Michael T. Stuart (2021 and 2022) has proposed imagination as an intellectual dual‐process virtue, consisting of imagination1 (underwritten by cognitive Type 1 processing) and imagination2 (supported by Type 2 processing). This paper investigates the consequences of taking such an account seriously. It proposes that the dual‐process view of imagination allows us to incorporate recent insights from virtue epistemology, providing a fresh perspective on how imagination can be epistemically reliable. The argument centers on the distinction between General Reliability (GR) and Functional (...) System Reliability (FSR), for example in relation to Kengo Miyazono and Uko Tooming's (2023) argument for epistemic generativity. Furthermore, the paper claims that the dual‐process virtue account enables us to integrate a wide range of findings from the literature on epistemology and imagination. Moreover, it suggests a novel way to distinguish the virtues of creativity and imagination and presents a case for viewing imagination as a virtue rather than a skill. (shrink)

In this article, I examine the possible thought experimenting qualities of Soren Kierkegaard's novel Fear and Trembling and in which way it can be explanatory. Kierkegaard's preference for pseudonyms, indirect communication, Socratic interrogation, and performativity are identified as features that provide the narrative with its thought experimenting quality. It is also proposed that this literary fiction functions as a Socratic-theological thought experiment due to its influences from both philosophy and theology. In addition, I suggest three functional levels of the fictional (...) narrative that, in different ways, influence its possible explanatory force. As a theoretical background for the investigation, two accounts of literary cognitivism are explored: Noel Carroll's Argument Account and Catherine Elgin's Exemplification Account. In relation to Carroll's proposal, I conclude that Fear and Trembling develops a philosophical argumentation that is dependent on the reader's own existential contribution. In relation to Elgin's thought, the relation between truth and explanatory force is acknowledged. At the end of the article, I argue that it is more accurate to see the explanatory force of Fear and Trembling in relation to its exploratory function. (shrink)

This chapter examines the tradition of alchemy as an example of a cumulative creation of past and present. As an illustration, the text discusses the British revival of alchemy that occurred in the nineteenth- and beginning of the twentieth century. During this period, all branches of science saw major developments and expansions. In response to the crisis of faith that naturalistic science had brought about, alchemical practice became one of the ways in which subjects scientifically and spiritually rethought and repackaged (...) the world. However, this wasn’t so much a static repetition of a fixed set of beliefs and practices as it was a creative reinvention of the tradition itself. By approaching the revival from a hermeneutic perspective, the article argues that this process entailed linguistic-historical contextualism, a fusion of horizons, as well as a continuous dialectic between a scientific and a spiritual conception of alchemy. (shrink)

One of the dominant themes of the symposium from which this collection of articles arose was the ontological status of consent. Is consent a particular state of mind? Is it the signification of that state of mind via a conventionally recognized act? Or, is consent a normative concept that evaluates not only the presence of a state of mind or act, but also the appropriateness of that state of mind or act in the particular circumstances?

Some societies tolerate or encourage high levels of chickenpox infection among children to reduce rates of shingles among older adults. This tradeoff is unethical. The varicella zoster virus (VZV) causes both chickenpox and shingles. After people recover from chickenpox, VZV remains in their nerve cells. If their immune systems become unable to suppress the virus, they develop shingles. According to the Exogenous Boosting Hypothesis (EBH), a person’s ability to keep VZV suppressed can be ‘boosted’ through exposure to active chickenpox infections. (...) We argue that even if this hypothesis were true, immunization policies that discourage routine childhood varicella vaccination in order to prevent shingles for other people are unethical. Such policies harm children and treat them as mere means for the benefit of others, and are inconsistent with how parents should treat their children and physicians should treat their patients. These policies also seem incompatible with institutional transparency. (shrink)

This book, in language accessible to the general reader, investigates twelve of the most notorious, most interesting, and most instructive episodes involving the interaction between science and Christianity, aiming to tell each story in its historical specificity and local particularity. Among the events treated in When Science and Christianity Meet are the Galileo affair, the seventeenth-century clockwork universe, Noah's ark and flood in the development of natural history, struggles over Darwinian evolution, debates about the origin of the human species, and (...) the Scopes trial. Readers will be introduced to St. Augustine, Roger Bacon, Pope Urban VIII, Isaac Newton, Pierre-Simon de Laplace, Carl Linnaeus, Charles Darwin, T. H. Huxley, Sigmund Freud, and many other participants in the historical drama of science and Christianity. (shrink)

