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Stigma and Openness 污名化与公开性
Pub Date : 2009-01-01 DOI: 10.13021/G8PPPQ.292009.112
C. Mills
Most of us exchange information about ourselves, our families, and our friends with others all the time. We make casual conversation with seatmates on an airplane, chat with colleagues at the workplace, send holiday letters with a summary of our family news, and have heart-to-heart conversation with our friends about the minutia of our lives. My question is how information about someone's mental illness should be treated in our routine exchanges with one another. On the one hand, it is widely regarded that mental illness should be regarded as any other illness: admitted openly and discussed without shame, on the model of how we treat diseases such as cancer or diabetes. If I would mention that my sister had breast cancer, why wouldn't I mention that she was struggling with bipolar disorder, when the conversation had turned to the topic of current family crises? If I would mention that my child was being treated for diabetes, why wouldn't I mention that he was being treated for depression? Mental illness is a genuine illness, with an identifiable physiological basis in aberrant brain chemistry. To avoid mentioning mental illness, when one would have openly mentioned some other form of illness, is to perpetuate a stigma surrounding mental illness that--one hopes--is woefully outdated. It certainly seems important to act collectively to reduce the stigma that wrongly surrounds mental illness, and one way to do this is to refuse to shroud mental illness in protective secrecy, as if it were indeed something one should hide. On the other hand, three distinctive features of mental illness need to be considered in deciding how best to proceed with open communication about it. The first feature is shared by other socially sensitive conditions such as homosexuality and AIDS, so we may gain insight by comparing how information about these other conditions should be shared as well. The other two, however, seem distinctive to mental illness. Reducing the Stigma of Mental Illness First, even if we believe that mental illness is unfairly stigmatized, the ongoing existence of stigma means that we need to weigh an individual's interest in avoiding the deleterious consequences of revealing his illness against the good to be achieved by taking one small step toward the goal of stigma reduction. Here we need to perform some weighing of clear and significant immediate harm to one individual versus diffuse and distant collective gains. This raises a host of philosophical difficulties. As with many collective action problems, such as those faced in reducing global warming, any one individual's contribution either to solving or worsening the problem is miniscule, if not completely without any actual practical significance, whereas the costs to the individual of engaging in or refraining from the relevant behavior may be great. We might want to distinguish here between the individual herself choosing to take the step of announcing her illness and someone else making that
我们中的大多数人一直在与他人交换关于自己、家人和朋友的信息。我们在飞机上与邻座的人随意交谈,在工作场所与同事聊天,发送节日信件,总结我们的家庭新闻,并与朋友就我们生活中的细节进行推心置腹的交谈。我的问题是,在我们日常的交流中,关于某人精神疾病的信息应该如何处理。一方面,人们普遍认为精神疾病应该像其他疾病一样:公开承认并毫无羞耻地讨论,就像我们如何治疗癌症或糖尿病等疾病一样。如果我提到我的妹妹患有乳腺癌,当我们的话题转到当前的家庭危机时,我为什么不提到她正在与双相情感障碍作斗争?如果我说我的孩子正在接受糖尿病治疗,我为什么不提他正在接受抑郁症治疗呢?精神疾病是一种真正的疾病,在异常的脑化学中具有可识别的生理基础。当一个人可以公开提及其他形式的疾病时,避免提及精神疾病,是在延续一种围绕着精神疾病的耻辱,人们希望这种耻辱已经可悲地过时了。当然,集体行动减少错误地围绕着精神疾病的污名似乎很重要,而这样做的一种方法是拒绝将精神疾病笼罩在保护性的秘密之中,就好像它确实是一种应该隐藏的东西一样。另一方面,在决定如何最好地进行关于精神疾病的公开交流时,需要考虑精神疾病的三个显著特征。第一个特征是同性恋和艾滋病等其他社会敏感疾病所共有的,所以我们可以通过比较这些其他疾病的信息应该如何共享来获得洞察力。然而,另外两种似乎是精神疾病特有的。首先,即使我们认为精神疾病受到了不公平的污名化,但污名化的持续存在意味着我们需要权衡个人的利益,以避免因透露自己的疾病而产生的有害后果,而不是通过朝着减少污名化的目标迈出一小步而获得的好处。在这里,我们需要进行一些权衡,是对个人造成明显而重大的直接伤害,还是分散而遥远的集体收益。这引发了一系列哲学难题。与许多集体行动问题一样,例如减少全球变暖所面临的问题,任何一个人对解决或恶化问题的贡献都是微不足道的,如果不是完全没有任何实际意义的话,而个人参与或不参与相关行为的成本可能是巨大的。在这里,我们可能想要区分个人自己选择宣布患病的步骤和其他人宣布患病的步骤。如果我们将精神疾病的案例与同性恋的案例进行比较,我们可能会对个体出柜与被他人出柜有不同的评估。有两个看似合理的原则表明,这种区别具有相当的重要性。一个原则是,受行为最直接影响的人应该对该行为是否被实施有最大的发言权。如果她是那个因外出而受到伤害的人,那么她应该决定是否公开自己的性取向。同样的,当一个人被诊断出患有艾滋病,或者像我们这里所关注的,精神疾病。另一个是相关的,但不同的,基于隐私的原则,每个人在某种意义上都是自己信息的所有者;泄露或不泄露是她的选择。考虑到个人的自我表露,实用主义和道德上的原因都鼓励公开分享有关精神疾病的信息。...
