Mentoring Away the Glass Ceiling in Academia: A Cultured Critique describes how women of diverse backgrounds perceive their mentoring experiences or the lack of mentoring experiences in the academy. This book provides a space for envisioning strategies and practices to improve mentoring practices and the collegiate environment.

Early in the COVID-19 pandemic there was widespread concern that healthcare systems would be overwhelmed, and specifically, that there would be insufficient critical care capacity in terms of beds, ventilators or staff to care for patients. In the UK, this was avoided by a threefold approach involving widespread, rapid expansion of critical care capacity, reduction of healthcare demand from non-COVID-19 sources by temporarily pausing much of normal healthcare delivery, and by governmental and societal responses that reduced demand through national lockdown. (...) Despite high-level documents designed to help manage limited critical care capacity, none provided sufficient operational direction to enable use at the bedside in situations requiring triage. We present and describe the development of a structured process for fair allocation of critical care resources in the setting of insufficient capacity. The document combines a wide variety of factors known to impact on outcome from critical illness, integrated with broad-based clinical judgement to enable structured, explicit, transparent decision-making founded on robust ethical principles. It aims to improve communication and allocate resources fairly, while avoiding triage decisions based on a single disease, comorbidity, patient age or degree of frailty. It is designed to support and document decision-making. The document has not been needed to date, nor adopted as hospital policy. However, as the pandemic evolves, the resumption of necessary non-COVID-19 healthcare and economic activity mean capacity issues and the potential need for triage may yet return. The document is presented as a starting point for stakeholder feedback and discussion. (shrink)

Different types of consent are used to obtain human biospecimens for future research. This variation has resulted in confusion regarding what research is permitted, inadvertent constraints on future research, and research proceeding without consent. The National Institutes of Health Clinical Center's Department of Bioethics held a workshop to consider the ethical acceptability of addressing these concerns by using broad consent for future research on stored biospecimens. Multiple bioethics scholars, who have written on these issues, discussed the reasons for consent, the (...) range of consent strategies, and gaps in our understanding, and concluded with a proposal for broad initial consent coupled with oversight and, when feasible, ongoing provision of information to donors. This article describes areas of agreement and areas that need more research and dialogue. Given recent proposed changes to the Common Rule, and new guidance regarding storing and sharing data and samples, this is an important and tim.. (shrink)

Despite the recent proliferation of scientific, clinical, and narrative accounts of auditory verbal hallucinations, the phenomenology of voice hearing remains opaque and undertheorized. In this article, we outline an interdisciplinary approach to understanding hallucinatory experiences which seeks to demonstrate the value of the humanities and social sciences to advancing knowledge in clinical research and practice. We argue that an interdisciplinary approach to the phenomenology of AVH utilizes rigorous and context-appropriate methodologies to analyze a wider range of first-person accounts of AVH (...) at 3 contextual levels: cultural, social, and historical; experiential; and biographical. We go on to show that there are significant potential benefits for voice hearers, clinicians, and researchers. These include informing the development and refinement of subtypes of hallucinations within and across diagnostic categories; “front-loading” research in cognitive neuroscience; and suggesting new possibilities for therapeutic intervention. In conclusion, we argue that an interdisciplinary approach to the phenomenology of AVH can nourish the ethical core of scientific enquiry by challenging its interpretive paradigms, and offer voice hearers richer, potentially more empowering ways to make sense of their experiences. (shrink)

