Bonnie Honig invigorates debate over the politics of refusal by insisting that withdrawal from unjust political systems be matched with collective action to change them. Historical and fictional characters from Muhammad Ali to the Bacchants of ancient Greek tragedy teach us how to turn rejection into transformative efforts toward self-governance.

This paper sets out to unpack the pragmatic structure of refusal—its illocutionary nature, success conditions, and normative effects. I argue that our ordinary concept of refusal captures a whole family of illocutions, comprising acts such as rejecting, declining, and the like, which share the property of being ‘negative second-turn illocutions’. Only _proper refusals_ (i.e. negative replies to permission requests), I submit, require speaker authority. I construe the ‘refusal family’ as a subclass of the directives-commissives intersection. After defending (...) my view against a number of potential objections, I highlight how a theoretically grounded analysis of refusal is not only of intrinsic value, but may also have significant moral and legal implications. (shrink)

Informed consent is a bedrock of ethical medical practice; however, scenarios in which a third party refuses life-saving treatment for an incapacitated patient present a unique and underexplored ethical quandary. Such conflicts are especially challenging when cultural or religious values influence decisions. In Muslim-majority contexts, healthcare practitioners often grapple with whether and how Islamic jurisprudence might justify overriding a guardian’s refusal. While numerous case reports exist on patient-centred autonomy and consent, few specifically address the intersection of parental refusal, (...) religious and ethical frameworks, and urgent clinical interventions. By examining this case and situating it within Islamic legal reasoning, we highlight a novel angle that offers healthcare providers religious insight and practical guidance. We present the case of an 18-year-old Muslim female with no prior significant medical history who arrived at the emergency department unconscious and in impending respiratory arrest. The clinical team recommended intubation to prevent critical deterioration. However, the patient’s sole legal guardian—her mother—adamantly refused consent for endotracheal intubation and other potentially life-saving measures, including CPR, citing personal mistrust and past negative healthcare experiences. In response, the team adopted a less effective non-invasive ventilation strategy and pursued repeated discussions to understand the mother’s rationale. Despite these efforts, the patient’s trajectory only improved gradually without the recommended definitive intervention. The patient, once conscious, deferred decision-making entirely to her mother. Subsequent readmissions repeated this pattern of refusal and partial treatment acceptance. Ultimately, the patient recovered sufficiently for discharge, though underlying risk factors remained poorly addressed as she defaulted on her subsequent follow-up appointment. This case underscores the tension between guardian decisions, patient welfare, and religious-ethical principles. Our analysis reveals a principled basis for prioritising patient well-being over third-party refusal by examining Islamic jurisprudential rulings on consent. The insights from this case could inform more religio-culturally sensitive policies and strengthen clinical decision-making frameworks in contexts where religious norms significantly shape healthcare choices. (shrink)

Herbert Marcuse examined the subjective and material conditions of radical social change and developed the "Great Refusal," a radical concept of "the protest against that which is." The editors and contributors to the exciting new volume The Great Refusal provide an analysis of contemporary social movements around the world with particular reference to Marcuse's revolutionary concept. The book also engages-and puts Marcuse in critical dialogue with-major theorists including Slavoj Žižek and Michel Foucault, among others. The chapters in this (...) book analyze different elements and locations of the contemporary wave of struggle, drawing on the work and vision of Marcuse in order to reveal, with a historical perspective, the present moment of resistance. Essays seek to understand recent uprisings-such as the Zapatistas in Mexico, the Arab Spring, and the Occupy movement-in the context of Marcuse's powerful conceptual apparatus. The Great Refusal also charts contemporary social movements against global warming, mass incarceration, police brutality, white supremacy, militarization, technological development, and more, to provide insights that advance our understanding of resistance today. Contributors include: Kevin B. Anderson, Stanley Aronowitz, Joan Braune, Jenny Chan, Angela Y. Davis, Arnold L. Farr, Andrew Feenberg, Michael Forman, Christian Fuchs, Stefan Gandler, Christian Garland, Toorjo Ghose, Imaculada Kangussu, George Katsiaficas, Douglas Kellner, Sarah Lynn Kleeb, Filip Kovacevic, Lauren Langman, Heather Love, Peter Marcuse, Martin J. Beck Matuštík, Russell Rockwell, AK Thompson, Marcelo Vieta, and the editors. (shrink)

When hospitals face surges of patients with COVID-19, fair allocation of scarce medical resources remains a challenge. Scarcity has at times encompassed not only hospital and intensive care unit beds—often reflecting staffing shortages—but also therapies and intensive treatments. Safe, highly effective COVID-19 vaccines have been free and widely available since mid-2021, yet many Americans remain unvaccinated by choice. Should their decision to forgo vaccination be considered when allocating scarce resources? Some have suggested it should, while others disagree. We offer a (...) framework for evaluating when it is ethical and briefly discuss its legality in American law. (shrink)

