Health institutions recommend that young infants be exclusively breastfed on demand, and it is widely held that parents who can breastfeed have an obligation to do so. This has been challenged in recent philosophical work, especially by Fiona Woollard. Woollard’s work critically engages with two distinct views of parental obligation that might ground such an obligation—based on maximal benefit and avoidance of significant harm—to reject an obligation to breastfeed. While agreeing with Woollard’s substantive conclusion, this paper (drawing on philosophical discussion (...) of the ‘right to rear’) argues that there are several more moderate views of parental obligation which might also be thought to ground parental obligation. We first show that an obligation to breastfeed might result not from a general obligation to maximally benefit one’s child, but from what we call ‘choice-specific’ obligations to maximise benefit within particular activities. We then develop this idea through two views of parental obligation—the Dual Interest view, and the Best Custodian view—to ground an obligation to exclusively breastfeed on demand, before showing how both these more moderate views fail. Finally, we argue that not only is there no general obligation to breastfeed children, but that it is often morally right not to do so. Since much advice from health institutions on this issue implies that exclusive breastfeeding on demand is the best option for all families, our argument drives the feeding debate forward by showing that this advice often misrepresents parents’ moral obligations in potentially harmful ways. (shrink)

Zangwill (“Our Moral Duty to Eat Meat”, “If you care about animals, you should eat them”) has argued that we have a duty to eat meat. In this paper I first show that Zangwill’s essays contain two distinct conclusions: (1) a rather weak thesis that his argument is officially supposed to establish, and (2) a much stronger, advertised thesis that his argument is not officially supposed to establish, but on whose basis he gives concrete recommendations for action and launches polemic (...) attacks on vegans, animal rights activists, and others. Consequently, I argue that Zangwill is likely culpable of some combination of epistemic failure, objectionable carnist activism, and trolling. In the second part of this paper I rebut Zangwill’s argument proper. I conclude by identifying some important issues in the vicinity concerning the suffering of wildlife and population ethics generalized to both human and non-human animals. (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on address- ing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as a (...) syndrome that reflects a dysfunction and is usually associated with significant distress or disability. More importantly, there is an explicit statement saying that all mental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)

My thanks to Professors Hawkins and Szmukler for their thoughtful commentaries; I am particularly glad to see these scholars' valuable expertise directed toward what raises pressing issues not only for psychiatry but for contemporary society.Prof. Hawkins reasons that the use of forced feeding with some anorexia is justified, while emphasizing that this will occur rarely. She and I are in agreement that a mere handful of cases may be affected by our debate, since anecdotal evidence from clinical settings as (...) well as the studies Hawkins cites suggest that forced feeding will often be contraindicated. Still, the matter can equally well be cast hypothetically, as I implied in my earlier discussion. If forced feeding... (shrink)

The conceptual and investigative tools for the analysis of social behavior can be expanded by integrating biological theory, control systems theory, and Pavlovian conditioning. Biological theory has focused on the costs and benefits of social behavior from ecological and evolutionary perspectives. In contrast, control systems theory is concerned with how machines achieve a particular goal or purpose. The accurate operation of a system often requires feed-forward mechanisms that adjust system performance in anticipation of future inputs. Pavlovian conditioning is ideally suited (...) to subserve this function in behavioral systems. Pavlovian mechanisms have been demonstrated in various aspects of sexual behavior, maternal lactation, and infant suckling. Pavlovian conditioning of agonistic behavior has been also reported, and Pavlovian processes may likewise be involved in social play and social grooming. Several further lines of evidence indicate that Pavlovian conditioning can increase the efficiency and effectiveness of social interactions, thereby improving their cost/benefit ratio. We extend Pavlovian concepts beyond the traditional domain of discrete secretory and other physiological reflexes to complex real-world behavioral interactions and apply abstract laboratory analyses of the mechanisms of associative learning to the daily challenges animals face as they interact with one another in their natural environments. Key Words: aggression; biological theory; control theory; feed-forward mechanisms; learning theory; nursing and lactation; Pavlovian conditioning; sexual behavior; social behavior; social grooming; social play. (shrink)