Zen is not just about what we do in the meditation hall, but what we do in the home, the workplace, and the community. That's the premise of this book: how to cook what Zen Buddhists call "the supreme meal"—life. It has to be nourishing, and it has to be shared. And we can use only the ingredients at hand. Inspired by the thirteenth-century manual of the same name by Dogen, the founder of the Japanese Soto Zen tradition, this (...) book teaches us how we can "enlarge the family we're feeding" if we just use some imagination. Bernie Glassman founded Greyston Bakery in Yonkers, New York, in 1982 to employ those whom other companies deem unemployable—the homeless, ex-cons, recovering addicts, low-skill individuals—with the belief that investing in people, and not just products, does pay. He was right. Greyston has evolved into an $8 million-a-year business with clients all over New York City. It is the sole supplier of brownies to Ben & Jerry's Ice Cream, and has even sold cakes to the White House. But financial profit is only one of two bottom lines that Greyston is committed to. The other one is social impact, and this goal is certainly being met. The bakery enterprise has led to the creation of the Greyston Foundation, an integrated network of organizations that provide affordable housing, child care, counseling services, and health care to families in the community. Using entrepreneurship to solve the problems of the inner city, Greyston has become a national model for comprehensive community development. Its giving back is more than just sloughing off a percentage of its profits and donating it to charity; it's about working with the community's needs right from the beginning—bringing them from the margins to the core. As its company motto goes, "We don't hire people to bake brownies. We bake brownies to hire people." This book is as much a self-manual as a business manual, addressing such concepts as • Beginner's mind • The Middle Way of Sustainability • The "hungry ghosts" of Buddhism as a picture of all humanity • Working with our faults • Indra's Net and the interconnectedness of life • Leaving no trace. (shrink)

‘Feminist logic’ may sound like an impossible, incoherent, or irrelevant project, but it is none of these. We begin by delineating three categories into which projects in feminist logic might fall: philosophical logic, philosophy of logic, and pedagogy. We then defuse two distinct objections to the very idea of feminist logic: the irrelevance argument and the independence argument. Having done so, we turn to a particular kind of project in feminist philosophy of logic: Valerie Plumwood's feminist argument for a relevance (...) logic. Plumwood's work serves as our primary case study as we turn to the project of considering three different ways we might understand her argument and revisionist arguments like it: as a priori theorizing, as ameliorative conceptual engineering, or as instances of anti-exceptionalist approaches to logic. After arguing that the anti-exceptionalist approach seems to provide the most promising means of understanding the kind of project undertaken in a feminist challenge to classical logic, we briefly address the consequences that this might have for logic instruction. Here, we argue for the perhaps unexpected conclusion that feminist programs ought to offer more, not less, instruction in logic for those who take interest. (shrink)

What is it for a life to be meaningful? In this article, I defend what I call Consequentialism about Meaning in Life, the view that one's life is meaningful at time t just in case one's surviving at t would be good in some way, and one's life was meaningful considered as a whole just in case the world was made better in some way for one's having existed.

While new generations of implantable brain computer interface devices are being developed, evidence in the literature about their impact on the patient experience is lagging. In this article, we address this knowledge gap by analysing data from the first-in-human clinical trial to study patients with implanted BCI advisory devices. We explored perceptions of self-change across six patients who volunteered to be implanted with artificially intelligent BCI devices. We used qualitative methodological tools grounded in phenomenology to conduct in-depth, semi-structured interviews. Results (...) show that, on the one hand, BCIs can positively increase a sense of the self and control; on the other hand, they can induce radical distress, feelings of loss of control, and a rupture of patient identity. We conclude by offering suggestions for the proactive creation of preparedness protocols specific to intelligent—predictive and advisory—BCI technologies essential to prevent potential iatrogenic harms. (shrink)

Purposeful infection of healthy volunteers with a microbial pathogen seems at odds with acceptable ethical standards, but is an important contemporary research avenue used to study infectious diseases and their treatments. Generally termed ‘controlled human infection studies’, this research is particularly useful for fast tracking the development of candidate vaccines and may provide unique insight into disease pathogenesis otherwise unavailable. However, scarce bioethical literature is currently available to assist researchers and research ethics committees in negotiating the distinct issues raised by (...) research involving purposefully infecting healthy volunteers. In this article, we present two separate challenge studies and highlight the ethical issues of human challenge studies as seen through a well-constructed framework. Beyond the same stringent ethical standards seen in other areas of medical research, we conclude that human challenge studies should also include: independent expert reviews, including systematic reviews; a publicly available rationale for the research; implementation of measures to protect the public from spread of infection beyond the research setting; and a new system for compensation for harm. We hope these additions may encourage safer and more ethical research practice and help to safeguard public confidence in this vital research alternative in years to come. (shrink)

