IntroductionLifestyle modifications are part of comprehensive treatment plans to help manage the symptoms of pre-existing chronic conditions. However, behavior change is notoriously difficult as patients often lack the necessary support. The present manuscript outlines the development of a Green Health Prescription pathway that was designed to link patients with appropriate lifestyle interventions and to support attendance. Strengths, Weaknesses, Opportunities, and Threats analysis was undertaken in three focus groups to highlight areas of strength and weakness within the proposed pathway prior to (...) delivery. The SWOT analyses revealed that the pathway was supported by all three focus groups. Weaknesses and threats were identified including sustainability of nature-based interventions in terms of funding, the need to connect patients with appropriate interventions based on their physical and mental health needs, and the requirement to have a “one-stop shop” for information to ensure that the pathway was accessible for all service-users and healthcare professionals. Results were addressed and considered throughout the development of the pathway.DiscussionThe Green Health Prescription pathway was launched in 2019 and gave patients the ability to receive a prescription from a healthcare professional, community service, or to self-refer. The pathway allows patients to contact a consultant, via a telephone service, who is trained to match them with a programme that the patient believes will be enjoyable and that fits their treatment needs. Data collection to assess the efficacy of the pathway is ongoing. (shrink)

The book introduces to readers the scope and nature of Meltzer’s contribution, and suggests the wider social context in which he saw psychoanalysis.

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)

: 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)

The U.S. Supreme Court declared procreation to be a fundamental right in the early twentieth century in a case involving Oklahoma's Habitual Criminal Sterilization Act, an act that permitted unconsented sterilization of individuals convicted of certain crimes. The right that the Court articulated in that case is a negative right: it requires that the government not place unjustified roadblocks in the way of people seeking to procreate, but it does not require the government to take positive steps to help people (...) procreate if they wish to. I argue that a positive legal right is morally necessary in the United States, given the profound significance of procreation, the current barriers to access to care, and the related issues of individual and societal justice. I assume at the outset that the right to procreate should be expansive enough to include a right to noncoital reproduction. The absence of a positive right to procreate reflects not just constitutional tradition but also a governmental and societal commitment to a longstanding set of reproductive hierarchies by which those who fall outside of the traditional framing of family too frequently find their procreative dreams hindered. Reconceiving procreative rights to include a positive right would create greater opportunities to argue and lobby for increased access to technologies that are out of reach for many. (shrink)

We argue that, under certain plausible assumptions, de Sitter space settles into a quiescent vacuum in which there are no dynamical quantum fluctuations. Such fluctuations require either an evolving microstate, or time-dependent histories of out-of-equilibrium recording devices, which we argue are absent in stationary states. For a massive scalar field in a fixed de Sitter background, the cosmic no-hair theorem implies that the state of the patch approaches the vacuum, where there are no fluctuations. We argue that an analogous conclusion (...) holds whenever a patch of de Sitter is embedded in a larger theory with an infinite-dimensional Hilbert space, including semiclassical quantum gravity with false vacua or complementarity in theories with at least one Minkowski vacuum. This reasoning provides an escape from the Boltzmann brain problem in such theories. It also implies that vacuum states do not uptunnel to higher-energy vacua and that perturbations do not decohere while slow-roll inflation occurs, suggesting that eternal inflation is much less common than often supposed. On the other hand, if a de Sitter patch is a closed system with a finite-dimensional Hilbert space, there will be Poincaré recurrences and dynamical Boltzmann fluctuations into lower-entropy states. Our analysis does not alter the conventional understanding of the origin of density fluctuations from primordial inflation, since reheating naturally generates a high-entropy environment and leads to decoherence, nor does it affect the existence of non-dynamical vacuum fluctuations such as those that give rise to the Casimir effect. (shrink)