Highlights: -/- • Breastfeeding and breastfeeding support can contribute to mitigating climate change. • Achieving global nutrition targets will save more emissions than fuel-switching. • Breastfeeding support programmes support a just transition. • This work can support the expansion of mitigation options in energy system models. -/- Abstract: -/- Renewable gas has been proposed as a solution to decarbonise industrial processes, specifically heat demand. As part of this effort, the breast-milk substitutes industry is proposing to use renewable gas as a (...) substitute for fossil natural gas. However, decarbonising the industrial processing of breast-milk substitutes can increase social license for these products, potentially undermining breastfeeding. World Health Organisation nutrition targets aim to increase exclusive breastfeeding to at least 50% globally by 2025 to improve maternal, infant, and young child health and nutrition. This target will have implications for the energy transition. A weakness of existing energy models is that demands for end-use products such as breast-milk substitutes are typically not considered explicitly. This paper develops an analytical framework for explicitly representing infant feeding methods in energy systems models. We compare the emissions saved in Ireland from decarbonising the industrial processing of breast-milk substitutes with renewable gas with the emissions saved by an increase in exclusive breastfeeding to 50% in both Ireland and a key export market, China. We demonstrate that the emissions saved from achieving the minimum global breastfeeding target are greater than when renewable gas is used to displace natural gas in the production of breast-milk substitutes in Ireland. We discuss the decarbonisation of breast-milk substitutes in relation to the principle of justice as non-maleficence, a principle based on the commitment to avoid harm, a novel application of a principle of justice. We conclude that breastfeeding support can be considered a demand-side measure for mitigating climate change by reducing the demand for energy services to produce breast-milk substitutes. A key recommendation is to position breastfeeding support as both a public health and a climate justice issue that is relevant for a just transition. The framework developed for this paper could be applied to support the inclusion of a wider range of mitigation options with social justice outcomes in energy system models. [Open access]. (shrink)

The debate over how to best guide HIV-infected mothers in resource-poor settings on infant feeding is more than two decades old. Globally, breastfeeding is responsible for approximately 300,000 HIV infections per year, while at the same time, UNICEF estimates that not breastfeeding (formula feeding with contaminated water) is responsible for 1.5 million child deaths per year. The largest burden of these infections and deaths occur in Sub-Saharan Africa. Using this region as an example of the burden faced more (...) generally in other resource-poor settings, we contrast the evolution of the clinical standard of care for infant feeding with HIV-infected mothers in high-income countries to the current international clinical guidelines for HIV-infected mothers and infant feeding in resource-poor settings. While the international guidelines of exclusive breastfeeding for a 6-month period seem to offer the least-worst strategy for reducing mother-to-child transmission of HIV during infancy while conferring some immunity through breastfeeding post-6 months, we argue that the impact of the policy on mothers and healthcare workers on the ground is not well understood. The harm reduction approach on the level of health policy translates into a complicated, painful moral dilemma for HIV-positive mothers and those offering them guidance on infant feeding. We argue that the underlying socio-economic disparities that continue to fuel the need for a harm reduction policy on infant feeding and the harm to women and children justify: (1) that higher priority be given to solving the infant feeding dilemma with improved data on safe feeding alternatives, and (2) support of innovative, community-driven solutions that address the particular economic and cultural challenges that continue to result in HIV-transmission to children within these communities. (shrink)

Tube feeding is often presented as a nearly risk free and beneficial treatment for patients with dementia. But evidence shows that its benefits are illusory, while its risks are greater than many realize. Assisted oral feeding and good hospice care are better options.

