We describe a case of an elderly patient suffering from advanced dementia whose chronic confusion has become a source of frustration for her caregivers. Mrs. M experiences a touching interaction with a new nurse who takes a different approach with her. We describe this interaction and elaborate upon it by drawing from Catholic social teaching and the philosophy of play. Cases like these do not involve dramatic or esoteric ethical problematics, but rather the sort of dilemma born of the everyday (...) tragedies of lingering illness, aging and caretakers’ fatigue. Nathan’s approach offers a different way of seeing and being with the wearisome patient. (shrink)

Physiologically accurate mouse models of cancer are critical in the pre‐clinical development of novel cancer therapies. However, current standardized animal‐housing temperatures elicit chronic cold‐associated stress in mice, which is further increased in the presence of tumor. This cold‐stress significantly impacts experimental outcomes. Data from our lab and others suggest standard housing fundamentally alters murine physiology, and this can produce altered immune baselines in tumor and other disease models. Researchers may thus underestimate the efficacy of therapies that are benefitted by immune (...) responses. A potential mediator, norepinephrine, also underlies stress pathways common in mice and humans. Therefore, research into mechanisms connecting cold‐stress and norepinephrine signaling with immune depression in mice could highlight new combination therapies for humans to simultaneously target stress while stimulating anti‐tumor immunity. (shrink)

Michel Foucault's early works criticize the development of modern democratic institutions as creating a surveillance society, which functions to control bodies by making them feel watched and monitored full time. His later works attempt to recover private space by exploring subversive techniques of the body and language. Following Foucault, pragmatists like Richard Shusterman and Richard Rorty have also developed very rich approaches to this project, extending it deeper into the literary and somatic dimensions of self-stylizing. Yet, for a debate centered (...) on the re-creation of the vision of the self, these discussions have yet to fully engage—even while they set the conditions for this engagement with—issues of posthuman technologies, such as AI, robotics, and genetic engineering. These certainly will constitute the primary engine of public institutional surveillance in the years to come. With this surveillance, the two spheres of private self-fashioning and public institutions will continue to evolve in relation to one another. As they do so, democratic society will change considerably. Perhaps Rorty's own normative and linguistic ideal of conversational maintenance may provide something of a democratic limit case on any future posthuman self-fashioning. (shrink)

_Shusterman’s Somaesthetics_ is a wide-ranging collection of penetrating essays by twelve scholars examining in rich detail the many dimensions of philosopher Richard Shusterman’s pragmatism and somaesthetics, complemented by his own chapter of responses to these scholars.

In a recent paper in Psychological Science, Kouider and Dupoux reported obtaining unconscious Stroop priming only when subjects had partial awareness of the masked distractor words . Kouider and Dupoux conjectured that semantic priming occurs only when such partial awareness is present. The present experiments tested this conjecture in an affective categorization priming task that differed from Kouider and Dupoux’s in using masked distractors that subjects had practiced earlier as visible words. Experiment 1 showed priming from practiced words when subjects (...) had no partial awareness of those words. Experiment 2 showed that, in the absence of partial awareness, practiced words yielded priming but not-practiced words did not. Experiment 3 corroborated Experiment 1 and 2s results using a different test of partial awareness. These results suggest that unconscious processing of subword elements drives masked semantic priming by practiced words. (shrink)

A collection of dramatic accounts about doctors who have faced the moral dilemma of choosing between obeying rules and doing what is best for a patient offers insight into the essential principles of medical ethics and their impact on ...

This volume is a wonderful introduction to Foucault and a testimony to the deep humanity of the man himself.

In the debate over clinicians’ conscience, there is a greater ethical, legal, and scholarly focus on negative, rather than positive, claims of conscience. This asymmetry produces a seemingly unjustified double standard with respect to clinicians’ conscience under the law. For example, a Roman Catholic physician working at a secular institution may refuse to provide physician-aid-in-dying on the basis of conscience, but a secular physician working at a Roman Catholic institution may not insist on providing physician-aid-in-dying on the basis of conscience. (...) This article outlines arguments against this asymmetry and critiques them for failing to distinguish between positive claims of conscience as positive or negative rights. I suggest the asymmetry debate should be focused on whether positive claims of conscience as positive rights ought to enjoy the same protections as negative claims of conscience. Clarifying the debate in this way helps elucidate some of the best reasons for the asymmetry, which these arguments have not addressed. This article does not take a definitive position on whether the asymmetry is justified, but attempts to bring some focus to the debate by directing arguments against the asymmetry to address the significant differences between positive claims of conscience as positive rights and negative claims of conscience. (shrink)

Lucid, non-intimidating presentation of propositional logic, propositional calculus and predicate logic by Russian scholar. Topics of concern in a variety of fields, including computer science, systems analysis, linguistics, etc. Accessible to high school students; valuable review of fundamentals for professionals. Exercises (no solutions). Preface. Three appendices. Indices. Bibliogaphy. 14 figures.