The proliferation of work by autistic writers continues apace, defying a long and multidisciplinary tradition of constructing autistic people as lacking the capacity for narration. To study neurodivergent literature, then, is to witness the refusal of these exclusionary narrative conventions, and to register the ideological presuppositions that underpin pathologization. In this article, I engage with recent insights from Neurodiversity Studies to explore the connections between narrative neuronormativity and other discourses of oppression, especially those that have generated racialized, gendered, and (...) colonial narratives of desubjectification. Focusing on the neuroqueer movement—an emergent practice of disidentification that refuses the interpellations of neuronormativity, ableism, heteronormativity, and cisnormativity—I discuss the concept of allism, arguing that this satirical critique of pathologization harbors a deconstructive force that denaturalizes the dialectic of recognition. Pursuing the discursive context and theoretical implications of this critique, I provide a short genealogy of narrative neuronormativity, connecting the operation of the dialectic in the early novel to the clinical texts of child psychology. To demonstrate the neuroqueer subversion of this tradition, I then read An Unkindness of Ghosts, by Rivers Solomon, a text that stages a disidentification with storytelling. Protagonist Aster’s neuroqueer refusal indexes the concomitance of the construction of Blackness as an ontological foil for whiteness and the construction of autism as a standard of disordered sociality that neuronorms can be measured against. My reading of Unkindness suggests that the extant techniques of literary narratorship are political instruments that will, unless repurposed, continue to disseminate these dispossessive dialectics. (shrink)

Patients with mental illness, and depression in particular, present clinicians and surrogate decision-makers with complex ethical dilemmas when they refuse life-sustaining non-psychiatric treatment. When treatment rejection is at variance with the beliefs and preferences that could be expected based on their premorbid or “authentic” self, their capacity to make these decisions may be called into question. If capacity cannot be demonstrated, medical decisions fall to surrogates who are usually advised to decide based on a substituted judgment standard or, when that (...) is not possible, best interest. We propose that in cases where the patient meets the widely accepted cognitive criteria for capacity but is making decisions that appear inauthentic, the surrogate may best uphold patient autonomy by following a “restorative representation” model. We see restorative representation as a subset of substituted judgement in which the decision-maker retains responsibility for deciding as the patient would have, but discerns the decision their “truest self” would make, rather than inferring their current wishes, which are directly influenced by illness. Here we present a case in which the patient’s treatment refusal and previously undiagnosed depression led to difficulty determining the patient’s authentic wishes and placed a distressing burden on the surrogate decision-maker. We use this case to examine how clinicians and ethicists might better advise surrogates who find themselves making these clinically and emotionally challenging decisions. (shrink)

Guided by a hermeneutical-critical methodology, this article argues that the contemporary relevance of the concept of the Great Refusal lies in its capacity to bridge theory and practice through subjective transformation (via the new sensibility) and material change (via technological reorientation). We propose its recontextualization to overcome the aporias in Herbert Marcuse’s argumentation by converging his thought with the philosophy of Gilbert Simondon. This convergence repositions the Great Refusal from the aesthetic to the technical dimension, revealing the natural-artificial (...) associated milieu as the crucial site for its concrete praxis and for contemporary political struggle. (shrink)

It has been forty years since the first multi-channel cochlear implant was used in Australia. While heralded in the hearing world as one of the greatest inventions in modern medicine, not everyone reflects on this achievement with enthusiasm. For many people in the Deaf community, they see the cochlear implant as a tool that reinforces a social construct that pathologizes deafness and removes Deaf identity. In this paper, I set out the main arguments for and against cochlear implantation. While I (...) conclude that, on balance, cochlear implants improve the well-being and broaden the open futures of deaf children, this does not justify mandating implants in circumstances where parents refuse them because this may compound unintended harms when society interferes in the parent-child relationship. For this reason, I argue that parental refusal of cochlear implantation falls within Gillam’s concept of the zone of parental discretion. (shrink)

Traditionally, healthcare workers have had the right to refuse to participate in abortions or physician-assisted suicide, but more recently there has been a movement in white Evangelical circles to expand these rights to include the refusal of any treatment at all to same-sex couples or their children, transgender individuals, or others who offend the provider’s moral sensibilities. Religious freedom of conscience exists in an uneasy tension with laws protecting equal rights in a liberal polity, and it is a particularly (...) fraught question in the context of medicine, where providers’ consciences must be balanced against patients’ rights to access appropriate care. This article examines the refusal of care to classes of people, usually classes defined by various sexual issues with which the caregivers disagree. This expands conscientious refusals from the traditional concept of responses to actions and instead directs it at specific types of people. The article draws on Reformed thought to argue that such refusals are not justified and are, in fact, both a profound misreading of Christian morality and a new and dangerously expansive account of the right to conscientious refusal in medicine. (shrink)

Proponents of vaccine mandates typically claim that everyone who can be vaccinated has a moral or ethical obligation to do so for the sake of those who cannot be vaccinated, or in the interest of public health. I evaluate several previously undertheorised premises implicit to the ‘obligation to vaccinate’ type of arguments and show that the general conclusion is false: there is neither a moral obligation to vaccinate nor a sound ethical basis to mandate vaccination under any circumstances, even for (...) hypothetical vaccines that are medically risk-free. Agent autonomy with respect to self-constitution has absolute normative priority over reduction or elimination of the associated risks to life. In practical terms, mandatory vaccination amounts to discrimination against healthy, innate biological characteristics, which goes against the established ethical norms and is also defeasible a priori. (shrink)

