The new introduction to the second edition of Habits of the Heart is a very helpful reminder of the main points of the first edition. Moreover, it is very useful in situating, indeed resituating the book’s concerns, given the lapse of time since the book’s first appearance. It provides new insights made possible by second thoughts, as well as by the questions and criticisms of others. The problem of individualism and the slackening, not to say refusal, of traditional communal ties, (...) has accelerated in American society since the first writing. We find phenomena such as middle class ‘cocooning,’ as well as an often low grade civil war, let us say the culture wars. There is a widespread disquiet — to the left, to the right, in the anxious middle — about the future direction of society. One thing is noted from the beginning as common across the divisions, namely, a certain view of the economy. Correspondingly, the authors themselves seem more insistent on issues of class than they were previously: “the festering secret that Americans would rather not face.”I will confine myself to two points: first, the issue of economy in terms of more basic metaphysical assumptions in the whole notion of ‘use.’ I will suggest some connections between serviceable disposability and the culture of autonomy, and between these and the equivocal relation to the other that besets the identification of freedom with autonomy. I work towards the question: must not our communal relations to others be placed in a deeply ambivalent position, if economic relations are dominated by serviceable disposability and freedom as autonomy is idolized?Second, I want to remark on how far we dwell in an ethos of will to power of which use and autonomy serve as masks. I must summon to our discussion the roaming, uninterred ghost of Nietzsche. Whence comes the spell that spoils our taste for the good? Whence comes this, this blandness of the good? The issue of nihilism and religion cannot be buried. Is this issue even more urgent than Bellah and his collaborators, in their essential decency, acknowledge? (shrink)

The line separating the “good life” and the savagery that the “good life” requires, or, perhaps what might be articulated as the line between the space of biopolitics and the space of necropolitics, is maintained in the present through both practices of global policing and imperial war. These practices of policing and war produce the very global refuse that constantly threatens the “good life”—actively wasting the lives and livelihoods of people and non-human lifeworlds Western colonialism established as the raw (...) materials, instruments, and objects of its civilizational goal—against which violence acts to protect a fundamentally human life worth living. At the same time, through capital-intensive projects of “saving” the very targeted populations it destroys, permanent war also produces the subordinated life that will come to serve as the means of maintaining and upholding that “good life.” Beyond this mode of colonial inhabitation, however, subsist other ecologies of life-making practices on the part of those deemed disposable, a planetary remainder which might well be our only hope for a possible future. (shrink)

Publication date: 22 December 2020 Source: International Letters of Social and Humanistic Sciences Vol. 89 Author: Temitope A. Ogunweide The study sought to assess the social context of solid waste disposal pattern of residents in Ibadan metropolis, in order to assess the Solid waste disposal patterns of people in Ibadan metropolis, Oyo State, Nigeria. Specifically, the study identified solid waste disposal habits of residents, frequency of clearing the dumpsters, accessibility of waste dumpsters to people determines the waste (...) disposal pattern of people; and analyze the willingness of people in Ibadan to pay for improved service. Solid waste management has been part of human activities right from time. Efforts by Oyo State Government is seen in the collection of dirt that have been placed on the medians. Waste generation is an unavoidable product of man activities, however, sustainable management of such waste is a challenge faced in many countries today. Nigeria, a developing country in Africa, has been in a quandary of how to efficiently manage the municipal solid waste its population generates. Many states in the country lack adequate plans and infrastructure required for efficient and sustainable management of municipal solid waste. For Ibadan, the largest city in Nigeria, the problem is further compounded by its rather large and still increasing population. In this research, Ibadan metropolis is taken as a case study; the rate of solid waste handling in households as regards solid waste management from household collection to final disposal are focused upon. The study found out that 45.6% drop their refuse in the dumpsters as 18.8% burns their refuse, 17.7% of the respondents drops their waste on the median, 12% in the drainage while 6% opts to drop their waste in the streams. On the effectiveness of the Private operators collecting waste from the respondents, the study found out that 7.6% effective, 37.5% of the respondents says the operators waste collection is poor, 7% says it is abysmal while 43.5% said it is not applicable to them because they do not have storage containers in their houses and as a result did not subscribe to their service. Many countries, particularly the developed ones, have employed options in the waste management hierarchy for sustainable management of their municipal solid waste and the blend of options employed is usually highly dependent on local factors. Following the waste management hierarchy, possible options for sustainable municipal solid waste management in Ibadan are discussed. It is concluded that waste reduction, reuse, and recycling are potential management options for the state. Landfilling will remain an important option for final disposal but reliance on this method could be significantly reduced if management options are exploited to the maximum in a sustainable solid waste management structure in Ibadan metropolis. Key Words: Waste handling, Ibadan Metropolis, Landfill, Municipal Solid Waste Word Count: 435. (shrink)

Douglas T. Going above and beneath the call ….

