The emergency department (ED) serves as the primary gateway for acute care and the source of health care of last resort. Emergency physicians are commonly expected to rapidly assess and treat patients with a variety of life–threatening conditions. However, patients do refuse recommended therapy, even when the consequences are significant morbidity and even mortality. This raises the ethical dilemma of how emergency physicians and ED staff can rapidly determine whether patient refusal of treatment recommendations is based on intact decision–making capacity (...) and how to respond in an appropriate manner when the declining of necessary care by the patient is lacking a basis in informed judgment. This article presents a case that illustrates the ethical tensions raised by the refusal of life–sustaining care in the ED and how such situations can be approached in an ethically appropriate manner. (shrink)

It describes and explains the patient-centered model examining and evaluating qualitative and quantitative research. It comprehensively covers the evolution and the six interactive components of the patient-centered clinical method, taking the reader through the relationships between the patient and doctor and the patient and clinician. All the editors are professors in the Department of Family Medicine at the University of Western Ontario, London, Canada.

An introduction to the philosophy of love, bridging analytic and continental philosophy and the philosophy of religion, through the writings of Harry G. Frankfurt and S.ren Kierkegaard.

Our everyday notion of freedom is an innate prejudice. It is based on our inadequate knowledge of the causes of things and on our tendency to accord too much credence to the way things appear, that is, to the way that things outside ourselves affect us. Imagination, the lowest kind of knowledge, is the source of falsity and error, and it lies at the origin of human bondage to affect. The imagination can be deployed in the service of attaining a (...) relatively freer existence through imagining ourselves as acting like the free man held up by Spinoza in E4Pref as a model of human nature. The free man embodies the sure maxims of life to a perfect degree. Spinoza explicitly says that the free man is noble and tenacious, that is, he possesses the active affects described under the virtue of strength of character. (shrink)

This chapter contains section titled: Introduction Theoretical Perspectives Challenges Conclusion References Further Reading.

The primary purpose of government is to secure public goods that cannot be achieved by free markets. The Coordination Principle tells us to consolidate sovereign power in a single institution to overcome collective action problems that otherwise prevent secure provision of the relevant public goods. There are several public goods that require such coordination at the global level, chief among them being basic human rights. The claim that human rights require global coordination is supported in three main steps. First, I (...) consider Pogge's and Habermas's analyses as alternatives to Hobbesian conceptions of justice. Second, I consider the core conventions of international law, which are in tension with the primacy of state sovereignty in the UN system. Third, I argue that the just war tradition does not limit just causes for war to self-defense; it supports saving innocent third parties from crimes against humanity as a just reason for war. While classical authors focused less on this issue, the point is especially clear in twentieth-century just war theories, such as those offered by the American Catholic bishops, Jean Elshtain, Brian Orend, and Michael Walzer. Against Walzer, I argue that we add intractable military tyranny to the list of horrors meriting intervention if other ad bellum conditions are met. But these results require us to reexamine the "just authority" of first resort to govern such interventions. The Coordination Principle implies that we should create a transnational federation with consolidated powers in place of a treaty organization requiring near-unanimity. But to be legitimate, such a global institution must also be directly answerable to the citizens of its member states. While the UN Security Council is inadequate on both counts, a federation of democracies with a directly elected executive and legislature could meet both conditions. (shrink)

Institutional Review Boards are confronted with new challenges in the face of expanding technologies while fulfll-ing their existing regulatory mandate to ensure that plans are in place to protect subjects and to inform them of risks and benefts of research participation. Existing regulations and guidance do not address the issue of incidental fndings , thus leaving awareness of the issue and the application of ethical principles to IRB judgment alone. In order to assure that researchers are aware of the potential (...) for IFs, IRBs must identify which studies are likely to identify IFs and establish what plans should be put into place prior to study initiation to assure the subjects are appropriately informed of the likelihood of IFs, how IFs will be communicated to subjects, and whether the burden of follow-up falls on the researchers or is the subject's responsibility. (shrink)

With rapidly expanding technological capacity, research has outpaced the existing infrastructure of ethical and regulatory guidance. In the area of incidental findings, this is particularly true.The regulations under which most Institutional Review Boards operate were established over 25 years ago and have not been substantially altered in the intervening years. The technology available today that creates the opportunity for IFs was not conceived of, or considered, in the crafting of those regulations. Therefore, little guidance can be derived directly from these (...) regulations. Rather, aspects of existing ethical guidance and regulations can be adapted to assist IRBs and researchers in dealing with issues surrounding IFs. (shrink)

