In lieu of an abstract, here is a brief excerpt of the content:Bioethics Inside the BeltwayNHGRI’s Intramural Ethics ExperimentRonald M. Green (bio)Early in 1995, the National Human Genome Research Institute (then known as the National Center for Human Genome Research) began a novel experiment. It established the Office of Genome Ethics in its Division of Intramural Research (DIR). An extramural “ELSI” funding program for research on the ethical, legal, and social implications of the Human Genome Project had been in existence (...) since 1990, and a joint Department of Energy, NIH Working Group to consider larger policy issues raised by the genome project had also been in existence since that date. But the establishment of the Office of Genome Ethics was the first effort to provide an in-house ethics service for the several hundred NHGRI genetic researchers working on the NIH campus.The experiment was also novel by NIH standards. The Clinical Center, which serves all NIH research institutes as a patient-care facility, has long had a bioethics program, but, to my knowledge, none of the 23 other institutes, centers, or divisions of the NIH had ever developed an ethics program to assist its on-campus researchers in identifying and addressing the ethical issues arising from their research. Behind this initiative lay the commitment to ethics in genetic research shared by Francis Collins, Director of NHGRI, Jeff Trent, Scientific Director of the Division of Intramural Research, and other senior scientists and administrators of the Institute.I was fortunate to be asked to serve as Director of this office. My previous experience in the federal context was limited. I had served on many NIH study sections and for a nine-month period had been a member of the Human Embryo Research Panel, but none of this amounted to an “insider’s view” of government bioethics. The preponderance of my bioethics career had transpired in the university and medical school/medical center environment.Because I had to continue to fulfill many Dartmouth commitments, I agreed to serve on an interim and half-time basis (one week in Bethesda; one week at home) for an 18-month period. I was assisted in maintaining this schedule by the appointment of a deputy, Mathew Thomas, a recent bioethics graduate of Duke University, who would serve on a full-time basis and provide continuity for our [End Page 181] work. Our objectives, established in consultation with NHGRI personnel, were to learn which functions would be most useful, to set up a program to provide them, and, eventually, to aid in the process of determining how an office like this might fit into NHGRI’s future.As this 18-month stint draws to a close, I can report that it has been an exhilarating experience. I am grateful for the opportunity to have worked with outstanding scientists in an area of growing importance and interest. I believe we have pioneered in the provision of bioethics education and counsel to a diverse group of genetic researchers. We have helped to “open the doors and windows” of the Genome Institute, facilitating two-way communication between NHGRI researchers and others interested in genetic and ethics. We have assisted with some knotty problems in genetic research while building a base of knowledge about highly specialized issues that is useful to researchers inside and outside NHGRI. What follows is an abbreviated overview and evaluation of our activities during this period.Main ActivitiesWorking with a core of interested supporters from every branch of the DIR, our office quickly established a roster of activities aimed at meeting identified needs. These included: (1) a consult service able to help investigators address urgent problems arising in their research or in the IRB review process; (2) a program of workshops and discussion groups dealing with challenging ethical issues raised by genetic research; (3) a program of public seminars bringing together NHGRI researchers and other clinicians, scientists, and scholars in the greater Washington area who are interested in genetic ethics; (4) a course on science research ethics to be offered to all NHGRI personnel; and (5) an ongoing program of research activities in genetics and ethics designed to provide depth and substance to the office’s work.ConsultationsIn an institute with scores of... (shrink)

Robert Brandom and John McDowell pursue similar, yet strikingly different approaches to a shared problem: that of how we can be answerable to the world in our beliefs about it in the wake of Sellars' critique of the myth of the given. While McDowell attempts to rehabilitate the idea that experience is capable of providing justifications for our beliefs, Brandom constructs a sophisticated social-pragmatist account of the objectivity of our conceptual commitments in which experience is, as he says, not one (...) of his words. In this article, I argue that McDowell is right in stressing the indispensability of the idea of experience, but that he is wrong in believing that Brandom lacks the resources for making sense of the idea of being answerable to the world in experience. Especially when we expand Brandom's account of discursive practice to include its relation to what he has called practical intentionality, his work provides the resources for an answer to McDowell's concerns, but only if it is understood not as an attempt to simply deny McDowell's claims about experience, but as an attempt to explain what we must be capable of doing in order for experience, in McDowell's sense, to be possible. (shrink)

Recent work has explored the extent to which intercollegiate athletics even belong at the university or meet the university’s mission. Just as play seems evident in athletics, it is also present in music, art, and theater. While these programs are popular targets when discussing possible cuts, few question their legitimacy at the university. In this article I argue that the justification for retaining the extracurricular status of intercollegiate sports should be based on their being especially playful. Indeed, on the basis (...) of this argument, I suggest that universities offer even greater and wider access to sport through club and intramural sports. However, while athletics might appear to be more playful, I hold that there is substantially more play present in university music, art, and theater programs than there is in intercollegiate sports. (shrink)

Recently the intramural debate among Christians over the correct interpretation of Genesis 1 and the age of the earth has become heated between leaders of certain science-based ministries. A major point of contention revolves around the question of whether there was animal death before Adam and Eve’s first sin. Many young-earth proponents charge that if God allowed death before Adam and Eve sinned, then God would not be morally perfect. In this paper I propose and critique a logical argument from (...) these charges. First, I formulate a logical problem based on the claims of young-earth proponents. Next, I discuss several theistic interpretations of God’s moral perfection and explain how deontological and consequentialist interpretations are problematic. After this I discuss Aquinas’ interpretation of God’s moral perfection. Finally, I provide a solution to the problem of death before the fall using Aquinas’ interpretation. I conclude that it is not logically contradictory to believe that God is all-knowing, all-powerful, and all-good and that He created a world that initially contained animal death. (shrink)

According to one tradition in the philosophy of language and mind, the content of a psychological attitude can be characterized by a set of possibilities. On the classic version of this account, advocated by Hintikka (1962) and Stalnaker (1984) among others, the possibilities in question are possible worlds, ways the universe might be. Lewis (1979, 1983a) proposed an alternative to this account, according to which the possibilities in question are possible individuals or centered worlds, ways an individual might be. The (...) motivation for the centered worlds theory has primarily to do with self-locating – or de se – attitudes. The focus of this paper is on the less-discussed question of how other-locating – or de re – attitudes ought to be treated within this framework. Most advocates of what we might call the modal approach to attitudes, Stalnaker and Lewis included, offer some kind of descriptivist solution to the well-known problems that other-locating attitudes raise. There are intramural differences between Stalnaker, Lewis, and other modal theorists (e.g. two-dimensionalists) on a number of issues: on the precise nature of the descriptivism involved, how attitude content relates to the asserted content of the sentences we utter, and on the proper semantic treatment of attitude reports. I pass over these differences to focus on a problem common to these various approaches: all face a problem when it comes to characterizing the contents of counterfactual attitudes like imagining, dreaming, and wishing. (shrink)

What is sexual orientation? The contemporary consensus among philosophers is that it is a disposition. Unsurprisingly, recent debates about the metaphysics of sexual orientation are almost entirely intramural. Behavioral dispositionalists argue that sexual orientation is a disposition to behave sexually. Desire dispositionalists argue that it is a disposition to desire sexually. We argue that sexual orientation is not best understood in terms of dispositions to behave or dispositions to desire before arguing that dispositions tout court fail to illuminate sexual orientation. (...) We then introduce and defend the idea that sexual orientation is best understood in terms of categorical phenomenal properties of sexual arousal. (shrink)