Howard Robinson has argued that even if the major claims of Berkeleian idealism are mistaken, including its account of the “physical world,” “the overall endeavour of defending idealism is more plausible than it is generally believed to be”. He argues that aspects of Berkeley’s arguments for idealism, including a Berkeleian argument against naive realism, can be shown to refute the representative realist’s view of perception, and its concomitant ontology. This ontology is at least partially materialist. According to Robinson, once naive (...) realism is disposed of and the objections to RR are exposed, Berkeleian Idealism can raise its shadowy head with at least the respectability afforded the currently more fashionable Representationalism. We shall argue that Robinson’s claim cannot plausibly be sustained. His defense of Berkeleian idealism, based in part on his understanding of naive realism and his critique of Representationalism, falters. “The overall endeavour of defending idealism” is not as plausible as Robinson takes it to be. (shrink)

A standard view in contemporary philosophy is that belief is involuntary, either as a matter of conceptual necessity or as a contingent fact of human psychology. We present seven experiments on patterns in ordinary folk-psychological judgments about belief. The results provide strong evidence that voluntary belief is conceptually possible and, granted minimal charitable assumptions about folk-psychological competence, provide some evidence that voluntary belief is psychologically possible. We also consider two hypotheses in an attempt to understand why many philosophers have been (...) tempted to view belief as involuntary: that belief is a prototype concept and that belief is a dual character concept. Altogether, our findings contribute to longstanding philosophical debates about the relationship between the will and the intellect, while also advancing scientific understanding of important social judgments. (shrink)

Some philosophers have argued for what I call the reason-giving requirement for conscientious refusal in reproductive healthcare. According to this requirement, healthcare practitioners who conscientiously object to administering standard forms of treatment must have arguments to back up their conscience, arguments that are purely public in character. I argue that such a requirement, though attractive in some ways, faces an overlooked epistemic problem: it is either too easy or too difficult to satisfy in standard cases. I close by briefly considering (...) whether a version of the reason-giving requirement can be salvaged despite this important difficulty. (shrink)

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown (...) that physicians have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

Discussions of uptake in the philosophy of language focus our attention on what role other people have in fixing the import, success, influence and social life of a speech act. The general idea in most discussions of uptake, despite their differences and disagreements, is whether and how an audience is cooperative or uncooperative when a speaker plays a critical role in how speech acts function. This essay is primarily concerned with “refusals”, or uncooperative uptakes. The essay analyzes the varieties of (...) refusal; when refusal is possible why it might be challenging and when it is ethical. It examines how and when the uptake of a speech act can constitute the pragmatic form and force of the original speech act. (shrink)

Freedom of Conscience and Freedom of Religion should be taken to protect two distinct sets of moral considerations. The former protects the ability of the agent to reflect critically upon the moral and political issues that arise in her society generally, and in her professional life more specifically. The latter protects the individual's ability to achieve secure membership in a set of practices and rituals that have as a moral function to inscribe her life in a temporally extended narrative. Once (...) these grounds are distinguished, it becomes more difficult to grant healthcare professionals' claims to religious exemptions on the basis of the latter than it is on the basis of the former. While both sets of considerations generate ‘internal reasons’ for rights to accommodation, the relevant ‘external’ reasons present in the case of claims of moral conscience do not possess analogues in the case of claims of religious conscience. However, the argument applies only to ‘irreducibly religious’ claims, that is to claims that cannot be translated into moral vocabulary. What's more, there may be reasons to grant the claims of religious persons to exemptions that have to do not with the nature of the claims, but with the beneficial effects that the presence of religious persons may have in the context of the healthcare institutions of multi-faith societies. (shrink)

