When people die suddenly and unexpectedly ethical issues often come to the fore. The aim of the study was to describe experiences of members of stroke teams in stroke units of ethical problems and how the teams manage the situation when caring for patients faced with sudden and unexpected death from stroke. Data were collected through four focus group interviews with 19 team members in stroke-unit teams, and analysed using interpretive content analysis. Three themes emerged from the analysis characterized by (...) information, decisions about care and support for the next-of-kin in the changing and uncertain situation, with mutual trust as the core. Mutual trust, both within the stroke team and with next-of-kin was seen by the stroke-team members as a way of handling ethical problems by administering care with the patient’s best interest at heart. (shrink)

Chervenak and McCullough, authors of the most acknowledged ethical framework for maternal–fetal surgery, rely on the ‘ethical–obstetrical’ concept of the fetus as a patient in order to determine what is morally owed to fetuses by both physicians and the women who gestate them in the context of prenatal surgery. In this article, we reconstruct the argumentative structure of their framework and present an internal criticism. First, we analyse the justificatory arguments put forward by the authors regarding the moral status of (...) the fetus qua patient. Second, we discuss the internal coherence and consistency of the moral obligations those authors derive from that concept. We claim that some of the dilemmas their approach is purported to avoid, such as the debate about the independent moral status of the fetus, and the foundation of the moral obligations of pregnant women (towards the fetuses they gestate) are not, all things considered, avoided. Chervenak and McCullough construct the obligations of physicians as obligations towards entities with equal moral status. But, at the same time, they assume that the woman has an independent moral status while the moral status of the fetus is dependent on the decision of the woman to present it to a physician for care. According to the logic of their own argumentation, Chervenak and McCullough implicitly admit a different moral status of the woman and the fetus, which will lead to different ascription of duties of the physician than those they ascribed. (shrink)

This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception about the nature of clinical research and the status of research subjects. Second, given that it is not clear who the research subject/s in MFS is/are, if clinical equipoise is to be used as a (...) criterion to test the ethical appropriateness of RCT, its meaning should be unambiguous. Third, because of the multidisciplinary character of MFS, it is not clear who should be in equipoise. As a result, we lack an adequate criterion for the ethical review of MFS protocols. In our account, which is based on Chervenak and McCullough's seminal work in the field of obstetric ethics, equipoise is abandoned. and RCT involving MFS can be ethically initiated when a multidisciplinary ethics review board (ERB), having an evidence-based assessment of the risks involved, is convinced that the value of answering the research hypothesis, for the sake of the health interests of future pregnant women carrying fetuses with certain congenital birth defects, justifies the actual risks research participants might suffer within a set limit of low/manageable. (shrink)

Recent research suggests holding a structural, rather than interpersonal, understanding of racism is associated with greater impetus to address racial disparities. We believe greater acknowledgment of structural racism also functions to mitigate against empathic failures in response to structural injustices. Given South Africa’s situatedness as a country characterized by historical racialized oppression and continuing unjust legacies, it is appropriate to examine these ideas there. Across three studies, we tested the hypotheses that members of advantaged groups’ perspective taking and empathic concern (...) may be compromised in response to people challenging the unequal status quo, and that a priori perceptions about the impact of structural racism may mitigate or exacerbate such empathic failures. In Study 1, a national sample of White South Africans endorsed perceptions of interpersonal racism more readily than perceptions of structural racism, and expressed high levels of competitive victimhood for perceived anti-White structural racism. Studies 2 and 3 showed that White participants at a historically White university responded with impaired perspective taking and intergroup empathy bias in response to people challenging structural disparities. Finally, reduced recognition of continuing structural racism predicted greater intergroup empathy bias, which, in turn, was associated with reduced willingness to engage in intergroup discussions about past harm. We propose that greater acknowledgment of structural racism is necessary not only to surmount intergroup empathic failures, but also to transcend the socioeconomically unequal legacies of apartheid and beyond. (shrink)

We encounter autonomy in virtually every area of philosophy: in its relation with rationality, personality, self-identity, authenticity, freedom, moral values and motivations, and forms of government, legal, and social institutions. At the same time, the notion of autonomy has been the subject of significant criticism. Some argue that autonomy outweighs or even endangers interpersonal or collective values, while others believe it alienates subjects who don't possess a strong form of autonomy. These marginalized subjects and communities include persons with physical or (...) psychological disabilities, those in dire economic conditions, LGBTI persons, ethnic and religious minorities, and women in traditional communities or households. This volume illuminates possible patterns in these criticisms of autonomy by bringing to light and critically assessing the contribution of women throughout the history of philosophy on this important subject. The essays in this collection cover a wide range of historical periods and influential female philosophers and thinkers, from medieval philosophy through to contemporary debates. Important authors whose work is considered, among many others, include Hildegard of Bingen, Margaret Cavendish, Anne Conway, Mary Wollstonecraft, Susan Moller Okin, Hélène Cixous, Iris Marion Young, and Judith Jarvis Thomson. Women Philosophers on Autonomy will enlighten and inform contemporary debates on autonomy by bringing into the conversation previously neglected female perspectives from throughout history. (shrink)