In A Feminist Theory of Refusal, Bonnie Honig provides a creative re-reading of Euripides’ Bacchae to generate a new understanding of refusal. Against the common definition of refusal as a withdrawal from the world, Honig conceptualizes refusal as a form of world-building. ‘Even when refusal seems to reject the world’, Honig writes, ‘it betrays a deep attachment to it, if not the world as it is, then surely to a more just world that is not (...) yet’ (p. 3). Tracing the bacchants’ arc of refusal in the play, Honig identifies three stages: first, enchanted by Dionysus, genderbending god of pleasure, intoxication, and the festival, the women flee the city, abandoning their work in the home; second, the bacchants establish a community on the hills of Cithaeron, where they eventually dismember the king, Pentheus; third, led by Agave, Pentheus’ mother, the women return to reclaim the city, only to find the male citizens unwilling to welcome them. In the last stage especially, Honig sees the potential for world-building in the bacchants’ effort to bring their alternate ways of living, developed in the heterotopia on Cithaeron, home. The bacchants’ world-building, however, requires the slow regicide of Pentheus, which Honig heralds as the destruction of sovereignty, patriarchy, and even kinship. Feminist refusal as world-building, Honig suggests, requires violence. (shrink)

This article examines how care functions as a critical feature in decolonial political theory and the politics of refusal. In recent years, political theorists have emphasized how refusal challenges the legitimacy of settler colonial government, asserts indigenous presence, and fuels decolonial politics. Care, I argue, plays a significant and under-examined role in the politics of refusal. I look, first, to the writings of William Apess to better examine the cruelty of settler colonial care and to highlight how (...) indigenous reworkings of care enact political presence and agency. I then examine how care has been taken up by contemporary indigenous activists in the Idle No More, Standing Rock, and Walking with Our Sisters movements. Care – expressed in online and on-the-ground grieving, social mobilization around environmental and health concerns, and teach-ins and healing practices – draws on affective intensities to build indigenous community, enact indigenous liberation, imagine and pursue radical alternatives, and create allied networks of support. In these examples, affective responses of joy, outrage, and mourning are not simply incidental accompaniments to the politics of refusal; they explain why refusal matters and how refusal in turn can challenge settler memory and pursue transformative decolonial politics. (shrink)

Chapter 3, “The Body’s Refusal”, combines a precise explication of Lacan’s theory of the four discourses with an account of how Foucault’s genealogy of knowledge operates within this schema, anchored around the Hysteric’s discourse. Building on Lacan’s concept of discourse as an ‘apparatus of jouissance’ and his view of the body as an ‘enjoying substance’, I examine how genealogy enables a materialist historiography that exposes power’s violent effects on the body. In the corpus of Foucault’s genealogies, bodies are acted (...) upon in discursively constituted institutional settings where resistances are rarely constructed, and struggles are not engaged. I introduce Foucault’s lecture course “Psychiatric Power” (1973–74), particularly his analysis of the “great maneuvers of hysteria”, as providing a crucial counterexample. Chapter 3 establishes a metaphorical parallel between the “insurrection of hysterics” in the late nineteenth century and Foucault’s “insurrection of subjugated knowledges” in the twentieth century, to explain how the “body” and “agency” interact in a genealogical framework. From the standpoint of the hysteric subject, I demonstrate that resistance is enacted through the body’s refusal to comply with the scientific administrative inquisition that determines the subject’s identity. (shrink)

Settling the debate over conscientious refusal (CR) in liberal democracies requires us to develop a conception of the healthcare provider’s moral role. Because CR claims and resulting policy changes take place in specific sociopolitical contexts with unique histories and diverse polities, the _method_ we use for deriving the healthcare norms should itself be a democratic, context-dependent inquiry. To this end, I begin by describing some prerequisites—which I call _publicity conditions_—for any democratic account of healthcare norms that conflict or jibe (...) with CR. Next, drawing on Ronald Dworkin’s jurisprudence and Tom Beauchamp & James Childress’s approach to bioethical reasoning, I briefly introduce one method for generating healthcare norms that is faithful to the publicity conditions and has potential to constructively, and democratically, derive important boundaries for CR. Finally, I argue that many critics of CR fail to similarly ground their accounts of healthcare norms in healthcare professionals’ sociopolitical contexts, often relying instead on their own interpretation of a generally stateable healthcare norm. This leads to their misconstruing both the value judgments on which their own approaches rest and the public, political values that are often invoked in favor of CR. (shrink)

COVID-19 vaccine refusal seems like a paradigm case of irrationality. Vaccines are supposed to be the best way to get us out of the COVID-19 pandemic. And yet many people believe that they should not be vaccinated even though they are dissatisfied with the current situation. In this paper, we analyze COVID-19 vaccine refusal with the tools of contemporary philosophical theories of responsibility and rationality. The main outcome of this analysis is that many vaccine-refusers are responsible for the (...) belief that they should not be vaccinated and epistemically rational in holding it. This is an important result because it provides insights into the legitimacy of certain public health policies. In particular, this result shows that a public health policy that would abandon the project of convincing certain vaccine-refusers with reasons – e.g., by simply making vaccination compulsory – is prima facie illegitimate. (shrink)