Moral pluralism poses a foundational problem for secular clinical ethics: How can ethical dilemmas be resolved in a context where there is disagreement not only on particular cases, but further, on...

"Next to Sartre's Search for a Method and in direct opposition to it, Foucault's work is the most noteworthy effort at a theory of history in the last 50 years." -- Library Journal.

What is the proper role of a clinical ethics consultant’s religious beliefs in forming recommendations for clinical ethics consultation? Where Janet Malek has argued that religious belief should have no influence on the formation of a CEC’s recommendations, Clint Parker has argued a CEC should freely appeal to all their background beliefs, including religious beliefs, in formulating their recommendations. In this paper, I critique both their views by arguing the position envisioned by Malek puts the CEC too far from religion (...) and the position envisioned by Parker puts the CEC too close. For a CEC to give recommendations about what is morally prohibited, permissible, or obligatory in the clinic, I propose a view of the CEC that is neither religious nor non-religious but quasi-religious. I argue that a quasi-religious approach avoids the problems of both religious and non-religious views while preserving their benefits. Additionally, a quasi-religious view resists the marginalization of “religious” traditions that occurs when secular ethicists come to think of their approach as somehow distinctly non-religious. (shrink)

This paper provides a close reading of Erwin Straus’ “The Upright Posture” from a disability studies perspective. Straus argues that the upright posture dominates the human world. But he excludes those who dwell in it otherwise. By reviewing phenomenological disability literature, this paper asks what a disabled phenomenology would look like, one rooted in the problem of inclusion from the outset. Disabled phenomenology addresses ‘subjectivity’ critically, asking: what socio-material arrangements make subjectivity possible in the first place? This project is, I (...) argue, equal parts political economy and existential phenomenology. I conclude with some suggestions for future research. (shrink)

Whether the prefrontal cortex is part of the neural substrates of consciousness is currently debated. Against prefrontal theories of consciousness, many have argued that neural activity in the prefrontal cortex does not correlate with consciousness but with subjective reports. We defend prefrontal theories of consciousness against this argument. We surmise that the requirement for reports is not a satisfying explanation of the difference in neural activity between conscious and unconscious trials, and that prefrontal theories of consciousness come out of this (...) debate unscathed. (shrink)

Legal precedent, professional‐society statements, and even many medical ethicists agree that some situations may call for a clinician to engage in an act of lying or nonlying deception of a patient or patient's family member. Still, the moral terrain of clinical deception is largely uncharted, and when it comes to practical guidance for clinicians, many might think that ethicists offer nothing more than the rule never to deceive. This guidance is insufficient to meet the real‐world demands of clinical practice, and (...) this article endeavors to articulate a framework to help clinicians better navigate the ethics of clinical deceit. The framework articulates four morally relevant dimensions of a potential deceptive act that should be examined to better determine the moral justification that might be required: the target of the act, the nature of the information, the nature of the act, and the context of the act. (shrink)

In a recent issue of the Journal of Medicine and Philosophy, several scholars wrote on the topic of ethics expertise in clinical ethics consultation. The articles in this issue exemplified what we consider to be two troubling trends in the quest to articulate a unique expertise for clinical ethicists. The first trend, exemplified in the work of Lisa Rasmussen, is an attempt to define a role for clinical ethicists that denies they have ethics expertise. Rasmussen cites the dependence of ethical (...) expertise on irresolvable meta-ethical debates as the reason for this move. We argue against this deflationary strategy because it ends up smuggling in meta-ethical assumptions it claims to avoid. Specifically, we critique Rasmussen’s distinction between the ethical and normative features of clinical ethics cases. The second trend, exemplified in the work of Dien Ho, also attempts to avoid meta-ethics. However, unlike Rasmussen, Ho tries to articulate a notion of ethics expertise that does not rely upon meta-ethics. Specifically, we critique Ho’s attempts to explain how clinical ethicists can resolve moral disputes using what he calls the “Default Principle” and “arguments by parity.” We show that these strategies do not work unless those with the moral disagreement already share certain meta-ethical assumptions. Ultimately, we argue that the two trends of attempting to avoid meta-ethics by denying that clinical ethicists have ethics expertise, and attempting to articulate how ethics expertise can be used to resolve disputes without meta-ethics both fail because they do not, in fact, avoid doing meta-ethics. We conclude that these trends detract from what clinical ethics consultation was founded to do and ought to still be doing—provide moral guidance, which requires ethics expertise, and engagement with meta-ethics. To speak of ethicists without ethics expertise leaves their role in the clinic dangerously unclear and unjustified. (shrink)

