During the Covid‐19 pandemic, as resources dwindled, clinicians, health care institutions, and policymakers have expressed concern about potential legal liability for following crisis standards of care (CSC) plans. Although there is no robust empirical research to demonstrate that liability protections actually influence physician behavior, we argue that limited liability protections for health care professionals who follow established CSC plans may instead be justified by reliance on the principle of reciprocity. Expecting physicians to do something they know will harm their patients (...) causes moral distress and suffering that may leave lasting scars. Limited liability shields are both appropriate and proportionate to the risk physicians are being asked to take in such circumstances. Under certain narrow circumstances, it remains unclear that the standard of care is sufficiently flexible to protect physicians from liability. Given this uncertainty, the likelihood that physicians would be sued for such an act, and their desire for such immunity, this limited protection is morally legitimate. (shrink)

Ten years ago, Megan Shinal sought the care of neurosurgeon Steven Toms for the surgical treatment of a recurrent nonmalignant tumor in the pituitary region of her brain. In their twenty-minute meeting, Shinal did not make a final decision about which surgical approach she wished to pursue. Subsequently, she spoke with Tom's physician assistant once by phone and once in person, when she signed the consent form, which did not appear to designate which surgical approach she had chosen. During the (...) operation—a total resection—Toms perforated Shinal's carotid artery, resulting in hemorrhage, stroke, brain injury, and partial blindness. The jury found that Toms had fulfilled his informed-consent obligations prior to performing the resection; however, in June 2017, the Supreme Court of Pennsylvania overturned the decision, relying on the Pennsylvania Medical Care Availability and Reduction of Error Act. The court found that the language of the act is unambiguous in its requirement that “a physician's duty to provide information to a patient sufficient to obtain her informed consent is non-delegable.” Presumably, this rule of nondelegation applies beyond the surgical theater to other major treatment decisions. And it is unclear whether it applies to other professionals in a subordinate position to the treating physician, such as residents and fellows. (shrink)

Volume 20, Issue 7, July 2020, Page 153-155.

Genetic testing has led to the establishment of the concept of the “previvor”: someone who is not yet sick, but who has a genetic predisposition to disease. The previvor experience demonstrates how the practice of medicine and medical decision making is evolving to render current law and policy increasingly inapplicable to modern medical practice. The introduction of previvorship to the medical landscape raises special issues for the physician-patient relationship and the legal doctrine of informed consent. It challenges some of the (...) most basic assumptions underlying the doctrine, is representative of the doctrine’s declining utility, and is illustrative of the need to transition to a shared decision-making model. Thus, we should begin to envision a legal doctrine that supports a robust shared decision-making approach to address individual preferences and values, the increasing complexity of risk/benefit assessment, and inherent (and sometimes irreducible) uncertainty. Such an approach should emphasize a new, more expansive, and inclusive model of illness. (shrink)

American history has been rife with human subjects research scandals, particularly those that involve “vulnerable” populations. State and federal laws and regulations often do not provide any special oversight mechanisms or protections to ensure the ethical and safe inclusion of cognitively impaired adults in research. At the New York State level, repeated efforts have been made to regulate research involving individuals who lack consent capacity. In January 2014, the New York State Task Force on Life and the Law released its (...) Report and Recommendations for Research with Human Subjects Who Lack Consent Capacity, which represents the most recent step in a decades-long process in the state to develop oversight mechanisms that are appropriately sensitive to the fine line between protecting a vulnerable population and impeding the advancement of research. These recommendations may serve as a model for research policy in other states and at the federal level, particularly in light of shifting societal concerns and changing political winds. (shrink)

Despite existing federal and state law and regulation, new human subjects research scandals involving “vulnerable” populations continue to surface. Although existing oversight mechanisms were enacted to ensure voluntary informed consent for participants and institutional review board oversight of HSR, these laws and regulations do not provide any special oversight mechanisms or protections to ensure the ethical and safe inclusion of cognitively impaired adults. The absence of rules to ensure consistently ethical conduct of research involving adults who lack consent capacity may (...) either lead to exploitation of this vulnerable population or the dearth of important research into the broad range of diseases that impair cognition. In other words, while some institutions and investigators are conducting research with this group without guidance, others are taking an extremely conservative approach and are excluding these individuals from research. Without safeguards that are adequate and robust but not overly burdensome, conducting research involving this population is ethically and legally challenging. (shrink)

