In this article, I confront Jessica Flanigan’s recent attempt to show not merely that women have a right to commit prenatal injury, but also that women who act on this right are praiseworthy and should not be criticized for this injury. I show that Flanigan’s arguments do not work, and I establish presumptive grounds against any such right—namely, prenatal injury, by definition, involves intentional or negligent harm and, as such, may be subsumed under a wider (...) class of actions that are presumptively wrong. (shrink)

In this article, I confront Jessica Flanigan’s recent attempt to show not merely that women have a right to commit prenatal injury, but also that women who act on this right are praiseworthy and should not be criticized for this injury. I show that Flanigan’s arguments do not work, and I establish presumptive grounds against any such right—namely, prenatal injury, by definition, involves intentional or negligent harm and, as such, may be subsumed under a wider (...) class of actions that are presumptively wrong. (shrink)

According to the psychological account of personal identity, our identity is based on the continuity of psychological connections, and so we do not begin to exist until these are possible, some months after conception. This entails the psychological account faces a challenge from the non-identity problem—our intuition that someone cannot be harmed by actions that are responsible for their existence, even if these actions seem clearly to cause them harm. It is usually discussed with regard to preconception harms, but in (...) the context of the psychological account, it is also applicable to prenatal harms. Inflicting prenatal injury is widely thought to be morally impermissible, but if the injury is identity-determining on the psychological account, then no-one seems to be harmed—rather, the injury is responsible for bringing them into existence. Here, I argue that identity-determining injuries can routinely occur on the psychological account, and that this undermines the account. I assess Nicola Williams’ proposal to salvage the account based on a trans-world account of personal identity, and show that it is unsuccessful. I then show that Jeff McMahan’s embodied mind account of personal identity is also susceptible. I conclude that identity-determining prenatal injuries pose a significant challenge for the psychological account and its variants, and provide a reason for supporting alternative accounts that fix personal identity at conception. (shrink)

Inflicting harm is generally preferable to inflicting death. If you must choose between the two, you should generally choose to harm. But prenatal harm seems different. If a mother must choose between harming her fetus or aborting it, she may choose either, at least in many cases. So it seems that prenatal harm is particularly objectionable, sometimes on a par with death. This paper offers an explanation of why prenatal harm seems particularly objectionable by drawing an analogy (...) to the all-or-nothing problem. It then argues that this analogy offers independent support for the ‘voluntarist’ view that at least some parental role obligations are grounded in the choice to be a parent. (shrink)

The development of new methods in the field of prenatal testing leads to an expansion of information that needs to be provided to expectant mothers. The aim of this research is to explore opinions and attitudes of gynecologists in Germany, Poland and Russia towards access to prenatal testing and diagnostics in these countries. Semi-structured interviews were conducted with n = 18 gynecologists in Germany, Poland and Russia. The interviews were analyzed using the methods of content analysis and thematic (...) analysis. Visible in all three countries is a connection of prenatal medicine with the politically and socially contentious issue of pregnancy termination. Respondents in Poland and Russia concentrated on the topic of inadequate resources. Quality of information for expectant mothers is an important point in all three countries. Only in Germany was the issue of language barriers in communication raised. With regard to non-invasive prenatal testing (NIPT) respondents in Germany focused on the ethical issues of routinization of testing; in Poland and Russia they concentrated on fair access to NIPT. Challenges in all three countries arise from structural factors such as imprecise and prohibitive regulations, lack of resources or organization of healthcare services. These should be addressed on a political and medico-ethical level. (shrink)

The most well-known goal of non-invasive prenatal testing (NIPT) is still to determine whether or not a fetus has trisomy 21. Since women often terminate the pregnancy upon a positive result, there is concern that the use of NIPT contributes to discrimination against persons with disabilities. If this concern is justified, it could have an impact on the wider social acceptability of existing testing practices and their potential further expansion. This paper demonstrates four different versions of the discrimination worry, (...) indicates how international policy papers have reacted to them, and identifies the ethically most relevant feature of the concern. (shrink)

The specific objects are to know the source of income and employment status of the children at work, to investigate the types of injury that affect the working child of the child laborer and to explore the hazardous work places and abuse of the working children. The study conducted with the secondary data of Bangladesh Labor Force Survey (ILO), 2013. SPSS software were used for finding the result. It is found that the predominating income source of the working child (...) was service sector and child labor mostly were self-employed. 18.5% child were engaged with hazardous work, 2.3% working child had experienced various types of injuries and almost 8.5% had subjected to insult, physically or sexually abuse. Most of the child don’t like their work and working environment that have adverse physical and emotional effects on children’s health. Public and private sectors should maintain child labor rules and regulations, arrange awareness program for child safety. (shrink)

As moral injury is a still-emerging concept within the area of military mental health, prevalence estimates for moral injury and its precursor, potentially morally injurious events (PMIEs), remain unknown for many of the world’s militaries. The present study sought to estimate the prevalence of PMIEs in the Canadian Armed Forces (CAF), using data collected from CAF personnel deployed to Afghanistan, via logistic regressions controlling for relevant sociodemographic, military, and deployment characteristics. Analyses revealed that over 65% of CAF members (...) reported exposure to at least one event that would be considered a PMIE. The most commonly PMIEs individuals reported included seeing ill or injured women and children they were unable to help (48.4%), being unable to distinguish between combatants and non-combatants (43.6%), and finding themselves in a threatening situation where they were unable to respond due to the rules of engagement under which they were required to operate (35.4%). These findings provide support for both the presence of exposure to PMIEs in CAF members and the need for formal longitudinal data collection regarding PMIE exposure and moral injury development. (shrink)

