The Hospital Standardised Mortality Ratio (HSMR) is a commonly used measure of hospital mortality that is standardised for age, comorbidities and other factors. By tradition, this statistic has always excluded patients classified as ‘palliative’. The HSMR has never been validated as a reliable measure of quality of care, and it can be very hard to interpret, partly due to difficulties with defining and applying the term ‘palliative’. In this paper, we review the Canadian experience with the palliative status flag, and (...) explain why it is so difficult to define and apply consistently. We also highlight some potential concerns about clinicians labelling inpatients as ‘palliative’ during their admission. Finally, we propose an organisational ethics framework, and six specific suggestions for hospitals to use when publishing statistics such as the HSMR. (shrink)

Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

Approximately 50 years have passed since Judith Jarvis Thomson wrote A Defense of Abortion (1971). Her article has significantly shaped the philosophical literature on abortion. In this paper, I will summarize some of the interesting and important work done on the topic since Thomson's article. I will highlight Thomson as a defender of the claim that abortion is morally permissible and Don Marquis as an influential opponent of that claim. I will start by articulating Thomson's case, focusing on the violinist (...) analogy. I will underscore key questions, concepts, and objections the analogy raises. I will then examine briefly how philosophers have addressed some of these issues. Next, I will outline Marquis’ work, provide a similar commentary on it, and discuss some of its main responses. I will then survey other philosophers who have addressed abortion beyond the scope of providing specific replies to Thomson or Marquis. I will close by highlighting significant points of agreement and disagreement in the literature, as well as crucial gaps in the current research. The paper is not an attempt to address every work on the topic over the last five decades, nor is it aimed at taking a position on the moral permissibility of abortion. My goal is to provide an overview of the dialectic. (shrink)

Keisha Ray and Jane Falls Cooper’s article “Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments” seeks to give environmental concerns greater p...

This research aims to examine the Indonesian Ulema Council’s (MUI) fatwa strategy on COVID-19 vaccination booster, which employed religious narrations and laboratory test evidence to justify its arguments. Religious texts become ideological frames that are legitimate and effective in influencing the human senses. This study uses maqashid al-Qur’an as approach. Hence, the use of text of the Qur’an, hadith, and quotations from various ulema’s opinions elucidates the vaccination aim under Islamic law. Based on the MUI fatwa, the primary purpose of (...) the vaccinations is for the sake of national benefits, whereas, from the perspective of maqashid al-Qur’an, it mainly leads to the preservation of the Indonesian people’s life as a whole. The COVID-19 vaccination carried out in Indonesia is for curative purposes; consequently, this programme is classified into the daruriyah [urgent] category. The results revealed that religious authority plays a crucial role in persuading its adherents.Contribution: This research shows that interpreting the Qur’anic verses using the maqashid theory should also be integrated with a scientific approach for the benefit of humanity. (shrink)

Martin offers an intriguing account of nineteenth century challenges to the traditional theory of judgment as a synthesis of subject and predicate (the synthesis theory)--criticisms motivated largely by the problem posed by existential judgments, which need not have two terms at all. Such judgments led to a theory of "thetic" judgments, whose essential feature is to "posit" something, rather than to combine terms (as in synthetic judgment). I argue, however, that Kant's official definition of judgment already implicitly recognizes the importance (...) of positing, and that its (otherwise confusing) abstract generality actually affords Kant's own logic an adequate way to accommodate existential judgments within the traditional synthesis theory. Preservation of a synthetic account of judgment is also found to be independently important for Kant's larger aims in the theory of cognition. (shrink)

This article confronts the challenges and opportunities presented by medical-legal partnerships (MLPs) representing families impacted by the family regulation system. Based on the authors’ experience developing a collaboration between a medical-legal partnership, interdisciplinary law school clinic and nurse home visiting program focused on clients impacted by the family regulation system, the article challenges traditional conceptions of the MLP model and proposes an expanded vision for MLPs to address systemic injustice and improve outcomes for families.

In this article it will be concluded that systematic menstrual tracking in women’s sport has the potential to cause harm to athletes. Since the ruling of Dobbs v. Jackson Women’s Health Organization (2022) in the United States, concerns regarding menstrual health tracking have arisen. Research suggests that the menstrual tracking of female athletes presents potential risks to “women’s autonomy, privacy, and safety in sport” (Casto 2022, 1725). At present, the repercussions of systematic menstrual tracking are particularly under-scrutinized, and this paper (...) seeks to combine novel research in the sport sciences with present ethical debates in the philosophy of sports. Utilizing Beauvoir’s feminist philosophy (2011), this paper argues that systematic menstrual tracking may contribute to the wider system of women’s oppression by exploiting female athletes, as well as enabling the internalization of submissive behaviour in cultures where athletes are expected to comply unquestioningly. Five policy recommendations are made concerning autonomy, informed consent, education, safeguarding and data access. The overall findings of this paper propose that a more in-depth understanding of the links between data, privacy, and the menstrual cycle are required by sports organizations and governing bodies if athletes are to be protected in a future where systematic menstrual tracking is inevitable. (shrink)