In Saks v. Franklin Covey Co., the Court of Appeals for the Second Circuit held that the American with Disabilities Act, Title VII of Civil Rights Act of 1964, the Pregnancy Discrimination Act, and New York state law do not proscribe an employer's self-insured employee health plan from excluding surgical impregnation procedures from its coverage. Although the court found that infertility qualifies as a disability under the ADA, it restricted required coverage of certain infedty treatments.Title I of the ADA prohibits (...) an employer from discriminating on the basis of disability “in regard to … fringe benefits available by virtue of employment, whether or not administered by the covered entity.” The ADA defines “disability” as “a physical or mental impairment that substantially limits one or more major life activities.” In Bragdon v. Abbott, the U.S. Supreme Court found that reproduction was a major life activity under the ADA. (shrink)

In Saks v. Franklin Covey Co., the Court of Appeals for the Second Circuit held that the American with Disabilities Act, Title VII of Civil Rights Act of 1964, the Pregnancy Discrimination Act, and New York state law do not proscribe an employer's self-insured employee health plan from excluding surgical impregnation procedures from its coverage. Although the court found that infertility qualifies as a disability under the ADA, it restricted required coverage of certain infedty treatments.Title I of the ADA prohibits (...) an employer from discriminating on the basis of disability “in regard to … fringe benefits available by virtue of employment, whether or not administered by the covered entity.” The ADA defines “disability” as “a physical or mental impairment that substantially limits one or more major life activities.” In Bragdon v. Abbott, the U.S. Supreme Court found that reproduction was a major life activity under the ADA. (shrink)

Morain and colleagues (2019) advocate rethinking the rather dogmatic guidance from both regulatory authorities and professional associations cautioning physician-investigators against obtaining inf...

In Kentucky Association of Health Plans, Inc. v. Miller,, the Supreme Court unanimously held that states’ “any willing provider” laws are not preempted by the Employee Retirement Income Security Act of 1974. The Court ruled that states can regulate their health maintenance organizations, and thus upheld a Kentucky law that requires insurers to reimburse services of any health care provider who is willing and able to meet established criteria. The Supreme Court has heard several cases related to ERISA in the (...) last few years, and other such cases are working their way through the court system. Coupled with this most recent decision in Miller, the Supreme Court may significantly alter the shape of the insurance industry. (shrink)

In Kentucky Association of Health Plans, Inc. v. Miller,, the Supreme Court unanimously held that states’ “any willing provider” laws are not preempted by the Employee Retirement Income Security Act of 1974. The Court ruled that states can regulate their health maintenance organizations, and thus upheld a Kentucky law that requires insurers to reimburse services of any health care provider who is willing and able to meet established criteria. The Supreme Court has heard several cases related to ERISA in the (...) last few years, and other such cases are working their way through the court system. Coupled with this most recent decision in Miller, the Supreme Court may significantly alter the shape of the insurance industry. (shrink)

Effective November 1, 2002, the federal Department of Health and Human Services reclassified developing fetuses as “unborn children,” thereby providing health insurance benefits for prenatal care under the State Children's Health Insurance Program. By broadening the current definition of “child” —and thus expanding SCHIP insurance coverage — DHHS hopes to increase the number of low-income pregnant women who receive prenatal services. As noted by one commentator, the new rule represents the first time “any federal policy has defined childhood as beginning (...) at conception.”In an attempt to improve access to publicly funded health insurance for poor children not covered by Medicaid, Congress established SCHIP a 10-year, $40 billion program jointly funded by federal and state governments. Through a series of block grants, SCHIP allows states to either expand income-eligibility for their existing Medicaid program or to create a separate child health program to decrease the number of uninsured poor and near-poor children. (shrink)

Effective November 1, 2002, the federal Department of Health and Human Services reclassified developing fetuses as “unborn children,” thereby providing health insurance benefits for prenatal care under the State Children's Health Insurance Program. By broadening the current definition of “child” —and thus expanding SCHIP insurance coverage — DHHS hopes to increase the number of low-income pregnant women who receive prenatal services. As noted by one commentator, the new rule represents the first time “any federal policy has defined childhood as beginning (...) at conception.”In an attempt to improve access to publicly funded health insurance for poor children not covered by Medicaid, Congress established SCHIP a 10-year, $40 billion program jointly funded by federal and state governments. Through a series of block grants, SCHIP allows states to either expand income-eligibility for their existing Medicaid program or to create a separate child health program to decrease the number of uninsured poor and near-poor children. (shrink)

