Rare diseases, defined as having a prevalence inferior to 1/2000, are poorly understood scientifically and medically. Appropriate diagnoses and treatments are scarce, adding to the burden of living with chronic medical conditions. The moral significance of rare disease experiences is often overlooked in qualitative studies conducted with adults living with rare diseases. The concept of morally problematic situations arising from pragmatist ethics shows promise in understanding these experiences. The objectives of this study were to (1) acquire an in-depth understanding of (...) morally problematic situations experienced by adults living with rare diseases in the province of Québec and (2) to develop an integrative model of the concept of morally problematic situations. To this end, an online survey targeting this population was developed through a participatory action research project. Respondents provided 90 long testimonies on the most important morally problematic situations they faced, often in healthcare settings. An integrative model was developed based on various qualitative analyses of these testimonies and relevant literature. The integrative model showcases that morally problematic situations have causes (i.e., contextual and relational factors, personal factors, jeopardized valuations), have affective repercussions (i.e., emotions and feelings, internal tensions), prompt action (i.e., through empowerment strategies leading to the evolution of situations), and elicit outcomes (i.e., factual consequences, residual emotions and feelings, positive or negative resolutions). In sum, this study advances understanding of the moral experiences of adults living with rare diseases while proposing a comprehensive conceptual tool to guide future empirical bioethics research on moral experiences. (shrink)

Background Rare diseases are generally poorly understood from scientific and medical standpoints due, to their complexity and low prevalence. As a result, individuals living with rare diseases struggle to obtain timely diagnoses and suitable care. These clinical difficulties add to the physical and psychological impacts of living with chronic and often severe medical conditions. From the standpoint of pragmatist ethics, the morally problematic situations that adults living with rare diseases experience matter crucially. However, there is little known about these experiences.Methods (...) A survey study was conducted with 121 adults living with rare diseases in Québec, Canada, to identify morally problematic situations encountered in the healthcare system and everyday life as part of a participatory action research project. Morally problematic situations elicited internal tensions and constraints to agency.Results Adults living with rare diseases experienced morally problematic situations of stigmatization, disbelief, and sometimes abuse in the healthcare system. These situations were compounded by diagnostic delays, inadequate care, and suboptimal follow-up, and led some individuals to opt-out of medical care. In their personal lives, these individuals sometimes found themselves in situations of physical and financial dependency. They often also had to give up professional occupations, academic training, or life projects.Conclusions Adults living with rare diseases experience important morally problematic situations navigating the healthcare system and their everyday lives, some of which could be alleviated through interventions developed through future participatory action research. (shrink)

As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by the (...) patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured. (shrink)

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. (...) Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion. (shrink)

Engineers encounter difficult ethical problems in their practice and in research. In many ways, these problems are like design problems: they are complex, often ill-defined; resolving them involves an iterative process of analysis and synthesis; and there can be more than one acceptable solution. This book offers a real-world, problem-centered approach to engineering ethics, using a rich collection of open-ended scenarios and case studies to develop skill in recognizing and addressing ethical issues.

Le livre de Caroline Petit, Galien de Pergame ou la rhétorique de la Providence, constitue la première étude d’ensemble du rôle de la rhétorique dans l’œuvre de Galien, aux sources du discours médical et scientifique, et de l’autobiographie intellectuelle. Caroline Petit’s Galien de Pergame ou la rhétorique de la Providence is the first comprehensive study of the role of rhetoric in Galen’s oeuvre, a cornerstone of medical and scientific discourse and of intellectual autobiography in the West.

Retraçant sont itinéraire philosophique dans Beau Voyage, quelques mois avant sa mort, Maurice Pradines (1874-1958) résume sa philosophie de la sensation par cet adage: "Nihil est in sensu quod non prius fuerit in intellectu". Pour l'auteur de la Philosophie de la sensation, la sensation est, en effet, originairement intelligente: elle n'a de légitimité biologique qu'en tant qu'elle donne quelque chose à comprendre. Renvoyant dos-à-dos le sensualisme (qui construit l'intelligence sur une sensation denué d'esprit) et le rationalisme (qui prétend trouver l'esprit (...) dans une raison transcendante), Pradines inscrit l'intentionalité au cœur de la physiologie de la sensation. Percevoir, pour un vivant, c'est d'abord percevoir quelque chose qui intéresse la vie, à savoir un danger à écarter ou un objet à conquérir. Aussi n'est-il guère surprenant que le sens ultime de la sensation soit l'espace: elle est le signe d'une distance à déployer ou, au contraire, à réduire. Les phénomènes psychiques ne peuvent être des données immédiates puisqu'ils font sens dans la stricte mesure où l'espace les élabore en même temps qu'il se construit. Les fondements d'une psychologie conséquente peuvent, dès lors, être posés. Elle consistera à saisir la genèse de l'esprit à partir du sens biologique de la sensation, c'est-à-dire d'une spatialité pensée elle-même comme "genèse première". (shrink)

