In 1992, the United States Supreme Court, in Planned Parenthood of Southeastern Pennsylvania v. Casey, upheld the ruling in Roe v. Wade, namely that women have a right “to choose to have an abortion before viability and to obtain it without undue interference from the State.”1 However, since this ruling, some states have imposed regulations that greatly limit this right by restricting access. Texas is a recent example of this. Two proposed restrictions in House Bill 2, which will be discussed (...) in detail below, will force all but eight clinics that are located in metropolitan areas to shut down. The U.S. Supreme Court put the proposed restrictions on hold in October 2014, allowing several clinics to remain open while the restrictions are being appealed in the U.S. Court of Appeals for the Fifth Circuit. If the restrictions are passed, however, those clinics will be forced to shut down and, as a result, many women in Texas will be required to travel more than 100 miles in order to access a safe and legal abortion. Much of the focus of these restrictions has been on women and rightly so. However, I want to turn the attention to physicians. The requirements exacerbate unfair treatment of abortion providers compared with other physicians. Abortion providers face threats from the public—some of which turn into violent attacks—and they are often ostracized by their fellow medical practitioners. There are so few abortion providers to begin with and the proposed requirements limit these physicians’ opportunities to practice the branch of medicine of their choosing. Although the HB 2 requirements may not result in an unconstitutional undue burden on physicians, the challenges created by the bill limit physicians’ abilities to provide abortions. As a result of these limits, HB 2 creates an unconstitutional undue burden for women seeking abortions by creating barriers directed at abortion providers and clinic staff who are willing and able to provide abortions. The first of the two controversial HB 2 requirements is the admitting privileges requirement: “A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced.”2 The second requirement is the ambulatory surgical center requirement: “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under [Texas Health & Safety Code] [...] for ambulatory surgical centres.”3 In order to meet these state-mandated obligations, some abortion clinics would have to spend more than $1 million in upgrades if they wish to remain open. The District Court decided that the ambulatory surgical center requirement places an unconstitutional undue burden on women, and that the two requirements together place an undue burden on women in Texas and especially in the Rio Grande Valley where the nearest clinic is a couple hundred miles away.4 Later, the U.S. Court of Appeals for the Fifth Circuit reversed the District Court’s decision and argued, “the admitting privileges requirement is constitutional on its face.”5 While the regulations are being appealed, the Supreme Court granted a stay of injunction, allowing about twelve abortion clinics to reopen until a final decision regarding the regulations is made. The District Court ruled that the purpose of the two regulations was to create a substantial obstacle for women seeking abortions in Texas. While the defendants argued that the regulations were designed to make abortions safer and reduce risk, the Court decided that this was not the case. An abortion, especially a first-term abortion, is a very safe procedure and is safer than many other routine surgical procedures. As stated in Planned Parenthood v. Casey, “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”6 The undue burden in this case is imposed, not through restricting women’s access directly, but by restricting physicians’ freedom to perform abortions. The admitting privileges requirement has reduced the number of physicians who can perform abortions and the ambulatory surgical center requirement has reduced the number of clinics where abortions can be performed. The American Medical Association states, “[t]he Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.”7 This means that physicians are not required to perform abortions, except in emergency situations, but can as long as the procedure is done safely and does not violate the law. The new Texas regulations, however, are so restrictive that few abortion providers, limited to only four urban areas, can legally perform abortions. Physicians do not have an absolute right to perform abortions as opposed to women who have an absolute right to have access to an abortion. Physicians do face many challenges that other professionals face in terms of obtaining qualifications and finding work. Abortion providers, however, face challenges that most other physicians do not. The restrictions imposed by these regulations exacerbate unfair treatment toward abortion providers and place further obstacles in their path in terms of providing the service they want and are qualified to provide. Both abortion clinics and abortion providers are being treated differently from other medical clinics and physicians. For instance, “grandfathering of existing facilities and the granting of waivers from specific requirements is prohibited for abortion providers, although other types of ambulatory surgical facilities are frequently granted waivers or are grandfathered.”8 Many abortion clinics cannot afford the necessary upgrades. Furthermore, it is extremely expensive to open a brand new clinic that complies with the ambulatory surgical center requirements. Being grandfathered in would be the only option available to abortion clinics that cannot afford the upgrade. However, unfair treatment of abortion clinics and providers is preventing those clinics from being grandfathered into the new system. As a result, many abortion clinics may be forced to close. Admitting privileges are proving difficult or impossible for physicians both to obtain and, for those who have already been granted privileges, to keep. Dr. Sherwood Lynn, an obstetrician-gynecologist who has performed abortions for decades, describes the process of obtaining admitting privileges and the difficulties abortion providers face. After sending in an application a physician must wait for the hospital to send them the required materials, “but if the address of the practice on the application is of an abortion provider or clinic, [the hospital] won’t send [them] the package of materials required. [They] simply can’t apply.”9 Dr. Lynn and several other physicians have surmised that hospitals are only withholding privileges from qualified physicians who perform abortions and that other physicians do not face this discriminatory treatment. Hospitals have also revoked privileges granted to physicians after learning that the physicians perform abortions. For instance, in Texas two doctors, “received notices [...] informing them that their admitting privileges to the University General Hospital of Dallas have been revoked, with the hospital’s CEO claiming the hospital was unaware they were providing abortion care and that the hospital believed such care would damage its reputation.”10 What is curious about this revocation is that, “federal and state laws [...] forbid hospitals from discriminating against doctors who perform abortions,” and yet hospitals are clearly doing just that.11 Dr. Pamela Richter, another abortion provider in Texas, had her temporary admitting privileges revoked with no explanation and because of this, the clinic where she performed abortions, Reproductive Services, can no longer provide abortions at all.12 As the hospital gave no reason for the revocation, it not clear Dr. Richter’s privileges were revoked because she performs abortions. Dr. Richter, however, has performed over 17,000 abortions and her privileges were revoked soon after HB 2 was introduced.13 According to the Texas Hospital Association, giving admitting privileges to doctors who do not work for the hospital is expensive and time-consuming but this does not account for the fact that hospitals are revoking previously granted privileges from physicians whom they learn are providing abortion services.14 As mentioned previously, the District Court found that the admitting privileges requirement and the ambulatory surgical center requirement do not further ensure the health and safety of women undergoing an abortion. Several physicians have testified to this fact. Dr. Lynn stated in an interview: The admitting privileges requirements are [...] absolutely unnecessary. If you have a number of patients waiting for procedures, and something happens and a patient needs to be transferred to a hospital, you’re not going to leave everyone else and go to the hospital. That makes no sense. You’re going to refer that person to a gynecologist at the hospital. There is no safety issue involved here. If a patient shows up with an emergency, every hospital is required to admit that patient. They have to by law.15 It is rare that complications will arise from an abortion performed in a clinic. Dr. Richter, for example, has performed more than 17,000 abortions and not once had to send a patient to a hospital because of complications resulting from the procedure. According to Dr. Lynn even if abortion providers were granted privileges to hospitals, it is unlikely that they will exercise them. In essence, having admitting privileges at a hospital does nothing to further ensure the safety of an already safe procedure. The only result of the admitting privileges requirement is to limit certain physicians’ ability to perform legal abortions. Not only do the HB 2 requirements fail to further ensure the health and safety of women, the HB 2 requirements may actually create more health risks to women who cannot access the eight remaining clinics. The first risk is that the remaining clinics would have an influx of patients that they may not be able to handle, forcing women to wait longer for an appointment. As stated by the District Court, “[e]ven assuming every woman in Texas who wants an abortion [...] could travel to one of the four metropolitan areas where abortions will still be available, the cumulative results of HB 2 are that, at most, eight providers would have to handle the abortion demand of the entire state.”16 Furthermore, “[t]hat the State suggests that these seven or eight providers could meet the demand of the entire state stretches credulity.”17 Abortion is a time sensitive procedure. It is safest when performed early in a pregnancy. The increase in patients to these remaining clinics, assuming all women in Texas can access them, will increase wait times and may force women to have abortions later in pregnancy. In the worst-case scenario, a woman would not see an abortion provider at all before viability. Such instances may be rare, but they are possible. In such cases, women’s access to legal abortions becomes impossible and thereby violate the ruling in Roe. Clinics may be able to avoid the aforementioned problems if they hire more physicians. However, there are two barriers to hiring more physicians. First, as mentioned previously, admitting privileges to Texas hospitals are difficult, if not impossible, for abortion providers to obtain. Second, given the negative treatment of abortion providers by anti-abortion groups, many physicians are not willing to perform abortions. The harassment abortion providers face is unique to those physicians and many physicians will not perform abortions for that reason. In an article published in the Austin Chronicle, anti- abortion activist Abby Johnson, “discusses how her group investigated appraisal district records to find the new location of where an Austin abortion physician plans to work.”18 Johnson states, “These abortionists are feeling the pressure from the pro-life movement in Texas. I think they feel like they’re on the run. And that’s how we want to keep it.”19 If the HB 2 requirements are passed and there remain at most eight abortion providers in Texas, these activists will concentrate on those clinics and, “the dangerous impact of their intimidation tactics will be exacerbated.”20 Even if the number of physicians needed to meet the demand in Texas can obtain admitting privileges and work at one of the remaining clinics, they may choose not to do such work because they are putting themselves at risk. The harm abortion providers face from such anti-abortion groups is not unique to Texas. There are stories from all over the country and from other countries where abortion is legal of physicians receiving death threats. Dr. George Tiller, an abortion provider in Kansas, was killed outside his church and had received numerous death threats prior to this. The HB 2 requirements are making it so that abortion providers either cannot provide their services any longer or will face increased threats and increased danger to themselves. Physicians are allowed to conscientiously object to providing medical interventions in certain circumstances for moral and religious reasons. However, there are limits on this right. According to the American Congress of Obstetricians and Gynecologists, “[w]hen conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal.”21 I would argue fear for one’s safety in the face of immediate threats is perhaps a stronger ground on which to refuse to provide care than a personal belief that abortion is immoral or against one’s religion. ACOG also states, “[p]roviders with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide.”22 This responsibility has been largely disputed by the medical community but in cases of rape, incest, and health risks to women, referrals must be made without exception. However, under the requirements of HB 2, working in proximity to an abortion provider may not be possible because they are so geographically limited. Referrals are supposed to be made within reason. Some areas of Texas, such as the Rio Grande Valley, are up to 200 miles away from the nearest clinic that would remain open if HB 2 is passed. Referrals may simply not be feasible given the geographical distances and the decreasing number of available physicians. As mentioned above, there are two risks to the health and safety of women as a result of HB 2. The second of these is that if a woman cannot access one of the remaining clinics, she may seek out a more convenient but illegal and unsafe abortion, which is far more likely to result in a dangerous complication. Dr. Lynn states, “[b]ecause of the restrictions lawmakers impose, women will seek abortions illegally, and we’re going to see a rise in septic abortions.”23 Some areas of Texas might effectively revert back to a pre-Roe era where abortions were performed in unsanitary conditions by unqualified people resulting in dangerous medical complications far more often than legal abortion procedures do now. Physicians like Dr. Lynn who want to prevent this from happening generally cannot do so without facing legal sanction. Physicians have a duty to provide safe medical care and if they cannot obtain admitting privileges, they cannot exercise this duty. ACOG released a statement expressing their objections to the new requirements. They state that HB 2 is, “plainly intended to restrict the reproductive rights of women in Texas through a series of requirements that improperly regulate medical practice and interfere with the patient-physician relationship.”24 Executive Vice-President of ACOG, Hal C. Lawrence III stated: The Texas bills set a dangerous precedent of a legislature telling doctors how to practice medicine and how to care for individual patients. ACOG opposes legislative interference, and strongly believes that decisions about medical care must be based on scientific evidence and made by licensed medical professionals, not the state or federal government.25 Abortion is one of only a few areas of medicine where the legislature imposes so many regulations restricting particular physicians’ ability to practice medicine. Not only are abortions providers being regulated by the state, they are also facing clear discrimination from others within the medical community. The state is closing down clinics that do not meet the ambulatory surgical center requirements and hospitals are denying physicians admitting privileges because they perform abortions. In summary, abortion providers are being discriminated against both by the legislature and other members of the medical community. Other physicians who do not perform abortions are not denied admitting privileges on discriminatory grounds. Clinics that cannot afford upgrades to become an ambulatory surgical center are being grandfathered in, while abortion clinics are being forced to close down. Ob-Gyns who conscientiously object to performing abortions and who are not located in close proximity to at least one abortion provider cannot effectively fulfill their duty to refer patients. Lastly, given the barriers these regulations will create, there will likely be a rise in complications resulting from abortions provided under grossly unsafe conditions. Physicians, whose duty it is to provide safe and effective medical care, are being denied the right to exercise this duty. While this denial may not be unconstitutional, it is certainly unjust and discriminatory and creates obstacles that other physicians do not face. Most importantly, these obstacles are creating an undue burden for women. The HB 2 requirements do not increase the health and safety of abortions; all they do is create substantial obstacles for women. In light of these observations, the requirements seem to me to be in clear violation of Casey, in which it was decided that, “[u]nnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on that right.”26 These regulations do just what Casey was meant to prohibit and this is accomplished through limiting physicians’ ability to practice safe abortions across the state of Texas. Therefore, the HB 2 requirements may not impose an undue burden on doctors but they do impose an undue burden on women. PDF available: Rachel Hill, "Texas HB 2," Voices in Bioethics. References: 1 Planned Parenthood of Southeastern Pennsylvania v. Casey, pg. 2. 2 Whole Women’s Health v. Lakey, pg. 2. 3 Ibid. 4 Ibid., 4. 5 Ibid., 2. 6 Planned Parenthood v. Casey, pg. 16 7 AMA Code of Medical Ethics, “Opinion 2.01 – Abortion,” American Medical Association. 8 Whole Women’s Health v. Lakey, pg. 10. 9 Dr. Sherwood Lynn, “A Texas Ob-Gyn Details the Horrific Consequences of Abortion Restrictions,” Cosmopolitan. 10 Feminist Newswire, “Texas Hospitals Revoke Admitting Privileges to Abortion Providers,” Feminist Majority Foundation Blog. 11 Ibid. 12 Ibid. 13 Ibid. 14 Glenn Hegar, “Texas Hospital Association’s Statement of Opposition to Section 2 of the Committee Substitute for Senate Bill 5,” Texas Hospital Association. 15 Dr. Lynn, “A Texas Ob-Gyn.” 16 Whole Women’s Health v. Lakey, pg. 10. 17 Ibid. 18 Mary Tuma, “Undercover Audio Reveals Anti-Abortion Tactics: Anti-abortion activists monitor and track providers, patients,” Austin Chronicle. 19 Ibid. 20 Ibid. 21 Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” The American Congress of Obstetricians and Gynecologists. 22 Ibid. 23 Dr. Lynn, “A Texas Ob-Gyn.” 24 “Ob-Gyns Denounce Texas Abortion Legislation: Senate Bill 1 and House Bill 2 Set Dangerous Precedent,” The American Congress of Obstetricians and Gynecologists. 25 Ibid. 26 Planned Parenthood v. Casey, pg. 16. (shrink)