There can be little doubt about the ethical imperative to ensure adequate vaccination uptake against certain infectious diseases. In the face of vaccine refusal, health authorities and providers instinctively appeal to coercive approaches or increased education as methods to ensure adequate vaccine uptake. Recently, some have argued that public fear around Ebola should be used as an opportunity for such approaches, should an Ebola vaccine become available. In this article, the author describes the difficulties associated with coercion and education when (...) addressing vaccine opposition. Both coercion and education can cause opposite effects than intended in certain circumstances. The correct area of focus is to address the breakdown in trust within clinical relationships. The author presents suggestions for an approach towards vaccine refusal that may be more promising. (shrink)

This paper addresses both ‘student engagement’ in contemporary universities, and student ‘disengagement’ – where the latter is often seen as a failure of performance, or absence of will. In a bold move, the paper asks whether students should be engaged in their university education, and whether there is value in forms of disengagement. It finds an original way in which student disengagement can be understood by drawing on the writings of Stanley Cavell – on the philosophical appeal to what we (...) say, our search for criteria, and on ideas of acknowledgement and avoidance in his work on Shakespearian tragedy. It shows what is at stake in our attunement with, and dissent from, criteria, and how such dissent can be educative. The paper considers the film ‘Stella Dallas’, in which Stella’s aversion to, her disengagement from, her culture’s criteria, is not a passive withdrawal, but rather the finding of voice, her education as a grownup. The paper concludes that disengagement, understood as aversion, dissent and refusal of voice, is not to be seen always as a lack of action or of care, but as the opposite: the active voicing of what we will, or will not, consent to in our education. (shrink)

John Harris claims that is it ‘palpable nonsense’ to suggest that ‘a child might competently consent to a treatment but not be competent to refuse it.’ In ‘Transitional Paternalism: How Shared Normative Powers Give Rise to the Asymmetry of Adolescent Consent and Refusal’ Neil Manson aims to explain away the apparent oddness of this asymmetry of consent and refusal, by appealing to the idea of shared normative powers, presenting joint bank accounts as an example. In this article, I will (...) argue that Manson's account fails to explain away the oddness. Rather, I will argue that there are ambiguities to which Manson has not paid sufficient attention. In fact, as odd as it may sound, I argue that Manson actually agrees with Harris. He fails to recognize that he agrees with Harris because he is not careful enough to distinguish between different asymmetries, which I have labelled the asymmetries of choice, permissibility and competence. (shrink)

John Harris claims that is it ‘palpable nonsense’ to suggest that ‘a child might competently consent to a treatment but not be competent to refuse it.’ In ‘Transitional Paternalism: How Shared Normative Powers Give Rise to the Asymmetry of Adolescent Consent and Refusal’ Neil Manson aims to explain away the apparent oddness of this asymmetry of consent and refusal, by appealing to the idea of shared normative powers, presenting joint bank accounts as an example. In this article, I will (...) argue that Manson's account fails to explain away the oddness. Rather, I will argue that there are ambiguities to which Manson has not paid sufficient attention. In fact, as odd as it may sound, I argue that Manson actually agrees with Harris. He fails to recognize that he agrees with Harris because he is not careful enough to distinguish between different asymmetries, which I have labelled the asymmetries of choice, permissibility and competence. (shrink)

A large part of the debate around the right to refuse life-prolonging treatment of anorexia nervosa sufferers centers on the issue of competence. Whether or not the anorexic should be allowed to refuse life-saving treatment does not depend solely or primarily on competence. It also depends on whether the anorexic’s suffering is bearable or tractable, and on the degree of involvement of the family in the therapeutic process. Anorexics could be competent to refuse lifesaving treatment (Giordano 2008). (...) However, the anorexic’s refusal of life-saving treatment should not be respected purely because it is a competent decision. In fact, anorexia has two characteristics that weaken the strength of the principle .. (shrink)

