While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to (...) fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters. (shrink)

Ethical problems regularly arise during daily care in nursing homes. These include violation of patients' right to autonomy and to be treated with respect. The aim of this study was to investigate how caregivers emphasize daily dialogue and mutual reflection to reach moral alternatives in daily care. The data were collected by participant observation and interviews with seven caregivers in a Norwegian nursing home. A number of ethical problems linked to 10 patients were disclosed. Moral problems were revealed as the (...) caregivers acted in ways that they knew were against patients' interest. We used a theoretical interpretation according to Habermas' discourse ethics on the importance of dialogue when deciding moral courses of action for patients. This theory has four basic requirements: communicative competence, equality, self-determination, and openness about motives. (shrink)

Telepsychiatry has long been discussed as a supplement to or substitute for face-to-face therapeutic consultations. The current pandemic crisis has fueled the development in an unprecedented way. More and more psychiatric consultations are now carried out online as video-based consultations. Treatment results appear to be comparable with those of face-to-face care in terms of clinical outcome, acceptance, adherence and patient satisfaction. However, evidence on videoconferencing in a variety of different fields indicates that there are extensive changes in the communication behaviour (...) in online conversations. We hypothesise that this might impact ethically relevant aspects of the therapeutic relationship, which plays a prominent role in psychiatry. In this paper, we review effects of video-based consultations on communication between therapists and patients in psychiatry. Based on a common understanding of video-based consultations as changing the lived experience of communication, we categorise these effects according to sensory, spatial and technical aspects. Departing from a power-based model of therapeutic relationships, we then discuss the ethical significance of this changed communication situation, based on dimensions of respect for autonomy, lucidity, fidelity, justice and humanity. We conclude that there is evidence for ethically relevant changes of the therapeutic relationship in video-based telepsychiatric consultations. These changes need to be more carefully considered in psychiatric practice and future studies. (shrink)

Although the discussion about feasibility in political theory is still in its infancy, some important progress has been made in the last years to advance our understanding. In this paper, we intend to make a contribution to this growing literature by investigating the proper place of feasibility considerations in political theory. A motivating force behind this study is a suspicion that many presumptions made about feasibility in several current debates—such as that between practice-independence and practice-dependence, ideal and non-ideal theory, and (...) political moralism and political realism—are too rigid and underestimate the numerous different ways in which feasibility concerns may enter into our theorizing. To chisel out this feasibility space, our aim is to suggest two metatheoretical constraints on normative political principles as intuitively plausible, the so-called ‘fitness constraint’ and the ‘functional constraint’, through which we elucidate five central aspects for determining proper feasibility constraints of an account in political theory. (shrink)

The question of what role social and political practices should play in the justification of normative principles has received renewed attention in post-millennium political philosophy. Several current debates express dissatisfaction with the methodology adopted in mainstream political theory, taking the form of a criticism of so-called ‘ideal theory’ from ‘non-ideal’ theory, of ‘practice-independent’ theory from ‘practice-dependent’ theory, and of ‘political moralism’ from ‘political realism’. While the problem of action-guidance lies at the heart of these concerns, the critics also share a (...) number of methodological assumptions. Above all, their methodology is practice-dependent in the sense that an existing practice is assumed to put substantial limitations on the appropriate normative principles for regulating it. In other words, we cannot formulate and justify an appropriate principle without first understanding the practice this principle is supposed to govern. The aim of this paper is to map out and analyze the common denominators of these debates with regard to methodological commitments. We will investigate how this practice-dependent method may be understood and motivated. In particular, we point to challenges that must be met in order for the position to remain both distinct and attractive. (shrink)

