Ethical challenges that arise within healthcare delivery institutions are currently categorized as either clinical or organizational, based on the type of issue. Despite this common binary issue-based methodology, empirical study and increasing academic dialogue indicate that a clear line cannot easily be drawn between organizational and clinical ethics. Disagreement around end-of-life treatments, for example, often spawn value differences amongst parties at both organizational and clinical levels and requires a resolution to address both the case at hand and large-scale underlying system-level (...) confounders. I refer to issues that contain elements of both clinical and organizational issues as hybrids and propose a new taxonomy to characterize hybrid cases. I contend that salient contextual features of an ethical issue, such as where it is identified, who it impacts and where it is ideally resolved in relation to its scope of impact, should inform procedure. Implementation of a Hybrid taxonomy viewing ethical issues as existing on a continuum furthers that end. The primary goals are to 1) systematize thinking about ethical issues that arise within healthcare delivery institutions and 2) allow the content of the ethical challenge to drive the process, rather than continuing to rely on the traditional binary issue-based choice. Failure to capture the complexity of hybrid situations perpetuates incomplete information and ultimately an inchoate resolution that creates more questions than answers. (shrink)

Although there is no federal legislation yet on e-cigarettes, the U.S. Food and Drug Administration proposed regulations in April 2014 that would prohibit sales of e-cigarettes to anyone under eighteen and require that they be approved by the FDA as a tobacco product and carry warning labels for consumers on their packaging. Only three U.S. states have extended the same restrictions placed on tobacco products to e-cigarettes; however, eighteen states have passed legislation enacting use restrictions on venues such as schools, (...) state property, or workplaces. Until there is applicable legislation at the federal, state, or municipal levels, health care organizations will have to develop institutional policies if they wish to consistently address the use of e-cigarettes by patients and visitors on their property. (shrink)

In both law and ethics, precedent shapes the deliberation of novel issues. Despite the interconnection between new and old decisions, few research ethics boards have an explicit mechanism for archiving issue-based research ethics decisions to inform future decisions. With the intent of promoting expediency, consistency, and accountability in REB decision-making, Sunnybrook Health Sciences Centre implemented a “decision bank”: a formal mechanism for systematically capturing institutional REB decisions. We describe the development of the decision bank, its implementation, and the lessons we (...) have learned from both. The decision bank, which is categorized by general issue themes such as consent, study design, and privacy, is still in the early implementation phase, but it provides a much-needed method to address the paucity of formal mechanisms and literature in a biomedical field otherwise inundated with evidence-based information. (shrink)

Background:In Ontario, Canada, patients who lack decision-making capacity and have no family or friends to act as substitute decision-makers currently rely on the Office of the Public Guardian and Trustee to consent to long-term care (nursing home) placement, but they have no legal representative for other placement decisions.Objectives:We highlight the current gap in legislation for difficult transition cases involving unrepresented patients and provide a novel framework for who ought to assist with making these decisions and how these decisions ought to (...) be made.Research design:This paper considers models advanced by Volpe and Steinman with regard to who ought to make placement decisions for unrepresented patients, as well as current ethical models for analyzing how these decisions should be made.Participants and research context:We describe an anonymized healthcare transition case to illustrate the fact that there is no legally recognized decision-maker for placement destinations other than long-term care facilities and to show how this impacts all stakeholders.Ethical considerations:The case provided is an anonymized vignette representing a typical transition case involving an unrepresented patient.Findings:As a result of a gap in provincial legislation, healthcare providers usually determine the appropriate placement destination without a clear framework to guide the process and this can cause significant moral distress.Discussion:We argue for a team decision-making approach in the short term, and a legislative change in the long-term, to respect the patient voice, evaluate benefit and risk, enhance collaboration between healthcare providers and patients, and promote social justice. We believe that our approach, which draws upon the strengths of interprofessional teams, will be of interest to all who are concerned with the welfare and ethical treatment of the patients for whom they care.Conclusions:One of the main strengths of our recommendation is that it provides all members of the healthcare team (including nurses, social workers, therapists, and others) an increased opportunity to advocate on behalf of unrepresented patients. (shrink)

This paper provides an account of social practices that reveals how they are constitutive of social agency, enable coordination around things of value, and are a site for social intervention. The social world, on this account, does not begin when psychologically sophisticated individuals interact to share knowledge or make plans. Instead, culture shapes agents to interpret and respond both to each other and the physical world around us. Practices shape us as we shape them. This provides resources for understanding why (...) social practices tend to be stable, but also reveals sites and opportunities for change. (shrink)

In this collection of previously published essays, Sally Haslanger draws on insights from feminist and critical race theory and on the resources of contemporary analytic philosophy to develop the idea that gender and race are positions ...