For good reasons, the green movement turned from wilderness to environmental justice as its central category in the 1980s and ’90s. Today, several leading wilderness advocates seem to compete for the most reactionary positions, particularly on the issue of migration. A case can, however, be made for a progressive, cosmopolitan, Marxist view of wilderness as a space less fully subjugated to capital than others. There is a long history of exploited and persecuted people seeking freedom in and through the wild. (...) This essay focuses on two such groups – maroons and Jewish partisans – and asks what we lose in a rapidly warming world where the remotest and supposedly wildest corners of the world are among the first to be destroyed. (shrink)

It is fashionable to argue that nature and society are obsolete categories. The two, we are told, can no longer be distinguished from one another; continuing loyalty to the ‘binary’ of the natural and the social blinds us to the logic of current ecological crises. This article outlines an argument for the opposite position: now more than ever – particularly in our rapidly warming world – we need to sift out the social components from the natural, if we wish to (...) understand the crises and retain the possibility of intervening in them. Tracing the current of hybridism to the writings of Bruno Latour, this article ends with a critique of the foremost proponent of a hybridism in Marxist garb: Jason W. Moore. Against his theories, it suggests that historical materialism is a form of property dualism that distinguishes between social and natural relations while considering them equally material in substance. That is also the analytical premise of ecological class hatred, the flames of which ecological Marxism seeks to fan. (shrink)

Fundado em 2003 e sob a coordenação do professor Dr. Antônio Carlos dos Santos, o Grupo de Ética e Filosofia Política da UFS congrega professores vinculados ao Departamento de Filosofia (DFL), ao Colégio de Aplicação (CODAP) e ao Programa de Pós-graduação em Filosofia (PPGF), além de discentes (graduação e pós-graduação). Em seus pouco mais de 15 anos de história, as discussões giraram em torno da Filosofia Política, do Direito, da Moral, da Economia, da Religião e da Ética, sempre pautando seus (...) estudos com um olhar analítico e/ou histórico de autores da Modernidade e da Contemporaneidade. (shrink)

Numerous grounds have been offered for the view that healthcare workers have a duty to treat, including expressed consent, implied consent, special training, reciprocity (also called the social contract view), and professional oaths and codes. Quite often, however, these grounds are simply asserted without being adequately defended or without the defenses being critically evaluated. This essay aims to help remedy that problem by providing a critical examination of the strengths and weaknesses of each of these five grounds for asserting that (...) healthcare workers have a duty to treat, especially as that duty would arise in the context of an infectious disease pandemic. Ultimately, it argues that none of the defenses is currently sufficient to ground the kind of duty that would be needed in a pandemic. It concludes by sketching some practical recommendations in that regard. (shrink)

This essay is a comparison between Schelling's and Blanchot's conceptions of the night of the imaginary. Schelling is the most romantic of the German idealist philosophers and Blanchot the most extreme of the French “deconstructionists.“ Their historical link is actually indirect, but they offer two complementary views on the “same“ impersonal nocturnal experience of the imaginary, the approach of which requires a certain self-overcoming of philosophy towards literature.

For over a century, a foreign national seeking permission to immigrate to the U.S. could have her application for immigration denied on the ground that she suffers from a serious contagious disease. For just under two decades, a foreign national seeking permission to immigrate could also have her application denied on the ground that she has not been vaccinated against each of a list of vaccination-preventable diseases. Two recently developed moral justifications for the use of such “vaccination-related exclusion criteria” have (...) focused on (a) the right and need of a society to prevent the spread of disease to others and (b) the public good of developing and protecting herd immunity. Herein I accept these two general justifications—especially as they are developed by Mark Navin—and explore their limits. In particular, with a focus on the recently developed vaccine against several strains of HPV, as well the short-lived requirement by the CDC that it, too, be required of prospective immigrants, I argue that neither of the two main justifications for the use of vaccination-related exclusion criteria support their use for diseases such as HPV (or even HIV), the transmission of which, unlike airborne diseases such as measles, pertussis and polio, is subject to a considerable degree of individual control. (shrink)

