BackgroundHuman infection studies (HIS) are valuable in vaccine development. Deliberate infection, however, creates challenging questions, particularly in low and middle-income countries (LMICs) where HIS are new and ethical challenges may be heightened. Consultation with stakeholders is needed to support contextually appropriate and acceptable study design. We examined stakeholder perceptions about the acceptability and ethics of HIS in Malawi, to inform decisions about planned pneumococcal challenge research and wider understanding of HIS ethics in LMICs.MethodsWe conducted 6 deliberative focus groups and 15 (...) follow-up interviews with research staff, medical students, and community representatives from rural and urban Blantyre. We also conducted 5 key informant interviews with clinicians, ethics committee members, and district health government officials.ResultsStakeholders perceived HIS research to have potential population health benefits, but they also had concerns, particularly related to the safety of volunteers and negative community reactions. Acceptability depended on a range of conditions related to procedures for voluntary and informed consent, inclusion criteria, medical care or support, compensation, regulation, and robust community engagement. These conditions largely mirror those in existing guidelines for HIS and biomedical research in LMICs. Stakeholder perceptions pointed to potential tensions, for example, balancing equity, safety, and relevance in inclusion criteria.ConclusionsOur findings suggest HIS research could be acceptable in Malawi, provided certain conditions are in place. Ongoing assessment of participant experiences and stakeholder perceptions will be required to strengthen HIS research during development and roll-out. (shrink)

Community engagement to protect and empower participating individuals and communities is an ethical requirement in research. There is however limited evidence on effectiveness or relevance of some of the approaches used to improve ethical practice. We conducted a study to understand the rationale, relevance and benefits of community engagement in health research. This paper draws from this wider study and focuses on factors that shaped Community Advisory Group members’ selection processes and functions in Malawi. A qualitative research design was used; (...) two participatory workshops were conducted with CAG members to understand their roles in research. Workshop findings were triangulated with insights from ethnographic field notes, key informant interviews with stakeholders, focus group discussions with community members and document reviews. Data were coded manually and thematic content analysis was used to identify main issues. Results have shown that democratic selection of CAG members presented challenges in both urban and rural settings. We also noted that CAG members perceived their role as a form of employment which potentially led to ineffective representation of community interests. We conclude that democratic voting is not enough to ensure effective representation of community's interests of ethical relevance. CAG members’ abilities to understand research ethics, identify potential harms to community and communicate feedback to researchers is critical to optimise engagement of lay community and avoid tokenistic engagement. (shrink)

ABSTRACTBuilding trust between researchers and communities involved in research is one goal of community engagement. This paper examines the implications of community engagement for trust within communities, including trust among community volunteers who assist with research and between these volunteers and other community members. We describe the experiences of two groups of community volunteers recruited as part of an HIV and TB intervention trial in Malawi: cluster representatives, recruited both to act as key informants for TB suspects and mortality reporting (...) and to identify and report community concerns, and community counsellors, recruited to provide semi-supervised HIV self-testing. We examine tensions experienced due to playing multiple roles, and the implications of volunteer responsibilities for short- and long-term community relationships. Data was collected through a workshop, in-depth interviews and focus group discussions with volunteers and community members. While the volunteer system init... (shrink)

Paediatric research in low-income countries is essential to tackle high childhood mortality. As with all research, consent is an essential part of ethical practice for paediatric studies. Ethics guidelines recommend that parents or another proxy provide legal consent for children to participate, but that children should be involved in the decision through providing assent. However, there remain uncertainties about how to judge when children are ready to give assent and about appropriate assent processes. Malawi does not yet have detailed guidelines (...) on assent. Understanding perspectives among children and their parents can assist in developing contextually-appropriate assent guidance. Qualitative research was conducted with children and parents in three settings in Southern Malawi, to take account of any variations between socioeconomic and cultural contexts. In each setting, interviews were conducted with parents and their children who had participated in paediatric research to understand their experiences of assent and views on appropriate assent practice. Focus groups were also conducted with children and parents, to understand broader social perspectives. We found widespread support for involving children in decisions on research participation. Participants identified a range of factors that affect children’s capacity to give assent, including intellectual capacity, emotional development, life experience and cultural norms. Age was often mentioned as a consideration, but deemed an unreliable sole indicator of capacity to assent. In relation to appropriate assent processes, participants emphasised considerations such as supporting effective understanding and minimizing harms. Views on how to achieve these aims varied; for example, there were different ideas about the appropriate order in which to approach children and parents, and about whose decision to respect in the event of disagreement. Parents and children agreed about the value of involving children in decisions on research, and about the need to promote children’s decision-making capacity while respecting parents’ interests in children’s welfare. Developing practical guidance that meets these principles is challenging, particularly given the need for flexible approaches that suit different study types, children’s capacities and family environments. Further discussion within the Malawi research and ethics community will help develop contextually-appropriate guidelines. (shrink)

Biometrics is the science of establishing the identity of an individual based on their physical attributes. Ethical concerns surrounding the appropriate use of biometrics have been raised, especial...

