India is home to 243 million adolescents. Two million of them belong to Scheduled Tribes living in underserved, rural areas. Few studies have examined the health of tribal adolescents. We conducted a cross-sectional survey to assess the health, nutrition and wellbeing of adolescent girls in rural Jharkhand, eastern India, a state where 26% of the population is from Scheduled Tribes. We aimed to identify priorities for community interventions to serve adolescents and their families. Between June 2016 and January 2017, interviewers (...) visited all households in 50 purposively sampled villages of West Singhbhum district, Jharkhand. They aimed to interview all girls aged 10–19. Interviewers conducted face-to-face interviews with girls to administer a survey about physical and mental health, disability, nutrition, sexual and reproductive health, gender norms, decision-making, education and violence. Interviewers also measured girls’ height, weight, and Mid-Upper Arm Circumference. Interviewers collected data from 3324 of an estimated 4068 girls residing in the study area. Their mean age was 14.3. 82% were from Scheduled Tribes. 89% of younger girls aged 10–14 and 46% of older girls aged 15–19 were in school or college. Girls dropped out of school because they were required for household work or work on the family farm or business. Over a third reported symptoms of anaemia in the past month, but less than a fifth had a blood test. The prevalence of thinness was 14% for younger girls and 6% for older girls. 45% of girls were stunted. 40% reported emotional violence in the past year, 14% physical violence, and 0.7% sexual violence. 12% had problems associated with depression or anxiety. 30% aged 15–19 had heard of contraception. Among married girls and their husbands, only 10% had ever used methods to prevent or delay pregnancy. Our study identified several priorities to improve adolescent girls’ health, nutrition and wellbeing in largely tribal areas of Jharkhand: reducing violence, early marriage and undernutrition, as well as improving mental health, knowledge about contraception and school retention. (shrink)

Since at least the 1960s, deontic logicians and ethicists have worried about whether there can be normative systems that allow conflicting obligations. Surprisingly, however, little direct attention has been paid to questions about how we may reason with conflicting obligations. In this paper, I present a problem for making sense of reasoning with conflicting obligations and argue that no deontic logic can solve this problem. I then develop an account of reasoning based on the popular idea in ethics that reasons (...) explain obligations and show that it solves this problem. (shrink)

Some patients who have been diagnosed as “dead by neurologic criteria” continue to exhibit certain brain functions, most commonly, neuroendocrine functions. This preservation of neurologic function after the diagnosis of “brain death” or “brainstem death” is an ongoing source of controversy and concern in the medical, bioethics, and legal literatures. Most obviously, if some brain function persists, then it is not the case that all functions of the entire brain have ceased and hence, declaring such a patient to be “dead” (...) would be a false positive, in any nation with so-called “whole brain death” laws. Furthermore, and perhaps more concerning, the preservation of any brain function necessarily entails the preservation of some amount of brain perfusion, thereby raising the concern as to whether additional areas of neural tissue may remain viable, including areas in the brainstem. These and other considerations cast significant doubt on the reliability of diagnosing either “brain death” or “brainstem death.”. (shrink)

The controversy over brain death and the dead donor rule continues unabated, with some of the same key points and positions starting to see repetition in the literature. One might wonder whether some of the participants are talking past each other, not all debating the same issue, even though they are using the same words (e.g., “death”). One reason for this is the complexity of the debate: It’s not merely about the nature of human life and death. Interwoven into this (...) debate are deep philosophical issues on realism, the normative/descriptive distinction, the relation of thought and language to the world, the mind–body problem, personhood, moral status, and the ethics of killing. There are also social and legal .. (shrink)

Edward Said's book Orientalism stands in a long lineage of critique of European scholarship responsible for shaping European understandings of foreign cultures. His book contributed significantly to the debate about the epistemological presuppositions informing European scholars of other cultures. However, while Said exposed in considerable detail the ways in which the Orient was distorted by the theories of the European academy, he left unexamined the possibility of genuine cross-cultural understanding. This article considers the significance of hermeneutics for cross-cultural rather than (...) historical understanding. It explores the implicit claim Gadamer makes for the universal validity of hermeneutics not only for understanding in history, but for a genuine intellectual rapprochement across geographical and cultural lines as well. S. Afr. J. Philos. Vol.21(4) 2002: 330-344. (shrink)

A “universalist” policy on brain death holds that brain death is death, and neurologic criteria for death determination are rightly applied to all, without exemptions or opt outs. This essay argues that advocates of a universalist brain death policy defend the same sort of coercive control of end-of-life decision-making as “pro-life” advocates seek to achieve for reproductive decision-making, and both are grounded in an illiberal political philosophy. Those who recognize the serious flaws of this kind of public policy with respect (...) to abortion must apply the same logic to brain death. (shrink)