Despite a growing body of research on the sociology of time and, analogously, on the sociology of sport, to date there has been relatively little sports literature that takes time as the focus of the analysis. Given the centrality of time as a feature of most sports, this would seem a curious lacuna. The primary aims of this article are to contribute new perspectives on the subjective experience of sporting injury and to analyze some of the temporal dimensions of (...) sporting “injury time” and subsequent rehabilitation. The article is based on data derived from a 2-year autoethnographic research project on 2 middle/long-distance runners, and concludes with some indicative comments regarding the need for sports physiotherapists and other health-care practitioners to take into account the subjective temporal dimension of injury and rehabilitative processes. (shrink)

One of the most fascinating and continually debated arguments in the philosophical literature on the badness of death comes from the work of Lucretius (Titus Lucretius Carus, circa 99-55 BCE). This chapter will focus on Lucretius’s famous Symmetry Argument. I will begin by saying more about what exactly Epicureanism teaches about death — and why Epicureans thought it could not be bad. After that, I will provide the passage from Lucretius’s epic poem that includes his reasons for thinking that death (...) cannot be bad and will show how Lucretius’s passage has been regimented into the Symmetry Argument against the badness of death. Next, I will discuss the lasting influence of Lucretius’s argument, summarizing some common ways of responding. Finally, I will turn to two other passages from Lucretius’s poem, both of which suggest that it is actually good (both for us and for the world) that our lives come to an end, and I will conclude by considering the implications of Lucretius’s thought for political policy. (shrink)

Guilt is a moral emotion that plays an important role in some understandings and manifestations of moral injury. In “Ulterior Motives and Moral Injury in War,” I note that soldiers returning from war are often assailed by profound feelings of guilt. Such soldiers might feel irrevocably diminished as persons, which is characteristic of a type of moral injury. I explore how the ulterior motives of the leaders who authorized the war might exacerbate the moral injury of (...) soldiers. According to the argument I develop, civilian and military leaders, by virtue of their practical authority over combatants serving in the military, confer upon those combatants a particular purpose. The ulterior motives that the leaders harbor constitutively determine the content of the purpose they confer. So long as a combatant remains under the practical authority of her leaders, there is nothing she can do to divest herself of the specific purpose conferred upon her. Even if the war and her conduct in it are just by hypothesis, her sense of integrity might demand more: that she helps kill only for scrupulous purposes. It might be impossible to reconcile the demands of integrity with the cynical purpose that her self-serving, career-minded, opportunistic leaders confer upon her. This failure to justify to herself the carnage she helps cause can exacerbate the severity of any psychological trauma she suffers. (shrink)

This article seeks to describe in general terms what has become the standard way of conceptualizing moral injury in the clinical psychological and psychiatric literature, which is the key source for applications of the concept in other domains. What we call “the standard model” draws on certain assumptions about beliefs, mental states, and emotions as well as an implicit theory of causation about how various forms of harm arise from certain experiences or “events” that violate persons’ moral beliefs and (...) systems. Our analysis makes these assumptions more explicit and subjects them to critical scrutiny. In so doing, we survey the current literature and identify basic features of how moral injuries are defined, how they are thought to occur, and the forms of treatment or repair that appear to be indicated. We caution that it matters how moral experience is characterized and argue that an alternative understanding of what is the moral in moral injury is important for overcoming critical challenges to the standard model. Moreover, recently evolving approaches to moral repair could be more consistent with an alternative model. Our concluding suggestion is that a more robust account of the nature of moral experience and its relations to self-identity and social experience more generally could advance understanding of the etiology of moral injury and promote rehabilitation. (shrink)

My aim is to argue that forgiveness may be conceived by analogy to healing. The analogy is not self-evident, but a number of subsidiary analogies will be seen to point in its direction, or so I will argue. In the course of the discussion we shall see how injustice (and wrong-doing) may be compared to physical injury (both change the state of the sufferer to the worse), and how the resentment caused by suffering injustice may be compared to the (...) physical pain caused by injury (both are aversive, action-motivating states). The analogies will be illustrated and supported by concrete examples, ultimately suggesting that, in an important sense, when we forgive, we actually heal. (shrink)

This paper explicates a conception of injury as right-violation, which allows us to distinguish between setbacks to interests that should, and should not, be the concern of theories of justice. It begins by introducing a hybrid theory of rights, grounded in (a) the mobilisation of our moral equality to (b) protect our most important interests, and shows how violations of rights are the concern of justice, while setbacks where one of the twin grounds of rights is defeated are not. (...) It then looks more closely at the substantive moral components of injury, namely harm—damage to one’s interests—and wrong—disrespect for one’s moral equality. It argues that, on the hybrid conception of rights, harm and wrong are individually necessary and jointly sufficient components of injury, and the disvalue of neither is reducible to the other—in particular, it is a mistake to construe the disrespect identified by wrong as another damaged interest. Finally, it distinguishes between the public and private dimensions of harm and wrong, and makes some preliminary suggestions as to whether the remedy for these different dimensions should lie in criminal, distributive, or corrective justice. (shrink)

The high prevalence of brain injury incidents in adolescence and adulthood demands effective models for re-learning lost cognitive abilities. Impairment in brain injury survivors’ higher-level cognitive functions is common and a negative predictor for long-term outcome. We conducted two small-scale interventions (N = 12; 33.33% female) with persons with acquired brain injuries in two municipalities in Sweden. Age ranged from 17 to 65 years (M = 51.17, SD = 14.53). The interventions were dialogic, inquiry-based, and inspired by the (...) Philosophy for Children Programme, a participatory thinking skills approach with documented higher-order cognitive outcomes, such as developed argumentation skills, in other target groups. Philosophical dialogues were conducted once a week in the two groups, totalling 12 dialogues per group. Group argumentation development was measured through compared scores from structured observations of filmed dialogues early and late in the intervention. Large positive changes in mean scores from early to late in the intervention, together with constantly high facilitator quality, suggest argumentation development in the sample due to the intervention. (shrink)