Much has been published about the ethical issues encountered by clinicians in genetics/genomics, but those experienced by clinical laboratory scientists are less well described. Clinical laboratory scientists now frequently face navigating ethical problems in their work, but how they should be best supported to do this is underexplored. This lack of attention is also reflected in the ethics tools available to clinical laboratory scientists such as guidance and deliberative ethics forums, developed primarily to manage issues arising within the clinic.We explore (...) what ethical issues are being experienced by clinical scientists, how they think such issues could be best analysed and managed, and whether their practice might be enhanced by more situated approaches to ethics deliberation and practice such as ethical preparedness. From thematic analysis of cases presented by clinical scientists at a specially convened meeting of the UK Genethics Forum, we derived three main ethical themes: (1) the redistribution of labour and responsibilities resulting from the practice of genomic medicine; (2) the interpretation and certainty of results and (3) the proposal that better standardisation and consistency of ethical approaches (for example, more guidelines and policy) could resolve some of the challenges arising.We argue that although standardisation is important for promoting shared understandings of good (including ethical) practice, supplementary approaches to enhance and sustain ethical preparedness will be important to help clinical scientists and others in the recently expanded genetic/genomic medicine environment foster quality ethical thinking. (shrink)

Consumer concern for “ethical products”, or ethical aspects of the goods which they purchase, is a subject of increasing interest and research,which is here illustrated by an examination of the Fair Trade movement, with special reference to coffee as an indicative commodity. Kate Bird, is currently Lecturer in the Development Administration Group, School of Public Policy, Birmingham University, Birmingham B15 2TT, England, having previously worked abroad and written her MSc dissertation at Wye College on fair trade in coffee products. (...) Dr Hughest holds the Sainsbury Chair in Agribusiness and Food Marketing at Wye College, University of London, Wye, Ashford, Kent TN25 5AH, England (email: [email protected]), where he is also Director of the Food Industry Management Group. He has wide international experience of food management issues. (shrink)

Consumer concern for “ethical products”, or ethical aspects of the goods which they purchase, is a subject of increasing interest and research,which is here illustrated by an examination of the Fair Trade movement, with special reference to coffee as an indicative commodity. Kate Bird, is currently Lecturer in the Development Administration Group, School of Public Policy, Birmingham University, Birmingham B15 2TT, England, having previously worked abroad and written her MSc dissertation at Wye College on fair trade in coffee products. (...) Dr Hughest holds the Sainsbury Chair in Agribusiness and Food Marketing at Wye College, University of London, Wye, Ashford, Kent TN25 5AH, England (email: [email protected]), where he is also Director of the Food Industry Management Group. He has wide international experience of food management issues. (shrink)

Background: Ethical care in maternity is fundamental to providing care that both prevents harm and does good, and yet, there is growing acknowledgement that disrespect and abuse routinely occur in this context, which indicates that current ethical frameworks are not adequate. Care ethics offers an alternative to the traditional biomedical ethical principles. Research aim: The aim of the study was to determine whether a correlation exists between midwifery-led care and care ethics as an important first step in an action research (...) project. Research design: Template analysis was chosen for this part of the action research. Template analysis is a design that tests theory against empirical data, which requires pre-set codes. Participants and context: A priori codes that represent midwifery-led care were generated by a stakeholder consultative group of nine childbearing women using nominal group technique, collected in Perth, Western Australia. The a priori codes were applied to a predesigned template with four domains of care ethics. Ethical considerations: Ethics approval was granted by the Edith Cowan University research ethics committee REMS no. 2019-00296-Buchanan. Findings: The participants generated eight a priori codes representing ethical midwifery care, such as: 1.1 Relationship with Midwife; 1.2 Woman-centred care; 2.1 Trust women’s bodies and abilities; 2.2. Protect normal physiological birth; 3.1. Information provision; 3.2. Respect autonomy; 4.1. Birth culture of fear and 4.2. Recognition of rite of passage. The a priori codes were mapped to the care ethics template. The template analysis found that midwifery-led care does indeed demonstrate care ethics. Discussion: Care ethics takes into consideration what principle-based bioethics have previously overlooked: relationship, context and power. Conclusion: Midwifery-led care has been determined in this study to demonstrate care ethics, which suggest that further research is defensible with the view that it could be incorporated into the ethical codes and conduct for the midwifery profession. (shrink)

Knowledge is a presumed motivator for changed consumption practices in ethical eating discourse: the consumer learns more about where their food comes from and makes different consumption choices. Despite intuitive appeal, scholars are beginning to illuminate the limits of knowledge-focused praxis for ethical eating. In this paper, we draw from qualitative interviews and focus groups with Toronto mothers to explore the role of knowledge in conceptions of ethical foodwork. While the goal of educating children about their food has become central (...) to Canadian and American discourses of “good” mothering, we identify a paradoxical maternal expectation surrounding meat consumption: to raise informed child consumers who know where their food comes from, and to protect children from the harsh realities of animal slaughter. Rather than revealing the story behind the meat on a child’s plate, mothers seek to shield children from knowledge of meat production. Our analysis of the child consumer contributes to ethical eating scholarship and illuminates a larger paradox surrounding knowledge of meat in an industrialized food system. In the practice of feeding children, mothers confront the visceral discomforts of meat consumption; their reactions speak to discordant feelings involved with eating meat in a setting far-removed from the lives and deaths of animals. Ultimately, the paper illustrates the limits of consumer-focused strategies for food-system change that call on individual mothers to educate young consumers and protect childhood innocence, all while getting ethically-sourced meals on the table. (shrink)

