BackgroundBiobanking biospecimens and consent are common practice in paediatric research. We need to explore children and young people’s (CYP) knowledge and perspectives around the use of and consent to biobanking. This will ensure meaningful informed consent can be obtained and improve current consent procedures.MethodsWe designed a survey, in co-production with CYP, collecting demographic data, views on biobanking, and consent using three scenarios: 1) prospective consent, 2) deferred consent, and 3) reconsent and assent at age of capacity. The survey was disseminated (...) via the Young Person’s Advisory Group North England (YPAGne) and participating CYP’s secondary schools. Data were analysed using a qualitative thematic approach by three independent reviewers (including CYP) to identify common themes. Data triangulation occurred independently by a fourth reviewer.ResultsOne hundred two CYP completed the survey. Most were between 16–18 years (63.7%, N = 65) and female (66.7%, N = 68). 72.3% had no prior knowledge of biobanking (N = 73).Acceptability of prospective consent for biobanking was high (91.2%, N = 93) with common themes: ‘altruism’, ‘potential benefits outweigh individual risk’, 'frugality', and ‘(in)convenience’.Deferred consent was also deemed acceptable in the large majority (84.3%, N = 86), with common themes: ‘altruism’, ‘body integrity’ and ‘sample frugality’. 76.5% preferred to reconsent when cognitively mature enough to give assent (N = 78), even if parental consent was previously in place. 79.2% wanted to be informed if their biobanked biospecimen is reused (N = 80).ConclusionProspective and deferred consent acceptability for biobanking is high among CYP in the UK. Altruism, frugality, body integrity, and privacy are the most important themes. Clear communication and justification are paramount to obtain consent. Any CYP with capacity should be part of the consenting procedure, if possible. (shrink)

Reasoning about bedrock abstract concepts such as time, number, and valence relies on spatial metaphor and often on multiple spatial metaphors for a single concept. Previous research has documented, for instance, both future-in-front and future-to-right metaphors for time in English speakers. It is often assumed that these metaphors, which appear to have distinct experiential bases, remain distinct in online temporal reasoning. In two studies we demonstrate that, contra this assumption, people systematically combine these metaphors. Evidence for this combination was found (...) in both directly elicited and spontaneous co-speech gestures about time. These results provide first support for the hypothesis that the metaphorical representation of time, and perhaps other abstract domains as well, involves the continuous co-activation of multiple metaphors rather than the selection of only one. (shrink)

While we often talk about time using spatial terms, experimental investigation of space-time associations has focused primarily on the space in front of the participant. This has had two consequences: the disregard of the space behind the participant and the creation of potential task demands produced by spatialized manual button-presses. We introduce and test a new paradigm that uses auditory stimuli and vocal responses to address these issues. Participants made temporal judgments about deictic or sequential relationships presented auditorily along a (...) body-centered sagittal or transversal axis. Results involving the transversal axis replicated previous work while sagittal axis results were surprising. Deictic judgments did not use the sagittal axis but sequential judgments did, in a previously undocumented way. Participants associated earlier judgments with the space in front of them and later judgments with the space behind them. These findings, using a new approach, p.. (shrink)

The overall goal of this target article is to demonstrate a mechanism for an embodied cognition. The particular vehicle is a much-studied, but still widely debated phenomenon seen in 7–12 month-old-infants. In Piaget's classic “A-not-B error,” infants who have successfully uncovered a toy at location “A” continue to reach to that location even after they watch the toy hidden in a nearby location “B.” Here, we question the traditional explanations of the error as an indicator of infants' concepts of objects (...) or other static mental structures. Instead, we demonstrate that the A-not-B error and its previously puzzling contextual variations can be understood by the coupled dynamics of the ordinary processes of goal-directed actions: looking, planning, reaching, and remembering. We offer a formal dynamic theory and model based on cognitive embodiment that both simulates the known A-not-B effects and offers novel predictions that match new experimental results. The demonstration supports an embodied view by casting the mental events involved in perception, planning, deciding, and remembering in the same analogic dynamic language as that used to describe bodily movement, so that they may be continuously meshed. We maintain that this mesh is a pre-eminently cognitive act of “knowing” not only in infancy but also in everyday activities throughout the life span. Key Words: cognitive development; dynamical systems theory; embodied cognition; infant development; motor control; motor planning; perception and action. (shrink)