As the technology for ectogenesis continues to advance, the ethical implications of such developments should be thoroughly and proactively explored. The possibility of full ectogenesis remains hypothetical at present, and myriad concerns regarding the safety and efficacy of the technology must be evaluated and addressed, while pressing moral considerations should be fully deliberated. However, it is conceivable that the technology may become sufficiently well established in the future and that eventually full ectogenesis might be deemed ethically acceptable as a reproductive (...) alternative to gestation within a human womb under certain circumstances. If the safety and efficacy of full ectogenesis are established, if ethical dilemmas are sufficiently well addressed, and if the technology is offered as a reproductive option to cisgender heterosexual individuals or couples desiring to become parents, there is a moral obligation grounded in social justice to ensure that full ectogenesis be made available to individuals or couples identifying as members of sexual‐ or gender‐minority groups who likewise seek to pursue parenthood. We examine the history of access to current family‐building options, including assisted reproductive technology, surrogacy and adoption, for these populations and conclude that in the absence of robust empirical evidence suggesting an increased risk of harm to children of individuals and couples who identify as members of sexual‐ or gender‐minority groups, equitable access to ectogenesis as a pathway to parenthood for sexual and gender minorities must be assured as a matter of reproductive justice. (shrink)

Environmental political theory poses new challenges to our received political concepts and values. Increasingly, we are reconceptualising nature as a subject rather than solely an object of politics. On one front, we are being challenged to think of natural entities as subjects of justice – as bearers of rights or interests that the political system should accommodate. On a second front, we are being challenged to see nature as a subject of power, constructed and ordered through scientific and political practice. (...) These reconceptualisations have significant implications for our political practices and institutions. (shrink)

Extracorporeal membrane oxygenation (ECMO) provides continuous circulation and/or oxygenation to adults with cardiac failure, pulmonary dysfunction, or both. The technology is similar to the traditional heart-lung bypass machines used during surgical procedures, however ECMO may be used outside the confines of the operating room and for extended periods of time. This paper explores the complexities, both clinical and ethical, of a donot-resuscitate (DNR) order for patients with cardiopulmonary failure on veno-arterial (VA-ECMO), a type of ECMO that provides resuscitation superior to (...) the chest compressions that DNR is intended to prevent. Clinically, a DNR order has limited utility for patients on VA-ECMO and its presence can serve to create confusion. Symbolically, however, the designation may serve as a stepping-stone for surrogates facing difficult end-of-life decisions. The paper concludes by suggesting that it is prudent to avoid DNR discussions in the context of VA-ECMO. (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)

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)

This article investigates the role of shame in shaping the epistolary form and aesthetic structure of Alice Walker's The Color Purple. I argue that the epistolary framing presents a crisis in the development of Celie's shamed self‐consciousness. To explain the connection between shame and Celie's self‐consciousness, I build on Jean Paul Sartre's theory of existentialism and explore three phases of Celie's evolution as it is represented in three phrases that I identify as significant transitions in the text: “I am,” “But (...) I'm here,” and “It mine.” The first section examines how shame fractures Celie's self‐consciousness; the second focuses on how Celie positions and locates herself in the world; and the third explains how Celie mobilizes shame by connecting her self‐consciousness to a past that is shameful but also generative. I conclude by considering the novel's emergence in the Cosby/Reagan era in order to illuminate the mutual constitution of black familial pride and black racial shame. (shrink)

Populated with the likes of Francis of Assisi, Teresa of Avila, and Padre Pio, this book is a fascinating inquiry into the status of saints in the modern world.

During his life time, the famed 16th century astronomer Tycho Brahe made a convincing case for what came to be known as the Tychonic System. It was a picture of the heavens as he saw it from his observational complex Uraniborg. Yet despite the scientific prowess that marked everything Brahe did, the design of his system was powerfully influenced by a beliefs that had been in place since Ancient Greece.

