Objective Gather information from physicians about factors contributing to unnecessary noninvasive imaging and impact of possible solutions. Methods Qualitative study of 14 physicians using a phenomenological approach and the Theoretical Domains Framework. Results Most participants self-reported that >10% of the imaging tests they order are unnecessary. External sources of pressure included: peer-review, patient demands, nursing expectations, specialist requests, as well as prior experience with patient advocates, and the compensation and pension system. Internal sources of pressure included reliance on anecdote, self-doubt (...) about diagnoses, and fear of missing a diagnosis and of professional liability. Participants expressed both optimism and concern about potential solutions, such as adopting decision support software. Conclusion Physicians are under pressure from multiple sources to order unnecessary imaging. Peer review, nursing expectations, and perceptions about Veteran compensation and pension are newly reported contributing factors. (shrink)

Governing Animals explores the role of the liberal state in protecting animal welfare. Examining liberal concepts such as the social contract, property rights, and representation, Kimberly K. Smith argues that liberalism properly understood can recognize the moral status and social meaning of animals and provides guidance in fashioning animal policy.

Although formal barriers to women’s social and political participation have crumbled, society remains, to a significant degree, gendered in the roles that women and men play. Women’s and men’s choices regarding work and family are largely responsible for maintaining and reinforcing the differences. While feminists recognize the need to criticize women’s choices, too often they focus on restrictive conditions rather than the choices themselves. Kimberly A. Yuracko argues instead that encouraging women to make choices in accordance with a grounded (...) and well-defined conception of perfectionism—a philosopy concerned with human flourishing—is the most effective way to redress persistent gender inequality. To this end, Yuracko seeks not only to expose the perfectionism underlying current choice critiques, but to articulate a concrete set of feminist perfectionist principles that would improve the quality of individual women’s lives and improve the social standing of women as a whole. (shrink)

This book provides an invaluable overview of the competing schools of thought in traditional and contemporary normative international theory and seeks to provide a new basis for doing international political theory and thinking about ethics in world politics today. · Part one explains the role and place of normative theory in the study of international politics before critically examining mainstream approaches in international relations and applied ethics. Here the student is introduced to the central debates between realists and idealists, and (...) cosmopolitans and communitarians. · Part two introduces the conceptual challenges of contemporary perspectives from critical theory, postmodernism and feminism and provides a platform for the author to develop her own Hegelian-Foucauldian approach for doing normative international theory. · In Part three the insights drawn from the first two parts are applied to the study of two key topics in contemporary theoretical debate: the principle of self-determination, and the democratic ideals of political cosmopolitanism. Finally conclusions are made for the future practice of theorizing international politics. Accessibly written and wide-ranging, this text will quickly become essential reading for all students and academics of politics and international relations seeking a deeper understanding of the underlying tensions and future potential of international or global political theory today. (shrink)

: In a short and much-neglected passage in the second Critique, Kant discusses the threat posed to human freedom by theological determinism. In this paper we present an interpretation of Kant’s conception of and response to this threat. Regarding his conception, we argue that he addresses two versions of the threat: either God causes appearances directly or he does so indirectly by causing things in themselves which in turn cause appearances. Kant’s response to the first version is that God cannot (...) cause appearances directly because they depend essentially on the passive sensibility of finite beings. Kant’s response to the second version is that human beings are endowed with transcendental freedom, which blocks the causal transitivity that is presupposed by this version. We also contrast his position on this topic with Leibniz’s and Spinoza’s. (shrink)

A philosophically and historically influential section of the Critique of Judgement presents an ‘intuitive intellect’ as a mind whose representation is limited to what actually exists, and does not extend to mere possibilities. Kant’s paradigmatic instance of such an intellect is however also the divine mind. This combination threatens to rule out the reality of the mere possibilities presupposed by Kant’s theory of human freedom. Through an analysis of the relevant issues in metaphysical cosmology, modal metaphysics and philosophical theology, I (...) show that Kant in fact possesses the resources to reconcile the philosophical claims of §76 of the Critique of Judgement with his keystone commitment to the reality of human freedom. (shrink)

In The Frontiers of Justice, Martha Nussbaum argues that social contract theory cannot accommodate political duties to animals because it requires the parties to the contract to enjoy rough physical and mental equality. Her interpretation of the social contract tradi­tion is unpersuasive; social contract theory requires only that the parties be equally free and deserving of moral consideration. Moreover, social contract theory is superior to her capabilities approach in that it allows us to limit the scope of the community of (...) justice to animals we are capable of recognizing as subjects of justice and with whom we have a political relationship. (shrink)