ABSTRACTThe principle of informed refusal poses a specific problem when it is invoked by a pregnant woman who, in spite of having accepted her pregnancy, refuses the diagnostic and/or therapeutic measures that would ensure the well‐being of her endangered fetus. Guidelines issued by professional bodies in the developed world are conflicting: either they allow autonomy and informed consent to be overruled to the benefit of the fetus, or they recommend the full respect of these principles. A number of medical (...) ethicists advocate the overruling of alleged irrational or unreasonable refusal for the benefit of the fetus. The present essay supports the view of fetal rights to health and to life based on the principle that an ‘accepted’ fetus is a ‘third person’. In developing countries, however, the implementation of the latter principle is likely to be in conflict with a ‘communitarian’ perception of the individual – in this case, the pregnant woman. Within the scope of the limitations to the right to autonomy of J.S. Mill's ‘harm principle’, the South African Patients’ Charter makes provision for informed refusal. The fact that, in practice, it is not implemented illustrates the well‐known difficulty of applying Western bioethical principles in real life in the developing world. (shrink)

Background Accepted ethical principles in pediatrics hold that parents’ reasons should not matter to determining ethical boundaries: it is the decision’s effect on the child that matters. However, there is ongoing discussion surrounding what ethical weight, if any, should be granted to parents’ reasons in decisions for their children and, to our knowledge, no empirical research focused on these questions. Refusal in pediatric oncology represents a particularly useful case in which to test these ethical principles. Understanding the influence of (...) parents’ reasons on treatment disagreements is important to assessing alignment between ethical guidance and clinical practice, determining whether intervention principles in pediatric ethics require revision, and mitigating implicit bias in clinicians’ and ethicists’ ethical judgments.Methods This was an exploratory, pilot qualitative study. Data was collected through semi-structured interviews with pediatric oncologists (n = 9) and clinical ethics consultants (n = 9), organized around two hypothetical cases of treatment refusal in pediatric oncology. Transcripts were coded in MAXQDA and analyzed using inductive content analysis.Results Participants agreed that it was important to engage with parents’ reasons in the context of decisions for the child. Three main themes emerged from the interviews: 1) parents’ reasons are not ethically relevant to assessments of harm, determinations of medical neglect or abuse, and decisions to seek state intervention; 2) parents’ reasons matter in other ways, including being instrumentally or intrinsically valuable; and 3) religious and mistrust-based reasons evoke different responses.Conclusions Our findings suggest there is, in principle, a strong commitment among pediatric oncologists and ethicists to conventional ethical guidance, especially the harm principle. Participants emphasized the instrumental value of engaging with parents’ reasons, including how exploring parents’ reasons can facilitate practical strategies for resolving disagreements. Our findings also suggest there may be some role-based differences in participants’ views about the value of engaging with parents’ reasons. (shrink)

In many jurisdictions, adolescents acquire the right to consent to treatment; but in some cases their refusals – e.g. of life-saving treatment – may not be respected. This asymmetry of adolescent consent and refusal seems puzzling, even incoherent. The aim here is to offer an original explanation, and a justification, of this asymmetry. Rather than trying to explain the asymmetry in terms of a variable standard of competence – where the adolescent is competent to consent to, but not refuse, (...) certain interventions – the account offered here focuses more closely on the normative power to render actions permissible. Where normative powers are shared they can readily give rise to an asymmetry between consent and refusal. We then turn to why it is justifiable that normative powers be shared in adolescence. Transitional paternalism holds that the acquisition of normative powers by competent adolescents should not be an instant one, achieved in a single step, but that there should be a transitional period where paternalistic protection is rolled back, but not entirely withdrawn until a later date. Transitional paternalism could be implemented without generating the asymmetry between consent and refusal but, it is argued, the asymmetric version of transitional paternalism is to be preferred insofar as it offers a greater respect for the adolescent's decisions than the symmetrical alternative. (shrink)

This paper explores whether the deliberate act of refusing to judge—motivated by caution, ethical principle, or strategic ambiguity—can itself be evaluated within the structural framework of Judgemental Philosophy. Utilizing the Judgemental Triad (Constructivity, Coherence, Resonance), we analyze if such acts constitute a genuine negation of judgement or merely shift the locus of attribution to a higher-order level. We argue that the refusal to judge is never truly outside the judgemental structure; it functions as a form of meta-attribution ("judgement should (...) not occur here" or "judgement is impossible here"), which must itself satisfy the criteria of Constructivity, Coherence, and Resonance to be considered structurally valid and meaningful. Consequently, even the explicit withholding of judgement becomes, paradoxically, a judgeable act, raising important questions about neutrality, responsibility, and the limits of ethical silence. (shrink)

John Harris claims that is it ‘palpable nonsense’ to suggest that ‘a child might competently consent to a treatment but not be competent to refuse it.’ In ‘Transitional Paternalism: How Shared Normative Powers Give Rise to the Asymmetry of Adolescent Consent and Refusal’ Neil Manson aims to explain away the apparent oddness of this asymmetry of consent and refusal, by appealing to the idea of shared normative powers, presenting joint bank accounts as an example. In this article, I (...) will argue that Manson's account fails to explain away the oddness. Rather, I will argue that there are ambiguities to which Manson has not paid sufficient attention. In fact, as odd as it may sound, I argue that Manson actually agrees with Harris. He fails to recognize that he agrees with Harris because he is not careful enough to distinguish between different asymmetries, which I have labelled the asymmetries of choice, permissibility and competence. (shrink)