It has typically been assumed that affective and social components of disagreement, such as trust and fair treatment, can be handled separately from substantive components, such as beliefs and logical principles. This has freed us to count as “deep” disagreements only those which persist even between people who have no animosity towards each other, feel equal to one another, and are willing to argue indefinitely in search of truth. A reliance on such ideal participants diverts us from the question of (...) whether we have swept away the opportunity for some real arguers to have their voices heard, and for those voices to determine the real substance of the disagreement. If affective and social issues need to be assessed side by side with belief differences and reasoning paradigms, investigating trust may assist us to understand and make progress on the affective and social components that are involved in disagreement. (shrink)

For individuals pursuing medically assisted gender transition, gender-affirming surgical treatments, such as oophorectomy (removal of the ovaries) and orchiectomy (removal of the testicles), cause sterility, and gender-affirming hormone treatment with medications (i.e., testosterone and estrogen) may negatively impact infertility. The major United States (US) medical associations already endorse fertility preservation (FP) through cryopreservation (i.e., “freezing” egg and sperm) for transgender individuals. Despite these endorsements from the relevant medical societies, medical insurance coverage for FP remains very limited in the US. Given (...) the high out-of-pocket costs for FP services, fertility preservation remains financially out of reach for many transgender individuals who may desire it. We present an ethical justification for universal FP coverage for all transgender and gender diverse (TGD) individuals who request this option during medically assisted gender transition. First, we argue that gender-affirming medical care is analogous to other medical interventions and treatment regimens that compromise fertility, such as cancer care, and that both types of interventions need to be afforded the same medical benefits and assistance in pursuing fertility goals. Second, we argue that the lack of FP for transgender individuals contributes to the ongoing and profound transphobia and anti-trans bias that has been exacerbated in the past several years across the healthcare landscape in the United States. We argue that the provision of FP coverage for transgender individuals is necessary for clinicians and third-party payers to state their unequivocal support for TGD patients and their healthcare needs. (shrink)

Students in critical thinking courses are often instructed to "read carefully" as a prerequisite to thinking critically. This instruction, which seems like a simple preliminary caution, in fact reveals controversial assumptions about how readers read, and whether critical thinking instruction presupposes the reading skill it purports to teach.

In lieu of an abstract, here is a brief excerpt of the content:Locating Heaven:Modern Science and the Place of Christ's Glorified BodyThomas Davenport O.P.It seems only fitting to respond to mysteries of faith with awe and astonishment, but there is something dangerous about being embarrassed by them. Unfortunately, when it comes to the mystery of the Ascension, Christians sometimes cannot help but gravitate toward the latter response. There are those nagging "why" questions, as we wonder if things would not (...) have been better off if Christ had stayed on earth. On top of that, there are the dumbfounded "where" questions by which we wonder where Christ went when he left the Apostles' sight and where he actually is right now, if anywhere. These are not new questions, of course, and the tradition of the Church offers a great deal of reflection to guide us, reflection which seems quite apt at answering the "why" questions, but which can appear inadequate to answer the "where" question.1Every Sunday, Catholics profess: "He ascended into heaven and is seated at the right hand of the Father." The Church has always been clear that the "right hand of the Father" should not be understood physically, for the [End Page 93] Father has no body, no physical hands; but does that mean we should understand everything about the Ascension in some non-physical sense, too?2 If Christ is "in heaven" only in a sort of spiritual sense, not a physical one, is he somehow non-physical too? If so, is he still human? If not, where is this body of his? It is hard—arguably impossible—to conceive of any physical body that is not in some place, let alone a living human body that is not in a place. What would it mean for a body to exist completely disconnected from any relation to other physical things? These would seem to be pressing questions for the mystery of the Ascension, but they are questions that, like the Ascension itself, are little talked about by theologians. A recent scholar has summed it up curtly by saying of the Ascension: "Once it was seen as the climax of the mystery of Christ.... Today it is something of an embarrassment."3Doubt and embarrassment about where Christ's glorified human body is breeds doubt and embarrassment about the present existence of Christ's human body, and there are a whole host of theological problems which arise if we deny the present existence of that body. In this paper I will first look at the theological importance of Christ's glorified body, from Scripture, the theological tradition, and particularly from the mystery of the Eucharist. Then, I will consider where ancient and medieval theologians thought Christ's glorified body was and point out the contemporary difficulties of their positions. Finally, I will argue that contemporary physics presents new avenues for a reasonable imagining of where the glorified body of Christ could be.The Importance of the Glorified BodyThe Scriptures make it quite clear: even though there was something new about Christ's body after the resurrection, it really was a human body, and specifically the same human body he had before his death, identifiable most [End Page 94] especially by the very wounds of his crucifixion.4 "While the senses could be fooled in the resurrection appearances, the sense of touch in particular was used to confirm both the reality of his body and its identity, most memorably when he told Thomas to probe his wounds.5 Aquinas argues in the Summa theologiae [ST] that, for a "true resurrection of Christ, it was necessary for the same body of Christ to once more be united to the same soul."6 If these resurrection appearances are not a manifestation of the continuity between the body that was crucified and the one in this new glorified state, then they seem to be mere parlor tricks used to assuage the disciple's fears or, worse, mislead them.While Christ took pains to manifest that he had the same human body, it clearly operated under different rules from the corruptible physical world we are so familiar with, disappearing from sight, entering locked rooms, even ascending into the... (shrink)

