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Chapter 8 approaches diversity through cultural and moral lenses. It concerns the acceptance of EU intervention, the legitimacy of its action in a sensitive field, ripe with moral and ethical controversies. The EU’s approach can broadly be divided into three strands, which are not mutually exclusive. The first is the Europeanisation of choice, most apparent in tobacco regulation, where the EU has adopted a quasi-prohibitionist stance with seemingly broad support from Member States. Strikingly, this occurs in the absence, both legally and politically, of arguments grounded in individual rights and autonomy. The second is an approach of insulation, relevant to alcohol and certain ‘heritage’ foods, where national regulatory choices remain shielded from European influence, either because of the EU’s reluctance to act or because of political deadlock. The third concerns the application of proportionality in free movement cases, and the extent to which cultural and moral arguments are accommodated in the adjudication of national restrictive measures.
This commentary highlights additional considerations for clinicians encountering substitute decision-makers who want to make different decisions than the healthcare or ethics team thinks an incapacitated patient would have made. This commentary first focuses on how evolving understandings of decision-making capacity and the increased availability of formal supported decision-making matter for cases like Mr. Andrews. This commentary then discusses relational autonomy in end-of-life decision-making and how patients may prioritize their family’s needs over their own medical preferences. This commentary then concludes by discussing other legal implications, namely the potential abuse of legal processes that facilitate decision-making on behalf of unrepresented patients and corresponding concern that physician paternalism is being masked as consideration for patient autonomy.
Previous chapters largely identify that it is Republicans and white Americans with higher levels of racial animus who accept racist rhetoric when threatened. However, the book’s theory about the way that whiteness is fundamentally linked to a desire for dominance would predict that a similar process could be at work for white Democrats as well. Chapter 6 introduces an original survey experiment that demonstrates that when white Democrats learn about a growing Latine population that is increasingly voting for the Republican Party, they come to feel threatened and, as a result, approve of negative, explicit racial appeals from a co-partisan politician. This provides troubling evidence of the way that a commitment to white dominance persists across partisan lines, and that the current arrangement we see (where Republicans accept and use negative racial appeals more than Democrats) is context-specific and unstable. This novel contribution casts doubt on recent findings that indicate white Democrats are increasingly egalitarian in their racial ideologies, as it demonstrates that they are willing to endorse racist rhetoric when they do not perceive the minoritized ethnoracial group as helping their partisan group interests.
Providing care in the perinatal period brings medical practice to the essence of what it means to be human: fertility, birth, death, dignity, personhood, parenthood, and beyond. Such a shifting technological and moral landscape necessitates practitioners to develop an adaptable ethical framework to address complex, emotionally charged, value-laden decisions. As the border of viability is pushed earlier in gestational life and we improve treatment of conditions that were once considered untreatable, areas for ethical inquiry and potential moral distress grow. Our ethical examinations of such advances often lag, evolving as the shortcomings of those leaps become apparent. Projected neurologic function often lies at the heart of ethical questions that emerge in the neonatal period. Despite rigorous efforts in research, reliable, evidence-based guidance is lacking. We must investigate many elements of the decision-making process concerning medical practitioners, families, and the courts. We must balance the rights of the patient and surrogate decision-makers, the duties of the physician and care team, legal precedent, and questions revolving around quality and quantity of life. Recent controversies highlight the challenge of communicating with desperate parents, the delicate balance involved in respecting family preferences today, and research that yields valuable evidence for superior care tomorrow.
Considers what the book covers and what it does not. Provides historiographical context about food cultures among the enslaved, many of which focused on what people ate, whether they were “well-fed” and “Mammies” within domestic spaces. Instead, this book centers everyday routines of food distribution, preparation, and consumption among the enslaved, stressing the vital role played by women who cooked for the quarters within slavery’s wider capitalistic development. Explores Black feminist epistemologies offering alternative methodologies where archival evidence is lacking. Questions dominant modes of feminist thinking. Rather than defining homes and kitchens as prisons, they can be refuges from a racist outside world, a “homeplace.” Examines the duality of cooking as a monotonous chore and an expression of love, and the key concept of “othermothering.” Explains how I utilize the terms “nurses” and “age” and my contribution to methodological discussions of primary sources, including WPA narratives, published autobiographies, travel accounts, enslavers’ records (especially postbellum), and archaeological evidence. Elaborates on regionality and temporality within the research.