Despite widespread knowledge that fraternity members are frequently involved in the sexual assaults of women, fraternities are rarely studied as social contexts-groups and organizations-that encourage the sexual coercion of women. An analysis of the norms and dynamics of the social construction of fraternity brotherhood reveals the highly masculinist features of fraternity structure and process, including concern with a narrow, stereotypical conception of masculinity and heterosexuality; a preoccupation with loyalty, protection of the group, and secrecy; the use of alcohol as a (...) weapon against women's sexual reluctance; the pervasiveness of violence and physical force; and an obsession with competition, superiority, and dominance. Interfraternity rivalry and competition-particularly over members, intramural sports, and women-encourage fraternity men's commodification of women. We conclude that fraternities will continue to violate women socially and sexually unless they change in fundamental ways. (shrink)

Subjectivism about well-being holds that ϕ is intrinsically good for x if and only if, and to the extent that, ϕ is valued, under the proper conditions, by x. Given this statement of the view, there is room for intramural dissent among subjectivists. One important source of dispute is the phrase “under the proper conditions”: Should the proper conditions of valuing be actual or idealized? What sort of idealization is appropriate? And so forth. Though these concerns are of the first (...) importance, this essay focuses on a second source of dispute. As stated, subjectivists must account for what it means for an individual x to value ϕ under any conditions. Though there has been some disagreement, most subjectivists hold that x values ϕ if and only if x desires ϕ. This essay argues that subjectivists have erred in accepting a desiderative theory of valuing. Instead, it argues that subjectivists should hold that x values ϕ to the extent that x judges or believes that ϕ is good for x. The resulting “judgment subjectivism” is intuitively superior to, and maintains important structural advantages over, its desiderative rival. (shrink)

According to embodied cognition, the philosophical and empirical literature on theory of mind is misguided. Embodied cognition rejects the idea that social cognition requires theory of mind. It regards the intramural debate between the Theory Theory and the Simulation Theory as irrelevant, and it dismisses the empirical studies on theory of mind as ill conceived and misleading. Embodied cognition provides a novel deflationary account of social cognition that does not depend on theory of mind. In this chapter, l describe embodied (...) cognition’s alternative to theory of mind and discuss three challenges it faces. (shrink)

