We conducted and analyzed qualitative interviews with 12 persons working on the Healthy Public Housing Initiative in Boston, Massachusetts in 2001. Our goal was to generate ideas and themes related to the ethics of the community-based participatory research in which they were engaged. Specifically, we wanted to see if we found themes that differed from conventional research that is based on an individualistic ethics. There were clearly distinct ethical issues raised with respect to projects and individuals who engage in community-based (...) collaborations. The differences that arose from the interviews were seeking equality between the partners, the need for the community partner to defend the community, dealing with unflattering data, meeting community expectations and producing tangible benefits to the community. (shrink)

This essay explores the process and issues related to community collaborative research that involves Native Americans generally, and specifically examines the Navajo Nation’s efforts to regulate research within its jurisdiction. Researchers need to account for both the experience of Native Americans and their own preconceptions about Native Americans when conducting research about Native Americans. The Navajo Nation institutionalized an approach to protecting members of the nation when it took over Institutional Review Board (IRB) responsibilities from the US Indian Health Service (...) (IHS) in 1996. While written regulations for the Navajo Nation IRB are not dissimilar, and in some ways are less detailed than those of the IHS IRB, in practice the Navajo Nation allows less flexibility. Primary examples of this include not allowing expedited review and requiring prepublication review of all manuscripts. Because of its broad mandate, the Navajo Nation IRB may also require review of some projects that would not normally be subject to IRB approval, including investigative journalism and secondary research about Navajo People that does not involve direct data collection from human subjects. (shrink)

It is common to think of medical and ethical modes of thought as different in kind. In such terms, some clinical situations are made more complicated by an additional ethical component. Against this picture, we propose that medical and ethical modes of thought are not different in kind, but merely different aspects of what it means to be human. We further propose that clinicians are uniquely positioned to synthesise these two aspects without prior knowledge of philosophical ethics.

In this essay, I consider whether it makes sense to say that our cognitive capacities—remembering, imagining, intending, hoping, expecting and so on—manifest as inner, subpersonal processes. Given whether something makes sense is a grammatical rather than theoretical or empirical issue, it cannot be explained but can only be better understood by describing and reflecting on situations in which it arises. As such, I approach this issue using the descriptive method of O.K. Bouwsma, which is a development of Wittgenstein's latter methodological (...) approach of conceptually clarifying our bounds of sense. In the course of my investigation, I come to the realisation that cognitive capacities do not, as much psychology and cognitive science imply, make sense as inner, subpersonal processes. Instead, they make sense as personal capacities, which manifest in many ways of acting. (shrink)

In The Time After, which references the process of photography as well as the future fate of our planet, fine arts photographer Doug Fogelson uses an iconoclastic multiple exposure technique in order to depict our collective surroundings, producing imagery that reflects our own alien experience of nature, as well as the distanced perspective of the viewer. This volume collects over 160 of Fogelson's spectacular images and pairs them with speculative and poetic essays by Derrick Jensen, Eiren Caffall, and Bridgette (...) R. McCullough. (shrink)

Healthcare systems around the world are struggling to maintain a sufficient workforce to provide adequate care during the COVID-19 pandemic. Staffing problems have been exacerbated by healthcare workers refusing to work out of concern for their families. I sketch a deontological framework for assessing when it is morally permissible for HCWs to abstain from work to protect their families from infection and when it is a dereliction of duty to patients. I argue that it is morally permissible for HCWs to (...) abstain from work when their duty to treat is outweighed by the combined risks and burdens of that work. For HCWs who live with their families, the obligation to protect one’s family from infection contributes significantly to those burdens. There are, however, a range of complicating factors including the strength of duty to treat which varies according to the HCW’s role, the vulnerability of family members to the disease, the willingness of family members to risk infection and the resources available to the HCW to protect their family. In many cases, HCWs in ‘frontline’ roles with a weak duty to treat and families at home will be morally permitted to abstain from work given the risks posed by COVID-19; therefore, society should provide additional incentives to maintain sufficient staff in these roles. (shrink)

In this essay, I investigate the longstanding philosophical problem of whether we have control over our actions in a deterministic world. In working through a range of everyday situations in which this problem could arise, I come to the realisation that determinism has no bearing on whether we have control over our actions, because having control over our actions and determinism only make sense under different aspects.

