Smith et al. demonstrate the viability of animal metacognition research. We commend their effort and suggest three avenues of research. The first concerns whether animals are explicitly aware of their metacognitive processes. The second asks whether animals have metaknowledge of their own uncertain responses. The third issue concerns the monitoring/control distinction. We suggest some ways in which these issues elucidate metacognitive processes in nonhuman animals.

As rationing decisions become more of an immediate reality for healthcare practitioners it is important to design mechanisms that facilitate carefully deliberated outcomes. No individual can be expected to be able to cover wide debate on their own, so an exercise has been designed that helps generate consensus decisions from diverse opinions. The exercise was piloted with two groups, an undergraduate medical class and the members of a general practice. Though the aims were different for each group, the tool was (...) useful to both for producing the desired outcomes. Expert and non-expert knowledge were drawn upon and rationing prioritisation lists regarding funding of infertility treatment were generated. A description of the exercise and the results produced by the two groups are provided, as well as the theoretical placement for the significance of forming consensus from diversity. (shrink)

This text includes practical coverage of all the issues likely to be of concern to students during their medical careers.

In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for examining the moral (...) dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors. The elements also help minimize or avoid certain miscalculations and harms. Emphasis is placed on the shared humanity of those who provide and those who receive assistance, acknowledgement of limits and risks related to the contributions of expatriate health care professionals, and the importance of providing skillful and relevant assistance. These elements articulate a moral posture for expatriate health care professionals that contributes to orienting the practice of clinicians in ways that reflect respect, humility, and solidarity. Health care professionals whose understanding and actions are consistent with the ethics of engaged presence will be oriented toward introspection and reflective practice and toward developing, sustaining and promoting collaborative partnerships. (shrink)

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, Sjöberg, (...) Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

Humanitarian healthcare work presents a range of ethical challenges for expatriate healthcare professionals, including tragic choices requiring the selection of a least-worst option. In this paper we examine a particular set of tragic choices related to the prioritization of care and allocation of scarce resources between individuals in situations of widespread and urgent health needs. Drawing on qualitative interviews with clinicians, we examine the nature of these choices. We offer recommendations to clinical teams and aid organizations for preparing and supporting (...) frontline clinicians in their efforts to determine the least-worst option, and in their responsibility for making such choices. (shrink)

In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for examining the moral (...) dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors. The elements also help minimize or avoid certain miscalculations and harms. Emphasis is placed on the shared humanity of those who provide and those who receive assistance, acknowledgement of limits and risks related to the contributions of expatriate health care professionals, and the importance of providing skillful and relevant assistance. These elements articulate a moral posture for expatriate health care professionals that contributes to orienting the practice of clinicians in ways that reflect respect, humility, and solidarity. Health care professionals whose understanding and actions are consistent with the ethics of engaged presence will be oriented toward introspection and reflective practice and toward developing, sustaining and promoting collaborative partnerships. (shrink)

Managing non-communicable diseases in crisis-affected and fragile humanitarian contexts requires special attention because primary health care systems often collapse or become compromised in such settings. As a result, addressing and managing these diseases become more challenging. Humanitarian organizations that intervene in crisis situations are increasingly including NCD management in the services they support and provide; however, they encounter a range of issues such as ensuring the quality of care, sustainability of programs, and the possibility of unintended harms. This case study (...) explores ethical considerations raised by a mobile NCD program run by an international humanitarian organization in a country affected by a protracted civil war. (shrink)

The Médecins Sans Frontières ethics review board has been solicited in an unprecedented way to provide advice and review research protocols in an ‘emergency’ mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, ranging from epidemiological research, to behavioural research, infectivity studies and clinical trials with investigational products at early development stages. This article examines the MSF ERB’s experience addressing issues related to both the process of review and substantive ethical issues (...) in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms. Having noticed different standards across ethics committees, we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the ‘optimal’ ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process. (shrink)

Humanitarian healthcare work presents a range of ethical challenges for expatriate healthcare professionals, including tragic choices requiring the selection of a least-worst option. In this paper we examine a particular set of tragic choices related to the prioritization of care and allocation of scarce resources between individuals in situations of widespread and urgent health needs. Drawing on qualitative interviews with clinicians, we examine the nature of these choices. We offer recommendations to clinical teams and aid organizations for preparing and supporting (...) frontline clinicians in their efforts to determine the least-worst option, and in their responsibility for making such choices. (shrink)

