According to the widely accepted principles of beneficence and distributive justice, I argue that healthcare providers and facilities have an ethical duty to reduce the ecological footprint of the services they provide. I also address the question of whether the reductions in footprint need or should be patient-facing. I review Andrew Jameton and Jessica Pierce’s claim that achieving ecological sustainability in the healthcare sector requires rationing the treatment options offered to patients. I present a number of reasons to (...) think that we should not ration health care to achieve sufficient reductions in a society’s overall consumption of ecological goods. Moreover, given the complexities of ecological rationing, I argue that there are good reasons to think that the ethical duty to reduce the ecological footprint of health care should focus on only nonpatient-facing changes. I review a number of case studies of hospitals who have successfully retrofitted facilities to make them more efficient and reduced their resource and waste streams. (shrink)

Background:Human health is dependent upon environmental sustainability. Many have argued that environmental sustainability advocacy and environmentally responsible healthcare practice are imperative healthcare actions.Research questions:What are the key obstacles to healthcare professionals supporting environmental sustainability? How may these obstacles be overcome?Research design:Data-driven thematic qualitative analysis of semi-structured interviews identified common and pertinent themes, and differences between specific healthcare disciplines.Participants:A total of 64 healthcare professionals and academics from all states and territories of Australia, and multiple healthcare (...) disciplines were recruited.Ethical considerations:Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were de-identified to protect participant anonymity.Findings:Qualitative analysis indicated that Australian healthcare professionals often take more action in their personal than professional lives to protect the environment, particularly those with strong professional identities. The healthcare sector’s focus on economic rationalism was a substantial barrier to environmentally responsible behaviour. Professionals also feared conflict and professional ostracism, and often did not feel qualified to take action. This led to healthcare professionals making inconsistent moral judgements, and feeling silenced and powerless. Constraints on non-clinical employees within and beyond the sector exacerbated these difficulties.Discussion:The findings are consistent with the literature reporting that organisational constraints, and strong social identification, can inhibit actions that align with personal values. This disparity can cause moral distress and residue, leading to feelings of powerlessness, resulting in less ethical behaviour.Conclusion:The data highlight a disparity between personal and professional actions to address environmental sustainability. Given the constraints Australian healthcare professionals encounter, they are unlikely to shift to environmentally responsible practice without support from institutions and professional associations. Professional development is required to support this endeavour. The poor transference of pro-ecological behaviour from one setting to another is likely to have international implications for healthcare practice. (shrink)

To contribute to our understanding of the relationship between philosophical ideas and medical and healthcare models. A diachronic analysis is put in place in order to evaluate, from an innovative perspective, the influence over the centuries on medical and healthcare models of two philosophical concepts, particularly relevant for health: how Man perceives his identity and how he relates to Nature. Five epochs are identified—the Archaic Age, Classical Antiquity, the Middle Ages, the Modern Age, the ‘Postmodern’ Era—which can be (...) seen, à la Foucault, as ‘fragments between philosophical fractures’. From a historical background perspective, up to the early 1900s progress in medical and healthcare models has moved on a par with the evolution of philosophical debate. Following the Second World War, the Health Service started a series of reforms, provoked by anti-positivistic philosophical transformations. The three main reforms carried out however failed and the medical establishment remained anchored to a mechanical, reductionist approach, perfectly in line with the bureaucratic stance of the administrators. In this context, future scenarios are delineated and an anthropo-ecological model is proposed to re-align philosophy, medicine and health care. (shrink)

In the face of environmental crises such as climate change, pollution and biodiversity loss—which all adversely impact on health—Gils-Schmidt and Salloch explore whether physicians can be justified in taking climate issues into account in clinical care.1 While their approach centres on the ‘climate-sensitive’ decisions, physicians can carry out on the micro-level of clinical decision-making, they encourage further discussions on how climate-related issues can be included across different levels of decision-making in healthcare. We propose a list of tasks and a (...) model to assist with navigating the range of factors and structural elements an environmentally sensitive ethics must address. Stephen Gardiner’s notion of a perfect moral storm is central to understanding these issues.2 Gardiner describes how a perfect moral storm occurs in the centre of three overlapping conditions for human action and policymaking in the face of climate change. This storm is driven by: (1) a lack of interest among current generations to meet global needs and accommodate the well-being of future generations, (2) a lack of ecological concerns for other parts of nature than humans and (3) weak ethical and political theories and institutions shaping policy decisions on issues with severe implications across borders and generations. Moreover, these conditions are embedded in the existing, complex world of ethically unjustified power imbalances and social injustice. The growing awareness of healthcare’s climate footprint has amplified and accelerated global, grassroots action to make healthcare more environmentally friendly. This includes incorporating environmental impacts into quality improvement methodologies, building communities of practice to explore how to make …. (shrink)

Engineering makes profound contributions to our health. Many of these contributions benefit whole populations, such as clean water and sewage treatment, buildings, dependable sources of energy, efficient harvesting and storage of food, and pharmaceutical manufacture. Thus, ethical assessment of these and other engineering activities has often emphasized benefits to communities. This is in contrast to medical ethics, which has tended to emphasize the individual patient affected by a doctor’s actions. However, technological innovation is leading to an entanglement of the activities, (...) and hence ethical responsibilities, of healthcare professionals and engineering professionals. The article outlines three categories of innovation: assistive technologies, telehealthcare and quasi-autonomous systems. Approaches to engineering ethics are described and applied to these innovations. Such innovations raise a number of ethical opportunities and challenges, especially as the complexity of the technology increases. In particular, the design and operation of the technologies require engineers to seek closer involvement with the persons benefiting from their work. Future innovation will require engineers to have a good knowledge of human biology and psychology. More particularly, healthcare engineers will need to prioritize each person’s wellbeing, agency, human relationships and ecological self rather than technology, in the same way that doctors prioritize the treatment of persons rather than their diseases. Content Type Journal Article Category Article Pages 204-221 DOI 10.1558/hrge.v17i2.204 Authors W. Richard Bowen, i-NewtonWales, 54 Llwyn y mor, Caswell, Swansea, SA3 4RD, UK Journal Human Reproduction & Genetic Ethics Online ISSN 2043-0469 Print ISSN 1028-7825 Journal Volume Volume 17 Journal Issue Volume 17, Number 2 / 2011. (shrink)