ABSTRACT‘Self-ambiguity’, we suggest, is best understood as an uncertainty about how strongly a given feature reflects who one truly is. When this understanding of self-ambiguity is applied to a view of the self as having both essential and shapable components, self-ambiguity can be seen to have two aspects: (1) uncertainty about one's essential or relatively unchangeable characteristics, e.g. one's sexuality, and (2) uncertainty about how to shape oneself, e.g. which values to commit to, actions to pursue, or essential features to (...) identify with. We explain how a narrative account of agency can accommodate these forms of self-ambiguity and argue that such an account also reveals another kind of self-ambiguity, namely, (3) uncertainty about whether one's established self-narrative represents who one really is. We illustrate this third form of self-ambiguity in the context of addiction where people's established addiction self-narratives make it difficult to identify with recovery. We argue that recovery will require embracing, especially, our third form of self-ambiguity as a chance for positive self-transformation. Treatment for addiction should, therefore, support people in going through and ultimately narratively resolving the inevitable self-ambiguities of the recovery process. (shrink)

Many different versions of cultural studies have emerged in the past decades. While during its dramatic period of global expansion in the 1980s and 1990s, cultural studies was often identified with...

Sometimes healthcare professionals conscientiously refuse to treat patients despite the patient requesting legal, medically indicated treatments within the professionals’ remit. Recently, there has been a proliferation of views using the concept of public reason to specify which conscientious refusals of treatment should be accommodated. Four such views are critically assessed, namely, those of Robert Card, Massimo Reichlin, David Scott, and Doug McConnell. This paper argues that McConnell’s view has advantages over the other approaches because it combines the requirement that (...) healthcare professionals publicly justify the grounds of their conscientious refusals of treatment with the requirement that those grounds align with minimally decent healthcare. This relatively restrictive approach accommodates conscientious refusals from minimally decent healthcare professionals while still protecting good healthcare, the independence of the healthcare professions, and the fiduciary relationships. (shrink)

All people are vulnerable to having their self-concepts shaped by others. This article investigates that vulnerability using a theory of narrative self-constitution. According to narrative self-constitution, people depend on others to develop and maintain skills of self-narration and they are vulnerable to having the content of their self-narratives co-authored by others. This theoretical framework highlights how vulnerability to co-authoring is essential to developing a self-narrative and, thus, the possibility of autonomy. However, this vulnerability equally entails that co-authors can undermine autonomy (...) by contributing disvalued content to the agent’s self-narrative and undermining her authorial skills. I illustrate these processes with the first-hand reports of several women who survived sexual abuse as children. Their narratives of survival and healing reveal the challenges involved in developing the skills required to manage vulnerability to co-authoring and how others can help in this process. Finally, I discuss some of the implications of co-authoring for the healthcare professional and the therapeutic relationship. (shrink)

Psychiatric involvement in patient morality is controversial. If psychiatrists are tasked with shaping patient morality, the coercive potential of psychiatry is increased, treatment may be unfairly administered on the basis of patients’ moral beliefs rather than medical need, moral disputes could damage the therapeutic relationship and, in any case, we are often uncertain or conflicted about what is morally right. Yet, there is also a strong case for the view that psychiatry often works through improving patient morality and, therefore, should (...) aim to do so. Our goal is to offer a practical and ethical path through this conflict. We argue that the default psychiatric approach to patient morality should be procedural, whereby patients are helped to express their own moral beliefs. Such a procedural approach avoids the brunt of objections to psychiatric involvement in patient morality. However, in a small subset of cases where patients’ moral beliefs are sufficiently distorted or underdeveloped, we claim that psychiatrists should move to a substantive approach and shape thecontentof those beliefs when they are relevant to psychiatric outcomes. The substantive approach is prone to the above objections but we argue it is nevertheless justified in this subset of cases. (shrink)

Addiction involves a chronic deficit in self-governance that treatment aims to restore. We draw on our interviews with addicted people to argue that addiction is, in part, a problem of self-narrative change. Over time, agents come to strongly identify with the aspects of their self-narratives that are consistently verified by others. When addiction self-narratives become established, they shape the addicted person’s experience, plans, and expectations so that pathways to recovery appear implausible and feel alien. Therefore, the agent may prefer to (...) enact her disvalued self-narrative because at least it represents who she takes herself to be. To recover, the agent needs to conduct narrative work, adjusting her existing self-narrative so that it better supports recovery-directed narrative projections. Reducing cravings, managing withdrawals, increasing self-control, and developing goals are all important for recovery but those approaches will often be in vain if the influence of self-narrative is ignored. If our analysis is correct, addiction treatment will typically be more effective if it incorporates support for self-narrative change. (shrink)