Research involving migrant youth involves navigating and negotiating complex challenges in order to uphold their rights and dignity, but also all while maintaining scientific rigour. COVID-19 has changed the global landscape within many domains and has increasingly highlighted inequities that exist. With restrictions focusing on maintaining physical distancing set in place to curb the spread of the virus, conducting in-person research becomes complicated. This article reflects on the ethical and methodological challenges encountered when conducting qualitative research during the pandemic with (...) Syrian migrant youth who are resettled in Canada. The three areas discussed from the study are recruitment, informed consent and managing the interviews. Special attention to culture as being part of the study’s methodology as an active reflexive process is also highlighted. The goal of this article is to contribute to the growing understanding of complexities of conducting research during COVID-19 with populations which have layered vulnerabilities, such as migrant youth. This article hopes that the reflections may help future researchers in conducting their research during this pandemic by being cognizant of both the ethical and methodological challenges discussed. (shrink)

Authorship of a scientific paper is important in recognition of one’s work, and in the academic setting, helps in professional promotion. Conflicting views of authorship have led to disputes and debates in many scientific communities. Addressing ethical issues in medical research and publishing, and conforming to the requirements of international organizations and local research ethics boards, has become an essential part of the research endeavor. Ethical issues of biomedical authorship have been a matter of debate for years. Authorship problems may (...) involve problems with integrity, including ghost authorship and guest authorship. Some scientific disciplines, such as engineering or social sciences, may not have a firm guideline for authorship criteria; however this article reviews the criteria of authorship recommended by related international organizations of biomedical field and discusses common scenarios that may lead to authorship disputes and misconducts as well as issues related to authorship in multicenter studies. The paper also discusses possible scenarios that might be legitimate to make changes in authorship lists. (shrink)

The most common solutions to the problem of high pharmaceutical prices have taken the form of regulations, price negotiations, or changes in drug coverage by insurers. These measures for the most part transfer the burden of drug expenditures between pharmaceutical companies and payers or between payers. The aim of this study is to propose an alternative model for the relationship between the main stakeholders involved in the price setting and purchasing of pharmaceuticals, one that encourages a more cooperative approach. We (...) draw from principles of ethics and health economics and apply them to the context of the pharmaceutical industry. The model prioritises two objectives, to make drugs financially accessible to the patients who need them, and to keep pharmaceutical companies viable and profitable. It is centered around the sharing of financial risk between the main stakeholders, which we describe as ‘enlightened risk sharing’. After establishing the foundations of this model, we expand on the type of policies that can follow these principles with current day examples. (shrink)

The application of evidence-based medicine helps clinicians avoid unnecessary procedures and decreases unnecessary harm for future patients while sparing economic burdens. Randomised controlled trials most accurately produce best research evidence. In arthroscopic surgery, however, many procedures have been extensively used without supportive evidence verified with RCTs. In this paper, we introduce two procedures, where over 30 years of procedure usage has continued prior to garnering evidence for the inefficacy of the procedures. The situations are attributed to the fact that clinical (...) trials in arthroscopic surgeries are challenging given the use of placebo controls. A placebo-control RCT can accurately answer research questions about efficacy and safety of surgical procedures; however, the majority of arthroscopic surgeries in practice have not been rigorously tested against placebo surgeries. This is because preparing surgical placebo controls, known as sham surgeries, are ethically controversial. Also considering that high-quality study results often do not change clinical practice due to insufficient knowledge translation, the benefits of such trials may be uncertain to society at large. Additionally, there are a lack of clear guidelines for conducting arthroscopic placebo surgeries in RCTs. We hope that this article helps drive discussion about appropriate use of placebo surgeries in RCTs to produce the best quality evidence in arthroscopic surgery. (shrink)

Thinkers in related fields such as philosophy, psychology, and education define metacognition in a variety of different ways. Based on an emerging standard definition in psychology, we present evidence for metacognition in animals, and argue that mindreading and metacognition are largely orthogonal.