In the present super-aging society, issues concerning what treatment should be given for incapacitated patients have become more important than ever before. This paper discusses whether or not an incapacitated patient’s refusal of treatment should be respected. The authors present a complete hypothetical scenario involving a 75-year-old moderately demented man suffering from malignant lymphoma. Of primary importance are the respect for patient dignity and the protection of human rights. Acts such as coercion, disregard, restriction, and surveillance can be unethical (...) in many situations. The effectiveness of chemotherapy for malignant lymphoma and its adverse outcomes could offset each other, leaving no net benefits for the patient. The patient is vulnerable and this very vulnerability requires the utmost protection and care. However, protection must be sensitive and comprehensive and the protection of his life at the expense of many other valuable factors is not justifiable. Coercing unwanted treatment would be intrusion, not protection, because of the physical and psychological suffering. When the refusal is explicit, consistent, and stable enough, it should to be viewed as true and current desire. Due to moderate dementia, the patient has lost his rational capacity, but his emotional capacity remains. If the remaining portion of his personality is rooted in his feelings, these feelings should be respected as much as possible. Those involved in the care of the patients who refuse treatment should not force them to undergo it simply on the grounds that it may be an established standard in their own country. What must be asked first is whether or not forced treatment would promote the patient’s subjective well-being. Additionally, treatment decisions should not be distorted due to the selfishness or discriminatory feelings of those involved in his care. In situations in which patients lack decisionmaking capacities, overriding the patients’ refusals of treatment should be regarded as an exception, rather than a standard course of action. Even in patients who are incapacitated, treatment refusal could stem from the feelings of the individual. Their subjective wellbeing would not be improved through close observation, restraint, denial, and coercion, the purpose of which they does not understand. (shrink)

We developed this study to examine the issue of parental refusal of treatment, looking at the issue through a cultural competence lens. Recent cases in Canada where courts have declined applications by clinicians for court orders to overrule parental refusal of treatment highlight the dispute in this area. This study analyses the 16 cases of a larger group of 24 cases that were selected by a literature review where cultural or religious beliefs or ethnic identity was described as (...) important reasons behind the refusal. The most significant finding was that nearly all of the cases cited unacceptable side effects as the main reason for declining treatment. We then analysed the detail of the cases and concluded that in the first instance a skilled clinical approach to develop an agreed management plan is by far the best approach. In the event that agreement cannot be reached we recommend engaging a mediator to help the clinician and parents/child to find an agreeable way forward. We argue that the option of se... (shrink)

Contributions to COVID-19 vaccination programmes promise valuable collective goods. They can support public and individual health by creating herd immunity and taking the pressure off overwhelmed public health services; support freedom of movement by enabling governments to remove restrictive lockdown policies; and improve economic and social well-being by allowing businesses, schools, and other essential public services to re-open. The vaccinated can contribute to the production of these goods. The unvaccinated, who benefit from, but who do not contribute to these goods (...) can be morally criticised as free-riders. In this paper defends the claim that in the case of COVID-19, the unvaccinated are unfair free-riders. I defend the claim against two objections. First, that they are not unfair free-riders because they lack the subjective attitudes and intentions of free-riders; second, that although the unvaccinated may be free-riders, their free-riding is not unfair. (shrink)

The conscientious refusal to dispense emergency contraception is legally protected in fourteen states. While the ethical dimensions of these objections have been explored within moral and feminist philosophy, conscientious refusal to the over-the-counter sale of EC has not been significantly studied through an egalitarian lens, especially with attention to the existing reproductive healthcare landscape in which these refusals occur. This article argues, through Amartya Sen’s capability approach, that conscientious refusal to EC creates a burdensome inequality for people (...) wishing to prevent pregnancy that manifests within a background of historical injustices, elevating its importance in our weighing of capabilities. (shrink)

This article explores risk in professional nursing practice. Professional risk refers to the threat of professional discipline if it is found that a registered nurse has violated professional nursing practice standards. We argue professional risk is socially constructed and understood differently by nurse regulatory bodies, unions, professional associations and frontline nurses. Regulatory bodies emphasize professional accountability of nurses; professional associations focus on system problems in health‐care; unions undertake protecting nurses' right to health and safety; and frontline nurses experience fear and (...) uncertainty in their attempt to interpret practice standards to avoid professional discipline. Perspectives of professional risk are investigated by analyzing three professional nursing bodies' views of professional codes governing the right of nurses to refuse unsafe work assignments. The workplace dynamics surrounding work refusal experienced by frontline nurses are illustrated primarily through the lens of the 2003 SARS influenza outbreak in Ontario, Canada. We conclude that frontline nurses in Ontario are required to manage risk by following professional protocols prioritizing patient care and professional accountability which disregard the systemic, unpredictable and hazardous circumstances in their everyday practice. Moreover, we argue professional protocols cannot anticipate every eventuality in clinical practice creating the fear of professional discipline for nurses. (shrink)