Team members co-regulate their activities and move together at the collective level of behavior while coordinating their actions toward shared goals. In parallel with team processes, team members need to resolve uncertainties arising from the changing task and environment. In this exploratory study we have measured the differential neurodynamics of seven two-person healthcare teams across time and brain regions during autonomous and collaborative segments of simulation training. The questions posed were: whether these abstract and mostly integrated constructs could be (...) separated neurodynamically; and, what could be learned about taskwork and teamwork by trying to do so? The taskwork and teamwork frameworks used were Neurodynamic Information, an electroencephalography derived measure shown to be a neurodynamic proxy for the pauses and hesitations associated with individual uncertainty, and inter-brain EEG coherence which is a required component of social interactions. No interdependency was observed between NI and IBC, and second-by-second dynamic comparisons suggested mutual exclusivity. These studies show that proxies for fundamental properties of teamwork and taskwork can be separated neurodynamically during team performances of ecologically valid tasks. The persistent expression of NI and IBC were not simultaneous suggesting that it may be difficult for team members to maintain inter-brain coherence while simultaneously reducing their individual uncertainties. Lastly, these separate dynamics occur over time frames of 15–30 s providing time for real-time detection and mitigation of individual and collaborative complications during training or live patient encounters. (shrink)

Green bioethics is an area of research and scholarship that examines the impact of healthcare practices and policies on the environment and emphasises environmental values, such as ecological sustainability and stewardship. Some green bioethicists have argued that healthcare providers should inform patients about the environmental impacts of treatments and advocate for options that minimise adverse impacts. While disclosure of information pertaining to the environmental impacts of treatments could facilitate autonomous decision-making and strengthen the patient–provider relationship in situations where (...) patients have clearly expressed environmental concerns, it may have the opposite effect in other situations if makes patients feel like they are being judged or manipulated. We argue, therefore, that there is not a generalisable duty to disclose environmental impact information to all patients during the consent process. Providers who practice green bioethics should focus on advocating for system-level changes in healthcare financing, organisation and delivery and use discretion when bringing up environmental concerns in their encounters with patients. (shrink)

In this study, I explore the challenges that ideological hegemonies of personhood imbibed by nurses and other healthcare workers could pose for the nursing profession, particularly in terms of inhibiting the acknowledgment of difference. Dominant or hegemonic conceptions of personhood in particular spaces often consist of self‐contained ideas and essentialist ontologies and normativity of what it means to be a person, lack of which results in the denial of personhood and the othering as non‐person or sub‐person. The other as (...) the residue of such self‐contained notions of personhood is most often denied the quality of care that the one who fits within such conceptions enjoy. For nurses and other healthcare workers to overcome such exclusionary tendencies in healthcare, they must overcome hegemonies and ideological dominance and be more open to alternative viewpoints and theories of personhood. I develop these lines of thought by focusing on the rich ideological traditions of Continental and African philosophies showing how exclusion takes place within these traditions based on conceptions of personhood and how such exclusion on the basis of difference impacts negatively on healthcare. I conclude by highlighting the need to go beyond hegemonic philosophies of personhood by decolonizing and demasculinizing healthcare, thereby allowing difference to flourish in an ecology of medical knowledge. (shrink)

The traditional organizational boundaries between healthcare, social work, police and other non-profit organizations are fading and being replaced by new relational patterns among a variety of disciplines. Professionals work from their own history, role, values and relationships. It is often unclear who is responsible for what because this new network structure requires rules and procedures to be re-interpreted and re-negotiated. A new moral climate needs to be developed, particularly in the early stages of integrated services. Who should do what, (...) with whom and why? Departing from a relational and hermeneutic perspective, this article shows that professionals in integrated service networks embark upon a moral learning process when starting to work together for the client’s benefit. In this context, instrumental ways of thinking about responsibilities are actually counterproductive. Instead, professionals need to find out who they are in relation to other professionals, what core values they share and what responsibilities derive from these aspects. This article demonstrates moral learning by examining the case of an integrated social service network. The network’s development and implementation were supported by responsive evaluation, enriched by insights of care ethics and hermeneutic ethics. (shrink)

Defining disease and delineating its boundaries is a contested area in contemporary philosophy of medicine. The leading naturalistic theory faces a new round of difficulties related to defining a normal environment alongside normal organismic functioning and to delineating a discrete boundary between risk factors and disease. Normative theories face ongoing and seemingly intractable difficulties related to value pluralism and the problematic relation between theory and practice. In this article, I argue for an integral—as opposed to a hybrid—philosophy of health based (...) on Bernard Lonergan’s notion of generalized empirical method that provides a way to settle these difficulties dynamically and comprehensively, both in theory, by orienting functional and statistical investigation toward an explanatory ecological viewpoint, and in practice, by framing critiques in relation to the normativity intrinsic to all human inquiry. (shrink)