In this book, Kate Schick presents the core themes of Rose's work and locates her ideas within central debates in contemporary social theory, engaging with the works of Benjamin, Honig, iek and Butler. She shows how Rose's speculative perspective brings a different gaze to bear on debates, eschewing well-worn liberal, critical theoretic and post-structural positions. Gillian Rose draws on idiosyncratic readings of thinkers such as Hegel, Adorno and Kierkegaard to underpin her philosophy, negotiating the 'broken middle' between the particular (...) and the universal. While of the left, she is sharply critical of much left-wing thought, insisting that it shirks the work of coming to know and of taking political risk in pursuit of a 'good enough justice'. (shrink)

This essay presents Augustine as a rich ethical resource on issues of wealth and poverty. Contrary to prevalent views that he had little to say on issues of economic justice, Augustine decries wealth as morally dangerous, promotes the agency of the poor in advocating for themselves with the wealthy, and supports distributive justice. Augustine envisions an interdependent Christian community where the wealthy not only help the poor, but rely on the poor to help them achieve salvation by “bearing their goods (...) to heaven,” as Augustine describes the receipt of alms. Augustine's view of wealth's moral danger is an apt resource for ethicists interested in virtue. His insistence on poor people's moral agency and interdependence among poor and wealthy speak to pressing issues of justice in today's unequal societies. (shrink)

Among contemporary ethicists, Hume is perhaps best known for his views about morality’s practical import and his spectator-centered account of moral evaluation. Yet according to the so-called “spectator complaint”, these two aspects of Hume’s moral theory cannot be reconciled with one another. I argue that the answer to the spectator complaint lies in Hume’s account of “goodness” and “greatness of mind”. Through a discussion of these two virtues, Hume makes clear the connection between his views about moral motivation and his (...) understanding of moral evaluation by providing us with two portraits of the Humean moral agent. (shrink)

Denis, Lara. Moral Self-Regard: Duties to Oneself in Kant's Moral Theory. New York: Garland Publishing. 2001. Engstrom, Stephen. “The Concept ofthe Highest Good in Kant's Moral The- ory.” Philosophy and Phenomenological Research 52, ...

There is an apparent tension between Immanuel Kant's model of moral agency and his often-neglected philosophy of moral education. On the one hand, Kant's account of moral knowledge and decision-making seems to be one that can be self-taught. Kant's famous categorical imperative and related 'fact of reason' argument suggest that we learn the content and application of the moral law on our own. On the other hand, Kant has a sophisticated and detailed account of moral education that goes well beyond (...) the kind of education a person would receive in the course of ordinary childhood experience. The task of this paper will be to reconcile these seemingly conflicting claims. Ultimately, I argue, Kant's philosophy of education makes sense as a part of his moral theory if we look not only at individual moral decisions, but also at the goals or ends that these moral decisions are intended to achieve. In Kant's case, this end is what he calls the highest good, and, I argue, the most coherent account of the highest good is a kind of ethical community and end of history, similar to the Groundwork 's realm of ends. Seen as a tool to bring about and sustain such a community, Kant's philosophy of moral education exists as a coherent and important part of his moral philosophy. (shrink)

There is an apparent tension between Immanuel Kant’s model of moral agency and his often-neglected philosophy of moral education. On the one hand, Kant’s account of moral knowledge and decision-making seems to be one that can be self-taught. Kant’s famous categorical imperative and related ‘fact of reason’ argument suggest that we learn the content and application of the moral law on our own. On the other hand, Kant has a sophisticated and detailed account of moral education that goes well beyond (...) the kind of education a person would receive in the course of ordinary childhood experience. The task of this paper will be to reconcile these seemingly conflicting claims. Ultimately, I argue, Kant’s philosophy of education makes sense as a part of his moral theory if we look not only at individual moral decisions, but also at the goals or ends that these moral decisions are intended to achieve. In Kant’s case, this end is what he calls the highest good, and, I argue, the most coherent account of the highest good is a kind of ethical community and end of history, similar to the Groundwork’s realm of ends. Seen as a tool to bring about and sustain such a community, Kant’s philosophy of moral education exists as a coherent and important part of his moral philosophy. (shrink)

Precarious employment is commonplace within the University-as-business model. Neoliberal and New Public Management agendas have influenced widespread insecurity, and limited career progression pathways within academic work. Qualitative multi-case data inform this investigation of how young academic workers cope with, and justify, their precarious situations in a large Australian university. This article introduces the notion of cruel optimism to analyse the unethical exploitation of desires of precariously employed academics. This analytical engagement extends empathetic engagement with the lived experiences and rationalisations of (...) precariously employed academic workers, paying homage to their desires and negotiations. Findings demonstrate that participants were heavily invested in working towards achieving their good life fantasy which encompassed secure employment and the recognition this provided. Cruel optimism operated as participants developed coping mechanisms to deal with the ongoingness of their troubling situation as precarious workers uncertain how to change their precarious circumstances. Participants experienced cruel optimism as they navigated through issues of identity, control, and desire, related to their present and future lives as academic workers experiencing an impasse of crisis ordinariness. Optimism directed towards the academic scene of desire motivated participants’ daily actions and informed their understandings. Ethical elements of the impasse of precarious employment are presented in relation to the neoliberal and New Public Management-oriented University context. This article provides a novel conceptualisation of how precarious employment contributes to a relation of cruel optimism among workers by highlighting how organisations exploit the desires of insecure employees for extended periods of time, contributing to an impasse of crisis ordinariness. (shrink)