The use of Nasogastric (NG) feeding in the provision of artificial nutrition and hydration at the end of life has, for the most part, been regarded as futile by the medical community. This position has been led chiefly by prevailing medical data. In Singapore, however, there has been an increase in its utilization supported primarily by social, religious and cultural factors expressly to prolong life of the terminally ill patient. Here this article will seek to review the ethical and (...) clinical impact of this treatment and provide some understanding for such decisions in the light of the Duty of Palliative Care [DoPC]. Complemented by virtue ethics theory, the DoPC highlights and seeks to realize the individual case specific goals of care that maximize comfort and quality of life of the patient in the face of rapid attenuation of treatment options and the eminence of the final outcome by considering each of these factors individually in order to provide the best outcome for the patient and the family. (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on addressing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as a syndrome (...) that reflects adysfunctionand is usually associated with significantdistress or disability. More importantly, there is an explicit statement saying thatallmental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)

Breastfeeding is analogous to pregnancy as an experience, in its exclusiveness to women, and in its cost and the effects it has on equitable share of labor. Therefore, the history of formula feeding provides useful insights into the future of full ectogenesis, which could evolve into a more severe version of what formula feeding is today: simplify life for some women and provide couples with a more equitable share of work at the cost of stigma, guilt and a (...) daily diet of studies purporting to show the benefits of natural pregnancy. Making pregnancy an optional route to motherhood would make women's life trajectory more similar to men's and thus put pressure on women to compete with men on the ground shaped by men's preferences. Despite being a treasured experience of many women today, bearing children could become the luxury of the few, the province of the very poor and a choice working women will pay a high price for as women who choose pregnancy become stigmatized as self-indulgent or unprofessional and penalized for it in the workplace. At the same time, scarce societal resources that could be used to support pregnant women and working mothers would instead be directed toward proving to women or even forcing them to gestate children "the right way." While not necessarily threatening on its own, when added to formula feeding, IVF, stem-cell produced ova and sex robots, full ectogenesis could diminish men's stake in women's wellbeing and even existence. (shrink)

Phase I clinical trials are the first stage of testing new pharmaceuticals in humans. The majority of these studies are conducted under controlled, inpatient conditions using healthy volunteers who are paid for their participation. This article draws on an ethnographic study of six phase I clinics in the United States, including 268 semistructured interviews with research staff and healthy volunteers. In it, I argue that an institutional banalization of risk structures the perceptions of research staff and healthy volunteers participating in (...) the studies. For research staff, there are three mechanisms by which risk becomes banal: a perceived homogeneity of studies, Fordist work regimes, and data-centric discourse. For healthy volunteers, repeat study participation contributes to the institutional banalization of risk both through the process of desensitization to risk and the formation of trust in the clinics. I argue that the institutional banalization of risk also renders invisible ethical concerns about exploitation of underprivileged groups in pharmaceutical research. (shrink)

A Palestinian administrative detainee in Israel asked for the author to care for him as an independent physician while in hospital on two hunger strikes, lasting 66 and 55 days, respectively. Hunger striking is placed in the context of other forms of food refusal and artificial feeding. The various perspectives on the challenge of the medical care of hunger strikers are reviewed, as seen by the state, the public, the doctor and the patient. Institutional statements on the management of (...) hunger strikers are reviewed and the local political considerations are highlighted. In conclusion, a trusting doctor–patient relationship is presented as the crucial element for securing a successful outcome, preserving the prisoner's life and dignity with no significant political damage incurred by the State. (shrink)

Prehensity -- Intensity -- Potentiality -- Sensibility.

This paper explores the consequences of the theoretical forward activation enzymatic pathway A 0 A 1 A 2 A 3 where E 1 convents A 0 to A 1, E 2 converts A 1 to A 2 and E 3 converts A 2 to A 3. A 0, which is environmentally determined, also serves to activate (or modulate) the activity of E 3 in such a way as to keep the concentration of A 2 ([A 2]) constant at a particular (...) set-point value. For mathematical simplicity, first order rate kinetics are used where k 1, k 2 and k 3 are the rate constants for E 1, E 2, and E 3 respectively. It is shown that if k 3 is modulated appropriately so as keep [A 2] at the setpoint value with a changing upstream [A 0], then the modulation of k 3 must be anticipatory of the dynamics of the biochemical pathway. In other words, the rate of change of k 3, will be a function of [A 0], k 1, k 2, k 3, and the set-point value of [A 2]. If the modulation of k 3 does not perfectly model (anticipate) the reaction pathway of which it is a part, then the actual [A 2] will deviate from the set-point value. This type of anticipatory feed-forward activation may represent an important aspect of biological organization. (shrink)

