John Rawls, among others, has argued that one of aims political philosophy is that it provides reasonable hope in the possibility of justice in the future. But what makes hope reasonable? What sorts of theories of justice are best suited to foster reasonable hope in us? To answer these questions, this paper investigates Rawls’s conception of reasonable hope and the kinds of unreasonableness Rawls sought to guard against with his account of a realistic utopia. Rawls's idea of reasonable hope goes (...) beyond the weaker kind of “reconciliation” put forward by Rousseau’s account of a conjectural history that sketches a picture of how we could have developed into the kind of people and the kind of society where justice is possible. It is one thing to believe, with Rousseau, that our deep natures are not incompatible with the possibility of a just society. It is something further to harbor any hope for this in the future. I argue that this temporal aspect, which is built into what Kant and Rawls mean by reasonable hope, is useful approach to the practice of political philosophy. An approach that takes the need for reasonable hope seriously is one that moves political theorizing from a more passive framework of theoretical imagination toward a more active one that entails political anticipation. (shrink)

This paper considers the responsibilities of the FDA with regard to disseminating information about the benefits and harms of e-cigarettes. Tobacco harm reduction advocates claim that the FDA has been overcautious and has violated ethical obligations by failing to clearly communicate to the public that e-cigarettes are far less harmful than cigarettes. We argue, by contrast, that the FDA’s obligations in this arena are more complex than they may appear at first blush. Though the FDA is accountable for informing the (...) public about the health risks and benefits of products it regulates, it also has other roles that inform when and how it should disseminate information. In addition to being a knowledge purveyor, it is also a knowledge producer, an advisor to the public, and a practical agent shaping the material conditions in which people make health-related choices. In our view, those other roles call for caution in the way the FDA interprets and communicates the available evidence. (shrink)

In The Minority Body, Elizabeth Barnes rejects prevailing social constructionist accounts of disability for two reasons. First, because they understand disability in terms of oppressive social responses to bodily impairment, they cannot make sense of disability pride. Second, they maintain a problematic distinction between impairment and disability. In response to these challenges, this paper defends a version of the social model of disability, which we call the Social Exclusion Model. On our account, to be disabled is to be in a (...) bodily or psychological state that is represented as an impairment in the prevailing ideology of one’s society, and to be excluded from valuable activities on the basis of this representation. While this model refers to a distinction between disability and impairment, it makes no presuppositions about which bodies function ‘normally’ and which do not. It is the ideology of impairment rather than impairment itself that does any work to determine whether a person is disabled. We argue that this model answers some of the important objections that Barnes raises against prevailing social constructionist accounts of disability, and that it’s focus on the oppressive social positioning of disabled people gives it explanatory power that Barnes’s own account lacks. (shrink)

Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surrogates regarding the possible use of PPPs as a means to help make (...) treatment decisions for decisionally-incapacitated patients. -/- Methods: This qualitative study used semi-structured interviews to determine the views of experienced surrogates [n=26] who were identified from two academic medical centers and two community hospitals. The primary outcomes were respondents’ overall level of support for the idea of using PPPs and the themes related to their views on how a PPP should be used, if at all, in practice. -/- Results: Overall, 21 participants supported the idea of using PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on substituted judgment. Major themes which emerged were that surrogates, not the patient’s preferences, should determine how treatment decisions are made, and concern that PPPs might be used to deny expensive care or be biased against minority groups. -/- Conclusions: Surrogates, like patients, strongly support the idea of using PPPs to help make treatment decisions for decisionally-incapacitated patients. These findings provide support for developing a PPP and assessing it in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions are made, including whether to use a PPP. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making. Future research is needed to assess this disagreement and consider ways to address it. (shrink)

Within bioethics, two prevailing approaches structure how we think about the role of medical surrogates and the decisions that they must make on behalf of incompetent patients. One approach views the surrogate primarily as the patient's agent, obediently enacting the patient's predetermined will. The second approach views the surrogate as the patient's custodian, judging for herself how to best safeguard the patient's interests. This paper argues that both of these approaches idealize away some of the ethically relevant features of advance (...) care planning that make patient preferences so inscrutable and surrogate decision-making so burdensome. It proposes a new approach to surrogate decision-making, the Fiduciary Agency Approach. On this novel approach, the surrogate has authority to not only act on the patient's behalf as the patient's agent but also to decide on the patient's behalf as the patient's fiduciary. One upshot of this new approach is that surrogates must sometimes go against the expressed dictates of the patients' advance directives not necessarily because doing so would be in the patient's best interest but rather because doing so would best represent the patients' will. (shrink)

