Patient consent has been formulated in terms of radical individualism rather than shared benefits. Medical education relies on the provision of patient consent to provide medical students with the training and experience to become competent doctors. Pelvic examination represents an extreme case in which patients may legitimately seek to avoid contact with inexperienced medical students particularly where these are male. However, using this extreme case, this paper will examine practices of framing and obtaining consent as perceived by medical students. This (...) paper reports findings of an exploratory qualitative study of medical students and junior doctors. Participants described a number of barriers to obtaining informed consent. These related to misunderstandings concerning student roles and experiences and insufficient information on the nature of the examination. Participants reported perceptions of the negative framing of decisions on consent by nursing staff where the student was male. Potentially coercive practices of framing of the decision by senior doctors were also reported. Participants outlined strategies they adopted to circumvent patients’ reasons for refusal. Practices of framing the information used by students, nurses and senior doctors to enable patients to decide about consent are discussed in the context of good ethical practice. In the absence of a clear ethical model, coercion appears likely. We argue for an expanded model of autonomy in which the potential tension between respecting patients’ autonomy and ensuring the societal benefit of well-trained doctors is recognised. Practical recommendations are made concerning information provision and clear delineations of student and patient roles and expectations. (shrink)

Promoting patient autonomy has become a key imperative in health service encounters. We will examine the potential negative effects of over-promoting patient autonomy and consider the impact on patient access, their experience and the provision of equitable services by focusing on an extreme manifestation of this trend, i.e. calls for patient involvement in health care decision making to be mandatory. Advocates of mandatory autonomy hold that patients have a duty to themselves, to society and to the medical system to make (...) decisions on their health care independently. Models of mandatory autonomy may be contrasted to those of optional autonomy that seek to ascertain patients’ decisional preferences and to understand wider limitations on their freedom to choose. Where choice as decisional responsibility becomes mandatory it ceases to promote agency and where autonomous choice is understood as an individualistic practice it will contribute to the cultural dominance of Western values. Moreover, taking a view that principlist ethics needs to take account of the social and cultural contexts of individual lives, we argue that if mandatory autonomy were to be over-emphasised as part of an ongoing move towards patient choice in UK National Health Service (NHS), educated and affluent people would be more able to exercise choices at the expense of people who are experienced in asserting preferences and who have the resources to make use of choices. We will argue that the promotion of autonomy needs to be tempered by steps to enable less powerful social, cultural and economic groups to contribute to decision making and to support individuals who may feel abandoned by having decisional responsibility transferred to them. Until constraints on individual choice can be understood and addressed, we advocate the model of optional autonomy used in shared decision making and make recommendations for practice, policy, education and research. (shrink)

An examination of the state of journalism and the need for change. For students and professionals on journalism fields.

The De Malo represents some of St. Thomas Aquinas' most mature thinking on goodness, badness, and human agency. Together with the second part of the Summa Theologiae, it is one of his most sustained contributions to moral philosophy and theology. Aquinas examines the full range of questions associated with evil: its origin, its nature, its variety, its relation to good, and its compatibility with the existence of an omnipotent, benevolent God. This edition offers the Leonine Commission's authoritative edition of the (...) Latin text with a new, clear, and readable English translation by Richard Regan with an extensive introduction and notes by Brian Davies. (shrink)

Health institutions recommend that young infants be exclusively breastfed on demand, and it is widely held that parents who can breastfeed have an obligation to do so. This has been challenged in recent philosophical work, especially by Fiona Woollard. Woollard’s work critically engages with two distinct views of parental obligation that might ground such an obligation—based on maximal benefit and avoidance of significant harm—to reject an obligation to breastfeed. While agreeing with Woollard’s substantive conclusion, this paper (drawing on philosophical discussion (...) of the ‘right to rear’) argues that there are several more moderate views of parental obligation which might also be thought to ground parental obligation. We first show that an obligation to breastfeed might result not from a general obligation to maximally benefit one’s child, but from what we call ‘choice-specific’ obligations to maximise benefit within particular activities. We then develop this idea through two views of parental obligation—the Dual Interest view, and the Best Custodian view—to ground an obligation to exclusively breastfeed on demand, before showing how both these more moderate views fail. Finally, we argue that not only is there no general obligation to breastfeed children, but that it is often morally right not to do so. Since much advice from health institutions on this issue implies that exclusive breastfeeding on demand is the best option for all families, our argument drives the feeding debate forward by showing that this advice often misrepresents parents’ moral obligations in potentially harmful ways. (shrink)