The author introduces two key issues of the Ebola epidemic very clearly. However, the author could elaborate further on the objections to using experimental drugs. The author does a very good job of enumerating the reasons for using these drugs. In terms of reasons against using the drugs, the author only writes that there are regulations in place that are usually followed. Several supporting facts are given to suggest different regulations should be put in place for a crisis like Ebola. (...) Ebola is a deadly disease with no cure. At present, all we have are these experimental drugs. Ordinarily, such drugs would not be given without extensive testing. However, in this case, there is no time for that to be done. People who contract Ebola have no other alternatives, so an unapproved experimental treatment is better than nothing at all. It is important to weigh the risks and benefits. Some may argue that the risks of using an experimental drug may be too great and that we should wait to administer any experimental drug until it has been proven safe. We do not know what the long-term side effects may be. While that argument may be appropriate for other situations, in the case of Ebola epidemic, I do not think it applies. As I have said, and as the author has said, there is no cure or other treatment available for Ebola. People who contract it will likely die of the disease and these experimental treatments are their only option. In this case, the benefits outweigh the risks. As the author mentions, access to these drugs is very problematic. However, they do not elaborate enough on both sides of the issue. There are reasons supporting and reasons against giving health care workers experimental treatments first and I think including them would have added to the depth of the argument presented here. (shrink)