Alex John London’s new book, For the Common Good: Philosophical Foundations of Research Ethics highlights the fact that establishing just social arrangements is not only a matter of incentivizing popular will to act for the common good; it also requires filling in informational gaps about which policies, arrangements, and interventions will advance the basic interests of members in an equitable, effective and efficient manner. Promoting justice requires, in part, acquiring the knowledge for how to do so. In developing this point, (...) London carefully traces these missteps in the main philosophical debates and then resuscitates the importance of questions of justice at the heart of research ethics. In doing so, it provides a transformative corrective for the field. This review critically examines one of the central pillars of London’s egalitarian research imperative approach: the way in which the social value of research is closely linked with minimizing uncertainty among reasonable experts. (shrink)

Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making would be better understood (...) as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)

Danielle Spencer's book, "Metagnosis: Revelatory Narratives of Health and Identity," does many things. It is a work of autotheory, putting Spencer's own embodied narrative in constant conversation with the testimony of others along with a remarkably diverse set of critical and theoretical approaches. In the book, Spencer coins a new term, "metagnosis", which occurs when one is newly diagnosed in adulthood with a lifelong condition. The book explores Spencer's own metagnostic experience involving her eyesight along with chronicling the experiences of (...) others to highlight the ways in which newfound knowledge of a diagnosis can in itself transform us.Born with strabismus—"misaligned eyes," Spencer is practiced at... (shrink)

This essay is a response to Robert Scharff’s “Before Empirical Turns and Transcendental Inquiry: pre-philosophical Considerations”. Scharff digs beneath the empirico-transcendental debate between Ihde and Stiegler in order to critique this debate’s Cartesian presuppositions. He uses the work of Nietzsche and the early Heidegger to further his critique. There is much to like in Scharff’s rich and intricate analytic interpretation but this is also the crux of my critique. The detour into Nietzsche’s and the early Heidegger’s work is ultimately unnecessary. (...) If Scharff looks closer, he will see that Feenberg’s revised theory of instrumentalization already accomplishes the return to technical experience and the critique of Cartesian techno scientific rationality that Scharff desires. (shrink)

The aim of this inquiry is to investigate Heidegger's ontology of technology. We will show that this ontology is aporetic. In Heidegger's key technical essays, ?The question concerning technology? and its earlier versions ?Enframing? and ?The danger?, enframing is described as the ontological basis of modern life. But the account of enframing is ambiguous. Sometimes it is described as totally binding and at other times it appears to allow for exceptions. This oscillation between, what we will call total enframing and (...) partial enframing, is underscored in the work of two influential scholars of Heidegger's later thought, Hubert Dreyfus and Iain Thomson. We will show that like Heidegger, Dreyfus and Thomson unwittingly perpetuate this dilemma that ultimately covers up the aporetic structure of enframing. (shrink)

Dana S. Belu combines Heidegger's phenomenology of technology with feminist phenomenology in order to make sense of the increased technicization of women's reproductive bodies during conception, pregnancy, and birth.

This article is an appreciative essay review of Andrew Feenberg's Heidegger and Marcuse: The Catastrophe and Redemption of History (2005).

Abstract: This paper provides a phenomenological interpretation of technological and natural childbirth. By using Heidegger’s ontology of technology to think about childbirth I argue that these two types of contemporary childbirth present us with a false dilemma as both reflect the same norms Heidegger associates with modernity, namely order, control, and efficiency. The paper briefly explains Heidegger’s concept of the enframing as the essence of the technological age while focusing on how it helps us to avoid falling into a technophilic (...) or technophobic trap. Although the technophobic approach popularized by Lamaze gained some favor with feminists who saw the increased use of reproductive technology as an extension of patriarchal control over women’s bodies, I argue that this natural birthing technique incorporated order and control in ways that are similar to its technophilic counterpart. In order to move beyond what I call the reproductive enframing, it is necessary to recognize the false dilemma presented by the technological and natural alternatives. (shrink)

This paper provides a phenomenological interpretation of technological and natural childbirth. By using Heidegger’s ontology of technology to think about childbirth I argue that these two types of contemporary childbirth present us with a false dilemma as both reflect the same norms Heidegger associates with modernity, namely order, control, and efficiency. The paper briefly explains Heidegger’s concept of the enframing as the essence of the technological age whilefocusing on how it helps us to avoid falling into a technophilic or technophobic (...) trap. Although the technophobic approach popularized by Lamaze gained some favor with feminists who saw the increased use of reproductive technology as an extension of patriarchal control over women’s bodies, I argue that this natural birthing technique incorporated order and control in ways that are similar to its technophilic counterpart. In order to move beyond what I call the reproductiveenframing, it is necessary to recognize the false dilemma presented by the technological and natural alternatives. (shrink)

