Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

Ignorance is commonly assumed to be a lack of knowledge in Plato’s Socratic dialogues. I challenge that assumption. In the Protagoras, ignorance is conceived to be a substantive, structural psychic flaw—the soul’s domination by inferior elements that are by nature fit to be ruled. Ignorant people are characterized by both false beliefs about evaluative matters in specific situations and an enduring deception about their own psychic conditions. On my interpretation, akrasia, moral vices, and epistemic vices are products or forms of (...) ignorance, and a person who lacks knowledge is not necessarily ignorant. (shrink)

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and (...) somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes ; limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice. (shrink)

This article introduces a non-Anglophone concept of gong qi as a metaphor for ‘corporation’. It contributes an endogenous perspective from a Sino-Japanese organizational context that enriches mainstream business ethics literature, otherwise heavily reliant on Western traditions. We translate the multi-layered meanings of gong qi based on analysis of its ideograms, its references into classical philosophies, and contemporary application in this Japanese multinational corporation in China. Gong qi contributes a perspective that sees a corporation as an inclusive and virtuous social entity, (...) and also addresses the elusive, implicit, and forever evolving nature of organizational life that is rarely noticed. We propose gong qi can be applied in other organizations and wider cultural contexts to show a new way of seeing and understanding business ethics and organization. Rather than considering virtue as a list of definable individual qualities, we suggest that the metaphor of gong qi reveals how virtue can be experienced as indeterminate, yet immanently present, like the substance of emptiness. This, then allows us to see the virtue of immanence, the beauty of implicitness, and hence, the efficacy of gong qi. (shrink)

Disrespect in health care often persists despite firm commitments to respectful service provision. This conceptual paper highlights how the ways in which respect and disrespect are characterised can have practical implications for how well disrespect can be tackled. We stress the need to focus explicitly on disrespect (not only respect) and propose that disrespect can usefully be understood as a failure to relate to people as equals. This characterisation is consonant with some accounts of respect but sometimes obscured by a (...) focus on respecting people’s autonomy and dignity. Emphasising equality is consistent with connections patients draw between being (dis)respected and (in)equality. It readily accommodates microaggressions as forms of disrespect, helping to understand how and why experiences of disrespect may be unintentional and to explain why even small instances of disrespect are wrong. Our view of disrespect with an emphasis on equality strengthens the demand that health systems take disrespect seriously as a problem of social injustice and tackle it at institutional, not just individual levels. It suggests several strategies for practical action. Emphasising relational equality is not an easy or short-term fix for disrespect, but it signals a direction of travel towards an important improvement ambition. (shrink)

Reading feminist theory as a complex imaginative achievement, Feminist Imagination considers feminist commitment through the interrogation of its philosophical, political and affective connections with the past, and especially with the `race' trials of the twentieth century. The book looks at: the 'directionlessness' of contemporary feminist thought; the question of essentialism and embodiment; the racial tensions in the work of Simone de Beauvoir; the totalitarian character in Hannah Arendt; the 'mimetic Jew' and the concept of mimesis in the work of Judith (...) Butler. Vikki Bell provides a compelling rethinking of feminist theory as bound up with attempts to understand oppression outside a focus on 'women'. She affirms feminism as a site and mode of making these connections. What emerges is a profound work brimming with insight that will be required reading for anyone who is seriously interested in feminist theory and, more generally, contemporary social theory. (shrink)

This paper is an attempt to examine issues and problemsraised by agricultural biotechnology by drawing on the richnessof contemporary ideas in ethical theory and thereby contribute tothe project of establishing new approaches to these problems. Thefundamental argument is that many of the negative aspects ofagricultural biotechnology are generated at the level of theunderlying conceptual frameworks that shape the technology''sinternal modes of organization, rather than the unintendedeffects of the application of an inherently benevolent set oftechniques. If ``food ethics'''' is to address (...) the adverse impacts ofagricultural biotechnology, it must ultimately challenge theseconceptual frames, which, I argue, emerge from Enlightenment,liberal, political, and economic theory.The translation of traditional bioethics (focusing on principlessuch as autonomy and rights, justice, and well being) into foodethics does not produce the critical tools that are ableadequately to challenge the harmful legacy of Enlightenmentthinking. What is needed are reorientations of ethics that arecapable of formulating concepts and approaches that to someextent break with the presuppositions that underpin biotechnologyat its foundation. This paper suggests that narrative andfeminist critiques of medical bioethics are a good place to startin this project. (shrink)

It is the study of how Thomas Paine's religious beliefs shaped his political ideology and influenced his political activism.