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)

Kant's theory of the intuitive intellect has a broad and substantial role in the development and exposition of his critical philosophy. An emphasis on this theory's reception and appropriation on the part of the German idealists has tended to divert attention from Kant's own treatment of the topic. In this essay, I seek an adequate overview of the theory Kant advances in support of his critical enterprise. I examine the nature of the intuitive intellect's object; its epistemic relation to its (...) object; its mode of comprehension; the relationship between these cognitive elements; and I ask which minds Kant regards as intuitive intellects. (shrink)

In this essay, Hutchings contends that Simone de Beauvoir's argument in The Ethics of Ambiguity provides a valuable resource for feminists currently addressing the question of the legitimacy of political violence, whether of the state or otherwise. The reason is not that Beauvoir provides a definitive answer to this question, but rather because of the ways in which she deconstructs it. In enabling her reader to appreciate ate what is presupposed by a resistant politics that adopts violence as its instrument, (...) Beauvoir illuminates the problems encountered by the kinds of “realistic and positive” and “idealistic and moral” arguments through which the use of violence in politics is routinely justified. At the same time, Beauvoir demonstrates that to deconstruct the question of the legitimacy of violence is neither to banish nor resolve it. She does not offer a recipe for determining the legitimacy or otherwise of the use of violence in politics in general; instead, she illuminates the irremediable difficulty and inescapability of such judgments in a violent and intransigent world. (shrink)

Boiger and Mesquita (2012) present a social constructionist perspective on emotion that argues for its multilevel contextualization through social interactions, relationships, and culture. The present comments offer a response to the authors’ call for input from other disciplines. We provide a sociological perspective on emotion construction at each of the contextual levels discussed by Boiger and Mesquita, and discuss a model that can address interdependencies between these levels. Our remarks are intended to identify additional literature that can be brought to (...) bear on multilevel emotion construction and to put forward some ideas for future research on the subject. (shrink)

This paper describes a 'structural typology' to assist in the analysis of ways in which policy-makers in one country explore educational provision in another and seek to 'borrow' from it. In this analysis we look specifically at England's 'cross-national attraction' to education in Germany over the past 200 years. The paper aims to provide an analytical programme to use in comparative education and to facilitate exploration of the importance of context in shaping educational phenomena.

Though many have recently attempted either to locate Arendt within feminism or feminism within the great body of Arendt's work, these efforts have proven only modestly successful. Even a cursory examination of Arendt's work should suggest that these efforts would prove frustrating. None of her voluminous writings deal specifically with gender, though some of her work certainly deals with notable women. Her interest is not in gender as such, but in woman as assimilated Jew or woman as social and political (...) revolutionary. In this paper, I argue that Arendt recognized that what frequently passes for a gender question is not essentially a matter of gender at all, but rather an idiosyncratic form of loneliness that typically affects, though is by no means limited to, women. In her work one finds the conceptual tools necessary to understand the “woman problem” rather than an explicit argument or a solution to it. (shrink)

This article seeks to illustrate egg donation's incompletely commodified status through an analysis of two cases of first impression, highlighting the tensions that arise from attempts to reconcile egg donation's reality as a robust commercial industry with the nonmarket norms that traditionally underlie reproduction. Antitrust and taxation litigation may seem unlikely sources for guidance in navigating the tensions in egg donation's uncertain place between the worlds of gift and market exchange. Nonetheless, this litigation forces an explicit consideration of how egg (...) donation is perceived, talked about, and operationalized, and where along the gift-market spectrum it fits. These cases also engage familiar questions of commodification, coercion, and exploitation, which are surprisingly central litigation issues. (shrink)

Joan Scott’s ‘fantasy echo’ is deployed to analyse the trope of the mother/daughter relationship in contemporary laments about feminism’s failures, exemplified by Susan Faludi’s ‘American Electra: Feminism’s Ritual Matricide’ (2010). I demonstrate that Faludi’s primary argument – that young feminists do not respect the generations that precede them and therefore halt feminist progress – unreflectively relies upon a feminist maternal fantasy and ignores the prominent role spectacle culture plays in the circumscription of contemporary feminism. Building upon Scott’s attention to literature (...) to interrupt fantasy echoes and their inert visions of how feminism should appear, the article interprets The Portrait of a Lady (1908) through the tools of Scott’s historiography. I argue that Henry James’s novel, focused on an American ‘New Woman’, is an early account of how young women are sold fantasies of feminist freedom through spectacle culture and troubles the assumption that older women only forge benevolent relationships with younger women out of generosity. (shrink)