While methodological and metatheoretical questions pertaining to feasibility have been intensively discussed in the philosophical literature on feasibility and justice in recent years, these discussions have not permeated the debate on global democracy. The overall aim in this paper is to demonstrate the fruitfulness of importing some of the advancements made in this literature into the debate on global democracy as well as to develop aspects that are relevant for explaining the role of feasibility in normative political theory. This is (...) done by pursuing two arguments. First, to advance the work on the role of feasibility, we suggest two metatheoretical constraints on normative political theorizing as intuitively plausible – the ‘fitness constraint’ and the ‘functional constraint’ – which elucidate a number of aspects relevant for determining proper feasibility constraints of an account in political theory. Second, to illustrate the usefulness of this feasibility framework, we sketch an account of global democracy consisting of normative principles which respond differently to these aspects and thus are tied to different feasibility constraints as well as exemplify how it may be applied in practice. (shrink)

Among the various human forms alluded to in the Hebrew prayer, mental retardation appears to be one of the most difficult to celebrate. It is the disability that other disabled persons do not want attributed to them. It is the disability for which prospective parents are most likely to use selective abortion (Wertz 2000). And it is the disability that prompted one of the most illustrious United States Supreme Court Justices to endorse forced sterilization, because "three generations of imbeciles are (...) enough." The mentally retarded have at times been objects of pity, compassion, or abuse by their caretakers and society at large. But they have rarely been seen as subjects, as citizens, as persons with equal entitlement to fulfillment. (shrink)

In this article I examine the proposition that severe cognitive disability is an impediment to moral personhood. Moral personhood, as I understand it here, is articulated in the work of Jeff McMahan as that which confers a special moral status on a person. I rehearse the metaphysical arguments about the nature of personhood that ground McMahan’s claims regarding the moral status of the “congenitally severely mentally retarded” (CSMR for short). These claims, I argue, rest on the view that only intrinsic (...) psychological capacities are relevant to moral personhood: that is, that relational properties are generally not relevant. In addition, McMahan depends on an argument that species membership is irrelevant for moral consideration and a contention that privileging species membership is equivalent to a virulent nationalism (these will be discussed below). In consequence, the CSMR are excluded from moral personhood and their deaths are less significant as their killing is less wrong than that of persons. To throw doubt on McMahan’s conclusions about the moral status and wrongness of killing the CSMR I question the exclusive use of intrinsic properties in the metaphysics of personhood, the dismissal of the moral importance of species membership, and the example of virulent nationalism as an apt analogy. I also have a lot to say about McMahan’s empirical assumptions about the CSMR. (shrink)

Infants who suffer severe neglect fail to thrive emotionally as well as bodily. The absence of early coexistential structures that provide well-being leads to a narrowing of the child's perceptual and social developmental horizon. What is the nature of these early structures? In this essay, an ontology of well-being or housedness is elaborated through phenomenological reflections on breast-feeding and infant perception. Merleau-Ponty's ontology of the flesh makes a contribution to the ontology of well-being: it gives us a conceptual and evocative (...) language to describe human existence in its pre-verbal, syncretic, and non-dualistic manifestations. It also allows for a re-evaluation and re-interpretation of the results of current research in infant perception. Through the structures of infant perception we perceive the coexistential fit between infants, other human beings, and the world of things. An infant's fundamental housedness in the flesh is taken up and cultivated or destroyed by the child's social and cultural environment. (shrink)