This article explores various analytical issues involved in conceptualizing the interrelationships of gender, class, race and ethnicity and other social divisions. It compares the debate on these issues that took place in Britain in the 1980s and around the 2001 UN World Conference Against Racism. It examines issues such as the relative helpfulness of additive or mutually constitutive models of intersectional social divisions; the different analytical levels at which social divisions need to be studied, their ontological base and their relations (...) to each other. The final section of the article attempts critically to assess a specific intersectional methodological approach for engaging in aid and human rights work in the South. (shrink)

Western philosophers have traditionally concentrated on theory as the means for expressing knowledge about a variety of phenomena. This absorbing book challenges this fundamental notion by showing how objects themselves, specifically scientific instruments, can express knowledge. As he considers numerous intriguing examples, Davis Baird gives us the tools to "read" the material products of science and technology and to understand their place in culture. Making a provocative and original challenge to our conception of knowledge itself, _Thing Knowledge _demands that we (...) take a new look at theories of science and technology, knowledge, progress, and change. Baird considers a wide range of instruments, including Faraday's first electric motor, eighteenth-century mechanical models of the solar system, the cyclotron, various instruments developed by analytical chemists between 1930 and 1960, spectrometers, and more. (shrink)

Some of the dialogue in the Star Wars films has become deservedly iconic, instantly recognizable even to people unfamiliar with the series. Several human characters speak two or more languages. This chapter examines whether Chewbacca's noises work like a language. It considers a typical exchange between Chewbacca and Han Solo. The conclusion that these noises are not real language is so obvious as to be unnecessary: Chewbacca does not speak. The Star Wars films and Expanded Universe materials teem with processes, (...) objects, and entities that are unique to their fictional setting, are without counterparts in real life, and would need to be learned by someone encountering them for the first time. Conversely, if more and more people do start to use a word in a new way, eventually the newer usage will become its accepted meaning, either coexisting with an older meaning or superseding it. (shrink)

In recent years consciousness has become a significant area of study in the cognitive sciences. The Frontiers of Consciousness is a major interdisciplinary exploration of consciousness. The book stems from the Chichele lectures held at All Souls College in Oxford, and features contributions from a 'who's who' of authorities from both philosophy and psychology. The result is a truly interdisciplinary volume, which tackles some of the biggest and most impenetrable problems in consciousness. The book includes chapters considering the apparent explanatory (...) gap between science and consciousness, our conscious experience of emotions such as fear, and of willed actions by ourselves and others. It looks at subjective differences between two ways in which visual information guides behaviour, and scientific investigation of consciousness in non-human animals. It looks at the challenges that the mind-brain relation presents for clinical practice as well as for theories of consciousness. The book draws on leading research from philosophy, experimental psychology, functional imaging of the brain, neuropsychology, neuroscience, and clinical neurology. Distinctive in its accessibility, authority, and its depth of coverage, Frontiers of Consciousness will be a groundbreaking and influential addition to the consciousness literature. (shrink)

Sustainability science seeks to extend scientific investigation into domains characterized by a distinct problem-solving agenda, physical and social complexity, and complex moral and ethical landscapes. In this endeavor it arguably pushes scientific investigation beyond its usual comfort zones, raising fundamental issues about how best to structure such investigation. Philosophers of science have long scrutinized the structure of science and scientific practices, and the conditions under which they operate effectively. We propose a critical engagement between sustainability scientists and philosophers of science (...) with respect to how to engage in scientific activity in these complex domains. We identify specific issues philosophers of science raise concerning current sustainability science and the contributions philosophers can make to resolving them. In conclusion we reflect on the steps philosophers of science could take to advance sustainability science. (shrink)