Photo ID 72893750 © Rawpixelimages|Dreamstime.com ABSTRACT Solidarity is a concept increasingly employed in bioethics whose application merits further clarity and explanation. Given how vital cooperation and community-level care are to mitigating communicable disease transmission, we use lessons from the COVID-19 pandemic to reveal how solidarity is a useful descriptive and analytical tool for public health scholars, practitioners, and policymakers. Drawing upon an influential framework of solidarity that highlights how solidarity arises from the ground up, we reveal how structural forces can (...) impact the cultivation of solidarity from the top down, particularly through ensuring robust access to important social determinants of health. Public health institutions can support solidarity movements among individuals and communities by adopting a lens of social justice when considering public health priorities and, in turn, promote health equity. INTRODUCTION Over the past two decades, scholars have invoked the concept of solidarity when assessing a wide range of topics in bioethics, from CRISPR-Cas9 technology to organ donation to structural racism.[1] However, the growing literature on solidarity has not fully examined the roles and responsibilities of institutions and governments in fostering solidarity, especially regarding public health measures that implicate entire populations. We argue that it remains unclear how public health institutions should engage with solidarity and how their engagement will affect public health and its ethics. We first take Prainsack and Buyx’ three-tiered framework as an analytical starting point.[2] We then explore how public health institutions can foster solidarity by carefully considering factors that may bolster it on an interpersonal, community, and national scale. We conclude that public health institutions should adopt a lens of social justice to promote solidarity at the interpersonal and community levels, thereby promoting equity in future public health efforts. BACKGROUND Calls for solidarity in bioethics raise longstanding normative questions about the nature and limits of our duties to one another and how to weigh autonomy over considerations of justice.[3] Though the term is diversely applied, Prainsack and Buyx propose a potentially unifying definition in the 2011 Nuffield Council report, “Solidarity: Reflections On An Emerging Concept in Bioethics.” The report defines solidarity as an activity involving “shared practices reflecting a collective commitment to carry financial, social, emotional, and or other ‘costs’ to assist others.” Their conceptualization also includes important features that distinguish solidarity from other values like empathy or altruism: solidarity emphasizes action rather than mere internal feeling and recognition of connection as motivation.[4] Bioethicists have since applied this conceptualization when analyzing issues in public and global health, given that population-level efforts need cooperation from individuals and communities. Prainsack and Buyx further note that solidarity is relevant in bioethics discourses about justice and equity, in support of providing aid to low- and middle-income countries, and as a value exemplified by European welfare states.[5] Other bioethicists have argued that promoting solidarity can contribute to community engagement, partnership with Tribal communities, and global health equity.[6] Most recently, scholars have applied solidarity as a lens to assess the COVID-19 pandemic, highlighting the pitfalls of national mitigation efforts and global disparities in disease outcomes.[7] I. Solidarity at Three Levels It seems impossible to foster solidarity in public health if we cannot identify it in general contexts. Prainsack and Buyx articulate three levels of solidarity: interpersonal solidarity, group solidarity, and legal or contractual codifications of solidarity.[8] They argue that each level inherently informs the one ‘above’ it in a unilateral direction. In other words, solidarity is fundamentally a bottom-up phenomenon. Solidarity among individuals influences group norms, which then have the potential to shape policy and institutional practice.[9] Within the Prainsack and Buyx framework, it would seem nonsensical to posit how solidarity might be expressed vertically or from the “top down.” It appears intuitively odd to imagine how a government entity might ‘be’ in solidarity with a person or group if solidarity requires some cognition about their condition per Prainsack and Buyx’ definition. Some have argued that solidarity does not seem like something that one can impose, as instances of it arise from agents recognizing and acting upon some bond rather than in response to a command. Indeed, people may be rightfully hesitant to engage in solidarity if the official messaging is overly paternalistic or coercive.[10] However, some authors have countered that governments can express solidarity through enacting structural and policy changes, though it is ambiguous how these actions are distinct from a justice-driven approach.[11] If a bottom-up approach is thus the most practical means of achieving policy that reflects solidarity, then it does not add much to public health. Institutions would be ineffective without the population’s initiation of the corresponding social norms. However, we find this conclusion overly pessimistic. Fostering a culture of solidarity to improve public health has potential merit. Prainsack and Buyx’ framework overlooks how public health actors can influence solidarity between individuals and across communities. To clarify, we agree with the view that solidarity is a bottom-up phenomenon. Solidarity may not be able to originate in a top-down fashion, but we suggest that public health institutions can take a more active role in providing the public with accurate information, promoting social justice, and intervening in the social determinants of health. II. The COVID-19 Pandemic as a Case Study Lessons learned from the ongoing COVID-19 pandemic support our argument. The pandemic deepened socioeconomic disparities in the US and hindered access to vital resources such as food, housing, and healthcare.[12] Prainsack recently noted: “[n]ext to the immediate health effects of the virus, poverty and grave inequalities have been the root causes of human suffering during the pandemic.”[13] Prior to the pandemic, many rural and low-income populations lacked reliable access to the internet and devices like laptops or smartphones. This continued lack of access restricts the flow of information and prevents people from accessing telemedicine services.[14] Preexisting social, political, and health inequities worsened health outcomes among many marginalized racial and ethnic groups. It is well-documented that communities of color, including Black, American Indian or Alaska Native, and Latinx populations, had greater COVID-related mortality and morbidity due to the effects of structural racism.[15] Although federal US agencies such as the Centers for Disease Control and Prevention enacted laws that provided safety nets (e.g., the Federal Eviction Moratorium), the majority of such programs have ended, leaving many with little assistance and the threat of further hardship.[16] These disparities are relevant because Prainsack, Buyx, and others note that solidarity arises from agents recognizing and acting on some perceived attainable collective goal(s). Income inequality and disparate access to food, education, and health care may lead people to consider public health goals unattainable. This could limit the desire to work toward those goals collectively.[17] The existing literature on collective action theory supports this intuition. It emphasizes that structural conditions, such as an absence of perceived hope for social change among a group, can lead to low ‘group efficacy’ and little willingness to cooperate, both within and across socioeconomic strata.[18] The pandemic spurred countless messages from public health agencies. The messaging did not recognize or attend to the different material realities and circumstances of the US population. How can people feel comfortable getting vaccinated if they deeply distrust the government, including public health institutions? How can people remain motivated to wear masks and distance themselves if they cannot afford basic necessities and work jobs without adequate pay and leave policies? We ask these questions to illustrate how socioeconomic disparities can marginalize people if they feel ignored, apathetic, or resentful of those better off or those in power whom they perceive to “not be doing enough.” This marginalization precludes the formation of solidarity. There are instances when a population has disparate access to resources and social capital, but solidarity may still emerge from a shared goal or vision for the future. For example, a heterogeneous population living in the same town may come together to protest an environmental injustice that impacts their water supply with the common goal of securing access to safe drinking water. However, many populations in the US failed to recognize shared goals of this kind during the COVID-19 pandemic. A significant minority of the US population was reluctant to acknowledge the severity of COVID-19 infection and thus refused to participate in efforts to mitigate its spread. Even between groups who shared the goal of slowing COVID-19 transmission, the methods were widely debated. Approximately 20 percent of the adult population eligible for vaccination remains unvaccinated.[19] Governmental bodies responsible for disseminating information, coordinating the allocation of resources, and establishing guidelines have a large role in mediating these disagreements and intervening in socioeconomic conditions that impact people's ability and willingness to engage in solidarity. III. Solidarity, Social Justice, and the Role of Public Health Institutions Adopting a lens of social justice provides further insights into how public health actors impact solidarity. Powers and Faden argue that the “foundational moral justification for the social institution of public health is social justice.”[20] Their theory of social justice has two aims. First, it ensures that everyone has a sufficient amount of the six core elements of well-being and that public health institutions are responsible for “adopting policies and creating environments” where all can flourish.[21] Second, public health institutions should distribute resources meant to promote well-being and focus on the “needs of those who are the most disadvantaged.”[22] Public health institutions should enact policies that address injustice. In doing so, public health institutions can seed the opportunity to build solidarity from the bottom up. Equipping individuals and communities with resources will foster cooperation and adherence to policies that require solidarity, such as masking and vaccination. This is consistent with arguments illustrating how institutions such as Tribal governments promote the conditions needed for their group, and especially its most vulnerable members, to flourish.[23] Addressing social determinants of health with a social justice lens will create the circumstances under which more individuals and groups can find common causes and foster solidarity. In the long run, such efforts may result in the establishment of values and practices from the bottom up. There are societal and public health preconditions required before institutions can expect their audience to act in solidarity with one another. Through their great influence over information and resources, public institutions do have the power to impact what values are most widespread. Furthermore, public health may foster trust and hope, which are important psychosocial factors that influence collective action,[24] if policies increase access to resources that promote well-being. Messaging efficacy also depends on the context of public trust, education, and whether the institutions meet one’s basic needs. Disparate messaging across different public institutions may confuse or disillusion individuals. To apply our theory of solidarity to the decision to vaccinate, a policy would be to foster conditions that facilitate access to vaccines and information about vaccine efficacy instead of imposing a top-down mandate without first eliciting public trust. IV. Counterargument Some argue that discordant public health messaging, ineffective government, and inadequate social programs can also bring people together under pressure and foster solidarity. One may argue that the most powerful motivators towards solidarity are strife and disparity, as evidenced throughout history. During the pandemic alone, political struggle and personal hardship inspired solidarity in the US, from individual neighbors helping each other to mutual aid groups forming across communities. We thus do not claim that solidarity is possible only when our government programs and public health institutions are most effective. We instead point out that solidarity can be further hindered when people feel alienated, hopeless, and pitted against each other. CONCLUSION Many competing conceptualizations of solidarity persist in the bioethics literature, and Prainsack and Buyx offer one compelling framework that public health ethicists continue to draw upon.[25] However, their framework fails to acknowledge how public health institutions impact interpersonal and group solidarity. Public health institutions can foster solidarity through actions other than mere messaging, invoking catchphrases like “we are all in this together.” Efforts to address socioeconomic preconditions and alleviate health disparities can cultivate group solidarity. As we saw during the pandemic, cooperation and solidarity go hand-in-hand with disease mitigation efforts; solidarity has clear intrinsic value.[26] As this relationship becomes more apparent, we will continue to see attempts from public health institutions to foster or invoke solidarity. Therefore, public health institutions would be remiss to ignore their role in addressing the social determinants of health. Adopting a social justice lens when planning public health interventions will clarify and strengthen their role in facilitating solidarity. Ultimately, if health disparities continue to persist or widen, it is very hard to imagine how group solidarity can ever be achieved. The widescale adoption of many public health measures needed to promote health and well-being would be conducive to solidarity. - Disclaimer: The opinions expressed are the authors’ and do not represent the views of the NIH, DHHS, or the U.S. government. Funding Disclosure: This work was supported in part by the Intramural Program of the National Institutes of Health Clinical Center. - [1] John J Mulvihill et al., “Ethical Issues of CRISPR Technology and Gene Editing through the Lens of Solidarity,” British Medical Bulletin 122 (2017): 17–29, https://doi.org/10.1093/bmb/ldx002; Ben Saunders, “Altruism or Solidarity? The Motives for Organ Donation and Two Proposals,” Bioethics 26, no. 7 (September 2012): 376–81, https://doi.org/10.1111/j.1467-8519.2012.01989.x; -Vanessa Y Hiratsuka, “SPECIAL REPORT: A Critical Moment in Bioethics: Reckoning with Anti-Black Racism through Intergenerational Dialogue A Call for Solidarity in Bioethics: Confronting Anti-Black Racism Together,” 2022, https://doi.org/10.1002/hast.1380. [2] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [3] Bob Simpson, “A ‘We’ Problem for Bioethics and the Social Sciences: A Response to Barbara Prainsack,” Science, Technology, & Human Values 43, no. 1 (January 12, 2018): 45–55, https://doi.org/10.1177/0162243917735899. [4] Barbara Prainsack and Alena Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics (London: Nuffield Council on Bioethics, 2011). [5] Barbara Prainsack and Alena Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach,” Bioethics 26, no. 7 (September 2012): 343–50, https://doi.org/10.1111/J.1467-8519.2012.01987.X. [6] Bridget Pratt, Phaik Yeong Cheah, and Vicki Marsh, “Solidarity and Community Engagement in Global Health Research,” The American Journal of Bioethics : AJOB 20, no. 5 (May 3, 2020): 43–56, https://doi.org/10.1080/15265161.2020.1745930; Sara Chandros Hull, F. Leah Nez (Diné), and Juliana M. Blome, “Solidarity as an Aspirational Basis for Partnership with Tribal Communities,” The American Journal of Bioethics 21, no. 10 (October 3, 2021): 14–17, https://doi.org/10.1080/15265161.2021.1965258; Mbih J. Tosam et al., “Global Health Inequalities and the Need for Solidarity: A View from the Global South,” Developing World Bioethics 18, no. 3 (September 1, 2018): 241–49, https://doi.org/10.1111/DEWB.12182. [7] Peter West-Oram, “Solidarity Is for Other People: Identifying Derelictions of Solidarity in Responses to COVID-19,” Journal of Medical Ethics 47, no. 2 (February 1, 2021): 65–68, https://doi.org/10.1136/MEDETHICS-2020-106522; Barbara Prainsack, “Solidarity in Times of Pandemics,” Democratic Theory 7, no. 2 (December 1, 2020): 124–33, https://doi.org/10.3167/DT.2020.070215; F. Marijn Stok et al., “Social Inequality and Solidarity in Times of COVID-19,” International Journal of Environmental Research and Public Health 18, no. 12 (June 2, 2021), https://doi.org/10.3390/IJERPH18126339; Ming Jui Yeh, “Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics,” American Journal of Public Health 112, no. 2 (February 1, 2022): 255–61, https://doi.org/10.2105/AJPH.2021.306578; Barbara Prainsack, “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.,” Am J Public Health 112, no. 2 (February 1, 2022): 232–33, https://doi.org/10.2105/AJPH.2021.306619. [8] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [9] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [10] Yeh, “Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics”; Prainsack, “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.” [11] Ho, Anita, and Iulia Dascalu. "Relational solidarity and COVID-19: an ethical approach to disrupt the global health disparity pathway." Global Bioethics 32, no. 1 (2021): 34-50; West-Oram, Peter. "Solidarity is for other people: identifying derelictions of solidarity in responses to COVID-19." Journal of Medical Ethics 47, no. 2 (2021): 65-68. [12] Monica Webb Hooper, Anna María Nápoles, and Eliseo J. Pérez-Stable, “COVID-19 and Racial/Ethnic Disparities,” JAMA 323, no. 24 (June 23, 2020): 2466, https://doi.org/10.1001/jama.2020.8598. [13] Prainsack, Barbara. “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.” Am J Public Health 112, no. 2 (February 1, 2022): 232–33. https://doi.org/10.2105/AJPH.2021.306619. [14] Camille A Clare, “Telehealth and the Digital Divide as a Social Determinant of Health during the COVID-19 Pandemic,” Network Modeling Analysis in Health Informatics and Bioinformatics 10 (2021): 26, https://doi.org/10.1007/s13721-021-00300-y. [15] Patrick Nana-Sinkam et al., “Health Disparities and Equity in the Era of COVID-19,” Journal of Clinical and Translational Science 5, no. 1 (March 16, 2021): e99, https://doi.org/10.1017/cts.2021.23. [16] Kathryn M Leifheit et al., “Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality,” American Journal of Epidemiology 190, no. 12 (December 1, 2021): 2503–10, https://doi.org/10.1093/aje/kwab196. [17] Barbara Prainsack, “Solidarity in Times of Pandemics,” Democratic Theory 7, no. 2 (December 1, 2020): 124–33, https://doi.org/10.3167/DT.2020.070215 [18] Maximilian Agostini and Martijn van Zomeren, “Toward a Comprehensive and Potentially Cross-Cultural Model of Why People Engage in Collective Action: A Quantitative Research Synthesis of Four Motivations and Structural Constraints.,” Psychological Bulletin 147, no. 7 (July 2021): 667–700, https://doi.org/10.1037/bul0000256. [19] Department of Health and Human Services (HHS) Centers for Disease Control and Prevention (HHS/CDC), “COVID Data Tracker,” 2023, https://covid.cdc.gov/covid-data-tracker. [20] Powers, Madison, and Ruth Faden. Social Justice: The Moral Foundation of Public Health and Health Policy. 1st editio. New York: Oxford Press, 2006, p. 9 and Chapter 4 [21] Powers and Faden, Social Justice: The Moral Foundation of Public Health and Health Policy; Madison Powers and Ruth Faden, Structural Injustice: Power, Advantage, and Human Rights (New York: Oxford University Press, 2019). [22] Powers, Madison, and Ruth Faden. Social Justice: The Moral Foundation of Public Health and Health Policy. 1st editio. New York: Oxford Press, 2006, p. 10 [23] Bobby Saunkeah et al., “Extending Research Protections to Tribal Communities,” The American Journal of Bioethics 21, no. 10 (October 3, 2021): 5–12, https://doi.org/10.1080/15265161.2020.1865477. [24] Agostini and van Zomeren, “Toward a Comprehensive and Potentially Cross-Cultural Model of Why People Engage in Collective Action: A Quantitative Research Synthesis of Four Motivations and Structural Constraints.” [25] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics. [26] Ruth Chadwick, “COVID‐19 and the Possibility of Solidarity,” Bioethics 34, no. 7 (September 8, 2020): 637–637, https://doi.org/10.1111/bioe.12813. (shrink)