Strategies to increase influenza vaccination rates have typically targeted healthcare professionals and individuals in various high-risk groups such as the elderly. We argue that they should focus on increasing vaccination rates in children. Because children suffer higher influenza incidence rates than any other demographic group, and are major drivers of seasonal influenza epidemics, we argue that influenza vaccination strategies that serve to increase uptake rates in children are likely to be more effective in reducing influenza-related morbidity and mortality than those (...) targeting HCPs or the elderly. This is true even though influenza-related morbidity and mortality amongst children are low, except in the very young. Further, we argue that there are no decisive reasons to suppose that children-focused strategies are less ethically acceptable than elderly or HCP-focused strategies. (shrink)

Several critics of realist theories of political legitimacy have alleged that it possesses a problematic bias towards the status quo. This bias is thought to be reflected in the way in which these...

Three plausible views—Presentism, Truthmaking, and Independence—form an inconsistent triad. By Presentism, all being is present being. By Truthmaking, all truth supervenes on, and is explained in terms of, being. By Independence, some past truths do not supervene on, or are not explained in terms of, present being. We survey and assess some responses to this.

European Journal of Philosophy, EarlyView.

Some healthcare systems are said to be grounded in solidarity because healthcare is funded as a form of mutual support. This article argues that health care systems that are grounded in solidarity have the right to penalise some users who are responsible for their poor health. This derives from the fact that solidary systems involve both rights and obligations and, in some cases, those who avoidably incur health burdens violate obligations of solidarity. Penalties warranted include direct patient contribution to costs, (...) and lower priority treatment, but not typically full exclusion from the healthcare system. We also note two important restrictions on this argument. First, failures of solidary obligations can only be assumed under conditions that are conducive to sufficiently autonomous choice, which occur when patients are given ‘Golden Opportunities’ to improve their health. Second, because poor health does not occur in a social vacuum, an insistence on solidarity as part of healthcare is legitimate only if all members of society are held to similar standards of solidarity. We cannot insist upon, and penalise failures of, solidarity only for those who are unwell, and who cannot afford to evade the terms of public health. (shrink)

European Journal of Philosophy, Volume 30, Issue 3, Page 1110-1124, September 2022.

Science strives for coherence. For example, the findings from climate science form a highly coherent body of knowledge that is supported by many independent lines of evidence: greenhouse gas emissions from human economic activities are causing the global climate to warm and unless GHG emissions are drastically reduced in the near future, the risks from climate change will continue to grow and major adverse consequences will become unavoidable. People who oppose this scientific body of knowledge because the implications of cutting (...) GHG emissions—such as regulation or increased taxation—threaten their worldview or livelihood cannot provide an alternative view that is coherent by the standards of conventional scientific thinking. Instead, we suggest that people who reject the fact that the Earth’s climate is changing due to greenhouse gas emissions oppose whatever inconvenient finding they are confronting in piece-meal fashion, rather than systematically, and without considering the implications of this rejection to the rest of the relevant scientific theory and findings. Hence, claims that the globe “is cooling” can coexist with claims that the “observed warming is natural” and that “the human influence does not matter because warming is good for us.” Coherence between these mutually contradictory opinions can only be achieved at a highly abstract level, namely that “something must be wrong” with the scientific evidence in order to justify a political position against climate change mitigation. This high-level coherence accompanied by contradictory subordinate propositions is a known attribute of conspiracist ideation, and conspiracism may be implicated when people reject well-established scientific propositions. (shrink)