In this book, Kate Ward addresses the issue of inequality from the perspective of Christian virtue ethics. Her unique contribution is to argue that moral luck, our individual life circumstances, affects one's ability to pursue virtue. She argues that economic status functions as moral luck and impedes the ability of both the wealthy and the impoverished to pursue virtues such as prudence, justice, and temperance. The book presents social science evidence that inequality reduces empathy for others' suffering, and increases (...) violence, fear, and the desire to punish others. For the wealthy, inequality creates "hyperagency" - abundant freedom, power, and choice beyond that enjoyed by other members of society. For the poor, scarcity of time, money, and other important goods can also impair their ability to pursue virtue. Having established the theological harm caused by inequality, Ward then makes the argument that both individual Christians and Christian communities have obligations to address the impact of inequality. As individuals, Christians should pursue what Ward calls encounter, conversion, and contentment. Encounter means genuinely reaching out to the less fortunate and spending enough time to get to know individuals as human beings. For Ward, conversion means informing oneself about the realities of poverty and inequality. Contentment means being satisfied with one's position and not striving for more material wealth. Christian communities, in Ward's view, have obligations to pursue political action, tithing, and aid, and to foster encounters in parishes and educational settings. (shrink)

The governance of pharmaceutical medicines entails complex ethical decisions that should, in theory, be the responsibility of democratically accountable government agencies. However, in many Low- and Middle-Income Countries (LMICs), regulatory and health systems constraints mean that many people still lack access to safe, appropriate and affordable medication, posing significant ethical challenges for those working on the “front line”. Drawing on 18 months of fieldwork in Ghana, we present three detailed case studies of individuals in this position: an urban retail pharmacist, (...) a rural over-the-counter medicine retailer, and a local inspector. Through these case studies, we consider the significant burden of “ethical labour” borne by those operating “on the ground”, who navigate complex moral, legal and business imperatives in real time and with very real consequences for those they serve. The paper ends with a reflection on the tensions between abstract, generalised ethical frameworks based on high-level principles, and a pragmatic, contingent ethics-in-practice that foregrounds immediate individual needs – a tension rooted in the gap between the theory and the reality of pharmaceutical governance that shifts the burden of ethical labour downwards and perpetuates long-term public health risks. (shrink)

BackgroundThere is growing interest in the collection, storage and reuse of biological samples for future research. Storage and future use of biological samples raise ethical concerns and questions about approaches that safeguard the interests of participants. The situation is further complicated in Africa where there is a general lack of governing ethical frameworks that could guide the research community on appropriate approaches for sample storage and use. Furthermore, there is limited empirical data to guide development of such frameworks. A qualitative (...) study to address this gap was conducted with key stakeholders in Malawi to understand their experiences and perspectives regarding storage and usage of samples for future research.MethodsThis study conducted 13 in-depth interviews with ethics committee members, regulators and researchers, and five focus group discussions with community representatives and clinical trial participants in Malawi. Interviews and focus group discussions were audio-recorded, transcribed verbatim, and thematically analysed.ResultsOn the current regulatory guidelines that governs the collection, storage and reuse of samples in Malawi, participants highlighted their different understanding of it, with some indicating that it prohibited the reuse and sharing of samples, while others believed it permitted.Views on the informed consent model used in Malawi, some stakeholders expressed that the current model limited options for sample contributors regarding future use. Researchers supported storing samples for future use in order to maximize their value and reduce research costs. However, they expressed concern over the exportation of samples highlighting that it could lead to misuse and would not support the development of research capacity within Malawi. They recommended use of broad consent or tiered consent and establishment of biobanks to address these concerns.ConclusionsStudy findings highlighted the need for a review of the current regulatory guideline and the development of infrastructure to support the use of stored biological samples for future use among the research community in Malawi. At the moment, there are ethical and practical concerns arising from the collection, storage and secondary use of biological samples make it hard to reconcile scientific progress and the protection of participants. (shrink)

Abstract Truth-telling is a key issue within the nurse–patient relationship. Nurses make decisions on a daily basis regarding what information to tell patients. This paper analyses truth-telling within an end of life scenario. Virtue ethics provides a useful philosophical approach for exploring decisions on information disclosure in more detail. Virtue ethics allows appropriate examination of the moral character of the nurse involved, their intention, ability to use wisdom and judgement when making decisions and the virtue of truth-telling. It is appropriate (...) to discuss nursing as a 'practice' in relation to virtue ethics. This is achieved through consideration of the implications of arguments made by Alasdair MacIntyre who believes that qualities such as honesty, courage and justice are virtues because they enable us to achieve the internal goods of practices. (shrink)

Post-Traumatic Stress Disorder is a mental health condition in which the experience of a traumatic event causes a series of psychiatric and behavioral symptoms such as hypervigilance, insomnia, irritability, aggression, constricted affect, and self-destructive behavior. This paper investigates two case studies to argue that the experience of PTSD is not restricted to humans alone; we have good epistemic reason to hold that some animals can experience genuine PTSD, given our current and best clinical understanding of the disorder in humans. I (...) will use this evidence to argue for two claims. First, because the causal structure of PTSD plausibly requires reference to a traumatic conscious experience in order to explain subsequent behaviors, the fact that animals can have PTSD provides new evidence for animal consciousness. Second, the discovery of PTSD in animals puts pressure on accounts which hold that animal behavior can be fully explained without reference to subjective experience. (shrink)

This chapter explores the possibility of identifying core moral claims with the states of mind which are called bodily imperatives—e.g. the ‘make it stop’ state of mind which is plausibly an aspect of, if not identical with, severe pain states and states such as severe thirst, hunger, sleeplessness, humiliation, terror, and torment. The chapter combines this idea with another, that the desire-like, conative, or ‘world-guiding’ states of mind which make normative claims on agents need not belong to the agent on (...) whom the claim is made, on a broadly Humean or desire-based view in metaethics. On the view defended, any subject’s bodily imperatives can make moral claims on any moral agent. The case is made that bodily imperatives are a good candidate for constituting the core moral claims or basic imperatives of morality, which all others are either built from, or at least constrained by. (shrink)

The main aim of the book is to provide a good understanding of a range of semantic phenomena and issues in semantics, adopting a truth-conditional account of meaning, but without using a compositional formalism. The book assumes no particular background in linguistics of philosophy, and all the technical tools used are explained as they are introduced. They style is accessible, with numerous examples.