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引用次数: 0
Ethics and Poverty Tours 道德扶贫之旅
Pub Date : 2009-01-01 DOI: 10.13021/G8PPPQ.292009.109
Evan Selinger
A new word has entered into travel discourse: "poorism." "Poorism" refers to organized tours that bring predominantly middle and upper class people to impoverished regions. Programs exist in Brazil (South America), Soweto (Africa), Mumbai (India), Rotterdam (Netherlands), and New York (United States). According to a recent Newsweek article, the poorism market already is "booming." Poorism attracts attention because advocates characterize it as a moral enterprise, a form of conscientious consumerism. But poorism is at best a morally complex endeavor. The Poorism Debate: Advocates Just as advocates of ecotourism associate nature-based tourism with environmental education and environmental justice, so too do champions of poorism associate their endeavor with education (raising awareness of global suffering) and justice (providing needed funds to destitute regions either by direct transfers to the poor themselves or by targeted spending within the impoverished areas visited). The Newsweek article focuses on trips taken by Kevin Outterson, a law professor at Boston University. Outterson offers the following observations on the consciousness-raising potential of poorism, as well as its capacity to promote service learning and beneficent volunteerism: "We live in a world of both poverty and abundance.Many universities encourage foreign study programs as part of a globalized curriculum. But it is possible to visit middle-income countries like Brazil and Mexico without actually encountering poverty, other than chance encounters on the streets. I took my students into Rocinha favela in Rio de Janeiro because the residents of Rocinha make the tourist experience of Rio possible.... Rocinha residents are the workers, cooks, maids, street sweepers, waiters, store clerks and street vendors who serve Ipanema, Leblon and Copacabana. To understand how Brazil works, you need to experience more than one perspective, especially if you can do that with the permission of the community. My students have generally been impressed with many aspects of Rocinha, especially how the community has self-organized in response to government neglect." Generalized further, advocates who adopt Outterson's outlook insist that poorism should be an obligation that all tourists accept. Mainstream tourism ostensibly idealizes geographies and further insulates people fromawareness of the extent of existing inequality. Poorism can provide a needed glimpse into the underbelly of geopolitics. Dramatically put, then, if the slogan "We should never forget" captures an appropriate attitude concerning the immorality of turning a blind eye toward the barbarism that occurred during the Holocaust, then the slogan "We should not avoid" seems to capture an appropriate attitude toward activities such as poorism that reveal large-scale degradation that the privileged may be complicit in by virtue of their ignorance of human rights violations. Timothy Engstrom, co-editor of a recent book on theories and