It is fashionable to argue that nature and society are obsolete categories. The two, we are told, can no longer be distinguished from one another; continuing loyalty to the ‘binary’ of the natural and the social blinds us to the logic of current ecological crises. This article outlines an argument for the opposite position: now more than ever – particularly in our rapidly warming world – we need to sift out the social components from the natural, if we wish to (...) understand the crises and retain the possibility of intervening in them. Tracing the current of hybridism to the writings of Bruno Latour, this article ends with a critique of the foremost proponent of a hybridism in Marxist garb: Jason W. Moore. Against his theories, it suggests that historical materialism is a form of property dualism that distinguishes between social and natural relations while considering them equally material in substance. That is also the analytical premise of ecological class hatred, the flames of which ecological Marxism seeks to fan. (shrink)

List of contributors; Acknowledgments; Introduction Robert S. Westman and David C. Lindberg; 1. Conceptions of the scientific revolution from Bacon to Butterfield: a preliminary sketch David C. Lindberg; 2. Conceptions of science in the scientific revolution Ernan McMullin; 3. Metaphysics and the new science Gary Hatfield; 4. Proof, portics, and patronage: Copernicus’s preface to De revolutionibus Robert S. Westman; 5. A reappraisal of the role of the universities in the scientific revolution John Gascoigne; 6. Natural magic, hermetism, and (...) occultism in early modern science Brian P. Copenhaver; 7. Natural history and the emblematic world view William B. Ashworth, Jr.; 8. From the secrets of nature to public knowledge William Eamon; 9. Chemistry in the scientific revolution: problems of language and communication Jan V. Golinski; 10. The new philosophy and medicine in seventeenth-century England Harold J. Cook; 11. Science and heterodoxy: an early modern problem reconsidered Michael Hunter; 12. Infinitesimals and transcendent relations: the mathematics of motion in the late seventeenth century Michael S. Mahoney; 13. The case of mechanics: one revolution or many? Alan Gabbey; Index. (shrink)

The process commonly referred to as business-as-usual has given rise to dangerous climate change, but its social history remains strangely unexplored. A key moment in its onset was the transition to steam power as a source of rotary motion in commodity production, in Britain and, first of all, in its cotton industry. This article tries to approach the dynamics of the fossil economy by examining the causes of the transition from water to steam in the British cotton industry in the (...) second quarter of the nineteenth century. Common perceptions of the shift as driven by scarcity are refuted, and it is shown that the choice of steam was motivated by a rather different concern: power over labour. Turning away from standard interpretations of the role of energy in the industrial revolution, this article opens a dialogue with Marx on matters of carbon and outlines a theory of fossil capital, better suited for understanding the drivers of business-as-usual as it continues to this day. (shrink)

This comprehensive anthology offers influential works of philosophy written in the last 125 years in Northern and Central Europe and in the United States'durable contributions that have shaped the contemporary philosophical landscape in English-speaking countries. Substantial yet readable selections represent leading American pragmatists, the early Cambridge analysts, members of the Vienna Circle, the so-called "ordinary language" philosophers, along with recent analytic and post-analytic philosophers.

Background:The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction.Aim:Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway.Research design:A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020.Ethical considerations:Ethical approval granted by the Regional Research Ethics Committee in (...) Western Norway (131421).Findings:Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful.Discussion:By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority.Conclusion:Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

Medical screening is justified on the strength of the assumption that the earlier disease is detected, the better it is for the patient. On examination, however, the assumption turns out to be severely flawed, and inadequate anyway, since it is not only the patient with whom we should be concerned, but healthy people as well. Instead of making assumptions about the ill, we should prove a test's overall benefit to the individual taking it before we recommend it.