Background: Issues concerning legislation and regulation with respect to the role of nurses in euthanasia and physician-assisted suicide gave the Minister for Health reason to commission a study of the role of nurses in medical end-of-life decisions in hospitals, home care and nursing homes.Aim: This paper reports the findings of a study of the role of nurses in euthanasia and physician-assisted suicide, conducted as part of a study of the role of nurses in medical end-of-life decisions. The findings for hospitals, (...) home care and nursing homes are described and compared.Method: A questionnaire was sent to 1509 nurses, employed in 73 hospitals, 55 home care organisations and 63 nursing homes. 1179 responses were suitable for analysis. The questionnaire was pilot-tested among 106 nurses, with a response rate of 85%.Results: In 37.0% of cases, the nurse was the first person with whom patients discussed their request for euthanasia or physician-assisted suicide. Consultation between physicians and nurses during the decision-making process took place quite often in hospitals and nursing homes and less frequently in home care situations . In some cases , nurses administered the euthanatics.Conclusions: The results show substantial differences between the intramural sector and the extramural sector , which are probably linked to the organisational structure of the institutions. Consultation between physicians and nurses during the decision-making process needs improvement, particularly in home care. Some nurses had administered euthanatics, although this task is by law exclusively reserved to physicians. (shrink)

Justin D’Arms and Daniel Jacobson have argued that to evaluate the funniness of a joke based on the consideration of whether it is morally appropriate to feel amused commits the “moralistic fallacy.” We offer a new and empirically informed reply. We argue that there is a way to take morality into consideration without committing this fallacy, that is, it is legitimate to say that for some people, witty but immoral jokes can fail to be funny because they are immoral. In (...) our account, one has an intramural moral reason not to feel amused if one focuses on the moral feature itself of a joke rather than the moral consequence implied in one’s reaction to the joke. When one judges a joke as not funny because of the intramural moral reason, one is in a negative emotional state with high arousal, for example, moral disgust or anger. This state is psychologically incompatible with amusement. That one has an intramural reason not to feel amused thus implies that one does not have a reason to feel amused. Moral consideration thus plays an indirect and appropriate role in the evaluation of the funniness of a joke. (shrink)