The article considers three theses about postabortion regret which seek to illustrate its pertinence to reasoning about abortion, and which are often deployed, either explicitly or implicitly, to dissuade women out of that reproductive choice. The first is that postabortion regret renders an abortion morally unjustified. The second is that that a relatively high incidence of postabortion regret—compared with a lower incidence of postnatal regret in the relevant comparator field—is good evidence for the moral impermissibility of abortion choice. The third (...) is that high rates of postabortion regret suggest that abortion is not the most prudent or welfare-maximising choice for the woman concerned. All three theses argue for the compellingness of knowledge about postabortion regret in moral and practical reasoning about abortion, especially from the pregnant woman's point of view. This article argues that all three theses are flawed. In particular, it seeks to remind readers that feelings of regret directed at past decisions are often decoupled from the fact of the matter about their moral or rational justification. Moreover, certain features of reproductive decisions in particular make regret an especially unsuitable yardstick for actual justification in this context, and even less epistemically reliable as evidence for a lack of justification than it may be in other fields of decision-making. The implication is that rates of postabortion regret, even if they can be presumed to be higher than rates of postnatal regret, are not as pertinent to moral and practical reasoning about abortion as is sometimes suggested. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:In Search of FaithKate RowlandSometimes I’m jealous of my patients’ faith. As a former happily religious person I miss the benefits I used to get from an active faith. I know that some of my patients must struggle with their faith, and I know the struggle probably affects their well–being. For those who simply believe or those who simply don’t believe, it’s easy. And for those who do believe, (...) there can be so much serenity and so much reward.As a doctor, I spend a lot of time reading science, weighing evidence, and making recommendations. Religion has been a respite from this. Faith, for me, has never been a series of decisions based on the best available evidence. I could analyze it as much as I wanted, peel its layers apart, question it, but in the end, it was just faith, not a hypothesis. It has always been something that I believe (or don’t), and practicing my faith had always been a relatively pleasant decision of figuring out what kind of community I want to share in.My faith life has been in shambles for the past several years. I feel distant from and unwelcome in the church where I was raised, and I haven’t found anywhere else to land. I cannot decide how to raise my own small children. I want them to have grounding in God, but I can’t decide how much I believe in God anymore, and I am fixated on the idea that I don’t want to be hypocritical or lie to [End Page 210] them. I don’t want them to see me worshipping in a way that is not really authentic to me.My husband is agnostic—literally—on the issue. He is open to introducing a loving, kind, forgiving God, but unsure about a God incarnate. We both worry about the identity with a particular religion usurping the actual relationship with God: I am [religion], therefore I believe [this], therefore my God does [this] or is [this].And so all of these fears and doubts have led us to live with no religion, and no outward faith. Our children attend a parochial nursery school run by a religion other than one where we were raised, and they have an apparently happy but neutral opinion of religion and God. They understand ceremonies. At age four, they have a more active faith life than I do, since they attend weekly services at school. But then, they have fewer choices than I do. They do what the teachers tell them. They would do what I told them to do, if I could ever decide what I believed in.I spend so many hours a week with my patients that they have become my main source of demonstration of active, living faith. I know that they share mostly good parts with me. I see so much of the good because I mostly see patients who get to choose how to practice their own religions; they don’t feel oppressed by religious or culturo–religious demands or expectations. It’s interesting that I see the positive sides of their faith, not the struggle, because I otherwise see a lot of the struggling parts of their lives. I see the flinty, edgy woman, the patient who has spent more time in the hospital in the past month than I have, the woman who is sick of her low platelet count that keeps her from living a normal life. And every day she has some message of faith: she tells our medical team what Bible passage is keeping her strong, she tells us how God watches over her when we tell her that her counts are better, she tells us to have a blessed day. Sometimes she curses at the hospital or her condition or at her medications, sometimes at us. So far her faith is unshaken.I take care of a woman who has burning mouth syndrome, a chronic condition that causes her lips, her tongue, and her palate to feel as though they are on fire. Eating makes it worse, drinking makes it worse, breathing makes it worse... (shrink)

Cross-sectorial, dynamic, and innovative partnerships are essential to resolve the challenges of humankind in the 21st century. At the same time, trust in each other’s integrity and good will is a precondition for the solution of any complex problem, and certainly for the success of the United Nations Sustainable Development Agenda. Experience shows that a nation’s economic and social success is at its greatest if, and when, there is cooperation and even cocreation involving a fair division of labor and responsibility (...) among the different societal stakeholders. This paper uses Ralf Dahrendorf’s seminal work on obligations, as well as the European Commission’s Science with and for Society unit’s definition of responsible research and innovation (RRI), to motivate industry responsibilities to make the world a healthier place. (shrink)

Jones, Kate One of the tensions touching the physician - patient relationship today is the physician's ability to correctly interpret what the patient psychologically and emotionally needs from the medical consultation following the diagnosis of chronic or serious illness. The analysis of the issue goes beyond the concern of what information is given to a patient and begins with the importance of good communication.