Most current talk of forgiveness and reconciliation in the aftermath of collective violence proceeds from an assumption that forgiveness is always superior to resentment and refusal to forgive. Victims who demonstrate a willingness to forgive are often celebrated as virtuous moral models, while those who refuse to forgive are frequently seen as suffering from a pathology. Resentment is viewed as a negative state, held by victims who are not "ready" or "capable" of forgiving and healing. Resentment's Virtue offers a (...) new, more nuanced view. Building on the writings of Holocaust survivor Jean Améry and the work of the South African Truth and Reconciliation Commission, Thomas Brudholm argues that the preservation of resentment can be the reflex of a moral protest that might be as permissible, humane or honorable as the willingness to forgive. Taking into account the experiences of victims, the findings of truth commissions, and studies of mass atrocities, Brudholm seeks to enrich the philosophical understanding of resentment. (shrink)

Introduction: Prehospital emergency medicine is a specific field of emergency medicine. The basic approach of prehospital emergency medicine is to provide patients with medical intervention at the scene of the incident. This special environment causes health professionals to encounter various problems. One of the most important problems in this field is ethics, in particular questions involving refusal of treatment and the processes associated with it. Objective: The objective of this study is to identify emergency health professionals’ views regarding (...) class='Hi'>refusal of treatment. Methods: This study was conducted with 356 health professionals who were on active duty in prehospital emergency health services. The data were collected through a form which included 10 statements. The participants were asked to indicate their level of agreement with the statements given by rating them between 0 and 10. Ethical considerations: Before conducting the research, permission was received from the local ethics committee. Participants were given written information about the purpose of the study. Participants were assured that their participation was voluntary. Results: The healthcare professionals with fewer years of experience in the profession and female participants adopted an attitude of giving priority to providing care. Young participants, in general, respected patient autonomy. However, paradoxically, when it comes to emergency medical cases, they expressed an opinion closer to paternalism. Conclusions: This study has found that prehospital emergency health professionals generally respect the patient’s right to refuse treatment; however, they do not prioritize this right when there is a life-threatening situation or when the person does not have decision-making capacity. In these cases, prehospital emergency health professionals tended to adopt a more paternalistic approach. (shrink)

Since 1991, the Patient Self-Determination Act (PSDA) has required all health care institutions that receive Federal funds to inform patients upon admission of their rights to make decisions about medical care and to execute advance directives. Implementation of the PSDA presents a special challenge for state mental hospitals. The relevance and possible negative therapeutic impact of discussing end of life decisions at the time of an acute psychiatric admission has recently been raised in the literature. Other ethical dilemmas arising from (...) the interplay between mental illness and informed consent for medical treatment, particularly for older patients committed to state mental hospitals, have been highlighted by the PSDA. In this article we discuss some of the issues raised by implementation of the PSDA in this setting. (shrink)

Minors are generally considered incompetent to provide legally binding decisions regarding their health care, and parents or guardians are empowered to make those decisions on their behalf. Parental authority is not absolute, however, and when a parent acts contrary to the best interests of a child, the state may intervene. The best interests standard is the threshold most frequently employed in challenging a parent''s refusal to provide consent for a child''s medical care. In this paper, I will argue that (...) the best interest standard provides insufficient guidance for decision-making regarding children and does not reflect the actual standard used by medical providers and courts. Rather, I will suggest that the Harm Principle provides a more appropriate threshold for state intervention than the Best Interest standard. Finally, I will suggest a series of criteria that can be used in deciding whether the state should intervene in a parent''s decision to refuse medical care on behalf of a child. (shrink)

This work traces the development of Heidegger's explanation of philosophy as a methodological atheism, relating it to his reading of Aristotle, Aquinas and Nietzsche. A predominant issue throughout this study is Heidegger's pursuit of an answer to the question: How did God get into philosophy?

BackgroundVaccination against human papillomavirus (HPV) is a pivotal tool for preventing a significant cause of cervical cancer. One particular culturally recognized context associated with negative attitudes toward the HPV vaccine is the religiousness of parents. However, relatively speaking, there remains a scarcity of studies that have focused specifically on religious groups, especially non-Christian groups. PurposeTo better understand the basis for members of an ultra-Orthodox Jewish community to object to the HPV vaccine and how such objections can and cannot be reduced, (...) thereby improving cultural competence—namely, the cultural understanding and ethical addressing of HPV vaccination refusal. MethodsThis qualitative study conducted semi-structured interviews with ten Israeli ultra-Orthodox mothers who are opposed to administering the HPV vaccine to their daughters. The content analysis addressed these results and extracted the major issues arising from these particular interviews. ResultsFour main novel insights were found pertaining to the negative stance toward HPV vaccination among mothers in an ultra-Orthodox Jewish community: (a) lack of knowledge about the HPV vaccine is not part of the reasoning against it; (b) rabbinical authority might have a lesser influence than expected for the moderation of HPV vaccine refusal; (c) complicated viewpoints regarding childhood vaccination may be the larger non-moderating context for HPV vaccination refusal; and (d) cultural competence is important for the ability to change the negative attitudes toward HPV vaccination. ConclusionsThe study may improve cultural competence regarding HPV vaccination and contribute to decreasing objections to the HPV vaccine in ultra-Orthodox communities. (shrink)

In their article, Navin, Brummett, and Wasserman (2022) advance the idea that there are qualitatively different types of decision-making capacity (DMC) for treatment refusals. Departing from what t...