This article argues humans should not be defined strictly at their physical boundaries with clear distinctions between anatomical bodies, mental states, and the rest of the world. Rather, diverse mental states, which are often diagnosed as “mental illness,” take shape within greater environmental forces and flows, including those that are constructed online. Drawing from a multi-sited ethnography of The Icarus Project, a radical mental health community, the author situates online narratives written by two of its members within posthuman emotional ecologies (...) in which the exchange of ideas online affects mental states in a profound way. These narratives can be seen as a new type of psychiatric resistance based in new technologies, one that “uncivilizes” mental illness by searching for alternative frameworks and metaphors to understand lived experiences with mental distress. This ethnographic perspective differs significantly from traditional bio-psychiatric models and interventions and can offer both patients and mental healthcare providers with an alternative language to frame mental health. (shrink)

Abstract:Under capitalism, bodies are oppressed in the interest of profit through exploitative labor conditions, effects of environmental pollution, neoliberal austerity, and privatized healthcare. Advertising, mainstream media, and corporate rhetoric present the controlled, well-groomed body as a prerequisite for employability and enlist norms of personal responsibility to stigmatize supposedly defective bodies. Against this current, body liberation movements with varying ways of understanding power and the intersection of different forms of oppression are achieving modest success. This paper examines the obstacles which (...) have prevented people with medically caused body odor conditions from enunciating such a counter-ideology so far. It argues that ecosocialism, ecopsychology, and ecofeminism offer frameworks for challenging exclusion and harassment in the workplace as well as in public spaces like libraries. It rejects the capitalist identification of self-improvement with the consumption of increasing numbers of commodities and treatments intended to suppress “nature” in favor of corporate-dictated versions of “civilization.”. (shrink)

The question of whether there are laws in ecology is important for a number of reasons. If, as some have suggested, there are no ecological laws, this would seem to distinguish ecology from other branches of science, such as physics. It could also make a difference to the methodology of ecology. If there are no laws to be discovered, ecologists would seem to be in the business of merely supplying a suite of useful models. These models would (...) need to be assessed for their empirical adequacy but not for their ability to capture fundamental truths, or the like. If, on the other hand, ecology does have laws, this prompts further questions about what these laws are and why even the best candidates for ecological laws fall short of what might be expected of laws. (shrink)

The SARS-CoV-2 pandemic has transgressed biomedical categories. According to Horton, it turned out to be a 'syndrome' that infected virtually all spheres of social life. The pandemic has created toxic social atmosphere highly unfavorable to clinical and clinic-ethical decision making. Constraints and pressures related to micro-, meso-, exo- and macro-environments framing doctors, nurses, and medical students in training were identified. These factors exacerbated moral distress (moral injury) amongst clinicians. In a joint Polish-Lithuanian project (IDUB 2020-2022) we examined predictors of moral (...) distress in pandemic clinical contexts. A survey-based, real-time, correlational and comparative study was conducted in Poland and Lithuania after the first year of pandemic with N=227 participants. Unexpected differences on regular and pandemic-type moral distress levels were found between the two national samples. Polish participants showed significantly higher moral distress levels than their Lithuanian counterparts. The following article discusses these findings and recommends the reinforcement of resilient medical decision making. (shrink)

Healthcare apps er blevet en omfattende industri. Vi kan ganske gratis downloade tusindvis af apps, som sætter os i stand til at monitorere alt fra vores fysiske form til vores mentale velbefindende, og vi kan gennem denne monitorering, producere endeløse datamængder og viden om os selv og vores liv – altså skabe et «monitoreret mig». Men hvordan forholder vi os til denne mulighed? I nærværende artikel tages udgangspunkt i foreløbige resultater fra et igangværende ph.d. projekt, hvor brugen af apps (...) og biofeedback anvendes i praksis, til at belyse en stigende stressproblematik blandt lærere i den danske folkeskole. Artiklens ærinde er, at tematisere de normer og fortolkningsrammer, som kommer til syne, når aktørerne selv italesætter sit «monitorerede mig» og hernæst diskutere, i hvilken position, disse normer og tolkninger af teknologien i anvendelse, bringer aktøren. Er «det monitorerede mig» en mulighed for frisættende autonomi – en empowerment? Eller bidrager monitoreringen i stedet til individualisering eller patologisering, hvor vi gennem ejerskabet af vores egen fortælling, producerer et overansvar for eksempelvis hvilken behandling vi skal modtage, eller hvordan vores arbejdsmiljø bør være?Nøgleord: Etik, humanistisk sundhedsforskning, selvmonitorering, Ecological Momentary StorytellingEnglish summary: The Monitored Me - empowerment or pathologization?Healthcare apps have become a major industry. We can freely download thousands of apps, that enable us to monitor everything, from our physical condition to our mental well-being, and we can through the monitoring produce endless amounts of data and knowledge about our inner selves and our lives - creating a “monitored me”. But how is this technological possibility dealt with, in practice? The present article presents and discusses results from a case study in which apps and biofeedback were used to illuminate an increasing stress problem among teachers in the Danish preliminary school system. The focus of the article is to analyze the self-interpretation framework that appears when the users of the technology articulate the "monitored me” and hereafter discuss how these self-interpretations position the user. Is “the monitored me” an opportunity for liberating autonomy – for empowerment? Or does it contribute to individualization or pathologization? (shrink)