This chapter conceptually analyzes the post-traumatic stress injuries called moral injury, moral fatigue or exhaustion, and broken spirit. It then identifies two puzzles. First, soldiers sometimes sustain moral injury even from doing right actions. Second, they experience moral exhaustion from making decisions even where the morally right choice is so obvious that it shouldn’t be stressful to make it; and even where rightness of decision is so murky that no decision could be morally faulted. The injuries result of (...) mistaken moral self-evaluation. Methods of preventing and treating these injuries are defended, including training in self-forgiveness, moral off-loading of actions and decisions to persons and devices less likely to feel inappropriate guilt, and the use of drugs to prevent such guilt. The foregoing has been about moral injury erroneously resulting from the non-violation of a correct moral code. But the chapter then introduces the concept of moral pseudo-injury—felt moral injury that has in reality resulted from violation of a false moral code, so that no one has really been morally injured. This can be used as a method in warfighting. And since the injuries it produces are illusory, this would be morally superior to physical violence. For it causes less injury to its victims, and should cause less guilt in those who must inflict it. Historical precedents are considered. Finally, our enemies often use moral pseudo-injury against us, in the form of terrorist violence against civilians. Terrorism causes comparatively few harms, yet we mistakenly see it as more morally horrific than conventional combat that causes much worse loss of life among armed forces members. Here we need the nuancing and clarifying power of philosophy to restore a sense of proportion, thence to prevent or therapize the moral pseudo-injury we may experience from these sorts of attacks. (This is a pre-penultimate version of the published version, available from OUP at the external link, which contains minor variances. The paper was earlier known as "PTSD Weaponized: A Theory of Moral Injury"; that now superseded version is archived under "past conferences" on the Center for Ethics and the Rule of Law website.). (shrink)

It is well documented that people with moderate-to-severe traumatic brain injury (TBI) can undergo personality changes, including becoming more impulsive in terms of how they behave. Legal guidance and academic commentary support the view that impulsiveness can render someone decisionally incompetent as defined by English and Welsh law. However, impulsiveness is a trait found within the healthy population. Arguably, impulsiveness is also a trait that gives rise to behaviours that should normally be tolerated even when they cause harm to (...) the person enacting the behaviours. The purpose of this paper is to show why both of these considerations present as significant challenges to the law in England and Wales. (shrink)

This article explores the Nuffield Council on Bioethics’ recent report about non-invasive prenatal testing. Given that such testing is likely to become the norm, it is important to question whether there should be some ethical parameters regarding its use. The article engages with the viewpoints of Jeff McMahan, Julian Savulescu, Stephen Wilkinson and other commentators on prenatal ethics. The authors argue that there are a variety of moral considerations that legitimately play a significant role with regard to (prospective) (...) parental decision-making in the context of NIPT, for example, views on the morality of abortion and understandings of the impact of disability on quality of life. The variable nature of such considerations, both singularly and combined, suggests that any approach to NIPT should be sensitive to and understanding of similarly variable parental assessments and decisions. The implications of the approach developed for current and future policies in this area are explored, along with the impact of such arguments on ideas about procreative beneficence. (shrink)

The Deaf culture in the United States is a unique culture that is not widely understood. To members of the Deaf community in the United States, deafness is not viewed as a disease or pathology to be treated or cured; instead it is seen as a difference in human experience. Members of this community do not hide their deafness; instead they take great pride in their Deaf identity. The Deaf culture in the United States is very communitarian not individualistic. Mary (...) Beth and Dominic are a married couple in their late 20s who are genetically deaf. They are active members in the Deaf community and work as advocates for individuals who are deaf, family members of Deaf people and sign language interpreters who identify with the Deaf culture. Mary Beth and Dominic approach the fertility clinic with a request that they only want a child with the genetic gene for deafness. They would want the embryos that do not have the gene to be destroyed. This would entail creating a child who would have the gene for deafness. Medically and ethically, should the fertility clinic agree to the couple’s request? The authors argue that the couple's request should be denied and provide reasons for it from the perspectives of foundational and clinical ethics. (shrink)

Until recently, the problem of traumatic brain injury in sports and the problem of performance enhancement via hormone replacement have not been seen as related issues. However, recent evidence suggests that these two problems may actually interact in complex and previously underappreciated ways. A body of recent research has shown that traumatic brain injuries, at all ranges of severity, have a negative effect upon pituitary function, which results in diminished levels of several endogenous hormones, such as growth hormone and (...) gonadotropin. This is a cause for concern for many popular sports that have high rates of concussion, a mild form of TBI. Emerging research suggests that hormone replacement therapy is an effective treatment for TBI-related hormone deficiency. However, many athletic organizations ban or severely limit the use of hormone replacing substances because many athletes seek to use them solely for the purposes of performance enhancement. Nevertheless, in the light of the research linking traumatic brain injury to hypopituitarism, this paper argues that athletic organizations’ policies and attitudes towards hormone replacement therapy should change. We defend two claims. First, because of the connection between TBI and pituitary function, it is likely many more athletes than previously acknowledged suffer from hormone deficiency and thus could benefit from hormone replacement therapy. Second, athletes’ hormone levels should be tested more rigorously and frequently with an emphasis on monitoring TBI and TBI-related issues, rather than simply monitoring policy violations. (shrink)

