care planning processes and practices seek to capture this sentiment and to allow treatment preferences to be documented and decision makers to be nominated. Despite good intentions, advance care planning is often deficient because (...) it is unable to facilitate a relational approach to decision making in cases when the patient’s competence is reduced. In this article we present findings from a study of the ways in which older people and their significant others understand decision making in such circumstances. Critical to the participants’ understanding was the emergent concept of “relational knowing,” a concept that is poorly articulated in the advance care planning literature. Our findings suggest that the dominant understanding of decision making in conditions of impaired competence is incomplete and obscures much of what matters to people. We conclude that, having recognized a broader set of ethical concerns, it is necessary to develop a relational and narrative based approach that applies in appropriate settings. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Future of Environmental PhilosophyVictoria Davion (bio)I agree with Baird Callicott that we still see many suggestions that we can deal with problems such as global climate change individually and voluntarily, and that this is hopelessly naïve. Obviously, many people aren't even in a position to think about these issues, as daily survival is a problem. Hence, proclamations such as those in the most recent version of the Earth Charter (...) (www.earthcharter.org), stating ideas such that we are all responsible for the future of our planet, and that we all belong to one human family are hopeless and useless. However, this leaves open the question of how to deal with serious issues such as global climate change. Baird is right we need to deal with issues of scale.This brings me to some of the things that Bryan Norton and Bill Throop have mentioned. Bryan suggests that the fact that environmental ethicists have been too focused on metaphysical foundations of environmental values and have not focused enough on concrete empirical issues. I agree with Bryan here. However, Baird's concern with how we are going to understand issues of scale necessary to deal with problems such as global climate change seems to bring us back to the need for a focus on metaphysical foundations of environmental values. Hence, I am having trouble with Bill's idea that we can somehow split the labor between those who are involved with more concrete issues and those involved with issues of metaphysical foundational value. And, I am worried about what these more applied environmental ethicists will bring to the table, if they aren't well grounded in philosophical traditions.I agree with Bill that this places a great burden on students of environmental [End Page 149] philosophy, but I am not sure how to get around this burden. This brings me to Clare Palmer's comments. It is still true that many mainstream programs believe that environmental philosophy is simply second-string. It is important that undergraduates have a course available, but that's about it. She is right to point out that in the days of Leiter, we need to have plenty of up-to-date information available for those who might be interested in environmental philosophy. However, I believe they will certainly need a strong grounding in the history of philosophy in order to be at all successful in academic philosophy, or particularly useful in collaboration on interdisciplinary projects. This will also require field training as several of our contributors point out. Again, I realize this places an increased burden on students, but I see no way around it.Victoria Davion Victoria Davion is head of the Department of Philosophy at the University of Georgia. She is founding and current editor of Ethics & the Environment. Her research areas include feminist philosophy, environmental ethics, ethics, and political philosophy. E-mail: [email protected] © 2007 Indiana University Press... (shrink)

In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and the other pillars (...) of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework. (shrink)

Many individual sentient wild animals are vulnerable to anthropogenic climate change. In this article, I suggest that animal ethicists who take sentient animals’ moral status seriously are likely to agree that, other things being equal, we have moral responsibilities to assist wild animals made vulnerable to climate change. However, I also argue that these ethicists are likely to diverge in terms of the strategies they believe would actually fulfil such moral responsibilities, depending on whether their primary concern is rectificatory justice (...) or duties of beneficence. To support this argument, I consider three plausible strategies for helping wild animals vulnerable to climate change: rescue and rehabilitation, habitat restoration, and assisted migration. I argue that different theoretical approaches to animal ethics are likely to diverge on aspects of all these strategies. These differences mean that the process of creating wide agreement among animal ethicists on climate adaptation strategies to assist vulnerable wild animals faces significant hurdles. (shrink)

In his paper The Opposite of Human Enhancement: Nanotechnology and the Blind Chicken problem (Nanoethics 2:305–316, 2008) Paul Thompson argues that the possibility of disenhancing animals in order to improve animal welfare poses a philosophical conundrum. Although many people intuitively think such disenhancement would be morally impermissible, it’s difficult to find good arguments to support such intuitions. In this brief response to Thompson, I accept that there’s a conundrum here. But I argue that if we seriously consider whether creating beings (...) can harm or benefit them, and introduce the non-identity problem to discussions of animal disehancement, the conundrum is even deeper than Thompson suggests. (shrink)