Reasons can interact in a variety of ways to determine what we ought to do or believe. And there can be cases where two reasons to do an act or have a belief are individually worse than a reason to not do that act or have that belief, but the reasons together are better than the reason to not do that act or have that belief. So the reasons together―which we can call the accrual of those reasons—can have a strength (...) that is an increasing function of the strengths of the individual reasons. In this paper, we will look at how reasons determine what we ought to do and believe in cases where the accrual of reasons is relevant. Our focus will not primarily be on questions about the nature of individual reasons and their weight. Instead, we will at the outset rely on our pretheoretical grip on what reasons there are and how weighty they are individually and ask the more formal or structural question of how to determine the strength of their accrual based on these facts. In looking at these issues, my goal will not be anything as ambitious as developing a full theory of the accrual of reasons. Rather, my goal will be more modest: I will introducing some of the challenges for providing an adequate model and argue that a promising approach to resolving these challenges involves making use of the familiar distinction in moral philosophy between derivative and non-derivative normative notions. (shrink)

How do multiple reasons combine to support a conclusion about what to do or believe? This question raises two challenges: How can we represent the strength of a reason? How do the strengths of multiple reasons combine? Analogous challenges about confirmation have been answered using probabilistic tools. Can reductive and nonreductive theories of reasons use these tools to answer their challenges? Yes, or more exactly: reductive theories can answer both challenges. Nonreductive theories, with the help of a result in confirmation (...) theory, can answer one, and there are grounds for optimism that they can answer the other. (shrink)

The established view regarding ‘brain death’ in medicine and medical ethics is that patients determined to be dead by neurological criteria are dead in terms of a biological conception of death, not a philosophical conception of personhood, a social construction or a legal fiction. Although such individuals show apparent signs of being alive, in reality they are dead, though this reality is masked by the intervention of medical technology. In this article, we argue that an appeal to the distinction between (...) appearance and reality fails in defending the view that the ‘brain dead’ are dead. Specifically, this view relies on an inaccurate and overly simplistic account of the role of medical technology in the physiology of a ‘brain dead’ patient. We conclude by offering an explanation of why the conventional view on ‘brain death’, though mistaken, continues to be endorsed in light of its connection to organ transplantation and the dead donor rule. (shrink)

One of the popular albeit controversial ideas in the last century of moral philosophy is that what we ought to do is explained by our reasons. And one of the central features of reasons that accounts for their popularity among normative theorists is that they can conflict. But I argue that the fact that reasons conflict actually also poses two closely related problems for this popular idea in moral philosophy. The first problem is a generalization of a problem in deontic (...) logic concerning the existence of conflicting obligations. The second problem arises from a tension between the fact that reasons can conflict and a model of how reasons explain ‘ought’s that has been widely accepted. Having presented each of these problems, I develop a unified solution to them that is informed by results in both ethics and deontic logic. An important implication of this solution is that we must distinguish between derivative and nonderivative reasons and revise our conception how it is that reasons explain ‘ought’s. (shrink)

A traditional picture is that cases of deontic constraints--- cases where an act is wrong (or one that there is most reason to not do) even though performing that act will prevent more acts of the same morally (or practically) relevant type from being performed---form a kind of fault line in ethical theory separating (agent-neutral) consequentialist theories from other ethical theories. But certain results in the recent literature, such as those due to Graham Oddie and Peter Milne in "Act and (...) Value", do not sit well this traditional wisdom. My aim in this paper is to argue that both the traditional wisdom and Oddie and Milne are mistaken. I begin by looking more closely at the traditional wisdom and why it fails (§1). Then I develop my account of this fault line in ethical theory and its importance (§2). Finally I show that a diagnosis of where Oddie and Milne go wrong follows as a corollary of this new account (§3). An important upshot will be that discussions of cases of deontic constraints would do best to focus on the account of the nature and importance of the cases identified in this paper rather than continuing to work with the mistaken traditional picture. (shrink)

The verdicts standard consequentialism gives about what we are obligated to do crucially depend on what theory of value the consequentialist accepts. This makes it hard to say what separates standard consequentialist theories from non-consequentialist theories. This article discusses how we can draw sharp lines separating standard consequentialist theories from other theories and what assumptions about goodness we must make in order to draw these lines. The discussion touches on cases of deontic constraints, cases of deontic options, and cases involved (...) in the so-called "actualism"/"possibilism" debate. What emerges is that there are various interesting patterns relating the different commitments of consequentialism, different principles about obligation and about goodness, and different rules concerning how facts about values determine facts about obligation. (shrink)