Physicians place significant weight on the distinction between acts and omissions. Most believe that autonomous refusals for procedures, such as blood transfusions and resuscitation, ought to be respected, but they feel no similar obligation to accede to requests for treatment that will, in the physician’s opinion, harm the patient (e.g., assisted death). Thus, there is an asymmetry. In this paper, we challenge the strength of this distinction by arguing that the ordering of values should be the same in both cases. (...) The reason for respecting refusals is that, in such cases, autonomy outweighs well-being. We argue that the same should be true in request cases, which means that requests should not be denied only due to the treatment being too harmful in the physician’s opinion. Our strategy is to consider and reject a number of arguments for the asymmetrical view, including an appeal to the doing–allowing distinction and positive and negative rights. The duty to respect refusals is still greater than the duty to grant requests on our view, but, by arguing that the ordering of values is the same in both cases, we show that there is less of a distinction in healthcare between requests and refusals than many currently believe. (shrink)

An overview of the philosophical and bioethics literature on conscientious refusals by health care professionals to provide abortion and contraceptive services.

Patients sometimes request procedures their doctors find morally objectionable. Do doctors have a right of conscientious refusal? I argue that conscientious refusal is justified only if the doctor's refusal does not make the patient worse off than she would have been had she gone to another doctor in the first place. From this approach I derive conclusions about the duty to refer and facilitate transfer, whether doctors may provide 'moral counseling,' whether doctors are obligated to provide objectionable procedures when no (...) other doctor is available, why the moral consensus among doctors seems relevant even though it does not determine whether something is morally acceptable, and whether doctors should stay out of fields whose standard procedures they find morally unacceptable. (shrink)

What constitutes illocutionary silencing? This is the key question underlying much recent work on Catherine MacKinnon's claim that pornography silences women. In what follows I argue that the focus of the literature on the notion of audience `uptake' serves to mischaracterize the phenomena. I defend a broader interpretation of what it means for an illocutionary act to succeed, and show how this broader interpretation provides a better characterization of the kinds of silencing experienced by women.

While the Trigonia story is a microcosmic representation of nineteenth-century evolutionary debates, it also serves as a model for assessing the impact of new empirical material upon a controversial issue potentially explained by several internally consistent but contradictory theories; for there can be no fact quite so pristine as a discovery anticipated by no one. The reaction to modern trigonians was, I suspect, completely typical; all parties to the dispute managed to incorporate the new datum into their systems. Evolutionists emphasized (...) the morphological differences between Mesozoic and modern forms and assumed that the disjunct distribution was an artifact of an imperfect record. Agassiz cited the known distribution in support of special creation, but announced that the discovery of a Tertiary species would discredit none of his ideas. Parkinson could not readily encompass the difference without evident improvement in his progressionist synthesis, but invoked almighty wisdom in his ignorance.I do not doublt that all these naturalists proceeded properly in refusing to yield to the anomalies of a single fact which destroyed no deductive sequence in any of their theories. When one considers the stupendous amount of misinformation current in early nineteenth-century scientific circles,49 it is easy to appreciate the salutary aspects of stubbornness in the face of inevitable contradictory citations.De Beer50 has marveled at Darwin's ability, in the 1844 sketch, to work his way through a mire of misinformation: “It is a matter for wonder that with the meagre materials at his disposal he was able to steer a straight course across a largely uncharted ocean of ignorance, with rocks of falsehood right across his path.” Yet Darwin approached these rocks with the idea of natural selection already firmly in mind. Any pure empiricist would have surrendered to confusion long before 1859. (shrink)

Health-care professionals sometimes appeal to their own consciences in order to justify their exemption from professional duties. I argue that we can only understand the content of a conscientious refusal as either a claim about the psychological dispositions of the refusing professional or as a purely normative claim about the status of the action that is the object of the refusal. If we adopt the former view, we would still need to adjudicate these refusals in terms of the acceptability of (...) the moral views that ground them. If the latter, then we effectively abandon the conception of conscientious refusals that is most widely discussed in the philosophical literature. Whichever option we choose, we must conclude that there is no reason to allow for traditionally understood conscientious refusals by health-care professionals. (shrink)

The autonomous right of competent adults to decide what happens to their own body and the corresponding right to consent to or refuse medical treatment are cornerstones of modern health care. For minors the situation is not so clear cut. Since the well-known case of Gillick, mature children under the age of 16 can agree to proposed medical treatment. However, those under the age of 18 do not enjoy any corresponding right to refuse medical treatment. Can this separation (...) of the right to agree to treatment and the right to refuse treatment for those under 18, regardless of capacity, be justified? This paper evaluates the key cases in this area of the law. Changes to the current law are then proposed which aim to make the law more consistent and reasonable. (shrink)