Non-Invasive Prenatal Testing is a technology which provides information about fetal genetic characteristics very early in pregnancy by examining fetal DNA obtained from a sample of maternal blood. NIPT is a morally complex technology that has advanced quickly to market with a strong push from industry developers, leaving many areas of uncertainty still to be resolved, and creating a strong need for health policy that reflects women’s social and ethical values. We approach the need for ethical policy-making by studying the (...) use of NIPT and emerging policy in the province of Ontario, Canada. Using an adapted version of constructivist grounded theory, we conducted interviews with 38 women who have had personal experiences with NIPT. We used an iterative process of data collection and analysis and a staged coding strategy to conduct a descriptive analysis of ethics issues identified implicitly and explicitly by women who have been affected by this technology. The findings of this paper focus on current ethical issues for women seeking NIPT, including place in the prenatal pathway, health care provider counselling about the test, industry influence on the diffusion of NIPT, consequences of availability of test results. Other issues gain relevance in the context of future policy decisions regarding NIPT, including funding of NIPT and principles that may govern the expansion of the scope of NIPT. These findings are not an exhaustive list of all the potential ethical issues related to NIPT, but rather a representation of the issues which concern women who have personal experience with this test. Women who have had personal experience with NIPT have concerns and priorities which sometimes contrast dramatically with the theoretical ethics literature. These findings suggest the importance of engaging patients in ethical deliberation about morally complex technologies, and point to the need for more deliberative patient engagement work in this area. (shrink)

The conduct of research in settings affected by disasters such as hurricanes, floods and earthquakes is challenging, particularly when infrastructures and resources were already limited pre-disaster. However, since post-disaster research is essential to the improvement of the humanitarian response, it is important that adequate research ethics oversight be available. We aim to answer the following questions: 1) what do research ethics committee members who have reviewed research protocols to be conducted following disasters in low- and middle-income countries perceive as the (...) key ethical concerns associated with disaster research?, and 2) in what ways do REC members understand these concerns to be distinct from those arising in research conducted in non-crisis situations? This qualitative study was developed using interpretative description methodology; 15 interviews were conducted with REC members. Four key ethical issues were identified as presenting distinctive considerations for disaster research to be implemented in LMICs, and were described by participants as familiar research ethics issues that were amplified in these contexts. First, REC members viewed disaster research as having strong social value due to its potential for improving disaster response, but also as requiring a higher level of justification compared to other research settings. Second, they identified vulnerability as an overarching concern for disaster research ethics, and a feature that required careful and critical appraisal when assessing protocols. They noted that research participants’ vulnerabilities frequently change in the aftermath of a disaster and often in unpredictable ways. Third, they identified concerns related to promoting and maintaining safety, confidentiality and data security in insecure or austere environments. Lastly, though REC members endorsed the need and usefulness of community engagement, they noted that there are significant challenges in a disaster setting over and above those typically encountered in global health research to achieve meaningful community engagement. Disaster research presents distinctive ethical considerations that require attention to ensure that participants are protected. As RECs review disaster research protocols, they should address these concerns and consider how justification, vulnerability, security and confidentially, and community engagement are shaped by the realities of conducting research in a disaster. (shrink)

The way in which medical professionals engage in bioethical issues ultimately reflects the type of care such patients are likely to receive. It is therefore critical for doctors and other health care professionals to have a broad understanding of disability. Our purpose in this paper is to explore ways of teaching bioethical issues to first year medical students by integrating alternative approaches. Such approaches include (a) the use of the narrative format, (b) the inclusion of a disability perspective, and (c) (...) the presentation and facilitation of classes by people with disabilities. We consider how these new kinds of presentations are evaluated by students, faculty, people with disabilities and professional ethicists. We hope new knowledge may provide health care professionals with a greater understanding of the perspectives of patients with disabilities, who are confronted by conflicting ethical values and frameworks for decision-making in their interaction with such professionals. (shrink)

It is clear that in the eyes of a growing number of humanitarian fieldworkers and decision-makers, palliative care is something humanitarian organizations should strive to provide as they address the needs of populations affected by crises. What remains less clear are the moral justifications underlying the push to do so. This chapter dives beneath surface prescriptions of what “ought to be” the place of palliative care within humanitarian response. It presents and analyses a series of evocative statements made by 24 (...) humanitarian healthcare actors about why, on what bases, and with what caveats, care for the dying deserves more attention within humanitarian healthcare response. Embedded in these statements are sometimes explicit, sometimes implicit ideas about what it means be a human and a humanitarian, and what humans need and deserve. Clarifying the experiences, practical considerations, understandings of care and responsibility, and norms and values underlying these feelings renders these available for more thorough reflection, discussion, and debate. (shrink)