The role of membrane receptors is regarded as being to transduce the signal represented by ligand binding from the external cell surface across the membrane into the cell. Signals are subsequently conveyed from the cytoplasm to the nucleus through a combination of second-messenger molecules, kinase/phosphorylation cascades, and transcription factor (TF) translocation to effect changes in gene expression. Mounting evidence suggests that through direct targeting to the nucleus, polypeptide ligands and their receptors may have an important additional signaling role. Ligands such (...) as those of the platelet-derived and fibroblast growth factor classes, as well as cytokines such as interferon-γ and interleukins-1 and -5, have been found to localize in the nucleus through the action of nuclear localization sequences (NLSs). Where tested, these NLSs appear to be essential for full signaling activity and may be responsible for cotranslocating receptors to the nucleus in complexes with their ligands. The implication is that, subsequent to endocytosis at the membrane, particular polypeptide ligands or their receptors, or both, may translocate to the nucleus to participate directly in gene regulation. BioEssays 20:400–411, 1998.© 1998 John Wiley & Sons Inc. (shrink)

This volume addresses the intriguing issue of indirect reports from an interdisciplinary perspective. The contributors include philosophers, theoretical linguists, socio-pragmaticians, and cognitive scientists. The book is divided into four sections following the provenance of the authors. Combining the voices from leading and emerging authors in the field, it offers a detailed picture of indirect reports in the world’s languages and their significance for theoretical linguistics. Building on the previous book on indirect reports in this series, this volume adds an empirical (...) and cross-linguistic approach that covers an impressive range of languages, such as Cantonese, Japanese, Hebrew, Persian, Dutch, Spanish, Catalan, Armenian, Italian, English, Hungarian, German, Rumanian, and Basque. (shrink)

Dr André Berge : médecin et psychanalyste, est directeur médical du Centre psycho-pédagogique Claude Bernard. Les données traditionnelles, toutes les valeurs, tous les principes sont discutés et sans cesse remis en cause. Et pourtant, personne ne saurait échapper à la nécessité d’adopter dans l’existence une ligne de conduite — c’est-à-dire une morale — sous peine de sombrer dans l’incohérence. Mais l’homme, s’il a besoin d’une morale, n’en est pas moins enclin à l’utiliser pour s’écraser lui-même et tend parfois à transformer (...) cet instrument en une arme qu’il lui arrive de retourner contre sa propre personne. C’est cela qu’il s’agit d’empêcher. Ce que veut établir cet ouvrage, ce sont les bases d’une morale psychologique tendant à remédier au désarroi des esprits et à contribuer à l’avènement d’un nouvel humanisme. (shrink)

Advocates for the professionalization of clinical bioethics argue that bioethics professionals play an important role in contemporary medicine and patient care, especially when addressing complex ethical questions that arise in the delivery of reproductive medicine. For bioethics consultants to serve effectively, they need adequate training in the medical and ethical issues that patients and clinicians will face, and they need skills to facilitate effective dialog among all parties. Because clinical ethics consultation is a “high‐stakes endeavor” that can acutely affect patient (...) care, efforts are under way to ensure that bioethics consultants have the competence to provide such guidance. Yet to date, no studies have examined whether the training of bioethics consultants meets the needs of health care professionals who are on the front lines of such issues. In fact, limited information is available on the reproductive health issues that bioethics training programs address or the degree to which these programs meet the needs of patients confronting reproductive health decisions and their clinicians. It is therefore important to answer this key question: What are the primary ethical issues encountered in reproductive medicine that currently affect patient care? Equally important, are bioethics training programs prepared to address those issues?To begin to answer these questions, we conducted parallel surveys of directors of graduate bioethics training programs and obstetrician‐gynecologists. The goal of this project is to lay the groundwork to establish a working partnership between bioethics educators and reproductive medicine practitioners to address the often troubling and frequently complex ethical issues in reproductive medicine. (shrink)