The familiar problems of democratic capitalism have given way to a deep crisis challenging the basic forms of governance introduced around the late 18th century and then gradually expanded and developed until the late 20th century. Associative Democracy and the Crises of Representative Democracies argues that we are in urgent need of normative guidelines and a strong understanding of a broad range of institutional options and innovative experiments in associative democracy in order to address the structural problems that existing institutional (...) arrangements are confronted with whilst maintaining and strengthening democratic forms of government and governance. The argument is developed against the background of a thorough survey of empirical social scientific studies on the crises of capitalisms and representative democracies. This book focuses primarily on democratic alternatives, though it also works out principles and institutions of democratic socialism as alternatives to capitalism. After introducing the theoretical approach, the book illustrates the ways this framework of analysis can be of use, with particular focus on three issues that are highly topical when it comes to the challenges our institutions are confronted with: democratic governance in relation to ecological crises and uncertainty; the threats to democracy raised by the crisis of political parties and representative party-democracy, and the challenges related to privatization and marketization of public services, particularly in healthcare. The book concludes by exploring opportunities to democratize the economy, locating viable alternatives to capitalism in the tradition of democratic socialism. This urgent and thought-provoking book will be of great interest to academics and students in various disciplines in the humanities and social sciences, including political science, sociology, and economics. (shrink)

Rieke van der Graaf, Karin Jongsma, Martine de Vries, Suzanne van de Vathorst, and Ineke Bolt have done well to voice ethical concerns over the decision of the IAB to host the next WCB in Qatar. Conferences should be more sustainable. Yet, attention to the carbon impact of conferences—and, perhaps, any country that a person might travel to for business or pleasure—are only one small part of environmentally responsible citizenship, especially for those trained in ethics and committed to health. Both (...) bioethics as a discipline and bioethicists as individuals need to interrogate their environmental choices. To this end, some ecological choices are more obvious targets of ethical scrutiny—diet and travel—while others appear sacrosanct, like reproduction and even healthcare use. This underscores the importance of making sustainable and ethical organizational choices, such as where to hold a conference, without absolving environmental accountability in other ethical calculations. Many organizations in academic and clinical medicine need to make drastic alterations in their practices and policies to effectively mitigate carbon. While the burden is not only on bioethics alone, the expectation that it should be remains. (shrink)

This paper presents an overview of the process of entanglement at the 25th International Philosophy of Nursing Conference (IPNC) at University of California at Irvine held on August 18, 2022. Representing collective work from the US, Canada, UK and Germany, our panel entitled ‘What can critical posthuman philosophies do for nursing?’ examined critical posthumanism and its operations and potential in nursing. Critical posthumanism offers an antifascist, feminist, material, affective, and ecologically entangled approach to nursing and healthcare. Rather than focusing (...) on the arguments of each of the three distinct but interrelated panel presentation pieces, this paper instead focuses on process and performance (per/formance) and performativity as relational, connected and situated, with connections to nursing philosophy. Building upon critical feminist and new materialist philosophies, we describe intra‐activity and performativity as ways to dehierarchise knowledge making practices within traditional academic conference spaces. Creating critical cartographies of thinking and being are actions of possibility for building more just and equitable futures for nursing, nurses, and those they accompany—including all humans, nonhumans, and more than human matter. (shrink)

We are in the midst of a global crisis of climate change and environmental degradation to which the healthcare sector directly contributes. Yet conceptions of health justice have little to say about the environment. They purport societies should ensure adequate health for their populations but fail to require doing so in ways that avoid environmental harm or injustice. We need to expand our understanding of health justice to consider the environment and do so without reinforcing the epistemic injustice inherent (...) in the field of bioethics. This paper considers what work in philosophy related to the environment should be applied to help build that understanding and develops ideas about the healthcare sector’s responsibilities of justice to the environment. It first introduces the dominant multivalent environmental and ecological justice (EJ) concept in philosophy and each of its dimensions: distribution, participation, recognition and well-being. It then shows why applying that conception alone to broaden our understanding of health justice will reinforce epistemic injustice within bioethics. Drawing on EJ literature from the global South, the paper demonstrates that different ontological and experiential starting points identify additional EJ dimensions—power and harmony—and give rise to a nuanced understanding of the recognition dimension relative to the dominant EJ conception. The paper concludes by applying them to articulate healthcare sector responsibilities of justice to the environment, demonstrating they ground responsibilities beyond reducing its carbon emissions. (shrink)

Robustness has lately become a bridging notion, in particular across the sciences of the natural and the artificial, crucial for prediction and control of natural and artificial systems in recent scientific practice, in biomedicine, neurobiology and engineering, as well as for risk management, planning and policy in ecology, healthcare, markets and economy. From biological, neurological and societal systems, arising by the interplay of self-organizing dynamics and environmental pressures, to the current sophisticated engineering that aims at artificially reproducing the (...) adaptability and resilience of living systems in front of perturbations in man-made devices, robustness seems to hold the key for orchestrating stability and change. This introduction offers a general survey of the contribution that the notion of robustness is providing to reframing major concepts within the life sciences, such as development, evolution, time and environment, and to reframing the relationship between biology and engineering, as well as between biology and physics. (shrink)

Genetically engineered (GE) insects, such as the GE OX513A Aedes aegypti mosquitoes, have been designed to suppress their wild-type populations so as to reduce the transmission of vector-borne diseases in humans. Apart from the ecological and epidemiological uncertainties associated with this approach, such biotechnological approaches may be used by individual governments or the global community of nations to avoid addressing the underlying structural, systemic causes of those infections... We discuss here key ethical questions raised by the use of GE mosquitoes, (...) with the aim of fostering discussion between the public, researchers, policy makers, healthcare organizations, and regulatory agencies at the local, national, and international levels. We affect that goal by outlining a procedural approach to decision-making about the use of the “biotechnology” that goes beyond “community engagement.” The protocol we advocate for entails informed deliberations and decision-making at the community level. It is designed to ensure that the voices of the marginalized and vulnerable groups that would be disproportionately affected by the decision are heard during the community-wide discussions. Moreover, we make the case that the values embedded in the risk assessment should be identified so that the community can make an informed decision about the use of GE insects. In addition, we advocate for the involvement of a variety of actors whose responsibility would be to ensure that the community has the opportunity to make an informed decision based on deliberations about the use of the “biotechnology.”. (shrink)