Inspired by Voltaire's advice that a text needs to be concise to have real influence, this anthology contains fiery extracts by forty eighteenth-century authors, from the most famous philosophers of the age to those whose brilliant writings are less well-known. These passages are immensely diverse in style and topic, but all have in common a passionate commitment to equality, freedom, and tolerance. Each text resonates powerfully with the issues our world faces today. Tolerance was first published by the Société française (...) d'étude du dix-huitième siècle (the French Society for Eighteenth-Century Studies) in the wake of the Charlie Hebdo assassinations in January 2015 as an act of solidarity and as a response to the surge of interest in Enlightenment values. With the support of the British Society for Eighteenth-Century Studies, it has now been translated by over 100 students and tutors of French at Oxford University."--Publisher's website. (shrink)

Le « Bulletin bibliographique de philosophie politique et sociale » est réalisé pour la revue Philosophique par une équipe de rédactrices et de rédacteurs. Il est coordonné par Caroline Guibet Lafaye (CNRS) et Fabien Ferri (université de Franche-Comté) au sein du Centre de Documentation et de Bibliographie Philosophiques de l’université de Franche-Comté (UR 2274 CDBP – Logiques de l’agir), et propose de brèves recensions d’ouvrages récemment parus, réparties dans diverses rubriques thématique...

Climate change and decarbonization raise complex justice questions that researchers and policymakers must address. The distributions of greenhouse gas emissions rights and mitigation efforts have dominated justice discourses within scenario research, an integrative element of the IPCC. However, the space of justice considerations is much larger. At present, there is no consistent approach to comprehensively incorporate and examine justice considerations. Here we propose a conceptual framework grounded in philosophical theory for this purpose. We apply this framework to climate mitigation scenarios (...) literature as proof of concept, enabling a more holistic and multidimensional investigation of justice. We identify areas of future research, including new metrics of service provisioning essential for human well-being. [Can be freely read by clicking the ReadCube link below.]. (shrink)

Up Against Foucault offers both a feminist critique of Foucauldian theories as well as an attempt to reconcile these seemingly irreconcilable perspectives. Feminists are often "up against Foucault" because he questions key conclusions in feminism regarding the nature of gender relations, and men's possession of power. This book, however, fills the gap in literature about Foucault by showing how his theories of sexuality and power relations are often applicable to the everyday realities of women's lives. Drawing upon their diverse backgrounds (...) in social theory and philosophy, the contributors discuss the ways in which Foucault provokes feminists into questioning their grasp of power relations, and examines the implications of his decision to overlook categories of gender in his discussion of sexuality and power relations. They also show that in spite of his lack of interest in gender, Foucault's ways of understanding the control of women and female sexuality ultimately have much to offer feminism. (shrink)

If, as many suppose, pornography changes people, a question arises as to how.1 One answer to this question offers a grand and noble vision. Inspired by the idea that pornography is speech, and inspired by a certain liberal ideal about the point of speech in political life, some theorists say that pornography contributes to that liberal ideal: pornography, even at its most violent and misogynistic, and even at its most harmful, is political speech that aims to express certain views about (...) the good life, 2aims to persuade its consumers of a certain political point of view—and to some extent succeeds in persuading them. Ronald Dworkin suggests that the pornographer contributes to the ‘moral environment, by expressing his political or social convictions or tastes or prejudices informally’, that pornography ‘seeks to deliver’ a ‘message’ , that it reflects the ‘opinion’ that ‘women are submissive, or enjoy being dominated, or should be treated as if they did’, that it is comparable to speech ‘advocating that women occupy inferior roles’.3 Pornography on this view is political speech that aims to persuade its listeners of the truth of certain ideas about women, and of course ‘the government must leave to the people the evaluation of ideas’.4 Another answer offers a vision that is not grand and noble, but thoroughly reductive. Pornography is not politically persuasive speech, but speech that works by a process of psychological conditioning. This view seems common enough in the social science literature. Consider, for example, this description of an early experiment, from a time that pre-dates contemporary political debate. (shrink)

