Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

Disrespect in health care often persists despite firm commitments to respectful service provision. This conceptual paper highlights how the ways in which respect and disrespect are characterised can have practical implications for how well disrespect can be tackled. We stress the need to focus explicitly on disrespect (not only respect) and propose that disrespect can usefully be understood as a failure to relate to people as equals. This characterisation is consonant with some accounts of respect but sometimes obscured by a (...) focus on respecting people’s autonomy and dignity. Emphasising equality is consistent with connections patients draw between being (dis)respected and (in)equality. It readily accommodates microaggressions as forms of disrespect, helping to understand how and why experiences of disrespect may be unintentional and to explain why even small instances of disrespect are wrong. Our view of disrespect with an emphasis on equality strengthens the demand that health systems take disrespect seriously as a problem of social injustice and tackle it at institutional, not just individual levels. It suggests several strategies for practical action. Emphasising relational equality is not an easy or short-term fix for disrespect, but it signals a direction of travel towards an important improvement ambition. (shrink)

This paper is an attempt to examine issues and problemsraised by agricultural biotechnology by drawing on the richnessof contemporary ideas in ethical theory and thereby contribute tothe project of establishing new approaches to these problems. Thefundamental argument is that many of the negative aspects ofagricultural biotechnology are generated at the level of theunderlying conceptual frameworks that shape the technology''sinternal modes of organization, rather than the unintendedeffects of the application of an inherently benevolent set oftechniques. If ``food ethics'''' is to address (...) the adverse impacts ofagricultural biotechnology, it must ultimately challenge theseconceptual frames, which, I argue, emerge from Enlightenment,liberal, political, and economic theory.The translation of traditional bioethics (focusing on principlessuch as autonomy and rights, justice, and well being) into foodethics does not produce the critical tools that are ableadequately to challenge the harmful legacy of Enlightenmentthinking. What is needed are reorientations of ethics that arecapable of formulating concepts and approaches that to someextent break with the presuppositions that underpin biotechnologyat its foundation. This paper suggests that narrative andfeminist critiques of medical bioethics are a good place to startin this project. (shrink)

There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and (...) somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes ; limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice. (shrink)

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

It is the study of how Thomas Paine's religious beliefs shaped his political ideology and influenced his political activism.

Reading feminist theory as a complex imaginative achievement, Feminist Imagination considers feminist commitment through the interrogation of its philosophical, political and affective connections with the past, and especially with the `race' trials of the twentieth century. The book looks at: the 'directionlessness' of contemporary feminist thought; the question of essentialism and embodiment; the racial tensions in the work of Simone de Beauvoir; the totalitarian character in Hannah Arendt; the 'mimetic Jew' and the concept of mimesis in the work of Judith (...) Butler. Vikki Bell provides a compelling rethinking of feminist theory as bound up with attempts to understand oppression outside a focus on 'women'. She affirms feminism as a site and mode of making these connections. What emerges is a profound work brimming with insight that will be required reading for anyone who is seriously interested in feminist theory and, more generally, contemporary social theory. (shrink)

Recruitment processes for clinical trials are governed by guidelines and regulatory systems intended to ensure participation is informed and voluntary. Although the guidelines and systems provide some protection to potential participants, current recruitment processes often result in limited understanding and experiences of inadequate decision support. Many trials also have high drop-out rates among participants, which are ethically troubling because they can be indicative of poor experiences and they limit the usefulness of the knowledge the trials were designed to generate. Drawing (...) on recent social-psychological and philosophical-ethical research on trial recruitment and patient participation in treatment decision-making, this paper identifies possibilities for improving communicative support for both initial decisions and ongoing participation in clinical trials. It highlights the potential of a shift in thinking about ‘voluntariness’, underpinned by relational understandings of autonomy, to encourage more nuanced judgements about the ethics of communication between trial staff and (potential) participants. The paper suggests that the idea of responsively enabling people to consider invitations or requests to participate in particular trials could serve as a general guide to communication. This might help ensure decisions about trial participation are meaningfully informed and voluntary, and that relationships between trial staff and participants contribute to positive experiences of trial participation and ultimately to the generation of the robust knowledge. (shrink)

Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis on the (...) family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making. (shrink)

In this paper, we argue that there are important ethical questions about healthcare improvement which are underexplored. We start by drawing on two existing literatures: first, the prevailing, primarily governance-oriented, application of ethics to healthcare ‘quality improvement’ (QI), and second, the application of QI to healthcare ethics. We show that these are insufficient for ethical analysis of healthcare improvement. In pursuit of a broader agenda for an ethics of healthcare improvement, we note that QI and ethics can, in some respects, (...) be treated as closely related concerns and not simply as externally related agendas. To support our argument, we explore the gap between ‘quality’ and ‘ethics’ discourses and ask about the possible differences between ‘good quality healthcare’ and ‘good healthcare’. We suggest that the word ‘quality’ both adds to and subtracts from the idea of ‘good healthcare’, and in particular that the technicist inflection of quality discourses needs to be set in the context of broader conceptualisations of healthcare improvement. We introduce the distinction between quality as a measurable property and quality as an evaluative judgement, suggesting that a core, but neglected, question for an ethics of healthcare improvement is striking the balance between these two conceptions of quality. (shrink)

Thomas E. Hill, Jr.; Servility and Self-Respect, The Monist, Volume 57, Issue 1, 1 January 1973, Pages 87–104, https://doi.org/10.5840/monist197357135.