Debates about female genital mutilation/cutting have polarized opinion between those who see it as an abuse of women’s health and human rights, to be ‘eradicated’, and those who may or may not oppose the practice, but see a double standard on the part of western campaigners who fail to challenge other unnecessary surgical interventions — such as male circumcision or cosmetic surgery — in their own communities and cultures. This article interrogates these debates about FGM/c in the context of measures (...) to reduce it in the UK over recent decades. It does not suggest that FGM/c is a legitimate practice, seeing it, rather, as an abuse of women’s and children’s rights that should be combated using a combination of measures. However, it argues that reduction strategies are undermined by inconsistencies in the law and the failure to back up the law with research and education. (shrink)

Daniel Brennan brings his research in political philosophy and his surfing experience together in this excellent and engaging contribution to philosophy of surfing and surf studies. In the course o...

Sets out Catholic teaching on hotly debated issues such as stem cell research, reproductive technologies, euthanasia and much more.

Different sectors have expressed the need to address the different notions of pluralism that characterize modern society, as well as their difficulties. The article provides a critical reading of three significantly different approaches to the issue: Chantal Mouffe's On the Political, John Rawls' Political Liberalism, and William E. Connolly's Pluralism. It discusses their strengths and weaknesses, as well as the possibilities they provide to understand pluralism and take their theoretical contributions to the field of practice.

Desde diversos ámbitos se ha señalado la necesidad de abordar las nociones y difi-cultades del pluralismo que caracteriza a la sociedad actual. Se busca aportar una lectura crítica de tres abordajes considerablemente diferentes del tema: En torno a lo político (2005) de Chantal Mouffe, Political Liberalism (1996) de John Rawls y Pluralism (2005) de William E. Connolly. Se sopesan sus fortalezas y debilidades, así como las posibilidades que brindan para comprender el pluralismo y llevar los aportes teóricos a la esfera (...) práctica. (shrink)

The paper applies the theoretical frameworks of epistemic injustice and narrativist philosophy of history to read the process of re-signification of an event that took place in a prison in the city of Buenos Aires, Argentina, in 1978, called “Massacre in the Seventh Ward” or “Mutiny of the Mattresses”. By looking into this case, we explore the exercise of epistemic resistance through category expansion, drawing on the most recent developments on hermeneutical injustice as a deficiency in the application (and not (...) only in the content) of the available concepts. This allows us to identify the selected case as an example of hermeneutical injustice, and to highlight some characteristics of such injustice that remain under-analysed in the specialised literature, linked to agency, temporality, and the concrete forms adopted by resistance. Among the latter, we highlight the role that can be played by the exercise of what in philosophy of history has been called the “practical past”: an intervention in the dispute of meanings about the past, born out of an explicit commitment to the present. Finally, the conclusions present some caveats to be considered in the study of epistemic injustice in the context of institutions such as prisons. (shrink)

Moira Gatens investigates the ways in which differently sexed bodies can occupy the same social or political space. Representations of sexual difference have unacknowledged philosophical roots which cannot be dismissed as a superficial bias on the part of the philosopher, nor removed without destroying the coherence of the philosophical system concerned. The deep structural bias against women extends beyond metaphysics and its effects are felt in epistemology, moral, social and political theory. The idea of sexual difference is contextualised in (...) _Imaginary Bodies_ and traced through the history of philosophy. Using her work on Spinoza, Gatens develops alternative conceptions of power, new ways of conceiving women's embodiment and their legal, political and ethical status. (shrink)

Moira Howes and Catherine Hundleby ABSTRACT: While anger can derail argumentation, it can also help arguers and audiences to reason together in argumentation. Anger can provide information about premises, biases, goals, discussants, and depth of disagreement that people might otherwise fail to recognize or prematurely dismiss. Anger can also enhance the salience of certain premises...

Clarke, Moira On the East coast of America, every 13 or 17 years, billions of red-eyed magicicadas emerge from underground. For the next few weeks every tree resounds with a near-deafening symphony, a courting ritual that has been measured at 94 decibels. Finally, the resulting offspring burrow back into the earth, there to remain inactive for the exact same duration, 13 or 17 years.