Chemical structures are among the trademarks of our profession, as surely chemical as flasks, beakers and distillation columns. When someone sees one of us busily scribbling formulas or structures, he or she has no trouble identifying a chemist. Yet these familiar objects, which accompany our work from start to end, from the initial doodlings (Fig. I) to the final polished artwork in a publication (Fig. II), are deceptively simple. They raise interesting and difficult questions about representation. It is the intent (...) of this article to reflect upon molecular graphics. (shrink)

In this commentary, we point to guidelines for performing human neuroimaging studies and their reporting in microbiota-gut-brain articles. Moreover, we provide a view on interpretational issues in MGB studies, with a specific focus on gut microbiota–derived metabolites. Thus, extending the target article, we provide recommendations to the field to increase reproducibility and relevance of this type of MGB study.

This chapter surveys essentialist and anti-essentialist theories of sex and gender. It does so by engaging three approaches to sex and gender: externalism, internalism, and contextualism. The chapter also draws attention to two key debates about sex and gender in the feminist literature: the debate about the sex/gender distinction (the distinction debate) and the debate about whether sex and gender have essences (the essentialism/anti-essentialism debate). In addition, it describes three problems that theories of sex and gender tend to face: the (...) Inclusion Problem, the Definition Problem, and the Exclusion Problem. Lastly, the chapter highlights why the division between essentialist and anti-essentialist accounts of sex and gender is not clear. (shrink)

This paper enquires into the politics of real-time in online media. It suggests that real-time cannot be accounted for as a universal temporal frame in which events happen, but explores the making of real-time from a device perspective focusing on the temporalities of platforms. Based on an empirical study exploring the pace at which various online media produce new content, we trace the different rhythms, patterns or tempos created by the interplay of devices, users’ web activities and issues. What emerges (...) are distinct forms of ‘realtimeness’ which are not external from but specific to devices, organized through socio-technical arrangements and practices of use. Realtimeness thus unflattens more general accounts of the real-time web and research, and draws attention to the agencies built into specific platform temporalities and the political economies of making real-time. (shrink)

Over the last two decades, the capabilities approach has become an increasingly influential theory of development. It conceptualises human wellbeing in terms of an individual's ability to achieve functionings we have reason to value. In contrast, the African ethic of ubuntu views human flourishing as the propensity to pursue relations of fellowship with others, such that relationships have fundamental value. These two theoretical perspectives seem to be in tension with each other; while the capabilities approach focuses on individuals as the (...) locus of ethical value, an ubuntu ethic concentrates on the relations between individuals. In this article, we ask: to what extent is the capabilities approach compatible with this African ethical theory? We argue that, on reflection, relations play a much stronger role in the capabilities approach than often assumed. There is good reason to believe that relationality is part of the concept of a capability itself, where such relationality has intrinsic ethical value. This understanding of the ethical centrality of relations grounds new normative perspectives on the capabilities approach, and offers a more comprehensive grasp of the relevance of relationships to empirical enquiry. (shrink)

This commentary comprises three different responses to Counted and Zock’s article: “Place Spirituality: An Attachment Perspective.” The first response is from Esther Sternberg, MD, who gives a psychophysiological and neuroscience critique. The second is from Altaf Engineer, PhD, from the perspective of architecture and environmental psychology, and the last response is from Hester Oberman, PhD, who gives a psychology of religion rebuttal.

Article published in Stance by Wolfe and Grosz.