There are people where two or more personalities seem to have independent-and sometimes mutually forgetful-control of the same bodily individual. This chapter gives a brief account of the history of the diagnosis of "Multiple Personality Disorder" or "Dissociative Identity Disorder", and the conflicting judgment of therapists, lawyers, and philosophers as to whether this is a real syndrome. It is suggested that the diagnosis may be therapeutically helpful for some other disturbances, including anorexia, even if it does not carry the strong (...) metaphysical moral that some have supposed. The cases are of interest to philosophers as they purport to represent "real -life" difficulties for standard theories of "personal identity." The chapter argues that the diagnosis depend on prior assumptions about such identity, and so don't easily confirm or rebut any available theory, including more ancient theories about demonic possession. (shrink)

Peirce's cosmogony involves an apparent tension concerning the statusof initial ideas. They appear both dependent and independent. Peirce appears to resolve this tension, maintaining elements of both his realism and his idealism in his cosmogony, by asserting that God serves as a necessary condition for the reality of the initial ideas and by holding, through his agapasticism, that the ideas, as firsts, retain an element of spontaneity or freedom. From another angle, it is plausible to suggest that for Peirce God (...) functions as a continuum of other continua. Such a view allows Peirce to understand evolutionas a developmental teleology in which both order and spontaneity playsignificant roles. (shrink)

This article focuses on two possible missions for a national bioethics commission. The first is handling differences of worldview, political orientation, and discipline. Recent work in political philosophy emphasizes regard for the dignity of difference manifested in "conversation" that seeks understanding rather than agreement. The President's Council on Bioethics gets a mixed review in this area. The second is experimenting with prophetic bioethics. "Prophetic bioethics" is a term coined by Daniel Callahan to describe an alternative to compromise-seeking "regulatory bioethics." It (...) involves a critique of modern medicine. In the contemporary context, the areas of biotechnology and access to health care cry out for prophetic attention. The Council has addressed biotechnology; unfortunately, that experience suggests that the kind of prophecy that it practices poses risks to conversation. With regard to access issues, the article proposes an effort that unites themes of human dignity, solidarity, and limits in support of reform, while highlighting, rather than papering over, differences. (shrink)

This volume is a continuation of Robert Greystones on the Freedom of the Will: Selections from His Commentary on the Sentences. From this, five of the most relevant questions were selected for editing and translation in this timely volume. This edition should prompt not just a footnote to, but a re-writing of the history of philosophy.

Noninvasive prenatal testing (NIPT) has become widely available in recent years. While initially used to screen for trisomies 21, 18, and 13, the test has expanded to include a range of other conditions and will likely expand further. This paper addresses the ethical issues that arise from one particularly controversial potential use of NIPT: screening for adult‐onset conditions (AOCs). We report data from our quantitative survey of Australian NIPT users' views on the ethical issues raised by NIPT for AOCs. The (...) survey ascertained support for NIPT for several traits and conditions including AOCs. Participants were then asked about their level of concern around implications of screening for AOCs for the future child and parent(s). Descriptive and comparative data analyses were conducted. In total, 109 respondents were included in data analysis. The majority of respondents expressed support for NIPT screening for preventable (70.9%) and nonpreventable AOCs (80.8%). Most respondents indicated concern around potential harmful impacts associated with NIPT for AOCs, including the psychological impact on the future child and on the parent(s). Despite this, the majority of participants thought that continuation of a pregnancy known to be predisposed to an AOC is ethically acceptable. The implications of these data are critically discussed and used to inform the normative claim that prospective parents should be given access to NIPT for AOCs. The study contributes to a body of research debating the ethical acceptability and regulation of various applications of NIPT as screening panels expand. (shrink)

As self-conscious curators and critics of moral history, the early Confucians are relevant to the contemporary debate over the fate of memorials dedicated to morally flawed individuals. They provide us with a pragmatic justification that is distinct from those utilized in the current debate, and in many respects superior to the alternatives. In addition to supplying this curative philosophic resource, the early Confucian practices of ancestral memorialization suggest preventative measures we might adopt to minimize the chances of establishing divisive and (...) oppressive memorials in the future. (shrink)