In some jurisdictions there is a puzzling asymmetry between consent and refusal, where, for some kinds of treatment, the adolescent patient has the power to permit her own treatment but her refusal does not have the same kind of normative significance as refusal of treatment by a competent adult. In this journal I recently offered a clarification and defence of this asymmetry in terms of a paternalistic justification of the sharing of normative powers between adolescents and other (...) parties. Lawlor (2016) offers a number of objections to this account. Three of his objections can be dealt with quickly. But one of them is much more challenging: the asymmetry of consent and refusal entails a practice of making sham offers (offers that purport to be responsive to the patient's choices, but which, in fact, are not). They do not really offer a choice at all. Genuine offers seem to require a commitment to be symmetrically responsive to whatever decision outcome is reached by the recipient of the offer. When we reflect upon the way that offers can be made in complex social contexts, where different parties have a ‘say’ in what ought to be done, the symmetry of responsiveness need not apply. Offers can be genuine, without being symmetrically responsive. Contrary to the seemingly plausible objection, the asymmetry of consent and refusal does not entail sham offers, or the offer of ‘sham choices’. (shrink)

This paper focuses on the possibility of sin as intellectual evil as operative in the contemporaneous culture in the debate over the essential nature of marriage and the accomplishment of the ends of marriage. It presents an account of theology as a science and the application of this understanding and its canons of operation to the issues presented in two recent documents—the Statement of the Wijngaards Institute for Catholic Research and the Affirmation of the Church’s Teaching on the Gift of (...) Sexuality, each of which addresses the encyclical Humanae vitae on the occasion of its 50th anniversary. The paper concludes with an examination of the essential nature of marriage to guide the fulfillment of its ends now described as intrinsic/essential and intrinsic/contingent. (shrink)

This article contributes to debates on mobilising queer perspectives on beauty as tools against racism and gender-based violence in contexts ruled by whiteness-centring racial mixture (mestizaje) regimes. Drawing on queer, critical race, feminist and visual studies’ frameworks and multimodal methods, the article explores representations on Marrón/Marrona/Marrxn 1 (racialised ‘brown-skinned’, as the colour marrón in Argentina is used as a racial category similar to moreno – both meaning shades of ‘brown’ – in other Latin American countries) beauty in relation to intersectional (...) antiracist discourses and queer politics of affect in sequential art – a medium that mobilises visual shorthands in connected ways to convey complex narratives, such as digital and printed illustrations, fanzines and comics – in Argentina, a society that envisions its national self as white, albeit within flexible boundaries shaped by racial mixture discourses. The article reflects on the connections between lived experience-based intersectional antiracism, queer politics of affect and sexual citizenship in artworks by Marrona artist-activist Abril Carissimo, aka @bbywacha. I argue that art practices that mobilise queer beauty as forms of affective refusal and care, offering perspectives grounded in lived experience and critical intersectional antiracist literacies, can function as an exercise in political imagination to confront historical oppressions and revendicate civil and human rights. Such an exercise proposes models of social justice-orientated and inclusive diversity in representation, while also challenging visual regimes of whiteness regarding erotic desire, gendered affect and the right to appear as a subject of rights in the public space. (shrink)

Kierkegaard and the limit of analogy -- Distinctions : marks of the paradox -- The paradox is not one: transfiguring transcendence -- Monstrance : articulating the paradox -- Silhouettes : figuring the immanent paradox -- Satan's angel : the interruption of the demonic -- Kierkegaard, Spinoza and the intellectual love of God -- Conclusion : theology for creatures.

In this paper, we run a laboratory experiment to compare two mechanisms in a procurement setting: Right-of-First-Refusal where the incumbent supplier is granted a privileged position versus standard First-Price-Auction. To this end, we have subjects compete against a computerized agent programmed to behave in a risk-neutral way in a FPA, and in a ROFR auction where the “incumbent” bidder is the computer. In contrast with theory, we observe that on average bidders are slightly but significantly more aggressive under the (...) ROFR when their costs are such that they are predicted to behave identically under both auction procedures. For the sub-sample of subjects for whom we can estimate a CRRA parameter, we confirm the theoretical prediction that the buyer’s expected cost is larger in the ROFR if the newcomer is not sufficiently risk-averse. (shrink)