On October 29, 2013, Texas House Bill 2 went into effect, greatly changing women’s access to an abortion in the state. This bill requires that physicians performing clinic-based abortions obtain admitting privileges at a hospital within 30 miles of the clinic. A few months later, on January 1, 2014, the Texas Health and Safety Code was amended to include the requirement that all abortion clinics must meet the standards of an ambulatory surgical centre. These requirements will result in heavy burdens (...) for women seeking an abortion. Many clinics cannot afford the upgrade and are being forced to close down. On August 29, 2014, a Federal District Court for the Western District of Texas ruling to overturned the two proposed requirements. The court deemed them unconstitutional violations of a woman’s right to obtain an abortion recognizing that their purpose was to create obstacles for women. The ruling was appealed and the Federal Appeals Court allowed for the new regulations, forcing all but eight clinics in Texas to close their doors. Before the enactment of HB2, there were approximately 40 abortion clinics serving Texas’ population of about 26 million. The new regulations would force all except eight clinics to close down. The remaining clinics are located in four cities forcing many women to travel hundreds of miles to access them. For some, it is more feasible to leave Texas to go to an abortion clinic outside the state. Even if every woman seeking an abortion was able to travel to one of the remaining clinics, the clinics could not meet the demand. Both of these requirements, the ambulatory surgical requirement and the admitting privileges requirement, constitute an undue burden for women. But what about the physicians? These requirements also place an undue burden on physicians who want to perform abortions. For affected physicians, it is difficult or impossible to obtain admitting privileges at a nearby hospital. Many hospitals are denying these privileges to physicians because the hospitals have no interest in participating in performing abortions and gain nothing by allowing it. If the majority of abortion clinics are forced to close down, physicians who want to perform abortions would have to relocate to one of the four cities mentioned previously, or even leave the state. Women seeking an abortion have to travel to the clinic once or twice. Physicians would have to relocate permanently. Much of the focus of these rulings has been on women’s rights and what constitutes an undue burden for women. In addition to this, physician’s rights should also be considered. There have been several cases of doctors facing harassment and even death threats for performing abortions. Fear of such treatment has led to many doctors to decline to perform abortions. Doctors do not have an obligation to perform abortions but it is within their rights as physicians to do so. However, given this harsh treatment by anti-abortion groups, not a lot of doctors are willing. The new regulations will leave open clinics in four cities in Texas making it more difficult for those few doctors who want to perform abortions to do so. The new regulations impose undue burdens on women and doctors alike. On Tuesday, October 14, the Supreme Court struck down the new requirements allowing thirteen clinics in Texas to reopen. (shrink)