旅游话语中出现了一个新词:“贫穷主义”。“贫穷主义”指的是有组织的旅游,主要是把中上层社会的人带到贫困地区。在巴西(南美洲)、索韦托(非洲)、孟买(印度)、鹿特丹(荷兰)和纽约(美国)都有这样的项目。根据《新闻周刊》最近的一篇文章,贫穷主义市场已经“蓬勃发展”。贫穷主义之所以引人注目,是因为倡导者将其描述为一种道德企业,一种有良心的消费主义。但贫穷主义充其量是一种道德上复杂的努力。正如生态旅游的倡导者将基于自然的旅游与环境教育和环境正义联系起来一样,贫穷主义的拥护者也将他们的努力与教育(提高对全球苦难的认识)和正义(通过直接向穷人本身转移资金或在贫困地区进行有针对性的支出,为贫困地区提供所需的资金)联系起来。《新闻周刊》的这篇文章关注的是波士顿大学法学教授凯文·奥特森(Kevin Outterson)的旅行经历。关于贫穷主义提高意识的潜力,以及它促进服务学习和慈善志愿服务的能力,奥特森提供了以下观察:“我们生活在一个既贫穷又富足的世界。许多大学鼓励国外学习项目作为全球化课程的一部分。但是,去巴西和墨西哥这样的中等收入国家旅行,除了在街上偶遇之外,也有可能不会遇到真正的贫困。我带我的学生们去了里约热内卢的Rocinha贫民窟,因为Rocinha的居民让里约热内卢的旅游体验成为可能....罗辛尼亚的居民包括工人、厨师、女佣、街道清洁工、服务员、店员和为伊帕内玛、莱布隆和科帕卡巴纳服务的街头小贩。要了解巴西是如何运作的,你需要体验不止一个视角,特别是如果你可以在社区允许的情况下这样做。我的学生们对罗西尼亚的许多方面都印象深刻,尤其是社区如何在政府忽视的情况下自我组织起来。”进一步概括,采用奥特森观点的倡导者坚持认为,穷主义应该是所有游客都接受的义务。主流旅游业表面上理想化了地理位置,并进一步使人们意识不到现有不平等的程度。贫穷主义可以让我们窥见地缘政治的阴暗面。因此,戏剧性地说,如果“我们永远不应该忘记”的口号抓住了对大屠杀期间发生的野蛮行为视而不见的不道德行为的适当态度,那么“我们不应该避免”的口号似乎抓住了对贫穷主义等活动的适当态度,这些活动揭示了特权阶层由于对侵犯人权的无知而可能参与的大规模退化。蒂莫西·恩格斯特罗姆(Timothy Engstrom)最近出版了一本关于成像理论与实践的书,他结合自己在贫民窟的旅行经历,对无知问题提出了以下见解。Engstrom评论说,为了理解为什么一些贫困之旅能够以强有力的方式影响参与者,考虑视觉技术和视觉文化习惯如何首先塑造我们感知或认为值得感知的东西,以及考虑这些技术和文化实践如何在经历时调解“真实的存在”是有用的。在此背景下,Engstrom着重于亲身体验贫民窟和了解卡特里娜飓风对新奥尔良造成的破坏之间的差异。在后一种情况下,典型的西方媒体报道将灾难描述为一场灾难,他们喜欢通过全景图像进行大规模的报道,包括直升机从远处拍摄的洪水全景,以及被困居民举着请求援助的标语的广告牌政治。…
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引用次数: 16
The Holocaust and Moral Education 大屠杀与道德教育
Pub Date : 2009-01-01 DOI: 10.4324/9781315126357-5
Lawrence A. Blum
F""("1he belief that schoo~ hav.e a resp?nsibility t~ teach ~ values is a very old Idea m Amencan education. In recent years, however, the aims and methods of programs in moral education have become a subject of intense debate. Some critics believe that such programs distract schools from their essential academic mission. Religious conservatives, wary of curricula that they perceive as favoring moral relativism, insist that the teaching of values should be left to parents and religious institutions. Their distrust extends to classroom efforts to foster "critical thinking II by inviting students to discuss their personal responses to texts and historical events. One of the most widely adopted and controversial approaches to moral education addresses the specific issues of prejudice, conformity, and individual responsibility. It does this by examining the rise of Nazism and its culmination in the Holocaust. Facing History and Ourselves, an organization created in 1976, has produced a curriculum and resource book and conducts workshops for teachers. Its materials are now offered, in some form, to 500,000 students mostly eighth and ninth graders each year. The program received an unexpected burst of attention last fall, when a political scientist who had criticized it for not presenting the "Nazi point of view" was named historian of the House of Representatives. Once her comments attracted public notice, Christina Jeffrey was abruptly dismissed. But her remarks provoked a spate of articles and letters in national publications concerning the teaching of the Holocaust. Most commentators spent little time refuting the charge that Facing History had fail.ed to aChi.eve "balance or objectivity" in its exploration of NaZIsm. Other, more significant questions about the program its assumptions and moral purposes engaged them instead. Was the Holocaust a "unique" event in human history? Is it legitimate to compare the Holoca~st to other historical crimes, such as those perpetrated m the Soviet Union in the 1930s, Cambodia in the 1970s, Rwanda and Bosnia in the 1990s? Should the Holocaust be used as a reference point for teaching children about racism and social injustice in general about scapegoating, intolerance, and prejudice that can occur in any society?