Bell argues that the dialogue that emanate from the aesthetic realm cannot be understood through a solely art-historical approach; instead, they must be understood as part of a collective endeavour. In this sense, the 'art' of post-dictatorship is not something that belongs to art or the artists themselves, but is about how the subjectivities and imaginations of new generations engage with questions of response, ethics and justice; and, in so doing, re-align themselves in relation to the past and to the (...) future. This book provides a valuable resource for those interested in the law, politics, art and sociology of contemporary Argentina. It will be of immense use to those studying in these areas and to those concerned more widely with transitional justice and memory politics. (shrink)

Recruitment processes for clinical trials are governed by guidelines and regulatory systems intended to ensure participation is informed and voluntary. Although the guidelines and systems provide some protection to potential participants, current recruitment processes often result in limited understanding and experiences of inadequate decision support. Many trials also have high drop-out rates among participants, which are ethically troubling because they can be indicative of poor experiences and they limit the usefulness of the knowledge the trials were designed to generate. Drawing (...) on recent social-psychological and philosophical-ethical research on trial recruitment and patient participation in treatment decision-making, this paper identifies possibilities for improving communicative support for both initial decisions and ongoing participation in clinical trials. It highlights the potential of a shift in thinking about ‘voluntariness’, underpinned by relational understandings of autonomy, to encourage more nuanced judgements about the ethics of communication between trial staff and (potential) participants. The paper suggests that the idea of responsively enabling people to consider invitations or requests to participate in particular trials could serve as a general guide to communication. This might help ensure decisions about trial participation are meaningfully informed and voluntary, and that relationships between trial staff and participants contribute to positive experiences of trial participation and ultimately to the generation of the robust knowledge. (shrink)

In this interview, Judith Butler speaks about her most recent work, especially Excitable Speech, in terms of how it represents a continuation of certain themes and how it represents moves into new terrains of debate. In particular, she addresses both possible critiques of her work, expecially around the issue of the possibility of political visions and the attention to speech when theorizing subjectification, and responds to questions around certain related themes such as: just what is the possibility of using the (...) same analytical framework to talk both about racializing and gendering processes? How useful is the concept of melancholia? How are textuality and visuality interconnected? (shrink)

This short piece introduces the Special Issue, giving both a general sense of the terms `belonging' and `performativity', and discussing key related concepts that unite the articles of the issue: difference and their differences; the politics of visuality; embodiment; and the idea of routes. The predominant themes as they appear in the different articles are discussed under these headings.

abstract The so‐called ‘morning‐after pill’ is a drug that prevents pregnancy if taken no later than 72 hours after presumably fertile sexual intercourse. This article argues against a right of conscientious objection for pharmacists with regard to dispensing this drug. Some arguments that might be advanced in support of this right will be considered and rejected. Section 2 argues that from a philosophical point of view, the most relevant question is not whether the morning‐after pill prevents implantation nor is it (...) whether preventing implantation is tantamount to abortion. Section 3 suggests a more general philosophical question as most pertinent, namely whether and to what extent a pharmacist can justifiably be exempted from dispensing the morning‐after pill when to do so would entail participating in something that goes against his or her deepest moral or religious convictions. Section 4 explains why, within liberal institutions, pharmacists should not have the right to conscientious objection to dispensing the morning‐after pill. (shrink)

In growing recognition that the business community must play a key role in the global issues encapsulated by the United Nations Sustainable Development Goals, Babson College, which has a business-focused curriculum, has striven first to reinvent its teaching of ethics and then, particularly over the past decade, to enhance its focus on sustainability, social responsibility, and social entrepreneurship. As previous initiatives did not build sufficient linkages between the liberal arts, natural sciences, and business curriculum, the College is now engaged in (...) a far more comprehensive effort to educate our undergraduate business students in “integrated sustainability,” which it defines as “systems thinking that integrates ecological integrity, social responsibility, and value creation simultaneously.” By examining the meaning, skills, and pedagogical opportunities in systems thinking within the context of larger discussions on humanistic management, this article shows how systems thinking is a particularly fruitful way to ground business students in the natural sciences and the liberal arts, develop their complex problem-solving skills, and thereby reinvigorate management education in ways that prepares students to “render service to humanity.” Our hope is that sharing Babson College’s experience in this regard – both our successes and challenges - may provide useful insights to other faculty and academic leaders seeking to enhance humanistic management within their own higher education institutions. (shrink)

This book addresses the metaphysics of Armstrongian states of affairs, i.e. instantiations of naturalist universals by particulars. The author argues that states of affairs are the best candidate for truthmakers and, in the spirit of logical atomism, that we need no molecular truthmakers for positive truths. In the book's context, this has the pleasing result that there are no molecular states of affairs. Following this account of truthmaking, the author first shows that the particulars in (first-order) states of affairs are (...) bare particulars. He then argues that the properties in states of affairs are simple, non-relational and concrete universals. Next, he argues that (material) relations in states of affairs are external relations. Lastly, he argues that a state of affairs is unified by a distinctive formal relation without giving rise to Bradley’s regress. (shrink)