It is always awkward when someone asks me informally what I’m working on and I answer that I’m trying to figure out what gender is. For outside a rather narrow segment of the academic world, the term ‘gender’ has come to function as the polite way to talk about the sexes. And one thing people feel pretty confident about is their knowledge of the difference between males and females. Males are those human beings with a range of familiar primary and (...) secondary sex characteristics, most important being the penis; females are those with a different set, most important being the vagina or, perhaps, the uterus. Enough said. Against this background, it isn’t clear what could be the point of an inquiry, especially a philosophical inquiry, into “what gender is”. (shrink)

A philosophically useful account of social structure must accommodate the fact that social structures play an important role in structural explanation. But what is a structural explanation? How do structural explanations function in the social sciences? This paper offers a way of thinking about structural explanation and sketches an account of social structure that connects social structures with structural explanation.

I’ll start by giving a very brief summary of Sider’s position and will identify some points on which my own position differs from his. I’ll then raise four issues, viz., how to articulate the 3-dimensionalist view, the trade-offs between Ted’s stage view of persistence and endurance with respect to intrinsic properties, the endurantist’s response to the argument from vagueness, and finally more general questions about what’s at stake in the debate. I don’t believe that anything I say raises insurmountable problems (...) for Sider’s view; and in fact, I’m sure he’s in a better position to defend his view more convincingly than I’m able to defend mine. However, there is plenty worth discussing further. (shrink)

The authoranalyzes the types of metaphors that are used to describe the Internetin issues of Wired magazine from before and after the dot-com collapse to understand the perceptions and expectations of some of the actors involved in the shaping of the Internet. In addition, the metaphors deployed in economics and geophysiology are used to demonstrate how metaphors can influence public debate, policy, and theory. The author argues that metaphors do not simply have a descriptive function but that they also carry (...) normative connotations. Language, alongside social practices and material objects, is an important tool in attempts to construct the future. Six overlapping metaphorical themes are identified: revolution, evolution, salvation, progress, universalism, and the “American dream.” A critical analysis of these metaphors, informed by a critique of the metaphors used in economics and geophysiology, leads the author to challenge the universalist claims made by some Internet enthusiasts for the inclusive potential of the Internet. (shrink)

The history of research in American Indian/Alaska Native communities has been marked by unethical practices, resulting in mistrust and reluctance to participate in research. Harms are not l...

Racism, sexism, and other forms of injustice are more than just bad attitudes; after all, such injustice involves unfair distributions of goods and resources. But attitudes play a role. How central is that role? Tommie Shelby, among others, argues that racism is an ideology and takes a cognitivist approach suggesting that ideologies consist in false beliefs that arise out of and serve pernicious social conditions. In this paper I argue that racism is better understood as a set of practices, attitudes, (...) social meanings, and material conditions, that systematically reinforce one another. Attitudes play a role, but even the cognitive/affective component of ideologies should include culturally shared habits of mind and action. These habits of mind distort, obscure, and occlude important facts about subordinated groups and result in a failure to recognize their interests. How do we disrupt such practices to achieve greater justice? I argue that this is sometimes, but not always, best achieved by argument or challenging false beliefs, so social movements legitimately seek other means. (shrink)

The False Claims Act, 31 U.S.C. § 3729, a post-Civil War law inspired by cases of defense contracting fraud, was revitalized in 1986. Since then it has been used to sue both manufacturers and providers of pharmaceuticals. In some cases, these suits were meant to target offlabel marketing of pharmaceuticals. In 2009, the 11th Circuit rendered a decision in Hopper v. Solvay Pharmaceuticals that dramatically limits the ability of private plaintiff whistle-blowers to bring qui tam suits under the FCA for (...) such marketing. In June 2010, the Supreme Court denied certiorari, making the Circuit court decision final. The Solvay decision creates a significant barrier to certain kinds of qui tam suits, requiring the plaintiff to demonstrate the intent to market off-label, including by showing specific prescriptions that were written as a result of efforts to do so. (shrink)

"Being and Logos" is... a philosophical adventure of rare inspiration.... Its power to illuminate the text..., its ecumenicity of inspiration, its methodological rigor, its originality, and its philosophical profundity—all together make it one of the few philosophical interpretations that the philosopher will want to re-read along with the dialogues themselves. A superadded gift is the author's prose, which is a model of lucidity and grace." —International Philosophical Quarterly "Being and Logos is highly recommended for those who wish to learn how (...) a thoughtful scholar approaches Platonic dialogues as well as for those who wish to consider a serious discussion of some basic themes in the dialogues." —The Academic Reviewer. (shrink)