While anger can derail argumentation, it can also help arguers and audiences to reason together in argumentation. Anger can provide information about premises, biases, goals, discussants, and depth of disagreement that people might otherwise fail to recognize or prematurely dismiss. Anger can also enhance the salience of certain premises and underscore the importance of related inferences. For these reasons, we claim that anger can serve as an epistemic resource in argumentation.

This book may be taken as a plea for a return to a teleological moral philosophy. Mrs Roberts examines responsibility and freedom in terms of human interests and purposes and seeks to establish the autonomy of the personal decision. F. H. Bradley's criteria for moral responsibility serves as a starting point, but Mrs Roberts finds these theoretical and remote. She builds up an account of the social context in which we learn to use words like 'responsibility', 'freedom' and 'action'. Ambiguities (...) in the use of 'action' and 'perception' are dealt with at length. (shrink)

Why would the work of the 17th century philosopher Benedict de Spinoza concern us today? How can Spinoza shed any light on contemporary thought? In this intriguing book, Moira Gatens and Genevieve Lloyd show us that in spite of or rather because of Spinoza's apparent strangeness, his philosophy can be a rich resource for cultural self-understanding in the present. _Collective Imaginings_ draws on recent re-assessments of the philosophy of Spinoza to develop new ways of conceptualising issues of freedom and (...) difference. This ground-breaking study will be invaluable reading to anyone wishing to gain a fresh perspective on Spinoza's thought. (shrink)

Summarizes author’s contextual empiricism and uses it to analyze the difference between neuro-endocrinological accounts of presumed behavioral sex differences and neuro-selectionist accounts. Contextual empiricism is a philosophical approach that both shows how feminist critique works in the sciences and makes a contribution to general philosophy of science.

Aristotle's Conception of Freedom MOIRA M. WALSH That human being is free, we say, who exists for his own sake and not for another's. ' 1. INTRODUCTION THERE IS NO PLACE in the Nicomachean Ethics, or the Politics, where Aristotle provides us with an explicit definition of freedom. Nevertheless, it is possible to glean Aristotle's notion of freedom from a series of passages in the Politics, in which Aristotle discusses such matters as the existence of the natural slave, and (...) the understanding of freedom underlying certain forms of democracy. This effort is useful insofar as it not only helps us to understand Aristotle, but also presents us with a conception of freedom interestingly different from many contemporary versions and perhaps worth our consideration. ~ The reader will notice that I deliberately retain, for the most part, the generic use of 'man' and of masculine pronouns in translating and commenting on Aristotle, a practice which cannot go without explanation in this day and age. Such terms in English convey just the same ambiguity as Aristode's Greek does when, for instance, he uses the masculine adjectives eleutheros or agathos as generic terms -- that is, they leave the reader uncertain as to whether women are considered capable of freedom or goodness in the same way that men are, with the suspicion that they are not. I do not share the opinion, apparently held by Aristotle, that members of my gender are.. (shrink)

Feminist critiques of science show that systematic biases strongly influence what scientific communities find salient. Features of reality relevant to women, for instance, may be under-appreciated or disregarded because of bias. Many feminist analyses of values in science identify problems with salience and suggest better epistemologies. But overlooked in such analyses are important discussions about intellectual virtues and the role they play in determining salience. Intellectual virtues influence what we should find salient. They do this in part by managing the (...) emotions, which are cognitively involved in what we actually do find salient. One reason intellectual virtues do not factor more strongly in feminist epistemology is the mistaken assumption that they could not serve as explicit epistemic community standards for scientific inquiry. There are good reasons, however, to think in terms of community intellectual virtue and consequently, to advance explicit public standards of intellectual virtue for scientific research. To show how explicit public standards for intellectual virtue might improve reasoning in biased conditions, I analyze a striking oversight in several evolutionary immunological hypotheses concerning women's reproduction and sexuality. I conclude that feminist epistemology would benefit from greater consideration of intellectual virtues, particularly in connection with social epistemological insights. (shrink)

This extremely accessible textbook provides a wide-ranging analysis of the relations between philosophy and feminist thought. Examining not only feminist critiques of philosophical ideas, Gatens also looks at the ways in which feminist theory can be informed by philosophical analysis and debates. Gatens adopts an historical approach, beginning with an analysis of Mary Wollstonecraft's critique of Rousseau. She then examines attempts by Harriet Taylor and J. S. Mill to extend liberal principles to women's situation. Other chapters discuss the work of (...) more recent philosophers, including Simone de Beauvoir, Luce Irigaray, Mary Daly and Dale Spender. Gatens concludes with a discussion of current debates in the politics of sexual difference. (shrink)