In 2009, Tennie et al. proposed the theory of the Zone of Latent Solutions, defined as the range of behaviors an individual of a species can invent independently, i.e., which it can acquire without any form of social learning. By definition, species limited to their ZLS are unable to innovate and/or transmit behavioral traits outside their ZLS, i.e., they lack traits which go beyond the level of the individual—traits resulting from a gradual cultural evolution over successive transmission events [“cumulative culture”, (...) Boyd and Richerson ]. However, this does not exclude an influence of social learning on the population frequency of these behaviors: social learning can facilitate the acquisition of latent solutions and thus speed up and consolidate their spread within a population. Cultures—defined as behaviors at least influenced by social learning—are therefore still possible. Here, we elaborate on the ZLS account and relate it to the theories of Vygotsky who studied the role of social learning in human culture. We argue that the ZLS is a missing phylogenetic “baseline” of Vygotsky’s Zone of Actual Development. Vygotsky’s neglect of a need for a human “baseline ZAD” may have been due to his interpretation of Köhler’s work on great ape behaviors: Köhler used his observations on individual chimpanzees to draw conclusions about the chimpanzee species as a whole, stating that chimpanzees can only copy what they could have invented themselves, thus coming close to the ZLS concept. Vygotsky—studying the range of behaviors individuals could achieve independently—seemingly did not see that Köhler was suggesting a species “baseline”, upon which Vygotsky’s idea of an individual’s ZAD could develop. As a result, Vygotsky also did not see the need for a ZLS for his own study subjects: humans. Yet, there is no reason to assume that humans lack a ZLS, and in fact we present evidence for a human ZLS for tool-use behaviors. (shrink)

Beauty has captured human interest since before Plato, but how, why, and to whom does beauty matter in today's world? Whose standard of beauty motivates African Americans to straighten their hair? What inspires beauty queens to measure up as flawless objects for the male gaze? Why does a French performance artist use cosmetic surgery to remake her face into a composite of the master painters' version of beauty? How does beauty culture perceive the disabled body? Is the constant effort to (...) remain young and thin, often at considerable economic and emotional expense, ethically justifiable? Provocative essays by an international group of scholars discuss beauty in aesthetics, the arts, the tools of fashion, the materials of decoration, and the big business of beautification—beauty matters—to reveal the ways gender, race, and sexual orientation have informed the concept of beauty and driven us to become more beautiful. Here, Kant rubs shoulders with Calvin Klein. Beauty Matters draws from visual art, dance, cultural history, and literary and feminist theory to explore the values and politics of beauty. Various philosophical perspectives on ethics and aesthetics emerge from this penetrating book to determine and reveal that beauty is never disinterested. Foreward by Eleanor Heartney; "Introduction" by Peg Brand [Weiser] included here. Authors include Marcia M. Eaton, Noel Carroll, Paul C. Taylor, Arthur C. Danto, Kathleen M. Higgins, Susan Bordo, Dawn Perlmutter, Eva Kit Wah Man, Anita Silvers, Hilary Robinson, Kaori Chino, Sally Banes, and Peg Brand's essay "Bound to Beauty: An Interview with Orlan." (available on PhilPapers). (shrink)

A shared presumption among practice-dependent theorists is that a principle of justice is dependent on the function or aim of the practice to which it is supposed to be applied. In recent contributions to this debate, the condition of epistemic uncertainty plays a significant role for motivating and justifying a practice-dependent view. This paper analyses the role of epistemic uncertainty in justifying a practice-dependent approach. We see two kinds of epistemic uncertainty allegedly playing this justificatory role. What we call ‘normative (...) epistemic uncertainty’ emerges from dealing with the problem of value uncertainty in justifying applied principles when our higher-level principles are open-textured, that is, when their content is too vague or unclear to generate determinate prescriptions. What we call ‘descriptive epistemic uncertainty’ emerges from dealing with uncertainty about empirical facts, such as the problem of moral assurance, that is, the problem that the requirements of justice cannot go beyond arrangements that we can know with reasonable confidence that we can jointly establish and maintain. In both cases, practice-dependent theorists conclude that the condition of epistemic uncertainty justifies a practice-dependent approach, which puts certain restrictions on theorizing regulative principles and has wide-ranging practical implications for the scope of justice. Our claim in this paper is that neither kind of epistemic uncertainty justifies a practice-dependent approach. (shrink)