Efforts to promote equitable public policy with algorithms appear to be fundamentally constrained by the “impossibility of fairness” (an incompatibility between mathematical definitions of fairness). This technical limitation raises a central question about algorithmic fairness: How can computer scientists and policymakers support equitable policy reforms with algorithms? In this article, I argue that promoting justice with algorithms requires reforming the methodology of algorithmic fairness. First, I diagnose the problems of the current methodology for algorithmic fairness, which I call “formal algorithmic (...) fairness.” Because formal algorithmic fairness restricts analysis to isolated decision-making procedures, it leads to the impossibility of fairness and to models that exacerbate oppression despite appearing “fair.” Second, I draw on theories of substantive equality from law and philosophy to propose an alternative methodology, which I call “substantive algorithmic fairness.” Because substantive algorithmic fairness takes a more expansive scope of analysis, it enables an escape from the impossibility of fairness and provides a rigorous guide for alleviating injustice with algorithms. In sum, substantive algorithmic fairness presents a new direction for algorithmic fairness: away from formal mathematical models of “fair” decision-making and toward substantive evaluations of whether and how algorithms can promote justice in practice. (shrink)

In this article I defend a new argument against moralist theories of legitimacy and in favour of realist theories. Moralist theories, I argue, are vulnerable to ideological and wishful thinking because they do not connect the demands of legitimacy with the interests of rulers. Realist theories, however, generally do manage to make this connection. This is because satisfying the usual realist criteria for legitimacy – the creation of a stable political order that transcends brute coercion – is usually necessary for (...) rulers to preserve their rule. (shrink)

Animals suffer harms not only in human captivity but in the wild as well. Some of these latter harms are due to humans, but many of them are not. Consider, for example, the harms of predation, i.e. of being hunted, killed, and eaten by other animals. Should we intervene in nature to prevent these harms? In this article, I consider two possible ways in which we might do so: (1) by herbivorising predators (i.e. genetically modify them so that their offspring (...) gradually evolve into herbivores) and (2) by painlessly killing predators. I argue that, among these options, painlessly killing predators would be preferable to herbivorising them. I then argue that painlessly killing predators, despite its costs to predators, might under certain circumstances be justifiable. (shrink)

There is significant controversy over whether patients have a ‘right not to know’ information relevant to their health. Some arguments for limiting such a right appeal to potential burdens on others that a patient’s avoidable ignorance might generate. This paper develops this argument by extending it to cases where refusal of relevant information may generate greater demands on a publicly funded healthcare system. In such cases, patients may have an ‘obligation to know’. However, we cannot infer from the fact that (...) a patient has an obligation to know that she does not also have a right not to know. The right not to know is held against medical professionals at a formal institutional level. We have reason to protect patients’ control over the information that they receive, even if in individual instances patients exercise this control in ways that violate obligations. (shrink)

This article explains and defends a novel idea about how people can be misled by a discussion topic, even if the discussion itself does not explicitly involve the making of false claims. The crucial aspect of this idea is that people are liable to infer, from the fact that a particular topic is being discussed, that this topic is important. As a result, they may then be led to accept certain beliefs about the state of the world they consider necessary (...) for the topic’s importance. What the article calls “importance misrepresentation” occurs when these beliefs about the state of the world are false or otherwise mistaken. The article explores different ways in which importance misrepresentation can occur, and it uses this idea to help clarify and strengthen some well‐known criticisms of the topic choices of academic philosophers. (shrink)

I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an overly (...) strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort. (shrink)

In this article I defend a new argument against moralist theories of legitimacy and in favour of realist theories. Moralist theories, I argue, are vulnerable to ideological and wishful thinking because they do not connect the demands of legitimacy with the interests of rulers. Realist theories, however, generally do manage to make this connection. This is because satisfying the usual realist criteria for legitimacy – the creation of a stable political order that transcends brute coercion – is usually necessary for (...) rulers to preserve their rule. (shrink)

A clear and provocative introduction to the ethics of COVID-19, suitable for university-level students, academics, and policymakers, as well as the general reader. It is also an original contribution to the emerging literature on this important topic. The author has made it available Open Access, so that it can be downloaded and read for free by all those who are interested in these issues. Key features include: -/- A neat organisation of the ethical issues raised by the pandemic. An exploration (...) of the many complex interconnections between these issues. A succinct case for a continued lockdown until we develop a vaccine. An original account of the Deep Moral Problem of the Pandemic, and a Revolutionary Argument for how we should change society post-pandemic. References to, and engagement with, many of the best writings on the pandemic so far (both in popular media and academic journals). -/- ISBN: 978-0-6489016-0-0. (shrink)