Proclaimed the “greenest television programme in the world,” the award-winning soap opera Coronation Street is seen as an industry success story. This paper explores how the integration of carbon literacy training led to a widespread transformational change of practice within Coronation Street. Using the theoretical lens of Communities of Practice, this study examines the nature of social learning and the enablers and barriers to change within the organization. Specifically, how boundary spanning practices, objects and people led to the transformation on (...) both a personal and group level. Based on a qualitative analysis of 22 interviews with Heads of Departments and other staff, the paper argues that CLT is a boundary practice which has evolved into a boundary spanning CoP. The importance of infrastructures supporting boundary objects and practices is highlighted as reinforcers of the CLT, both as a boundary object and a community, with the “ultimate” boundary spanning object being the show. A significant enabler in social learning and change in practice is the creation of discursive and creative space, both within CoP and across the boundaries. Findings also highlight the role of “self” in the process of social learning and organizational change. Distinct patterns emerged in the relationship between self-identity, social learning and change across a range of boundary objects, practices and communities both in the CLT and CoP. This suggests that in a diverse social learning setting such as CLT there are different transformational catalysts within the CoP and these identities can influence how knowledge is translated into practice. (shrink)

Many philosophers, psychologists, and medical practitioners believe that killing is no worse than letting die on the basis of James Rachels's Bare-Difference Argument. I show that his argument is unsound. In particular, a premise of the argument is that his examples are as similar as is consistent with one being a case of killing and the other being a case of letting die. However, the subject who lets die has both the ability to kill and the ability to let die (...) while the subject who kills lacks the ability to let die. Modifying the latter example so that the killer has both abilities yields a pair of cases with morally different acts. The hypothesis that killing is worse than letting die is the best explanation of this difference. (shrink)

Kopeikin (forthcoming a, forthcoming b) and Rachels’ (1975) bare-difference cases elicit the intuition that killing is no different than letting die. Hill’s (2018) bare-difference cases elicit the intuition that killing is worse than letting die. At least one of the intuitions must be mistaken. This calls for an error theory. Hill has an error theory for the intuition elicited by the Kopeikin/Rachels’ cases. Kopeikin and Rachels have an error theory for the intuition elicited by Hill’s cases. A (...) natural thought is that we are at an impasse. There is no plausible basis for preferring one error theory to the other. I argue that this natural thought is mistaken. Not all error theories are equal. Preliminary considerations favor Hill’s error theory and disfavor the Kopeikin/Rachels error theory. But preliminary considerations are not decisive. The way forward in the bare-difference debate is not to evaluate intuitions. The intuitions are in. What is left to do now is evaluate the comparative status of the Hill and the Kopeikin/Rachels error theories. (shrink)

Background Achieving meaningful consent can be challenging, particularly in contexts of diminished literacy, yet is a vital part of participant protection in global health research. Method We explored the challenges and potential solutions of achieving meaningful consent through a qualitative study in a predominantly hill tribe ethnic minority population in northern Thailand, a culturally distinctive population with low literacy. Semi-structured interviews were conducted with 37 respondents who had participated in scrub typhus clinical research, their family members, researchers and other (...) key informants. A thematic analysis was conducted. Results Our analysis identified four interrelated themes surrounding participants’ ability to give consent: varying degrees of research understanding, limitations of using informal translators, issues impacting decisions to join research, and voluntariness of consent. Suggestions for achieving more meaningful consent included the use of formal translators and community engagement with research populations. Conclusions Participant’s agency in decision making to join research should be supported, but research information needs to be communicated to potential participants in a way that they can understand. We found that improved understanding about the study and its potential benefits and harms goes beyond literacy or translation and requires attention to social and cultural factors. (shrink)