Antimicrobial resistance (AMR) describes the evolution of treatment‐resistant pathogens, with potentially catastrophic consequences for human medicine. AMR is driven by the over‐prescription of antibiotics, and could be reduced through consideration of the ethical dimensions of the dilemma faced by doctors. This dilemma involves balancing apparently opposed interests of current and future patients, and unique contextual factors in different countries, which may modify the core dilemma. We describe three example countries with different economic backgrounds and cultures—South Africa, Sri Lanka and the (...) United Kingdom. Then we discuss how country‐specific factors impact on the prominence of various ethical dimensions of the dilemma (visibility and moral equality of future generations; Rule of Rescue; prescribing autonomy and conflicts of interest; consensus on collective action). We conclude that a nuanced understanding of national prescribing dilemmas is critical to inform the design of effective stewardship approaches. (shrink)

The first systematic analysis of current debates surrounding the role of practice in political theory Should social and political practices should play a role in the justification of normative political principles? In several sub-domains of political theory, theorists have suggested that practices constrain principles in various ways. This book joins five key debates in the current theoretical literature that have been largely taking place in isolation and identifies common strands of argument and their shared problems. By illuminating these connections and (...) cross-fertilising key debates in the current theoretical literature, it develops a unified way forward for practice-based political theory. (shrink)

The debate between moral realism and antirealism plays an important role in contemporary metaethics as well as in the interpretation of Kant's moral philosophy. This volume aims to clarify whether, and in what sense, Kant is a moral realist, an antirealist, or something in-between. Based on an explication of the key metaethical terms, internationally recognized Kant scholars discuss the question of how Kant's moral philosophy should be understood in this regard. All camps in the metaethical field have their inhabitants: Some (...) contributors read Kant's philosophy in terms of a more or less robust moral realism, objectivism, or idealism, and some of them take it to be a version of constructivism, constitutionism, or brute antirealism. In any case, all authors introduce and defend their terminology in a clear manner and argue thoughtfully and refreshingly for their positions. With contributions of Stefano Bacin, Jochen Bojanowski, Christoph Horn, Patrick Kain, Lara Ostaric, Fred Rauscher, Oliver Sensen, Elke Schmidt, Dieter Schönecker, and Melissa Zinkin. (shrink)

The question of whether global democracy requires a world state has with few exceptions been answered with an unequivocal ‘No’. A world state, it is typically argued, is neither feasible nor desirable. Instead, different forms of global governance arrangements have been suggested, involving non-hierarchical and multilayered models with dispersed authority. The overall aim of this paper is to addresses the question of whether global democracy requires a world state, adopting a so-called ‘function-sensitive’ approach. It is shown that such an approach (...) is equipped to resist the predominant binary view of a world state and offer a more differentiated and nuanced answer to this question. In brief, a basic presumption of a function-sensitive approach is that the content, justification and status of principles of democracy are dependent on the aim they are set out to achieve, what functions they are intended to regulate (e.g., decision-making, implementation, enforce... (shrink)

In recent years, philosophers influenced by Peirce's pragmatism have contributed to the democracy debate by offering not simply a justification of democracy that relies on epistemic as well as moral presumptions, but a justification on purely epistemic grounds, that is, without recourse to any moral values or principles. In a nutshell, this pragmatist epistemic argument takes as its starting-point a few fundamental epistemic principles we cannot reasonably deny, and goes on to claim that a number of interpersonal epistemic commitments follow, (...) which in turn justify democracy in a fullfledged, deliberative sense. In light of the fact of reasonable pluralism, this freestanding epistemic justification of democracy is allegedly superior to the mainstream, morally anchored liberal alternatives, because epistemic principles are universally shared despite moral disagreement. The pragmatist epistemic approach has been praised for being a valuable contribution to democratic theory, but few attempts have so far been made to systematically scrutinize the argument as a whole. The present paper sets out to do that. In particular, our investigation focuses on the underappreciated but central coherence form of the pragmatist epistemic argument: the central claim that in order to be an internally coherent believer, one must accept democracy. While we endorse the fundamental premise for the sake of argument, our analysis shows that the argument fails in both of the two further steps, and. More specifically, the epistemic principles are too weak to entail the suggested interpersonal epistemic commitments; and even if these epistemic commitments are granted, they are insufficient to ground democracy. (shrink)