Food sharing may be used for mate attraction, sexual access, or mate retention in humans, as in many other species. Adult humans tend to perceive more intimacy in a couple if feeding is observed, but the increased perceived intimacy may be due to resource provisioning rather than feeding per se. To address this issue, 210 university students (66 male) watched five short videos, each showing a different mixed-sex pair of adults dining together and including feeding or simple (...) provisioning or no food sharing. A survey concerning attraction and intimacy in the dyad was completed after each video. Both provisioning and feeding produced higher ratings of “Involvement,” with feeding producing the highest ratings. Similarly, the perceived attraction of each actor to the other was lowest when no food sharing was shown and highest when feeding was displayed. These findings are consistent with a view of feeding as a courtship display in humans. (shrink)

Current, prevalent models of the food system, including complex-adaptive systems theories and commodity-as-relation thinking, have usefully analyzed the food system in terms of its elements and relationships, confronting persistent questions about a system’s identity and leverage points for change. Here, inspired by Heldke’s analysis, we argue for another approach to the “system-ness” of food that carries those key questions forward. Drawing on Niklas Luhmann’s systems theory, we propose a model of the food system defined by the relational process of (...) class='Hi'>feeding itself; that is, the food system is made of feeding and only feeding, and system structures are produced by the coupling of that process to its various contexts. We argue that this approach moves us away from understandings of the food system that take structures and relations as given, and sees them instead as contingent, thereby helping to identify leverage points for food system change. The new approach we describe also prompts us as critical agrifood scholars to be constantly reflexive about how our analyses are shaped by our own assumptions and subjectivities. (shrink)

Dubreuil (Biol Phil 25:53–73, 2010b , this journal) argues that modern-like cognitive abilities for inhibitory control and goal maintenance most likely evolved in Homo heidelbergensis , much before the evolution of oft-cited modern traits, such as symbolism and art. Dubreuil’s argument proceeds in two steps. First, he identifies two behavioral traits that are supposed to be indicative of the presence of a capacity for inhibition and goal maintenance: cooperative feeding and cooperative breeding. Next, he tries to show that these (...) behavioral traits most likely emerged in Homo heidelbergensis . In this paper, I show that neither of these steps are warranted in light of current scientific evidence, and thus, that the evolutionary background of human executive functions, such as inhibition and goal maintenance, remains obscure. Nonetheless, I suggest that cooperative breeding might mark a crucial step in the evolution of our species: its early emergence in Homo erectus might have favored a social intelligence that was required to get modernity really off the ground in Homo sapiens. (shrink)

Using Demographic and Health Survey datasets from Ghana and Nigeria, this study examined whether the protective effects of breast-feeding are greatest where the poorest sanitation conditions prevail. It was found that mixed-fed infants aged between 0 and 11 months tend to have a higher risk of diarrhoea than fully breast-fed children, while the risk of diarrhoea among weaned infants is twice that of mixed-fed infants. The probit regression models employed in the analysis were used to predict the probability of (...) diarrhoea associated with each breast-feeding pattern for both ‘poor’ and ‘good’ sanitation areas. It was found that the risk of diarrhoea among mixed-fed infants in the poor sanitation areas tends to be high while the same risk among fully breast-fed infants tends to be minimal. In essence, the health risks of mixed feeding are real, particularly for infants aged less than 7 months, and are even worse for those weaned before 6 months of age. (shrink)

The effects of breast-feeding and supplementation practices on recent diarrhoea occurrence and stunted growth are modelled using logistic regression techniques. Data from the Demographic and Health Survey of Bolivia, 1989, show that, among children aged 3-36 months at the date of interview, the benefits of breast-feeding to child health were most pronounced among children living in rural poverty. Reduced breast-feeding among these children increased the likelihood of diarrhoea and stunted growth. In addition, the introduction of solid foods (...) to currently lactating infants negatively influenced child health. (shrink)