Gender staff in the World Bank -- the world's largest and most influential development institution -- have a policy problem. Having prioritised efforts to get women into paid employment as the ȁ8cure-allȁ9 for gender inequality they must deal with the work that women already do -- the unpaid labour of caring, socialisation, and human needs fulfilment. This article explores the most prominent policy solution enacted by the Bank to this tension between paid and unpaid work: the restructuring of normative heterosexuality (...) to encourage a two-partner model of love and labour wherein women work more and men care better. Through a case study of Bank gender lending in Ecuador I argue that staff are trying to (re)forge normative arrangements of intimacy, a policy preference that remains invisible unless sexuality is taken seriously as a category of analysis in development studies. Specifically, I focus on four themes that emerge from the attempt to restructure heteronormativity in the loan: (1) the definition of good gender analysis as requiring complementary sharing and dichotomous sex; (2) the Bank's attempt to inculcate limited rationality in women such that they operate as better workers while retaining altruistic attachments to loved ones; (3) the Bank's attempt to inculcate better loving in men, such that they pick up the slack of caring labour when their (partially) rational wives move into productive work, and; (4) the invocation of a racialised hierarchy resting on the extent to which communities approximate ideals of sharing monogamous partnership. Aside from providing clear evidence that the world's largest development institution is involved in micro-processes of sexuality adjustment alongside macro-processes of economic restructuring, I also critique the Bank's sexualised policy interventions and suggest that they warrant contestation. (shrink)

This paper explores the tensions that arise when one considers the relevance of institutionalized philosophy to social, political, and environmental change. It considers the time it takes to think deeply, critically, creatively, against the urgent need for protest in the streets, for persuasion of our political representatives, for profound alterations to what we consume. Since philosophy in the academy can reek of disproportionate privilege and self-protection and norms that govern institutionalized philosophy often drive away some of the most curious minds (...) and diverse perspectives, this paper considers: if our philosophical work does not help in substantial ways to address social, political, and environmental crises, can we, in good conscience, continue it? To think through this question, this paper will share a video-based assignment on “activism” that helps me, and hopefully students in my classes, navigate, but not resolve, this tension. (shrink)

On close reading of the Enneads, the work written by Plotinus, we can see that the One, the ultimate factor in his system of hypostases, can be examined on the base of many concepts that are interwoven, creating many paths for approaching the divine level. Of course, since all the hypostases, Matter — Nature — Soul — Intelligence, are dependent on the infinite power of the One, theoretically and practically everything can be related to the One or the God or (...) the Good. But there are some modes of existence most related to the One, thus illuminating the Plotinian mystical empiricism. The One, on the one hand, is related to empiricism as It presupposes the immediate approach of It, being immanent and transcendent at the same time, and on the other hand, It is related to mysticism as It cannot be perfectly conceived and experienced otherwise than through the mystical union. (shrink)

According to the popular ‘epistemic virtue account’ (EVA) of theory choice, we should choose between scientific theories on the basis of their epistemic virtues: empirical fit, simplicity, unity etc. More specifically, we should use a rule that aggregates theories’ virtues into a ranking of the overall goodness of the theories. However, an application of Arrow’s impossibility theorem shows that, given plausible premises, there is no rule that can aggregate theories’ virtues into a theory ranking. The EVA-supporter might try to avoid (...) the impossibility result of Arrow’s theorem by asserting that we have more fine-grained distinctions between theories’ epistemic virtues than initially supposed. We show that implausibly fine-grained distinctions between virtue quantities are necessary to escape the impossibility result. This is shown via novel proofs of Arrow’s theorem for cases in which the quantities to be aggregated are measured on any combination of different scales of information, as is likely the case when aggregating epistemic virtues. (shrink)

Gerken's On Folk Epistemology: How we think and talk about knowledge develops and defends strict purist invariantism about knowledge. Along the way, Gerken argues that less-orthodox competitors to strict purist invariantism are plagued by certain heretofore unrecognized or underappreciated difficulties. Given Gerken's own explicit methodological commitments, this defensive component of the book's project is dialectically crucial. By Gerken's own lights, we ought to be persuaded to embrace strict purist invariantism only if it turns out that the strict purist invariantist is (...) better positioned than their competitors to explain the folk epistemological “inputs” to epistemic theorizing. My own goal here is to articulate some reasons to worry that Gerken's defensive efforts are less-than-fully successful. In particular, I argue that we ought to adopt a more expansive and more nuanced conception of the relevant folk epistemological “inputs.” Moreover, I suggest that, at least insofar as we have reason to embrace a kind of qualified methodological preference for theoretical explanations that vindicate our ordinary epistemic practice, we might well have good reason for favoring (certain of) the alternate theoretical explanations of these inputs that less-orthodox views of knowledge supply over the kind of explanations that Gerken convincingly argues strict purist invariantism can offer. (shrink)