Daniel Dennett is arguably one of the most influential yet radical philosophers in America today. In this volume, Dennett is confronted by colleagues and critics, from philosophy, biology and psychology. His reply constitutes an extensive essay which clarifies, and develops further, central themes in his philosophy. The debate ranges over Dennett's whole corpus, but special attention is given to his major work on consciousness, Consciousness Explained. The volume includes a critical assessement of Dennett's views on behaviouralism and the subjectivity of (...) consciousness, the nature of perception and mental representation, intentional laws and computational psychology, the rationality of thought, culture as a virus, the architecture of mind, and the role of artifacts in thinking. Also included is an introduction to Dennett's philosophy and a full bibliography of his publications. (shrink)

In this paper, we argue that there are important ethical questions about healthcare improvement which are underexplored. We start by drawing on two existing literatures: first, the prevailing, primarily governance-oriented, application of ethics to healthcare ‘quality improvement’ (QI), and second, the application of QI to healthcare ethics. We show that these are insufficient for ethical analysis of healthcare improvement. In pursuit of a broader agenda for an ethics of healthcare improvement, we note that QI and ethics can, in some respects, (...) be treated as closely related concerns and not simply as externally related agendas. To support our argument, we explore the gap between ‘quality’ and ‘ethics’ discourses and ask about the possible differences between ‘good quality healthcare’ and ‘good healthcare’. We suggest that the word ‘quality’ both adds to and subtracts from the idea of ‘good healthcare’, and in particular that the technicist inflection of quality discourses needs to be set in the context of broader conceptualisations of healthcare improvement. We introduce the distinction between quality as a measurable property and quality as an evaluative judgement, suggesting that a core, but neglected, question for an ethics of healthcare improvement is striking the balance between these two conceptions of quality. (shrink)

Therapeutic privilege is a defence that may be available to doctors who fail to disclose to the patient relevant information when seeking informed consent for treatment if they have a reasonable belief that providing that information would likely cause the patient concerned serious physical or mental harm. In a landmark judgement, the Singapore Court of Appeal introduced a novel interpretation of TP, identifying circumstances in which it might be used with patients who did not strictly lack capacity but might be (...) inclined to refuse recommended treatments. In this paper, we explore the conceptual and practical challenges of this novel interpretation of TP. We propose that more emphasis should be placed on forms of shared and supported decision-making that foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being. The kind of privilege that doctors might need to invoke is one of time and supportive expertise to ensure a flexible, responsive approach calibrated to the individual patients’ needs. The provision of such service would extinguish the need for the novel TP proposed by the Singapore Court of Appeal. (shrink)

The current public health crisis has exposed deep cracks in social equality and justice for marginalised and vulnerable communities around the world. The reported rise in the number of ‘do not resuscitate’ orders being imposed on people with disabilities has caused particular concerns from a human rights perspective. While the evidence of this is contested, this article will consider the human rights implications at stake and the dangers associated with using ‘quality of life’ measures as determinant of care in medical (...) decision-making and triage assessments. (shrink)

In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call ’normative complexity’. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as something that requires theoretical and practical attention alongside the more recognised challenges of complex systems, which we label, for short, as ’explanatory complexity’. In brief, normative complexity relates to (...) the inherent difficulty of deciding what kinds of changes are ’improvements’ or, more broadly, what is valuable in healthcare. We suggest that explanatory and normative complexity intersect and that anyone interested in healthcare improvement needs to be sensitive to both. After briefly introducing the idea of normative complexity, we consider some contrasting examples of conversations, reflecting on how they do and might contribute to healthcare quality. We discuss both conversations that are deliberately organised and facilitated (’orchestrated conversations’) and more informally occurring and routine conversations. In the first half of the paper, we draw on some examples of orchestrated and routine conversations to open up these issues. In the second half of the paper, we bring some more theoretical lenses to bear on both conversations and normative complexity, summarise what we take to be the value of conversations and draw together some of the implications of our discussion. In summary, we argue that conversations can play a crucial role in negotiating the normative complexity of healthcare quality improvement because of their capacity to hold together a plurality of perspectives, to contribute and respond to emergence and to help underpin institutional conditions for empathy and imagination. (shrink)