Le « Bulletin bibliographique de philosophie politique et sociale » est réalisé pour la revue Philosophique par une équipe de rédactrices et de rédacteurs. Il est coordonné par Caroline Guibet Lafaye (CNRS) et Fabien Ferri (Université de Franche-Comté) au sein de Centre de Documentation et de Bibliographie Philosophiques de l’Université de Franche-Comté (UR 2274 CDBP–Logiques de l’Agir), et propose de brèves recensions d’ouvrages récemment parus, réparties dans diverses rubriques thématiques....

BackgroundPatient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients’ expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is (...) currently undergoing this particular process.MethodsQualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods.Results and discussionPatient autonomy is much more than a simple notion defined as the patient’s right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies.Conclusions Knowing how to respect the various facets of patients’ autonomy should be part of physician’s professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia. (shrink)

Este artigo científico procurou investigar o processo de adaptação da Universidade Brasileira aos novos paradigmas impostos pelas políticas neoliberais. A análise se faz a partir de breve histórico do liberalismo e de suas imbricações no ensino. Apontando também a relativização da suposta democratização e modernização do ensino pelas novas perspectivas impostas pelo mercado. São levantadas também questões como autonomia universitária e legitimação da instituição de ensino superior.

Caroline New is an energetic activist who has interpolated critical realist ideas into the front-line of political activism. In this wide-ranging interview, she begins by reflecting on her life and how she became a realist and her account is illustrated with personal anecdotes recalling memories of well-known philosophers and activists from the time. She discusses how her position set her apart from other feminists and she examines the interacting threads of longstanding debates on the political left, as well as (...) longstanding debates within critical realist circles, such as the relative importance of quantitative methods in social research and the scope for agency as a source of intentional change. Finally she brings some of her ideas to bear on contemporary issues. This engaging interview notably provides some of the social context in which critical realism developed, while also pointing towards its future potential. (shrink)

Caroline New is an energetic activist who has interpolated critical realist ideas into the front-line of political activism. In this wide-ranging interview, she begins by reflecting on her life and how she became a realist and her account is illustrated with personal anecdotes recalling memories of well-known philosophers and activists from the time. She discusses how her position set her apart from other feminists and she examines the interacting threads of longstanding debates on the political left, as well as (...) longstanding debates within critical realist circles, such as the relative importance of quantitative methods in social research and the scope for agency as a source of intentional change. Finally she brings some of her ideas to bear on contemporary issues. This engaging interview notably provides some of the social context in which critical realism developed, while also pointing towards its future potential. (shrink)

In this article, I argue for the notion of what I term ‘uncanny water’ as a conceptual tool for reading contemporary oceanic fictions. The uncanny’s affective capacity to destabilise epistemological and ontological certainties makes it a particularly potent literary tool for challenging the nature/culture binary. I argue that fictions which actively defamiliarise the ocean can be used to redress the anthropocentric privilege found in hitherto narratives of the oceanic that were predicated upon mastery and control, and that uncanny moments of (...) displacement and uncertainty can illuminate human/oceanic interconnections and foster a sense of responsibility and compassion towards the oceans. I identify resonances between the uncanny’s continuing referentiality and the notion that feminist transcorporeality interrelates the subject into networks of materiality which extend across time and space in unknowable ways. Both transcorporeality and the uncanny work against the conceit of the individual through the dissolution of boundaries, and, crucially, both require a suspension of assumptions of the self as whole, discrete and impermeable. To demonstrate this, I read the uncanny waters of contemporary fictions from the Northern Atlantic Littoral (Atlantic Canada and the westernmost parts of the UK). The littoral position of these spaces makes them ideally placed to negotiate the borders between habitable and unhabitable spaces, and the limitations of knowledge that run alongside this. I assert that iterations of uncanny water offer a transoceanic dialogue which shifts constructions of subjectivity away from national and terrestrial boundaries to one more akin to the fluid and relational dialectics of transcorporeality. (shrink)