In several jurisdictions, irremediable suffering from a medical condition is a legal requirement for access to assisted dying. According to the expressivist objection, allowing assisted dying for a specific group of persons, such as those with irremediable medical conditions, expresses the judgment that their lives are not worth living. While the expressivist objection has often been used to argue that assisted dying should not be legalised, I show that there is an alternative solution available to its proponents. An autonomy-based approach (...) to assisted suicide regards the provision of assisted suicide (but not euthanasia) as justified when it is autonomously requested by a person, irrespective of whether this is in her best interests. Such an approach has been put forward by a recent judgment of the German Federal Constitutional Court, which understands assisted suicide as an expression of the person’s right to a self-determined death. It does not allow for beneficence-based restrictions regarding the person’s suffering or medical diagnosis and therefore avoids the expressivist objection. I argue that on an autonomy-based approach, assisted suicide should not be understood as a medical procedure but rather as the person’s autonomous action. (shrink)

Until now, there has been no theoretical foundation that explains why organizations implement whistle-blowing systems. By understanding whistle-blowing systems as an instrument that is desired by society, the legitimacy theory could be transferred to the whistle-blowing concept. A survey of German managers shows that legitimacy theory may be supported. Further insights into legitimacy theory are given by the motivation for the design of the implemented systems. The survey shows that, in particular, the implementation of external whistle-blowing systems is seemingly not (...) driven by desired effectiveness. This supports legitimacy theory, since it reveals that external systems are symbolic rather than substantive systems. However, the results do not hold for internal whistle-blowing systems because the implementation of internal systems is ostensibly driven by power theories. The results are interesting for the planned statutory whistleblower protection as they reveal a partially restrained attitude toward whistle-blowing. Whistle-blowing systems are not effective if management is not convinced of their benefits. (shrink)

Pessimism over a democracy’s ability to produce good outcomes is as longstanding as democracy itself. On one hand, democratic theorists consider democracy to be the only legitimate form of government on the basis that it alone promotes or safeguards intrinsic values like freedom, equality, and justice. On the other, skepticism toward the ordinary citizen’s cognitive capacities remains a perennial concern. Qualms about the epistemic value of democracy have only been made more pertinent by a fundamental problem of deep epistemic disagreement (...) which underlies the post-truth phenomenon. I argue that the democratic theorists who have sought to defend democracy on epistemic grounds have thus far neglected such deep and intractable disagreements. Without addressing this oversight, the epistemic democrat will find that collective decision-making processes quickly become paralyzed and will not be able to yield the epistemic benefits they promise. Hence, the work for epistemic democrats is to recognize and take into account the ramifications of epistemic disagreements so as to make a stronger case for epistemic democracy. (shrink)

Interviews with female impersonators reveal the social, cultural, and economic aspects of their occupation and the subculture of the homosexual transvestite.

In a recent article, Wilkinson puts forward the notion of identity-relative paternalism. According to Wilkinson’s final formulation of this principle, ‘[i]ndividuals should be prevented from doing to future selves (where there are weakened prudential unity relations between the current and future self) what it would be justified to prevent them from doing to others’.1 In medical ethics, it is usually assumed that hard paternalism, that is, acting against a competent person’s wishes for their own benefit, is not justified. According to (...) Mill’s harm principle, we may only limit people’s freedom if they cause harm to others.2 Harm to self is not a sufficient reason for overriding competent persons’ decisions. Wilkinson, however, draws on Parfit’s reductionist view of personal identity to argue that sometimes, patients’ future selves are sufficiently disconnected from their present selves to treat future selves like different persons. If a competent person’s medical decision negatively affects a future self, this should be treated like a case of harm to others. Thus, overriding competent persons’ decisions in such cases—and treating them against their will—could be justified. In this commentary, I point out two problems with this approach. First, I demonstrate that the cases Wilkinson’s argument is based on are not examples of harm to others but rather cases of surrogate decision making gone wrong, …. (shrink)

It is widely thought that knowledge is factive – only truths can be known. However, this view has been recently challenged. One challenge appeals to approximate truths. Wesley Buckwalter and John Turri argue that false-but-approximately-true propositions can be known. They provide experimental findings to show that their view enjoys intuitive support. In addition, they argue that we should reject the factive account of knowledge to avoid widespread skepticism. A second challenge, advanced by Nenad Popovic, appeals to multidimensional geometry to build (...) a case where it seems intuitive that a person knows p even though p is false. In addition, Popovic argues that we should reject the factive account of knowledge because most of us would not become widespread skeptics if we discovered that ordinary objects in our world are actually four-dimensional. In this paper, we defend the factive account of knowledge against these arguments by challenging the intuitive appeal of the cases and arguing that there is no real threat of widespread skepticism for the factive account of knowledge. (shrink)