BackgroundWhile evaluation of ethical aspects in health technology assessment has gained much attention during the past years, the integration of ethics in HTA practice still presents many challenges. In response to the increasing demand for expansion of health technology assessment methodology to include ethical issues more systematically, this article reports on a multi-stage study that aimed at construction of a framework for improving the integration of ethics in HTA.MethodsThe framework was developed through the following phases: 1) a systematic review and (...) content analysis of guidance documents for ethics in HTA; 2) identification of factors influencing the integration of ethical considerations in HTA; 3) preparation of an action-oriented framework based on the key elements of the existing guidance documents and identified barriers to and facilitators of their implementation; and 4) expert consultation and revision of the framework.ResultsThe proposed framework consists of three main components: an algorithmic flowchart, which exhibits the different steps of an ethical inquiry throughout the HTA process, including: defining the objectives and scope of the evaluation, stakeholder analysis, assessing organizational capacity, framing ethical evaluation questions, ethical analysis, deliberation, and knowledge translation; a stepwise guide, which focuses on the task objectives and potential questions that are required to be addressed at each step; and a list of some commonly recommended or used tools to help facilitate the evaluation process.ConclusionsThe proposed framework can be used to support and promote good practice in integration of ethics into HTA. However, further validation of the framework through case studies and expert consultation is required to establish its utility for HTA practice. (shrink)

BackgroundThe amount of research utilizing health information has increased dramatically over the last ten years. Many institutions have extensive biobank holdings collected over a number of years for clinical and teaching purposes, but are uncertain as to the proper circumstances in which to permit research uses of these samples. Research Ethics Boards (REBs) in Canada and elsewhere in the world are grappling with these issues, but lack clear guidance regarding their role in the creation of and access to registries and (...) biobanks.MethodsChairs of 34 REBS and/or REB Administrators affiliated with Faculties of Medicine in Canadian universities were interviewed. Interviews consisted of structured questions dealing with diabetes-related scenarios, with open-ended responses and probing for rationales. The two scenarios involved the development of a diabetes registry using clinical encounter data across several physicians' practices, and the addition of biological samples to the registry to create a biobank.ResultsThere was a wide range of responses given for the questions raised in the scenarios, indicating a lack of clarity about the role of REBs in registries and biobanks. With respect to the creation of a registry, a minority of sites felt that consent was not required for the information to be entered into the registry. Whether patient consent was required for information to be entered into the registry and the duration for which the consent would be operative differed across sites. With respect to the creation of a biobank linked to the registry, a majority of sites viewed biobank information as qualitatively different from other types of personal health information. All respondents agreed that patient consent was needed for blood samples to be placed in the biobank but the duration of consent again varied.ConclusionParticipants were more attuned to issues surrounding biobanks as compared to registries and demonstrated a higher level of concern regarding biobanks. As registries and biobanks expand, there is a need for critical analysis of suitable roles for REBs and subsequent guidance on these topics. The authors conclude by recommending REB participation in the creation of registries and biobanks and the eventual drafting of comprehensive legislation. (shrink)

BackgroundThe role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues.MethodsWe conducted seven (...) day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly.ResultsBroad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research.ConclusionBecause no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record for purposes other than clinical care. This could be done, for example, through a web-based patient portal to their electronic health record. Researchers and policy makers should continue to engage the public to promote greater public understanding of the research process and to look for feasible alternatives to existing approaches to project-specific consent for observational research. (shrink)

While evaluation of ethical aspects in health technology assessment has gained much attention during the past years, the integration of ethics in HTA practice still presents many challenges. In response...

The humanitarian sector continually faces organizational and operational challenges to respond to the needs of populations affected by war, disaster, displacement, and health emergencies. With the goal of improving the effectiveness and efficiency of response efforts, humanitarian innovation initiatives seek to develop, test, and scale a variety of novel and adapted practices, products, and systems. The innovation process raises important ethical considerations, such as appropriately engaging crisis-affected populations in defining problems and identifying potential solutions, mitigating risks, ensuring accountability, sharing benefits (...) fairly, and managing expectations. This paper aims to contribute to knowledge and practice regarding humanitarian innovation ethics and presents two components related to a value-sensitive approach to humanitarian innovation. First is a mapping of how ethical concepts are mobilized in values statements that have been produced by a diverse set of organizations involved in humanitarian innovation. Analyzing these documents, we identified six primary values (do-no-harm, autonomy, justice, accountability, sustainability, and inclusivity) around which we grouped 12 secondary values and 10 associated concepts. Second are two proposed activities that teams engaged in humanitarian innovation can employ to foreground values as they develop and refine their project’s design, and to anticipate and plan for challenges in enacting these values across the phases of their project. A deliberate and tangible approach to engaging with values within humanitarian innovation design can help to ground humanitarian innovation in ethical commitments by increasing shared understanding amongst team members, promoting attentiveness to values across the stages of innovation, and fostering capacities to anticipate and respond to ethically challenging situations. (shrink)