This chapter interrogates Hollywood film as a powerful public pedagogical machine and as an influential component of the broader media culture, that serves as a primary terrain where the authority of violence and the violence of authority expresses, justifies, and legitimates itself in the U.S. Allegiances to, identifications with, beliefs in, desires for, and attitudes about violence, authority, militarism, and power are largely constructed, imbued, directed and shaped through dominant media formations as they create images and spectacles of violence, either (...) real or fabricated. During a time of continuing imperial aggression, expanding Pentagon budgets, increased international violence, growing authoritarian tendencies, and when an “imperially ambitious” United States has embarked on what Anatole Lieven calls a policy of “unilateral global domination through absolute military superiority,” the inculcation into the mass consciousness of the justification for, identification with, acceptance and pursuit of mass violence through military aggression becomes all the more crucial. (shrink)

In this nationwide study of American and Canadian journalists, I found that their moral and ethical values are solidly connected to the Judeo-Christian tradition, even among those who do not claim to be religiously oriented. This study shows that religious values are imbedded deeply, if not always consciously, in the moral and ethical values of journalists and that journalists of varying religious orientations tend to endorse a core group of moral and ethical principles at the heart of the religious heritage (...) of the United States and Canada. However, journalists have expanded their definition of what religion coverage means in an increasingly diverse and secular society, and few want to connect their professional values only with Christian teaching. (shrink)

Plato seems to have been pessimistic about how most people stand with regard to virtue. However, unlike the Stoics, he did not conclude that most people are vicious. Rather, as we know from discussions across several dialogues, he countenanced decent ethical conditions that fall short of genuine virtue, which he limited to the philosopher. Despite Plato's obvious interest in this issue, commentators rarely follow his lead by investigating in detail such conditions in the dialogues. When scholars do investigate what kind (...) of virtue, if any, Plato thinks is open to non-philosophers, they typically look to the Republic. But in the Republic Plato sets out an ideal city; therefore, the virtue available to non-philosophers there is likely different from what he thinks is available to them in the real world. If we want to determine Plato's thoughts about the virtue of actual non-philosophers, we must look elsewhere. In this paper, I set my sights on the Phaedo. (shrink)

In this paper, I investigate Aristotle’s claim in 'Nicomachean Ethics' III.1 about situations that “overstrain human nature.” By setting out and answering several interpretative questions about such situations, I offer a comprehensive interpretation of this passage. I argue that in (at least some of) these cases, the agent voluntarily does something wrong, even though there is a right action available. Furthermore, I argue that Aristotle would think it is possible for a rare agent to perform the right action in (at (...) least some of) these cases, overcoming the limitations of human nature by identifying with the divine part of the soul. (shrink)

Current mainstream approaches to conscientious objection either uphold the standards of public health care by preventing objections or protect the consciences of health‐care professionals by accommodating objections. Public justification approaches are a compromise position that accommodate conscientious objections only when objectors can publicly justify the grounds of their objections. Public justification approaches require objectors and assessors to speak a common normative language and to this end it has been suggested that objectors should be required to cast their objection in terms (...) of public reason. We provide critical support for such a public reason condition and argue that it would be neither too demanding nor too permissive. We also respond to objections that it unfairly favours secular over religious objectors and that public reasons cannot be held with the kind of sincerity thought to characterize conscientious objections. (shrink)

Priority setting (also known as resource allocation or rationing) occurs at every level of every health system and is one of the most significant health care policy questions of the 21st century. Because it is so prevalent and context specific, improving priority setting in a health system entails improving it in the institutions that constitute the system. But, how should this be done? Normative approaches are necessary because they help identify key values that clarify policy choices, but insufficient because different (...) approaches lead to different conclusions and there is no consensus about which ones are correct, and they are too abstract to be directly used in actual decision making. Empirical approaches are necessary because they help to identify what is being done and what can be done, but are insufficient because they cannot identify what should be done. Moreover, to be really helpful, an improvement strategy must utilize rigorous research methods that are able to analyze and capture experience so that past problems are corrected and lessons can be shared with others. Therefore, a constructive, practical and accessible improvement strategy must be research-based and combine both normative and empirical methods. In this paper we propose a research-based improvement strategy that involves combining three linked methods: case study research to describe priority setting; interdisciplinary research to evaluate the description using an ethical framework; and action research to improve priority setting. This describe-evaluate-improve strategy is a generalizable method that can be used in different health care institutions to improve priority setting in that context. (shrink)