We address the ethics of scenarios in which one party entraps, intentionally tempts or intentionally tests the virtue of another. We classify, in a new manner, three distinct types of acts that are of concern, namely acts of entrapment, of intentional temptation and of virtue testing. Our classification is, for each kind of scenario, of itself neutral concerning the question whether the agent acts permissibly. We explain why acts of entrapment are more ethically objectionable than like acts of intentional temptation (...) and why these, in turn, are more ethically objectionable than like acts of virtue testing. Along the way, we scrutinize, and eventually reject, the view that acts of entrapment are ethically unacceptable because intentional temptation is involved in entrapment. (shrink)

Objectives: To explore how subjects in a placebo-controlled vitamin A supplementation trial among Ghanaian women aged 15–45 years perceive the trial and whether they know that not all trial capsules are the same, and to identify factors associated with this knowledge.Methods: 60 semistructured interviews and 12 focus groups were conducted to explore subjects’ perceptions of the trial. Steps were taken to address areas of low comprehension, including retraining fieldworkers. 1971 trial subjects were randomly selected for a survey measuring their knowledge (...) that not all trial capsules are the same. The subjects’ fieldworkers were also interviewed about their characteristics and trial knowledge. Factors associated with knowledge were explored using multi-level modeling.Results: Although subjects knew they were taking part in research, most thought they were receiving an active and beneficial medication. Variables associated with knowledge were education and district of residence. Radio broadcasts benefited those with some schooling. Fieldworkers’ characteristics were not associated with subjects’ knowledge.Conclusions: Research and debate on new or improved consent procedures are urgently required, particularly for subjects with little education. (shrink)

Bell argues that the dialogue that emanate from the aesthetic realm cannot be understood through a solely art-historical approach; instead, they must be understood as part of a collective endeavour. In this sense, the 'art' of post-dictatorship is not something that belongs to art or the artists themselves, but is about how the subjectivities and imaginations of new generations engage with questions of response, ethics and justice; and, in so doing, re-align themselves in relation to the past and to the (...) future. This book provides a valuable resource for those interested in the law, politics, art and sociology of contemporary Argentina. It will be of immense use to those studying in these areas and to those concerned more widely with transitional justice and memory politics. (shrink)

In this interview, Judith Butler speaks about her most recent work, especially Excitable Speech, in terms of how it represents a continuation of certain themes and how it represents moves into new terrains of debate. In particular, she addresses both possible critiques of her work, expecially around the issue of the possibility of political visions and the attention to speech when theorizing subjectification, and responds to questions around certain related themes such as: just what is the possibility of using the (...) same analytical framework to talk both about racializing and gendering processes? How useful is the concept of melancholia? How are textuality and visuality interconnected? (shrink)

In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call ’normative complexity’. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as something that requires theoretical and practical attention alongside the more recognised challenges of complex systems, which we label, for short, as ’explanatory complexity’. In brief, normative complexity relates to (...) the inherent difficulty of deciding what kinds of changes are ’improvements’ or, more broadly, what is valuable in healthcare. We suggest that explanatory and normative complexity intersect and that anyone interested in healthcare improvement needs to be sensitive to both. After briefly introducing the idea of normative complexity, we consider some contrasting examples of conversations, reflecting on how they do and might contribute to healthcare quality. We discuss both conversations that are deliberately organised and facilitated (’orchestrated conversations’) and more informally occurring and routine conversations. In the first half of the paper, we draw on some examples of orchestrated and routine conversations to open up these issues. In the second half of the paper, we bring some more theoretical lenses to bear on both conversations and normative complexity, summarise what we take to be the value of conversations and draw together some of the implications of our discussion. In summary, we argue that conversations can play a crucial role in negotiating the normative complexity of healthcare quality improvement because of their capacity to hold together a plurality of perspectives, to contribute and respond to emergence and to help underpin institutional conditions for empathy and imagination. (shrink)

This introduction argues for the importance of Suárez’s philosophy for historians of medieval philosophy as well as historians of early modern philosophy. It also provides synopses of each of the essays in the volume and a brief biography of Suárez, placing his life and works into some historical context.