The need for a shift toward healthier and more sustainable diets is evident and is supported by universalized standards for a “planetary health diet” as recommended in the recent EAT-Lancet report. At the same time, differences exist in tastes, preferences and food practices among diverse ethnic groups, which becomes progressively relevant in light of Europe’s increasingly multi-ethnic cities. There is a growing tension between current sustainable diets standards and how diverse ethnic resident groups relate to it within their ‘culturally appropriate’ (...) foodways, raising questions around inclusion. What are dynamics of inclusiveness in migrant food practices? And what does this mean towards the transition to healthy and sustainable food? We study this question among Syrian migrants with different lengths of stay in the Netherlands. Our theoretical framework is based on practice theories, which emphasize the importance of socio-material context and of bodily routines and competences. We use qualitative methods, combining in-depth semi-structured life-history interviews with participant observation. Our findings indicate that inclusiveness takes different forms as migrants’ food practices and the food environment change. Regarding health and sustainability in food practices, understandings and competences around particularly fresh food change over time among both short- and long-term migrants, replacing making things from scratch with seasonal products with buying more processed products and out-of-season vegetables and fruits. We conclude that the performances of food practices and their configurations in food environments and lifestyles are dynamic and cannot unequivocally be interpreted as in- or exclusive, but that a more nuanced understanding is required. (shrink)

Medical Officer of Health reports for London boroughs, 1900–19, are analysed to determine the incidence of neonatal breast-feeding, duration of lactation, reasons for early supplementation and premature weaning, and their relationship with infant mortality. In a sample of 222,989 infants, breast-feeding rates were very high. Over 90% were breast-fed in the first month, almost 80% at 3 months, and over 70% at 6 months. The poorest boroughs had the highest rates of neonatal breast-feeding, but also a higher (...) incidence of early supplementation and premature weaning. There was a significant positive correlation between breast-feeding and infant mortality due to poor maternal diet and health, poor nutritional quality of supplementary and substitute foods, and the use of an unhygienic feeding bottle. Energetic campaigns to counteract these problems probably contributed to the fall of infant mortality in this period. (shrink)

Critical development and food studies scholars argue that the current food security paradigm is emblematic of a ‘New Green Revolution’, characterized by agricultural intensification, increasing reliance on biotechnology, deepening global markets, and depeasantization. High-profile examples of this model are not hard to find. Less examined, however, are food-security programs that appear to work at cross-purposes with this model. Drawing on the case of Feed the Future in Guatemala, I show how USAID engages in activities that valorize ancestral crops, subsistence production, (...) and agroecological practices. Rather than the result of macro-level planning—of either the New Green Revolution or a greener reform regime—I argue that nonconforming food security projects can be traced to individual actors and their interactions on the ground. I draw on an ‘interface approach’ (Long 1990 ), focusing on the lifeworlds of development workers, their interfaces with each other, and with the to-be-developed. Doing so reveals how food security projects are significantly shaped by the relationships and interests of development actors enmeshed in particular organizational and national settings. This research contributes a fresh perspective on the food security paradigm and its role within the ‘corporate food regime’. (shrink)

Whilst it is generally accepted that breast-feeding lowers the likelihood of conception, this relationship is not straightforward and there appears to be a wide variation in the effectiveness of the association between individual mother-infant pairs. Up to about 6 months post-partum breast-feeding probably can be used as a family planning method, with up to 98% effectiveness if behavioural guidelines are adhered to . But beyond this time significant variations appear between different countries, and even different communities within countries, (...) which make any overall recommendation impossible. To understand the reasons for variation in the duration of lactational infecundity it is necessary to understand the mechanisms involved, but knowledge of these processes is still far from complete. There are, nevertheless, enough data to indicate that suckling and maternal milk output are intimately linked with the return of fecundity. (shrink)

Feed-forward Pavlovian conditioning can serve as a proximate mechanism for the evolution of social behavior. Feed-forward can provide the impetus for animals to associate other individuals' presence, and cooperation with them, with the acquisition of resources, whether or not the animals are genetically related. Other social behaviors such as play and grooming may develop as conditioned stimuli in feed-forward social systems.