Background We investigated the personal philosophies of eight persons with a tetraplegic condition (four male, four female), all living in Sweden with a chronic spinal cord injury (SCI) and all reporting a good life. Our purpose was to discover if there is a philosophical mindset that may play a role in living a good life with a traumatic SCI. Methods Two rounds of in-depth qualitative interviews were performed by the same interviewer, a philosophical practitioner by training (de Miranda). The (...) second round systematically covered the following elements: bodily sense, sense of self, sense of belonging, sense of the possible, sense of purpose and philosophical sense. This six-step method developed by de Miranda is called SMILE_PH, an acronym for Sense-Making Interviews Looking at Elements of Philosophical Health. Results All the interviewees, as a consequence of their trauma, reported having gone through a reinvention of themselves which implied questioning the meaning and purpose of their life in particular and life in general. A philosophical rather than realistic sense of the possible was abstracted toward teleological growth. All interviewees developed a sense of purpose based on self-interested altruism and solidarity with disabled peers. Conclusions To reinvent a good life with SCI, in addition to physical training and willpower, one needs to consider philosophical questions about the self and life, what Kant called the cosmic interests of reason: What may I hope? What must I do? What can I know? Our results indicate that we should, in the future, explore what the philosophical health approach may bring to rehabilitation processes in the months or years that follow the trauma. (shrink)

Should the government censor dangerous anti-vaccination propoganda? Should it restrict the praise of terrorist groups, or speech intended to promote discriminatory attitudes? In other words, should the government curb the advocacy of dangerous ideas and actions (i.e. 'harmful advocacy'), or should the government take a more permissive approach? Strong free speech supporters argue that citizens should be free to engage in and to hear harmful advocacy, arguing that restrictions are deeply objectionable at best, and, at worst, wholly impermissible. To support (...) their position, strong free speech supporters have offered a wide range of arguments and ideas. One of the most interesting arguments revolves around the idea that restrictions on harmful advocacy are deeply insulting to citizens. The worry, broadly understood, is that this kind of censorship is demeaning, treats citizens as though they are stupid, or as though they are children. As such, even when censorship is effective in preventing harms to citizens, it nonetheless comes at the significant political cost of failing to properly respect the citizenry at large. By contrast, so the thought goes, an alternative political scheme that prohibits censorship, or permits it only in exceptional cases, does a better job of respecting citizens as independent, rational, morally responsible agents. This alternative political system may, sometimes, be less effective at preventing speech harms. But it is a political system where citizens can stand tall and hold their heads high. In this paper, I consider and reject three versions of the worry that censorship is insulting. §1 explores the idea that censorship is insulting qua involving a negative appraisal of the citizens being interfered with. The key idea here is that censorship involves a lack of what Stephen Darwall terms ‘appraisal respect’, insofar as the government is suggesting that citizens cannot be trusted to manage their own beliefs and intentions. Drawing on the work of Thomas Nagel, §2 explores the idea that censorship diminishes the political status of citizens. Finally, §3 explores the suggestion that censorship is incompatible with a full appreciation of the thinking nature of citizens, and thus involves a lack of what Darwall would term ‘recognition respect’. The paper argues that censorship is not necessarily premised upon an insulting view of the citizenry. On the contrary, it argues that the best kind of censorship stems from a rich appreciation of the diverse range of capabilities, needs, vulnerabilities, and responsibilities of citizens, as well as the need for co-operation between citizens if societal flourishing is going to be achieved on a large scale. Granted, such a vision places an emphasis on the imperfections and liabilities of citizens – at least when compared to the rather solitary, highly intellectual creature one sometimes finds in the philosophical literature. Still, such a vision of citizens as imperfect falls well short of being genuinely insulting. To err is human. And there’s nothing insulting about being treated like a human. (shrink)

Reid argues that Hume’s claim that justice is an artificial virtue is inconsistent with the fact that gratitude is a natural sentiment. This chapter shows that Reid’s argument succeeds only given a philosophy of mind and action that Hume rejects. Among other things, Reid assumes that one can conceive of one of a pair of contradictories only if one can conceive of the other—a claim that Hume denies. So, in the case of justice, the disagreement between Hume and Reid is, (...) at bottom, a disagreement over their respective conceptions of how the human mind works at its most fundamental level. (shrink)

Traumatic brain injury is the leading cause of death in children. Children with severe TBI are in need of neurointensive care where the goal is to prevent secondary brain injury by avoiding secondary insults. Monitoring of cerebral blood flow (CBF) and autoregulation in the injured brain is crucial. However, there are limited studies performed in children to investigate this. Current studies report on age dependent increase in CBF with narrow age range. Low initial CBF following TBI has been (...) correlated to poor outcome and may be more prevalent than hyperemia as previously suggested. Impaired cerebral pressure autoregulation is also detected and correlated with poor outcome but it remains to be elucidated if there is a causal relationship. Current studies are few and mainly based on small number of patients between the age of 0–18 years. Considering the changes of CBF and cerebral pressure autoregulation with increasing age, larger studies with more narrow age ranges and multimodality monitoring are required in order to generate data that can optimize the therapy and clinical management of children suffering TBI. (shrink)

In this article, we engage with a theory of management advanced by MacIntyrean scholars of business ethics and organization studies to develop an account of “chronic moral injury” in the workplace. In contrast to what we call “acute moral injury,” which focuses on grave, traumatic events, chronic moral injury results from poor institutional form—when an individual desiring excellence must function within a vicious institution that impedes the acquisition of virtues and marginalizes practices. In other words, chronic moral (...) injury occurs when practitioners who pursue excellence in their practice work within corrupt or malformed organizations. To demonstrate this point, we recount the events associated with the rise and fall of the biotech company, Theranos. This case study advances an empirical contribution to MacIntyrean studies by demonstrating how chronic moral injury can happen under such conditions and what the negative consequences may entail for workers. (shrink)