DURING THE PAST TWO HUNDRED YEARS, uncertainty and suspicion about the philosophical enterprise have become acute. The educated public is confused about the intellectual and cultural importance of philosophy, and philosophers themselves are divided on its theoretical purpose and meaning. There are, to be sure, specifically philosophical sources of this condition. They include Kant’s critique of traditional metaphysics, the logical positivists’ debunking of ethics and theology, Wittgenstein’s restrictions on the scope of meaningful discourse, Richard Rorty’s call for an end to (...) epistemology, and the deconstructionist attempt to envisage a postphilosophical world. Yet it would be a mistake to assume that the unease of philosophers is solely the result of an intramural debate. The practice of philosophy has always been responsive to the cultural context in which it occurs. The extended crisis of philosophy through the last two centuries is the natural reflection of an ongoing crisis in modernity. (shrink)

Freedom is among the central values in political philosophy. Freedom also features heavily in normative arguments in ethics, politics, and law. Yet different sides often invoke freedom to establish very different conclusions. Some argue that freedom imposes strict constraints on state power. For example, when promoting public health, there is a limit on how far the state can interfere with individual freedom. Others, in contrast, argue that freedom is not just a constraint but also an important goal of state power (...) and collective action. Good public health policy, for example, promotes people’s freedom. Of course, different arguments often draw on different theories of freedom. So, to evaluate such arguments, we need to analyze these different theories and their implications and assess their plausibility. -/- The broadly liberal tradition views freedom as being about external options. Such theories typically start with an account of when someone has a specific freedom or unfreedom to do something. For example, some argue that only a narrow set of interpersonal interferences count as constraints on freedom. Others argue that a far broader set of factors, including ill health and natural constraints, can reduce one’s freedom. -/- Since the 1980s and 1990s, scholarship has increasingly recognized that to use liberal freedom in normative arguments, one must move beyond specific freedom and unfreedom. Most laws and policies both subtract and add specific freedoms. What matters is how a person’s freedom is affected overall. Philosophers and economists have thus engaged in intricate debates about how to measure overall freedom. Moreover, policies and law affect not only one person at one point in time but also multiple persons across time. So, liberal freedom-based arguments also require distributive criteria for intertemporal and interpersonal distributions of freedom. -/- In the early 21st century, republicanism has developed into a prominent alternative to liberal theories. Republicans argue that being a free person is not just, or not even primarily, about liberal option-freedom. Freedom requires being free from dominating power. Republicans and liberals have engaged in a lively debate on who offers the better theory. In developing the republican ideal, republicans also engage in intramural debates. For example, is domination primarily an interpersonal or structural phenomenon? And what economic institutions does republicanism imply? -/- Theorizing around freedom has become richer and moved from narrower questions regarding specific freedom and unfreedom to overall freedom and to republican theories of nondomination. But recent theorizing also seeks to extend its focus and scope. Historically, theorizing started with the freedom of able-bodied male citizens within nation states. Recent theorizing shifts the focus to include issues around gender, disability, freedom at the international level, and the freedom of nonhuman animals and future generations. Beyond fascinating implications of existing theories, a more inclusive focus is likely to also yield important lessons on how current theories can be improved. (shrink)

This paper contains an overview of the significance of dualism for theism and a modal argument for dualism. It concludes with remarks on the relevance of the modal case on behalf of dualism for an intramural materialist quarrel between animalists and brain-identity theorists.

: The revival of philosophical pragmatism has generated a wealth of intramural debates between neopragmatists like Richard Rorty and contemporary scholars devoted to explicating the classical pragmatism of John Dewey and William James. Of all these internecine conflicts, the most divisive concerns the status of language and experience in pragmatist philosophy. Contemporary scholars of classical pragmatism defend experience as the heart of pragmatism while neopragmatists drop the concept of experience in favor of a thoroughly linguistic pragmatism. I argue that both (...) positions engender formidable risks. After discussing the present impasse, I describe a third version of pragmatism which involves a reconstruction of the classical pragmatist concept of experience in light of the criticisms of foundationalism crucial to the neopragmatist linguistic turn. This third version of pragmatism does justice to both Rorty and Dewey by focusing on experience as a temporal field. (shrink)

In the triumvirate of personalities and motives—from Wright and Baldwin to Coates—we encounter the essential elements of the “crisis” that configures black passage in the New World. These lines of kinship, both consanguineous and ineffable, travelling from father to son, from uncle to nephew, from one generation to the next, lend us a figurative rhythm that grasps the notion of the processional —the traversal of time and space that remains fundamentally mysterious, just as we can put our finger directly on (...) the problem—black life is still as endangered and precarious as it ever was. If one regards such passage as a “crisis,” then it is precisely because it is riddled with turning points, sudden ruts and rifts in the road when the way seemed smooth and clear—those moments when decisions must be made—and from that perspective, African-American cultural apprenticeship offers, by definition, crisis not as a state of exception, but rather, as a steady state, given historical pressures that bear in on it and that become, as a result, intramural pressures. What I wish to do in these remarks is to clarify one of the questions engendered by this predicament, and that is to say, the riddle of identity and how it matters, but even more than an inquiry into the identitarian, I am searching for a protocol through intramural space. (shrink)

Difference, diversity and disagreement are inevitable features of our ethical, social and political landscape. This collection of new essays investigates the ways that various ethical and religious traditions have dealt with intramural dissent; the volume covers nine separate traditions: Confucianism, Buddhism, Christianity, Judaism, Islam, liberalism, Marxism, South Asian religions and natural law. Each chapter lays out the distinctive features, history and challenges of intramural dissent within each tradition, enabling readers to identify similarities and differences between traditions. The book concludes with (...) an Afterword by Michael Walzer, offering a synoptic overview of the challenge of intramural dissent and the responses to that challenge. Committed to dialogue across cultures and traditions, the collection begins that dialogue with the common challenges facing all traditions: how to maintain cohesion and core values in the face of pluralism, and how to do this in a way that is consistent with the internal ethical principles of the traditions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Blossoming of Bioethics at NIHEzekiel J. Emanuel (bio)The establishment of the Department of Clinical Bioethics at the Warren G. Magnuson Clinical Center of the National Institutes of Health (NIH) has coincided with a burgeoning of interest and activity related to bioethical issues at NIH. The department has precipitated a reexamination and revitalization of existing bioethics activities in the Clinical Center and has launched new programs especially in the (...) areas of education and research. In addition, the department contributes to the work of others throughout NIH who address bioethical issues.The Organizational Location of the Department of Clinical BioethicsBefore describing the history and current activities of the Department of Clinical Bioethics, I will say something about it administrative location. Comprehension of the department’s organizational location is essential to understanding its history, role, and function. Prior to interviewing for the position of chair of the department, I did not—and, if truth be told, still do not fully—understand the details of the organizational structure of NIH. I therefore assume that many other bioethicists outside of the Institutes, especially those who do not regularly receive NIH funding, may not fully grasp its organizational intricacies.The Department of Clinical Bioethics is a department within the Warren G. Magnuson Clinical Center, which is NIH’s “hospital.” Hospital is in quotes because all of the patients at the Clinical Center must be enrolled in a research protocol and, therefore, are research subjects. The Clinical Center is where NIH’s clinical researchers admit their research subjects or see them in the out-patient setting. The Department of Clinical Bioethics reports directly to the Director of the Clinical Center, John I. Gallin, M.D., and receives its finances, space, and other resources from the Clinical Center.In this way, the department is part of NIH’s intramural (“inside”) program. People employed by NIH conduct intramural research, training, and other initiatives. The extramural program, which receives approximately 87 percent of NIH’s budget, funds research at institutions outside NIH. The extramural program awards grants and contracts for research, training, and conferences conducted [End Page 455] by investigators who are not affiliated with NIH. The National Human Genome Research Institute’s ELSI (Ethical, Legal, and Social Implications) program, for example, is part of NIH’s extramural program. As part of the NIH intramural program, the Department of Clinical Bioethics is not empowered to fund independent initiatives of people outside of NIH through grants and contracts. However, the department can collaborate with bioethicists and others on research, educational, and other programs outside of NIH and has some funds to support these collaborations.In addition, it is important for bioethicists to understand that NIH is a collection of 24 institutes and centers. Although there is coordination and collaboration between the institutes and centers, each is funded separately, and each has its own scope, programs, administrative structures, research agendas, training priorities, boards of advisors, and so forth. In this sense, NIH is more like a university that has many distinct schools, each with its own dean, faculty, budget, and fund raising office, than one that is tightly integrated and centrally-administered. Within NIH’s diffuse administrative structure, the Department of Clinical Bioethics is located within one of the centers (the Clinical Center) and has defined authority and responsibility only for bioethics within that center; in addition, because the Clinical Center’s mission is to support clinical research at other institutes, the department’ mission includes supporting the work of those institutes as well. Intellectual exchanges and relationships with other institutes and centers are neither pre-ordained nor administratively established; such relationships must be developed case-by-case, topic-by-topic, and initiative-by-initiative.The History and the Development of the Department of Clinical BioethicsThe Department of Clinical Bioethics was launched in late 1996. Although the department’s creation marked a major commitment to bioethics by the Clinical Center, and especially by its director, Dr. Gallin, it was formed on a pre-existing foundation of bioethics activities at NIH. 1In 1977, John Fletcher, Ph.D., was appointed by then Director Mortimer Lipsett as the bioethicist at the Clinical Center; his official title was Assistant for Bioethics... (shrink)