The easiest and most tempting solution of these problems is to dissolve them by pointing out the artificiality of the issues leading to these "third things." Though tempted, I am not convinced that Kant's philosophy can be treated thus as an exercise in a complicated solution of pseudo-problems. Also, I would thereby deprive myself of the uncomfortable and nagging sense of obscure importance which assails me—and many Kant students share this feeling—whenever I consider these points. I am prepared to admit (...) that the problems may be represented as artificial. But I want to maintain, with special emphasis on the Kantian schema, that a serious reconsideration repays the effort, even if it should force us to reconsider critically also some of Kant's systematic assumptions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Soldiers of the Invisible Front: How Ukrainian Therapists Are Fighting for the Mental Health of the Nation Under FireIrina Deyneka and Eva RegelIrina DeynekaWhen the Russian army attacked my country, I became a volunteer for a hotline offering psychological support to those in crisis; refugees, those who were under the shelling, those who were hiding in bomb shelters, and who were directly in the zone of fighting. People were (...) lost and disoriented by constant bombing, by the fact that their country was under attack. Once, I had a woman who lived in Mariupol on one of these calls. I was living then in another city, Odessa, but was experiencing the same horrors of war that my client was—the shelling, uncertainty, and despair. We were processing my client’s feelings of grief and anxiety when I heard the sirens on her end. I offered to stop our session so she could seek shelter. She told me she would not have time to find shelter and wanted to continue our meeting. And so, we continued... But soon, Odessa’s sirens broke the silence, and it was my turn to decide what to do; should I continue our session or try to find a bomb shelter for myself? I decided to stay because I thought that was the right thing to do morally, professionally, and personally.I eventually left Odessa, but only after a bomb destroyed a house next to mine, and I saw a family, my neighbors, perish in the destruction. I am now a member of one of Slovakia’s Non-Governmental Organizations (NGOs) and work in a mobile brigade providing medical and psychological support to refugees. I can remember every one of my clients. Children, adults... I can remember their stories, their traumas, their memories of the horrors of war and devastation. Sometimes I meet with them only once, and they move on to another refugee center or are on their way to a Western part of Ukraine, trying to escape the war. And frequently, I do not know how many sessions I will be able to have with clients. Sometimes it is only one time, and sometimes we can meet for many months. Initially, I thought, What can I do in one therapy session? Now, I know that I can do a lot. I can provide people who survived the most inhuman conditions and witnessed death and destruction around them with a space and time to talk through and process their experiences. I am their support, and they lean on me as they try to make sense of what has happened to them and their country. I always tell my clients that my goal as a psychotherapist is to help them withstand, survive, and hold on while still being able to continue to function in a country at war. All I can do is treat each of the therapy sessions as our last one and try to provide as many strategies and skills as possible to cope with anxiety and depression, to be able to function, and to live in the present.Every session is about installing hope, moving slowly forward, and away from traumatic events. One of my clients, a 14-year-old boy, was diagnosed with a neurological condition, involuntary facial muscle spasm, or tics. He was barely talking when I first saw him, and I decided to use art therapy as a trauma-processing tool during one of the therapy sessions. He was drawing an explosion, fire, and destruction of his neighbor’s house. He blacked out the horrors of his experience to preserve his strength. Yet, he began slowly remembering his experiences, re-creating the story of his trauma, and making memories. I was fortunate to work with [End Page E4] him for many months, carefully and thoughtfully helping him re-create the sorry of his trauma, helping to become its witness. Ultimately, it was great to see that he could control his memories and his emotional stress; he felt empowered and in control.Eva RegelThis is the story of Irina Deyneka, one of many Ukrainian psychotherapists working in Ukraine, providing mental health support to a nation ravaged by... (shrink)