Sugar, pork, beer, corn, cider, scrapple, and hoppin' John all became staples in the diet of colonial America. The ways Americans cultivated and prepared food and the values they attributed to it played an important role in shaping the identity of the newborn nation. In A Revolution in Eating, James E. McWilliams presents a colorful and spirited tour of culinary attitudes, tastes, and techniques throughout colonial America. Confronted by strange new animals, plants, and landscapes, settlers in the colonies and West (...) Indies found new ways to produce food. Integrating their British and European tastes with the demands and bounty of the rugged American environment, early Americans developed a range of regional cuisines. From the kitchen tables of typical Puritan families to Iroquois longhouses in the backcountry and slave kitchens on southern plantations, McWilliams portrays the grand variety and inventiveness that characterized colonial cuisine. As colonial America grew, so did its palate, as interactions among European settlers, Native Americans, and African slaves created new dishes and attitudes about food. McWilliams considers how Indian corn, once thought by the colonists as "fit for swine," became a fixture in the colonial diet. He also examines the ways in which African slaves influenced West Indian and American southern cuisine. While a mania for all things British was a unifying feature of eighteenth-century cuisine, the colonies discovered a national beverage in domestically brewed beer, which came to symbolize solidarity and loyalty to the patriotic cause in the Revolutionary era. The beer and alcohol industry also instigated unprecedented trade among the colonies and further integrated colonial habits and tastes. Victory in the American Revolution initiated a "culinary declaration of independence," prompting the antimonarchical habits of simplicity, frugality, and frontier ruggedness to define American cuisine. McWilliams demonstrates that this was a shift not so much in new ingredients or cooking methods, as in the way Americans imbued food and cuisine with values that continue to shape American attitudes to this day. (shrink)

“Indulging herself in air and exercise” as she wanders down a lane near the great house of Rosings, Elizabeth Bennet is unaware that she is just about to experience one of her most difficult challenges, and that Mr. Darcy is on his way with his letter.1 Just like present-day personality theorists, Jane Austen manifestly directed a great deal of creative and intellectual energy into devising a great variety of tests. But what are such situations designed to test for? What aspects (...) of character or personality, or traits and abilities, are meant to be scrutinized? A likely response from critics interested in Austen’s ethics is that such challenges should reveal which, if any, of the virtues are in good working order. .. (shrink)

It is fortunate for the community in which she lives that one of the things about which Elinor Dashwood cares a great deal is the social duty of “general civility”—the practice, in Hume’s words, of “gentle usage.” The heroine of Sense and Sensibility is respectful and considerate toward others, whether or not these are dearly loved family members or comparative strangers. According to Karen Stohr, throughout the novel, “Elinor is the exemplar of moderation, propriety and moral rectitude,” and the reader’s (...) assessment is seemingly quite straightforward: we can rest assured that although others may be unscrupulous, self-aggrandizing, and/or self-deceiving, Elinor Dashwood is virtuous from beginning to end.1.. (shrink)

To Wayne Booth it was clear, authors seek to exert control and writers like Jane Austen endeavor to satisfy this imperative through rhetorical techniques that may include the creation of a wise male figure who can be counted upon to provide the necessary guidance for flawed heroine and reader alike. We require help "to direct our reactions," and thus throughout Austen's novel Emma, her hero and "chief corrective," Mr. Knightley, stands in the reader's mind for what Emma lacks.1 Subsequent scholars (...) have questioned Booth's interpretation of Mr. Knightley's role and narrative status, and the subtitle of Mary Waldron's influential essay—"The Confusions of Mr. Knightley"—anticipates her views on the subject.2In... (shrink)

As of this writing, twenty‐one states have passed laws barring transgender youth‐athletes from competing on public‐school sports teams in accordance with their gender identity. Proponents of these regulations claim that transgender females in particular have inherent physiological advantages that threaten a “level playing field” for their cisgender competitors. Existing evidence is limited but does not support these restrictions. Gathering more robust data will require allowing transgender youth to compete (rather than preemptively barring them), but even if trans females are shown (...) to retain some advantage, this would not have greater moral significance than the many other “fair” physical and economic advantages found across sports. These regulations deprive transgender youth, an exceptionally vulnerable population, from the vast physical, mental, and social benefits of sports. While we advocate for transgender inclusion under our current, gender‐segregated model of sport, we propose changes to the overarching structure that would promote a more inclusive and fairer athletic environment. (shrink)

This book focuses on some of the most pressing methodological, ethical, and technique-philosophical questions that are connected with the concept of artificial autonomous systems. (Series: Hermeneutics and Anthropology / Hermeneutik und ...