Why do some addicted people chronically fail in their goal to recover, while others succeed? On one established view, recovery depends, in part, on efforts of intentional planning agency. This seems right, however, firsthand accounts of addiction suggest that the agent’s self-narrative also has an influence. This paper presents arguments for the view that self-narratives have independent, self-fulfilling momentum that can support or undermine self-governance. The self-narrative structures of addicted persons can entrench addiction and alienate the agent from practically feasible (...) recovery plans. Strategic re-narration can redirect narrative momentum and therefore support recovery in ways that intentional planning alone cannot. (shrink)

Robert Card’s “Reasonability View” is a significant contribution to the debate over the place of conscientious objection in health care. In his view, conscientious objections can only be accommodated if the grounds for the objection meet a reasonability standard. I identify inconsistencies in Card’s description of the reasonability standard and argue that each version he specifies is unsatisfactory. The criteria for reasonability that Card sets out most frequently have no clear underpinning principle and are too permissive of immoral objections. Card (...) has also claimed that petitioners must justify their positions with Rawlsian public reason. I argue that, although the resulting reasonability standard is principled, it is overly restrictive. I also show that a reasonability standard built on Rawls’ more lenient conception of reasonableness would be overly permissive of objections at odds with professional healthcare standards. Finally, I argue for my favored solution, which bases the reasonability standard on minimal professional standards. (shrink)

Research in anthropology has shown that kin terminologies have a complex combinatorial structure and vary systematically across cultures. This article argues that universals and variation in kin terminology result from the interaction of (1) an innate conceptual structure of kinship, homologous with conceptual structure in other domains, and (2) principles of optimal, “grammatical” communication active in language in general. Kin terms from two languages, English and Seneca, show how terminologies that look very different on the surface may result from variation (...) in the rankings of a universal set of constraints. Constraints on kin terms form a system: some are concerned with absolute features of kin (sex), others with the position (distance and direction) of kin in “kinship space,” others with groups and group boundaries (matrilines, patrilines, generations, etc.). Also, kin terms sometimes extend indefinitely via recursion, and recursion in kin terminology has parallels with recursion in other areas of language. Thus the study of kinship sheds light on two areas of cognition, and their phylogeny. The conceptual structure of kinship seems to borrow its organization from the conceptual structure of space, while being specialized for representing genealogy. And the grammar of kinship looks like the product of an evolved grammar faculty, opportunistically active across traditional domains of semantics, syntax, and phonology. Grammar is best understood as an offshoot of a uniquely human capacity for playing coordination games. (shrink)

I argue that Aristotle believes that virtue comes in degrees. After dispatching with initial concerns for the view, I argue that we should accept it because Aristotle conceives of heroic virtue as the highest degree of virtue. I support this interpretation of heroic virtue by considering and rejecting alternative readings, then showing that heroic virtue characterized as the highest degree of virtue is consistent with the doctrine of the mean.

Daniel Sulmasy has recently argued that good medicine depends on physicians having a wide discretionary space in which they can act on their consciences. The only constraints Sulmasy believes we should place on physicians’ discretionary space are those defined by a form of tolerance he derives from Locke whereby people can publicly act in accordance with their personal religious and moral beliefs as long as their actions are not destructive to society. Sulmasy also claims that those who would reject physicians’ (...) right to conscientious objection eliminate discretionary space thus undermining good medicine and unnecessarily limiting religious freedom. I argue that, although Sulmasy is correct that some discretionary space is necessary for good medicine, he is wrong in thinking that proscribing conscientious objection entails eliminating discretionary space. I illustrate this using Julian Savulescu and Udo Schuklenk’s system for restricting conscientious objections as a counter-example. I then argue that a narrow discretionary space constrained by professional ideals will promote good medicine better than Sulmasy’s wider discretionary space constrained by his conception of tolerance. Sulmasy’s version of discretionary space would have us tolerate actions that are at odds with aspects of good medicine, including aspects that Sulmasy himself explicitly values, such as fiduciary duty. Therefore, if we want the degree of religious freedom in the public sphere that Sulmasy favours then we must decide whether it is worth the cost to the healthcare system. (shrink)