The place of science.--The structure of science.--Nature: occurrents.--Nature: complexes.--Awareness.--Operations.--Meaning.--Meaning: correlational symbols.--Meaning: constructs and hypotheses.--The development of knowledge.--Models.--Description.--Explanation.--Quantitative methods.

The national standards for clinical ethics consultation set forth by the American Society for Bioethics and Humanities endorse an “ethics facilitation” approach, which characterizes the role of the ethicist as one skilled at facilitating consensus within the range of ethically acceptable options. To determine the range of ethically acceptable options, ASBH recommends the standard model of decision-making, which is grounded in the values of autonomy, beneficence, nonmaleficence, and justice. H. Tristram Engelhardt Jr. has sharply criticized the standard model for presuming (...) contentful moral claims in circumscribing the range of ethically acceptable options, which, he argues, cannot be rationally justified in a pluralistic context. Engelhardt’s solution is a secular clinical ethics based on a contentless principle of permission. The first part of this article lays out Engelhardt’s negative claim, that reason cannot establish contentful moral claims, and his positive claim, that secular clinical ethics ought to be based on a contentless principle of permission. The second part critiques these negative and positive claims. The purpose of this paper is to defend secular clinical ethics expertise—defined as the ability of ethicists to offer justified moral recommendations grounded in consensus positions endorsed by the American Society for Bioethics and Humanities—from the radical critiques of Engelhardt, who argues that no moral or metaphysical claims, and hence no bioethical consensus, can be rationally justified. Engelhardt’s critiques have caused some to worry that secular clinical ethics is in a state of theoretical crisis; this article concludes that Engelhardt’s view is an unstable basis for that worry. (shrink)

In his influential article ‘Essence and Modality’, Fine proposes a definition of necessity in terms of the primitive essentialist notion ‘true in virtue of the nature of’. Fine’s proposal is suggestive, but it admits of different interpretations, leaving it unsettled what the precise formulation of an Essentialist definition of necessity should be. In this paper, four different versions of the definition are discussed: a singular, a plural reading, and an existential variant of Fine’s original suggestion and an alternative version proposed (...) by Correia which is not based on Fine’s primitive essentialist notion. The first main point of the paper is that the singular reading is untenable. The second that given plausible background assumptions, the remaining three definitions are extensionally equivalent. The third is that, this equivalence notwithstanding, Essentialists should adopt Correia’s version of the definition, since both the existential variant, which has de facto been adopted as the standard version of the definition in the literature, and the plural reading suffer from problems connected to Fine’s primitive essentialist notion. (shrink)

It is widely agreed that fiction is necessarily incomplete, but some recent work postulates the existence of universal fictions—stories according to which everything is true. Building such a story is supposedly straightforward: authors can either assert that everything is true in their story, define a complement function that does the assertoric work for them, or, most compellingly, write a story combining a contradiction with the principle of explosion. The case for universal fictions thus turns on the intuitive priority we assign (...) to the law of non-contradiction. My goal in this paper is to show that our critical and reflective literary practices set constraints on story-telling which preclude universal fictions. I will raise four stumbling blocks for universal fictionalists: the gap between saying and making true, our actual interpretive reactions to story-level contradictions, the criteria we accept for what counts as a story in our literary practices, and the undesirability of the universal fictionalist’s closure principles. (shrink)

The premise that every work belongs to an art-kind has recently inspired a kind-centred approach to theories of art. Kind-centred analyses posit that we should abandon the project of giving a general theory of art and focus instead on giving theories of the arts. The main difficulty, however, is to explain what makes a given kind an art-kind in the first place. Kind-centred theorists have passed this buck on to appreciative practices, but this move proves unsatisfactory. I argue that the (...) root of this dissatisfaction stems not from the act of kicking the can down the road, but from not kicking it far enough. The missing ingredient, I argue, is a notion of convention which does the work of marking the difference between art and non-art for a given physical medium. (shrink)