This article echoes those voices that demand new approaches and ‹senses’ for management education and business programs. Much of the article is focused on showing that the polemic about the educative model of business schools has moral and epistemological foundations and opens up the debate over the type of knowledge that practitioners need to possess in order to manage organizations, and how this knowledge can be taught in management programs. The article attempts to highlight the moral dimension of management through (...) a reinterpretation of the Aristotelian concept of practical wisdom. I defend the ideas that management is never morally neutral and that Aristotelian practical wisdom allows the recovery of moral considerations in management practice. I analyze the impact and implications that the introduction of practical wisdom in business schools entails for the conception and objectives of management education. This view reconfigures management education in terms of attention to values, virtues and context. Therefore, management programmes should prepare students to critically evaluate what they hear and to make decisions coherent with their values and virtues. In the final section, I reflect on the pedagogical implications of this approach. I point out that an integrated model of ethics and practical wisdom promotes education of cognition and education of affect as well. I provide an example to illustrate my perspective and to support my conclusions. (shrink)

This case study discusses the scope of responsibilities and the basis of legitimacy of multinational corporations in a complex operating environment. In January 2013 a precedent was set when Shell was held liable in The Hague for oil pollution in the Niger Delta. The landmark ruling climaxed the ongoing dispute over the scope of Shell’s responsibilities for both the company’s positive and negative impact. Shell’s was considered a forerunner in corporate social responsibility and had even assumed public responsibilities in a (...) context of a public responsibility void. However, the company remained a regular target of civil society activism and legal proceedings concerned with malpractice. The court case attracted international attention for its novelty and increasing media and civil society pressure required immediate action. How can Shell respond to this negative publicity to keep its license to operate? What is the scope of the company’s responsibilities in such a controversial human rights context? Students are expected to discuss these questions going beyond a simple moralistic or liability thinking. They are encouraged to take into account the complex structural processes that connect persons and institutions in very different social and geographical positions. The experiences of Shell are an excellent case in point since attention is drawn to the background conditions of globally operating companies, in which the isolation of perpetrators based on causality is not realistic. The case also reveals the particular challenges, which MNCs face in the context of increasing demands to take on public responsibilities while respecting their economic mandate. (shrink)

International business organizations are regularly addressed on their corporate social responsibility (CSR). As illustrated in this paper, it is not yet clear exactly what CSR means to organizations and how to deal with it. In this paper, the authors explore how a sensemaking approach helps to understand the business challenges of CSR within an organizational context. The theories of Karl Weick are applied to the experiences of CSR in Royal Dutch Shell. The authors argue that the key to CSR in (...) international business organizations is to engage stakeholders and start a process of joint sensemaking. Three main competencies are crucial in this: the competency to engage stakeholders through listening and understanding; the creation of an organizational language so that CSR makes sense to members of the organization; and recognizing the momentum of taking action. (shrink)

Goldman joins the ranks of epistemologists, philosophers, and science studies scholars trying to use economic models of science. For Goldman, these models are part of social rather than individual epistemics. His hope is that these models will illustrate that non-epistemic goals of individual scientists such as professional success do not necessarily undermine epistemic aims of science such as the acquisition of truth. This paper shows that there are inconsistencies between Goldman's individual and social epistemics, that these models do not live (...) up to Goldman's standards of evaluation, and that the economic models that Goldman uses are not social. (shrink)

This study shows that professional identity should not be viewed as a composed variable with a uniform structure. Based on the literature and previous research, we view teachers? job satisfaction, self?efficacy, occupational commitment and change in the level of motivation as indicators of teachers? professional identity. Using two?step cluster analysis, three distinct professional identity profiles have empirically been identified, based on data of 1214 teachers working in secondary education in the Netherlands. These profiles differed significantly regarding the indicators of teachers? (...) professional identity. Teachers belonging to the found profiles did not significantly differ in their amount of experience. (shrink)