Following decades of maltreatment of women in obstetric care, professional respect for maternal autonomy in obstetric decision making and care have become codified in global and national professional ethical guidelines. Yet, using the example of birth after cesarean, identifiable threats to maternal autonomy in obstetrics continue. This paper focuses on how current scientific knowledge and obstetric practice patterns factor into restricted maternal autonomy as evidenced in three representative maternal accounts obtained prior and subsequent to birth after cesarean. Short- and long-term (...) remedies to improve the current state of restricted maternal autonomy in clinical practice surrounding decision making on birth after cesarean are provided. (shrink)

Following decades of maltreatment of women in obstetric care, professional respect for maternal autonomy in obstetric decision making and care have become codified in global and national professional ethical guidelines. Yet, using the example of birth after cesarean, identifiable threats to maternal autonomy in obstetrics continue. This paper focuses on how current scientific knowledge and obstetric practice patterns factor into restricted maternal autonomy as evidenced in three representative maternal accounts obtained prior and subsequent to birth after cesarean. Short- and long-term (...) remedies to improve the current state of restricted maternal autonomy in clinical practice surrounding decision making on birth after cesarean are provided. (shrink)

This introduction presents the converging points of view (including those from continental philosophy, analytic philosophy, psychology and sociology) on issues regarding reproductive technologies, especially as they relate to childbirth.

This is an appreciative five page book review of Elkholy's Heidegger and a Metaphysics of Feeling (2008). It raises a critical question about the difference between Heidegger's account of aletheia and Elkholy's concept of ontological occlusion.

This review argues that Carman's book is an excellent source for making sense of Heidegger's early work on interpretation.

The paper aims to put certain basic mathematical elements and operations into an empirical perspective, evaluate the empirical status of various analytic operations widely used within psychology and suggest alternatives to procedures criticized as inadequate. Experimentation shows the "manyness" of items to be a perceptual quality for both young children and animals and that natural operations are performed by naive children analogous to those performed by persons tutored in arithmetic. Number, counting, arithmetic operations therefore can make distinctions that are not (...) inevitably arbitrary, and conceptual operations can obviously have a status as natural events with psychology. If the elements and conceptual operations involved in mathematical systems were not inherent in physiological process, various primitive discriminations could not be possible. Also, since some calculi have a natural status in a given empirical circumstance, the axioms of others can not be satisfied. Therefore the psychologist when acting as an empirical scientist seeks a calculus having a structure whose elements are isomorphic with natural units of stimulus and response and whose operations are isomorphic with whatever natural processes are involved. Measurement poses a special problem for the empirical scientist. It concerns but a single class of natural qualities and this only in a limited way. The concept of quantity has a natural counterpart but quantity and measurement are not wholly analogous. Measurement is defined, as H. S. Leonard suggests, as a theoretical activity. Measurement theory has a formal structure but empirical end. Measurement hypothesizes about the position of a particular quality within a definite range of qualities. It therefore is beholden to definite empirical restrictions. Some hypotheses-making systems use terms and relations per se as the context and starting point for dealing with discriminable events. Such procedures are 'transcendent." In empirical science, questions are part of problem-solving activity and their reference is naturally restricted. In providing description and explanation, psychological researchers frequently use calculi in a transcendent way. This results in theories that are only quasi-empirical and "half" true. The roles measurement plays in psychology are discussed. Of particular concern are those cases in which the results of measuring or a theory of measurement are used to define the "real" units, or the "real" relations involved in problematic psychological events, and thence to describe and explain behaviors of interest. Metaphysical or ontological usages of measurement sometimes occur. The implication of these arguments with regard to a view of empirical science is discussed. (shrink)

When people are making certain medical decisions – especially potentially transformative ones – the specter of regret may color their choices. In this paper, I ask: can predicting that we will regret a decision in the future serve any justificatory role in our present decision-making? And if so, what role? While there are many pitfalls to such reasoning, I ultimately conclude that considering future retrospective emotions like regret in our decisionmaking can be both rational and authentic. Rather than indicating that (...) one is about to make a mistake or that there is some underlying value that one already cares about but is overlooking, the prediction that one will regret a decision in the future makes one confront how her present values and priorities may change as a result of her choice in ways she cannot presently anticipate. (shrink)