Across the humanities and social sciences it has become commonplace for scholars to argue that categories once assumed to be “natural” are in fact “social” or, in the familiar lingo, “socially constructed”. Two common examples of such categories are race and gender, but there many others. One interpretation of this claim is that although it is typically thought that what unifies the instances of such categories is some set of natural or physical properties, instead their unity rests on social features (...) of the items in question. Social constructionists pursuing this strategy—and it is these social constructionists I will be focusing on in this paper—aim to “debunk” the ordinary assumption that the categories are natural, by revealing the more accurate social basis of the classification.2 To avoid confusion, and to resist some of the associations with the term ‘social construction’, I will sometimes use the term ‘socially founded’ for the categories that this sort of constructionist reveals as social rather than natural. (shrink)

Recent work on social injustice has focused on implicit bias as an important factor in explaining persistent injustice in spite of achievements on civil rights. In this paper, I argue that because of its individualism, implicit bias explanation, taken alone, is inadequate to explain ongoing injustice; and, more importantly, it fails to call attention to what is morally at stake. An adequate account of how implicit bias functions must situate it within a broader theory of social structures and structural injustice; (...) changing structures is often a precondition for changing patterns of thought and action and is certainly required for durable change. (shrink)

Theorists analyzing the concepts of race and gender disagree over whether the terms refer to natural kinds, social kinds, or nothing at all. The question arises: what do we mean by the terms? It is usually assumed that ordinary intuitions of native speakers are definitive. However, I argue that contemporary semantic externalism can usefully combine with insights from Foucauldian genealogy to challenge mainstream methods of analysis and lend credibility to social constructionist projects.

This essay proposes a design perspective on argumentation, intended as complementary to empirical and critical scholarship. In any substantive domain, design can provide insights that differ from those provided by scientific or humanistic perspectives. For argumentation, the key advantage of a design perspective is the recognition that humanity’s natural capacity for reason and reasonableness can be extended through inventions that improve on unaided human intellect. Historically, these inventions have fallen into three broad classes: logical systems, scientific methods, and disputation frameworks. (...) Behind each such invention is a specifiable “design hypothesis”: an idea about how to decrease error or how to increase the quality of outcomes from reasoning. As problems in contemporary argumentation practice become more complex, design thinking rises in relevance and importance. A design research agenda in argumentation would focus on theorizing design innovations and on evaluating design hypotheses. (shrink)

Much contemporary social epistemology takes as its starting point individuals with sophisticated propositional attitudes and considers (i) how those individuals depend on each other to gain (or lose) knowledge through testimony, disagreement, and the like and (ii) if, in addition to individual knowers, it is possible for groups to have knowledge. In this paper I argue that social epistemology should be more attentive to the construction of knowers through social and cultural practices: socialization shapes our psychological and practical orientation so (...) that we perform local social practices fluently. Connecting practical orientation to an account of ideology, I argue that to ignore the ways in which cognition is socially shaped and filtered is to allow ideology to do its work unnoticed and unimpeded. Moreover, ideology critique cannot simply challenge belief, but must involve challenges to those practices through which we ourselves become the vehicles and embodiments of ideology.V. (shrink)

Self-reported data are regarded by medical researchers as invalid and less reliable than data produced by experts in clinical settings, yet individuals can increasingly contribute personal information to medical research through a variety of online platforms. In this article we examine this ‘participatory turn’ in healthcare research, which claims to challenge conventional delineations of what is valid and reliable for medical practice, by using aggregated self-reported experiences from patients and ‘pre-patients’ via the internet. We focus on 23andMe, a genetic testing (...) company that collects genetic material and self-reported information about disease from its customers. Integral to this research method are relations of trust embedded in the information exchange: trust in customers’ data; trust between researchers/company and research subjects; trust in genetics; trust in the machine. We examine the performative dimension of these trust relations, drawing on Shapin and Schaffer’s discussion of how material, literary and social technologies are used in research in order to establish trust. Our scepticism of the company’s motives for building trust with the self-reporting consumer forces us to consider our own motives. How does the use of customer data for research purposes by 23andMe differ from the research practices of social scientists, especially those who also study digital traces? By interrogating the use of self-reported data in the genetic testing context, we examine our ethical responsibilities in studying the digital selves of others using internet methods. How researchers trust data, how participants trust researchers, and how technologies are trusted are all important considerations in studying the social life of digital data. (shrink)