Health-care professionals sometimes appeal to their own consciences in order to justify their exemption from professional duties. I argue that we can only understand the content of a conscientious refusal as either a claim about the psychological dispositions of the refusing professional or as a purely normative claim about the status of the action that is the object of the refusal. If we adopt the former view, we would still need to adjudicate these refusals in terms of the acceptability of (...) the moral views that ground them. If the latter, then we effectively abandon the conception of conscientious refusals that is most widely discussed in the philosophical literature. Whichever option we choose, we must conclude that there is no reason to allow for traditionally understood conscientious refusals by health-care professionals. (shrink)

James Rachels has argued on Utilitarian grounds that since removing life-sustaining treatment and physician-assisted suicide both aim at the very same end,hastening death to limit suffering, there are no morally significant moral distinctions between them. Others have argued for maintaining this distinction based on various forms of deontological and rights-based ethical theories that maintain that all acts of killing are inherently wrong. I argue that the enduring controversy over physician-assisted suicide might not be caused by such fundamental differences of opinion (...) about moral theory, such as that which exists between Utilitarianism and Deontology, so much as by a commonly held misunderstanding of technology. In particular, the conclusion that there are no relevant ethical distinctions between killing and letting die can only be drawn by a Utilitarian, such as Rachels, by ignoring the recent work of philosophers of technology on the non-neutrality thesis. (shrink)

James Rachels has argued on Utilitarian grounds that since removing life-sustaining treatment and physician-assisted suicide both aim at the very same end,hastening death to limit suffering, there are no morally significant moral distinctions between them. Others have argued for maintaining this distinction based on various forms of deontological and rights-based ethical theories that maintain that all acts of killing are inherently wrong. I argue that the enduring controversy over physician-assisted suicide might not be caused by such fundamental differences of opinion (...) about moral theory, such as that which exists between Utilitarianism and Deontology, so much as by a commonly held misunderstanding of technology. In particular, the conclusion that there are no relevant ethical distinctions between killing and letting die can only be drawn by a Utilitarian, such as Rachels, by ignoring the recent work of philosophers of technology on the non-neutrality thesis. (shrink)

What role does audience uptake play in determining whether a speaker refuses or consents to sex? Proponents of constitution theories of uptake argue that which speech act someone performs is largely determined by their addressee’s uptake. However, this appears to entail a troubling result: a speaker might be made to perform a speech act of sexual consent against her will. In response, we develop a social constitution theory of uptake. We argue that addressee uptake can constitute a speaker’s utterance of (...) ‘no’ as a speech act of consent under some conditions, but that this does not prevent us from judging that an addressee committed rape. Second, we claim that addressee uptake is not the only form of uptake that matters—the uptake of other members of the discursive community matters too, and can override the addressee’s uptake, constituting the speaker’s utterance as the speech act it was intended to be. (shrink)

In their article, Navin, Brummett, and Wasserman (2022) advance the idea that there are qualitatively different types of decision-making capacity (DMC) for treatment refusals. Departing from what t...

The search for a historically conscious individual who is disposed to “radical action” is the main thrust of this paper. This is premised on the following claims: first, that the modern society is a pathological society whose rules, most often but not necessarily, imply control and domination; thus a “refusal” to abide by these rules is the most appropriate alternative available; and, second, that there is still hope for the Enlightenment’s project of emancipation, that is, such “refusal,” which means a (...) political fight for liberation, is still winnable no matter how formidable the forces of domination may be. But this paper can only do so much. I do not offer any universal and prefab solution to the pathological society. What I do instead is argue that the emergence of a historically conscious individual who is disposed to “radical action,” which eventually leads to a “collective radical action,” is still possible today. I also argue that “radical action” presupposes an awareness of the concrete socio-historical situations, thus the importance of “historicity.” This is done through a reconstructive reading of Marcuse’sCritical Theory. In fact, my argument is just an echo on what Marcuse did more than four decades ago. (shrink)