Digital health and welfare technologies and artificial intelligence are proposed to revolutionise healthcare systems around the world by enabling new models of care. Digital health and welfare technologies enable remote monitoring and treatments, and artificial intelligence is proposed as a means of prediction instead of reaction to individuals’ health and as an enabler of proactive care and rehabilitation. The digital transformation not only affects hospital and primary care but also how the community meets older people's needs. Community care is (...) often provided by informal and formal care‐givers, most of whom are women. Gender equality is at the heart of many national strategies, but do all genders have equal rights, responsibilities and opportunities when it comes to community care and its digital transformation? The digital transformation of community care is entangled with how care is provided to older people and the working conditions of community‐care professionals. Current and, even more so, future community‐care systems are and will be partly constituted by networks of technological artefacts. These health and welfare technological artefacts and the discourse surrounding them mediate and constitute social relations and community care. This article looks into how health and welfare technology and artificial intelligence‐based devices and systems mediate and constitute gender relations in community care and presents an argument for reflexivity, embodiment, pluralism, participation and ecology as an alternative strategy to treating community care as one‐size‐fit‐all and being blind to gender‐related issues. (shrink)

Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of (...) the lived world and, crucially, the consequences of their behaviour. We argue that active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed. (shrink)

The vulnerability of the human world is an edited book that collects papers reflecting on the problem of well-being, health, and vulnerability in our current society. The ‘human world’ to which we refer points to the anthropological, environmental, and ecological issues in relation to health and well-being that we propose to discuss. It addresses the need for a critical anthropological concept that overcomes the biases of modern anthropocentrism while addressing the specific responsibility of humans in contemporary world crisis. We do (...) not try to give a final definition for what vulnerability is, but we problematize the notion of well-being as a standard of non-vulnerability that is often imposed on human beings; often well-being becomes a measure within which human beings should fit to not be vulnerable. Consequently, well-being has been implicitly defined as the opposite of vulnerability – especially when vulnerability is conceived as a risk or a threat to oneself or the community, rather than a potential source of growth and transformation. For this reason, we believe that well-being is more the title of a problem rather than its solution. This paradigm initiates, indeed, a “positive” conception of health that aims to push the boundaries of human finitude such as suffering, illness and the recognition of mortality. Usually, we assume that well-being is the final goal of our choices and the gist of a decent life, but we spend more time striving for well-being than asking ourselves what being well means for us, as individuals and societies. This paradox may generate emotional frustration which often worsens our condition rather than helps it reach its optimum. Moreover, it may generate and increase inequalities between people and countries who may suffer from the discrepancies in their access to healthcare or vaccination. Therefore, it also raises questions about collective justice and interdependence. Indeed, the concept of well-being seems to block a critical and epistemological appraisal of the concept of “health,” conflating thereby the impression of being “well,” which is normed by sociological, cultural and moral standards with the lived reality of what it means to be healthy – which itself needs to be questioned in light of the scientific paradigms that built human biology and environmental approaches over the past decades. (shrink)

Countering the claims that competition contradicts and undermines ethical thought processes and actions, Christoph Lütge successfully argues that competition and ethics do not necessarily have to oppose one another. He highlights how intensified competition can in fact work in favour of ethical goals, and that many criticisms of competition stem from an out-dated understanding of how modern societies and economies function. Illustrating this view with examples from ecology, healthcare and education, the author calls for a more entrepreneurial spirit (...) in analysing the relationship between competition and ethics. This book delivers important arguments for the ethics of innovation, using a combination of theoretical and practical evidence to support it. Researchers and scholars of economics, business, philosophy and politics will greatly benefit from the fresh interdisciplinary perspectives and thorough exploration of the complex relationship between modern competition and ethics. (shrink)

The Political Crisis and Christian Ethics addresses themes in political philosophy in the context of a crisis in democracy after the denial of the 2020 election by the Republican candidate for president. The refusal to accept the results of the election divided the electorate and drove the president's followers to fail in their attempted coup attempt in January of 2020. Democracy is defended in Reinhold Niebuhr's writing on politics and in Barack Obama's use of the theologian's thought. It is developed (...) further in the political theory of Paul Tillich. The themes of just peacemaking are reviewed in Paul Tillich's critique of John Foster Dulles' work and in the author's critique of just peacemaking in the work of Glen Stassen. Domestically the issues of race, inequality, ecology, and healthcare are addressed from the perspective of prophetic realism. The book concludes in terms of Alfred North Whitehead's philosophy of education and religion and a vision of the good president. In summary, The Political Crisis and Christian Ethics is a volume of American, Christian political theory in a period of overcoming the trauma of 2016 with Christian ethics and political philosophy. (shrink)