Social problems such as racism, sexism, and inequality are often cited as structural rather than individual in nature. What does it mean to invoke a social structural explanation, and how do such explanations relate to individualistic ones? This article explores recent philosophical debates concerning the nature and usages of social structural explanation. I distinguish between two central kinds of social structural explanation: those that are autonomous from psychology, and those that are not. This distinction will help clarify the explanatory power (...) that each type of SSE has, points of convergence with methodological traditions such as critical theory and rational choice theory, and the difficulties that each type of SSE faces. (shrink)

This chapter contains sections titled: Multiple Educational Aims and Authorities Vouchers, Parental Choice, and Public Voice Curricular Controversies in a Multicultural Society Educating Cosmopolitans or Patriots? Affirmative Action, Academic Freedom, and Higher Education Democracy, Democratic Education, and Deliberation Acknowldgements.

Human dignity defines the foundation of mutual respect between persons in the law. In German constitutional law it defends a realm of individual freedom and inviolable protection against the interests of the collective. Dignity as a legal concept is not a good to be balanced or weighed against other goods, but a prohibition norm, not a reason but a constraint, thus guaranteeing a non-consequentialist and especially a non-utilitarian understanding of basic rights.

(2014). Tin Men: Ethics, Cybernetics and the Importance of Soul. Journal of Military Ethics: Vol. 13, No. 1, pp. 3-19. doi: 10.1080/15027570.2014.908011.

ion and Ideation - The Semantics of chemical and biological fundamental concepts. The methods of abstraction and ideation are indispensable tools to introduce new concepts in a scientific terminology. The latter is paradigmatically introduced within the 'protophysical program' whereas abstraction is commonly applied in logics and mathematics. The application within the reconstruction of chemistry and biology causes several problems. Ideation appears to be inadequate whereas the application of abstraction necessitates a critical and minute examination of the corresponding equivalence relations. These (...) problems are solved by the introduction of the method of materially-synthetic abstraction which is exemplified by the introduction of the chemical concept of 'substance' and the biological concept of 'hereditary factor'. (shrink)

Summary The concept of evolutionary epistemology has been critically discussed by philosophers who have mainly pointed to unacceptable philosophical tenets (cf. Vittorio Hösle, this Journal, Vol. 19 (1988), pp. 348–377). However, as most philosophers are extremely reluctant to critically treat the biological theories on which the ideas of evolutionary epistemology are based, the invalid concepts of adaption escaped their critical scrutiny. Therefore the influence of preconceived biological theories on the biological basis of evolutionary epistemology and the distorting consequences on the (...) philosophical level could not be elaborated. The following context sketches a new view of organismic reasoning and its impact on evolutionary aspects of epistemology. The basic theorem of adaptation is shown to be unacceptable and invalid if organisms are conceived as autonomous entities which can only evolve according to their specific internal organismic properties. (shrink)

The most widely debated conception of democracy in recent years is deliberative democracy--the idea that citizens or their representatives owe each other mutually acceptable reasons for the laws they enact. Two prominent voices in the ongoing discussion are Amy Gutmann and Dennis Thompson. In Why Deliberative Democracy?, they move the debate forward beyond their influential book, Democracy and Disagreement.What exactly is deliberative democracy? Why is it more defensible than its rivals? By offering clear answers to these timely questions, (...) class='Hi'>Gutmann and Thompson illuminate the theory and practice of justifying public policies in contemporary democracies. They not only develop their theory of deliberative democracy in new directions but also apply it to new practical problems. They discuss bioethics, health care, truth commissions, educational policy, and decisions to declare war. In "What Deliberative Democracy Means," which opens this collection of essays, they provide the most accessible exposition of deliberative democracy to date. They show how deliberative democracy should play an important role even in the debates about military intervention abroad.Why Deliberative Democracy? contributes to our understanding of how democratic citizens and their representatives can make justifiable decisions for their society in the face of the fundamental disagreements that are inevitable in diverse societies. Gutmann and Thompson provide a balanced and fair-minded approach that will benefit anyone intent on giving reason and reciprocity a more prominent place in politics than power and special interests. (shrink)

To what extent should we focus on implicit bias in order to eradicate persistent social injustice? Structural prioritizers argue that we should focus less on individual minds than on unjust social structures, while equal prioritizers think that both are equally important. This article introduces the framework of transactive memory into the debate to defend the equal priority view. The transactive memory framework helps us see how structure can emerge from individual interactions as an irreducibly social product. If this is right, (...) then debiasing interventions are structural interventions. One upshot is that the utility of the individual versus structural distinction is not apparent for the purposes of intervention. (shrink)