La présente contribution analyse le rôle du principe de précaution lorsque des médicaments ou des vaccins exposent les patients à un risque d’atteintes corporelles. S’il était pleinement consacré en droit de la responsabilité civile, le principe de précaution permettrait de faire peser sur les laboratoires pharmaceutiques, non seulement la charge des dommages que les médicaments ou les vaccins causent, mais encore celle des risques graves et irréversibles, même scientifiquement incertains, auxquels ils exposent les patients, ce qui peut sembler injuste. L’examen (...) du droit positif montre cependant que le principe de précaution a d’ores et déjà contribué à assouplir les conditions de la responsabilité civile en matière de médicaments et de vaccins. (shrink)

Schopenhauer, "le vieux prophete", disait Nietzsche. Paru en 1819 dans l'obscurite la plus totale, son ouvrage majeur, Le Monde comme Volonte et comme representation, lui a valu d'atteindre en 1900 a une celebrite posthume telle qu'aucun penseur n'en a jamais connue - influence que son extension meme a fini par occulter aujourd'hui. Car Schopenhauer a fait cristalliser la crise des croyances qui marque la fin du XIXe siecle, dessinant pour l'avenir la physionomie de l'homme moderne. Un homme qui sous un (...) ciel vide eprouve dans le ressentiment la condition qu'il s'est lui-meme assignee : un intellect regi secretement par des pulsions irrationnelles, une concurrence vitale qui l'isole de ses semblables et de la nature, une sexualite dominatrice mais sans joie, une irresponsabilite aveugle vis-a-vis de son propre comportement comme de l'histoire collective, bref l'enracinement de son existence entiere dans une inconscience fondamentale. Nietzsche et Freud n'ont pas ete les seuls heritiers de Schopenhauer qui a remodele ce territoire invisible sur lequel la litterature edifie son discours. Aussi est-il present, on l'ignore generalement, dans la genealogie de tant de grands ecrivains - de Tolstoi, Strindberg, Maupassant, Conrad, Proust, Pirandello, jusqu'a Kafka, Thomas Mann, Celine, Beckett, Bernhard. Ce sont les voies de ce renouvellement inventif qui sont ici tracees. (shrink)

Le projet de réforme de la Chancellerie du 13 mars 2017 consacre pour l’essentiel les solutions dégagées depuis plusieurs décennies par la jurisprudence en matière de réparation des dommages résultant d’une atteinte à un bien corporel dont la finalité est de trouver un juste équilibre entre le droit de la victime à obtenir la réparation intégrale de ses préjudices et la nécessité de ne pas sacrifier les intérêts du responsable.

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were (...) asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

In this paper, we give an axiomatization of the ordinal number system, in the style of Dedekind’s axiomatization of the natural number system. The latter is based on a structure $(N,0,s)$ consisting of a set N, a distinguished element $0\in N$ and a function $s\colon N\to N$. The structure in our axiomatization is a triple $(O,L,s)$, where O is a class, L is a class function defined on all s-closed ‘subsets’ of O, and s is a class function $s\colon O\to (...) O$. In fact, we develop the theory relative to a Grothendieck-style universe (minus the power set axiom), as a way of bringing the natural and the ordinal cases under one framework. We also establish a universal property for the ordinal number system, analogous to the well-known universal property for the natural number system. (shrink)