Philosophizing about the social sciences involves an initial problem of denotation. Although the natural sciences are the scene of intramural disputes like those between proponents of quantum mechanics and relativity theory, no one doubts either what the natural sciences are or that they are sciences; and all of them may be said to use, broadly speaking, the same scientific method. But the case of the social sciences is different. It resembles somewhat the situation in mathematics where the intuitionists deny that (...) non-constructible concepts or problems belong to mathematics; and even more the situation in philosophy where groups like the analysts and the existentialists not only do not speak the same language but do not even recognize one another's right to be called “philosophy.” Similarly, the disciplines which comprise the social sciences today differ from one another in basic ways, involving long-standing disputes over which ones have a right to the names of the several social sciences and what their proper methods are. Familiar examples of these disputes are the controversies between the classicists and institutionalists in economics, and between the analytical and sociological schools in jurispurdence. Consequently, it is impossible for philosophers, or social scientists philosophizing about their general field, to proceed to discuss “the” subject-matter or “the” method of “the” social sciences as if the phrases containing these definite articles were definite descriptions on whose objects there was general agreement. (shrink)

On March 28, 2017, the national Academy of Sciences, Engineering, and Medicine released a much-anticipated report on the Environmental Protection Agency's controlled human inhalation exposure studies. To understand the genesis of the document, a quick review of recent events is in order.Prior to 2006, the EPA adopted the Common Rule for intramural or extramural research funded by the agency.1 Although the EPA did not have a formal policy that applied to research sponsored by private companies, it applied scientific and ethical (...) standards to these studies on a case-by-case basis. In the 1990s, in support of requests to the agency to loosen its restrictions on pesticide residues on... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.3 (2004) vii-viii [Access article in PDF] John C. Fletcher 1931-2004 John Fletcher was one of the pioneers in the still-young field of bioethics. In this short tribute, I can only hope to highlight a few of the many contributions he made to the field.For many of us, our first introduction to John occurred in October 1971. At an international symposium sponsored by the (...) Kennedy Foundation, the film "Who Should Survive?" depicted the dramatic case of an infant with Down syndrome and an intestinal blockage. The parents of the infant refused surgery to relieve the obstruction, and the healthcare providers for the infant decided not to pursue a court order permitting the surgery. During a period of approximately two weeks the infant was allowed to die.In the second part of "Who Should Survive?" John was one of several panelists invited to discuss the decisions made in this case. After acknowledging how troubling the infant's death was to him, John nonetheless sought to be empathic with the parents. He pointed out that in the re-enactment of the case the faces of the parents were never seen, and he worried that the film did not permit the parents to discuss the reasons for the choice they had made. John realized that his position would not be shared by most other panelists. Yet he had the courage to take an unpopular stand and to challenge other panelists—and the audience—not to reach premature closure on complex ethical dilemmas.Already in 1967, John had begun contributing to the literature of bioethics. His essay "Human Experimentation: Ethics in the Consent Situation," appeared in Law and Contemporary Problems. At the time, John was deeply immersed in studying the ethical dimensions of research with human subjects at the NIH Clinical Center. Paul Ramsey cited John's work with appreciation in his 1970 book, The Patient as Person. By the time he completed his dissertation at Union Theological Seminary in 1969, John was arguably one of the best trained bioethicists in the world—before there was a field of bioethics.After serving as chaplain, teaching at Virginia Theological Seminary, and founding and leading a seminary without walls in Washington, DC, John became the chief of the ethics program at the NIH Clinical Center in 1977. There he had the unenviable task of providing a second review for all clinical protocols emerging from the intramural programs of the NIH institutes. John discovered that in some cases the institutional review boards of the institutes had overlooked important ethical questions. This role also [End Page vii] required courage. At times John found it necessary to challenge senior NIH researchers, even institute directors, and to request protocol revisions that in his view were required for the protection of human subjects.In 1980, after Martin Cline had performed an unauthorized gene transfer experiment involving thalassemia patients, John joined with physician W. French Anderson to write an essay entitled "Gene Therapy in Human Beings: When Is It Ethical to Begin?" [New England Journal of Medicine 303: 1293-97]. Not only did this essay help to defuse a potentially explosive problem for NIH, which had funded Cline's research. It also provided a set of guidelines for the conduct of human gene transfer research that is of continuing relevance today.At times John disagreed with federal policies on research, for example, conservative policies on human embryo research. He also chafed at the idea of subjecting his publications to prior NIH review, both for accuracy and for political correctness. Thus, he welcomed the opportunity to move to the University of Virginia in 1987. There his academic career flowered, and he enjoyed some of his most productive years of research and writing.Among his many contributions during these later years, John participated as Committee co-chair in an effort to "redress the wrongs of Tuskegee." The Tuskegee Syphilis Study Legacy Committee proposed in May 1996 that President Clinton apologize to the participants in the Tuskegee study on behalf of the federal government. In May 1997, the President did in... (shrink)