How should you live? Should you devote yourself to perfecting a single talent or try to live a balanced life? Should you lighten up and have more fun, or buckle down and try to achieve greatness? Should you try to be a better friend? Should you be self-critical or self-accepting? And how should you decide among the possibilities open to you? Should you consult experts, listen to your parents, or should you do lots of research? Should you make lists of (...) pros and cons, or go with your gut? These are not questions that can be answered in general or in the abstract. Rather, these questions are addressed to the first person point of view, to the perspective each of us occupies when we reflect on how to live without knowing exactly what we're aiming for. To answer them, this book focuses on the process of living one's life from the inside, rather than on defining goals from the outside. Drawing on traditional philosophical sources as well as literature and recent work in social psychology, this book argues that to live well, we need to develop reflective wisdom: to care about things that will sustain us and give us good experiences, to have perspective on our successes and failures, and to be moderately self-aware and cautiously optimistic about human nature. Further, we need to know when to think about our values, character, and choices, and when not to. A crucial part of wisdom, the book maintains, is being able to shift perspectives: to be self-critical; to be realistic; to examine life when reflection is appropriate, but not when we should lose ourselves in experience. (shrink)

What is well-being? This is one of humanity's oldest and deepest questions; Valerie Tiberius offers a fresh answer. She argues that our lives go well to the extent that we succeed in what matters to us emotionally, reflectively, and over the long term. So when we want to help others achieve well-being, we should pay attention to their values.

It is commonly accepted that what we ought to do collectively does not imply anything about what each of us ought to do individually. According to this line of reasoning, if cooperating will make no difference to an outcome, then you are not morally required to do it. And if cooperating will be personally costly to you as well, this is an even stronger reason to not do it. However, this reasoning results in a self-defeating, yet entirely predictable outcome. If (...) everyone is rational, no one will cooperate, resulting in an aggregate outcome that is devastating for everyone. This dismal analysis explains why climate change and other collective action problems are so difficult to ameliorate. The goal of this paper is to provide a different, exploratory framework for thinking about individual reasons for action in collective action problems. I argue that the concept of commitment gives us a new perspective on collective action problems. Once we take the structure of commitment into account, this activates requirements of diachronic rationality that give individuals instrumental reasons to cooperate in collective action problems. (shrink)

This paper argues that some widely used laws of implication are false, and arguments based upon them invalid. These laws are Exportation, Commutation, (as well as various restricted forms of these), Exported Syllogism and Disjunctive Syllogism. All these laws are false for the same reason – that they license the suppression or replacement in some position of some class of propositions which cannot legitimately be suppressed or replaced. These laws fail to preserve the property of sufficiency of premiss set for (...) conclusion. They are false, and can be seen to be false, independently of their respon- sibility for the paradoxes. Hence the main ‘independent’ argument for the paradoxes – that they follow from an allegedly immaculate set of laws – is undermined. Counterexamples to all these laws are produced. (shrink)

There is a bias in neuroscience toward localizing and modularizing brain functions. Single cell recording, imaging studies, and the study of neurological deficits all feed into the Gallian view that different brain areas do different things and the things being done are confined to particular processing streams. At the same time, there is a growing sentiment that brains probably don’t work like that after all; it is better to conceive of them as fundamentally distributed units, multi‐tasking at every level. This (...) sentiment, however, is much less congenial to the tried‐and‐true experimental protocols available today and to theorizing about the brain in general. This essay examines the tension between current experimental methods and large-scale views of the brain. We argue that this disconnection between experiment and what really are guiding theoretical metaphors seriously impedes progress in neuroscience. (shrink)

The authors offer ways to encourage and educate Americans to participate in the public deliberations that make democracy work and lay out the principles of..

Feminist Political Theory provides both a wide-ranging history of western feminist thought and a lucid analysis of contemporary debates. It offers an accessible and thought-provoking account of complex theories, which it relates to 'real-life' issues such as sexual violence, political representation and the family. This timely new edition has been thoroughly updated to incorporate the most recent developments in feminism and feminist scholarship throughout, in particular taking into account the impact of black and postmodern feminist thought on feminist political theory.

This book explores interdisciplinary approaches to animal-focused curriculum and pedagogy in environmental education, with an emphasis on integrating methods from the arts, humanities, and natural and social sciences. Each chapter, whether addressing curriculum, pedagogy, or both, engages with the extant literature in environmental education and other relevant fields to consider how interdisciplinary curricular and pedagogical practices shed new light on our understandings of and ethical/moral obligations to animals. Embracing theories like intersectionality, posthumanism, Indigenous cosmologies, and significant life experiences, and considering (...) topics such as equine training, meat consumption and production, urban human-animal relationships, and zoos and aquariums, the chapters collectively contribute to the field by foregrounding the lives of animals. The volume purposefully steps forward from the historical marginalization of animals in educational research and practice. (shrink)