Gene editing techniques, such as CRISPR, are being heralded as powerful new tools for delivering agricultural products and foods with a variety of beneficial traits quickly, easily, and cheaply. Proponents are concerned, however, about whether the public will accept the new technology and that excessive regulatory oversight could limit the technology’s potential. In this paper, we draw on the sociotechnical imaginaries literature to examine how proponents are imagining the potential benefits and risks of gene editing technologies within agriculture. We derive (...) our data from a content analysis of public comments submitted to the Food and Drug Administration’s 2017 docket titled “Genome Editing in New Plant Varieties Used for Food.” Our sample frame consists of 26 comments representing 30 agriculture and biotech companies, organizations, and trade associations. Our findings reveal three key sociotechnical imaginaries, including that gene editing technologies in agriculture: are not GMO but instead equivalent to traditional plant breeding; have the potential to usher in a new Green Revolution; and could facilitate the democratization of agricultural biotechnologies. We argue that forming and projecting these collective interpretations of the potential of gene editing technologies for crops and foods plays an important role in efforts by proponents to influence regulatory oversight, modes of governance, and build public acceptance. This research contributes to calls by science and technology studies scholars to investigate emergent concerns and imaginaries for novel technoscientific advances to help inform upstream models of public engagement and governance decisions. (shrink)

As capitalist society remains incapable of addressing climate breakdown, one measure is waiting in the wings: solar geoengineering. No other technology can cut global temperatures immediately. It would alleviate the symptoms of the crisis, not its causes. But might it be combined with radical emissions cuts? This essay, the final instalment of two, subjects geoengineering to a materialist psychoanalysis and argues that it represents a fantasy of repression, setting itself up for a dreadful return of the repressed.

This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in (...) the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection. (shrink)

This paper offers a critique of Martha Nussbaum’s description of the capability approach, and offers an alternative. I will argue that Nussbaum’s characterization of the capability approach is flawed, in two ways. First, she unduly limits the capability to two strands of work, thereby ignoring important other capabilitarian scholarship. Second, she argues that there are five essential elements that all capability theories meet; yet upon closer analysis three of them are not really essential to the capability approach. I also offer (...) an alternative description of the capability approach, which is called the cartwheel view of the capability approach. This view is at the same time radically multidisciplinary yet also contains a foundationally robust core among its various usages, and is therefore much better able to make the case that the capability approach can be developed in a very wide range of more specific normative theories. Finally, the cartwheel view is used to argue against Nussbaum's claim that all capabilitarian political theory needs to be politically liberal. (shrink)

Journal of Political Philosophy, Volume 30, Issue 2, Page 249-270, June 2022.

This article reveals a 91-year-old cognitively intact man’s lived experiences of being cared for in a geriatric context in which the majority of the patients were cognitively impaired. A narrative patient story was analysed phenomenologically. The findings indicate that this patient’s basic needs for ethical care were not met. The staff did not see him as a unique individual with his own preferences, resources and abilities to master his life. In order to survive this lack of ethical care, he played (...) the role of an ‘old cognitively impaired man’, which provided him with at least the understanding and attention the cognitively impaired patients received from the staff. The findings also indicate that ethical care is independent of whether or not older cognitively intact and impaired patients stay or live in the same unit, but it is more dependent on a caregiver’s ability to respect and confirm each and every patient for who he or she is and would like to be. (shrink)

The body as an object of the violence generated in the framework of the Colombian armed conflict occupies a central place in different works of art and literature in the country. In various cases, such centrality is due to the commitment of the authors to resignify the occurrence of massacres, kidnappings, disappearances or forced displacement, which involve or fall on the bodies of the victims. Such is the case of the works analyzed comparatively in this article: the installation Signos cardinales (...) by Libia Posada and the novel En el brazo del río by Marbel Sandoval. Both of these works converge in the resignification of the body in the context of forced displacement. Among the objectives, it seeks to define the way in which a cartographic narrative is configured in the works. It is also intended to reflect on the relationship between the body and forced displacement: internal and cross-border. The analysis proposed here revolves around the concept of cartographic narrative, which will be approached from, on the one hand, Ítalo Calvino, who defines cartography as a space-time union articulated in the idea of ​​itinerary; and on the other, by Michel de Certeau, since he considers the narrative structures, implicit in cartography, as a spatial syntax, that is, a notion that allows us to address the representation of forced displacement as a symbolic delimitation of reordering itineraries of space. (shrink)