Context Opioid treatment agreements (OTAs) are documents that clinicians present to patients when prescribing opioids that describe the risks of opioids and specify requirements that patients must meet to receive their medication. Notwithstanding a lack of evidence that OTAs effectively mitigate opioids’ risks, professional organizations recommend that they be implemented, and jurisdictions increasingly require them. We sought to identify the jurisdictions that require OTAs, how OTAs might affect the outcomes of lawsuits that arise when things go wrong, and instances in (...) which the law permits flexibility for clinicians and health care institutions to adopt best practices. -/- Methods We surveyed the laws and regulations of all 50 states and the District of Columbia to identify which jurisdictions require the use of OTAs, the circumstances in which OTA use is mandatory, and the terms OTAs must include (if any). We also surveyed criminal and civil judicial decisions in which OTAs were discussed as evidence on which a court relied to make its decision to determine how OTA use influences litigation outcomes. -/- Findings Results show that a slight majority (27) of jurisdictions now require OTAs. With one exception, the jurisdictions’ requirements for OTA use are triggered at least in part by long-term prescribing. There is otherwise substantial variation and flexibility within OTA requirements. Results also show that even in jurisdictions where OTA use is not required by statute or regulation, OTA use can inform courts’ reasoning in lawsuits involving patients or clinicians. Sometimes, but not always, OTA use legally protects clinicians from liability. -/- Conclusions -/- Our results show that OTA use is entwined with legal obligations in various ways. Clinicians and health care institutions should identify ways for OTAs to enhance clinician–patient relationships and patient care within the bounds of relevant legal requirements and risks. (shrink)

We often find ourselves in situations where it is up to us to make decisions on behalf of others. How can we determine whether such decisions are morally justified, especially if those decisions may change who it is these others end up becoming? In this paper, I will evaluate one plausible kind of justification that may tempt us: we may want to justify our decision by appealing to the likelihood that the other person will be glad we made that specific (...) choice down the line. Although it is tempting, I ultimately argue that we should reject this sort of appeal as a plausible justification for the moral permissibility of our vicarious decisions. This is because the decisions that we make on behalf of another may affect the interests and values that that person will hold in the future. As I will show, this complicates the justificatory relationship between present decisions and future attitudes, since the latter can depend on the former. This is not to say that the predicted future attitudes of others can play no significant role in justifying our decisions on others’ behalf. Rather, appealing to the future attitudes in our moral justifications may play an important role in our practical thinking but only when we consider the future attitudes of all relevant possible futures. (shrink)

We appreciate that all our commentators accepted the central framework we argued for, namely that the FDA has multiple roles and attendant responsibilities, and we are excited to see this framework...

Those arguing that conscientious objection in medicine should be declared unethical by professional societies face the following challenge: conscientious objection can function as an important reforming mechanism when it involves health care workers refusing to participate in certain medical interventions deemed standard of care and legally sanctioned but which undermine patients’ rights. In such cases, the argument goes, far from being unethical, conscientious objection may actually be a professional duty. I examine this sort of challenge and ultimately argue that these (...) acts of conscience done in the interest of reforming professional norms or medical regulations are best understood as episodes of civil disobedience rather than episodes of conscientious objection. In contrast to the private, exempting nature of conscientious objection, civil disobedience is a public breach of a norm or law undertaken with the aim of bringing about a change in governmental policies or professional standards. Consequently, clinicians may have a duty to engage in civil disobedience even while professional societies are right to declare limitations on the ethical appropriateness of conscientious objection. (shrink)

Many people view disabilities as misfortunes, call this the standard view. In this paper, I examine one criticism that has been launched against the Standard View. Rather than determine in advance whether having a disability is good or bad for a person, some critics argue that the Standard View is reflective of and brings about inappropriate emotional responses toward people with disabilities and their circumstances. For instance, philosophers have recently argued that in holding the standard view, we become prone to (...) a destructive kind of unwarranted pity or that the view leads us to hold certain untenable or inappropriate hopes for our children and for our society. I think this sort of challenge to the Standard View has a lot of appeal, but I worry that if it is not properly articulated, the approach is vulnerable to what has been known as “The Wrong Kind of Reason” problem. The paper highlights and addresses this worry. (shrink)

While pharmaceutical industry involvement in producing, interpreting, and regulating medical knowledge and practice is widely accepted and believed to promote medical innovation, industry-favouring biases may result in prioritizing corporate profit above public health. Using diabetes as our example, we review successive changes over forty years in screening, diagnosis, and treatment guidelines for type 2 diabetes and prediabetes, which have dramatically expanded the population prescribed diabetes drugs, generating a billion-dollar market. We argue that these guideline recommendations have emerged under pervasive industry (...) influence and persisted, despite weak evidence for their health benefits and indications of serious adverse effects associated with many of the drugs they recommend. We consider pharmaceutical industry conflicts of interest in some of the research and publications supporting these revisions, and in related standard-setting committees and oversight panels. We raise concern over the long-term impact of these multifaceted involvements. Rather than accept industry conflicts of interest as normal, needing only to be monitored and managed, we suggest challenging that normalcy, and ask: what are the real costs of tolerating such industry participation? We urge the development of a broader focus to fully understand and curtail the systemic nature of industry’s influence over medical knowledge and practice. (shrink)