In 2016, following pandemic influenza threats and the 2014–2016 Ebola virus disease outbreaks, the WHO developed a guidance document for managing ethical issues in infectious disease outbreaks. In this article, we analyse some ethical issues that have had a predominant role in decision making in response to the current COVID-19 pandemic but were absent or not addressed in the same ways in the 2016 guidance document. A pandemic results in a health crisis and social and political crises both nationally and (...) globally. The ethical implications of these global effects should be properly identified so that appropriate actions can be taken globally and not just in national isolation. Our analysis, which is a starting point to test the broader relevance of the 2016 WHO document that remains the only available guidance document applicable globally, concludes that the WHO guidance should be updated to provide reasoned and thoughtful comprehensive ethics advice for the sound management of the current and future pandemics. (shrink)

BackgroundStigma refers to a distinguishing personal trait that is perceived as or actually is physically, socially, or psychologically disadvantageous. Little is known about the opinion of those who have more or less stigmatizing health conditions regarding the need for consent for use of their personal information for health research.MethodsWe surveyed the opinions of people 18 years and older with seven health conditions. Participants were drawn from: physicians' offices and clinics in southern Ontario; and from a cross-Canada marketing panel of individuals (...) with the target health conditions. For each of five research scenarios presented, respondents chose one of five consent choices: (1) no need for me to know; (2) notice with opt-out; (3) broad opt-in; (4) project-specific permission; and (5) this information should not be used. Consent choices were regressed onto: demographics; health condition; and attitude measures of privacy, disclosure concern, and the benefits of health research. We conducted focus groups to discuss possible reasons for observed consent choices.ResultsWe observed substantial variation in the control that people wish to have over use of their personal information for research. However, consent choice profiles were similar across health conditions, possibly due to sampling bias. Research involving profit or requiring linkage of health information with income, education, or occupation were associated with more restrictive consent choices. People were more willing to link their health information with biological samples than with information about their income, occupation, or education.ConclusionsThe heterogeneity in consent choices suggests individuals should be offered some choice in use of their information for different types of health research, even if limited to selectively opting-out. Some of the implementation challenges could be designed into the interoperable electronic health record. However, many questions remain, including how best to capture the opinions of those who are more privacy sensitive. (shrink)

`Being sensitive' in nursing was explored using Schwartz-Barcott and Kim's hybrid model of concept development, producing a tentative definition of the concept. Three phases were employed: theoretical, empirical/fieldwork and analytical. An exploration of the literature identified where the common idea of `being sensitive' as a nurse was embedded and demonstrated that a theoretical development of this fundamental aspect of nursing was absent. The empirical phase was conducted using semistructured interviews with nine expert palliative care and cancer nurses. This method (...) was particularly useful for the exploration of this concept because of its firm grounding in practical example. A definition of what the concept `being sensitive' means in nursing, and subsequent clarification of `being insensitive', have been posed from the research process undertaken. The essential nature of this concept being integral to nursing practice is emphasized. Potential implications for the development of nursing practice through teaching of this concept were identified. (shrink)

Do bioethicists need yet another theoretical approach with which to frame their disagreements? Many pragmatists contend that pragmatism, unlike its liberal and utilitarian counterparts, is uniquely commendable in (a) beginning from our lived experiences and (b) locating those experiences amid our social relations. In place of an " principlism," pragmatism offers a practical "bedside-bioethic"; in lieu of "autonomy run amuk," pragmatism proposes an ethic rooted in our communal resources. To date, however, efforts to develop such a bioethic have been stymied (...) by pragmatists' own abstract theoretical commitments, commitments that prevent them, most directly, from beginning with the lived experiences and communal resources of those who hold theological commitments. This self-imposed methodological constraint, I argue, has needlessly thwarted pragmatism's most striking methodological promise: its potential to cultivate productive debates among secular and theologically-informed participants. (shrink)