A careful reading of Heloise's letters reveals both her contribution to Abelard's ethical thought and the differences between her ethical concerns and his. In her letters, Heloise focuses on the innate moral qualities of the inner person or animus. Hypocrisy—the misrepresentation of the inner person through false outer appearance, exemplified by the potentially deceitful religious habit or habitus—is a matter of great moral concern to her. When Abelard responds to Heloise's ideas, first in his letters to her and later in (...) his Collationes and Scito te ipsum, he turns the discussion away from her original interests. He transforms her metaphor of the habitus as false appearance into a discussion of another type of habitus, the habitual process of acquiring virtue, and integrates her focus on the animus into his developing ideas about sin as intention. Examining the differences between Heloise's ethical thought and Abelard's allows us to appreciate the distinct contributions of both. (shrink)

Dive into the moral philosophy at the heart of all four seasons of NBC’s The Good Place, guided by academic experts including the show’s philosophical consultants Pamela Hieronymi and Todd May, and featuring a foreword from creator and showrunner Michael Schur Explicitly dedicated to the philosophical concepts, questions, and fundamental ethical dilemmas at the heart of the thoughtful and ambitious NBC sitcom The Good Place Navigates the murky waters of moral philosophy in more conceptual depth to call into question what (...) Chidi’s ethics lessons—and the show—get right about learning to be a good person Features contributions from The Good Place’s philosophical consultants, Pamela Hieronymi and Todd May, and introduced by the show’s creator and showrunner Michael Schur Engages classic philosophical questions, including the clash between utilitarianism and deontological ethics in the “Trolley Problem,” Kant’s categorical imperative, Sartre’s nihilism, and T.M Scanlon's contractualism Explores themes such as death, love, moral heroism, free will, responsibility, artificial intelligence, fatalism, skepticism, virtue ethics, perception, and the nature of autonomy in the surreal heaven-like afterlife of the Good Place Led by Kimberly S. Engels, co-editor of Westworld and Philosophy. (shrink)

In The Myth of Ownership, Liam Murphy and Thomas Nagel argue that achieving fairness in taxation is principally a matter of distributive justice. Distributive justice can be understood as being concerned with what is owed to people as a matter of justice. For Nagel and Murphy, fairness in tax schemes is subsumed to the question of distributive justice: fairly allocated tax liabilities are just those that are compatible with the preferred theory of distributive justice. Subsuming assessments of tax fairness to (...) distributive justice, however, overlooks the following possibility: that the question of how we ought to divvy up tax liabilities, and the burdens associated with running a society more generally, requires different, non-distributive considerations of justice. These are considerations of justice that aren’t essentially about distributive justice at all. I argue here that the division of burdens in a society is specifically a matter of contributive justice. Contributive justice is concerned with what people owe as a matter of justice, rather than what is owed to them. It makes the division of burdens itself evaluative salient in assessments of fairness. Even a comprehensive specification of distributive justice leaves indeterminate how the burdens of running a society should be fairly divided up. Each of the chapters in this dissertation develops one part of an account of contributive justice. I first make conceptual space for an account of contributive justice. By taking Murphy and Nagel’s lead, and working within the post-distribution, a distinctive need for principles of justice in contribution can be shown. Murphy and Nagel decline to introduce non-distributive principles for guiding the provision of post-distributive public goods. Instead, they favor efficiency in determining the provision of post-distributive of public goods. I show that contributive justice is genuinely distinct from both efficiency and distributive justice. I also identify one respect in which principles of contributive justice should bear: that of determining the financing and delivery and civic cultural public goods. I then argue that a principle of contribution in accordance with ability (a principle of “ability-to-pay”, or “ability-to-contribute”, for short) stands out as a candidate principle of contributive justice. The version of ability-to-pay that I defend is, in particular, a deontic principle of ability-to-pay. I show that a deontic principle of ability-to-pay is more closely allied with a view of society as a cooperative enterprise than utilitarian versions of ability-to-pay. An account of ability to contribute is developed by grafting a notion of opportunity cost onto Amartya Sen’s capability theory. Lastly, I incorporate contributive justice in an account of contributive legitimacy. Contributive legitimacy gives us a set of conditions under which the state’s use of coercive force to extract tax contributions is legitimate, and hence justified. Drawing on empirical evidence from the development and fiscal sociology literature, I show that contributive legitimacy in a state’s tax extraction practices is essential to rule of law, and the avoidance of kleptocratic authoritarianism. Contributive legitimacy supplements our understanding of conventional notions of political legitimacy and helps us identify possible failures of political legitimacy. These are failures that might be overlooked were we to focus solely on distribution. (shrink)

In “Potential Subjects’ Responses to an Ethics Questionnaire in a Phase I Study of Deep-Brain Stimulation in Early Parkinson’s Disease,” Finder, Bliton, Gill, Davis, Konrad, and Charles undertake informed consent research on what they describe as a Phase I trial of deep brain stimulation (DBS) for Parkinson’s disease. We argue that the authors should have more carefully characterized the nature of the DBS study at the start of their clinical study.