Criminal offences and regulatory breaches in using social networking evidence in personal injury litigation Pages 2-7 Current Criminal Law ISSN 1758-8405 Volume 2 Issue 3 March 2010 Author SALLY RAMAGE WIPO 900614 UK TM 2401827 USA TM 3,440.910 Orchid ID 0000-0002-8854-4293 Sally Ramage, BA (Hons), MBA, LLM, MPhil, MCIJ, MCMI, DA., ASLS, BAWP. Publisher & Managing Editor, Criminal Lawyer series [1980-2022](ISSN 2049-8047); Current Criminal Law series [2008-2022] (ISSN 1758-8405) and Criminal Law News series [2008-2022] (ISSN 1758-8421). Sweet & Maxwell (...) (Thomson Reuters) (Licensed Annotator of UK Statutes) in Current Law Statutes Annotated, (2006, 2009, 2010 editions) (sole and separate S&M contracts) for 7 UK Criminal Justice Statutes: UK Safeguarding Vulnerable Persons Act 2006; UK International Development Act 2006; UK Fraud Act 2006; UK Policing and Crime Act 2009, UK Local Democracy Act 2009; UK Bribery Act 2010; and UK Crime and Security Act 2010. Trade Mark SALLY RAMAGE ® 2401827 (2005-2025) in the UK, WIPO Trade Mark SALLY RAMAGE® 900164; USA-(Trade Mark 3,440,910) (2008-2028). WARNING: The doing of an unauthorized act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. Essentially, Social Network information may not always be admissible in a court of law but may be the door to lead to other, non-contentious evidence. In fact, even illegally obtained evidence may sometimes be admissible evidence, though this is not absolute. Most of the information available on social networking sites will be ‘personal data’. The data controller is the network operator, without whose consent, collecting such information could be an offence, unless it was necessary for the purpose of preventing or detecting crime. (shrink)

There is a long-standing debate in philosophy about whether it is morally permissible to harm one person in order to prevent a greater harm to others and, if not, what is the moral principle underlying the prohibition. Hypothetical moral dilemmas are used in order to probe moral intuitions. Philosophers use them to achieve a reflective equilibrium between intuitions and principles, psychologists to investigate moral decision-making processes. In the dilemmas, the harms that are traded off are almost always deaths. However, the (...) moral principles and psychological processes are supposed to be broader than this, encompassing harms other than death. Further, if the standard pattern of intuitions is preserved in the domain of economic harm, then that would open up the possibility of studying behavior in trolley problems using the tools of experimental economics. We report the results of two studies designed to test whether the standard patterns of intuitions are preserved when the domain and severity of harm are varied. Our findings show that the difference in moral intuitions between bystander and footbridge scenarios is replicated across different domains and levels of physical and non-physical harm, including economic harms. (shrink)

Objectives: To explore individuals’ perception of the personal, family and societal educational needs following a spinal cord injury. Methods: Sixty-one patients who sustained a traumatic SCI between March 2015 and June 2016 referred to Brain and Spinal Cord Injury Research Center were included in a cross sectional study and completed an online survey containing open-and closed-ended questions, in Iran. Participants’ responses were analyzed i using a qualitative approach with a thematic analysis. Results: Following a thematic analysis of the (...) patient’s perceived educational needs, 3 themes and 14 subthemes were identified. The 3 themes included personal, family, and societal educational perceived needs. Within personal educational needs, there were 7 subthemes which included personal independence and transportation, financial independence, life skills modification, knowledge about SCI, prevention of SCI complications, relationships and sexual function, and psychological adjustments. Among family educational needs, the 3 subthemes were caregiver skills and communication, first aid and emergency skills, and emotional and psychological support. For societal educational needs, the 4 subthemes described were social integration, interpersonal communication skills, SCI awareness and injury prevention, sympathize while avoiding pity. Conclusion: According to our findings, people with SCI have various needs that need to be addressed. Educational support should be a part of a comprehensive rehabilitation program and geared towards addressing the patients’ personal and family needs, while educating the community about SCI in order to allow for reintegration into society. (shrink)

This paper discusses a dialectic whereby the law not only influenced medical thinking in late nineteenth-century Germany, but also underwent medicalization of its own initiative. At the end of the 1880s, social legislation was crucial in initiating the German discourse on traumatic nervous disorders. By employing doctors as medical experts in court, the law also created a new experiential realm for doctors, altering their behavior toward patients and shifting their focus from therapy to investigation. However, in the wake of their (...) experiences in court, doctors developed a dual etiology of traumatic symptoms, which included the law itself as a pathogenic element with the power to aggravate symptoms. Two medical views of law can be distinguished: some doctors claimed that it was the desire to receive the pensions offered under social legislation that induced workers to perpetuate and exaggerate their symptoms; others argued that since pension claims embroiled claimants in intimidating legal proceedings, the pathogenic effect of social legislation stemmed from fear rather than greed. (shrink)

In a context of imperfect risk protection, households may protect against the impact of a health shock by employing various financial and non-financial coping mechanisms, such as foregoing or reducing needed medical care, labor substitution, consumption reduction, borrowing money, dissaving, and selling assets. However, leveraging certain coping mechanisms may reduce future productivity, potentially trapping households in chronic or persistent poverty. Resources and risk are not necessarily shared equitably within a household; the ability and willingness of the household to leverage coping (...) mechanisms, or the choice of coping mechanism may depend on the social protection policy context, household socioeconomic status, and type of intrahousehold risk sharing. Vietnam has been making policy changes aimed towards achieving Universal Health Coverage for the past several decades, culminating in a 2015 change mandating universal insurance coverage. This can potentially influence both providers in making decisions around service delivery and households around financing care. This research aims to contribute to the literature exploring the relationships among direct and indirect health care costs, potentially maladaptive coping mechanisms, and household living standards, within the particular health financing and social protection environment in Vietnam. (shrink)

Based upon a collaborative autoethnographic research project, this article explores from a sociological perspective the emotional dimension of the injured sporting body. It takes as its analytic focus the journey, rehabilitative, emotional and narrative, of two middle-aged, non-élite, middle/long-distance runners who encountered serious, long-term knee injuries. The paper examines in particular the interactional and narrative elements of the rehabilitative journey, focussing on dimensions of the emotion management, emotion work, and emotional intersubjectivity of the researcher/author and her training partner as they (...) struggled to contend with the liminality of the injured athletic role, and to maintain positive identities in the face of serious threat to their running selves. (shrink)