Este livro inclui as palestras apresentadas no XIII Congresso Internacional de Estética, ocorrido em Belo Horizonte em outubro de 2017, cujo título, “Os fins da arte”, explora o duplo sentido do termo “fim” que, polissêmico, indica término, conclusão e epílogo, assim como o propósito, a meta, o objetivo, a motivação, e ainda o limite e a decadência. O uso plural desse termo amplifica, ainda, suas possibilidades de interpretação. Os textos deste livro mostram de modo evidente o quanto a questão do (...) “fim” contribui de maneira estratégica para pensar a arte durante o último século e o início deste. O livro conta com textos dos filósofos e filósofas da arte Márcia Ferreira Gonçalves, Gunter Gebauer, Rosa Gabriella Gonçalves, Giorgia Cecchinato, Alessandro Bertinetto, Cliff Hill Kormann, Rodrigo Duarte, Rita Velloso e do filósofo francês David Lapoujade, um dos principais nomes da filosofia na atualidade. (shrink)

ABSTRACT Hill [AJP, 2018] argues that Rachels’s famous bare-difference argument for the moral irrelevance between killing and letting die fails. In this paper, I argue that certain features in Hill’s cases might lead our intuitions astray. I propose new cases and suggest that they support the conclusion that, in itself, intentional killing is morally equivalent to intentional letting-die.

ABSTRACT Hill [AJP, 2018] argues that Rachels’s famous bare-difference argument for the moral irrelevance between killing and letting die fails. In this paper, I argue that certain features in Hill’s cases might lead our intuitions astray. I propose new cases and suggest that they support the conclusion that, in itself, intentional killing is morally equivalent to intentional letting-die.

Thomas E. Hill, Jr.; Servility and Self-Respect, The Monist, Volume 57, Issue 1, 1 January 1973, Pages 87–104, https://doi.org/10.5840/monist197357135.

Thomas E. Hill, Jr., interprets and extends Kant's moral theory in a series of essays that highlight its relevance to contemporary ethics. He introduces the major themes of Kantian ethics and explores its practical application to questions about revolution, prison reform, and forcible interventions in other countries for humanitarian purposes.

Conceptual engineering involves revising our concepts. It can be pursued as a specific philosophical methodology, but is also common in ordinary, non-philosophical, contexts. How does our capacity for conceptual engineering fit into human cognitive life more broadly? I hold that conceptual engineering is best understood alongside practices of conceptual exploration, examples of which include conceptual supposition (i.e., suppositional reasoning about alternative concepts), and conceptual comparison (i.e., comparisons between possible concept choices). Whereas in conceptual engineering we aim to change the concepts (...) we use, in conceptual exploration, we reason about conceptual possibilities. I approach conceptual exploration via the linguistic tools we use to communicate about concepts, using metalinguistic negotiation, convention-shifting conditionals, and metalinguistic comparatives as my key examples. I present a linguistic framework incorporating conventions that can account for this communication in a unified way. Furthermore, I argue that conceptual exploration helps undermine skepticism about conceptual engineering itself. (shrink)

In this paper I discuss the interrelated topics of stereotype threat and attributional ambiguity as they relate to gender and gender identity. The former has become an emerging topic in feminist philosophy and has spawned a tremendous amount of research in social psychology and elsewhere. But the discussion, at least in how it connects to gender, is incomplete: the focus is only on cisgender women and their experiences. By considering trans women's experiences of stereotype threat and attributional ambiguity, we gain (...) a deeper understanding of the phenomena and their problematic effects. (shrink)

Assertions about appearances license inferences about the speaker's perceptual experience. For instance, if I assert, 'Tom looks like he's cooking', you will infer both that I am visually acquainted with Tom (what I call the "individual acquaintance inference"), and that I am visually acquainted with evidence that Tom is cooking (what I call the "evidential acquaintance inference"). By contrast, if I assert, 'It looks like Tom is cooking', only the latter inference is licensed. I develop an account of the acquaintance (...) inferences of appearance assertions building on two main previous lines of research: first, the copy raising literature, which has aimed to account for individual acquaintance inferences through the "perceptual source" semantic role; second, the subjectivity literature, which has focused on the status of acquaintance inferences with predicates of personal taste, but hasn't given much attention to the added complexities introduced by appearance language. I begin by developing what I take to be the most empirically-sound version of a perceptual source analysis. I then show how its insights can be maintained, while however taking anything about perception out of the truth conditions of appearance sentences. This, together with the assumption that appearance assertions express experiential attitudes, allows us to capture the acquaintance inferences of bare appearance assertions without making incorrect predictions about the behavior of appearance verbs in embedded environments. (shrink)

Much recent philosophical work argues that power constrains speech—pornography silences women, testimonial injustice thwarts a speaker’s transmission of knowledge, bias distorts the performative force of subordinated speech. Though the constraints that power places on speech are serious, power also enables some speech. Power doesn’t just keep us from speaking—it also makes us speak. In this paper I explore how power produces, rather than constrains, speech. I discuss a kind of speech I call extracted speech: speech that is unjustly elicited from (...) an agent. I discuss examples of coerced confession, intimidated “consent,” and mandatory self-disclosure as instances of extracted speech, and theorize a bit about what significance this speech has more generally for philosophy of language and political philosophy. (shrink)

Debates about expanding newborn screening with whole genome sequencing are fueled by data about public perception, public opinion, and the positions taken by public advocates and advocacy groups. One form of evidence that merits attention as we consider possible uses of whole‐genome sequencing during the newborn period is parents’ (and children's) diverse experiences with existing expanded screening protocols. What do we know about this experience base? And what implications might these data have for decisions about how we use whole genome (...) sequencing and how we assess its impact in the future? Although the broader literature on genetic susceptibility testing suggests that testing usually does not have adverse effects on children's psychosocial well‐being, certain newborn screening results have been demonstrated to cause distress, alter behavior, and even to influence the formation of new parental and family identities. (shrink)