How do we achieve social justice? How do we change society for the better? Some would argue that we must do it by changing the laws or state institutions. Others that we must do it by changing individual attitudes. I argue that although both of these factors are important and relevant, we must also change culture. What does this mean? Culture, I argue, is a set of social meanings that shapes and filters how we think and act. Problematic networks of (...) social meanings constitute an ideology. Entrenched ideologies are resilient and are barriers to social change, even in the face of legal interventions. I argue that an effective way to change culture is through social movements and contentious politics, and that philosophy has a role to play in promoting such change. (shrink)

In this article we examined the ways in which strategic ambiguity in the use of keywords served an enabling function within a discourse marked by conflict and ideological divisions. Our analysis focused on the intertextual relationships between five documents intended by the government to guide the development of biotechnology in New Zealand. Through our analysis we identified ‘sustainability’ as a keyword and three major roles for the deployment of the discourse strategy of strategic ambiguity in the use of this keyword. (...) First, strategic ambiguity lent an internal and intertextual coherence to the texts. Second, it allowed multiple perspectives and objectives to co-exist. Third, strategic ambiguity facilitated the participation of discourse actors who subscribed to ideologies that were more or less incommensurable. (shrink)

Not all of the studies cited in the target article as evidence that fluctuating asymmetry (FA) predicts male mating success demonstrate that the observed asymmetry is, in fact, FA. FA is a population-level pattern of differences between sides. Unless the population-level distributional criteria of bilateral traits are reported, the meaning of asymmetry in individuals is unknown.

Argument is a pervasive feature of human interaction, and in its natural contexts of occurrence, it is organized around the management of disagreement. Since disagreement can occur around any kind of speech act whatsoever, not all arguments involve a claim supported by reasons; many involve standpoints attributed to someone but claimed by no one. And although truth and validity are often at issue in naturally occurring arguments, these do not exhaust the standards to which arguers are held. Arguers hold one (...) another accountable for cooperating in the management of disagreement, infusing argumentation with a natural normativity that exists apart from any theorized appraisal standard applied to the claim-reason relationship. Argumentation’s natural normativity is visible not only in how arguments unfold in interaction but also in how humanity continuously strives to improve its methods of disagreement management. (shrink)

Argument is a pervasive feature of human interaction, and in its natural contexts of occurrence, it is organized around the management of disagreement. Since disagreement can occur around any kind of speech act whatsoever, not all arguments involve a claim supported by reasons; many involve standpoints attributed to someone but claimed by no one. And although truth and validity are often at issue in naturally occurring arguments, these do not exhaust the standards to which arguers are held. Arguers hold one (...) another accountable for cooperating in the management of disagreement, infusing argumentation with a natural normativity that exists apart from any theorized appraisal standard applied to the claim-reason relationship. Argumentation’s natural normativity is visible not only in how arguments unfold in interaction but also in how humanity continuously strives to improve its methods of disagreement management. (shrink)

Are sagging pants cool? Are cows food? Are women more submissive than men? Are blacks more criminal than whites? Taking the social world at face value, many people would be tempted to answer these questions in the affirmative. And if challenged, they can point to facts that support their answers. But there is something wrong about the affirmative answers. In this chapter, I draw on recent ideas in the philosophy of language and metaphysics to show how the assertion of a (...) generic claim of the sort in question ordinarily permits one to infer that the fact in question obtains by virtue of something specifically about the subject so described, i.e., about women, or blacks, or sagging pants. In the examples I’ve offered, however, this implication inference is unwarranted. The facts in question obtain by virtue of broad system of social relations within which the subjects are situated, and are not grounded in intrinsic or dispositional features of the subjects themselves. The background relations are obscured, however, and as a result, the assertion is at least systematically misleading; a denial functions to block the problematic implication. Revealing such implications or presuppositions and blocking them is a crucial part of ideology critique. (shrink)

[Sally Haslanger] In debates over the existence and nature of social kinds such as 'race' and 'gender', philosophers often rely heavily on our intuitions about the nature of the kind. Following this strategy, philosophers often reject social constructionist analyses, suggesting that they change rather than capture the meaning of the kind terms. However, given that social constructionists are often trying to debunk our ordinary (and ideology-ridden?) understandings of social kinds, it is not surprising that their analyses are counterintuitive. This (...) article argues that externalist insights from the critique of the analytic/synthetic distinction can be extended to justify social constructionist analyses. /// [Jennifer Saul] Sally Haslanger's 'What Good Are Our Intuitions? Philosophical Analysis and Social Kinds' is, among other things, a part of the theoretical underpinning for analyses of race and gender concepts that she discusses far more fully elsewhere. My reply focuses on these analyses of race and gender concepts, exploring the ways in which the theoretical work done in this paper and others can or cannot be used to defend these analyses against certain objections. I argue that the problems faced by Haslanger's analyses are in some ways less serious, and in some ways more serious, than they may at first appear. Along the way, I suggest that ordinary speakers may not in fact have race and gender concepts and I explore the ramifications of this claim. (shrink)