Edited by
Katherine Warburton, California Department of State Hospitals, University of California, Davis, USA,Stephen M. Stahl, University of California, Riverside, USA
Anosognosia, a term that denotes a lack of insight into one’s own condition, is a defining characteristic of many psychotic illnesses. As a result, generations of psychiatrists have pursued a paternalistic approach to care. Yet in the past century, the overall trend in patient care has been toward autonomy. What does it mean to respect the autonomy of patients whose lack of insight may bring them harm ? This chapter will explore these questions through each of the four principles generally employed in bioethical analysis: beneficence, nonmaleficence, justice, and autonomy. Each will have an illustrative case study and explore how anosognosia can further complicate already perplexing ethical scenarios.
Paternalistic interference in an older person’s choices or actions appears to relegate the needs, values, and interests of that person as less valuable than the judgement of others about what is in the older person’s interests. For relational egalitarians, concerned to promote a society in which people stand in democratic relations of equality, paternalism prima facie undermines relational equality. This chapter draws on exploration of the sources of older people’s vulnerability and dependence on others for care, to better understand when and why paternalistic interference is objectionable. Objectionable paternalistic interference, on my view, occurs where it is either an effect of social relations of domination and oppression that prevent people from having their needs met without autonomy-undermining interference or it creates the conditions under which domination, exploitation, and oppression flourish, generating pathogenic vulnerabilities, including the risk of the person being denied the services they require to meet their needs.
Chapter 5 examines how white supremacy manifested itself in different forms across English-speaking societies from roughly 1800 to 1865. It reveals a fundamental tension between claims of white people as uniquely freedom-loving and their role as colonizers and enslavers. The chapter explores how even self-styled “enlightened” whites often justified slavery and oppression through paternalistic arguments about racial “degradation” rather than explicit racial hatred. It details various strategies for removing nonwhites from white spaces, including deportation schemes, forced relocation, and cultural elimination through boarding schools. It highlights how violence against indigenous peoples in the USA, Australia, and Canada often culminated in genocide, while colonial authorities blamed such violence on “degraded whites” to justify further oppression. Throughout this period, white supremacy demonstrated remarkable adaptability, shifting between seemingly benevolent paternalism and outright elimination of nonwhite populations. Though the US Civil War ultimately established Black citizenship rights, white supremacy persisted by finding new ways to maintain racial hierarchies.
Many believe that relationships can make a constitutive difference to the moral status of paternalistic treatment. For example, it is often assumed that it’s easier to justify paternalizing a spouse than a stranger. But although this thought is widespread, there exists no detailed account of how relationships could mitigate paternalistic complaints. The aim of this paper is to develop an account of this phenomenon, drawing on the work of Margaret Gilbert and the notion of joint commitments. According to the resulting view, close relations can constitutively mitigate paternalistic complaints by rendering paternalistic interference consistent with the will of the paternalized agent.
It is often thought that compulsory retirement funding gains support from paternalistic considerations. This paper examines this claim. I argue that compulsory retirement funding is more coherent when understood as an attempt at temporal smoothing than counterfactual insurance. An implication is that any paternalistic case for retirement funding faces problems that are more severe than they would be if compulsory retirement funding were insurance. I label these the problems of ‘inverted bias’ and of the ‘arbitrariness of income from labour’. The paper then makes some suggestions about how these points about paternalism bear on the problem of justice in retirement funding.
Chinese traditional culture is perceived as a sustaining factor for political trust within the authoritarian regime. Given the complexity and multidimensionality of Chinese cultural traditions, it is inadequate to address this notion through a singular index. This chapter categorizes Chinese traditional values into two dimensions: a nonpolitical dimension, encompassing traditional family and social values, and a political dimension, which includes traditional political values. I then empirically examine how these varying dimensions of Chinese cultural traditions influence ordinary people’s orientations toward political institutions and government officials.
Chapter 1 considers dual transformations – how cadets at West Point became officers, and how immigrants enlisted to become soldiers – and follows these groups to war in Florida. It argues that officers graduated from the military academy with deeply held beliefs regarding what it meant to be a leader in the army family – a stern father to enlisted men and the Native peoples whom the army considered its wards, and a committed protector of supposedly harmless women. Soldiers, many of whom joined up soon after arriving in New York City from places throughout Europe, had other ideas and asserted their privileges as white men, often resisting officers’ efforts to impose discipline.
This introduction shows how US Army officers used reports and other official correspondence to deploy specific narratives, constructing an identity for themselves and their institution premised on protecting women. This previously unacknowledged process erased or reframed evidence of women’s wartime activities. Yet, acknowledging this process reveals how paternalism shaped army culture; naturalized officers’ authority over enlisted men; and provided a cultural foundation for military law, policy, and strategy. Breaking up the fictive separation of women and war shows how army culture developed between 1835 and 1848. It also illuminates how that culture shaped, rather than removed, violence against women.