In this essay, Hutchings contends that Simone de Beauvoir's argument in The Ethics of Ambiguity provides a valuable resource for feminists currently addressing the question of the legitimacy of political violence, whether of the state or otherwise. The reason is not that Beauvoir provides a definitive answer to this question, but rather because of the ways in which she deconstructs it. In enabling her reader to appreciate ate what is presupposed by a resistant politics that adopts violence as its instrument, (...) Beauvoir illuminates the problems encountered by the kinds of “realistic and positive” and “idealistic and moral” arguments through which the use of violence in politics is routinely justified. At the same time, Beauvoir demonstrates that to deconstruct the question of the legitimacy of violence is neither to banish nor resolve it. She does not offer a recipe for determining the legitimacy or otherwise of the use of violence in politics in general; instead, she illuminates the irremediable difficulty and inescapability of such judgments in a violent and intransigent world. (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)

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)

This book presents a comprehensive overview of what the criminal law would look like if organised around the principle that those who deserve punishment should receive punishment commensurate with, but no greater than, that which they deserve. Larry Alexander and Kimberly Kessler Ferzan argue that desert is a function of the actor's culpability, and that culpability is a function of the risks of harm to protected interests that the actor believes he is imposing and his reasons for acting in (...) the face of those risks. The authors deny that resultant harms, as well as unperceived risks, affect the actor's desert. They thus reject punishment for inadvertent negligence as well as for intentions or preparatory acts that are not risky. Alexander and Ferzan discuss the reasons for imposing risks that negate or mitigate culpability, the individuation of crimes, and omissions. (shrink)

In a crossed-out section in his Fisk University commencement address on Otto von Bismarck, W. E. B. Du Bois mentions that Hegel was one of the figures that influenced him early on in his intellectual development. I argue that although Du Bois uses Hegelian language and employs a Hegelian conception of history in his address “The Conservation of Races,” he abandons both in his essay “Sociology Hesitant.” He became critical of the teleological conception of history because it rests on determinism, (...) which in his view denies the possibility for social change. With what I call his “mystical holism,” Du Bois is at odds with Hegel’s methodological holism, a distinguishing characteristic of absolute idealism. Du Bois’s dynamic idealism, which grows out of opposition to Hegelian idealism, leaves us with hope for a world without racism or at the very least in a better position to develop idealism as an anti-racist system of philosophical thought. (shrink)

It has been argued that infants possess a rich, sophisticated theory of mind that is only revealed with tasks based on spontaneous responses. A mature theory of mind implies the understanding that mental states are person-specific. Previous studies on infants’ understanding of motivational mental states such as goals and preferences have revealed that, by 9 months of age, infants do not generalize these motivational mental states across agents. However, it remains to be determined if infants also perceive epistemic states as (...) person-specific. Therefore, the goal of the present study was to use a switch agent paradigm with the classic false belief violation-of-expectation task. Results revealed that 16-month-old infants attributed true and false beliefs to a naïve agent—they did not perceive beliefs as person-specific. These findings indicate that infants’ understanding of beliefs is not as sophisticated as the rich mentalistic view suggests. (shrink)

The field of global ethics draws on traditions of moral theory, mostly derived from western philosophy, in order to address moral problems specific to an increasingly globalised world. This book provides an accessible introduction to the field of global ethics for students of politics, international relations and globalisation. It offers an overview and assessment of key perspectives in global ethics and their implications for substantive moral issues in global politics. These issues include the morality of state and non-state violence, the (...) obligations of rich to poor in a globalising world and the scope and nature of international human rights. The aim of the book is to help non-specialist students understand the assumptions underpinning different moral traditions and to enable them to make up their own minds about the best way of approaching moral judgment and prescription in a shared world, which is nevertheless marked by massive cultural differences and inequalities of power. (shrink)

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)