A fundamental cognitive function found across a wide range of species and necessary for survival is the ability to navigate complex environments. It has been suggested that mobility may play an important role in the development of spatial skills. Despite evolutionary arguments offering logical explanations for why sex/gender differences in spatial abilities and mobility might exist, thus far there has been limited sampling from nonindustrialized and subsistence-based societies. This lack of sampling diversity has left many unanswered questions regarding the effects (...) that environmental variation and cultural norms may have in shaping mobility patterns during childhood and the development of spatial competencies that may be associated with it. Here we examine variation in mobility, performance on large-scale spatial skills, and performance on small-scale spatial skills among Twa forager/pastoralist children whose daily lives have been dramatically altered since settlement and the introduction of government-funded boarding schools. Unlike in previous findings among Twa adults, boys and girls show similar patterns of travel on all measures of mobility. We also find no significant differences in spatial task performance by gender for large- or small-scale spatial skills. Further, children performed as well as adults did on mental rotation, and they outperformed adults on the water-level task. We discuss how children’s early learning environments may influence the development of both large- and small-scale spatial skills. (shrink)

The article discusses some of the major issues which need to be examined in a gendered reading of citizenship. However, its basic claim is that a comparative study of citizenship should consider the issue of women's citizenship not only by contrast to that of men, but also in relation to women's affiliation to dominant or subordinate groups, their ethnicity, origin and urban or rural residence. It should also take into consideration global and transnational positionings of these citizenships. The article challenges (...) the gender-blind and Westocentric character of many of the most hegemonic theorizations of citizenship, focusing in particular on the questions of membership in ‘the community’, group rights and social difference and the ways binaries of public/private and active/passive have been constructed to differentiate between different kinds of citizenships. The article argues that in order to be able to analyse adequately people's citizenship, especially in this era of ethnicization on the one hand and globalization on the other hand, and with the rapid pace at which relationships between states and their civil societies are changing, citizenship should best be analysed as a multi-tiered construct which applies, at the same time to people's membership in sub-, cross- and supra-national collectivities as well as in states. (shrink)

In this paper, I defend the agent/patient distinction against critics who argue that causal interactions are symmetrical. Specifically, I argue that there is a widespread type of causal interaction between distinct entities, resulting in a type of ontological asymmetry that provides principled grounds for distinguishing agents from patients. The type of interaction where the asymmetry is found is when one of the entities undergoes a change in kind, structure, powers, or intrinsic properties as a result of the interaction while the (...) other does not. Interactions of this type are widespread in molecular biology and chemistry. I focus specifically on (i) the actions of enzymes on substrates and (ii) water molecules breaking the bonds of polarized molecules. Finally, I respond to objections by laying out and to a limited extent defending three commitments of my account: emergent entities and powers, realism about chemical kinds or structures, and the assumption of the agent/patient distinction in functional attributions in biology. (shrink)

I argue that the debate between proponents of substance causation and proponents of causation by powers, as to whether substances or their powers are causes, hinges on whether or not powers are self-exemplifying or non-self-exemplifying properties. Substance causation is committed to powers being non-self-exemplifying properties while causation by powers is committed to powers being self-exemplifying properties. I then argue that powers are non-self-exemplifying properties, in support of substance causation.

