Caesarean delivery is a common and life-saving intervention. However, it involves an overall increased risk for short-term and long-term complications for both mother and child compared with vaginal delivery. From a medical point of view, healthcare professionals should, therefore, not recommend caesarean sections without any anticipated medical benefit. Consequently, caesarean sections requested by women for maternal reasons can cause conflict between professional recommendations and maternal autonomy. How can we assure ethically justified decisions in the case of caesarean sections on maternal (...) request in healthcare systems that also respect patients’ autonomy and aspire for shared decisions? In the maternal–professional relationship, which can be characterised in terms of reciprocal obligations and rights, women may not be entitled to demand a C-section. Nevertheless, women have a right to respect for their deliberative capacity in the decision-making process. How should we deal with a situation of non-agreement between a woman and healthcare professional when the woman requests a caesarean section in the absence of obvious medical indications? In this paper, we illustrate how the maternal–professional relationship is embedded in a nexus of power, trust and risk that reinforces a structural inferiority for women. To accommodate for beneficial use of power, these decision processes need to be trustworthy. We propose a framework, inspired by Lukes’ three-dimensional notion of power, which serves to facilitate trust and allows for beneficial power in shared processes of decision-making about the delivery mode for women requesting planned C-sections. (shrink)

En tolkning af “Sein und Zeit” (herefter SuZ) kræver en afklaring af værensspørgsmålets rolle i værket, thi holdningen hertil bestemmer vurderingen af de mange enkeltanalyser, der indgår deri. Essayets tese er, at værensspørgsmålet er bærende i hele SuZ – hvilket ikke er så indlysende, som det måske synes. En række tolkninger har søgt at vise, at værensspørgsmålet er et pseudo-spørgsmål, der bør glemmes, men at de enkelte analyser i SuZ i sig selv er interessante . Andre tolkninger går ud fra, (...) at værensspørgsmålet selv aldrig bliver stillet i SuZ, men at der kun foretages en analyse af Dasein . Derfor bliver det et mål at vise, at de to hovedopgaver i SuZ, Daseinsanalysen og destruktionen af ontologiens historie, ikke er to hinanden uafhængige momenter, der hver især skal forberede grunden ud fra hvilken værensspørgsmålet skal stilles, men derimod er selve udfoldelsen af værensspørgsmålet. (shrink)

Journal of the History of Biology provides a fifty-year long record for examining the evolution of the history of biology as a scholarly discipline. In this paper, we present a new dataset and preliminary quantitative analysis of the thematic content of JHB from the perspectives of geography, organisms, and thematic fields. The geographic diversity of authors whose work appears in JHB has increased steadily since 1968, but the geographic coverage of the content of JHB articles remains strongly lopsided toward the (...) United States, United Kingdom, and western Europe and has diversified much less dramatically over time. The taxonomic diversity of organisms discussed in JHB increased steadily between 1968 and the late 1990s but declined in later years, mirroring broader patterns of diversification previously reported in the biomedical research literature. Finally, we used a combination of topic modeling and nonlinear dimensionality reduction techniques to develop a model of multi-article fields within JHB. We found evidence for directional changes in the representation of fields on multiple scales. The diversity of JHB with regard to the representation of thematic fields has increased overall, with most of that diversification occurring in recent years. Drawing on the dataset generated in the course of this analysis, as well as web services in the emerging digital history and philosophy of science ecosystem, we have developed an interactive web platform for exploring the content of JHB, and we provide a brief overview of the platform in this article. As a whole, the data and analyses presented here provide a starting-place for further critical reflection on the evolution of the history of biology over the past half-century. (shrink)

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

This article presents a new criticisms of reductive approaches to knowledge-‘wh’ (i.e., those approaches on which whether one stands in the knowledge-‘wh’ relation to a question is determined by whether one stands in the knowledge-‘that’ relation to some answer(s) to the question). It argues in particular that the truth of a knowledge-‘wh’ attribution like ‘Janna knows where she can buy an Italian newspaper’ depends not only on what Janna knows about the availability of Italian newspapers, but on what she believes (...) about the matter. This dependence of Janna's knowledge-‘wh’ on her (possibly false) beliefs is incompatible with the reductive approach. (shrink)

On Ramchandra Dattatraya Ranade, 1886-1957, educationist and Indic philosopher.