At several key moments in his works, Hume draws our attention to the differences between two conceptions of philosophy. Deploying what were already then well‐worn metaphors, he calls these two “species” of philosophy “anatomy” and “painting.” Hume’s remarks about philosophical anatomy and painting have recently given rise to a number of scholarly debates. I focus here on just one of these debates: did Hume intend to combine anatomy and painting in some of his later works? Through an examination of the (...) evidence that has to date been adduced, I argue that we have at least one very good reason to think that such were Hume’s intentions, and no good reason to suppose otherwise. (shrink)

This piece undertakes to sketch the contemporary approaches toward meaning known as pragmatics and semantics. Today, this pairing is associated with a controversy or question that concerns the proposition. Yet, while the pragmatics/semantics debate attests to the proposition's precise status being in doubt, the underlying belief remains that the work of the proposition or something like it – e.g., utterances, a portion of which function propositionally – eventually can be established. Jacques Derrida in his writings on Husserl questions even this (...) assumption. He argues that there is an internal limit to propositionality, thanks to a writing that ultimately exceeds it. Moreover, Derrida focuses on themes that are central for the discussions of semantics and pragmatics, while a good deal of common ground exists between Derrida's interlocutor, Husserl, and the analytic tradition. Accordingly, after here reviewing pragmatics and semantics, and some of the complexity of their relation, I turn to Husserl and to Derrida ultimately for a perspective that calls into doubt these projects as such. (shrink)

Many approaches to addressing labour injustices—shortfalls from minimally decent wages and working conditions— focus on how governments should orient themselves toward other states in which such phenomena take place, or to the firms that are involved with such practices. But of course the question of how to regard such labour practices must also be faced by individuals, and individual consumers of the goods that are produced through these practices in particular. Consumers have become increasingly aware of their connections to complex (...) global production processes that often involve such injustice. For example, activist campaigns have exposed wrongful harm in factories producing clothes, shoes and mobile phones and farms producing coffee, tea and cocoa. These campaigns have promoted the message to ordinary people that by becoming connected to unjust labour practices through their purchasing behaviour, they acquire special additional moral responsibilities to contribute to reforming such practices, or to address the hardships suffered by the victims of the wrongdoing that result from them. The moral significance of the responsibilities of individual consumers has not, however, received much analytical scrutiny. Why should we believe that there are such responsibilities? And if there are such responsibilities, what are their grounds? How stringent are the responsibilities triggered by such connections? Finally, what are the implications of such responsibilities—the courses of action that they prescribe or proscribe? The activists who assert special ethical responsibilities for consumers have promoted many particular courses of action, but have seldom articulated the grounds of these responsibilities or explained why they should be taken to be stringent. And moral and political theorists have not devoted much focussed attention to this issue. For the consumer who is concerned to act in a morally permissible way, this presents a troubling practical challenge regarding the goods they may (or may not) purchase, and the moral relevance of their consumption choices more generally. While we cannot address all of these pressing questions in this chapter, we try to make some headway with them by discussing two general approaches to the question of how individuals should conceive of their responsibilities with respect to such practices, taking as our starting point the recent work of the late Iris Marion Young—the most sustained treatment of this topic by a prominent political theorist. In a series of influential articles and a posthumously published book, Young articulated an approach to conceiving of individual responsibilities to address labour injustices—the social connection model—at home and abroad. She also argued that an alternative model—the liability model—which she claimed had dominated discourse on this topic, suffered from very serious flaws. In a critical vein, we will argue that Young’s arguments against the liability model are not convincing, and that the alternative she proposes is itself vulnerable to some damaging objections. We also find, however, that the liability model would need to be extended in various ways to provide an adequate account of individual responsibility to address shortfalls from minimally decent wages and working conditions, and we begin the task of sketching an extended framework. (shrink)

Achieving equity in international research is one of the pressing concerns of the twenty-first century. In this era of progressive globalization, there are many opportunities for the deliberate or accidental export of unethical research practices from high-income regions to low- and middle-income countries and emerging economies. The export of unethical practices, termed “ethics dumping,” may occur through all forms of research and can affect individuals, communities, countries, animals, and the environment. Ethics dumping may be the result of purposeful exploitation but (...) often arises from lack of awareness of good ethical and governance practice. This chapter describes the work of the TRUST project toward counteracting the practice of ethics dumping through the development of tools for the improvement of research governance structures. Multi-stakeholder consultation informs all of TRUST’s developments. Most importantly, this gives voice to marginalized vulnerable groups and indigenous people, who have been equal and active partners throughout the project. At the heart of the TRUST project is an ambitious aim to develop a Global Code of Conduct for Research in Resource-Poor Settings. Uniquely, the Code provides guidance across all research disciplines in clear, short statements, focusing on research collaborations that entail considerable imbalances of power, resources and knowledge and using a new framework based on the values of fairness, respect, care, and honesty. The code was recently adopted by the European Commission as a reference document for Horizon 2020 and Horizon Europe. (shrink)

I am a social gerontologist, broadly defined as a social scientist who studies how later life is experienced, structured, and controlled in a society and in social settings. Although gerontology is often confused with geriatrics (a medical specialty), gerontologists are typically not clinicians but may study issues related to old age and health care such as the societal conditions that shape how medical care is provided and financed and how early exposure to education relates to later life health.In this essay, (...) I argue that thinking like a gerontologist is important when considering what makes a good life in late life. To think like a gerontologist is to consider the cultural and societal values—past and present—that shape the experience of aging, to recognize people as complex beings whose individual lives do not follow predictable patterns or easily identified trajectories, and to recognize our own habits of regarding older persons as “other” and the consequences of “othering” for older persons and social systems. After a brief history of gerontology, highlighting a few core concepts that gerontologists share, I propose three important questions to consider regarding a good life in late life. (shrink)