Philosophies of Difference engages with the concept of difference in relation to a number of fundamental philosophical and political problems. Insisting on the inseparability of ontology, ethics and politics, the essays and interview in this volume offer original and timely approaches to thinking nature, sexuate difference, racism, and decoloniality. The collection draws on a range of sources, including Latin American Indigenous ontologies and philosophers such as Henri Bergson, Jacques Derrida, Luce Irigaray, Immanuel Kant, Maurice Merleau-Ponty, Charles Mills, and Eduardo Viveiros (...) de Castro. -/- The contributors think embodiment and life by bringing continental philosophy into generative dialogue with fields including plant studies, animal studies, decoloniality, feminist theory, philosophy of race, and law. Affirming the importance of interdisciplinarity, Philosophies of Difference contributes to a creative and critical intervention into established norms, limits, and categories. Invoking a conception of difference as both constitutive and generative, this collection offers new and important insights into how a rethinking of difference may ground new and more ethical modes of being and being-with. Philosophies of Difference unearths the constructive possibilities of difference for an ethics of relationality, and for elaborating non-anthropocentric sociality. -/- The chapters in this book were originally published in a special issue in Australian Feminist Law Journal. (shrink)

In theoretical work about the language of personal taste, the canonical example is the simple predicate of personal taste, 'tasty'. We can also express the same positive gustatory evaluation with the complex expression, 'taste good'. But there is a challenge for an analysis of 'taste good': While it can be used equivalently with 'tasty', it need not be (for instance, imagine it used by someone who can identify good wines by taste but doesn't enjoy them). This kind of two-faced behavior (...) systematically arises with complex sensory-evaluative predicates, including those with other appearance verbs, such as 'look splendid' and 'sound nice'. I examine two strategies for capturing these different uses: one that posits an ambiguity in appearance verbs, and one that does not. The former is in line with an approach to 'look'-statements prominent in work in philosophy of perception, and I consider how the motivation given in that tradition carries over to the present context. I then show how the data used to support the verbal ambiguity approach can equally be captured on the second strategy, which appeals only to independently-motivated flexibility in adjective meaning. I close by discussing some considerations that are relevant for choosing between the two options. (shrink)

If I told you that screening technologies are iteratively transforming how people experience pregnancy and early parenting, you might take notice. If I mentioned that a new class of newborn patients was being created and that particular forms of parental vigilance were emerging, you might want to know more. If I described how the particular stories told about screening in public, combined with parents’ fierce commitment to safeguarding their children’s health, make it difficult for problematic experiences with screening to translate (...) into negative opinions about it, you would most likely be intrigued. An extensive qualitative literature documents all these social phenomena, and more, in connection with the spread of prenatal and newborn screening. So why is it, then, that commentators frequently assert that the predicted psychosocial impact of increased screening and testing associated with “the genomic revolution” has been far less severe and worthy of attention than predicted? How can or should social science “evidence” that sits outside adopted measurement conventions be considered? Why is it that summary statements about the psychosocial impact of genomic information often ignore qualitative evidence, or sideline it as relevant only for improving communication among patients, clinicians, and public health systems? This essay addresses such questions, using qualitative research on prenatal and newborn screening as a case study for illustrating the broad methodological, ideological, and dialogical issues at stake. (shrink)

In an important and widely cited paper, Zerilli, Knott, Maclaurin, and Gavaghan (2019) argue that opaque AI decision makers are at least as transparent as human decision makers and therefore the concern that opaque AI is not sufficiently transparent is mistaken. I argue that the concern about opaque AI should not be understood as the concern that such AI fails to be transparent in a way that humans are transparent. Rather, the concern is that the way in which opaque AI (...) is opaque is very different than the way in which humans are opaque. What matters is the degree to which the opaque processes of a class of decision makers are stable, uniform, and safe. The degree to which such processes have these features in humans is higher than the degree to which such processes have these features in opaque AI. And therefore we should require AI to be more transparent than humans. (shrink)

A first-person account of some victims of the virus, the author puts faces and circumstances to the tragedy of the Covid-19 pandemic. Told from a chaplain’s point of view, these narratives will take the reader beyond the numbers and ask questions like: What is the cost of keeping families separated at the end of life, and, if patient/family centered care is so central to healthcare these days, why was it immediately discarded? Is potentially saving human lives worth the risk of (...) damaging them beyond repair? (shrink)

This paper examines social network size in contemporary Western society based on the exchange of Christmas cards. Maximum network size averaged 153.5 individuals, with a mean network size of 124.9 for those individuals explicitly contacted; these values are remarkably close to the group size of 150 predicted for humans on the basis of the size of their neocortex. Age, household type, and the relationship to the individual influence network structure, although the proportion of kin remained relatively constant at around 21%. (...) Frequency of contact between network members was primarily determined by two classes of variable: passive factors (distance, work colleague, overseas) and active factors (emotional closeness, genetic relatedness). Controlling for the influence of passive factors on contact rates allowed the hierarchical structure of human social groups to be delimited. These findings suggest that there may be cognitive constraints on network size. (shrink)

We offer a novel account of metalinguistic comparatives, such as 'Al is more wise than clever'. On our view, metalinguistic comparatives express comparative commitments to conventions. Thus, 'Al is more wise than clever' expresses that the speaker has a stronger commitment to a convention on which Al is wise than to a convention on which she is clever. This view avoids problems facing previous approaches to metalinguistic comparatives. It also fits within a broader framework—independently motivated by metalinguistic negotiations and convention-shiftingexpressions— (...) that gives linguistic conventions a role in the semantics. (shrink)

I present a counterexample to Kirk-Giannini’s Dilemmatic Theory of gaslighting.