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt to capture a comprehensive (...) overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and (...) made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Translational ethics (TE) has been developed into a specific approach, which revolves around the argument that strategies for bridging the theory‐practice gap in bioethics must themselves be justified on ethical terms. This version of TE incorporates normative, empirical and foundational ethics research and continues to develop through application and in the face of new ethical challenges. Here, I explore the idea that the academic field of bioethics has not yet sufficiently analysed its own philosophical foundation for how it can, and (...) should, be practically relevant; neither has it comprehensively discussed the limitations on what impacts bioethicists should pursue. As a result, there has not been adequate training on how to suitably and appropriately impact real‐world practices. Moreover, bioethical perspectives are often competing with other strong interests, for example, economic and political, which may weaken their impact on policy‐making. The TE approach I propose can not only facilitate practical impacts of academic bioethics by being better informed by real‐world ethical issues but it also supports targeted and ethical justifications of the actual impact of academic work in real‐world contexts. In this paper, I clarify the premises for this TE approach, identify further challenges and sketch out potential solutions for the implementation of this methodological framework. (shrink)

Volume 20, Issue 4, May 2020, Page 71-73.

Cappelen et al. (2015) open their paper, “Fairness is intuitive,” with the observation, “A key question in the social sciences is whether it is intuitive to behave in a fair manner or whether fair behavior requires active self-control” (p. 2). They purport to offer “evidence showing that fair behavior is intuitive to most people” (p. 1). Their premise is that deciding by intuition is faster than deciding by deliberation. While this premise in and on itself is rather uncontroversial—the conclusion that (...) they draw from it is not: “Since a decision that relies on intuition is typically made faster than a decision that relies on deliberation, the response time of a fair decision relative to a selfish decision provides an important indication of the intuitiveness of fair behavior” (p. 2). This reasoning, in fact, amounts to a reverse inference fallacy. ‘Intuitive’ may mean ‘fast’, but this would not imply that ‘fast’ means ‘intuitive’. However, we may ask, under which empirical conditions might we be allowed to draw the inference of ‘intuitive’ from ‘fast’? Naturally, these conditions would require that ‘fast’ rule out ‘deliberative’. To achieve this, we would need information beyond relative response speed alone—such as absolute decision times. And this begs the question, which range of decision times would rule out ‘deliberative’—or at the very least, render it improbable? Although the precise cut-off for deliberative decisions may be difficult to establish (see e.g., Schnei... (shrink)

In the face of environmental crises such as climate change, pollution and biodiversity loss—which all adversely impact on health—Gils-Schmidt and Salloch explore whether physicians can be justified in taking climate issues into account in clinical care.1 While their approach centres on the ‘climate-sensitive’ decisions, physicians can carry out on the micro-level of clinical decision-making, they encourage further discussions on how climate-related issues can be included across different levels of decision-making in healthcare. We propose a list of tasks and a model (...) to assist with navigating the range of factors and structural elements an environmentally sensitive ethics must address. Stephen Gardiner’s notion of a perfect moral storm is central to understanding these issues.2 Gardiner describes how a perfect moral storm occurs in the centre of three overlapping conditions for human action and policymaking in the face of climate change. This storm is driven by: (1) a lack of interest among current generations to meet global needs and accommodate the well-being of future generations, (2) a lack of ecological concerns for other parts of nature than humans and (3) weak ethical and political theories and institutions shaping policy decisions on issues with severe implications across borders and generations. Moreover, these conditions are embedded in the existing, complex world of ethically unjustified power imbalances and social injustice. The growing awareness of healthcare’s climate footprint has amplified and accelerated global, grassroots action to make healthcare more environmentally friendly. This includes incorporating environmental impacts into quality improvement methodologies, building communities of practice to explore how to make …. (shrink)