In this paper, I explore the “expressivist critique” of the use of prenatal testing to select against the birth of persons with impairments. I begin by setting out the expressivist critique and then highlighting, through an investigation of an influential objection to this critique, the ways in which both critics and proponents of the use of technologies of genetic selection negotiate a difficult set of dilemmas surrounding the relationship between genes and identity. I suggest that we may be able (...) to advance the debate about these technologies by becoming more aware of the ways in which this debate is itself in part a political contestation over this relationship. Ultimately, I will argue, the real force of the expressivist objection lies in its capacity to draw our attention to political questions about the role of the state and about relationships between different social groups rather than between parents and prospective children. That is to say, crucial issues, when evaluating the force of this criticism, turn out to be: the nature of the institutions which determine how decisions about prenatal selection are made; and how we think of each other, that is, what we take to be the defining characteristics of human beings. Paradoxically, arguments about the ethics of the “sorting society”, both supportive and critical, are an important arena in which these institutions and these ideas about identity are contested and shaped. An increased awareness of the reflexive nature of the process of debating these issues may assist us in better negotiating them. (shrink)

: This article critically examines the constitution of impairment in prenatal testing and screening practices and various discourses that surround these technologies. While technologies to test and screen prenatally are claimed to enhance women's capacity to be self-determining, make informed reproductive choices, and, in effect, wrest control of their bodies from a patriarchal medical establishment, I contend that this emerging relation between pregnant women and reproductive technologies is a new strategy of a form of power that began to emerge (...) in the late eighteenth century. Indeed, my argument is that the constitution of prenatal impairment, by and through these practices and procedures, is a widening form of modern government that increasingly limits the field of possible conduct in response to pregnancy. Hence, the government of impairment in utero is inextricably intertwined with the government of the maternal body. (shrink)

Death can be bad for an individual who has died, according to the “deprivation approach,” by depriving that individual of goods. One worry for this account of death’s badness is the Lucretian symmetry argument: since we do not regret having been born later than we could have been born, and since posthumous nonexistence is the mirror image of prenatal nonexistence, we should not regret dying earlier than we could have died. Anthony Brueckner and John Martin Fischer have developed a (...) response to the Lucretian challenge by arguing that it is rational to have asymmetric attitudes toward posthumous and prenatal nonexistence. Recently, Jens Johansson has criticized the Brueckner/Fischer position, claiming that it is irrelevant whether it is actually rational to care about future pleasures but not past pleasures. What matters, according to Johansson, is whether it would be rational for us to care about past pleasures had we come into existence earlier. In this paper, I add to the conversation between Johansson and Brueckner/Fischer by suggesting a way to defend the latter side’s position in a way that has not yet been suggested. I do this by considering a suggestion of Johansson’s for interpreting the Brueckner/Fischer position and by arguing that Johansson’s worry for the position I consider is actually incoherent. (shrink)

Eugenic thinking involves distinguishing between sorts or kinds of people in terms of the perceived desirable or undesirable traits that those people are likely to transmit to future generations. While eugenics itself is often thought of as an ideology that generated a social movement of global influence from roughly 1900 to 1945, eugenic thinking both pre-dates this period and continues to inform a range of contemporary debates and social policies, including those concerning prenatal screening, transhumanism, population control, and disability. (...) Various sciences, including the then-nascent sciences of psychology and psychiatry, played important roles in early twentieth-century eugenics, and their legacy is reflected in contemporary eugenic thinking and policies. Understanding the history of eugenics and the role of these early sciences of cognition in that history is useful in reflecting further on ongoing forms of eugenic thinking to which the contemporary cognitive sciences are relevant. (shrink)

Projects of human improvement take both individual and intergenerational forms. The biosciences provide many technologies, including prenatal screening and the latest gene editing techniques, such as CRISPR, that have been viewed as providing the means to human improvement across generations. But who is fit to furnish the next generation? Historically, eugenics epitomizes the science-based attempt to improve human society through distinguishing kinds of people and then implementing social policies—from immigration restriction to sexual sterilization and euthanasia—that influence and even direct (...) what sorts of people populate our future. Despite recognition of the horrors of the eugenic extremes of the past and of the subhumanizing of those sufficiently below appearance or ability norms to be viewed as “defective” or “unfit”, many people continue to be drawn to strands of eugenic thinking. (shrink)

In the intersection between eugenics past and present, disability has never been far beneath the surface. Perceived and ascribed disabilities of body and mind were one of the core sets of eugenics traits that provided the basis for institutionalized and sterilization on eugenic grounds for the first 75 years of the 20th-century. Since that time, the eugenic preoccupation with the character of future generations has seeped into what have become everyday practices in the realm of reproductive choice. As Marsha Saxton (...) (2000) and Adrienne Asch (2000, 2003) have forcefully argued, the use of prenatal screening technologies to facilitate the selective abortion of fetuses with features that signify disabling traits—the paradigm here being trisomy 21 in a fetus indicating Down Syndrome in the child—express a negative view of such disabilities sufficient to warrant terminating an otherwise wanted pregnancy. The eliminative structure of what Rosemary Garland Thompson (2012) has called eugenic logic persists in contemporary practices governing reproductive choice, social inclusion, and democratic participation and their relationship to disability. The tie between eugenics and contemporary disability studies suggests that eugenics and reflection on its history can also play a more positive role in disability politics. After focusing on eugenics in the first half of the paper, we will shift in the second half of the paper to eugenic resonances in contemporary thought and practice, concluding with some thoughts about ongoing practices of silencing and the very idea of eradicating disability. (shrink)