(1)学校的信仰。你要发言吗?传授价值观是美国教育中一个非常古老的观念。然而,近年来,道德教育计划的目标和方法已经成为一个激烈争论的话题。一些批评人士认为,这样的项目分散了学校的基本学术使命。宗教保守派对他们认为倾向于道德相对主义的课程持谨慎态度,坚持认为价值观的教学应该留给父母和宗教机构。他们的不信任延伸到课堂上培养“批判性思维II”的努力,通过邀请学生讨论他们对文本和历史事件的个人反应。道德教育中最广泛采用和最具争议的方法之一是解决偏见、顺从和个人责任等具体问题。它通过考察纳粹主义的兴起及其在大屠杀中的高潮来做到这一点。1976年成立的“面对历史和我们自己”组织制作了课程和参考书,并为教师举办了讲习班。它的教材现在每年以某种形式提供给50万名学生,其中大部分是八年级和九年级的学生。去年秋天,一名曾批评该节目没有呈现“纳粹观点”的政治学家被任命为众议院历史学家,该节目意外地引起了人们的关注。当她的评论引起公众注意时,克里斯蒂娜·杰弗里突然被解雇了。但她的言论在国家出版物上引发了关于大屠杀教学的大量文章和信件。大多数评论家几乎没有花时间反驳《面对历史》失败的指控。我要去aChi。甚至“平衡或客观”在其对纳粹主义的探索中。其他更重要的问题,关于这个项目,它的假设和道德目的,反而吸引了他们。大屠杀是人类历史上“独一无二”的事件吗?将大屠杀与其他历史罪行进行比较是否合理,比如上世纪30年代在苏联、70年代在柬埔寨、90年代在卢旺达和波斯尼亚犯下的罪行?大屠杀是否应该作为一个参照点,向儿童讲授种族主义和一般的社会不公正,以及任何社会都可能出现的替罪羊、不容忍和偏见?
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引用次数: 1
Crossing a Moral Line: Long-Term Preventive Detention in the War on Terror 跨越道德底线:反恐战争中的长期预防性拘留
Pub Date : 2008-10-15 DOI: 10.13021/G8PPPQ.282008.115
A. Walen
It is often argued that suspected terrorists captured in the war on terror can be detained just the same way captured enemy soldiers can: until the relevant war is over. But there is a deep disanalogy between suspected terrorists and captured enemy soldiers. Soldiers cannot be held accountable for the use of force (as long as it conforms to the law of war), whereas terrorists normally can. Detaining people who can be held accountable as if they cannot is crossing an important moral line, sacrificing the rights of the individual for the welfare of the whole.