In this paper, we show that non-well-founded sets can be defined constructively by formalizing Hallnäs' limit definition of these within Martin-Löf's theory of types. A system is a type W together with an assignment of ᾱ ∈ U and α̃ ∈ ᾱ → W to each α ∈ W. We show that for any system W we can define an equivalence relation = w such that α = w β ∈ U and = w is the maximal bisimulation. Aczel's proof (...) that CZF can be interpreted in the type V of iterative sets shows that if the system W satisfies an additional condition (*), then we can interpret CZF minus the set induction scheme in W. W is then extended to a complete system W * by taking limits of approximation chains. We show that in W * the antifoundation axiom AFA holds as well as the axioms of CFZ -. (shrink)

This monograph on the capability approach does two things. First, it provides an advanced introduction to the capability approach, as an account used in philosophy, as well as other disciplines. Second, it provides an account of the capability approach which is able to encompass all existing views and theories on the capability approach, including the writings on the capability approach by Martha Nussbaum and Amartya Sen.

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and (...) nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Right HeartIngrid GouldI remarked to a friend, “We haven’t spoken since my arrest!” Alarm and confusion clouded his face, given my half-century of squeaky-clean living. “Cardiac arrest,” I clarified. “The fire department rebooted me.”An electrophysiologist diagnosed Arrhythmogenic Right Ventricular Dysplasia, prescribed medication, and implanted a defibrillator. For the next three-and-a-half years, he helped me live with a disease I didn’t know existed until he told me I had (...) it.The disease progressed—an ironic, disease-centric term since its advancement was to my detriment— prompting my cardiologist to recommend seeing someone who specialized in heart failure. I resisted the very idea of heart failure, a terrible term for a struggling organ, but took her advice and scheduled an appointment.The new cardiologist urged transplant testing, a lengthy process. I agreed, figuring that by the time I needed a new heart in 15–20 years, they’d be rolling off 3D printers.To record occasional transplant musings and inchoate fears and perhaps, over time, untangle them, I began journaling. I chronicled my passage through the echocardiogram, heart catheterization, 31 tubes of bloodwork, interviews with different clinical specialties, a pulmonary function test in a machine reminiscent of Star Trek’s Transporter, and more. Testing had barely begun when my medication stopped working—a Halloween shock.I began a harsher medication, underwent an ablation, and spent six weeks in a wearable defibrillator, a vest with abundant wires, and a purse-sized battery pack that made me resemble a character in [End Page 123] the Jetsons. This attire did not bring holiday comfort or joy to the TSA1 when I flew to visit my sister. As my R-waves faded to a whisper, I swapped the vest for a second implanted defibrillator, substantially more sensitive than the first.In early 2018, we learned I had qualified for transplant listing, though I wished to get as much mileage as possible from the original engine. My cardiologist warned, “There is no Plan B—no machine, device, or medication for the long-term. You will need a transplant.” He explained that since most cardiac patients have left-heart problems, companies develop products for the left side of the heart. My problem was on the right—a tiny market. He also cautioned that a patient needs to be sick enough to warrant transplant and well enough to remain a candidate, survive the surgery, and recover.Although clinically I was ready, I was not personally ready. I felt too good to trade an excellent quality of life for the promised miserable post-transplant year. The cardiologist wisely asked if I wanted to speak with another patient. When I requested someone beyond the dreaded first year, he put me in touch with two women who had received new hearts a few years earlier and befriended each other. They soon became my invaluable mentors and cherished friends. I will never forget seeing them stride into our first meeting and thinking, “They are beautiful! They look totally normal!”By May, climbing four flights of stairs took as much effort as five used to take. Tests confirmed further deterioration and suggested I had 7–13 months of declining health before my heart would give out completely. We chose a date for hospital admission, and I started telling people outside my immediate family. Most were flabbergasted, believing heart transplants were the last hope of the desperately ill. I did not look moribund, though, apparently, I was.The eight months after my first transplant appointment let me prepare psychologically to bid farewell to my heart—the metaphor for kindness, love, and bravery in our culture—and to welcome a new organ from a generous person less medically fortunate than I.In the hospital, I met others awaiting their hearts. A sudden intimacy arises when mortal choices catapult people into a medical realm suggestive of science fiction. Add the emotional intensity that accompanies knowing your extended life comes courtesy of a person who breathes no more on this earth and you wonder how an organ recipient integrates sorrow and gratitude.Two weeks after I was hospitalized, my cardiologist informed me the wait was over... (shrink)