Abstract In this paper I discuss one apparent counterexample to the rationality constraint on belief ascription. The fact that there are inconsistent believers does not seem compatible with the idea that only rational creatures can be ascribed beliefs. I consider Davidson's explanation of the possibility of inconsistent believers and claim that it involves a reformulation of the rationality constraint in terms of the believers' subscription to norms of rationality. I shall argue that Davidson's strategy is partially successful, but that the (...) emphasis on the notion of subscription badly fits with the motivations behind his theory of interpretation. (shrink)

Prolonged solitary confinement has become a widespread and standard practice in U.S. prisons—even though it consistently drives healthy prisoners insane, makes the mentally ill sicker, and, according to the testimony of prisoners, threatens to reduce life to a living death. In this profoundly important and original book, Lisa Guenther examines the death-in-life experience of solitary confinement in America from the early nineteenth century to today’s supermax prisons. Documenting how solitary confinement undermines prisoners’ sense of identity and their ability to (...) understand the world, Guenther demonstrates the real effects of forcibly isolating a person for weeks, months, or years. -/- Drawing on the testimony of prisoners and the work of philosophers and social activists from Edmund Husserl and Maurice Merleau-Ponty to Frantz Fanon and Angela Davis, the author defines solitary confinement as a kind of social death. It argues that isolation exposes the relational structure of being by showing what happens when that structure is abused—when prisoners are deprived of the concrete relations with others on which our existence as sense-making creatures depends. Solitary confinement is beyond a form of racial or political violence; it is an assault on being. (shrink)

According to the conceptual act theory, emotions emerge when physical sensations in the self and physical actions in others are meaningfully linked to situations during a process that can be called both cognitive and perceptual (creating emotional experiences, and emotion perceptions, respectively). There are key four hypotheses: (a) an emotion (like anger) is a conceptual category, populated with instances that are tailored to the environment; (b) each instance of emotion is constructed within the brain’s functional architecture of domain-general core systems; (...) (c) the workings of each system must be holistically understood within the momentary state of the brain, the body, and the surrounding context; (d) being emergent states, emotional episodes have functional features that physical states, alone, do not have. Similarities and differences to other theoretical approaches to emotion are discussed. (shrink)

Contemporary biomedical ethics and environmental ethics share a common ancestry in Aldo Leopold's and Van Rensselaer Potter's initial broad visions of a connected biosphere. Over the past five decades, the two fields have become strangers. Public health ethics, a new subfield of bioethics, emerged from the belly of contemporary biomedical ethics and has evolved over the past 25 years. It has moved from its traditional concern with the tension between individual autonomy and community health to a wider focus on social (...) justice and solidarity. Public health has a broad focus that includes individual, community, and environmental health. Public health ethics attends to these broad commitments reflected in the increasing concern with the connectedness of health of individuals to the health of populations, to the health of animals, to the health of the environment; it is well situated to reconnect all three “fields” of ethics to promote a healthier planet. (shrink)

The world of wage labour seems to have become a soulless machine, an engine of social and environmental destruction. Employees seem to be nothing but 'cogs' in this system - but is this true? Located at the intersection of political theory, moral philosophy, and business ethics, this book questions the picture of the world of work as a 'system'. Hierarchical organizations, both in the public and in the private sphere, have specific features of their own. This does not mean, however, (...) that they cannot leave room for moral responsibility, and maybe even human flourishing. Drawing on detailed empirical case studies, Lisa Herzog analyses the nature of organizations from a normative perspective: their rule-bound character, the ways in which they deal with divided knowledge, and organizational cultures and their relation to morality. The volume examines how individual agency and organizational structures would have to mesh to avoid common moral pitfalls and develops the notion of 'transformational agency', which refers to a critical, creative way of engaging with one's organizational role while remaining committed to basic moral norms. The volume goes on to explore the political and institutional changes that would be required to re-embed organizations into a just society. Whether we submit to 'the system' or try to reclaim it, Herzog argues, is a question of eminent political importance in our globalized world. (shrink)