Due to the pandemic and the suspension of in-person school classes, there was an interruption in the meals served to approximately 40 million students who benefited from the Brazilian National School Feeding Program (PNAE). This article describes two case studies, comparing the strategies adopted by two municipalities for maintaining school feeding during the Covid-19 pandemic in the northern region of the state of Rio de Janeiro, Brazil, and discuss possible impacts of these strategies on food and nutrition security. (...) These municipalities together cover about 81% of the population in the region. In July 2020, we conducted interviews with PNAE municipal managers, following a qualitative approach. We discuss the results in relation to existing Brazilian guidance on food and nutrition security. The municipalities have developed distinct strategies to overcome operational obstacles and maintain PNAE goals, such as distributing food kits and making cash transfers to students’ families. The main determinants of these strategies are financial availability, the relationship between municipal teams and school communities, and the pre-pandemic PNAE logistics and management. Depending on the strategy and duration of the pandemic, the impacts on food and nutrition security can be wide-ranging, affecting food quality and local farmers who sell products to PNAE. It is necessary to acknowledge that this is not a short-term pandemic and find ways to perform school feeding in accordance with PNAE criteria. (shrink)

My mother is a lousy cook. She has many other fine talents, but creating an attractive, tasty meal has always been beyond her reach. Even so, breakfast and dinner were daily rituals in my childhood home for which attendance was required. Just as we kids had no end of complaints about having to show up for meals (instead of getting to sleep in before school or hang with friends in the evening), we also took it for granted that my mother (...) made every one of those meals, day after day, year after year. Much later, I came to realize that not only did she make the food, but by constructing these gatherings at the kitchen table, she made our family. Like most mothers in the world, her daily work at the stove created the food-centered events around which our family grew, bonded, fought, and shared, and to which we return periodically to get reacquainted. Even as “women’s work” is expanded and redefined, feeding the family remains a central responsibility in families of all kinds. Lang Bui, owner of the Ypsilanti-based Vietnamese restaurant, Da Lat, knows all about the value of food and cooking to the creation of family. She does most all of the wonderful cooking for this low-priced, high-quality restaurant, while her two daughter-in-laws wait on the tables. (Lately, her one-year-old granddaughter also adds to the family atmosphere, toddling quietly about the front of the dining area.) Their efforts have.. (shrink)

In the described case, the consult requester, nurse Gloria, wants help with the question: “is it ethically justifiable to compel tube feeding over the objection of a young adult with anorexia nervo...