The left must confront the politics of removing carbon from the atmosphere – a topic rapidly making its way to the top of the climate agenda. We here examine the technology of direct air capture, tracing its intellectual origins and laying bare the political economy of its current manifestations. We find a space crowded with ideology-laden metaphors, ample fossil-capital entanglements and bold visions for a new, ethereal frontier of capital accumulation. These diversions must be cut short if a technology with (...) the capacity to help repair at least some climate damage is to be of any use. Only socialising the means of removal will allow this to happen. (shrink)

In 'Art as Festival', I put Heidegger and Gadamer into dialogue concerning their respective critiques of traditional aesthetics and their more positive views on the work of art. I use the festival theme to examine some of the philosophical issues in Heidegger's and Gadamer's approaches to the work of art. Specifically, I look at the way both figures conceive the work of art as an encounter which, like the festival, involves a transcendence of subjectivity in an encounter with an event (...) - in this case, the artwork - which the individual does not direct, but rather in which they participate. Putting the theme of festival into play also provides a useful critical lever, especially in the way that it raises important issues of community. More specifically, reflecting on the festival celebration raises questions of the nature of this community, of the relation of the community created in the festival event to the community of the everyday, and thus also of the relation of the aesthetic and the political. (shrink)

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the (...) responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

During the past decade, screening tests using computed tomography have disseminated into practice and been marketed to patients despite neither conclusive evidence nor professional agreement about their efficacy and cost-effectiveness at the population level. This phenomenon raises questions about physicians' professional roles and responsibilities within the setting of medical innovation, as well as the appropriate scope of patient autonomy and access to unproven screening technology. This article explores how physicians ought to respond when new screening examinations that lack conclusive evidence (...) of overall population benefit emerge in the marketplace and are requested by individual patients. To this end, the article considers the nature of evidence and how it influences decision-making for screening at both the public policy and individual patient levels. We distinguish medical and ethical differences between screening recommended for a population and screening considered on an individual patient basis. Finally, we discuss specific cases to explore how evidence, patient risk factors and preferences, and physician judgment ought to balance when making individual patient screening decisions. (shrink)

Human embryos produced in labs since the 1970s have generated layers of uncertainty for law and policy: ontological, moral, and administrative. Ontologically, these lab-made entities fall into a gray zone between life and not-yet-life. Should in vitro embryos be treated as inanimate matter, like abandoned postsurgical tissue, or as private property? Morally, should they exist largely outside of state control in the zone of free reproductive choice or should they be regarded as autonomous human lives and thus entitled to constitutional (...) protection like full-fledged citizens? Administratively, if they deserve protection, what institutional and policy mechanisms are best suited to carrying out the necessary oversight? Using a method termed comparative problematization, this article traces divergent answers to these questions produced in three countries—the United States, United Kingdom, and Germany—across the last twenty-five years. Comparison reveals distinct bioconstitutional foundations that give rise to systematically different understandings of each state’s responsibilities toward human life and hence its particular treatment of claims on behalf of embryonic lives. (shrink)

Pragmatic difficulties are considered a hallmark of autism spectrum conditions (ASC), but remain poorly understood. We discuss and evaluate existing hypotheses regarding the literalism of ASC individuals, that is, their tendency for literal interpretations of non‐literal communicative intentions. We present evidence that reveals a developmental stage at which neurotypical children also have a tendency for literalism and suggest an explanation for such behaviour that links it to other behavioural, rule‐following, patterns typical of that age. We discuss evidence showing that strict (...) adherence to rules is also widespread in ASC, and suggest that literalism might be linked to such rule‐following behaviour. (shrink)