While many Catholic hospitals permit the prescription of the emergency contraception drug levonorgestrel for rape victims, some continue to prohibit this practice as a matter of institutional conscience. While the standard approach to this issue has been to offer an argument that levonorgestrel either is or is not morally permissible, we have taken a different tack. We begin by briefly describing and acknowledging that reasonable disagreement exists on this question (part one), and then arguing that the reasonable disagreement itself can (...) serve as a compelling basis for Catholic leadership at hospitals that prohibit emergency contraception for rape victims to accommodate physicians who wish to provide levonorgestrel as a matter of conscience (part two). We end by anticipating and responding to some objections. (shrink)

Given recent legal developments in the United States, now is a critical time to draw attention to how ‘conscientious objection’ is sometimes used by health care providers to discriminate against the LGBTQ community. We review legal developments from 2019 and present several cases where health care providers used conscientious objection in ways that discriminate against the LGBTQ community, resulting in damaged trust by this underserved population. We then discuss two important conceptual points in this debate. The first involves the interpretation (...) of discrimination (provider versus patient-centered views), and we argue for a patient-centered view; the second involves the use of the people versus procedure distinction to reach a compromise between LGBTQ individuals and the clinicians who do not want to treat them. We argue the distinction is problematic when applied to treatment of the LGBTQ population. (shrink)

The legal and ethical asymmetry between honoring positive claims of conscience versus negative claims of conscience was recently analyzed by several articles in this journal. The first author of this article (ALB) identified unique but defeasible reasons against honoring positive claims of conscience, such as the greater threat they post to institutional values and institutional resources than negative claims of conscience. However, ALB wrote, when these reasons can be overcome, positive claims of conscience should enjoy the same ethical and legal (...) respect as negative claims of conscience. This article argues that the prescription of birth control by non-Roman Catholic physicians in Roman Catholic institutions is an example of a positive claim of conscience that can overcome concerns of institutional values and resources, and therefore ought to receive the same ethical respect and legal protection as negative claims of conscience. In making this argument, this article also responds to several of the thoughtful comments raised by Alberto Giubilini and Dominic Wilkinson. (shrink)

La contribution de Michel Troper à la théorie générale du droit et à la théorie constitutionnelle est aujourd'hui reconnue et célébrée un peu partout dans le monde. Un talent d'architecte se tient à l'origine de cette audience rarement égalée dans la sphère francophone : celui qu'il faut pour accommoder toutes les exigences, quel que soit l'ordre de valeur dans lequel on les trouve : originalité, rigueur, souci de la fonction, esthétisme, solidité, adaptation, intelligence, inquiétude, esprit critique, renoncement, réalisme... A ces (...) mérites, on ajoutera une curiosité insatiable, un goût prononcé pour l'échange et le débat, un refus distingué de l'académisme, un sens exigeant de l'amitié et une méfiance profônde pour les adjectifs... C'est cet édifice de qualités que les élèves, collègues et amis de Michel Troper sont heureux de célébrer en lui offrant ces Mélanges. (shrink)

Our aim in this article is to bring some clarity to the clinical ethics expertise debate by critiquing and replacing the taxonomy offered by the Core Competencies report. The orienting question for our taxonomy is: Can clinical ethicists offer justified, normative recommendations for active patient cases? Views that answer “no” are characterized as a “negative” view of clinical ethics expertise and are further differentiated based on (a) why they think ethicists cannot give justified normative recommendations and (b) what they think (...) ethicists can offer, if they cannot offer recommendations. Views that answer “yes” to the orienting question are characterized as a “positive” view of clinical ethics expertise. Positive views are distinguished according to four additional questions. First (P1), how are those recommendations generated? Second (P2), what is the nature of the recommendations? Third (P3), we ask, how are the recommendations justified? And finally (P4), how are the recommendations communicated? (shrink)

This article describes and rejects three standard views of reason in secular clinical ethics. The first, instrumental reason view, affirms that reason may be used to draw conceptual distinctions, map moral geography, and identify invalid forms of argumentation, but prohibits recommendations because reason cannot justify any content-full moral or metaphysical commitments. The second, public reason view, affirms instrumental reason, and claims ethicists may make recommendations grounded in the moral and metaphysical commitments of bioethical consensus. The third, comprehensive reason view, also (...) affirms instrumental reason, but encourages ethicists to make recommendations grounded in the moral and metaphysical commitments of their private worldviews. A compatibilist view of public reason is then defended, which holds that each standard view captures an important role for reason in different aspects of secular clinical ethics. The article ends by identifying three implications for enduring theoretical debates in clinical ethics. (shrink)