Companion Animal Ethics explores the important ethical questions and problems that arise as a result of humans keeping animals as companions. The first comprehensive book dedicated to ethical and welfare concerns surrounding companion animals Scholarly but still written in an accessible and engaging style Considers the idea of animal companionship and why it should matter ethically Explores problems associated with animals sharing human lifestyles and homes, such as obesity, behavior issues, selective breeding, over-treatment, abandonment, euthanasia and environmental impacts Offers insights (...) into practical ways of improving ethical standards relating to animal companions. (shrink)

There is increased recognition of a common suite of global challenges that hamper food system sustainability at the community scale. Food price volatility, shortages of basic commodities, increased global rates of obesity and non-communicable food-related diseases, and land grabbing are among the impediments to socially just, economically robust, ecologically regenerative and politically inclusive food systems. While international political initiatives taken in response to these challenges and the groundswell of local alternatives emerging in response to challenges are well documented, more attention (...) is needed to the analysis of similarities between community approaches to global pressures. While we are not suggesting the application of a template set of good practices, the research reported in this paper point to the benefits of both sharing good practices and enabling communities to adopt good practices that are suited to their place-based capacities. The work also suggests that sharing community-derived good practices can support and reinforce global networks of sustainable community food systems, foster knowledge co-creation and ultimately cement collective action to global pressures. In turn these networks could enhance the sustainability and resilience of community food systems and facilitate wide scale food system transformation. (shrink)

This paper is divided into two parts. In Section 1, I explore and defend a “regulative view” of folk-psychology as against the “standard view”. On the regulative view, folk-psychology is conceptualized in fundamentally interpersonal terms as a “mind-making” practice through which we come to form and regulate our minds in accordance with a rich array of socially shared and socially maintained sense-making norms. It is not, as the standard view maintains, simply an epistemic capacity for coming to know about the (...) mental states and dispositions already there. Importantly, the regulative view can meet and beat the standard at its own epistemic game. But it also does more. In Section 2, I show how the regulative view makes progress on two other problems that remain puzzling on the standard view: the problem of “first-person authority” – accounting for the special features of self-knowledge; and the problem of “reactive.. (shrink)

The medicalisation of pregnancy and childbirth has been encouraged by the continuing growth of technology that can be applied to the reproductive journey. Technology now has the potential to fully separate reproduction from the human body with the prospect of ectogenesis—the gestation of a fetus outside of the human body. This paper considers the issues that have been caused by the general medicalisation of pregnancy and childbirth and the impact that ectogenesis may have on these existing issues. The medicalisation of (...) pregnancy and childbirth is criticised for its impact on the relationship between doctors and pregnant women and the way in which doctors treat fetuses. It is argued that ectogenesis may cause more imbalance in the doctor and intended parent relationship and may result in an increased lack of clarity regarding a doctor’s duty to the fetus. This paper finds that extensive guidance and revised legislation will be necessary to minimise the impact of ectogenesis on the existing issues caused by the medicalisation of reproduction. (shrink)

Wildlife Ethics A systematic account of the ethical issues related to wildlife management and conservation Wildlife Ethics is the first systematic, book-length discussion of the ethics of wildlife conservation and management, and examines the key ethical questions and controversies. Tackling both theory and practice, the text is divided into two parts. The first describes key concepts, ethical theories, and management models relating to wildlife; the second puts these concepts, theories, and models to work, illustrating their significance through detailed case studies (...) on controversies in wildlife management and conservation. The book explores pressing topics including human responsibilities due to climate change, tradeoffs when managing zoonotic disease risks, the ethics of the wildlife trade, culling non-native species, indigenous wildlife use, and zoo-based conservation programs. Readers are encouraged to explore different ways of valuing wild animals and their practical implications. This essential text: Explains and explores relationships between valuing biodiversity, human utility, ecosystems, species, and animal welfare Describes established approaches to wildlife management, such as sustainable use, and emerging concepts, such as compassionate conservation Discusses key ethical theories, including utilitarianism, ecocentrism, and animal rights Offers a practical model of how to analyze ethical issues in wildlife management and conservation Wildlife Ethics: The Ethics of Wildlife Management and Conservation is an accessible introduction to complex ethical issues, making the book an important resource for students in fields such as conservation biology, ecology, environmental science and policy, game management, public health and veterinary medicine. It will also be an invaluable tool for wildlife managers, conservationists, One Health practitioners, practicing veterinarians and animal rehabilitation staff, contemporary wildlife professionals and other stakeholders. (shrink)