This essay is based on a portion of the author’s Spinoza Lecture, which was presented in Amsterdam on 24 May 2022. Although Spinoza is not the main subject of the lecture, his anxieties and fears about his Sephardic Jewishness and its links to Africa and by extension racialized blackness offer an opportunity to outline Euromodern hegemonic geography of reason as a misrepresentation from which a shift in point of view can offer a set of important challenges to the portrait of (...) philosophy it promotes. These challenges are elaborated through the author’s summary of Africana and Black philosophy and the questions that philosophy, understood in intellectual, historical, and political terms, generates. Among these are the meanings of humanity, freedom, justification, redemption, reality, political transformation, and love. (shrink)

The other Hölderlin, an unheroic, unprophetic, un-German, in a word: a poor Hölderlin, might have played an essential role in the development of Eugen Fink’s experienceable ontology as an/other form of idealism. Understood cosmologically as a “quarrel” or “game” between heaven and earth, it is designed to realize Husserl’s term “Weltbewusstseinsleben” as illustrated by Fink’s remark: “Coexistence in cognition is at the same time a testimony to the heavenly spirit.” Thus, a twofold question arises: If, in cognition, coexistence is at (...) the same time a testimony to the heavenly spirit, what is it outside of cognition, if anything? And how does it come to cognition? Reading Fink and Hölderlin together, I suggest the following answers: 1. In cognition, coexistence is at the same time a testimony to the “heavenly”, that is to say: higher, i.e. communal spirit, precisely because 2. it is nothing outside of cognition–nothing but the cosmological laceration of man, the openness of human beings to the world, about which 3. nothing more can be said than that it has always already been there for us to know, for it is being brought to our cognition time and again: through poetry. (shrink)

This essay explores the extent to which Aristotle’s zoological researches were influenced by his general psychological theory and specific psychological doctrines, and the match or mismatch between the results of his zoological investigations and his general position on questions such as definition, essence, form, and matter. It argues that psychology provides the major articulating framework for Aristotle’s zoology. Certain key points in his zoology and specific psychological doctrines influence his interpretation of the biological phenomena.

This chapter argues that neuroscientist Benjamin Libet’s data do not justify his assertion that “the brain ‘decides’ to initiate [certain actions] before there is any reportable subjective awareness that such a decision has taken place,” and do not justify associated worries about free will. The data are examined in light of some recent findings about reaction times, and some familiar distinctions in the philosophy of action, for example, the distinction between decisions and desires.

This introductory chapter provides an overview of the book, defines some key terms, makes salient a serious problem luck poses for libertarianism, and provides background on the following topics: the expression “free will,” the nature of decision, the timing of actions, and agents’ abilities.

This chapter critically examines recent work on free will and moral responsibility by Randolph Clarke, Robert Kane, and Timothy O’Connor, in an attempt to clarify issues about control and luck that are central to the debate between libertarians and their critics. It is argued that present luck, that is, luck at the time of action, poses an as yet unresolved problem for libertarianism.

Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive‐compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post‐trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide continued access can be understood to represent a metaphorical identity theft. Such a loss recapitulates the pain of (...) an individual's initial injury or illness and becomes especially tragic because it could be prevented by robust policy. A failure to fulfill this normative obligation constitutes a breach of disability law, which would view post‐trial access as a means to achieve social reintegration through this neurotechnological accommodation. (shrink)

Local food systems can have economic and social benefits by providing income for producers and improving community connections. Ongoing global climate change and the acute COVID-19 pandemic crisis have shown the importance of building equity and resilience in local food systems. We interviewed ten stakeholders from organizations and institutions in a U.S. midwestern city exploring views on past, current, and future conditions to address the following two objectives: 1) Assess how local food system equity and resilience were impacted by the (...) COVID-19 pandemic, and 2) Examine how policy and behavior changes could support greater equity and resilience within urban local food systems. We used the Community Capitals Framework to organize interviewees’ responses for qualitative analyses of equity and resilience. Four types of community capital were emphasized by stakeholders: cultural and social, natural, and political capital. Participants stated that the local food system in this city is small; more weaknesses in food access, land access, and governance were described than were strengths in both pre- and post-pandemic conditions. Stakeholder responses also reflected lack of equity and resilience in the local food system, which was most pronounced for cultural and social, natural and political capitals. However, local producers’ resilience during the pandemic, which we categorized as human capital, was a notable strength. An improved future food system could incorporate changes in infrastructure (e.g., food processing), markets (e.g., values-based markets) and cultural values (e.g., valuing local food through connections between local producers and consumers). These insights could inform policy and enhance community initiatives and behavior changes to build more equitable and resilient local food systems in urban areas throughout the U.S. Midwest. (shrink)