A primary argument against the badness of death (known as the Symmetry Argument) appeals to an alleged symmetry between prenatal and posthumous nonexistence. The Symmetry Argument has posed a serious threat to those who hold that death is bad because it deprives us of life’s goods that would have been available had we died later. Anthony Brueckner and John Martin Fischer develop an influential strategy to cope with the Symmetry Argument. In their attempt to break the symmetry, they claim (...) that due to our preference of future experiential goods over past ones, posthumous nonexistence is bad for us, whereas prenatal nonexistence is not. Granting their presumption about our preference, however, it is questionable that prenatal nonexistence is not bad. This consideration does not necessarily indicate their defeat against the Symmetry Argument. I present a better response to the Symmetry Argument: the symmetry is broken, not because posthumous nonexistence is bad while prenatal nonexistence is not, but because (regardless as to whether prenatal nonexistence is bad) posthumous nonexistence is even worse. (shrink)

Some parents have taken steps to ensure that they have deaf children, a choice that contrasts with the interest that other parents have in enhancing the traits of their children. Julian Savulescu has argued that, morally speaking, parents have a duty to use assisted reproductive technologies to give their children the best opportunity of the best life. This view extends beyond that which is actually required of parents, which is only that they give children reasonable opportunities to form and act (...) on a conception of a life that is good for them. Does the selection of deaf children violate that responsibility? Morally speaking, parents should refrain from using assisted reproductive treatments or prenatal interventions in order to have a child with a disability. Deafness and other disabilities represent intrinsic disadvantages that cannot be offset by other advantages that families and society can offer to people. By the same token, neither should parents seek enhancements of intelligence or physical traits that would undercut intrinsic goods of human life in similar ways. These moral arguments do not, however, sustain the judgment that the law should necessarily interfere with parents' decisions in these matters, even if those choices are morally unwise. (shrink)

In ‘Public Reason and Prenatal Moral Status’ (2015), Jeremy Williams argues that the ideal of Rawlsian public reason commits its devotees to the radically permissive view that abortion ought to be available with little or no qualification throughout pregnancy. This is because the only (allegedly) political value that favours protection of the foetus for its own sake—the value of ‘respect for human life’—turns out not to be a political value at all, and so its invocation in support of considerations (...) bearing upon the permissibility of abortion is beyond public reason’s remit. Thus, it will scarcely if ever be legitimate to restrict women’s equality and bodily autonomy for the sake of the foetus, even at full term. In this paper, I argue that Williams fails to establish that Rawlsian reasonable citizens must endorse the radically permissive stance vis-à-vis abortion. Citizens can, I claim, reasonably accord the value of respect for human life weight, and indeed converge on the claim that it outweighs other salient political values, during later stages of gestation. Nevertheless, Williams’s argument gets something right in that it reveals why the value of respect for human life is inadmissible at the bar of public reason in early stages of pregnancy. But then, far from throwing Rawlsian public reason into disrepute, Williams’s argument actually (albeit inadvertently) provides arguably more compelling grounds than any hitherto rallied for endorsing Rawls’s much maligned claim that opposition to the duly qualified right to abortion in the first trimester of pregnancy is ‘unreasonable’. (shrink)

Male genital problems and injuries may occur quite simply because of the scrotum and penis are not protected like other organs. Genital problems and injuries normally happen through: recreational activities (like Football, Hooky, biking, basketball), work- related tasks (like contact to irritating chemicals), downhill drop, and sexual activity. A genital injury frequently causes harsh pain that typically disappear fast without causing enduring harm. Home handling is generally all that is required for trivial problems or injuries. Pain, inflammation, staining, or (...) rashes that are coexist with other symptoms might be a source for concern. Genital problems in men is one of the most common problems which requires fast intervention. In this paper we present an expert system that help men diagnose their genital problems and give them the proper treatment. SL5 Object expert system language was used to design and implement this expert system. (shrink)

Some patients, following brain injury, do not outwardly respond to spoken commands, yet show patterns of brain activity that indicate responsiveness. This is “cognitive-motor dissociation” (CMD). Recent research has used machine learning to diagnose CMD from electroencephalogram (EEG) recordings. These techniques have high false discovery rates, raising a serious problem of inductive risk. It is no solution to communicate the false discovery rates directly to the patient’s family, because this information may confuse, alarm and mislead. Instead, we need a (...) procedure for generating case-specific probabilistic assessments that can be communicated clearly. This article constructs a possible procedure with three key elements: (1) a shift from categorical “responding or not” assessments to degrees of evidence; (2) the use of patient-centred priors to convert degrees of evidence to probabilistic assessments; and (3) the use of standardized probability yardsticks to convey those assessments as clearly as possible. (shrink)

Male genital problems and injuries may occur quite simply because of the scrotum and penis are not protected like other organs. Genital problems and injuries normally happen through: recreational activities (like Football, Hooky, biking, basketball), workrelated tasks (like contact to irritating chemicals), downhill drop, and sexual activity. A genital injury frequently causes harsh pain that typically disappear fast without causing enduring harm. Home handling is generally all that is required for trivial problems or injuries. Pain, inflammation, staining, or rashes (...) that are coexist with other symptoms might be a source for concern. Genital problems in men is one of the most common problems which requires fast intervention. In this paper we present an expert system that help men diagnose their genital problems and give them the proper treatment. SL5 Object expert system language was used to design and implement this expert system. (shrink)

A substantial proportion of human embryos spontaneously abort soon after conception, and ethicists have argued this is problematic for the pro-life view that a human embryo has the same moral status as an adult from conception. Firstly, if human embryos are our moral equals, this entails spontaneous abortion is one of humanity’s most important problems, and it is claimed this is absurd, and a reductio of the moral status claim. Secondly, it is claimed that pro-life advocates do not act as (...) if spontaneous abortion is important, implying they are failing to fulfill their moral obligations. We report that the primary cause of spontaneous abortion is chromosomal defects, which are currently unpreventable, and show that as the other major cause of prenatal death is induced abortion, pro-life advocates can legitimately continue efforts to oppose it. We also defend the relevance of the killing and letting die distinction, which provides further justification for pro-life priorities. (shrink)