A cause is proportional to its effect when, roughly speaking, it is at the right level of detail. There is a lively debate about whether proportionality is a necessary condition for causation. One of the main arguments against a proportionality constraint on causation is that many ordinary and seemingly perfectly acceptable causal claims cite causes that are not proportional to their effects. In this paper, I suggest that proponents of a proportionality constraint can respond to this objection by developing an (...) idea that is present in Yablo’s early work on proportionality, but which has strangely been ignored by both Yablo and others in the subsequent debate. My suggestion is that proportionality—and, indeed, causation itself—is relative to a domain of events. At the metaphysical level, this means that the causal relation has an extra relatum—namely, a domain of events. At the level of language, it introduces a new way in which causal claims are context-sensitive: what is expressed by a causal claim depends on the contextually relevant domain of events. As I argue, this suggestion allows us to accommodate the truth of ordinary causal claims while extending the explanatory benefits of a proportionality constraint. (shrink)

In Pregnant Embodiment: Subjectivity and Alienation, Iris Marion Young describes the lived bodily experience of women who have “chosen” their pregnancies. In this essay, Lundquist underscores the need for a more inclusive phenomenology of pregnancy. Drawing on sources in literature, psychology, and phenomenology, she offers descriptions of the cryptic phenomena of rejected and denied pregnancy, indicating the vast range of pregnancy experience and illustrating substantial phenomenological differences between “chosen” and unwanted pregnancies.

Research in the U. S. on fair trade consumption is sparse. Therefore, little is known as to what motivates U. S. consumers to buy fair trade products. This study sought to determine which values are salient to American fair trade consumption. The data were gathered via a Web-based version of the Schwartz Value Survey (SVS) and were gleaned from actual consumers who purchase fair trade products from a range of Internet-based fair trade retailers. This study established that indeed there are (...) significant interactions between personal values and fair trade consumption and that demographics proved to be useless in creating a profile of the American fair trade consumer. (shrink)

Plus qu'un ouvrage concernant les rapports ombrageux et controversés de l'art et de la pathologie, ce recueil est d'abord une rencontre, un creuset entre des champs, la clinique et la théorie qui, pour s'y confronter, excèdent les limites du " prêt-à-penser ". C'est pourquoi ici les divergences de méthodes et de perspectives entre des approches phénoménologique et psychanalytique ne dressent pas de strictes délimitations, mais font résonner des dissonances capables de laisser penser l'écart entre l'art et la pathologie comme établi (...) sur une entr'appartenance plus essentielle, ne livrant rien de son secret à celui qui s'en tient à des distinctions de principe. Encore faut-il entendre pathologie en son sens grec, au sens où la rencontre avec le monde ouvre, dans le réel, une brèche incolmatable dont seul l'art peut authentiquement rendre compte et dans laquelle la psychose s'engouffre si aucune mise en œuvre ne vient l'endiguer ou la ressourcer. " Aussi ne faut-il pas s'étonner que penser l'art et penser la folie puissent converger dans la mesure où ni l'un ni l'autre ne sont conceptualisables. Finalement, penser l'art ou penser la folie, c'est avoir ouverture à eux, à travers les œuvres, à travers les êtres malades et cela n'est possible précisément que dans une rencontre. Qu'est-ce qu'une rencontre? C'est cette situation qui n'a pas d'antécédent, qui n'a pas d'espace ni de temps qui puisse la précéder. L'épiphanie de quelqu'un dans le regard d'un autre implique nécessairement l'autophanie de celui-ci. L'échec de la rencontre, récusant tout passage lucide à l'ouvert, rejette le thérapeute sur sa facticité. C'est pour se dérober à l'épreuve sans partage de cette absence de soi, que la psychiatrie médicale, scientifico-médicale fait l'impasse sur la présence de l'autre, en objectivant tout ce qui touche à l'homme, en faisant de lui un cas particulier de cette objectivation universelle qui est la caractéristique de la culture de notre époque. ". (shrink)

Jean Greisch a soixante ans. A l'occasion de cet anniversaire, trente de ses collègues et amis de divers continents ont souhaité unir leurs réflexions à ce que son œuvre, désormais considérable, inspire sur les différentes scènes de la pensée. La thématique générale, qui constitue l'intitulé du présent volume, est emblématique d'une production singulière : passage entre les deux langues de son Luxembourg natal, entre la phénoménologie et la philosophie de la religion, entre la métaphysique et la théologie, entre les sciences (...) humaines et l'herméneutique, entre la poésie et l'éthique. Enseignant, traducteur, conférencier international et auteur, il continue de frayer différents types de passages : dresser des ponts, ouvrir des brèches, risquer des percées, souffrir des traversées, ménager des transitions, inventer des tracés. (shrink)