Neither the George Washington University embryo splitting experiment nor the technique of embryo splitting itself has ethical flaws. The experiment harmed or wronged no one, and the investigators followed intramural review procedures for the experiment, although some might fault them for failing to seek extramural consultation or for not waiting until national guidelines for research on preembryos were developed. Ethical objections to such cloning on the basis of possible loss of individuality, possible lessening of individual worth, and concern about potential (...) harm to the resulting children are discussed and challenged, as are objections to the creation of embryos for the purpose of genetic diagnosis. Many of the ethical questions raised by the George Washington experiment are similar to those posed by existing reproductive technologies that allow the simultaneous production of several embryos. A multidisciplinary group should consider whether regulation of cloning is needed, and laws should be enacted to prohibit a commercial market for all frozen embryos. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical Bioethics at NIH:History and A New VisionJohn C. Fletcher (bio)On July 3, 1995, Dr. John I. Gallin, Director of the Magnuson Clinical Center of the National Institutes of Health (NIH), convened a one-day "Conference on the Future of Clinical Bioethics at the National Institutes of Health Intramural Program." Conferees included NIH officials and a panel of consultants from bioethics programs around the nation.1 The subject was the future (...) of NIH's intramural bioethics program and specifically a vision of a new multi-component program, presented by Dr. Gallin, the first speaker. Dr. Harold Varmus, Director of NIH, was there to assure his support for Dr. Gallin's vision. This author, honored to be second speaker, was invited to sketch a brief history of bioethics at NIH. The present article reviews some of this history and then reports on Dr. Gallin's proposal, points of consensus among speakers and conferees, and the search for a Chief of the Clinical Bioethics Program.History of Bioethics at NIHIt is often said that NIH is a well-kept secret as the nation's leading biomedical research facility. Also, few people know that NIH has a long history in bioethics. Some key events in that history are shown in Figure 1, beginning with two that occurred prior to the birth of bioethics. NIH made an early policy response to protect human subjects of research and to find acceptable limits for scientific freedom. The Clinical Center (CC), a 550-bed research hospital, opened in 1953. A subcommittee of the Medical Board, the Clinical Research Committee (CRC), was formed for prior group review of all studies with normal volunteers. The traditional practice was for researchers themselves to decide when studies would begin, which subjects to recruit, and whether informed consent would be sought. The CRC intervention bit into this tradition. In addition, patient studies that posed significant risks or departed widely from medical practice were reviewed by referral from the Clinical Directors of the various Institutes. Was this CRC an early institutional review [End Page 355] board (IRB)? As a guest researcher, I was permitted to observe the CRCs meetings between 1966 and 1969. It functioned much like an IRB but had no community or non-scientist members. Other IRB-like review groups undoubtedly existed prior to the CRC. Robert Levine (personal communication, September 7, 1995) recalls that Beth Israel Hospital in Boston had one in 1938. Historical research is clearly needed on the earliest forms of research review.Table 1. Bioethics at NIHEventYearClinical Research Committee1953Surgeon-General's PPO #1291966NIGMS funds Hastings Genetics Group1973OPRR's Mission1974NLM's grant to KennedyInstitute for Bibliography of Bioethics1974Recombinant DNA Advisory Committee1974STEP Series Bioethics Speakers1975Pre-IRBs at the CC1975-76Assistant for Bioethics to Director, CC1977RAC-Human Gene Therapy Subcommittee1983Lipsett Proposal (ICD)1983Liaison Group, CC1983Bioethics Program, CC1985Durable Power of Attorney for Researchwith Incapacitated Subjects1985-86NLM funds National Reference Centerfor Bioethics Literature1985National Institute for Nursing Research1986Bioethics Post-Doctoral Fellows Program1989ELSI Program1989Bioethicists on CC-IRBs1989CC-Ethics Committee1990Office of Human Subjects Research1992 [End Page 356]Between 1963 and 1967, the media exposed instances of ethically troubling research, and Beecher (1966) and Pappworth (1967) published sharp criticisms of the weak state of research ethics. In 1966, Surgeon-General William Stewart and NIH Director James Shannon issued a policy requiring local group review of all research involving human subjects before making an application for NIH peer review (Surgeon General 1966). The policy was the first in any nation to mandate ethics committees for clinical research. However, it did not apply to the NIH intramural program until Congress passed the National Research Act in 1974 (Public Law 93-348; 202, 88 Stat. 342, 1974). This lag permitted NIH intramural investigators the luxury of feeling above the norms imposed on ordinary mortals and guaranteed more resistance to the inevitable change to come. Resistance to change marked the intramural program from the mid-1960s to the mid-1970s... (shrink)

_ Source: _Page Count 19 The ideal of personal autonomy faces a challenge from advocates of orthonomy, who think good government should displace self-government. These critics claim that autonomy is an arbitrary kind of psychological harmony and that we should instead concentrate on ensuring our motivations and deliberations are responsive to reasons. This paper recasts these objections as part of an intramural debate between approaches to autonomy that accept or reject the requirement for robust rational capacities. It argues that autonomy (...) depends upon such responsiveness to reasons, countering objections that ‘externalist’ rationalist criteria strip the self from self-government. (shrink)

For some time now, academic philosophers of mathematics have concentrated on intramural debates, the most conspicuous of which has centered on Benacerraf's epistemological challenge. By the late 1980s, something of a consensus had developed on how best to respond to this challenge. But answering Benacerraf leaves untouched the more advanced epistemological question of how the axioms are justified, a question that bears on actual practice in the foundations of set theory. I suggest that the time is ripe for philosophers of (...) mathematics to turn outward, to take on a problem of real importance for mathematics itself. (shrink)

The ideal of personal autonomy faces a challenge from advocates of orthonomy, who think good government should displace self-government. These critics claim that autonomy is an arbitrary kind of psychological harmony and that we should instead concentrate on ensuring our motivations and deliberations are responsive to reasons. This paper recasts these objections as part of an intramural debate between approaches to autonomy that accept or reject the requirement for robust rational capacities. It argues that autonomy depends upon such responsiveness to (...) reasons, countering objections that ‘externalist’ rationalist criteria strip the self from self-government. (shrink)

Despite its imperative to include all gendered positions under one umbrella, ‘trans’ is continually riven by intramural confrontation over the differences between its masculine and feminine iterations. Whether in political organizing, on social media or in the pages of academic trans theory, it sometimes seems like ‘trans’ is subject to an interminable and gendered custody battle. Dissatisfied with the terms of masc–femme antagonism, this essay uses the gendered interfaces of critique and autotheory to enmesh the work of Jules Gill-Peterson and (...) Paul B. Preciado. Reading into the interdependence of Gill-Peterson’s and Preciado’s texts yields a different theory: trans as an auto-antonym, a word that produces opposite meanings depending on context. Treating trans as auto-antonymic conjures a relational and even erotic escape from the naturalization of gendered antagonism in trans theory, affirming the unexpected bridges, reversals or ‘sex changes’ of specifically trans writing. (shrink)

Using video recordings of draft meetings conducted as part of an intramural basketball program as data, this conversation analytic study examines the use of an incomplete utterance in a joint evaluative activity. In particular, we focus on how the participants, volunteer coaches, who meet to draft players for their respective teams, produce a syntactically incomplete utterance as a means to critically assess a player, a non-present third party to the interaction. Analysis reveals that the participants use an incomplete utterance as (...) part of dispreferred design; it allows them to withhold articulating overt criticism of others. By trailing off where the criticism is due, the participants display reluctance to verbalize what is to be said and treat its articulation as delicate. The syntactic structure of the utterance that includes a contrastive conjunction and accompanying embodied actions such as head shakes help them convey a critical stance. We examine the use of incomplete utterances in both agreement and disagreement sequences; the recipients display their unproblematic understanding of the critical assessment and respond by providing their own assessments that either affiliate or disaffiliate with the conveyed critical stance. (shrink)