This paper examines some ethical issues arising from whole-genome association studies for multigenic diseases, focusing on the case of autism. Events occurring following the announcement of a genetic test for autism in France (2005–2009) are described to exemplify the ethical controversies that can arise when genetic testing for autism is applied prematurely and inappropriately promoted by biotech companies. The authors argue that genetic tests assessing one or a few genes involved in highly multigenic disorders can only be useful if: (1) (...) the genetic linkage found in the scientific study must be statistically convincing, reproducible and also applicable to the population to which the individual considered belongs (scientific validity); (2) the relative risk conferred by the ‘high-risk’ allele should be high enough to be significant to the patient (significant impact); (3) use of the test should lead to some improvement of outcome for the patient, resulting from adapted treatment if available, or at least from adjustment of lifestyle (or life goals) prompted by the new knowledge generated (clinical utility). Decisions concerning genetic testing for autism involve scientific judgement, value judgement and good knowledge of a constantly evolving therapeutic environment. The implementation of genetic tests for highly multigenic diseases thus requires strong mechanisms to ensure that they are used in a fashion that can benefit patients, and these mechanisms must be able to cope with rapid progress in scientific knowledge and therapeutic intervention. (shrink)

What is it to be a woman? What is it to be a man? We start by laying out desiderata for an analysis of 'woman' and 'man': descriptively, it should link these gender categories to sex biology without reducing them to sex biology, and politically, it should help us explain and combat traditional sexism while also allowing us to make sense of the activist view that gendering should be consensual. Using a Putnam-style 'Twin Earth' example, we argue that none of (...) the existing analyses in the feminist literature succeeds in meeting all of our desiderata. Finally, we propose a positive account that we believe can satisfy all the desiderata outlined. According to our theory, the genders 'woman' and 'man' are individuated not by their contemporary connections to sex biology, but by their historical continuity with classes that were originally closely connected to sex biology. (shrink)

Translational research in medicine requires researchers to identify the steps to transfer basic scientific discoveries from laboratory benches to bedside decision-making, and eventually into clinical practice. On a parallel track, philosophical work in ethics has not been obliged to identify the steps to translate theoretical conclusions into adequate practice. The medical ethicist A. Cribb suggested some years ago that it is now time to debate ‘the business of translational’ in medical ethics. Despite the very interesting and useful perspective on the (...) field of medical ethics launched by Cribb, the debate is still missing. In this paper, I take up Cribb’s invitation and discuss further analytic distinctions needed to base an ethics aiming to translate between theory and practice. (shrink)

The Alligator's Child was full of 'satiable curtiosity. One day while rummaging in a trunk in the lumber room he came across a photograph of his father wearing an aardvark uniform and standing by a large ant hill. All excitement, he rushed to his father and breathlessly said, ‘Father, I didn't know that you had been an aardvark! What is it like to be an aardvark?’.

The concept of energy, the premier concept of physics and indeed of all science, is here investigated from the standpoint of its early historical origin and the philosophical implications thereof. The fundamental assumption is made that the root of the concept is the notion of invariance or constancy in the midst of change. Salient points in the development of this idea are presented from ancient times up to the publication of Lagrange'sMécanique Analytique (1788).