This paper investigates how deans and directors at the top 50 global MBA programs (as rated by the "Financial Times" in their 2006 Global MBA rankings) respond to questions about the inclusion and coverage of the topics of ethics, corporate social responsibility, and sustainability at their respective institutions. This work purposely investigates each of the three topics separately. Our findings reveal that: (1) a majority of the schools require that one or more of these topics be covered in their MBA (...) curriculum and one-third of the schools require coverage of all three topics as part of the MBA curriculum, (2) there is a trend toward the inclusion of sustainability-related courses, (3) there is a higher percentage of student interest in these topics (as measured by the presence of a Net Impact club) in the top 10 schools, and (4) several schools are teaching these topics using experiential learning and immersion techniques. We note a fivefold increase in the number of stand-alone ethics courses since a 1988 investigation on ethics, and we include other findings about institutional support of centers or special programs; as well as a discussion of integration, teaching techniques, and notable practices in relation to all three topics. (shrink)

I motivate and develop a novel account of the epistemic assessability of suspension as a development of my knowledge-first, virtue-epistemological research program. First, I extend an argument of Ernest Sosa's for the claim that evidentialism cannot adequately account for the epistemic assessability of suspension. This includes a kind of knowledge-first evidentialism of the sort advocated by Timothy Williamson. I agree with Sosa that the reasons why evidentialism fails motivate a virtue-epistemological approach, but argue that my knowledge-first account is preferable to (...) his view. According to my account, rational belief is belief that manifests proper practical respect for what it takes to know. Beliefs are the only primary bearers of epistemic evaluation since they are the only candidates for knowledge. However, suspension can manifest a derivative kind of practical respect for what it takes to know. Thus, we can explain why the same sort of assessment is applicable to both belief and suspension, and why belief has a privileged claim to these properties. Lastly, I'll look at Sosa's and Williamson's treatments of Pyrrhonian skepticism, which treats a certain kind of suspension as the epistemically superior practice, and argue that my account provides a better anti-skeptical response than either of their approaches. (shrink)

Inventing the Market explores two paradigms of the market in the thought of Adam Smith and G.W.F. Hegel, bridging the gap between economics and philosophy, it shows that both disciplines can profit from a broader, more historically situated ...

Blaise Pascal (1623–1662) Blaise Pascal was a French philosopher, mathematician, scientist, inventor, and theologian. In mathematics, he was an early pioneer in the fields of game theory and probability theory. In philosophy he was an early pioneer in existentialism. As a writer on theology and religion he was a defender of Christianity. Despite chronic ill […].

This paper argues, on the basis of data from St'át'imcets (Lillooet Salish), for a theory of wide-scope indefinites which is similar, though not identical, to that proposed by Kratzer (1998). I show that a subset of S'át'imcets indefinites takes obligatory wide scope with respect to if-clauses, negation, and modals, and is unable to be distributed over by quantificational phrases. These wide-scope effects cannot be accounted for by movement, but require an analysis involving choice functions (Reinhart 1995, 1997). However, Reinhart's particular (...) choice function analysis is unable to account for the St'át'imcets data. A Kratzer-style theory, on the other hand, accounts not only for the wide-scope effects, but also for the emergence of narrower-than-widest interpretations for indefinites which contain bound variables. I depart from Kratzer's analysis in claiming that St'át'imcets choice function indefinites are not 'specific'; the discourse context does not provide a value for the function variable. Therefore, I utilize wide- scope existential closure over choice functions rather than leaving the variables free. However, my analysis provides support for Kratzer's claim that English indefinites are ambiguous between a choice function interpretation and a quantificational interpretation, since St'át'imcets determiners overtly encode the English ambiguity. I conclude by suggesting that the proposed analysis of wide-scope indefinites may be universally valid. (shrink)

This paper discusses global reserve currencies from the perspective of structural global justice. Drawing on notions of structural justice and background justice, it suggests that the structures of global finance, by creating positions of privilege and disadvantage, can lead to injustices both with regard to distributive outcomes and with regard to domination. While the role of the dollar and Euro as global reserve currencies are not the only factors that contribute to these structural injustices, they need to be taken into (...) account to fully grasp the dynamics of global finance. They also have an impact on other mechanisms, such as sovereign debt, capital flows, and the governance of international financial institutions. The paper’s arguments support the claim that one cannot conceptualize global justice as justice between independent states. Rather, the global monetary regime constitutes a case of “background injustice” (Ronzoni 2009). (shrink)