There is an ongoing increase in the use of mobile health technologies that patients can use to monitor health-related outcomes and behaviours. While the dominant narrative around mHealth focuses on patient empowerment, there is potential for mHealth to fit into a growing push for patients to take personal responsibility for their health. I call the first of these uses ‘medical monitoring’, and the second ‘personal health surveillance’. After outlining two problems which the use of mHealth might seem to enable us (...) to overcome—fairness of burdens and reliance on self-reporting—I note that these problems would only really be solved by unacceptably comprehensive forms of personal health surveillance which applies to all of us at all times. A more plausible model is to use personal health surveillance as a last resort for patients who would otherwise independently qualify for responsibility-based penalties. However, I note that there are still a number of ethical and practical problems that such a policy would need to overcome. The prospects of mHealth enabling a fair, genuinely cost-saving policy of patient responsibility are slim. (shrink)

In this paper, I argue against Millian Descriptivism: that is, the view that, although sentences that contain names express singular propositions, when they use those sentences speakers communicate descriptive propositions. More precisely, I argue that Millian Descriptivism fares no better (or worse) than Fregean Descriptivism: that is, the view that sentences express descriptive propositions. This is bad news for Millian Descriptivists who think that Fregean Descriptivism is dead.

The idea of using responsibility in the allocation of healthcare resources has been criticized for, among other things, too readily abandoning people who are responsible for being very badly off. One response to this problem is that while responsibility can play a role in resource allocation, it cannot do so if it will leave those who are responsible below a “sufficiency” threshold. This paper considers first whether a view can be both distinctively sufficientarian and allow responsibility to play a role (...) even for those who will be left with very poor health. It then draws several further distinctions that may affect the application of responsibility at this level. We conclude that a more plausible version of the sufficientarian view is to allow a role for responsibility where failure to do so will leave someone else who is not responsible below the sufficiency threshold. However, we suggest that individuals must exhibit “sufficient responsibility” in order for this to apply, involving both a sufficient level of control and an avoidable failure to respond adequately to reasons for action. (shrink)

Thanks to David Kaplan (1989a, 1989b), we all know how to handle indexicals like ‘I’. ‘I’ doesn’t refer to an object simpliciter; rather, it refers to an object only relative to a context. In particular, relative to a context C, ‘I’ refers to the agent of C. Since different contexts can have different agents, ‘I’ can refer to different objects relative to different contexts. For example, relative to a context cwhose agent is Gottlob Frege, ‘I’ refers to Frege; relative to (...) a context 0* whose agent is Alexius.. (shrink)

Whole-genome analysis and whole-exome analysis generate many more clinically actionable findings than traditional targeted genetic analysis. These findings may be relevant to research participants themselves as well as for members of their families. Though researchers performing genomic analyses are likely to find medically significant genetic variations for nearly every research participant, what they will find for any given participant is unpredictable. The ubiquity and diversity of these findings complicate questions about disclosing individual genetic test results. We outline an approach for (...) disclosing a select range of genetic results to the relatives of research participants who have died, developed in response to relatives? requests during a pilot study of large-scale medical genetic sequencing. We also argue that studies that disclose individual research results to participants should, at a minimum, passively disclose individual results to deceased participants? relatives. (shrink)

A considerable literature has emerged around the idea of using ‘personal responsibility’ as an allocation criterion in healthcare distribution, where a person's being suitably responsible for their health needs may justify additional conditions on receiving healthcare, and perhaps even limiting access entirely, sometimes known as ‘responsibilisation’. This discussion focuses most prominently, but not exclusively, on ‘luck egalitarianism’, the view that deviations from equality are justified only by suitably free choices. A superficially separate issue in distributive justice concerns the two–way relationship (...) between health and other social goods: deficits in health typically undermine one's abilities to secure advantage in other areas, which in turn often have further negative effects on health. This paper outlines the degree to which this latter relationship between health and other social goods exacerbates an existing problem for proponents of responsibilisation (the ‘harshness objection’) in ways that standard responses to this objection cannot address. Placing significant conditions on healthcare access because of a person's prior responsibility risks trapping them in, or worsening, negative cycles where poor health and associated lack of opportunity reinforce one another, making further poor yet ultimately responsible choices more likely. It ends by considering three possible solutions to this problem. (shrink)