We call systematic disputes that are particularly hard to resolve deep disagreements. We can divide most theories of deep disagreements in analytic epistemology into two camps: the Wittgensteinian view and the fundamental epistemic principles view. This essay analyzes how both views deal with two of the most pressing issues a theory of deep disagreement must address: their source and their resolution. After concluding that the paradigmatic theory of each camp struggles on both fronts, the essay proceeds to show that, despite (...) their differences, these theories share some core assumptions and think of deep disagreements similarly: as grounded in fundamental epistemic differences between the parties. This underlying conception of deep disagreements the author calls “the fundamental model.” The essay provides reasons to be wary of this conception, and hence, mainstream epistemologists’ treatment of the issue. (shrink)

Numerous societal issues, from climate change to pandemics, require public engagement with scientific research. Such engagement reveals challenges that can arise when experts communicate with laypeople. One of the most common frameworks for framing these communicative interactions is the deficit model of science communication, which holds that laypeople lack scientific knowledge and/or positive attitudes towards science, and that imparting knowledge will fill knowledge gaps, lead to desirable attitude/behavior changes, and increase trust in science. §1 introduces the deficit model in more (...) detail and shows that adhering to this model often fails to achieve its aims, which motivates the main question of this chapter: how can Ludwik Fleck’s theory of thinking collectives address the persistent problem of deficit approaches in science communication? I suggest that it can do so by exposing the deficit model’s implicit assumption of an expert-lay divide. Accordingly, §2 lays out Fleck’s theory and §3 contrasts it with contemporary debates about science communication. Following this descriptive work, §4 draws on Fleck’s ideas to make four concrete suggestions for further questioning the expert-lay divide. (shrink)

Previous research suggests that implicit sequence learning is superior for believers in the paranormal and individuals with increased cerebral dopamine. Thirty-five healthy participants performed feedback-guided anticipations of four arrow directions. A 100-trial random sequence preceded two 100-trial biased sequences in which visual targets on trial t tended to be displaced 90° clockwise or counter-clockwise from those on t − 1. ISL was defined as a positive change during the course of the biased run in the difference between pro-bias and counter-bias (...) responses. It was hypothesized that this difference would be greater for believers in the paranormal than for skeptics, for those who received dopamine than for those who received placebo, and for believers who received dopamine than for the other groups. None of the hypotheses were supported by the data. It is suggested that a simple binary guessing task with a focus on prediction accuracy during early trials should be considered for future explorations. (shrink)

Global citizenship education (GCE) is an active entanglement in the civic priorities of the planet. In recent research, the concept has emerged as a multivalent coalescence of being, an engagement with planetary tensions and revisions of cosmopolitan ideology. In this article, I argue for a theoretical interpretation of GCE reliant on liminal-oriented practice and the potentialities of regenerative agency. Privileging Axel Honneth’s interpretation of social freedom and Boaventura de Sousa Santos’ postabyssal thinking, I argue that interfaces with the limit of (...) our global perception reveal the regenerative qualities of our relations, allowing us to conceive ourselves as uniquely influenced by globality and possessing critical agency for otherness. Although such global perceptions can only ever be wrought within the ideological constraints of locality, a globally situated agency is more agile as a regenerative set of dispositions and interknowledge ‘globalities’. I further argue that regenerative liminalities hold significant implications for teaching and learning, as they signify the importance of a global consciousness over a technologically rationalized competency-based approach. (shrink)

In Building Better Beings, Vargas develops and defends a naturalistic account of responsibility, whereby responsible agents must possess a feasibly situated capacity to detect and respond to moral considerations. As a preliminary step, he also offers a substantive account of how we might justify our practices of holding responsible—viz., by appeal to their efficacy in fostering a ‘valuable form of agency’ across the community at large, a form of agency that precisely encompasses sensitivity to moral considerations. But how do these (...) accounts relate to one another? Though I find much that is appealing in Vargas’s general approach, I challenge his insistence that these accounts should be treated as ‘conceptually independent’, arguing that this generates an objectionable “justification gap”: on his analysis, someone could remain an appropriate target of our responsibility practices and yet fail to be a morally responsible agent. In closing, I offer a potential solution to this problem, though it means re-visioning how the account of moral responsibility is conceptually tied to the justification of our responsibility practices. (shrink)

The commentaries in response to our feature paper1 are indicative of the varied perspectives that can be taken towards artificial amnion and placenta technology (AAPT) and more specifically its relationship with pregnancy (loss). Kennedy rightly argues that empirical research is essential for understanding the experiences of pregnancy loss and AAPT2 and our own advocacy of empirical research is evident in previous work.3–5 Kennedy also acknowledges the current impossibility of researching AAPT experiences since it has not yet been applied in clinical (...) settings. It is precisely for this reason that we draw on the reported experiences of neonatal intensive care (NICU) parents since they present the closest analogy which can be drawn with the technology.1 What we reject in Kennedy’s response, however, is the claim that the experiences of NICU parents have been ‘exploited’ by us.2 Studies documenting the experiences of NICU parents were drawn on to indicate that our considerations are more than mere speculation. As stated, the experiences of NICU parents, particularly the pregnant individual who experiences pregnancy loss, are the closest indication we have of how AAPT and what it entails may be experienced. To claim that this data is being exploited by us is to undermine the very purpose that such research is undertaken—to indicate how future care may be improved. It would be much more harmful to not use this information. While we believe that experiences of …. (shrink)