The use of ‘S knows p’ varies from context to context. The contextualist theories of Cohen, Lewis, and DeRose explain this variation in terms of semantic hypotheses: ‘S knows p’ is indexical in meaning, referring to features of the ascriber’s context like salience, interests, and stakes. The linguistic evidence against contextualism is extensive. I maintain that the contextual variation of knowledge claims results from pragmatic factors. One is variable strictness (Davis, Philos Stud, 132(3):395–438, 2007). In addition to its strict use, (...) ‘S knows p’ may be used loosely to implicate that S is close enough to knowing p for contextually indicated purposes. Here I explore another variable: belief about what is known. This factor is pragmatic rather than semantic in that it affects the use of ‘S knows p’ without affecting its truth conditions. While variation in strictness accounts for the variation in the bank, parking, and some lottery cases, variation in belief accounts for the variation in other lottery cases and the epistemology cases. Along the way, I sketch an insensitive invariantist semantics that is strict but non-skeptical, and show how it works with these pragmatic factors. (shrink)

Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for thinking about vaccine-sensitive resource (...) allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics. (shrink)

Machine learning algorithms pervade contemporary society. They are integral to social institutions, inform processes of governance, and animate the mundane technologies of daily life. Consistently, the outcomes of machine learning reflect, reproduce, and amplify structural inequalities. The field of fair machine learning has emerged in response, developing mathematical techniques that increase fairness based on anti-classification, classification parity, and calibration standards. In practice, these computational correctives invariably fall short, operating from an algorithmic idealism that does not, and cannot, address systemic, Intersectional (...) stratifications. Taking present fair machine learning methods as our point of departure, we suggest instead the notion and practice of algorithmic reparation. Rooted in theories of Intersectionality, reparative algorithms name, unmask, and undo allocative and representational harms as they materialize in sociotechnical form. We propose algorithmic reparation as a foundation for building, evaluating, adjusting, and when necessary, omitting and eradicating machine learning systems. (shrink)

The aim of the article is to further assess and develop feminist standpoint theory by introducing the notion of the `situated imagination' as constituting an important part of this theory as well as that of `situated knowledge'. The article argues that the faculty of the imagination constructs as well as transforms, challenges and supersedes both existing knowledge and social reality. However, like knowledge, it is crucial to theorize the imagination as situated, that is, as shaped and conditioned (although not determined) (...) by social positioning. (shrink)

Peterson et al. (2023) identify two potential uses of psychedelic drugs in Alzheimer’s disease and related disorders (AD/ADRD). The first is to treat depression and anxiety that commonly occur afte...

I offer an analysis of the role played by consideration of an item's functions when it is judged aesthetically. The account applies also to artworks, of which some serve extrinsic functions (such as the glorification of God and the communication of religious lore) and others have the function of being contemplated for their own sake alone. Along the way, I deny that aesthetic judgements fit the model of judgements either of free beauty or of dependent beauty, given how these two (...) came to be described in the early twentieth century. (shrink)

An inquiry into the nature of the universe draws out the implications of the quantum theory and argues that our universe is only one among many possible universes and that other universes may exist.

Recent empirical work has offered strong support for ‘biased pluralism’ and ‘economic elite’ accounts of political power in the United States, according a central role to ‘business interest groups’ as a mechanism through which corporate influence is exerted. Here, we propose an additional channel of influence for corporate interests: the ‘policy-planning network,’ consisting of corporate-dominated foundations, think tanks, and elite policy-discussion groups. To evaluate this assertion, we consider one key policy-discussion group, the Council on Foreign Relations. We first briefly review (...) the origins of this organization and then review earlier findings on its influence. We then code CFR policy preferences on 295 foreign policy issues during the 1981–2002 period. In logistic regression analyses, we find that the preferences of more affluent citizens and the CFR were positive, statistically significant predictors of foreign policy outcomes while business interest group preferences were not. These findings are discussed with a consideration of the patterns of CFR ‘successes’ and ‘failures’ for the issues in our dataset. Although a full demonstration of a causal connection between corporate interests, the policy-planning network and policy outcomes requires further research, we conclude that this has been shown to be a plausible mechanism through which corporate interests are represented and that ‘biased pluralism’ researchers should include it in their future investigations. (shrink)