International business organizations are regularly addressed on their corporate social responsibility (CSR). As illustrated in this paper, it is not yet clear exactly what CSR means to organizations and how to deal with it. In this paper, the authors explore how a sensemaking approach helps to understand the business challenges of CSR within an organizational context. The theories of Karl Weick are applied to the experiences of CSR in Royal Dutch Shell. The authors argue that the key to CSR in (...) international business organizations is to engage stakeholders and start a process of joint sensemaking. Three main competencies are crucial in this: the competency to engage stakeholders through listening and understanding; the creation of an organizational language so that CSR makes sense to members of the organization; and recognizing the momentum of taking action. (shrink)

Over twenty years have passed since JLME published “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain.” This article revisits the conclusions drawn in that piece and explores what we have learned in the last two decades regarding the experience of men and women who have chronic pain and whether women continue to be treated less aggressively for their pain than men.

The philosophy of empowerment, which is based on the premises that clients must be active, equal and collaborative participants, who are aware and commited to change, has guided research in empowerment interventions. This article reports on a small part of a research study that sought to understand Chinese cancer patients’ conceptualization of empowerment. Qualitative delineation of the concept of empowerment by means of in-depth interviews was carried out with 12 Chinese patients with cancer. The findings showed that empowerment is a (...) process whereby patients develop a sense of inner strength through connection with others, including families, friends and health care professionals. It is also a process of transformation through which they actively develop new perspectives by reframing and reinterpreting their illness. Acceptance of illness was shown to result from a realization of a lack of control in the situation, which is then enhanced by the beliefs of Confucianism and Taoism. In the cancer context, personal control comprises both primary and secondary processes. Active involvement, awareness of the situation, partnership, self-determination and self-reliance are important values in empowerment. The concept and therapeutic foundations of empowerment provide ample legitimacy for its vigorous pursuit in nursing. (shrink)

Nous étions des survivantes, des veuves, condamnées à vivre. Mais petit à petit notre lutte a été de se dire : « On veut quand même être vivantes, vivantes ! », SurVivantes.Survivre, cela veut dire qu’auparavant on avait vécu.Je me suis mariée en 1987. En 1988, nous avons eu notre première fille Anna et nous sommes allés voir la famille de mon mari. Une photo a été..

A large part of the explainable AI literature focuses on what explanations are in general, what algorithmic explainability is more specifically, and how to code these principles of explainability into AI systems. Much less attention has been devoted to the question of why algorithmic decisions and systems should be explainable and whether there ought to be a right to explanation and why. We therefore explore the normative landscape of the need for AI to be explainable and individuals having a right (...) to such explanation. This exploration is particularly relevant to the medical domain where the (im)possibility of explainable AI is high on both the research and practitioners’ agenda. The dominant intuition overall is that explainability has and should play a key role in the health context. Notwithstanding the strong normative intuition for having a right to explanation, intuitions can be wrong. So, we need more than an appeal to intuitions when it comes to explaining the normative significance of having a right to explanation when being subject to AI-based decision-making. The aim of the paper is therefore to provide an account of what might underlie the normative intuition. We defend the ‘symmetry thesis’ according to which there is no special normative reason to have a right to explanation when ‘machines’ in the broad sense, make decisions, recommend treatment, discover tumors, and so on. Instead, we argue that we have a right to explanation in cases that involve automated processing that significantly affect our core deliberative agency and which we do not understand, because we have a general moral right to explanation when choices are made which significantly affect us but which we do not understand. (shrink)