Contemporary reasoning about health is infused with the work products of experts, and expert reasoning about health itself is an active site for invention and design. Building on Toulmin’s largely undeveloped ideas on field-dependence, we argue that expert fields can develop new inference rules that, together with the backing they require, become accepted ways of drawing and defending conclusions. The new inference rules themselves function as warrants, and we introduce the term “warranting device” to refer to an assembly of the (...) rule plus whatever material, procedural, and institutional resources are required to assure its dependability. We present a case study on the Cochrane Review, a new method for synthesizing evidence across large numbers of scientific studies. After reviewing the evolution and current structure of the device, we discuss the distinctive kinds of critical questions that may be raised around Cochrane Reviews, both within the expert field and beyond. Although Toulmin’s theory of field-dependence is often criticized for its relativism, we find that, as a matter of practical fact, field-specific warrants do not enjoy immunity from external critique. On the contrary, they can be opened to evaluation and critique from any interested perspective. (shrink)

This short commentary reflects on policy making for open data. The articles in this special issue all raise interesting challenges and questions for research policy, broadly defined, including how to stimulate researchers to make data open in the first place, how to reuse data sensibly, and how to ensure data are appropriately stored and made accessible for future users. This commentary reflects on the author’s own experience of taking part in an international policy forum that was tasked with preparing a (...) report about the importance of making research data open. The author describes how she attempted to ensure insights from science and technology studies—made by contributors to this special issue and many others in the field—were incorporated in the final report. She also describes how technologically determinist arguments were invoked to close down discussions about the political dimensions of open access to research data. (shrink)

This article examines how weblog authors present their online gender identity, in order to establish how these modes of presentation fit into the research landscape about gender identity and computer-mediated communication. After a preliminary descriptive analysis of a sample of Dutch and Flemish weblogs, the authors conduct a qualitative content analysis of four of these `blogs'. They conclude that these weblog writers present their gender identity through narratives of `everyday life' that remain closely related to the binary gender system. However, (...) their performance of `masculinity' and `femininity' is more diffuse and heterogeneous than some theories in the field of gender and CMC would assume. In addition, the act of diary writing on weblogs can be understood as challenging the masculine connotation of the weblog as an ICT, demonstrating that the use of a technology is pivotal in shaping the ways in which technologies themselves are conceived of as `masculine' or `feminine'. (shrink)

How does an object persist through change? How can a book, for example, open in the morning and shut in the afternoon, persist through a change that involves the incompatible properties of being open and being shut? The goal of this reader is to inform and reframe the philosophical debate around persistence; it presents influential accounts of the problem that range from classic papers by W. V. O. Quine, David Lewis, and Judith Jarvis Thomson to recent work by contemporary philosophers. (...) The authors take on the question of persistence by examining three broad approaches: perdurantism, which holds that change over time is analogous to change over space; exdurantism, according to which identity over time is analogous to identity across possible worlds; and endurantism, which holds that ordinary objects persist by enduring. Each of these approaches appears to be coherent, but each also has its own metaphysical problems. Persistence includes papers that argue for perdurantism, exdurantism, or endurantism, as well as papers that explore some metaphysical difficulties challenging each account. In this way the collection allows readers to balance the trade-offs of each approach in terms of intuitiveness, theoretical attractiveness, and elegance.Contributors:Yuri Balashov, William Carter, Graeme Forbes, Sally Haslanger, Katherine Hawley, H. S. Hestevold, Mark Hinchliffe, Mark Johnston, Roxanne Marie Kurtz, David K. Lewis, Ned Markosian, D. H. Mellor, W. V. O. Quine, Theodore Sider, Richard Taylor, Judith Jarvis Thomson, Peter van Inwagen, Dean Zimmerman. (shrink)

A very distinctive and important new option for Christian theology. McFague proposes in a clear and challenging way a theological program based on what she calls 'the organic model' for conceiving God.

The past three years have seen a dramatic increase in our understanding of the structural organization and expression strategies of the dispersed, repetitive yeast transposon, Ty. These studies have led to a logical comparison of Ty with retroviral proviruses and other mobile, repetitive elements. Such comparisons have culminated in the hypotheses that transposition occurs via the formation of Ty‐encoded virus‐like particles and that these particles represent a basic unit of all ‘retro‐systems’.