This article concerns the striking photograph of a young man, Fernando Brodsky, taken shortly after he was kidnapped in Argentina in 1979. Brodsky was detained in the notorious Escuela de la Armada in Buenos Aires, and remains disappeared. The negative of the photograph was smuggled out of ESMA and the image became part of a bundle of photographic evidence submitted by families of the disappeared during the trials of the military after the return to democracy in 1983. This article seeks (...) to understand the vitality of the photograph, the different courses it takes, the archives it joins and leaves, asking: ‘What sort of life can the photograph have? What sort of desire? What sort of politics?’ The article proposes that we might consider the role of such images ‘biopolitically’, which is to say in the context of the relations established through the attempts to govern populations in times of military rule and in times of transitional democracy. The re-appearance of Fernando in the photograph is part of post-dictatorship politics in which the demand ‘ aparición’ resounds. Fernando, an absolute witness who does not, who cannot, speak nevertheless re-appears in the law courts and in art exhibitions. The article considers the difference between the photograph’s appearance as evidence and its reappearance in the art galleries, arguing that its ‘desires’ can be imagined differently in each. The article argues that while the photograph does not escape archives tout court, in raising the question of how it should be filed, it prompts reflection on the biopolitical present, with its inequitable distribution of life and security among populations. This is a politics of the present, more than it is a politics of memory. (shrink)

Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis on the (...) family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making. (shrink)

In this article I argue that, if one is persuaded by the arguments of Emmanuel Levinas, the pursuit of something called ‘ethical feminism’ is rendered difficult, for, according to Levinas, there is a hiatus between ethics and politics in so far as politics does not flow from ethics. Indeed, politics obliges one to engage in the non-ethical, so that the ethical cannot be understood as a basis for feminist politics. I contend that one can argue that it is in the (...) way that the dangers of the non-ethical are handled that politics begins. If this is so, one can refigure the question of ethics within feminism. Ethics becomes a check on freedom and politics rather than its originary source. However, I argue, along with Michel Foucault and William Connolly, that ethical responses, while coming from the other, have also to be subjected to genealogical critique, so that their conditions of possibility are not naturalized. (shrink)

A 'social trap' is a situation where individuals, groups or organisations are unable to cooperate owing to mutual distrust and lack of social capital, even where cooperation would benefit all. Examples include civil strife, pervasive corruption, ethnic discrimination, depletion of natural resources and misuse of social insurance systems. Much has been written attempting to explain the problem, but rather less material is available on how to escape it. In this book, Bo Rothstein explores how social capital and social trust are (...) generated and what governments can do about it. He argues that it is the existence of universal and impartial political institutions together with public policies which enhance social and economic equality that creates social capital. By introducing the theory of collective memory into the discussion, Rothstein makes an empirical and theoretical claim for how universal institutions can be established. (shrink)

This paper is a philosophical study of the nature of thinking based on the philosophies of Martin Heidegger and Rudolf Steiner. For Heidegger, the pre-Socratic Greek philosophers exemplified genuine thinking, appreciating the meaning of Being. But this kind of philosophy was soon replaced by the onto-theological approach, in which Being was reductively objectified, and the question of the meaning of Being was forgotten. Hence, according to Heidegger, we still have to learn to think. Commentators on Heidegger point to the similarities (...) between his approach to thinking and that of various mystical teachings, such as those of Meister Eckhart or Zen Buddhism. Another less well known philosopher who devoted himself to this question was Rudolf Steiner. Like Heidegger, Steiner claims that we do not know what it means to really think. Steiner was however more outspoken in insisting that only through a kind of meditative practice can we directly experience the nature of thinking. Present day materialistic explanations of thinking as caused by the brain stand in clear opposition to his spiritual conception of thinking. Drawing upon Heidegger and Steiner I argue against the materialistic understanding of thinking as jumping to unwarranted conclusions. The paper ends with describing some of the elements of Steiner Waldorf education which are intended to promote the development of living, creative thinking. (shrink)

Rom Harré’s career spans more than 40 years of original contributions to the development of both psychology and other human and social sciences. Recognized as a founder of modern social psychology, he developed the microsociological approach ‘ethogenics’ and facilitated the discursive turn within psychology, as well as developed the concept of positioning theory. Used within both philosophy and social scientific approaches aimed at conflict analysis, analyses of power relations, and narrative structures, the development and impact of positioning theory can be (...) understood as part of a second cognitive revolution. Whereas the first cognitive revolution involved incorporating cognition as both thoughts and feelings as an ineliminable part of psychology and social sciences, this second revolution released this cognition from a focus on individuals, and towards a focus of understanding individuals as participating in public practices using public discourses as part of their cognition. This edited volume adds to the scholarly conversation around positioning theory, evaluates Rom Harré’s significance for the history and development of psychology, and highlights his numerous theoretical contributions and their lasting effects on the psychological and social sciences. Included among the chapters: What is it to be a human being? Rom Harré on self and identity The social philosophy of Harré as a philosophy of culture The discursive ontology of the social world Ethics in socio-cultural psychologies Discursive cognition and neural networks The Second Cognitive Revolution: A Tribute to Rom Harré is an indispensable reader for anyone interested in his cognitive-historical turn, and finds an audience with academics and researchers in the social and human science fields of cognitive psychology, social psychology, discursive psychology, philosophy, sociology, and ethnomethodology. (shrink)