Community-based healthcare organisations manage competing, and often conflicting, priorities. These conflicts can arise from the multiple roles these organisations take up, and from the diverse range of stakeholders to whom they must be responsive. Often such conflicts may be titled conflicts of interest; however, what precisely constitutes such conflicts and what should be done about them is not always clear. Clarity about the duties owed by organisations and the roles they assume can help identify and manage some of these conflicts. (...) Taking divisions of general practice in Australia as an example, this paper sets out to distinguish two main types of conflicts of interest, so that they may be more clearly identified and more effectively managed. (shrink)

In his 2014 article “Motivations for Relativism as a Solution to Disagreements”, Steven Hales argues that relativism is a plausible disagreement resolution strategy for epistemically irresolvable disagreements. I argue that his relativistic strategy is not adequate for disagreements of this kind, because it demands an impossible doxastic state for disputants to resolve the disagreement. Contrarily, Fogelin’s :1–8, 1985) theory of deep disagreement does not run into the same problems. Deep disagreements, according to Fogelin, cannot be resolved through argumentation because the (...) conditions for argumentation are lacking in such contexts. I advance the view that deep disagreements arise due to differences in disputants’ mutually supporting interrelated beliefs. This view avoids the hurdles caused by the tiered structure of support found at the heart of Hales’s view on disagreement: the assumption that belief and perspective can be separated, and that disagreement is located. (shrink)

This paper presents a new theory of modal reasoning, i.e. reasoning about what may or may not be the case, and what must or must not be the case. It postulates that individuals construct models of the premises in which they make explicit only what is true. A conclusion is possible if it holds in at least one model, whereas it is necessary if it holds in all the models. The theory makes three predictions, which are corroborated experimentally. First, conclusions (...) correspond to the true, but not the false, components of possibilities. Second, there is a key interaction: it is easier to infer that a situation is possible as opposed to impossible, whereas it is easier to infer that a situation is not necessary as opposed to necessary. Third, individuals make systematic errors of omission and of commission. We contrast the theory with theories based on formal rules. (shrink)

This paper examines the methodological claim made famous by P.F. Strawson: that we understand what features are required for responsible agency by exploring our attitudes and practices of holding responsible. What is the presumed metaphysical connection between holding responsible and being fit to be held responsible that makes this claim credible? I propose a non-standard answer to this question, arguing for a view of responsible agency that is neither anti-realist (i.e. purely 'conventionalist') nor straightforwardly realist. It is instead ‘constructivist’. On (...) the ‘Scaffolding View’ I defend, reactive attitudes play an essential role in developing, supporting, and thereby maintaining the capacities that make for responsible agency. While this view has relatively novel implications for a metaphysical understanding of capacities, its chief virtue, in contrast with more standard views, is providing a plausibly defensible account of how so-called responsible agents genuinely deserve to be treated as such. (shrink)