The coronavirus pandemic has necessitated extraordinary human resilience in order to preserve and prolong life and social order. Risks to health and even life are being confronted by workers in health and social care, as well as those in roles previously never defined as “frontline,” such as individuals working in community supply chain sectors. The strategy adopted by the United Kingdom government in facing the challenges of the pandemic was markedly different from other countries. The present study set out to (...) examine what variables were associated with resilience, burnout, and wellbeing in all sectors of frontline workers, and whether or not these differed between the UK and Republic of Ireland. Individuals were eligible if they were a frontline worker in the UK or RoI during the pandemic. Part of a larger, longitudinal study, the participants completed an online survey to assess various aspects of their daily and working lives, along with their attitudes toward their government’s handling of the crisis, and measurement of psychological variables associated with heroism. A total of 1,305 participants provided sufficient data for analysis. UK-based workers reported lower wellbeing than the RoI-based participants. In multivariate models, both psychological and pandemic-related variables were associated with levels of resilience, burnout, and wellbeing in these workers, but which pandemic-related variables were associated with outcomes differed depending on the country. The judgment of lower timeliness in their government’s response to the pandemic appeared to be a key driver of each outcome for the UK-based frontline workers. These findings provide initial evidence that the different strategies adopted by each country may be associated with the overall wellbeing of frontline workers, with higher detriment observed in the UK. The judgment of the relatively slow response of the UK government to instigate their pandemic measures appears to be associated with lower resilience, higher burnout, and lower wellbeing in frontline workers in the UK. (shrink)

This special issue is the result of concerns about the marginalized status of gender within the sociology of religion. The collection of exciting new research in this special issue advocates for the importance of a gender lens on questions of religion in order to highlight issues, practices, peoples, and theories that would otherwise not be central to the discipline. We encourage sociologists who study religion to engage more in interdisciplinary and intersectional scholarship, acknowledge developments in the global South, and develop (...) more compelling theoretical frameworks that analyze religion from a gendered perspective. Our aim is to bring religion to the attention of gender and feminist scholars and to encourage religion scholars to consider gender not just as a variable but as a social structure. We hope that both groups of scholars will consider gender and religion as mutually constitutive social categories. (shrink)

A new reading of Plato's account of conventionalism about names in the Cratylus. It argues that Hermogenes' position, according to which a name is whatever anybody 'sets down' as one, does not have the counterintuitive consequences usually claimed. At the same time, Plato's treatment of conventionalism needs to be related to his treatment of formally similar positions in ethics and politics. Plato is committed to standards of objective natural correctness in all such areas, despite the problematic consequences which, as he (...) himself shows, arise in the case of language. (shrink)

There is a wealth of evidence which indicates that arguments are not very efficient tools for changing minds. Against this skepticism, Novaes (2023) presents evidence that, given the right social context, arguments sometimes play a significant role in belief revision. However, drawing on Levy (2021), I argue that the evidence Novaes cites is compatible with the view that it is not arguments that change individual minds but instead belief outsourcing that occurs alongside the consideration of arguments.

We discuss a case where medically optimal investigations of health problems in a donor-conceived child would require their egg donor to participate in genetic testing. We argue that it would be justified to contact the egg donor to ask whether she would consider this, despite her indicating on a historical consent form that she did not wish to take part in future research and that she did not wish to be informed if she was found to be a carrier of (...) a ‘harmful inherited condition’. We suggest that we cannot conjecture what her current answer might be if, by participating in clinical genetic testing, she might help reach a diagnosis for the donor-conceived child. At the point that she made choices regarding future contact, it was not yet evident that the interests of the donor-conceived child might be compromised by her answers, as it was not foreseen that the egg donor’s genome might one day have the potential to enable diagnosis for this child. Fertility consent forms tend to be conceptualised as representing incontrovertible historical boundaries, but we argue that rapid evolution in genomic practice means that consent in such cases is better seen as an ongoing and dynamic process. It cannot be possible to compel the donor to aid in the diagnosis of the donor-conceived child, but she should be given the opportunity to do so. (shrink)

A medical student's ability to present a case history is a critical skill that is difficult to teach. Case histories presented without theatrical engagement may fail to catch the attention of their intended recipients. More engaging presentations incorporate ‘stage presence’, eye contact, vocal inflection, interesting detail and succinct, well organised performances. They convey stories effectively without wasting time. To address the didactic challenge for instructing future doctors in how to ‘act’, the Mayo Medical School and The Mayo Clinic Center for (...) Humanities in Medicine partnered with the Guthrie Theater to pilot the programme ‘Telling the Patient's Story’. Guthrie teaching artists taught storytelling skills to medical students through improvisation, writing, movement and acting exercises. Mayo Clinic doctors participated and provided students with feedback on presentations and stories from their own experiences in patient care. The course's primary objective was to build students' confidence and expertise in storytelling. These skills were then applied to presenting cases and communicating with patients in a fresher, more engaging way. This paper outlines the instructional activities as aligned with course objectives. Progress was tracked by comparing pre-course and post-course surveys from the seven participating students. All agreed that the theatrical techniques were effective teaching methods. Moreover, this project can serve as an innovative model for how arts and humanities professionals can be incorporated for teaching and professional development initiatives at all levels of medical education. (shrink)

Strohminger gives a lively and accurate critique of McGinn’s book but is somewhat inaccurate herself in describing the current theoretical state of the science on disgust. My comment primarily focuses on the issues I have with McGinn’s and Strohminger’s discussions and briefly offers a possible unifying account of the function and meaning of disgust.

Many philosophers and members of the public think it is wrong to procreate. If one wants children, it is permissible to adopt. But procreation is allegedly impermissible because there is some respect in which adoption is better than procreation. I show that such objections are unsound.