Chapter 2 shows how officers and enlisted men related to one another. Both groups were white, but where many officers were middle class, enlisted men were often poor immigrants with unstable access to white men’s privileges in the Jacksonian Era. Officers had to hold the army together to fight a war, and they could not do it by punishment alone. Much as officers sought to tame the Florida wilderness and the Seminole people, they sought to gentle their soldiers. As the regulars fought their enemies and struggled with each other, a shared culture emerged, premised on the common ideal that regulars should protect women. Hierarchical white male unity – based on the concept of the army family in which all military men protected and subordinated all women – helped the army function. This framework appealed to paternalistic officers because it allowed for intense distinctions (of rank) between white men. In this climate, although rhetoric rooted in the need to protect women could bolster army cohesion, it could also serve as a weapon. Soldiers used such language to rebut officers’ claims of superiority.
The concept of heteronomy, as developed by Kant, has long remained underutilized in constitutional theory. The present article takes as its point of departure Kant’s transcendental formulation of the balance between autonomy and heteronomy as a crucial element in the safeguarding of individual freedom and the integrity of the constitutional order. Kant developed his argument in two stages. In the transcendental, ahistorical stage, he constructs autonomy as a form of self-binding to certain universal maxims, which renders his constitutional theory a duty-based one, in which moral autonomy amounts to self-heteronomy. At this juncture, Kant maintains his principled objection to constitutional heteronomy as reflected in his argument about majority-decision, his rationale for a system of separation of powers that ensures legislative supremacy, and his anti-paternalistic account of law. In the pragmatic, historical stage, Kant’s arguments appear to have been shaped by his engagement with the political developments of the late 18th century. The adoption of an anthropological mode of thought led his constitutional theory to evolve towards a form of coercive heteronomy. A number of paternalistic attitudes can then be identified, including Kant’s endorsement of monarchy as a superior route to republicanism, his argument for constrained republican representation without universal right to vote, and his opposition to the right to resist oppression. While this article aims to provide an internal critique of Kant’s theory of constitutional heteronomy, it also underscores the timeliness of his contribution to the field, as it sheds early light on one of the formative dilemmas that continues to plague liberal constitutionalism today.
This case critiques liberalism in an example about best serving a Latinx community. It posits that it is crucial that community programs geared towards a minority group incorporate that group’s culture and priorities into their programming. Accepting the way things have always been does not ensure a culturally competent strategy. CRT tenet critique of liberalism provides us with a foundation for an effective strategy for transformation where race and culture are centered in practice and interventions, specifically in regards to the Latinx community.
This paper proposes a conceptual model of decision-making tying specific preferences to broader individual goals. Specifically, we consider terminal goals, representing fundamental objectives, and instrumental goals, serving as complexity-reducing intermediate steps toward achieving terminal goals and determining eventual preferences. Notably, the hierarchical goal structure allows for contextual misalignments between different instrumental goals, which may lead to suboptimal decisions – as evaluated from an outside perspective. Thus, applied to the discussion about nudging and paternalism, the model provides a methodological justification for paternalistic interventions as it is compatible with arguments in favour of interventions aimed to correct such choices.
Popular minimalist and moderate liberal interpreters suggest that, both in the 1780s and in the more fully developed political works of the 1790s, Kant adopts a narrow and skeptical approach to state-sponsored efforts addressing social welfare. Interpreted with due attention to context, however, relevant passages from Kant’s 1784 lectures in political philosophy—the Naturrecht Feyerabend—suggest no necessarily narrow commitments in the realm of social supports. Read in conjunction with his Feyerabend discussion of innate right, meanwhile, the contemporaneous essay on enlightenment provides us reasons (including an active conception of civic agency and a positive understanding of the state’s role) to conclude that the account of justice that Kant’s early works advance indeed could support a rich menu of such programs. Publications from the 1790s might, of course, take a contrary stance. It falls to those who favor a more conservative reading, however, to prove that Kant altered an earlier, agency-oriented position friendly to state-sponsored supports.
Anosognosia, a term that denotes a lack of insight into one’s own condition, is a defining characteristic of many psychotic illnesses. As a result, generations of psychiatrists have pursued a paternalistic approach to care. Yet in the past century, the overall trend in patient care has been toward autonomy. What does it mean to respect the autonomy of patients whose lack of insight may bring them harm? This chapter will explore these questions through each of the four principles generally employed in bioethical analysis: beneficence, nonmaleficence, justice, and autonomy. Each will have an illustrative case study and explore how anosognosia can further complicate already perplexing ethical scenarios.
Institutional actors should aim to increase the long-term market value of their firms. This claim implies that firms should adopt a profit-maximizing mission. Business ethicists have been too quick to dismiss moral defenses of profit maximization. Even though there are limits to the moral benefits of profit maximization, a profit-maximizing approach is still morally better than alternative approaches to defining an institutional mission.