Although it is not yet officially recognized as a clinical entity which is diagnosable, Internet Gaming Disorder (IGD) has been included in section III for further study in the DSM-5 by the American Psychiatric Association (APA, 2013). This is important because there is increasing evidence that people of all ages, in particular teens and young adults, are facing very real and sometimes very severe consequences in daily life resulting from an addictive use of online games. This article summarizes general aspects (...) of IGD including diagnostic criteria and arguments for the classification as an addictive disorder including evidence from neurobiological studies. Based on previous theoretical considerations and empirical findings, this paper examines the use of one recently proposed model, the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, for inspiring future research and for developing new treatment protocols for IGD. The I-PACE model is a theoretical framework that explains symptoms of Internet addiction by looking at interactions between predisposing factors, moderators, and mediators in combination with reduced executive functioning and diminished decision making. Finally, the paper discusses how current treatment protocols focusing on Cognitive-Behavioral Therapy for Internet addiction (CBT-IA) fit with the processes hypothesized in the I-PACE model. (shrink)

From trauma expert and somatic healer Kimberly Johnson comes a guide for tapping into the wisdom and resilience of the body to rewire the nervous system, heal from trauma, and live fully.

Many of us think that we just aren't enough. Not good enough, not pretty enough, not rich enough, and not happy enough. But just because we think something doesn't mean it's true. You are more than you think you are teaches you how to revise your belief system, fulfill your deepest dreams and desires, and create an epic, successful, and inspiring life. Unlocking your True Self is the key to new levels of joy, beauty, and peace. But what is the (...) True Self, and how can you realize its infinite potential? In this easy-to-read book, Kimberly Snyder answers these questions and shows you how to tap into this unstoppable force to transform every aspect of your life for the better. Drawing inspiration from the teachings of the great guru Paramahansa Yogananda along with personal stories and the latest scientific research, Kimberly offers simple exercises, potent ancient practices, and in-depth meditations to help you overcome negative beliefs and see yourself as you truly are--a goddess, a warrior, a lover, and a creator of your extraordinary destiny" -- Back cover. (shrink)

Philosophy has long been concerned with ‘moral status’. Discussions about the moral status of children, however, seem often to promote confusion rather than clarity. Using the creation of ‘savior siblings’ as an example, this paper provides a philosophical critique of the moral status of children and the moral relevance of parenting and the role that formative experience, regret and relational autonomy play in parental decisions. We suggest that parents make moral decisions that are guided by the moral significance they attach (...) to children, to sick children and most importantly, to a specific sick child (theirs). This moral valorization is rarely made explicit and has generally been ignored by both philosophers and clinicians in previous critiques. Recognizing this, however, may transform not only the focus of bioethical discourse but also the policies and practices surrounding the care of children requiring bone marrow or cord blood transplantation by better understanding the values at stake behind parental decision making. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Invisible HarmKimberly ZieselmanI’m a 48–year–old intersex woman born with Androgen Insensitivity Syndrome (AIS) writing to share my personal experience as a patient affected by a Difference of Sex Development (DSD). Although I appear to be a DSD patient “success story”, in fact, I have suffered and am unsatisfied with the way I was treated as a young patient in the 1980’s, and the continued lack of appropriate care for (...) intersex people even today.As the Executive Director of the advocacy organization Advocates for Informed Choice and a board member of the AIS–DSD Support Group since 2012, I have heard doctors reference the “silent happy majority” of DSD patients all too often. They speak [End Page 122] of patients who were treated in childhood and went on to live (seemingly) contented lives. It appears however that doctors have drawn this conclusion from the fact that most of their patients have not returned to complain about their treatment. While there is little evidence to support the success doctors claim, there is quite a bit of evidence that suggests my suffering is the norm rather than the exception.Medical professionals would likely include me in that “silent majority,” only seeing a woman who identifies and appears typically female, graduated law school, married for over twenty years, with adopted children and a successful career. And while I have been fortunate in many ways, I no longer want my voice to be presumed buried within that silent majority. Instead, I am speaking out today to tell my story.My StoryAt age 15 I was diagnosed with amenorrhea and referred to a reproductive oncologist who told my parents I had a partially developed uterus and ovaries that would likely soon become cancerous. We were told my vagina was abnormally short and might require surgery in order to have heterosexual intercourse.Neither my parents nor I was ever told I had AIS and XY chromosomes, or that the gonads being removed were testes, not ovaries. I was told I needed a “full hysterectomy” to prevent cancer and hormone replacement therapy. That summer I spent my 16th birthday recuperating from surgery. I spent the next 25 years living a lie.A lie that has had a profound and harmful impact on me.At some level, I knew I was not being told the whole truth. My parents’ and the doctors’ actions signaled to me something more might be going on. But I was afraid to ask questions; my parents were distressed and I didn’t want to cause them any more pain. Over the years I have wondered just how much my parents knew but withheld from me (albeit with good intentions). I sensed something awful was being hidden from me, and I didn’t know whom I could trust.When I asked my doctor if I could meet someone else with my condition, I was told I was different, that there was “nobody” with my medical condition in the world, that my situation was “very rare.” I was told to get on with my life and not talk about my surgery because it wasn’t important; I was healthy and could adopt if I wanted to become a parent. I was told I must take a hormone pill each day for the rest of my life to stay healthy.But what I heard was, “you are not a real woman: you are a damaged freak, so go out and fake the rest of your life and be sure nobody knows your secret.” So that’s what I did. I was a “good girl” and took my pills, didn’t ask questions and did what the men in white coats asked me to do. There was no support provided for either my parents or me. No social workers, no therapists. Perhaps most shockingly, there was no true informed consent.A few years ago I was diagnosed with post-traumatic stress syndrome caused by anxiety I had been harboring for over two decades about my past surgery and fear of getting cancer. I decided to obtain my medical records from the hospital and discover the truth.Covering several pages of... (shrink)