In the Republic, Plato argues that the soul has three distinct parts or elements, each an independent source of motivation: reason, spirit, and appetite. In this paper, I argue against a prevalent interpretation of the motivations of the spirited part and offer a new account. Numerous commentators argue that the spirited part motivates the individual to live up to the ideal of being fine and honorable, but they stress that the agent's conception of what is fine and honorable is determined (...) by social norms. I argue that while it is correct to hold that spirit aims to be fine and honorable, it is not the case that the agent’s conception of what it is to be fine and honorable is determined by social norms. Instead, there is a fact of the matter about what it is to be fine and honorable, and it is this fact that shapes the individual’s conception of the fine and honorable. I argue that being fine and honorable involves living up to your rational views about how you should behave, despite appetitive temptations to the contrary. I claim that this condition of the soul is the basis of a variety of interrelated admirable traits, some with moral and others with aesthetic connotations. (shrink)

Food - what we eat, how much we eat, how it is produced and prepared, and its cultural and ecological significance- is an increasingly significant topic not only for scholars but for all of us. Theology on the Menu is the first systematic and historical assessment of Christian attitudes to food and its role in shaping Christian identity. David Grumett and Rachel Muers unfold a fascinating history of feasting and fasting, food regulations and resistance to regulation, the symbolism attached (...) to particular foods, the relationship between diet and doctrine, and how food has shaped inter-religious encounters. Everyone interested in Christian approaches to food and diet or seeking to understand how theology can engage fruitfully with everyday life will find this book a stimulus and an inspiration. (shrink)

Background International collaborators face challenges in the design and implementation of ethical biomedical research. Evaluating community understanding of research and processes like informed consent may enable researchers to better protect research participants in a particular setting; however, there exist few studies examining community perspectives in health research, particularly in resource-limited settings, or strategies for engaging the community in research processes. Our goal was to inform ethical research practice in a biomedical research setting in western Kenya and similar resource-limited settings. Methods (...) We sought to use mabaraza , traditional East African community assemblies, in a qualitative study to understand community perspectives on biomedical research and informed consent within a collaborative, multinational research network in western Kenya. Analyses included manual, progressive coding of transcripts from mabaraza to identify emerging central concepts. Results Our findings from two mabaraza with 108 community members revealed that, while participants understood some principles of biomedical research, they emphasized perceived benefits from participation in research over potential risks. Many community members equated health research with HIV testing or care, which may be explained in part by the setting of this particular study. In addition to valuing informed consent as understanding and accepting a role in research activities, participants endorsed an increased role for the community in making decisions about research participation, especially in the case of children, through a process of community consent. Conclusions Our study suggests that international biomedical research must account for community understanding of research and informed consent, particularly when involving children. Moreover, traditional community forums, such as mabaraza in East Africa, can be used effectively to gather these data and may serve as a forum to further engage communities in community consent and other aspects of research. (shrink)

Gyngell and colleagues consider that the recent Nuffield Council report does not go far enough: heritable genome editing is not just justifiable in a few rare cases; instead, there is a moral imperative to undertake it. We agree that there is a moral argument for this, but in the real world it is mitigated by the fact that it is not usually possible to ensure a better life. We suggest that a moral imperative for HGE can currently only be concluded (...) if one first buys into an overly deterministic view of a genome sequence, and the role of variation within in it, in the aetiology of the disease: most diseases cannot simply be attributed to specific genetic variants that we could edit away. Multiple, poorly understood genetic and environmental factors interact to influence the expression of diseases with a genetic component, even well understood ‘monogenic’ disorders. Population-level genome analyses are now demonstrating that many genetic ’mutations' are much less predictive than previously thought 1. Furthermore, HGE might introduce new risks just as it reduces old ones; or remove protections not yet clearly delineated. (shrink)

A major goal of this work is to specify some steps of the process by which participants maintain coherency in their conversations.The underlying element of the analysis is a construct called a “context space.” Roughly, a group of utterances that refers to a single issue or episode forms the basis for a context space. Superficially, a conversation is a sequence of utterances; at a deeper level it is a structured entity whose utterances can be parsed into hierarchically related context spaces.As (...) a conversation proceeds, each conversant builds a discourse model that includes the conversation's context space structure, a notion of the present discourse topic, and a list of items being focused upon. Conversational coherency depends upon a lack of conflict between the respective models of the participants. Conflicts are prevented by speakers following high level syntactic and semantic relational rules that enable listeners to identify their discourse models. These rules, given in the study, are highly integrated with the view of conversation presented here—a hierarchy of related context spaces. (shrink)

Self‐trust is essential to the well‐being of people with chronic illnesses and those who care for them. In this exploratory essay, we draw on a trove of health narratives to catalyze examination of this important but often overlooked topic. We explore how self‐trust is impeded at both personal and structural levels, how it can best be nourished, and how it is related to self‐advocacy. Because people's ability to trust themselves is intrinsically linked to the trust others have in them, we (...) pay particular attention to the role that allies such as clinical professionals play in the development of self‐trust, highlighting the importance of eliciting patient narratives, of curious listening, and of compassionately raising questions. We also contrast the self‐trust paradigm with that of self‐management, which tends to replace the former's attention to patients’ experiences, abilities, qualities, or judgments with a professionally dominated discourse dedicated to addressing illness through behavior changes prescribed by clinicians. We close with a call to action, exhorting readers to focus on supporting self‐trust in health care settings and on creative research in this critical yet heretofore underrepresented domain. (shrink)

Contemporary discussions of practical reason often refer vaguely to the Kantian conception of reasons as an alternative to various means-ends theories, but it is rarely clear what this is supposed to be, except that somehow moral concerns are supposed to fare better under the Kantian conception. The theories of Nagel, Gewirth, Darwall, and Donagan have been labeled “Kantian” because they deviate strikingly from standard preference models, but their roots in Kant have not been traced in detail and important differences may (...) go unnoticed. All this is not surprising, of course, because Kant’s conception of practical reason is inseparable from his ideas of freedom, which are notoriously difficult and controversial. It is hard enough to characterize these ideas accurately in Kantian terminology, harder still to explain them in terms of contemporary debates about reasons for action. (shrink)

This paper explores the idea that a proper valuing of natural environments is essential to (and not just a natural basis for) a broader human virtue that might be called 'appreciation of the good'. This kind of valuing can explain, without any commitment to a metaphysics of intrinsic values, how and why it is good to value certain natural phenomena for their own sakes. The objection that such an approach is excessively human-centred is considered and rebutted.