In this essay I examine the formal structure of the concept of futility, enabling identification of the appropriate roles played by patient, professional, and society. I argue that the concept of futility does not justify unilateral decisions to forego life-sustaining medical treatment over patient or legitimate surrogate objection, even when futility is determined by a process or subject to ethics committee review. Furthermore, I argue for a limited positive ethical obligation on the part of health care professionals to assist patients (...) in achieving certain restricted goals, including the preservation of life, even in circumstances in which most would agree that that life is of no benefit to the patient. Finally, I address the objection that professional integrity overrides this limited obligation and find the objection unconvincing. In short, my aim in this essay is to see the concept of futility finally buried, once and for all. (shrink)

The dead donor rule, which requires that organ donors not be killed by the process of organ procurement, is thought to protect vulnerable patients from exploitation and from being harmed through organ procurement. In current practice, the majority of transplantable organs are retrieved from patients who are declared dead by neurological criteria, or "brain-dead." Because brain death is considered to be sufficient for death, it is thought that brain-dead donors are neither harmed nor wronged by organ removal.In this essay I (...) argue that this is not the case. Brain-dead donors can be, and many are, harmed and wronged by... (shrink)

In this chapter, we begin by sketching in the broadest possible strokes the ideas behind two formal systems that have been introduced with to goal of explicating the ways in which reasons interact to support the actions and conclusions they do. The first of these is the theory of defeasible reasoning developed in the seminal work of Pollock; the second is a more recent theory due to Horty, which adapts and develops the default logic introduced by Reiter to provide an (...) account of reasons. However, the implementations are complex enough, in both cases, to prevent anything more than this sketch. And we would not want to give the impression that we think that work on the logic of reasons must follow the path mapped out in either of these theories—indeed, we feel that the field is wide open. In the remainder of the chapter, therefore, will concentrate on a number of issues bearing on the logic of reasons that are either not treated in the work of Pollock and Horty, or whose treatment there is, we feel, either inadequate or incomplete. These are: first, the question of whether it is necessary to understand logical interactions among reasons themselves, rather than simply between reasons and the actions or conclusions they support, and if so, what principles might govern these interactions; second, priority relations among reasons and the notion of reason accrual; and third, some problems posed by undercutting defeat. (shrink)

ABSTRACT:Organismal superposition holds that the same individual both is and is not an organism, as a consequence of organismal pluralism. When coupled with the assumption that death is the cessation of an organism, this entails that there is no unique answer as to whether brain death is biological death. This essay argues that concerns about organismal pluralism and superposition do not undermine a theory of biological death, nor entail any metaphysical indeterminacy about the biological vital status of a brain-dead individual.

Background Doctors sometimes encounter parents who object to prescribed treatment for their children, and request suboptimal substitutes be administered instead. Previous studies have focused on parental refusal of treatment and when this should be permitted, but the ethics of requests for suboptimal treatment has not been explored. Methods The paper consists of two parts: an empirical analysis and an ethical analysis. We performed an online survey with a sample of the general public to assess respondents’ thresholds for acceptable harm and (...) expense resulting from parental choice, and the role that religion played in their judgement. We also identified and applied existing ethical frameworks to the case described in the survey to compare theoretical and empirical results. Results Two hundred and forty-two Mechanical Turk workers took our survey and there were 178 valid responses. Respondents’ agreement to provide treatment decreased as the risk or cost of the requested substitute increased. More than 50% of participants were prepared to provide treatment that would involve a small absolute increased risk of death for the child and a cost increase of US$<500, respectively. Religiously motivated requests were significantly more likely to be allowed. Existing ethical frameworks largely yielded ambiguous results for the case. There were clear inconsistencies between the theoretical and empirical results. Conclusion Drawing on both survey results and ethical analysis, we propose a potential model and thresholds for deciding about the permissibility of suboptimal treatment requests. (shrink)

There is consensus among computer scientists, logicians, and philosophers that good reasoning with qualitative beliefs must have the structural property of cumulative transitivity or, for short, cut. This consensus is typically explicitly argued for partially on the basis of practical and mathematical considerations. But the consensus is also implicit in the approach philosophers take to almost every puzzle about reasoning that involves multiple steps: philosophers typically assume that if each step in reasoning is acceptable considered on its own, the whole (...) chain of reasoning must also acceptable. In this paper I focus on whether there are good philosophical reasons for thinking that the consensus that good reasoning must satisfy cut is true. My central claim is that we should not accept the consensus—good reasoning might not satisfy cut. In particular, I consider four arguments for the consensus and explain why they are unpersuasive. (§2-5). I then show that the issue of whether good reasoning is cut turns on a substantive yet until now unnoticed question in epistemology (§6). (shrink)