Encounters with illness, impairment, and aging can disrupt one’s experiential relationship with self, body, others, and world. “Healing” takes place when the individual is able to re-integrate his or her world, even if the condition is not medically curable. Drawing on work in the phenomenology of the body, this article examines a series of eight “healing strategies” individuals employ, each representing a different way of orienting toward the painful or impaired body. One may lean into freeing oneself from the body, (...) through strategies of “refusing,” “ignoring,” “objectifying,” or “transcending” its problems. Conversely, one may choose to embrace the body, through strategies such as “accepting,” “listening,” “befriending,” or “witnessing.” It can be beneficial to have a good number of such coping strategies at one’s disposal, enhancing flexible response to chronic challenges. They also are often used in synergistic or complementary combinations. (shrink)

Looking from a critical race perspective at Wittig’s lesbian, in this article, I draw two conclusions. First, I suggest that it is actually trans exclusionary lesbians' own transphobia that makes them cis-gendered. And second, it becomes clear that the politicisation of choosing and refusing gender needs to acknowledge racism’s shaping role in the construction of gender. My approach not only intervenes in transphobic feminisms that are obsessed with simplistic understandings of sexual violence, but also questions rigid cis/trans binaries and rejects (...) accounts of trans/gender that ignore the role of racialisation for the emergence of gender. The main question that I address is: how to conceptualise the complex im/possibilities of refusing and choosing in relation to gender? It is my aim to connect seemingly disparate knowledge productions on genderqueer, trans and other ‘impossible’ genders and sexualities. I am particularly interested in a phenomenon that can be described as ‘lesbian haunting’: the ambivalences one will find in tracing lesbian theory in relation to transing gender. With this, it is my attempt to rethink lesbian, queer and trans feminist approaches on violence, and to investigate the role of sexual violence within broader concepts of violence. More specifically, in order to understand both ‘gender’ and ‘transing gender’ as always already racialised, my approach builds on theories that identify ‘ungendering’ as an effect of normative racial violence (e.g. Spillers, 1987; Lewis, 2017; Snorton, 2017). (shrink)

To speak of patients' choices is to obscure the distinction between request and refusal of treatment. The distinction is particularly crucial for questions of killing or letting die.

This essay analyzes Fred Moten’s “antipolitical” romance with the “fugitive black sociality” that he radically opposes to “politics,” defined as inescapably tied to antiblack modernity. By comparing Moten’s argument to other voices in the black radical tradition, and by triangulating Moten with Hannah Arendt and Sheldon Wolin, this essay opens inherited conceptions of the political to risk and reworking but also complicates figurations of fugitivity and resists the antagonism Moten posits between black fugitivity and democratic politics.

Consensual homicide remains a crime in jurisdictions where active voluntary euthanasia has been legalized. At the same time, both jurisdictions, in which euthanasia is legal and those in which it is not, recognize that all patients (whether severely ill or not) have the right to refuse or withdraw medical treatment (including life-saving treatment). In this paper, I focus on the tensions between these three norms (the permission of active euthanasia, the permission to reject life-saving treatment, and the prohibition of (...) consensual homicide), assuming a justification of euthanasia based on the right to (personal) autonomy. I argue that the best way to provide a coherent account of these norms is to claim that patients have two distinct rights: the right to autonomy and the right to bodily integrity. This solution has some relevant implications for the discussion of the legalization of active euthanasia. (shrink)

Citing grounds of conscience, pharmacists are increasingly refusing to fill prescriptions for emergency contraception, or the "morning-after pill." Whether correctly or not, these pharmacists believe that emergency contraception either constitutes the destruction of post-conception human life, or poses a significant risk of such destruction. We argue that the liberty of conscientious refusal grounds a strong moral claim, one that cannot be defeated solely by consideration of the interests of those seeking medication. We examine, and find lacking, five arguments for requiring (...) pharmacists to fill prescriptions. However, we argue that in their professional context, pharmacists benefit from liberty restrictions on those seeking medication. What would otherwise amount to very strong claims can be defeated if they rest on some prior restriction of the liberty of others. We conclude that the issue of what policy should require pharmacists to do must be settled by way of a theory of second best. Asking "What is second best?" rather than "What is best?" offers a way to navigate the liberty restrictions that may be fixed obstacles to optimality. (shrink)