Governments, companies, and citizens all think trust is important. Especially today, in the networked era, where we make use of all sorts of e-services and increasingly interact and buy online, trust has become a necessary condition for society to thrive. But what do we mean when we talk about trust and how does the rise of the Internet transform the functioning of trust? This books starts off with a thorough conceptual analysis of trust, drawing on insights from - amongst others (...) philosophy and sociology - to sharpen our understanding of the topic. The book explains how the arrival of large systems - such as the internet - has changed the character of trust which today is no longer based on interpersonal interactions but has become completely mediated by technologies. Based on the layered building plan of the Internet itself, a new conceptual lens called 4 Cs is developed to analyse and understand trust in the networked era. The 4Cs refer to the 4 layers which all have to be taken into account to assess trust online, namely: context, code, codification, and curation. The 4Cs bring together the firsthand experiences of the user (context), the sort of technology that is being used (code), the legal implication (codification) and business interests (curation) in order to get a clear picture of the trust issues that may arise. In the final part of the book some real-life cases are discussed (digital hotel keys, Airbnb, online personalization) to illustrate how trust -analysed through the 4 Cs lens- might flourish or be challenged in our current networked era. (shrink)

In this paper, we discuss formal reconstructions of Anselm’s ontological argument. We first present a number of requirements that any successful reconstruction should meet. We then offer a detailed preparatory study of the basic concepts involved in Anselm’s argument. Next, we present our own reconstructions—one in modal logic and one in classical logic—and compare them with each other and with existing reconstructions from the reviewed literature. Finally, we try to show why and how one can gain a better understanding of (...) Anselm’s argument by using modern formal logic. In particular, we try to explain why formal reconstructions of the argument, despite its apparent simplicity, tend to become quite involved. (shrink)

En Self-Constitution. Agency, Identity, and Integrity (2009), Christine Korsgaard defiende la conclusión de que el imperativo categórico rige la acción humana porque es el único principio que permite alcanzar la unidad psíquica plena, la cual, según Korsgaard, es un prerrequisito esencial para la acción efectiva. Para los agentes humanos, alcanzar esa unidad -que consiste en hacer coherentes distintos impulsos hacia la acción- es una actividad constante, denominada "autoconstitución". De acuerdo con Korsgaard, ésta es la fuente originaria de la normatividad y (...) de las identidades prácticas e incluso de la identidad personal. Después de exponer las ideas centrales del libro, presento dos objeciones: primero, critico la equiparación del imperativo categórico con la autoconstitución exitosa, pues no toda falla de auto-constitución es una falla moral. Segundo, argumento que la tesis de que la identidad personal es producto de la autoconstitución es problemática y que, al defenderla, Korsgaard confunde identidad práctica con identidad personal. In Self-Constitution. Agency, Identity, and Integrity (2009), Christine Korsgaard argues that the categorical imperative rules human action because it is the sole principle that allows us to reach the complete psychic unity that, Korsgaard thinks, is an essential prerequisite for effective action. Reaching this unity -which consists in making cohere diverging impulses for action- is for human agents a constant activity called "self-constitution." According to Korsgaard, this activity is the source of normativity, of human practical identities and even of personal identity. After explaining the main ideas of the book, I present two objections. First, I criticize the linkage of the categorical imperative to successful self-constitution, for not every failure of the latter counts as a moral failure. Second, I argue that the thesis that personal identity is a product of self-constitution is problematic and that it betrays a confusion between practical identity and personal identity. (shrink)

La adolescencia es un periodo crítico de la vida para el desarrollo de depresión. Durante este periodo la prevalencia de adolescentes que sufren trastornos depresivos aumenta considerablemente, debido a múltiples factores biológicos, sociales y psicológicos. Además entre los 14 y 18 años emergen importantes diferencias de género en depresión, de forma que al final de este periodo las tasas de depresión en las chicas llegan a doblar las observadas en los chicos (Hankin et al., 1998). Estas diferencias tenderán a mantenerse (...) a lo largo del ciclo vital. De este modo las estadísticas indican que en la vida adulta las mujeres experimentan el Trastorno Depresivo Mayor dos veces más que los hombres, siendo las diferencias aún mayores para el Trastorno Distímico. (shrink)

This study critically assesses recent debates about the colonial construction of Hinduism. Written by experts in their field, the chapters present historical and empirical arguments as well as theoretical reflections on the topic, offering new insights into the nature of the construction of religion in India.