人们经常认为,在反恐战争中抓获的恐怖分子嫌疑人可以像抓获的敌方士兵一样被拘留:直到相关战争结束。但是,恐怖分子嫌疑人和被俘的敌方士兵之间存在着深刻的差异。士兵不能对使用武力负责(只要它符合战争法),而恐怖分子通常可以。拘留那些可以被问责的人,就好像他们不能被问责一样,这是跨越了一条重要的道德底线,是为了整体的福利而牺牲个人的权利。
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引用次数: 1
Performance-Enhancing Technologies and the Values of Athletic Competition 提高成绩的技术和体育竞赛的价值
Pub Date : 2008-06-22 DOI: 10.13021/G8PPPQ.282008.116
D. Wasserman
For decades, the American criminal justice system has been engaged in a "war on drugs" that critics say cannot be won. The enthusiasm for that war has been flagging for some time; a 1989 issue of the Quarterly (then called QQ) featured an article by Claudia Mills titled "The War on Drugs: Is it Time to Surrender?" In amateur and professional sports, however, the war on performance-enhancing drugs has been steadily escalating in recent years. Major doping scandals have roiled several sports, and drug testing has become ever more stringent. Yet at the time of the 2008 Beijing Olympics, where concerns about doping were pervasive, a few voices called for surrender. Some commentators argued that the war on doping was futile, since the technological sophistication of the dopers would always outstrip, if only for a few critical weeks or months, the capacity to detect their work. Others, however, argued that even if the war could be won, it wouldn't be worth fighting. As John Tierney wrote in the New York Times, "We all know the body can be improved. We all know Olympic athletes have the highest-functioning bodies in the world. They can call themselves natural, just as they used to call themselves amateur, but at some point that claim may seem the most unnatural thing of all." To bolster his case, Tierney noted that the fans themselves include people "with laser-corrected eyes, chemically whitened teeth and surgically enhanced anatomies. Not to mention the pharmacopeia coursing through our veins." These are still minority opinions. Just a year before the Olympics began, Barry Bonds broke Hank Aaron's lifetime home run record to a chorus of denunciation from sports pundits for his reported steroid use. Several months later, that chorus grew even more strident with the release of the Mitchell Report on doping in professional baseball, which gave Bonds lots of company and his detractors a surfeit of new targets. Along with cycling, the subject of frequent scandals involving widespread steroid use, baseball has now submitted itself to an intensive regime of drug testing and monitoring. But even in the unlikely event that anti-doping measures are successful in their narrow objective of deterring illegal drug use, they are ill-equipped to deal with a wider range of biotechnological interventions, which may bring far more significant changes in the performance capabilities of athletes. Unlike steroids, whose possession is illegal and whose use is widely regarded as unhealthy, these new technologies, genetic modification in particular, may at some point become legal and safe. Also unlike steroids, these technologies won't all be intended to confer a competitive advantage. Some, like the prosthetic limbs of runner Oscar Pistorius, will be designed to restore function lost to disease or disability; others, especially genetic modifications, will be intended for more general enhancement purposes. And in some cases, such as germline genetic engineering, the intervent