This paper looks at selected reviews of women’s philosophical (and literary) works by Revolutionary author and politician Pierre-Louis Roederer. This study occasions the following remarks. Women’s works, when they raised political radical and sometimes feminist agendas were not only read and reviewed, but considered part of the general Revolutionary effort to relieve social and political inequalities. Secondly Roederer appears, from these reviews, as committed to convincing the French intellectual community that works by women ought to be taken as seriously as (...) works by men, and to combat the prejudices which meant that they often were not. I will highlight in particular his reading of Mary Wollstonecraft’s Maria, or the Wrongs of Woman as both a fictionalized continuation of the philosophical programme of her Vindication of the Rights of Woman, and as a contribution to the philosophy of emotions – for which he compares it to Sophie de Grouchy’s Letters on Sympathy. I will also look at an unpublished draft in which he compares and contrasts Grouchy, Germaine de Staël, Emilie du Chatelet and Suzanne Necker’s writings on love. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 46, no. 2. © 2020 by Feminist Studies, Inc. 259 Heather Berg Left of #MeToo In her 1949 call to “End the Neglect of the Problems of the Negro Woman!” Claudia Jones tells the story of Dora Jones, a Black domestic worker enslaved for forty years by her employer.1 Elizabeth Ingalls, a wealthy white woman, had traveled to Dora Jones’s Alabama home as a missionary teacher (...) and persuaded the seventeen-year-old Jones to travel to Boston as her housekeeper in 1907. Ingalls would keep Jones captive until 1947. In the intervening years, Ingalls subjected Jones to routine physical abuse and an endless expanse of intensive, unpaid domestic labor. With no days off and permitted to leave only for errands, Jones was allowed no personal relationships or contact with the outside world. Ingalls’s first husband, the bureaucrat Walter Harman, raped Jones over the course of three years, and Jones became pregnant.2 Ingalls would term this an “affair” and, as court documents showed, pushed Jones to “submit” to an abortion.3 Later, when Jones protested her abusive conditions and attempted to escape, Ingalls blackmailed her, threatening 1. Claudia Jones, “An End to the Neglect of the Problems of the Negro Woman!” Political Affairs (June 1949): 11. 2. I am inferring non-consent based on Jones’s captivity. On unfreedom and the politics of consent, see Saidiya Hartman, “Seduction and the Ruses of Power,” Callaloo 19, no. 2 (1996): 537–60. 3. United States v. Ingalls et al., Cr. No. 10568-SD (District Court, S.D. California, July 29, 1947). 260 Heather Berg to “commit Jones to prison” for interracial “adultery” and the abortion she had as a result. Jones finally won her freedom in 1947, a year after Ingalls’s adult daughter reported her mother to the police.4 Claudia Jones offers Dora Jones’s story as evidence of the exceptional precarity of Black women domestic workers. Like others in her cohort of “black left feminists” (to borrow Erik McDuffie’s term), Jones focused on domestic work as a field that epitomized the “triple oppression” at which she took aim.5 Sexual violence at work is not exceptional in Claudia Jones’s telling. Instead, it operates alongside a catalog of abuses at the intersection of capitalism, state terror, the degradation of women, imperialism, and white supremacy. An active member of the Communist Party, Jones insisted on thinking these systems together, maintaining that only through collective struggle against them could justice be won. Women would not be comrades in that struggle in any simple way. Jones was sharply critical of the idea that Black women’s oppression could be explained by “the rotten bourgeois notion about a ‘battle of the sexes.’”6 Instead, she urged working-class Black people to fight “against their common oppressors, the white ruling class.”7 Solidarity among women was illusory, in part, because of white women’s roles as employers of Black women’s domestic work. Against a narrative of sexual violence that describes simple dominance by men over women, Dora Jones’s story highlights the ways that systems of domination work together to enable abuse. Her suffering was not the same as that visited on bourgeois white women. Instead, it was perpetrated and enabled by one. There is no sisterhood to be found here. A critique of this framework is now common sense in most feminist circles, and yet the loudest feminist intervention in recent years trades in exactly the “bourgeois notion about a ‘battle of the sexes.’” Some seventy years after “An End to the Neglect’s” publication, the #MeToo movement has brought broad international attention to 4. For an overview of the case and its legal legacy, see Risa L. Goluboff, The Lost Promise of Civil Rights (Cambridge, MA: Harvard University Press, 2010), 162–5. 5. Erik S. McDuffie, Sojourning for Freedom: Black Women, American Communism, and the Making of Black Left Feminism (Durham, NC: Duke University Press, 2011), 9. 6. Jones, “An End to the Neglect of the Problems of the Negro Woman!” 13. 7. Ibid. Heather Berg 261 the problem of workplace sexual violence. In 2006, civil rights activist Tarana Burke founded an anti-violence movement based... (shrink)

ABSTRACT: Can virtue ethics say anything worthwhile about laws? What would a virtue-ethical account of good laws look like? I argue that a plausible answer to that question can be found in Plato’s parent analogies in the Crito and the Menexenus. I go on to show that the Menexenus gives us a philosophical argument to the effect that laws are just only if they enable citizens to flourish. I then argue that the resulting virtue-ethical account ofjust laws is not viciously (...) paternalistic. Finally, I refute the objection that the virtue-ethical account I am proposing is not distinct from a consequentialist account.RÉSUMÉ: Peut-on construire une théorie de la loi à partir de l’éthique de la vertu? Qu’est ce qu’une bonne loi? Je dis que l’on trouvera une réponse à la question dans l’analogie entre les lois et les parents présentée par Platon dans le Criton et le Ménéxène. Dans §2, je montre que le Ménéxène apporte une défense philosophique de l’argument que les lois sont bonne seulement si elles amènent les citoyens a la vertu.Dans §3, je montre que celte théorie des lois selon la vertu n’est pas outre mesure paternaliste. Dans la dernière section, je réponds a l’objection suivante : que la théorie que je défend n’est ni plus ni moins qu’une théorie conséquentialiste. (shrink)