How far can consistent assessment capture all the worthwhile features of educational achievement? Are some important components of learning necessarily open to a range of potentially inconsistent judgments by different assessors? I argue for a cautiously affirmative answer to this question, drawing on analogies with aesthetic judgments and a rehearsal of the holistic characteristics of some assessment criteria. I also employ recent treatments of moral particularism and of concepts of incommensurability to oppose the drive for consistency in assessment required by (...) a high stakes accountability regime. (shrink)

The social impacts of computer technology are often glorified in public discourse, but there is growing concern about its actual effects on society. In this article, we ask: how does “consent” as an analytical framework make visible the social dynamics and power relations in the capture, extraction, and labor of data science knowledge production? We hypothesize that a form of boundary violation in data science workplaces—gender harassment—may correlate with the ways humans’ lived experiences are extracted to produce Big Data. The (...) concept of consent offers a useful way to draw comparisons between gender relations in data science and the means by which machines are trained to learn and reason. Inspired by how Big Tech leaders describe unsupervised machine learning, and the co-optation of “revolutionary” rhetoric they use to do so, we introduce a concept we call “techniques of invisibility.” Techniques of invisibility are the ways in which an extreme imbalance between exposure and opacity, demarcated along fault lines of power, are fabricated and maintained, closing down the possibility for bidirectional transparency in the production and applications of algorithms. Further, techniques of invisibility, which we group into two categories—epistemic injustice and the Brotherhood—include acts of subjection by powerful actors in data science designed to quell resistance to exploitative relations. These techniques may be useful in making further connections between epistemic violence, sexism, and surveillance, sussing out persistent boundary violations in data science to render the social in data science visible, and open to scrutiny and debate. (shrink)

Utilitarianism has an apparent pedigree when it comes to animal welfare. It supports the view that animal welfare matters just as much as human welfare. And many utilitarians support and oppose various practices in line with more mainstream concern over animal welfare, such as that we should not kill animals for food or other uses, and that we ought not to torture animals for fun. This relationship has come under tension from many directions. The aim of this article is to (...) add further considerations in support of that tension. I suggest three ways in which utilitarianism comes significantly apart from mainstream concerns with animal welfare. First, utilitarianism opposes animal cruelty only when it offers an inefficient ratio of pleasure to pain; while this may be true of eating animal products, it is not obviously true of other abuses. Second, utilitarianism faces a familiar problem of the inefficacy of individual decisions; I consider a common response to this worry, and offer further concerns. Finally, the common utilitarian argument against animal cruelty ignores various pleasures that humans may get from the superior status that a structure supporting exploitation confers. (shrink)

“Public Trust in Expert Knowledge: Narrative, Ethics, and Engagement” examines the social, cultural, and ethical ramifications of changing public trust in the expert biomedical knowledge systems of emergent and complex global societies. This symposium was conceived as an interdisciplinary project, drawing on bioethics, the social sciences, and the medical humanities. We settled on public trust as a topic for our work together because its problematization cuts across our fields and substantive research interests. For us, trust is simultaneously a matter of (...) ethics, social relations, and the cultural organization of meaning. We share a commitment to narrative inquiry across our fields of expertise in the bioethics of transformative health technologies, public communications on health threats, and narrative medicine. The contributions to this symposium have applied, in different ways and with different effects, this interdisciplinary mode of inquiry, supplying new reflections on public trust, expertise, and biomedical knowledge. (shrink)

The nonvisual self-touch rubber hand paradigm elicits the compelling illusion that one is touching one’s own hand even though the two hands are not in contact. In four experiments, we investigated spatial limits of distance and alignment on the nonvisual self-touch illusion and the well-known visual rubber hand illusion. Common procedures and common assessment methods were used. Subjective experience of the illusion was assessed by agreement ratings for statements on a questionnaire and time of illusion onset. The nonvisual self-touch illusion (...) was diminished though never abolished by distance and alignment manipulations, whereas the visual rubber hand illusion was more robust against these manipulations. We assessed proprioceptive drift, and implications of a double dissociation between subjective experience of the illusion and proprioceptive drift are discussed. (shrink)