Viewing animals as a disposable resource is by no means novel, but does milking the cow for all its worth now represent a previously unimaginable level of exploitation? New technology has intensified milk production fourfold over the last 50 years, rendering the cow vulnerable to various and frequent clinical interventions deemed necessary to meet the demands for dairy products. A major question is whether or not the veterinary code of practice fits, or is in ethical tension, with the administration of (...) ‘efficient’ techniques, such as artificial insemination, to enhance reproduction levels among cattle? Vets perform these interventions and their ‘success’ is measured by the maximisation of milk production, requiring perpetually pregnant cows. Our empirical research on 33 farm vets explores how their professional ethical code promising to protect the welfare of the animal ‘above all else’, is increasingly in conflict with, and subordinate to, the financial demands of clients. Since vets cannot stand outside of the productive power–knowledge relations that have intensified the consumption of animal bodily parts and secretions, we argue that a process of adiaphorization’ occurs, whereby humans become morally indifferent to cruel practices deemed necessary to our consumerist ways of life. However, this indifference reflects and reinforces a taken-for-granted anthropocentrism among vets, animal owners and the population generally. We suggest that posthumanist ideas may offer new insights for the study of human–animal relations in organisations that transcend the coercive and negative impact of discourses that deny any alternative to prevailing farm/veterinary practices. Our study has major implications in relation to climate warming and zoonotic diseases, both partly derived from our unethical relationship to animals, that are increasingly threatening our, and their, lives. (shrink)

This paper builds on existing research investigating CSR and ethical consumption within luxury contexts, and makes several contributions to the literature. First, it addresses existing knowledge gaps by exploring the ways in which consumers perform ethical luxury purchases of fine jewellery through interpretive research. Second, the paper is the first to examine such issues of consumer ethics by extending the application of theories of practice to a luxury product context, and by building on Magaudda’s :15–36, 2011) circuit of practice framework. (...) This is significant in that, to date, consumer research using practice theories has focused mainly on routine and habitual practices. Our findings and discussion provide an analysis of intentional and less intentional ethical consumer performances within the interconnected nexus of activities of consumers’ fine jewellery consumption practice, where meanings, understandings and intelligibility of social phenomena are worked through the various activities that shape such a practice. Finally, the paper concludes with significant managerial and policy-related implications, as our extended circuit of practice analysis conveys that if ethics and sustainability dimensions are to be embedded in fine jewellery consumption practice, they must first be made an intrinsic part of the nexus of the social and material environment of trading and consumption places. (shrink)

Psychologists say a measure has construct validity when it, in fact, measures the construct it is intended to measure. Construct validity is both an important notion in psychological research methods and the source of much confusion and debate among psychologists. I argue that this confusion arises, in part, because of a failure to distinguish between construct validity, a feature of measures relative to a construct, and construct legitimacy, a feature of the construct itself. I propose a prescriptive account of construct (...) validity on the basis of this distinction, then provide evidence for my account through two examples from research psychology. (shrink)

It is widely held that our beliefs can be epistemically faultless despite being morally flawed. Theories of moral encroachment challenge this, holding that moral considerations bear on the epistemic status of our attitudes. According to attitude-based theories of moral encroachment, morality encroaches upon the epistemic standing of our attitudes on the grounds that we can morally injure others with our epistemic practices. In this paper, I aim to show that current attitude-based theories have asymmetric mechanisms: moral features only make it (...) harder for attitudes to secure epistemic merits. I argue that, if attitudes can incur moral injury, failure to form attitudes can too. To make sense of this, I contend, attitude-based accounts require symmetric mechanisms, allowing that moral considerations make it both harder and easier for attitudes to attain epistemic merits. I maintain that, once we recognize this, attitude-based encroachment views must soon concede that they sometimes demand we believe against the evidence. (shrink)

In Pregnant Embodiment: Subjectivity and Alienation, Iris Marion Young describes the lived bodily experience of women who have “chosen” their pregnancies. In this essay, Lundquist underscores the need for a more inclusive phenomenology of pregnancy. Drawing on sources in literature, psychology, and phenomenology, she offers descriptions of the cryptic phenomena of rejected and denied pregnancy, indicating the vast range of pregnancy experience and illustrating substantial phenomenological differences between “chosen” and unwanted pregnancies.