In recent work, Peter Hanks and Scott Soames argue that propositions are types whose tokens are acts, states, or events. Let’s call this view the type view. Hanks and Soames think that one of the virtues of the type view is that it allows them to explain why propositions have semantic properties. But, in this paper, we argue that their explanations aren’t satisfactory. In Section 2, we present the type view. In Section 3, we present one explanation—due to Hanks (2007, (...) 2011) and Soames (2010)—of why propositions have semantic properties. We criticize this first explanation in Section 4. In Section 5, we present another explanation—due to Soames (2104)—of why propositions have semantic properties. We criticize this second explanation in Section 6. (shrink)

Healthcare practitioners have access to a range of ethical guidance. However, the normative role of this guidance in ethical decision-making is underexplored. This paper considers two ways that healthcare practitioners could approach ethics guidance. We first outline the idea of deference to ethics guidance, showing how an attitude of deference raises three key problems: moral value; moral understanding; and moral error. Drawing on philosophical literature, we then advocate an alternative framing of ethics guidance as a form of moral testimony by (...) colleagues and suggest that a more promising attitude to ethics guidance is to approach it in the spirit of ‘critical engagement’ rather than deference. (shrink)

The rise of managerialism within healthcare systems has been noted globally. This paper uses the findings of a scoping study to investigate the management of poor performance among nurses and midwives in the United Kingdom within this context. The management of poor performance among clinicians in the NHS has been seen as a significant policy problem. There has been a profound shift in the distribution of power between professional and managerial groups in many health systems globally. We examined literature published (...) between 2000 and 10 to explore aspects of poor performance and its management. We used Web of Science, CINAHL, MEDLINE, British Nursing Index, HMIC, Cochrane Library and PubMed. Empirical data are limited but indicate that nurses and midwives are the clinical groups most likely to be suspended and that poor performance is often represented as an individual deficit. A focus on the individual as a source of trouble can serve as a distraction from more complex systematic problems. (shrink)

Greg Bognar has recently offered a prioritarian justification for ‘fair innings’ distributive principles that would ration access to healthcare on the basis of patients' age. In this article, I agree that Bognar's principle is among the strongest arguments for age-based rationing. However, I argue that this position is incomplete because of the possibility of ‘time-relative' egalitarian principles that could complement the kind of lifetime egalitarianism that Bognar adopts. After outlining Bognar's position, and explaining the attraction of time-relative egalitarianism, I suggest (...) various ways in which these two kinds of principle could interact. Since various options have very different implications for age-based rationing, proponents of such a rationing scheme must take a position on time-relative egalitarianism to complement a lifetime prioritarian view like Bognar's. (shrink)

Several recent articles have weighed in on the question of whether moral philosophers can be counted as moral experts. One argument denying this has been rejected by both sides of the debate. According to this argument, the extent of disagreement in modern moral philosophy prevents moral philosophers from being classified as moral experts. Call this the Argument From Disagreement. In this article, I defend a version of AD. Insofar as practical issues in moral philosophy are characterized by disagreement between moral (...) philosophers who are more or less equally well credentialed on the issue, non-philosophers have no good reasons to defer to their views. (shrink)

Thanks to David Kaplan, we all know how to handle indexicals like ‘I’. ‘I’ doesn’t refer to an object simpliciter; rather, it refers to an object only relative to a context. In particular, relative to a context C, ‘I’ refers to the agent of C. Since different contexts can have different agents, ‘I’ can refer to different objects relative to different contexts. For example, relative to a context c whose agent is Gottlob Frege, ‘I’ refers to Frege; relative to a (...) context c* whose agent is Alexius Meinong, ‘I’ refers to Meinong. (shrink)