Background:Stigma is considered a major barrier to accessing healthcare services by female sex workers. Current knowledge of nurses’ attitudes appears to imply a stigma toward female sex workers. But in-depth understanding of their perceptions is scarce. Furthermore, factors that inform a conceptual understanding of how this occurs are lacking.Objectives:The study aimed to explore nurses’ attitudes toward female sex workers and factors affecting caring for female sex workers.Research design:This was a qualitative study. A content analysis approach was adopted in analyzing (...) the data.Participants and research context:Thirty-three practicing nurses participated in seven semi-structured focus group interviews and three key informants participated in three individual interviews in Hong Kong.Ethical considerations:This study was approved by the Ethics Committee of one university in Hong Kong.Findings:The findings revealed three themes: (1) accept, stigmatize, or against sex work; (2) reluctance, hesitation, or willingness to care for female sex workers; and (3) factors affecting the care of female sex workers.Discussion and conclusion:This study found that nurses held different attitudes toward female sex workers, and they experienced feelings of reluctance, hesitation, or willingness to care for female sex workers. Multi-level factors could affect their level of comfort of caring for female sex workers. Intervention should be developed to encourage health professionals to examine their personal views toward female sex workers introspectively, how their attitude may have affected the provision of quality services, and to enhance the provision of sensitive non-discriminative services to female sex workers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Respire, Con-spireMarielle Macé (bio)Translated by Alexis Ann StanleyA rather suffocating atmosphere is becoming our customary environment, ecologically, politically, and socially. It is time to affirm "a universal right to breathe"–what Achille Mbembe called the essential demand for justice that escalated during the age of the Anthropocene and is now crudely reemerging in the current pandemic's attack on the respiratory system.But the right to breathe is not "merely" the right (...) to live, to breathe in unpolluted spaces, or to share clean air; it is also the right to a breathable life, a life worth caring for. It is the right to love life, life with and among one another: the right to fraternize in and through breath, the right to detoxify our relationships and breathe with others. To respire with: to con-spire.Because in order to breathe, one needs air, but one especially needs other living beings, a world and landscapes with which to breathe, in which to breathe, and which can breathe through us. To breathe is not only to maintain one's own breath or nourish one's own organic system as if it lived an unconnected life; it is to acquiesce to the world, to the fact that there is a world—this one, precisely—and to participate in it. A person who breathes, in fact, partakes both in and of the world. Moreover, they make a gift to it, contributing to the way of the world in its entirety by a breath that tightly holds the ties binding each of our bodies to the current state of the living._______The lack of air, the feeling of a stifling age, even the fear of overwhelming suffocation—such is our current "natural" condition, the primary characteristic not only of our virtually toxic living environment, but also of our smothering, asphyxiating political condition wrought with violence and discrimination. Such also is the state of our social condition—the way we (rather poorly) create community—or rather, of our distinct social conditions. For there is a very inequitable distribution of the right to air or to breathe determined by which lives "count" and which do not.The Anthropocene is perhaps the age of a new respiratory 'condition.' Toxic fumes, pestilential odors, extensive carbon consumption, agro-chemical [End Page 177] discharge, microparticles, deforestation and soil asphyxiation, radioactive clouds with phantom trajectories and invisible powers of penetration… the history of industrial modernity is that of "the continuous and large-scale alteration of life's atmospheric conditions" (Zimmer 25). Recently, wildfires affecting America and Europe have been adding their horrifying fumes to century-old pollution. Even clouds ("the clouds up there, the marvelous clouds" of Baudelaire) are being targeted: China recently announced the country's intention to accelerate its cloud seeding program1 (in 2008, over one thousand shells loaded with silver iodide were dispersed in order to clear the skies of Beijing and prevent rain from ruining the opening ceremony of the Olympic games. This technique is also used more and more frequently to generate rainfall and avoid agricultural droughts. This type of 'sky colonization' or climate militarization is a profanation of language as much as of nature: to "sow the clouds" (or "grow meat")—even language tells us something is wrong…)It took a great amount of time and much denial before widespread bodily infection and industrial pollution's public health effects could be recognized. Industrialists may object (at times with doctors), but in the most working-class regions, bodies know: "lungs and our sense of smell protest in their own way against any conclusive evidence which would exonerate factories" (Zimmer 23).The history of pollution is, in fact, also a question of exploitation as well as a social history: that of the unequal distribution of air and the inequitable exposure (depending on one's living milieux) to what is oppressive, stifling—in a word, unbreathable. Unsanitary housing, proximity to mines or factories, and lack of access to healthcare are always factors; respiratory diseases are the most prevalent of occupational illnesses2; and the staggering surge in childhood lead poisoning in the very heart of our capitals—the weakest of bodies have... (shrink)

Background:In Ontario, Canada, patients who lack decision-making capacity and have no family or friends to act as substitute decision-makers currently rely on the Office of the Public Guardian and Trustee to consent to long-term care (nursing home) placement, but they have no legal representative for other placement decisions.Objectives:We highlight the current gap in legislation for difficult transition cases involving unrepresented patients and provide a novel framework for who ought to assist with making these decisions and how these decisions ought to (...) be made.Research design:This paper considers models advanced by Volpe and Steinman with regard to who ought to make placement decisions for unrepresented patients, as well as current ethical models for analyzing how these decisions should be made.Participants and research context:We describe an anonymized healthcare transition case to illustrate the fact that there is no legally recognized decision-maker for placement destinations other than long-term care facilities and to show how this impacts all stakeholders.Ethical considerations:The case provided is an anonymized vignette representing a typical transition case involving an unrepresented patient.Findings:As a result of a gap in provincial legislation, healthcare providers usually determine the appropriate placement destination without a clear framework to guide the process and this can cause significant moral distress.Discussion:We argue for a team decision-making approach in the short term, and a legislative change in the long-term, to respect the patient voice, evaluate benefit and risk, enhance collaboration between healthcare providers and patients, and promote social justice. We believe that our approach, which draws upon the strengths of interprofessional teams, will be of interest to all who are concerned with the welfare and ethical treatment of the patients for whom they care.Conclusions:One of the main strengths of our recommendation is that it provides all members of the healthcare team (including nurses, social workers, therapists, and others) an increased opportunity to advocate on behalf of unrepresented patients. (shrink)