Engineering is a practice that must function in an environment of incomplete and uncertain knowledge. This environment has become even more difficult in an increasingly complex world. Engineering ethics has to be framed and taught in a way that addresses these realities. This paper proposes a combination of the philosophy of pragmatism and the ethic of care as a possible framework for the practice of engineering ethics that can provide flexibility and openness to address engineering ethics problems more realistically within (...) the ethos and culture of engineering. Embedding values into practice, pragmatism and care provide a broad, reflective, and corrective framework for engineering ethics that can accommodate the realities in which engineering operates. It is shown that these two approaches are more consonant with design methodologies and have a natural fit with design thinking, so they mesh well with what engineers do and with the complexities of their work today. As humans more and more try to alter the socio-techno-natural world, e.g., the earth’s climate, the combination of pragmatism and care will allow enhanced ethical behavior. Alterations to complex adaptive systems will produce highly uncertain results that require engineers to have a mindset that allows them to act with humility in the face of significant uncertainty and potential catastrophic failures. (shrink)

Legally defining “death” in terms of brain death unacceptably obscures a value judgment that not all reasonable people would accept. This is disingenuous, and it results in serious moral flaws in the medical practices surrounding organ donation. Public policy that relies on the whole-brain concept of death is therefore morally flawed and in need of revision.

One family of maximizing act consequentialist theories are actualist direct theories. Indeed, historically there are at least three different forms of actualist direct consequentialism (due to Bentham, Moore, and contemporary consequentialists). This paper is about the logical differences between these three actualist direct theories and the differences between actualist direct theories and their competitors. Three main points emerge. First, the sharpest separation between actualist direct theories and their competitors concerns the so-called inheritance principle. Second, there are a myriad of other (...) logical differences among actualist direct theories. Third, one theory (Moore's theory) stands out among actualist direct theories because it entails a variety of logical principles. This fact may count in favor of that theory. (shrink)

In this paper I examine two controversialissues that occurred in two different centuriesbut that are inextricably linked with eachother – the 1835 murder committed by a Frenchpeasant, Pierre Riviere and documented byMichel Foucault and the 1990's debate regardingthe controversial methods of FacilitatedCommunication used with students labeledautistic in the United States. In this paper Iargue that both controversies foreground thecrisis of the humanist subject. In other words,I argue that both controversies are generatedby a seemingly simple question: Are personsidentified as mentally disabledcapable/incapable (...) of representing themselves?In response to this question, I will use amaterialist analysis to explore theimplications that the poststructuralistdepiction of the humanist subject as a fictionholds for both the Riviere case and theFacilitated Communication debate. (shrink)

Brain dead organ donors are the principal source of transplantable organs. However, it is controversial whether brain death is the same as biological death. Therefore, it is unclear whether organ removal in brain death is consistent with the ‘dead donor rule’, which states that organ removal must not cause death. Our aim was to evaluate the public9s opinion about organ removal if explicitly described as causing the death of a donor in irreversible apneic coma. We conducted a cross-sectional internet survey (...) of the American public (n=1096). Questionnaire domains included opinions about a hypothetical scenario of organ removal described as causing the death of a patient in irreversible coma, and items measuring willingness to donate organs after death. Some 71% of the sample agreed that it should be legal for patients to donate organs in the scenario described and 67% agreed that they would want to donate organs in a similar situation. Of the 85% of the sample who agreed that they were willing to donate organs after death, 76% agreed that they would donate in the scenario of irreversible coma with organ removal causing death. There appears to be public support for organ donation in a scenario explicitly described as violating the dead donor rule. Further, most but not all people who would agree to donate when organ removal is described as occurring after death would also agree to donate when organ removal is described as causing death in irreversible coma. (shrink)

Business ethics researchers and practitioners are interested in understanding the temporal mechanisms of various managerial activities, processes, and policies. In this direction, I borrow notions of time from Virginia Woolf’s _Mrs. Dalloway_ to examine how social time intersperses with the paid and (unpaid) care work of female employees during the pandemic. I explore how discussions of social time in connection to care work appear in newspaper discourses of “shecession”, i.e. the large-scale job/income losses experienced by women during the COVID-19 pandemic. (...) Since shecession is a byproduct of the pandemic times, exploring the role of time in it is crucial. In fact, my findings show that the macro social time of the pandemic affects working women with care responsibilities who are situated at the intersection of multiple vulnerable social categories by simultaneously being a penalizer and a lost opportunity. Similarly, I also find that the micro social times of working women embed, stratify, and synchronize differently during the pandemic when compared to normal times. Working women with care responsibilities are thus adversely affected by both micro and macro social time changes. My findings, therefore, could be instrumental in developing and implementing inclusive policies and processes in business organizations and labor markets. In so doing, my study also indicates how a consideration of social time enriches the application of care ethics in work contexts. Ultimately, this article is also about developing caring organizations, societies, and families which care for the caregivers (working women), since receiving care is a precondition of giving care. (shrink)