Um dos grandes problemas postos pelo tema dos direitos humanos à filosofia é, entre outros, o de sua fundamentação filosófica. No pano de fundo deste debate, surgem questões específicas: como se pode fundamentar/justificar filosoficamente a exigência de reconhecimento aos direitos humanos? Neste estudo, procuro abordar, de modo direto, o núcleo argumentativo sobre o qual está estruturada da proposta de Höffe. Para ele, os direitos humanos têm uma profunda relação com a noção de justiça. O conceito de justiça, na sua concepção, (...) deve ser entendido fundamentalmente como troca. Embora o conceito pareça demasiado simples, ele oferece uma série de dificuldades no que se refere à sua fundamentação. (shrink)

Under what conditions do motherhood penalties emerge in countries undergoing transition from state socialism to capitalism? This analysis identifies the ways managers in global financial firms employ gendered assumptions in constructing and implementing labor practices among highly skilled professional workers in Hungary. Relying on 33 in-depth interviews with employers as well as interviews with headhunting firms, labor and employment lawyers, and analysis of antidiscrimination cases brought before Hungary’s Equal Treatment Authority between 2004 and 2008, we identify several strategies global employers (...) use to shed, demote, and marginalize professional mothers. By demonstrating the salience of motherhood as a status characteristic in the postsocialist labor market, our work contributes to existing scholarship on motherhood penalties. Our work also extends this scholarship by showing how the salience of motherhood is strongly conditioned by state-level arrangements that shape the opportunity context in which employers design and carry out employment practices. (shrink)

Breast milk and the placenta are phenomena of female human embodiment that challenge the philosophical notion of separate, sovereign subjects independent of other human be­ings and an objective world “out there.” A feminist phenomenological analysis, indebted to Merleau-Ponty and Irigaray, reveals placenta and milk to be intercorporeal, “chiasmic” forms of shared organic existence. This analysis is a philosophical and psychological exploration of “matrotopy,” i.e., the fact that humans eat their mothers through breast milk and placenta. This exploration, however, requires an (...) understanding of the larger environmental field which sustains the female body and its offspring. Environmental degradation, particularly through estrogen mimicking substances in plastics and pesticides, targets the endocrine system of developing fetuses and endangers the future of the human species from the inside. Invisible organo-chemical technologies pose a new and immediate danger and ethical challenge to women and men in the twenty-first century. A “placental ethics” respects the insertion of the human being into the dynamic field of nature; it calls for an awareness that, unless we develop a changed attitude toward technology, the gradual extinction of our species continues to happen in female bodies today. (shrink)

This article explores Southern Saami reindeer herders’ experiences and contestations over state consultation and corporate dialogue during a conflict over the Øyfjellet wind energy project in Norway. Informed by a committed research approach and juxtaposition with findings from Indigenous peoples' territorial struggles in Latin-America, the article provides critical perspectives on governance practices in a Nordic-Saami green colonial context. The research draws on ethnography from a consultation meeting between Jillen Njaarke, the impacted reindeer herding community, and state authorities, as well as (...) diverse written material. The study suggests that the state- and corporate-led “dialogues” displaced the root cause of the conflict, revealed epistemic miscommunication, and perpetuated relations of domination which limited emancipatory effects for Jillen Njaarke. The premises and discourses underpinning the “dialogues” further reproduced racist notions which devalue ancestral Saami reindeer herding knowledges, practices, and landscape relations. These findings challenge dialogue as prescription of good governance and conflict resolution in a context where democracy and compliance with Indigenous peoples’ rights are perceived as high. (shrink)

Women's activities and relations to men are persistent metaphors for man's projects. I query the prominence of these and the lack of equivalent metaphors where men are the metaphoric vehicle for women and women's activities. Women's role as metaphor results from her otherness and her relational and mediational importance in men's lives. Otherness, mediation, and relation characterize the role of metaphor in language and thought. This congruence between metaphor and women makes the metaphor of woman especially potent in man's conceptual (...) economy. (shrink)