What makes solitude a positive experience? What distinguishes experiences of solitude from experiences of loneliness? We review some of the literature on the benefits of solitude, focusing on freedom, creativity, and spirituality. Then, we argue that the relationship between agent and environment is an important factor in determining the quality of experiences of solitude. In particular, we find that solitude may support a person’s sense of agency, expanding the possibilities for action that a person has, and creating the conditions for (...) authenticity. We describe a phenomenology of solitude, based on a study that explores the nature of experiences of loneliness and solitude in a religious community. One finding is that solitude is characterised by presence, whereas loneliness is characterised by absence. Another finding is that solitude can contribute to a sense of empowerment that enables agents to pursue and achieve the goals they find valuable. (shrink)

As conflict between multinational corporations and local communities escalates, scholars, executives, activists, and community leaders are calling for companies to become more accountable for the impact of their activities on external stakeholders. In order for business to do so, managers must first understand the causes of conflict with local communities, and communities must understand what courses of action are available to challenge activities they deem harmful to their interests. In this article, I present a framework for examining the factors that (...) contribute to multinational and community conflict including stakeholder power inequality, stakeholder perception gaps and cultural context. Moreover, I describe some of the ways that communities can increase their leverage in conflict situations. (shrink)

This study investigated the knowledge of academic integrity and associated emotions of a small sample of international students studying at Canadian postsecondary institutions using survey methodology. Depending on the survey item, 25–60 participants provided responses. Many respondents appeared knowledgeable about academic integrity and misconduct and reported that expectations in their home countries and in Canada were similar. There was, however, disagreement on the concept of duplicate submission/self-plagiarism, indicating an important gap in educating students about specific aspects of policy in postsecondary (...) education in Canada. In addition, more than a third of respondents provided neutral responses to a situation involving contract cheating, suggesting a lack of certainty in how to respond when witnessing peers’ engagement in outsourcing academic work. Many respondents reported feeling confident upon reading the academic integrity and misconduct policies of their Canadian postsecondary institution, although nearly one third indicated feeling fearful, anxious, and/or confused. These negative feelings were associated with reduced knowledge of academic integrity and misconduct. Future research should further explore the experiences and emotions of international students related to academic integrity and misconduct to better understand the successes and challenges that they face in their postsecondary studies in Canada. Our findings have important implications for the delivery of academic integrity education, enhancing supports and resources, and refining academic integrity policies and procedures to improve the experience of students who come from abroad to study in Canada. (shrink)

George Berkeley, Bishop of Cloyne, was one of the great philosophers of the early modern period. He was a brilliant critic of his predecessors, particularly Descartes, Malebranche, and Locke. He was a talented metaphysician famous for defending idealism, that is, the view that reality consists exclusively of minds and their ideas. Berkeley's system, while it strikes many as counter intuitive, is strong and flexible enough to counter most objections. His most studied works, the Treatise Concerning the Principles of Human Knowledge (...) Principles, for short) and Three Dialogues between Hylas and Philonous Dialogues), are beautifully written and dense with the sort of arguments that delight contemporary philosophers. He was also a wide ranging thinker with interests in religion (which were fundamental to his philosophical motivations), the psychology of vision, mathematics, physics, morals, economics, and medicine. Although many of Berkeley's first readers greeted him with incomprehension, he influenced both Hume and Kant, and is much read (if little followed) in our own day. (shrink)

A provocateur does not pose a threat of harm. Hence, a forceful response to provocation is generally considered wrongful. And yet, a provocateur is often denied recourse to a self-defence justification if she defends herself against such a violent response. In recent work, Kimberly Ferzan argues that a provocateur forfeits defensive rights but this forfeiture cannot be explained in the same way as an aggressor’s rights forfeiture. Ordinarily, one forfeits the right not to be harmed and to self-defend against harm (...) by threatening to violate another person’s rights. But provocateurs forfeit their defensive rights because they bring about the situation in which defence becomes necessary. As I argue here, positing these two types of forfeiture justifications is neither desirable nor necessary. I suggest a unified rights forfeiture account that grounds rights forfeiture in moral responsibility for an unjust threat. My account offers clearer distinctions than alternative unified accounts, which I briefly discuss. Furthermore, the account can provide better explanations of intuitively plausible judgements. A provocateur will have less extensive defensive rights than an innocent victim, but will not lose all her defensive rights simply because ‘she started it.’. (shrink)

This volume brings together leading scholars from political theory, law, and economics in order to discuss the relationship between financial markets and justice, and invites us to rethink the place and role of financial markets in our societies.