To address what I call the “Uniformity”, “Capriciousness”, and “Reducibility” objections, recent agent-causation theories hold that agent-causation is a type of substance causation. Substance causation consists in substances producing effects by exercising or manifesting their powers. Importantly, these versions of agent-causation assume a realist metaphysics of powers, where powers are properties of substances that can exist unmanifested. However, the realist theories of powers that agent-causal theories have relied upon explicitly hold that powers—rather than their substances—are causes. Substances are merely derivative (...) causes, as the bearers of powers. Critics therefore argue that agent-causation is reducible to causation by the agent’s powers. In this paper, I argue that agent-causation is reducible to causation by the agent’s powers only if powers are self-exemplifying properties. I also offer reasons for why powers—especially agent-causal powers—are non-self-exemplifying properties, in support of the irreducibility of agent-causation. (shrink)

According to telling based views of testimony (TBVs), B has reason to believe that p when A tells B that p because A thereby takes public responsibility for B's subsequent belief that p. Andrew Peet presents a new argument against TBVs. He argues that insofar as A uses context-sensitive expressions to express p, A doesn't take public responsibility for B's belief that p. Since context-sensitivity is widespread, the kind of reason TBVs say we have to believe what we're told, is (...) not widespread. Peet doesn't identify any problem with his own argument though he does attempt to limit its sceptical potential by identifying special contexts in which TBVs stand a chance of success. A more general defence of TBVs can be provided by showing Peet's argument to be unsound. I argue that Peet's argument is unsound because it requires us to wrongly suppose that speakers do far less labour than their audiences in context-sensitive linguistic communication. I aim to show why—in the context of the epistemology of testimony and the philosophy of language—it's important to recognize the labour that speakers can do, and so can can be held responsible for not doing, in episodes of context-sensitive linguistic communication. (shrink)

Training for members of research ethics committees varies from state to state in Europe. To follow this up, the European Forum for Good Clinical Practice organised a workshop in March 2007 to explore these issues and look for solutions. This article summarises the discussion, providing ways forward to develop REC training.

Inattentional blindness studies have shown that an unexpected object may go unnoticed if it does not share the property specified in the task instructions. Our aim was to demonstrate that observers develop an attentional set for a property not specified in the task instructions if it allows easier performance of the primary task. Three experiments were conducted using a dynamic selective-looking paradigm. Stimuli comprised four black squares and four white diamonds, so that shape and colour varied together. Task instructions specified (...) shape but observers developed an attentional set for colour, because we made the black–white discrimination easier than the square–diamond discrimination. None of the observers instructed to count bounces by squares reported an unexpected white square, whereas two-thirds of observers instructed to count bounces by diamonds did report the white square. When attentional set departs from task instructions, you may fail to see what you were told to look for. (shrink)

The paper examines the effects of intersecting social divisions on constructions of multi‐layered citizenships and the politics of belonging in contemporary Britain. It starts with conceptual clarifications of the notions of citizenship, belonging and intersectionality and then turns to examine contemporary politics of belonging in contemporary Britain, focusing on the current debate on the ‘death of multiculturalism’ and on ‘social cohesion’. It illustrates how the use of civic and democratic values as signifiers of belonging can end up as exclusionary, rather (...) than inclusionary in that discourse. (shrink)

In this paper we explore the idea that Pentecostalism is best supported by conjoining it to a postmodern, narrative epistemology in which everything is a text requiring interpretation. On this view, truth doesn’t consist in a set of uninterpreted facts that make the claims of Christianity true; rather, as James K. A. Smith says, truth emerges when there is a “fit” or proportionality between the Christian story and one’s affective and emotional life. We argue that Pentecostals should reject this account (...) of truth, since it leads to either a self-refuting story-relativism or the equally problematic fallacy of story-ism: favoring one’s own story over others without legitimate reason. In either case, we contend, the gospel itself is placed at risk. (shrink)