Many political realists reject the idea that the first task for political philosophy is to justify the existence of coercive political institutions. Instead, they say, we should begin with the factual existence of CPIs, and ask how they ought to be structured. In holding this view, they adopt a form of political naturalism that is broadly Aristotelian in character. In this article, I distinguish between two forms that this political naturalism might take - what I call a ‘strong’ form, and (...) a ‘weak’ form - and argue that both ought to be rejected. (shrink)

Which famous twentieth-century philosopher instigated a revolution in philosophy, arguing that the philosopher’s business is not to advance general theories about reality, but rather to help release our thinking from the intellectual cramps produced by a misunderstanding of the forms of language? Wittgenstein? Wrong! according to John W. Cook. This revolution in philosophy actually had no author. Apparently, it arose through a misinterpretation of Wittgenstein’s later writings. In fact, Cook implies, Wittgenstein himself was not genuinely engaged in a (...) struggle with philosophical puzzles, but rather had an ontological theory up his sleeve: he was a conventional empiricist in the tradition of Berkeley, Ernst Mach, and Russell, though he happened to express himself so obscurely that some philosophers, believing themselves inspired by his writings, dreamed up the whole revolution by mistake, as it were. However, Cook is not arguing that the revolution should be canceled; rather he looks at Wittgenstein’s work from the standpoint of that accidental revolution, berating Wittgenstein, as it were, for not having thought to be a Wittgensteinian himself. (shrink)

Research ethics guidelines grew out of several infamous episodes where research subjects were exploited. There is significant international synchronization of guidelines. However, indigenous groups in New Zealand, Canada and Australia have criticized these guidelines as being inadequate for research involving indigenous people and have developed guidelines from their own cultural perspectives. Whilst traditional research ethics guidelines place a lot of emphasis on informed consent, these indigenous guidelines put much greater emphasis on interdependence and trust. This article argues that traditional guidelines (...) are premised on relationships of equal power, and that often the researcher has more power that is not fully equalized by providing information. Where there is a relationship of unequal power, then focusing on interdependence and trust is more likely to achieve ethical safety. We illustrate this thesis by describing the detail of a research project looking at the use of interpreters, where we video-recorded live consultations and then interviewed the patient, interpreter and doctor. We conclude by suggesting that mainstream research ethics guidelines should pay more attention to the development of a trustworthy relationship between subject and researcher, and that, following the lead from clinical medicine, we should develop a culturally competent ethical framework for research on human subjects. (shrink)

We developed this study to examine the issue of parental refusal of treatment, looking at the issue through a cultural competence lens. Recent cases in Canada where courts have declined applications by clinicians for court orders to overrule parental refusal of treatment highlight the dispute in this area. This study analyses the 16 cases of a larger group of 24 cases that were selected by a literature review where cultural or religious beliefs or ethnic identity was described as important reasons (...) behind the refusal. The most significant finding was that nearly all of the cases cited unacceptable side effects as the main reason for declining treatment. We then analysed the detail of the cases and concluded that in the first instance a skilled clinical approach to develop an agreed management plan is by far the best approach. In the event that agreement cannot be reached we recommend engaging a mediator to help the clinician and parents/child to find an agreeable way forward. We argue that the option of se... (shrink)

In this paper, I argue that, when it comes to explaining what can be described as “representational” properties of propositions, Soames’s new conception of propositions—on which the proposition that Seattle is sunny is the act of predicating the property being sunny of Seattle and to entertain that proposition is to perform that act—does not have an advantage over traditional ones.

Pickeringet al’s paper argues that the capacity of the decision-maker is the sole consideration in whether a decision should stand, and that the risk of the decision should not be considered. This argument ignores the existence of the player who is of the view that a decision is not wise. This paper argues that patient autonomy is not the sole determinant of whether a person is able to make an unwise decision, particularly in healthcare where there are always others affected (...) by the patient decision. Rather than asserting that patients have an unfettered autonomous choice on clinical decisions this paper argues that these decisions should be looked at through the lens of quality in health care that has proposed four parameters to be balanced; the patient experience, wise use of resources, the effect on public health and the clinician experience. (shrink)