几十年来,美国刑事司法系统一直在进行一场“毒品战争”,批评人士称这场战争不可能获胜。一段时间以来,人们对这场战争的热情一直在减弱;1989年的《季刊》(当时还叫《QQ》)刊登了克劳迪娅·米尔斯的一篇文章,题为《禁毒战争:是投降的时候了吗?》然而,在业余和职业体育运动中,近年来,针对提高成绩药物的战争一直在稳步升级。重大的兴奋剂丑闻已经搅乱了几项运动,药物检测也变得越来越严格。然而,在2008年北京奥运会期间,对兴奋剂的担忧普遍存在,一些声音呼吁投降。一些评论人士认为,反兴奋剂战争是徒劳的,因为服用兴奋剂者的技术水平总是会超过检测他们行为的能力,哪怕只是在关键的几周或几个月里。然而,另一些人则认为,即使能打赢这场战争,也不值得打。正如约翰·蒂尔尼在《纽约时报》上所写的,“我们都知道身体是可以改善的。我们都知道奥运会运动员的身体是世界上功能最好的。他们可以称自己为自然爱好者,就像他们过去称自己为业余爱好者一样,但在某种程度上,这种说法似乎是最不自然的。”为了支持他的观点,蒂尔尼指出,粉丝本身包括那些“用激光矫正眼睛、化学美白牙齿和通过手术增强解剖结构的人”。更不用说我们血管里流淌的药典了。”这些仍然是少数人的意见。就在奥运会开幕前一年,巴里·邦兹打破了汉克·亚伦的本垒打纪录,引起了体育权威人士对他使用类固醇的一致谴责。几个月后,关于职业棒球运动员服用兴奋剂的米切尔报告(Mitchell Report)发布后,这种合唱变得更加尖锐,这给邦兹带来了许多同伴,也给他的批评者提供了过多的新目标。与自行车运动一样,棒球运动现在也接受了严格的药物检测和监控。自行车运动经常出现涉及广泛使用类固醇的丑闻。但是,即使反兴奋剂措施在阻止非法药物使用的狭隘目标上取得了成功(这种可能性不大),它们也无法应对更广泛的生物技术干预措施,而这些干预措施可能会给运动员的表现能力带来更大的变化。类固醇的持有是非法的,其使用被广泛认为是不健康的,而这些新技术,特别是基因改造技术,可能在某一时刻变得合法和安全。与类固醇不同的是,这些技术并不都是为了获得竞争优势。有些假肢,比如跑步运动员奥斯卡·皮斯托瑞斯(Oscar Pistorius)的假肢,将用于恢复因疾病或残疾而丧失的功能;其他的,尤其是基因改造,将用于更普遍的增强目的。在某些情况下,比如生殖系基因工程,干预将不是由运动员自己进行,而是由他们的父母进行。禁止这种技术将会禁止整个运动员阶层,包括一些无法遵守规定的运动员和其他不需要对他们的增强负责的运动员。此外,如果不禁止其他技术增强,禁止生物技术增强将很难站得住或维持下去,比如在北京奥运会上占主导地位的提高成绩的泳装,其成本使许多小型高中和大学运动队破产。试图根据其外部或内部位置,或其自然或人为特征来区分禁止和允许的修改,已被证明是诡辩中特别徒劳的练习。与其批评最近做出的区分,我只想指出,区分被禁止和被允许的修改的依据的持续不确定性,可能会破坏任何监管制度的道德权威和实际效力。…
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引用次数: 2
Pushing Drugs or Pushing the Envelope: The Prosecution of Doctors in Connection with Over-Prescribing of Opium-Based Drugs 推动药物或挑战极限:与过量处方鸦片类药物有关的医生的起诉
Pub Date : 2008-01-01 DOI: 10.13021/G8PPPQ.282008.118
Deborah Hellman
When a doctor writes prescriptions in his office, following consultation with a patient, and receives no compensation other than the normal fee for service, can this still be drug trafficking? Recent court judgments have emphatically held that it can, but in so doing courts wrongly impose criminal liability on doctors for trusting patients.
当一名医生在与病人会诊后在他的办公室开处方,除了正常的服务费外没有得到任何补偿时,这是否仍然是贩毒?最近的法院判决已经强调了这一点,但是这样一来,法院就错误地将医生信任病人的刑事责任强加给了医生。
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引用次数: 1
Enlightenment Thinking Could Bring Health Care for All Americans 启蒙思想可以为所有美国人带来医疗保健
Pub Date : 2008-01-01 DOI: 10.13021/G8PPPQ.282008.120
S. Gambescia
Looking to the founding precepts of our nation, inspired by Enlightenment thinking, will do more to guide us in finding a way to finally provide basic health care services for all than trying to predict the vagaries of our political parties and their leaders.
在启蒙思想的启发下,回顾我们国家的建国信条,将比试图预测我们的政党及其领导人的反复无常更能指导我们找到一条最终为所有人提供基本医疗保健服务的途径。
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引用次数: 0
Teaching the Bible in the Public Schools: Reading the Bible as Literature 在公立学校教导圣经:把圣经当作文学来读
Pub Date : 2007-12-01 DOI: 10.13021/G8PPPQ.272007.157
J. Segal
There is increased interest in teaching the Bible "as literature" in public schools. The proponents may be in for a surprise. Read as literature, the Bible significantly parts company with central tenets of both Judaism and Christianity.
在公立学校里,人们越来越有兴趣把《圣经》作为“文学”来教授。支持者们可能会大吃一惊。作为文学作品,《圣经》在很大程度上与犹太教和基督教的核心教义分道扬镳。
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引用次数: 0
Soldiers, Slaves and the Liberal State 士兵、奴隶和自由国家
Pub Date : 2007-04-01 DOI: 10.13021/G8PPPQ.272007.159
David J. Garren
Individuals in the liberal state who serve in the military ought to be permitted the right to exercise their liberty and autonomy and to refuse to serve in those wars they sincerely believe to be unjust.
在自由主义国家服兵役的个人应该被允许行使他们的自由和自治的权利,并拒绝在他们真诚地认为是不公正的战争中服役。
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引用次数: 1
Assisted Human Reproduction: Lessons of the Canadian Experience 辅助人类生殖:加拿大经验的教训
Pub Date : 2007-04-01 DOI: 10.13021/G8PPPQ.272007.161
R. Landau
The Canadian Assisted Human Reproduction Act, passed by the Canadian government on March 29, 2004, raises several important ethical issues.
加拿大政府于2004年3月29日通过的《加拿大辅助人类生殖法》提出了几个重要的伦理问题。
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引用次数: 0
期刊
Report from the Institute for Philosophy & Public Policy
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