In this paper we use the contemporary example of trans youth panics to introduce the notion of hermeneutical backlash, in which defenders of an established, unjust hermeneutical regime actively work to undermine and discredit hermeneutical liberation. We argue that the strategies and tropes of the trans youth panic illustrate a general propaganda vulnerability of epistemic liberation movements, and so are troubling for reasons that go beyond their application to trans youth. This exploration of a few specific cases of hermeneutical liberation (...) and hermeneutical backlash calls attention to the need for further theoretical work on the dynamics of struggles for hermeneutical justice. (shrink)

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)

Denne artikkelen tar utgangspunkt i et skille mellom samfunnsstrukturer som avgrenser legers skjønnsmessige utfoldelse på den ene siden, og profesjonens tilrettelegging for kultiveringen av erkjennelsesmessige ferdigheter på den annen. Ved å videreføre H. Grimen og A. Molanders anvendelse av S.E. Toulmins modell for praktisk resonnering i en klinisk kontekst redegjør jeg for legeskjønnets multidimensjonale, epistemiske struktur. Gjennomgangen viser hvordan skjønnsanvendelse i legerollen kan analyseres i henhold til en fagteknisk, en distributiv og en relasjonell dimensjon. Mot denne bakgrunnen diskuterer jeg så (...) spenninger som oppstår i skjæringspunktet mellom strukturering og kultivering av skjønnets ulike dimensjoner. Diskusjonen tydeliggjør at den medisinske profesjonen ikke kan betraktes som en selvtilstrekkelig premissleverandør når det gjelder å sikre adekvat kultivering av medlemmenes skjønnsutøvelse i en klinisk kontekst. Ved å synliggjøre og vektlegge de relevante profesjonseksterne bidragene i profesjonens pågående selvregulering kan befolkningens berettigete tillit til profesjonen styrkes ytterligere.Nøkkelord: strukturelt skjønn, epistemisk skjønn, profesjon, selvregulering, tillitEnglish summary: In Between Structures of Society and Profession: On Delimitation, Cultivation and Premises for Adequately Exercising Judgment in the Role as PhysicianThe point of departure of this article is a distinction between societal structures that delimit the discretion of the physician on the one hand and the profession's arrangements for the cultivation of the physician's judgment on the other. By developing H. Grimen and A. Molander's application of S.E. Toulmin's model for practical reasoning in a clinical context, the multi-dimensional epistemic structure of the physician's judgment in terms of technical, distributive, and relational judgment is accounted for. Against this backdrop, tensions emerging in the intersection between delimitation and cultivation of professional judgment in its various dimensions are discussed. The discussion clarifies that the medical profession is not a self-sufficient provider when it comes to ensuring an adequate cultivation of its members' judgment in a clinical context. It is argued that by emphasising and implementing the relevant external contributions to the profession's ongoing self-regulation, the public's justified trust in the medical profession can be strengthened. (shrink)

The concept of intrinsic value is often invoked to articulate objections to the genetic engineering of animals, particularly those objections that are not directed at the negative effects the technique might have on the health and welfare of the modified animals. However, this concept was not developed in the context of genetic engineering. Given this external origin, this paper critically examines the assumption that the concept of intrinsic value is suitable to articulate and justify moral objections more specifically directed at (...) the genetic engineering of animals. I discuss four different theories of intrinsic value, two of which defend a moral concept of intrinsic value and two a non-moral one. I conclude that only a particular non-moral concept of intrinsic value is suitable to express specific objections to genetic engineering, because these objections can only be defended in the form of indirect duties regarding animals. (shrink)

This article is in a larger textbook of articles in Medical Ethics.

Char et al. describe an interesting and useful approach in their paper, “Identifying ethical considerations for machine learning healthcare applications.” Their proposed framework, which see...

Open peer commentary on the article “Second-Order Science: Logic, Strategies, Methods” by Stuart A. Umpleby. Upshot: Umpleby’s target article is important for bridging the gap between the natural and social sciences. While I agree with his claims, his proposals may not reach far enough. Concrete methods of empirical research, which are of crucial importance for a breakthrough, deserve further elaboration.

The Desarguesian nature of angular-momentum theory is illustrated by drawing correspondences between relations satisfied by then-j symbols and various collinearity properties of the appropriate diagrams. No examples of Pappus' theorem have been found. A relation is suggested between the operations of angular-momentum theory and Hilbert's constructions for the addition and multiplication of points on a line.