In lieu of an abstract, here is a brief excerpt of the content:Feeding Tiger, Finding GodScience, Religion, and "the Better Story" in Life of PiGregory Stephens (bio)Yann Martel's Life of Pi is an allegorical castaway story about a sixteen-year-old Indian polytheist who survives 227 days on a lifeboat with a Bengal tiger. Martel frames this postmodern variant on the Noah's ark tale as "a story that will make you believe in God" (viii). But these words are neither Martel's, nor (...) those of the semifictional "Martel-like" narrator one encounters in the "Author's Note" (Innes 25). Rather, they are voiced by Mr. Adirubasamy, an elderly Indian man whom the Canadian quasi-author meets at a coffee house in Pondicherry. The virtual author, like the real Martel, is the author of two failed books, and looking for a capital-S "Story."1 Yet after tracking down the primary narrator of the novel (Pi Patel) in Toronto, reading his diaries of his Pacific Ocean ordeal, and listening to taped interviews with Pi, the quasi-author agreed with Mr. Adirubasamy that "this was, indeed, a story to make you believe in God" (x).That apparently "evangelical premise" could awaken resistance among readers who take this "explicit but deceptive statement" too literally (Ishmael). As one reviewer notes, "Martel's statement is likely to have the opposite effect on his reader, provoking a determined counter-reaction not to succumb to a didactic religious agenda."2 Although the novel has its didactic moments, most reviewers seem to have taken a measured view of the author's "religious agenda." In interviews, Martel notes that he comes from a secular background in Quebec. There are no indications that writing this book represented a Damascus conversion experience for him. Life of Pi is not a conversion narrative perse, but it is in part an ascent narrative (a journey toward enlightenment) that also contains elements of descent narratives.3 As a secular writer with sympathies for the religious imagination, Martel can pitch his revisioning of comparative religion to readers who have what Salman Rushdie once called a "God-shaped hole" in their heart.4 These "implied readers" (Iser) would have a hunger for some of the animating power of faith, if not a capacity for blind commitment to dogmatic faith itself.Reviewing Life of Pi for the Nation, Charlotte Innes describes it as "a religious book that makes sense to a nonreligious person" (25). In similar fashion, the Pequod argues that Martel's book "achieves something more quietly spectacular" than a literal conversion, or a restoring of one's faith in God: "it makes the reader want to believe in God. Martel gives the reader the democratic choice: the desire to believe rather than the belief itself" (Ishmael).Those responses of the secular left contrast sharply with the responses of my first-year students at the University of the West Indies, to whom I have twice taught Life of Pi. For students from a fundamentalist background, it is a challenge to buy into a narrative [End Page 41] that proclaims a God that transcends the imaginations of most believers in the three faiths in which the young Pi has been trained (Hinduism, Christianity, and Islam). In analyzing the theme of finding God, I position the text at a midway point between two different kinds of reception: secular readers for whom the notion of religious belief is at best metaphorical, and religious readers who may resist the narrative's conceit that the true God exists outside the confines of institutional religion.Life of Pi is suffused by a pervasive liminality.5 The teenaged Pi is in motion between continents, between faiths, and between childhood and adulthood, which means that the novel is also a bildungsroman.6 I here focus above all on the text's and Pi's location in the contested space between believers and nonbelievers, and on the novel's attempted mediation between those seeming binary opposites. I ask two perhaps paradoxical questions: In what ways would this be seen by the nonreligious as a religious book with appeal? Put differently, to what degree and in what ways might this text actually give secular readers a desire to believe, even if it does... (shrink)

The response to feeding needs in advanced dementia patients is a subject of ethical inquiry. Advanced dementia is the debilitating result of a range of neurodegenerative diseases. As this terminal illness progresses, patients develop mild to severe dysphagia that can make swallowing difficult. Of the two available options, artificial tube feeding or oral hand feeding, an estimated one-third of these patients will receive artificial tube feeding. However, observational studies have failed to validate the clinical benefits of (...) tube feeding. Ethics of care, the feminist philosophical perspective, and Ubuntu philosophy offer arguments for the choice of oral hand-feeding as a preferrable first option by caregivers as far as possible. These moral theories acknowledge that human beings can be dependent for long periods, mostly early and later years of life. Both views reflect an approach that draws people into a system of interdependent caring relationships. They encourage hand feeding as a way of exhibiting solidarity and respecting human dignity even at the end of life. (shrink)

In this article, we examine the emergence of a concept of medical feeding that emphasizes artificiality and medical technology. We discuss how this concept has been created in specific contrast to the daily provision of food and water; medical definitions retain clear disjunctures with cultural and religious beliefs surrounding food, gendered aspects of eating and feeding, and the everyday practices of social and family life in the United States. We begin with an examination of the historical processes involved (...) in creating artificial nutrition and hydration as a medical concept, including the evolution of terminology and practices in relation to technology advancement, legal cases, and public discourse. We.. (shrink)