Are normative reasons based in our desires, or are they instead grounded in our rational faculties? A familiar way of approaching this question focuses on the fact that individuals are often motivated by very different concerns. Our desires seem to provide us with operative or motivating reasons that are not shared by others, and the question is whether desires can also provide us with different good or normative reasons. Reasons internalism is the view that an agent’s normative reasons for action (...) must be within the reach of his or her interest and understanding. Many contemporary followers of Hume as well as Kant endorse this view, but their versions of internalism differ in one key respect. The Humean view is that reasons are relative to the particular motivations of individuals and thus not universally shared. In contrast, the Kantian view is that being fully rational involves converging on reasons that all agents share as such. But what is common to both of these versions of reasons internalism is a focus on the relative powers of the faculties of reason and desire. Hegel, however, introduces an interesting and distinctive way of approaching the question of the source or grounding of normative reasons. Instead of focusing exclusively on the relative powers of inner faculties, Hegel proposes that what we have reasons to do depends largely upon how we understand ourselves within an actual social space. We will consider three different versions of this claim, the most plausible of which sheds new light on reasons internalism. We need not think that there are only two possibilities: either reasons are universal or they are relative to subjective motivations. Instead, what distinguishes a Hegelian approach is the contention that what counts as normative depends in part upon fundamental self-conceptions that we share as participants in a complex social world. (shrink)

Moving away from the strong body of critique of pervasive ‘bad data’ practices by both governments and private actors in the globalized digital economy, this book aims to paint an alternative, more optimistic but still pragmatic picture of the datafied future. The authors examine and propose ‘good data’ practices, values and principles from an interdisciplinary, international perspective. From ideas of data sovereignty and justice, to manifestos for change and calls for activism, this collection opens a multifaceted conversation on the kinds (...) of futures we want to see, and presents concrete steps on how we can start realizing good data in practice. (shrink)

Suppose a diner says, 'Can you pass the salt?' Although her utterance is literally a question (about the physical abilities of the addressee), most would take it as a request (that the addressee pass the salt). In such a case, the request is performed indirectly by way of directly asking a question. Accordingly this utterance is known as an indirect speech act. On the standard account of such speech acts, a single utterance constitutes two distinct speech acts. On this account (...) then, 'Can you pass the salt?' is both a question and a request. In a provocative essay, Rod Bertolet argues that there are no indirect speech acts. According to Bertolet, 'Can you pass the salt?' is only a question. It is a question that merely functions as a request (without also being one). In this paper we respond to Bertolet's skeptical argument. Appealing to Searle's theory of speech acts and to certain features of linguistic communication, we argue that, despite Bertolet's challenge, there is good reason to countenance indirect speech acts. (shrink)

In this article, drawing upon a feminist epistemology, we examine the critical roles that philosophical standpoint, historical usage, gender, and language play in a knowledge arena which is increasingly opaque to the general public. Focussing on the language dimension in particular, in its historical and social dimensions, we explicate how some keywords in use across artificial intelligence (AI) discourses inform and misinform non-expert understandings of this area. The insights gained could help to imagine how AI technologies could be better conceptualised, (...) explained, and governed, so that they are leveraged for social good. (shrink)

This special thematic issue of The Journal of Medicine and Philosophy brings together a cross-cultural set of scholars from Asia, Europe, and North America critically to explore foundational questions of familial authority and the implications of such findings for organ procurement policies designed to increase access to transplantation. The substantial disparity between the available supply of human organs and demand for organ transplantation creates significant pressure to manipulate public policy to increase organ procurement. As the articles in this issue explore, (...) however, even if well intentioned, the desire to maximize organ procurement does not justify undermining foundational elements of human flourishing, such as the family. While defending at times quite different understandings of autonomy, informed consent, and familial authority, each author makes clear that a principled appreciation of the family is necessary. Otherwise, health care practice will treat the family in a cynical and instrumental fashion unlikely to support social or individual good. (shrink)

Clinical Ethics, Ahead of Print. This paper is a response to a recent BMJ Blog: ‘The duty to treat: where do the limits lie?’ Members of the Surrey Heartlands Integrated Care Service Clinical Ethics Group reflected on arguments in the Blog in relation to resuscitation during the COVID-19 pandemic.Clinicians have had to contend with ever-changing and conflicting guidance from the Resuscitation Council UK and Public Health England regarding personal protective equipment requirements in resuscitation situations. St John Ambulance had different guidance (...) for first responders.The situation regarding resuscitation led the CEG to consider ethical aspects of health care professionals’ responses to the need for resuscitation during COVID-19. Members agreed that professionals should, ideally, have the level of PPE required for an aerosol generating procedure. However, there was no consensus regarding professionals’ duty to care when this is not available. On the one hand, it was agreed that the casualty/patient’s interests regarding resuscitation should be prioritised due to professionals’ contract with the public and professional privilege. On the other hand, risk thresholds were considered relevant to individual decision-making and professionals’ duty to care. All agreed that decision-making should not be influenced by rewards or reprimands. It was agreed also that decisions to resuscitate should not be considered as moral heroism or supererogatory - regardless of PPE availability - but rather as ‘minimally decent’. We agreed that it may be acceptable for professionals, with good reasons, to opt out of resuscitation attempts and these should be reflected on and discussed before the event. (shrink)