Hegel and Feminist Philosophy traces the legacy of Hegel in the work of thinkers such as de Beauvoir, Irigaray and Butler, and also in contemporary debates in ...

Elizabeth Anderson’s “pluralist–expressivist” value theory, an alternative to the understanding of value and rationality underlying the “rational actor” model of human behavior, provides rich resources for addressing questions of environmental and animal ethics. It is particularly well-suited to help us think about the ethics of commodification, as I demonstrate in this critique of the pet trade. I argue that Anderson’s approach identifies the proper grounds for criticizing the commodification of animals, and directs our attention to the importance of maintaining social (...) practices and institutions that respect the social meanings of animals. Her theory alone, however, does not adequately address the role of the state in this project. Drawing on social contract theory to fill this gap, I conclude that the state’s role in regulating the pet trade should be limited to ensuring the welfare of animals in the stream of commerce, not prohibiting their mass marketing altogether. (shrink)

In recent years, scholars have come to understand emotions as dynamic and socially constructed—the product of interdependent cultural, relational, situational, and biological influences. While researchers have called for a multilevel theory of emotion construction, any progress toward such a theory must overcome the fragmentation of relevant research across various disciplines and theoretical frameworks. We present affect control theory as a launching point for cross-disciplinary collaboration because of its empirically grounded conceptualization of social mechanisms operating at the interaction, relationship, and cultural (...) levels, and its specification of processes linking social and individual aspects of emotion. After introducing the theory, we illustrate its correspondence with major theories of emotion construction framed at each of four analytical levels: cultural, interactional, individual, and neural. (shrink)

Beginning with the nineteenth-century critiques of slave agriculture, African American writers have been centrally concerned with their relationship to the American landscape. Drawing on and responding to the dominant ideology of democratic agrarianism, nineteenth-century black writers developed an agrarian critique of slavery and racial oppression. This black agrarianism focuses on property rights, the status of labor, and the exploitation of workers, exploring how racial oppression can prevent a community from establishing a responsible relationship to the land. Black agrarianism serves as (...) an important starting point for understanding black environmental thought as it developed in the twentieth century, and for illuminating the connections between social justice and environmental stewardship. (shrink)

Beginning with the nineteenth-century critiques of slave agriculture, African American writers have been centrally concerned with their relationship to the American landscape. Drawing on and responding to the dominant ideology of democratic agrarianism, nineteenth-century black writers developed an agrarian critique of slavery and racial oppression. This black agrarianism focuses on property rights, the status of labor, and the exploitation of workers, exploring how racial oppression can prevent a community from establishing a responsible relationship to the land. Black agrarianism serves as (...) an important starting point for understanding black environmental thought as it developed in the twentieth century, and for illuminating the connections between social justice and environmental stewardship. (shrink)

As resident physicians practicing Internal Medicine in hospitals within the USA, we are confronted on a daily basis with patients who wish to leave the hospital floor to smoke a cigarette. While many physicians argue that hospitals should do everything in their power to prevent patients from smoking, we argue that a more comprehensive and nuanced approach is needed. In part 1 of this perspective piece, we outline the various forms of smoking bans in hospital settings, applauding the development of (...) indoor smoking bans while questioning the move towards stricter, campus-wide smoking bans. In part 2, we turn to traditional biomedical ethics to guide our approach to the hospitalised patient who smokes. This approach, which is informed by our backgrounds in harm reduction and medical anthropology, takes into account the lived realities of patients and acknowledges the complicated sociohistorical contexts of tobacco use. (shrink)

, Technology, Time and the Conversations of Modernity (reviewed by Stephen Findley).

Char et al. aspire to provide “a systematic approach to identifying … ethical concerns” around machine learning healthcare applications, which includes artificial intelligence and...