Purpose We explored the views of Botswana stakeholders involved in developing, implementing and applying ethical standards for return of individual study results from genomic research. This allowed for mapping opportunities and challenges regarding actionability requirements that determine whether individual genomic research results should be fed back. Methods Using in-depth interviews, this study explored the views of sixteen (16) stakeholders about the extent, nature and timing of feedback of individual genomic research findings, including incidental findings that arise in the context of (...) African genomics research. Coded data was analyzed through an iterative process of analytic induction to document and interpret themes. Results Overall, respondents were of the view that feedback of actionable individual genomic results was an important outcome that could benefit participants. However, a number of themes surfaced that pointed to opportunities and challenges that exist in Botswana that could help in planning for feeding back of individual genomic results that were mapped. Some of the opportunities cited by the respondents included the existence of good governance; democracy and humanitarianism; universal healthcare system; national commitment to science; research and innovation to transform Botswana into a knowledge-based economy; and applicable standard of care which could promote actionability. On the other hand, contextual issues like the requirement for validation of genomic research results in accredited laboratories, high cost of validation of genomic results, and linkage to care, as well as lack of experts like genomic scientists and counselors were considered as challenges for return of individual results. Conclusion We propose that decisions whether and which genomic results to return take into consideration contextual opportunities and challenges for actionability for return of results in a research setting. This is likely to avoid or minimize ethical issues of justice, equity and harm regarding actionability decisions. (shrink)

Feeding difficulties in older patients who are suffering from dementia present problems with balancing conflicting ethical principles. They have been considered by several writers in recent years, and the views of nursing and care staff have been studied in different contexts. The present study used focus groups to explore the way in which nursing and care staff in a National Health Service trust deal with conflict between ethical principles in this area. Three focus groups were convened, one each from (...) the staff of three wards caring for patients with dementia. Case histories were discussed and transcripts analysed. It emerged that staff were aware of making fine judgements of utility concerning the spectrum of feeding methods available. Informants gave some weight to the principle of autonomy, but sought to balance that against their commitment to care. In explaining their perspectives, informants gave more weight to personal attitudes and trust culture than to professional ethics. (shrink)

Breastfeeding has become a subject of moral concern as its benefits have become well known. Encouraging mothers to breastfeed has been the goal of extensive public health promotion efforts. Emmanuel Levinas makes absolute responsibility to the Other central to his ethics, with giving food to the Other the paradigmatic ethical act. However, Levinas also provides an important critique of the autonomous individual who is taken for granted by breastfeeding promotion efforts. I argue that the ethical obligation to feed the hungry (...) child must be recognized as coextensive with meeting the needs of women, especially given the current absence of important social and economic supports for breastfeeding. Under a Levinasian framework, each of us is ethically responsible for feeding children; this responsibility is not limited to mothers. This ethical responsibility needs to be expressed through improving social and economic supports necessary for those individuals who wish to breastfeed, instead of attempting to convince women to breastfeed. This ethical responsibility must also be understood in a broader context of a politics of hunger, which provides access to quality food for all, and goes beyond mere nutrition to include the importance of culture, touch, and intimacy in the enjoyment of food—what Levinas calls “good soup.”. (shrink)

In this paper, I argue that clinically-oriented practical and theoretical approaches to the problem of pain should more carefully heed narrative and phenomenological research. I begin with the work of S. Kay Toombs, contending that her phenomenological account of multiple sclerosis demonstrates how a degenerative condition attendant with pain ultimately effect a constriction of one’s world. Drawing upon two of artist Yosl Bergner’s depictions of the story, I then present a reading of Kafka’s “The Vulture” as a literary account of (...) the constrictive movement of acute, localized pain to chronic, systemic pain. I conclude by discussing the implications of literary and phenomenological accounts of pain for its diagnosis, management, and treatment. (shrink)

Philosophers of science have in recent years become increasingly interested in the notion of interdisciplinarity. One important form interdisciplinarity can take is that of a dynamic exchange of problems and solutions between disciplines—what has recently been called problem-feeding. On this model problems arising within specific disciplines are sometimes solved more effectively by, or in collaboration with, other disciplines. In this paper we explore this model as a framework for thinking about, and actively structuring, interdisciplinary research. We point to the (...) applicability of the problem-feeding model, and to some of the prerequisites of problem-feeding interdisciplinarity, highlighting in particular the harmonisation of goals and the establishment of mutual trust between disciplines. (shrink)