This issue’s “Legal Briefing” column covers recent legal developments involving medical decision making for incapacitated patients who have no available legally authorized surrogate decision maker. These individuals are frequently referred to either as “adult orphans” or as “unbefriended,” “isolated,” or “unrepresented” patients. The challenges involved in obtaining consent for medical treatment on behalf of these individuals have been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the “single greatest category of problems” encountered (...) in bioethics consultation. In 2012, JCE published a comprehensive review of the available mechanisms by which to make medical decisions for the unbefriended. The purpose of this “Legal Briefing” is to update the 2012 study. Accordingly, this “Legal Briefing” collects and describes significant legal developments from only the past three years. My basic assessment has not changed. “Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform.” Most facilities are “muddling through on an ad hoc basis.” But the situation is not wholly negative. There have been a number of promising new initiatives. I group these developments into the following seven categories: 1. Increased Attention and Discussion 2. Prevention through Better Advance Care Planning 3. Prevention through Expanded Default Surrogate Lists 4. Statutorily Authorized Intramural Mechanisms 5. California Litigation Challenging the Team Approach 6. Public Guardianship 7. Improving Existing Guardianship Processes. (shrink)

This article explores the role scientists at the National Cancer Institute, a US federal science agency, played in researching and testing vaccines against the human papillomavirus. Drawing upon archival sources and oral history interview data, I challenge narratives that attribute the design of HPV vaccines to profit motive. Instead, I show that the researchers who developed the technology attempted to construct ethical approaches to vaccine development based on the values that emerged from their situated environments of technological, organizational, and institutional (...) constraint. I argue that interpretations of “translational research” native to the NCI influenced these researchers’ efforts to design and test HPV vaccines. The organizational culture of translational research emerging in the NCI positioned intramural research as a countervailing and supplementary force to market-oriented translational research and development. Over time, NCI researchers’ conceptions of the Institute’s role allowed them to develop understandings of ethical HPV vaccine research as oriented toward addressing cervical cancer health disparities, especially in developing nations. NCI scientists’ understanding of their role in serving the public good through continued HPV vaccine innovation reflects the material and political economic environment they faced at different historical junctures that constrained the possibilities for innovation and ethical action. (shrink)

This paper explores changing attitudes toward novelty in early Christianity by focusing on a case study: Augustine of Hippo. It demonstrates that Augustine develops an unapologetically Christian version of the argument from antiquity, unapologetically Christian in that he redefines the very meaning of antiquity in terms of proximity to Christ and in that he relocates the argument from antiquity from the realm of apologetics, where it had become a stock weapon in the arsenal of his predecessors, to the realm of (...) intramural Christian debate. In the process, Augustine relativized temporal measures of “novelty” and “antiquity” and recalibrated the meaning of these terms theologically, with reference to Christ. (shrink)

This case is another in a series intended to highlight the new questions emerging from advances in mapping the human genome and the application of genetic findings to clinical practice. The National Human Genome Research Institute, a component of the National Institutes of Health, by law is directed to designate a portion of its annual budget to furthering understanding of the ethical, legal, and social questions emerging from research on the human genome. As part of the effort, the Institute supports (...) research by scientists and scholars around the nation with the aim of clarifying and resolving the tough ethical and research choices facing this endeavor. But recently it has launched an intramural program, which is expected to take a catalytic role in grappling with the array of issues the researchers face in carrying out investigations in human genetics. (shrink)

The current trend of some philosophers away from narrow sectarian interests and inconsequential intramural skirmishes is nowhere better evidenced than in this book of collected essays. The breadth of Professor Findlay's interest in philosophy is indicated by the inclusion of three important articles in ethics, "Morality by Convention," "The Justification of Attitudes," and "The Methodology of Normative Ethics," two essays in the philosophy of logic, and one paper in philosophical theology, the much discussed "disproof" of God's existence.--C. V.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Institution of TheoryPaul M. HedeenThe Institution of Theory, by Murray Krieger; xi & 103 pp. Baltimore: Johns Hopkins University Press, 1994, $35.00 cloth, $12.95 paper.Murray Krieger is an insider who promoted literary theory as an “instrument” (p. 80) and watched it go on to become an “institution” (p. 80). In this volume he recounts its rise, assesses it, and suggests its revision.For Krieger, theory is a continuation (...) of traditional institutional battles. The debate between the old historical scholarship and the new criticism, which he describes in his first chapter, parallels the current debate between new historicism and deconstruction (p. 25). But Krieger shows that there is a much older parallel in the debate between the Tories with their myth of the Golden Age and the Whigs with their myth of progress (p. 27). American criticism divides itself between formalists who emulate “the great literatures of the West” (p. 35) and historicists who value literature “shaped by and... reflect[ing] American experience” (p. 35). For Krieger, the ancient quarrel between formalism and historicism is the real context for this century’s debate between new criticism and the older and newer historicisms (p. 38–40).The first of his four chapters describes the old historicism’s resistance to theory, especially its resistance to the formal principles of the new criticism, the preinstitutionalized theory of the 1950s. The new criticism could be defended as being “for the text” (p. 8), but the theories that came after it—structuralism, poststructuralism, and their “interdisciplinary mixtures” (p. 10)—established successive hybrids built upon “the domain of contingency” (p. 12). Krieger argues that this process, coupled with the rise of human sciences and the demystification of literary values, has resulted in a full-scale assault upon institutions, advancing the “anti-institutional institution” (p. 19) of theory and replacing discipline-based “academic structures” (p. 19).Thankfully, Krieger mitigates these relatively crude oppositions by discussing how poststructuralism has energized the intramural debates within the theoretical camps. In the end he finds the current opposition between deconstruction (with its embrace of textuality) and new historicism (its embrace of contingencies) to be an either/or fallacy. The “poem... helps create history,” he asserts, “even as... history had to help create the poem” (p. 45).In his third chapter, Krieger relies upon this “middling” insight to describe [End Page 403] the fight between those who see literary works as tools of ideology and those who regard them as resistant to ideology (p. 48). The tradition of resistance may support “a given ideological structure,” but at the same time it believes that literature is a “structure of complexities that eludes any attempt to make [it] into an ideology’s servant” (p. 55). And so Krieger escapes from “unified meaning” (p. 64), an escape he traces through a history of literary thought that culminates in Paul de Man.Krieger is now ready for some classifying of his own: the new historicism in one category, grouped with the ideological (closed, totalizing, and controlling traditions); deconstruction in a separate category, grouped with the counterideological (open and liberating traditions). He does not reject ideological theories out of hand; he proposes “a balancing act [of letting] loose the counterideological potential of” certain texts “while resisting the universalizing thematic consequences” of this very process (p. 76).Having traced the institutionalization of theory, having contextualized and thus legitimized the many sides of contemporary theory’s debates, Krieger concludes by uttering an enlightened “plea for theory to reengage the lingering promise of the aesthetic [and] to allow a chance for the extraordinary particular, which is not already contained within a ruling universal” (pp. 90, 91). If this were possible—and he has shown it to be both historically and theoretically defensible—then one should also acknowledge “the authority of human consciousness” (p. 91), for it alone is receptive to that “extraordinary particular.”More than the usual powder for theory’s morning-after headache, Krieger’s volume is a compelling argument for theory to acknowledge the very traditions it has sought to discredit and exclude.Paul M. HedeenWartburg CollegeCopyright © 1995 The Johns Hopkins University Press... (shrink)