In the United States today, the use or possession of many drugs is a criminal offense. Can these criminal laws be justified? What are the best reasons to punish or not to punish drug users? These are the fundamental issues debated in this book by two prominent philosophers of law. Douglas Husak argues in favor of drug decriminalization, by clarifying the meaning of crucial terms, such as legalize, decriminalize, and drugs; and by identifying the standards by which alternative drug policies (...) should be assessed. He critically examines the reasons typically offered in favor of our current approach and explains why decriminalization is preferable. Peter de Marneffe argues against drug legalization, demonstrating why drug prohibition, especially the prohibition of heroin, is necessary to protect young people from self-destructive drug use. If the empirical assumptions of this argument are sound, he reasons, drug prohibition is perfectly compatible with our rights to liberty. (shrink)

The 2023 doctors’ strikes in the UK have elicited a familiar moral outcry that such strikes are morally wrong. We consider five arguments that might be thought to show doctors’ strikes are morally impermissible but show that they all fail. The most we can conclude from such arguments is that doctors’ strikes are morally permissible in a narrower range of circumstances than strikes in other sectors.We then outline two independent but compatible justifications for doctors’ strikes, one that appeals to doctors’ (...) interests in fair pay and working conditions and one that appeals to doctors’ duty to protect public health. We also suggest that doctors’ strikes can be supererogatory when they aim to correct a government failing in its own duty to protect public health. Finally, we assess the 2023 UK doctors’ strikes. We conclude that they are justified and there is a case for considering them supererogatory. (shrink)

In Discovering Alabama Forests, ecologist-educator Doug Phillips and photographer Robert Falls celebrate the current health and diversity of Alabama woodlands while sounding a call for their wise management and protection in the future.

This full-color guide explains how to get better photos from an SL1. Written by professional photographer Doug Sahlin, this book explains the camera?s controls and shooting modes.

A full-color guide to the art of digital portrait photography Portrait photography entails taking posed photographs of individuals or set scenery and is the most common photo style among the most novice photography hobbyist to the most advanced photographer. With this easy-to-understand guide, bestselling author and professional photographer Doug Sahlin walks you through the best techniques for getting professional-quality digital portraits. Packed with hundreds of full-color photos and screen shots, this book discusses best practices for taking formal portraits, wedding (...) photos, event photos, casual photos, and more. You'll examine the difference between using the built-in flash and natural lighting and take a look at the benefits of upgrading to a photo lighting kit and pro backdrop. Portrait photography is the most popular style of photography Features helpful information for everyone from beginner hobbyists to advanced photographers Shares insider tips for selecting equipment and choosing from the various tools for portrait photography Walks you through working with a wide range of subjects, including children, pets, and wildlife Discusses lighting and editing images Takes a look at ways to create a portrait that is suitable for framing Make sure your subjects are ready for their close ups with this fun and friendly guide to digital portrait photography. (shrink)

Drawing on Charles Peirce’s descriptions of his correspondence course on the “Art of Reasoning,” I argue that Peirce believed that the study of logic stands at the center of a liberal arts education. However, Peirce’s notion of logic included much more than the traditional accounts of deduction and syllogistic reasoning. He believed that the art of reasoning required a study of both abductive and inductive inference as well the practice of observation and imagination. Employing these other features of logic, his (...) course foreshadowed a number of developments in twentieth century educational theory: the belief that non-traditional students should be educated, the claim that the art of reasoning was important to all theoretical practices, and that the art of reasoning was important to the overall growth of a person. The upshot is that Peirce’s course in the art of reasoning should make us reconsider making logic courses, under Peirce’s broad conception of logic, required courses in high school and higher education. (shrink)

In this paper I will revisit the debate over pornography by doing three things: (a) I will suggest a more sophisticated, two‐dimensional set of distinctions between positons in the debate; (b) I will then go on to attack both libertarians and the group I call “repressive feminists”; and (c) I will conclude by suggesting that by means of Hume's theory of sympathy we could support a limited form of censorship to bring women more fully into our moral and political community. (...) I turn first to the labors of definition. (shrink)

From the one-room chapel in a prairie town to the grandiose cathedral on a city street, churches stand at the heart of the Minnesota landscape.

Waterfalls and underground caverns,lady’s slippers and dwarf trout lilies,cross-country skiing and fishing adventures—alluring photographs and captivating stories survey these and other delights of Minnesota’s popular state parks.