With the arrival of European explorers and settlers during the seventeenth century, Native American ways of life and the environment itself underwent radical alterations as human relationships to the land and ways of thinking about nature all changed. This colonial ecological revolution held sway until the nineteenth century, when New England's industrial production brought on a capitalist revolution that again remade the ecology, economy, and conceptions of nature in the region. In Ecological Revolutions, Carolyn Merchant analyzes these two major (...) transformations in the New England environment between 1600 and 1860. In a preface to the second edition, Merchant introduces new ideas about narrating environmental change based on gender and the dialectics of transformation, while the revised epilogue situates New England in the context of twenty-first-century globalization and climate change. Merchant argues that past ways of relating to the land could become an inspiration for renewing resources and achieving sustainability in the future. (shrink)

Ecological-enactive approaches to cognition aim to explain cognition in terms of the dynamic coupling between agent and environment. Accordingly, cognition of one’s immediate environment (which is sometimes labeled “basic” cognition) depends on enaction and the picking up of affordances. However, ecological-enactive views supposedly fail to account for what is sometimes called “higher” cognition, i.e., cognition about potentially absent targets, which therefore can only be explained by postulating representational content. This challenge levelled against ecological-enactive approaches highlights a putative explanatory gap between (...) basic and higher cognition. In this paper, we examine scientific cognition—a paradigmatic case of higher cognition—and argue that it shares fundamental features with basic cognition, for enaction and affordance selection are central to the scientific enterprise. Our argument focuses on modeling, and on how models promote scientific understanding. We base our argument on a non-representational account of scientific understanding and on the material engagement theory, for models are hereby conceived as material objects designed for scientific engagements. Having done so, we conclude that the explanatory gap is significantly less threatening to the ecological-enactive approach than it might appear. (shrink)

Arguing that ecological thinking can animate an epistemology capable of addressing feminist, multicultural, and other post-colonial concerns, this book critiques the instrumental rationality, hyperbolized autonomy, abstract individualism, and exploitation of people and places that western epistemologies of mastery have legitimated. It proposes a politics of epistemic location, sensitive to the interplay of particularity and diversity, and focused on responsible epistemic practices. Starting from an epistemological approach implicit in Rachel Carson’s scientific projects, the book draws, constructively and critically, on ecological theory (...) and practice, on (post-Quinean) naturalized epistemology, and on feminist and post-colonial theory. Analyzing extended examples from developmental psychology, from medicine and law, and from circumstances where vulnerability, credibility, and public trust are at issue, the argument addresses the constitutive part played by an instituted social imaginary in shaping and regulating human lives. The practices and examples discussed invoke the responsibility requirements central to this text’s larger purpose of imagining, crafting, articulating a creative, innovative, instituting social imaginary, committed to interrogating entrenched hierarchical social structures, en route to enacting principles of ideal cohabitation. (shrink)

The author argues that all forms of life are interconnected and that no being, construct, or object can exist independently from the ecological entanglement, nor does "nature" exist as an entity separate from the uglier or more synthetic elements of life. Realizing this interconnectedness is what the author calls the ecological thought. He investigates the philosophical, political, and aesthetic implications of this interconnectedness.

In this article I argue that we should pay extra attention to the ecological dimension of natural selection. By this I mean that we should view natural selection primarily as acting on the outcomes of the interactions organisms have with their environment, which influences their relative reproductive output. A consequence of this view is that natural selection is not sensitive to what system of inheritance ensures reoccurrences of organism-environment interactions over generations. I end by showing the consequences of this view (...) when looking at how processes like niche construction and the Baldwin effect relate to natural selection. (shrink)

How does the complex nature of ecological systems affect ecologists' ability to study them? This Element argues that ecological systems are complex in a rather special way: they are causally heterogeneous. The author presents an updated philosophical account with an optimistic outlook of the methods and status of ecological research.

This is a book about how we see: the environment around us (its surfaces, their layout, and their colors and textures); where we are in the environment; whether or not we are moving and, if we are, where we are going; what things are good for; how to do things (to thread a needle or drive an automobile); or why things look as they do.The basic assumption is that vision depends on the eye which is connected to the brain. The (...) author suggests that natural vision depends on the eyes in the head on a body supported by the ground, the brain being only the central organ of a complete visual system. When no constraints are put on the visual system, people look around, walk up to something interesting and move around it so as to see it from all sides, and go from one vista to another. That is natural vision—and what this book is about. (shrink)

In this paper, we address the question of how an agent can guide its behavior with respect to aspects of the sociomaterial environment that are not sensorily present. A simple example is how an animal can relate to a food source while only sensing a pheromone, or how an agent can relate to beer, while only the refrigerator is directly sensorily present. Certain cases in which something is absent have been characterized by others as requiring ‘higher’ cognition. An example of (...) this is how during the design process architects can let themselves be guided by the future behavior of visitors to an exhibit they are planning. The main question is what the sociomaterial environment and the skilled agent are like, such that they can relate to each other in these ways. We argue that this requires an account of the regularities in the environment. Introducing the notion of general ecological information, we will give an account of these regularities in terms of constraints, information and the form of life or ecological niche. In the first part of the paper, we will introduce the skilled intentionality framework as conceptualizing a special case of an animal’s informational coupling with the environment namely skilled action. We will show how skilled agents can pick up on the regularities in the environment and let their behavior be guided by the practices in the form of life. This conceptual framework is important for radical embodied and enactive cognitive science, because it allows these increasingly influential paradigms to extend their reach to forms of ‘higher’ cognition such as long-term planning and imagination. (shrink)