After severe brain injury, one of the key challenges for medical doctors is to determine the patient’s prognosis. Who will do well? Who will not do well? Physicians need to know this, and families need to do this too, to address choices regarding the continuation of life supporting therapies. However, current prognostication methods are insufficient to provide a reliable prognosis. -/- Functional Magnetic Resonance Imaging (MRI) holds considerable promise for improving the accuracy of prognosis in acute brain injury (...) patients. Nonetheless, research on functional MRI in the intensive care unit context is ethically challenging. These studies raise several ethical issues that have not been addressed so far. In this article, Prof. Charles Weijer and his co-workers provide a framework for researchers and ethics committees to design and review these studies in an ethically sound way. (shrink)

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon “near-suicide”. This study attempted to explore this phenomenon by examining how the seriousness of the patient’s illness or injury and the subjective evaluation of the patient’s and family’s financial situation after paying treatment fees affect the final decision on the (...) treatment process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families’ financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost–benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients’ likelihood of making “near-suicide” decisions and improve social equality in the healthcare system. (shrink)

Objective: Eye injuries are one of the leading causes of disabling ocular morbidity. The objective of this bibliometric study was to evaluate the top 100 cited articles on ocular trauma published between 1975 and 2018 via multidimensional citation analysis. Methods: We analyzed the top 100 cited articles among 3,768 ocular trauma articles published between 1975 and 2018; these articles were obtained from the databases in Web of Science and PubMed based on their citation rates per article, publication years, countries of (...) origin, institutions or organizations, the most common subjects, funding status, article types, and levels of evidence. The data obtained were analyzed with the SPSS® 20.0 software package program. Results: In the top 100 cited articles on ocular trauma, the total number of authors was 420 and the average authorship was 4.20±2.23 (range: 1–14). In our study, 70 of the top 100 cited articles were published in journals with an impact factor (IF) of ≥2.00 (range: 2.016–8.806), and Q index or quartile score of these journals was mostly Q1. Although the most preferred journal was Ophthalmology according to the total number of citations and articles (n=2,183 and n=23, respectively), Eye was the most preferred journal according to the mean number of citations per article. Besides, the three most common topics among the top 100 cited articles were mechanical eyeball injury (40 articles), epidemiology of ocular trauma (19 articles), and traumatic eye infection (17 articles). The average level of evidence was found to be 3.14±0.66 (range: 1–4), and the mean number of citations per article was the highest level at 2. Moreover, we also found that the most commonly preferred article type by authors was clinical research (92 articles), and most of them were in the B level of evidence group (70 articles). Conclusion: Analysis of the top 100 most cited articles on ocular trauma as an update study can provide us scientific contributions and vital current data in clinical implementations. (shrink)

Many of our most important goals require months or even years of effort to achieve, and some never get achieved at all. As social psychologists have lately emphasized, success in pursuing such goals requires the capacity for perseverance, or "grit." Philosophers have had little to say about grit, however, insofar as it differs from more familiar notions of willpower or continence. This leaves us ill-equipped to assess the social and moral implications of promoting grit. We propose that grit has an (...) important epistemic component, in that failures of perseverance are often caused by a significant loss of confidence that one will succeed if one continues to try. Correspondingly, successful exercises of grit often involve a kind of epistemic resilience in the face of failure, injury, rejection, and other setbacks that constitute genuine evidence that success is not forthcoming. Given this, we discuss whether and to what extent displays of grit can be epistemically as well as practically rational. We conclude that they can be (although many are not), and that the rationality of grit will depend partly on features of the context the agent normally finds herself in. In particular, grit-friendly norms of deliberation might be irrational to use in contexts of severe material scarcity or oppression. (shrink)

This paper defends and develops Elizabeth Harman’s Actual Future Principle with a concept called Schrödinger’s Fetus. I argue that all early fetuses are Schrödinger’s Fetuses: those early fetuses that survive and become conscious beings have full moral status already as early fetuses, but those fetuses that die as early fetuses lack moral status. With Schrödinger’s Fetus, it becomes possible to accept two widely held but contradictory intuitions to be true, and to avoid certain reductiones ad absurdum that pro-life and pro-choice (...) positions face. It also gives a simple solution to the problem of prenatal harm. (shrink)

This paper clarifies Merleau-Ponty’s original account of “higher-order” cognition as fundamentally embodied and enacted. Merleau-Ponty’s philosophy inspired theories that deemphasize overlaps between conceptual knowledge and motor intentionality or, on the contrary, focus exclusively on abstract thought. In contrast, this paper explores the link between Merleau-Ponty’s account of motor intentionality and his interpretations of our capacity to understand and interact productively with cultural symbolic systems. I develop my interpretation based on Merleau-Ponty’s analysis of two neuropathological modifications of motor intentionality, the case (...) of the brain-injured war veteran Schneider, and a neurological disorder known as Gerstmann’s syndrome. Building on my analysis of Schneider’s sensorimotor compensatory performances in relation to his limitations in the domains of algebra, geometry, and language usage, I demonstrate a strong continuity between the sense of embodiment and enaction at all these levels. Based on Merleau-Ponty’s interpretations, I argue that “higher-order” cognition is impaired in Schneider insofar as his injury limits his sensorimotor capacity to dynamically produce comparatively more complex differentiations of any given phenomenal structure. I then show how Merleau-Ponty develops and specifies his interpretation of Schneider’s intellectual difficulties in relation to the ambiguous role of the body, and in particular the hand, in Gerstmann’s syndrome. I explain how Merleau-Ponty defends the idea that sensorimotor and quasi-representational cognition are mutually irreducible, while maintaining that symbol-based cognition is a fundamentally enactive and embodied process. (shrink)