This short piece introduces the Special Issue, giving both a general sense of the terms `belonging' and `performativity', and discussing key related concepts that unite the articles of the issue: difference and their differences; the politics of visuality; embodiment; and the idea of routes. The predominant themes as they appear in the different articles are discussed under these headings.

Modes of engagement. The reader may engage with this article in several different modes. It could be approached in straightforward, if quirky, sociological mode as an exploration of the idea that the literature on post‐divorce arrangements and step‐families, and especially literature, that attends to children's contact with their non‐resident fathers, can be re‐read in order to consider the issue of contact via communication technologies, a form of parent‐child contact not captured in the ways that ‘contact’ is measured in present studies. (...) Of interest in itself, perhaps, this point of entrance opens up onto further questions about the management of human affect, and how rearrangements in lines of affect have reverberations beyond those captured by an Oedipal model, insofar as they are not about contact and severance but are various kinds of displacement for all involved. In particular, I am concerned here with the rearrangement of affect for the fathers as their role becomes dispersed, shared and intermittent, a set of problematics that also includes the various ways in which the very body of the mother is removed or circumvented. On a second level the article speaks to a different literature, in that it is an elaboration of the notion of the network as a dispersed hybrid that entails both human and non‐human entities, within which any absolute distinction between human and non‐human is to be prob‐lematised but, I wish to argue, without losing the specificity of human interaction, that is, the questions of human emotion, human desire and human ethics. This elaboration moves toward a critique of the very ubiquity and endless utility of the network idea through the suggestion that its appeal may conceal moments and movements where more unexpected effects are taking place. Indeed, I suggest that there may be some twists in the familial dynamics of ‘households that no longer hold’, where some selected thoughts from a reading of Deleuze and Guattari, specifically around the notion of ‘becoming’, may lead one to read other stories than that proffered through the master trope of the network, ones that are maybe closer to some of the original impulses behind actor‐network theory. And thirdly, the article may be engaged as a reflection on contemporary ways in which familial life is governed in contemporary Britain. The family as both a site of economic arrangements and a site of the arrangement of human affect‐sexuality‐reproduction, are held together and in tension through forms of contemporary government of the family. Contemporary rationalities of familial morality seek to make its members responsible parents without intervening to the extent that they would seek to make them responsible spouses, seen here in the implication that fathers' economic responsibilities for children are not co‐extensive with their emotional connections to women.1 As opposed to any other familial figure ‐ such as the pater familias or the mother of Donzelot's thesis ‐who may have been the link between family and government, it is through the promotion of the figure of the child that familial life is presently and predominantly governed. It is my contention here that it is through the promise of non‐government that a notion of an ethical parent is promoted, whose duties to his children and his nation‐state should mean that the former should not need to be dependent upon the latter. Alongside other policies that seek to simultaneously promote familial life and paid work‐life through the notion of the ethical citizen, and the attendant judgements of those dependent on welfare state provision, contemporary policies surrounding the household that no longer holds expose the various and contradictory modes by which families are ‘made up’ within contemporary regimes. (shrink)

I defend the relatively orthodox view that reasons for action are premises in good practical reasoning, against recent counterexamples that suggest that, like “government house” moral justifications, some reasons are to be ignored in deliberation. I also explain, positively, what is right about the orthodoxy. Unless reasons are premises in good practical reasoning, reasons cannot be normative in the way they are usually taken to be, and relatedly, are unfit to play certain familiar theoretical and related everyday roles that give (...) many appeals to reasons their distinctive point. (shrink)

Consider normative properties and facts, such as facts consisting in something's being what you ought to do, or the property of being morally wrong. Normative naturalism is the view that normative properties and facts such as these exist, and that they are natural properties and facts. Some suspect, however, that normativity is incompatible with a wholly naturalistic worldview: that the normative couldn't be natural because it's somehow “just too different” from the natural. I critically examine recent forms of this “just (...) too different” objection to normative naturalism, with a view to making the debate accessible to a general philosophical audience. (shrink)

Many healthcare practices expose people to risks of harmful outcomes. However, the major theories of moral philosophy struggle to assess whether, when and why it is ethically justifiable to expose individuals to risks, as opposed to actually harming them. Sven Ove Hansson has proposed an approach to the ethical assessment of risk imposition that encourages attention to factors including questions of justice in the distribution of advantage and risk, people’s acceptance or otherwise of risks, and the scope individuals have to (...) influence the practices that generate risk. This paper investigates the ethical justifiability of preventive healthcare practices that expose people to risks including overdiagnosis. We applied Hansson’s framework to three such practices: an ‘ideal’ breast screening service, a commercial personal genome testing service, and a guideline that lowers the diagnostic threshold for hypertension. The framework was challenging to apply, not least because healthcare has unclear boundaries and involves highly complex practices. Nonetheless, the framework encouraged attention to issues that would be widely recognised as morally pertinent. Our assessment supports the view that at least some preventive healthcare practices that impose risks including that of overdiagnosis are not ethically justifiable. Further work is however needed to develop and/or test refined assessment criteria and guidance for applying them. (shrink)