Background When patients refuse basic nursing care in the hospital setting, ethical tension arises between promoting patient dignity by providing hygiene and honoring bodily autonomy by respecting patient refusal of interventions. Research Aim To describe patient factors, clinical context, and the role of ethics consultation when basic care is refused to identify implications for future practice and/or policy. Research Design We conducted a retrospective qualitative content analysis of adult and pediatric ethics consultation documentation between January 2015 and December 2025 (...) at a quaternary academic medical center, screening 2,381 consultations to identify cases involving refusal of basic nursing care. We collected patient demographics, admission and clinical information, reasons for ethics consultation, and actions taken by the ethics consultation service. Data were summarized via descriptive statistics, and categories were abstracted to develop a framework. Participants and Research Context Patients receiving inpatient care at an academic medical center in the Midwestern United States. Ethical Considerations University of Michigan IRBMED deemed the study exempt (HUM00256591). Findings 34 ethics consultations for 29 unique patients involved refusal of basic nursing care. Patients were adults (100%), with an average LACE score of 12.8; 15 (44%) had decision-making capacity. Care over objection was provided in 16 (47%) of cases, and physical restraints were used in 2 (6%) cases. Refusals involved hygiene (18, 53%), wound care (15, 44%), and repositioning (9, 26%), and occurred across nursing units and clinical services. Refusals were addressed through persuasion (9, 26%), soft paternalism (13, 38%), hard paternalism (3, 9%), or permitted refusal (9, 26%). Discussion Ethics consultation involvement resulted in four approaches to refusal of basic nursing care based on patient agency, decision-making capacity, and clinical context. Conclusions When refusal results in dignitary or physical harm, healthcare teams should address barriers and encourage participation. In rare circumstances, care over objection is ethically permissible with multidisciplinary input. (shrink)

Ch. 9, "Blanchot's 'holocaust'", discusses the French thinker's philosophy of the Holocaust.

Rae Langton and Jennifer Hornsby argue that there may be a free-speech argument against pornography, if pornographic speech has the power to illocutionarily silence women: women's locution ‘No!’ that aims to refuse unwanted sex may misfire because pornography creates communicative conditions where the locution does not count as a refusal. Central to this is the view that women's speech lacks uptake, which is necessary for illocutionary acts like that of refusal. Alexander Bird has critiqued this view by arguing (...) that uptake is not necessary for the illocutionary act of refusal. The Hornsby-Langton view, then, is philosophically indefensible. Here I defend the philosophical cogency of the Hornsby-Langton approach. (shrink)

In this paper I inquire into Bogen and Woodward’s data/phenomena distinction, which in a similar way to Cartwright’s construal of the model of superconductivity —although in a different domain—argues for a ‘bottom-up’ construction of phenomena from data without the involvement of theory. I criticise Bogen and Woodward’s account by analysing their melting point of lead example in depth, which is usually cited in the literature to illustrate the data/phenomenon distinction. Yet, the main focus of this paper lies on Matthias Kaiser’s (...) case study of the plate tectonic revolution, the most extensive case study that has been put forth to support the bottom-up construction of phenomena. On the basis of new historical evidence, which has been overlooked not only by Kaiser but also by the entire historical literature on the plate tectonic revolution, I demonstrate that phenomena are not constructed from the bottom-up but rather, admittedly counter-intuitively, from the top-down.Keywords: Data; Phenomena; Bottom-up; Theory-ladenness; Plate tectonic revolution. (shrink)

I argue that a parental prerogative to sometimes prioritize the interests of one’s children over the interests of others is insufficient to make the parental refusal of routine childhood vaccines morally permissible. This is because the moral permissibility of vaccine refusal follows from such a parental prerogative only if the only (weighty) moral reason in favor of vaccination is that vaccination is a means for promoting the interests of others. However, there are two additional weighty moral reasons in (...) favor of routine vaccination: fairness and concern for the vulnerable. These moral reasons in favor of vaccination are not defeated by a parental prerogative to prioritize the interests of one’s children over the interests of others. (shrink)

This article develops a novel reading of the politics of Dalit writing in Namdeo Dhasal's poetry by tracing its sonic and performative resonances with tamasha, a Dalit folk art form. Against readings of Dalit literary politics as the restoration of a stolen humanity, I propose that reading Dhasal through tamasha evinces Dalit subjectivity as fugitive. Building on resonances across Dalit writing and Black studies — particularly the work of Fred Moten — this article shows how Dhasal's noisy, vernacular rhythms disrupt (...) and distend literary order, refusing recognition and restoration into the imaginaries of the caste-ized subject proper to such order. Through close readings of four newly translated poems, the article follows how the cadence of Dhasal's refrains suspend Dalit bodies in an in-between that is both interstitial and surrounding. This fugitivity refuses a Dalit futurity along paths that seek the restoration of a humanity tainted with caste. (shrink)

Some authors argue that it is permissible for clinicians to conscientiously provide abortion services because clinicians are already allowed to conscientiously refuse to provide certain services. Call this the symmetry thesis. We argue that on either of the two main understandings of the aim of the medical profession—what we will call “pathocentric” and “interest‐centric” views—conscientious refusal and conscientious provision are mutually exclusive. On pathocentric views, refusing to provide a service that takes away from a patient's health is professionally justified (...) because there are compelling reasons, based on professional standards, to refuse to provide that service (e.g., it does not heal, and it is contrary to the goals of medicine). However, providing that same service is not professionally justified when providing that service would be contrary to the goals of medicine. Likewise, the thesis turns out false on interest‐centric views. Refusing to provide a service is not professionally justified when that service helps the patient fulfill her autonomous preferences because there are compelling reasons, based on professional standards, to provide that service (e.g., it helps her achieve her autonomous preferences, and it would be contrary to the goals of medicine to deny her that service). However, refusing to provide that same service is not professionally justified when refusing to provide that service would be contrary to the goals of medicine. As a result, on either of the two most plausible views on the goals of medicine, the symmetry thesis turns out false. (shrink)