During the last decades, in different places and under different circumstances, some physicians and other health professionals have supported state violence. The Holocaust is a prime example for how doctors can cooperate with the state to plan, give ideological support to and implement violent policies. As a consequence of the Industrial Revolution, people gained access to health promotion and health protection, not as an achievement of the welfare state, but as a tool necessary to maintain healthy and more productive workers. (...) Gradually, all social strata, employees and their relatives gained access to health coverage. Physicians as a group increased in number and changed the structure of their profession by establishing a symbiotic relationship with the state. Between the state and the medical class, different models of cooperation can be distinguished. In general, we can affirm that with the implementation of a public health system, greater interdependence among the state and the medical class was established. In the case of authoritarian or totalitarian regimes, the support of the medical class for violent policies depends on the degree of previous cooperation. National Socialist Germany and the Soviet Union are two striking examples of totalitarian states in which strong public health systems and subsequent close cooperation between the medical class and the state can be observed. In both countries, violent state policies were quickly accepted and integrated into medical practice. Practices such as forced sterilization, murder of patients or experimentation with prisoners were prevalent under National Socialism. The abuse of psychiatry as tool for exerting power was common in the Soviet Union. South American dictatorships constitute examples of totalitarian states with weak previous cooperation between the medical class and the state, as they did not have strong public health systems. In those countries, support for state violence can be found, such as participation of health care professionals in torture or abduction of babies, but cooperation was not as strong as in Nazi Germany or the Soviet Union. In other cases in which no strong previous relationship existed between medicine and the state, authoritarian regimes were not accompanied by medical support for violence, such as in the case of the Rwandan genocide or in Cambodia, where doctors were persecuted and murdered based on their membership of the bourgeois class. (shrink)

This article examines the social circumstances, both current and past, that have affected the development and transformation of feminist consciousness among Asian American women. Gender, race, class, and culture all influenced the relative lack of participation of Asian American women in the mainstream feminist movement in the United States. It concludes that Asian American women have to come to terms with their multiple identities and define feminist issues from multiple dimensions. By incorporating race, class, and cultural issues along with gender (...) concerns, a transcendent feminist consciousness that goes beyond these boundaries may develop. (shrink)

Our world is under going an enormous digital transformation. Nearly no area of our social, informational, political, economic, cultural, and biological spheres are left unchanged. What can philosophy contribute as we try to under- stand and think through these changes? How does digitization challenge past ideas of who we are and where we are headed? Where does it leave our ethical aspirations and cherished ideals of democracy, equality, privacy, trust, freedom, and social embeddedness? Who gets to decide, control, and harness (...) the powers of digitization and for which purposes? Epistemologically, do most of us understand these new mediations – and thus fabrics – of our new world? Lastly – how is the new technological landscape shaping not only our living conditions but also our collective imaginary and our self-identities? (shrink)

Patients with mental illness, and depression in particular, present clinicians and surrogate decision-makers with complex ethical dilemmas when they refuse life-sustaining non-psychiatric treatment. When treatment rejection is at variance with the beliefs and preferences that could be expected based on their premorbid or “authentic” self, their capacity to make these decisions may be called into question. If capacity cannot be demonstrated, medical decisions fall to surrogates who are usually advised to decide based on a substituted judgment standard or, when that (...) is not possible, best interest. We propose that in cases where the patient meets the widely accepted cognitive criteria for capacity but is making decisions that appear inauthentic, the surrogate may best uphold patient autonomy by following a “restorative representation” model. We see restorative representation as a subset of substituted judgement in which the decision-maker retains responsibility for deciding as the patient would have, but discerns the decision their “truest self” would make, rather than inferring their current wishes, which are directly influenced by illness. Here we present a case in which the patient’s treatment refusal and previously undiagnosed depression led to difficulty determining the patient’s authentic wishes and placed a distressing burden on the surrogate decision-maker. We use this case to examine how clinicians and ethicists might better advise surrogates who find themselves making these clinically and emotionally challenging decisions. (shrink)