The second volume in an unprecedented publishing event: the complete College de France lectures of one of the most influential thinkers of the last century Michel Foucault remains among the towering intellectual figures of postmodern philosophy. His works on sexuality, madness, the prison, and medicine are classics his example continues to challenge and inspire. From 1971 until his death in 1984, Foucault gave public lectures at the world-famous College de France. These lectures were seminal events. Attended by thousands, they created (...) benchmarks for contemporary critical inquiry. The lectures comprising Abnormal begin by examining the role of psychiatry in modern criminal justice, and its method of categorizing individuals who "resemble their crime before they commit it." Building on the themes of societal self-defense in the first volume of this series, Foucault shows how and why defining "abnormality" and "normality" were prerogatives of power in the nineteenth century, shaping the institutions--from the prison system to the family--meant to deal in particular with “monstrosity,” whether sexual, phsyical, or spiritual. The College de France lectures add immeasurably to our appreciation of Foucault's thought, and offer a unique window on his singular worldview. (shrink)

One of the most significant and persistent debates in secular clinical ethics is the question of ethics expertise, which asks whether ethicists can make justified moral recommendations in active patient cases. A critical point of contention in the ethics expertise debate is whether there is, in fact, a bioethical consensus upon which secular ethicists can ground their recommendations and whether there is, in principle, a way of justifying such a consensus in a morally pluralistic context. In a series of recent (...) articles in this journal, Janet Malek defends a positive view of ethics expertise, claiming that secular ethicists should comport their recommendations with bioethical consensus. In response, Nick Colgrove and Kelly Kate Evans deny the existence of a secular bioethical consensus; question why, even if it did exist, consensus should be considered a reliable way of resolving bioethical questions; and recommend a friendlier approach to clinical ethics based on the thought of H. Tristram Engelhardt Jr. In this article, I respond to Colgrove and Evans on all three points. In part one, I show there is a secular bioethical consensus but note it could be better consolidated and created through a more systematic and inclusive process. In part two, I argue that bioethical consensus is morally justified but note that this justification cannot be plausibly based upon claims that it only invokes moral principles available to or shared by all. In part three, I argue Engelhardt’s approach cannot be described as “friendlier” to clinical ethics because it is incompatible with many current healthcare laws and policies. (shrink)

Douglas Diekema has argued that it is not the best interest standard, but the harm principle that serves as the moral basis for ethicists, clinicians, and the courts to trigger state intervention to limit parental authority in the clinic. Diekema claims the harm principle is especially effective in justifying state intervention in cases of religiously motivated medical neglect in pediatrics involving Jehovah’s Witnesses and Christian Scientists. I argue that Diekema has not articulated a harm principle that is capable of justifying (...) state intervention in these cases. Where disagreements over appropriate care are tethered to metaphysical disagreements, it is moral-metaphysical standards, rather than merely moral standards, that are needed to provide substantive guidance. I provide a discussion of Diekema’s harm principle to the broader end of highlighting an inconsistency between the theory and practice of secular bioethics when overriding religiously based medical decisions. In a secular state, ethicists, clinicians, and the courts are purportedly neutral with respect to moral-metaphysical positions, especially regarding those claims considered to be religious. However, the practice of overriding religiously based parental requests requires doffing the mantle of neutrality. In the search for a meaningful standard by which to override religiously based parental requests in pediatrics, bioethicists cannot avoid some minimal metaphysical commitments. To resolve this inconsistency, bioethicists must either begin permitting religiously based requests, even at the cost of children’s lives, or admit that at least some moral-metaphysical disputes can be rationally adjudicated. (shrink)

This paper reports of a case where a physician conscientiously objected to prescribing PrEP to a bisexual patient so as not to “enable immoral sexual behavior.” The case represents an instance of conscience creep, a phenomenon whereby clinicians invoke conscientious objection in sometimes objectionable ways that extend beyond the traditional contexts of abortion, sterilization, or physician aid in dying. This essay uses a reasonability view of conscientious objection to argue that the above case represents a discriminatory instance of conscience creep (...) that should not be permitted. (shrink)

Local theories of consciousness state that one is conscious of a feature if it is adequately represented and processed in sensory brain areas, given some background conditions. We challenge the core prediction of local theories based on long-lasting postdictive effects demonstrating that features can be represented for hundreds of milliseconds in perceptual areas without being consciously perceived. Unlike previous empirical data aimed against local theories, localists cannot explain these effects away by conjecturing that subjects are phenomenally conscious of features that (...) they cannot report. We also discuss alternative explanations that localists could offer. (shrink)