In “The Logic of Deep Disagreements,” Robert Fogelin claims that parties to a deep disagreement lack the common ground needed for arguments to work, making the disagreement impervious to rational resolution. Although Fogelin’s article received numerous responses, there has been no attempt to elucidate the epistemological theory behind Fogelin’s theses. In this article, I examine Fogelin’s theory of deep disagreements in light of his broader philosophy. The picture that emerges is that of relativism of distance, à la Bernard Williams. By (...) interpreting Fogelin’s theory as relativism of distance, it avoids some of the critiques that have been raised against it. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 39.2 (2003) 308-311 [Access article in PDF] Joseph Hamburger. John Stuart Mill on Liberty and Control. Princeton: Princeton University Press, 1999. Pp. xx + 239. Cloth, $35.00. C. L. Ten, editor. Mill's Moral, Political and Legal Philosophy. Aldershot: Dartmouth Publishing Company, 1999. Pp. xxiii + 498. Cloth, $180.00. John Stuart Mill's On Liberty is commonly viewed as the classic defense of individual liberty, (...) and Mill himself as the grandfather of modern liberalism. In John Stuart Mill on Liberty and Control Joseph Hamburger seeks to dislodge this orthodox interpretation [End Page 308] of Mill. As the title of the work suggests, Hamburger, who died shortly before this work came to press, seeks to convince the reader that a proper understanding of Mill's account of individual liberty needs to be nuanced by an appreciation of those substantial controls that Mill was willing to place upon individuals.Hamburger suggests that the association of Mill with modern liberalism results from viewing the arguments presented in On Liberty in isolation from the context in which they were written. Hamburger argues that Mill's real purpose in writing On Liberty is neither self-evident nor is it one that is easily assimilated to modern libertarian ideals. Hamburger interprets "Mill as making an esoteric argument in On Liberty" (xvii). There are two additional pieces that Hamburger claims one needs in order to properly decipher the puzzle, and thus grasp the true import of Mill's claims concerning liberty. First, Hamburger argues that Mill's desire to bring about cultural reform was dependent upon his rejection of Christianity. Mill's unpublished writings reveal that he was far more antagonistic to the influence of Christian religion than is often recognized. Hamburger argues that for Mill initiating true moral reform depended upon overcoming the old social order of which Christianity was a primary constituent. In order for this to occur, one needed "to establish liberty for those who would implement his plan for moral reformation" (86). Second, Hamburger argues that we must also grasp Mill's view of history if we are to properly understand his project of moral reform and the place of On Liberty within this project. Hamburger claims that Mill's vision of history was strongly influenced by thinkers such as Comte and St. Simon. From them, Mill adopted the view that societies alternate between transitional and natural states, and that the values that are applicable in these states are quite different. Hamburger claims that "Mill easily recognized his own age as being transitional," and that this influences all of his arguments in On Liberty (111).Putting the above together, Hamburger concludes that Mill's arguments are specifically directed toward securing the liberty of those who would combat the influence of Christianity and the old moral order, and that "the liberty recommended in On Liberty was especially valued because it would hasten the undermining of old doctrines and institutions which occurred in transitional periods" (212). Hamburger argues that the liberty that Mill meant to secure in this work was not intended to apply equally to all persons or in all periods. Thus, Hamburger argues that Mill was quite willing to advocate strong forms of social control in other contexts.The latter claim, which Hamburger argues provides a more coherent interpretation of On Liberty, does not necessarily follow from Mill's view of religion and history. Here, I think there is room for two distinct judgments regarding Hamburger's achievement in this book. Hamburger has undoubtedly provided a great service in examining the often neglected areas of Mill's corpus and their relevance to his more prominent works. Philosophers who view On Liberty as an isolated piece of argument, or at best only consider it in relation to Mill's Utilitarianism, thus would profit much from reading this work. I am less convinced, however, of Hamburger's claim that heeding these aspects of Mill's thought will lead one to form a radically different understanding of Mill's claims concerning... (shrink)

This book offers an introduction to the way art is perceived, interpreted, and felt and approaches these mindful events from a multidisciplinary perspective.

Philosophers and social scientists have focussed a great deal of attention on our human capacity to trust, but relatively little on the capacity to hope. This is a significant oversight, as hope and trust are importantly interconnected. This paper argues that, even though trust can and does feed our hopes, it is our empowering capacity to hope that significantly underwrites—and makes rational—our capacity to trust.

The class forcing theorem, which asserts that every class forcing notion ${\mathbb {P}}$ admits a forcing relation $\Vdash _{\mathbb {P}}$, that is, a relation satisfying the forcing relation recursion—it follows that statements true in the corresponding forcing extensions are forced and forced statements are true—is equivalent over Gödel–Bernays set theory $\text {GBC}$ to the principle of elementary transfinite recursion $\text {ETR}_{\text {Ord}}$ for class recursions of length $\text {Ord}$. It is also equivalent to the existence of truth predicates for the (...) infinitary languages $\mathcal {L}_{\text {Ord},\omega }$, allowing any class parameter A; to the existence of truth predicates for the language $\mathcal {L}_{\text {Ord},\text {Ord}}$ ; to the existence of $\text {Ord}$ -iterated truth predicates for first-order set theory $\mathcal {L}_{\omega,\omega }$ ; to the assertion that every separative class partial order ${\mathbb {P}}$ has a set-complete class Boolean completion; to a class-join separation principle; and to the principle of determinacy for clopen class games of rank at most $\text {Ord}+1$. Unlike set forcing, if every class forcing notion ${\mathbb {P}}$ has a forcing relation merely for atomic formulas, then every such ${\mathbb {P}}$ has a uniform forcing relation applicable simultaneously to all formulas. Our results situate the class forcing theorem in the rich hierarchy of theories between $\text {GBC}$ and Kelley–Morse set theory $\text {KM}$. (shrink)