This paper sets out to launch a challenge to the usual ‘modernist’ view of the relationship between ecology and ethics. Two ‘post-modern’ interpretations of this relationship are considered. The first ‘deep’ interpretation holds that ecology reveals that nature has intrinsic value. The second interpretation derives from the work of Michel Foucault. The aim of his critique is to reveal how certain values are taken for granted by the acceptance of certain scientific models, and how the acceptance of those (...) models as true makes it impossible to articulate alternative values. I end by suggesting, contra Foucault, that phenomenological enquiry could serve to articulate alternative and perhaps more eco-friendly values. (shrink)

Ecological Psychology and Enactivism both challenge representationist cognitive science, but the two approaches have only begun to engage in dialogue. Further conceptual clarification is required in which differences are as important as common ground. This paper enters the dialogue by focusing on important differences. After a brief account of the parallel histories of Ecological Psychology and Enactivism, we cover incompatibility between them regarding their theories of sensation and perception. First, we show how and why in ecological theory perception is, crucially, (...) not based on sensation. We elucidate this idea by examining the biological roots of work in the two fields, concentrating on Gibson and Varela and Maturana. We expound an ecological critique of any sensation-based approach to perception by detailing two topics: classic retinal image theories and perception in single-celled organisms. The second main point emphasizes the importance of the idea of organism-environment mutuality and its difference from structural coupling of sensations and motor behavior. We point out how ecological - phenomenological methods of inquiry grow out of mutualism and compare Gibson’s idea of visual kinesthesis to Merleau-Ponty’s idea of the lived body. Third, we conclude that Ecological Psychology and varieties of Enactivism are laying down different paths to pursue related goals. Thus, convergence of Ecological Psychology and Enactivism is not possible given their conflicting assumptions, but cross-fertilization is possible and desirable. (shrink)

Autism spectrum disorder (ASD) is a psychopathological condition characterized by persistent deficits in social interaction and communication, and restricted, repetitive patterns of behavior and interests. To build an ecological-enactive account of autism, I propose we should endorse the affordance-based approach of the skilled intentionality framework (SIF). In SIF, embodied cognition is understood as skilled engagement with affordances in the sociomaterial environment of the ecological niche by which an individual tends toward the optimal grip. The human econiche offers a whole landscape (...) of affordances, and situated individuals respond to a field of relevant affordances. An important part of SIF is an ecological-enactive interpretation of the free energy principle and predictive processing. Predictive processing accounts indicate that in ASD too much precision is assigned to prediction errors. Autistic persons depend heavily on current sensory information and less on prior beliefs and cannot attune to stable regularities. To reduce uncertainty, they over-rely on routines, strict habits, and a familiar environment—a predictable ecological niche they construct. I argue that skilled intentionality gives us the framework from which to analyze the autistic field of affordances. Autistic patterns of affordance-related bodily states of action readiness are only sensitive to very specific solicitations in the environment and achieve optimal grip in well-known situations. Autism is to be understood as a disorder of bodily normativity. Taking this approach helps us figure out what neurotypical people can do to attune their environment in order to scaffold the needs of autistic individuals by redesigning the landscape of affordances. (shrink)

Ill persons suffer from a variety of epistemically-inflected harms and wrongs. Many of these are interpretable as specific forms of what we dub pathocentric epistemic injustices, these being ones that target and track ill persons. We sketch the general forms of pathocentric testimonial and hermeneutical injustice, each of which are pervasive within the experiences of ill persons during their encounters in healthcare contexts and the social world. What’s epistemically unjust might not be only agents, communities and institutions, but the (...) theoretical conceptions of health that structure our responses to illness. Thus, we suggest that although such pathocentric epistemic injustices have a variety of interpersonal and structural causes, they are also sustained by a deeper naturalistic conception of the nature of illness. (shrink)

Ecological psychology is one of the most influential theories of perception in the embodied, anti-representational, and situated cognitive sciences. However, radical enactivists claim that Gibsonians tend to describe ecological information and its ‘pick up’ in ways that make ecological psychology close to representational theories of perception and cognition. Motivated by worries about the tenability of classical views of informational content and its processing, these authors claim that ecological psychology needs to be “RECtified” so as to explicitly resist representational readings. In (...) this paper, we argue against this call for RECtification. To do so, we offer a detailed analysis of the notion of perceptual information and other related notions such as specificity and meaning, as they are presented in the specialized ecological literature. We defend that these notions, if properly understood, remain free of any representational commitment. Ecological psychology, we conclude, does not need to be RECtified. (shrink)

Cognitive ecology is the study of cognitive phenomena in context. In particular, it points to the web of mutual dependence among the elements of a cognitive ecosystem. At least three fields were taking a deeply ecological approach to cognition 30 years ago: Gibson’s ecological psychology, Bateson’s ecology of mind, and Soviet cultural-historical activity theory. The ideas developed in those projects have now found a place in modern views of embodied, situated, distributed cognition. As cognitive theory continues to shift (...) from units of analysis defined by inherent properties of the elements to units defined in terms of dynamic patterns of correlation across elements, the study of cognitive ecosystems will become an increasingly important part of cognitive science. (shrink)

In this article, we critically reflect on the concept of biomimicry. On the basis of an analysis of the concept of biomimicry in the literature and its philosophical origin, we distinguish between a strong and a weaker concept of biomimicry. The strength of the strong concept of biomimicry is that nature is seen as a measure by which to judge the ethical rightness of our technological innovations, but its weakness is found in questionable presuppositions. These presuppositions are addressed by the (...) weaker concept of biomimicry, but at the price that it is no longer possible to distinguish between exploitative and ecological types of technological innovations. We compare both concepts of biomimicry by critically reflecting on four dimensions of the concept of biomimicry: mimesis, technology, nature, and ethics. (shrink)