Background: Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative into paediatric practice (...) using the discourse and methodology of healthcare quality improvement. -/- Discussion: Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. -/- Conclusions: We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods. (shrink)

In growing recognition that the business community must play a key role in the global issues encapsulated by the United Nations Sustainable Development Goals, Babson College, which has a business-focused curriculum, has striven first to reinvent its teaching of ethics and then, particularly over the past decade, to enhance its focus on sustainability, social responsibility, and social entrepreneurship. As previous initiatives did not build sufficient linkages between the liberal arts, natural sciences, and business curriculum, the College is now engaged in (...) a far more comprehensive effort to educate our undergraduate business students in “integrated sustainability,” which it defines as “systems thinking that integrates ecological integrity, social responsibility, and value creation simultaneously.” By examining the meaning, skills, and pedagogical opportunities in systems thinking within the context of larger discussions on humanistic management, this article shows how systems thinking is a particularly fruitful way to ground business students in the natural sciences and the liberal arts, develop their complex problem-solving skills, and thereby reinvigorate management education in ways that prepares students to “render service to humanity.” Our hope is that sharing Babson College’s experience in this regard – both our successes and challenges - may provide useful insights to other faculty and academic leaders seeking to enhance humanistic management within their own higher education institutions. (shrink)

With the progress of science we become more and more aware of the undiscovered, and of our feebleness to visualize or express what is dimly known to us. Geologists estimate that man evolved some 1,000,000 years ago on an earth which astronomers say is some 2,000,000,000 years old. Caution is required in accepting such figures, for we must remember how far out Lord Kelvin was in estimating the age of the earth—before the discovery of radium. Man has been civilized for (...) some 5,000 years, and Galileo, with his telescope and revolutionary ideas, lived some 300 years ago. There may be, we are told, a million million years before the sun grows weak and the earth becomes farther from the sun so that all life freezes. Long before this man may use up the metals available for his machines, and those ready sources of energy now so wastefully used, by which he at present multiplies and swarms in cities. In such case he will return through birth control or famine, or both, to a simple, uncrowded, pastoral existence. There is little likelihood of his being able to use atomic energy, other than that which reaches the earth as sun radiation and is available directly or as energy stored in water-power, wood, coal, and oil. (shrink)

This article concerns the striking photograph of a young man, Fernando Brodsky, taken shortly after he was kidnapped in Argentina in 1979. Brodsky was detained in the notorious Escuela de la Armada in Buenos Aires, and remains disappeared. The negative of the photograph was smuggled out of ESMA and the image became part of a bundle of photographic evidence submitted by families of the disappeared during the trials of the military after the return to democracy in 1983. This article seeks (...) to understand the vitality of the photograph, the different courses it takes, the archives it joins and leaves, asking: ‘What sort of life can the photograph have? What sort of desire? What sort of politics?’ The article proposes that we might consider the role of such images ‘biopolitically’, which is to say in the context of the relations established through the attempts to govern populations in times of military rule and in times of transitional democracy. The re-appearance of Fernando in the photograph is part of post-dictatorship politics in which the demand ‘ aparición’ resounds. Fernando, an absolute witness who does not, who cannot, speak nevertheless re-appears in the law courts and in art exhibitions. The article considers the difference between the photograph’s appearance as evidence and its reappearance in the art galleries, arguing that its ‘desires’ can be imagined differently in each. The article argues that while the photograph does not escape archives tout court, in raising the question of how it should be filed, it prompts reflection on the biopolitical present, with its inequitable distribution of life and security among populations. This is a politics of the present, more than it is a politics of memory. (shrink)

Constitutivists attempt to ground reasons for action in the constitutive features of agency. Central to Enoch's famous “shmagency” objection to constitutivism is the idea that constitutivists should worry about the question whether there is reason to be an agent rather than a “shmagent”-where a shmagent is a non-agent being who lacks the constitutive features of agency, but is otherwise as similar to agents as can be. I explain why constitutivism isn’t in trouble even if there’s no reason to be an (...) agent. The nature of agency can in principle ground authoritative reasons for agents to act, even if there isn’t, in addition, a reason to be an agent. Relatedly, I explain why a prominent strand in previous responses to Enoch is misleading in focusing on whether the request for reasons to be an agent, as posed by the shmagent, is even possible or intelligible. Even if the shmagent’s request for reasons is possible and intelligible-as I argue it is-this doesn’t matter for constitutivists, for the request is misguided: constitutivists need no reasons to be an agent. (shrink)