The concept of moral distress can be extended from clinical settings to larger environmental concerns affecting health care. Moral distress—a common experience in complex societies—arises when individuals have clear moral judgments about societal practices, but have difficulty in finding a venue in which to express concerns. Since health care is large in scale and climate change is proving to be a major environmental problem, scaling down health care is inevitably a necessary element for mitigating climate change. Because it is extremely (...) challenging to discuss these concerns in health care settings, those concerned about climate change and health care experience distress. This article outlines some philosophical concepts and perspectives that may be useful in mitigating this distress. (shrink)

The article by Jessica Pierce and Christina Kerby, raises some important but seldom asked questions about the use of natural resources in healthcare. They take for their example latex gloves, which are in wide everyday use, especially since the establishment of principles of universal precautions in infection control as a reaction to the spread of HIV. They trace the production of latex gloves back through rubber processing to their origins in Malaysian rubber plantations and elsewhere. They then ask, but do (...) not answer, some hard questions about the ethics of our relationship as patients to the impact of the materials we use on communities and the environment. To draw out their theme more starkly, consider the rumor widespread in South America that some babies purportedly adopted by Northerners are sold and cut up for their organs. Suppose this story were true; suppose your donated organ were obtained in this way. You would probably be so revolted by the immorality of its acquisition that you would refuse to accept it. But now take a morally more ambiguous case, as Pierce and Kerby intend. Suppose that the process of obtaining latex gloves is part of the gradual erosion of the Malaysian environment, and that workers in latex factories are poorly paid. Now, should or would you refuse to use latex gloves? Should or would you even be more selective in their use? The practice of universal precautions presumes a virtually unlimited supply of gloves; yet to react to resource scarcity with selective precautions hazards discrimination. Is there any way philosophically to balance the local justice issue of discrimination in comparison to injustice on a global scale and to future generations? (shrink)

At the September 1992 Birth of Bioethics conference observing the 30th anniversary of the Seattle kidney dialysis program, Warren Reich discussed the “bilocated” birth of the term bioethics. He showed that the term bioethics was coined in Michigan by Van Rensselaer Potter and that the term was also apparently conceived of independently at about the same time in 1970–1971 in Washington, D.C., by Andre Hellegers and Sargent Shriver. Potter's work, like many similar works in the early 1970s, was concerned with (...) the growing global biological crisis of human overpopulation, the destruction of species, and how to respond to these. He prefaced his book Bioethics with a “Bioethical Creed for Individuals,” outlining duties to respond to this crisis in a meaningful and scientific way. Hellegers and Shriver used the neologism to name the new Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics. The Center was to study concerns somewhat different from Potter's: the technological revolution in healthcare and its impact on reproduction, investigator-patient relations, and medical ethics. (shrink)

In addition to good medical services, all aspects of an economy must work together to ensure a high level of public health. However, the abundant economies of the North are contributing heavily to global environmental disaster, with increasing concomitant damage to human health. Environmental health problems result from toxicity (i.e., pollution), scarcity (i.e., poverty), and energy degradation (i.e., entropy). Common to these three factors in environmental demise are the limits of the Earth. Production has evolved to a point where the (...) Earth is no longer safe from radical depletion. Therefore, simple living is a necessary feature of global public health. Rarely do readers of this journal see these limits first hand, but they are real. Our limited perceptions and efforts hinder our ability to understand how to reduce the impact of production on natural ecosystems. Contrary to standard media portrayals, growth and technology cannot solve our public health problems, because they are unequally distributed across the world and neither can they solve the problem of limits. The need for modest consumption in developed nations is an essential and almost completely ignored element of the answer to environmental and associated health problems. A radical and rapid change to public health is needed in order to avoid abysmal global health consequences during the next century. These changes involve a restructuring of our economy, including the health care industry. In the short run, this is an ethical demand. In the long run, this is an inevitability. The actual and appropriate role of bioethicists in championing these changes is unclear. (Abstract by Bruce R. Smith). (shrink)

About 1970, Van Rensselaer Potter coined the term bioethics to bring under one heading broad questions of human survival, environment, and biology. In 1971, Potter outlined a statement of principles that linked the ethics of the biological sciences with the ethics of environmental concern. Regrettably, the field that adopted his rubric bioethics immediately diverged from Potter’s interests. Bioethics has become for the most part identified with medical ethics or health care ethics and in so doing has developed few ethical principles (...) and analyses in relationship to environmental ethics. Similarly, environmental ethics seldom touches on clinical or health care issues, even though the field of environmental health has grown greatly in recent decades. It is the purpose of this article to indicate briefly some of the topics that could be treated effectively as part of a project to reconnect medical ethics and environmental ethics into what may be called sustainable bioethics. (shrink)

Professor Brooks’ paper projects an aura of inevitable catastrophe. He correctly notes that the climate is always changing and that somewhere in the near or far future there will always be somethin...

AbstractIn her article from 2019, Fleur Johns describes a change: from a style of development work marked by a propensity for ‘planning’, to one marked by a propensity for ‘prototyping’. Our project in this paper is to propose a modest shift in perspective. Where Johns traces a transition from old to new styles, we emphasise the enduring links between planning and prototyping, such that both styles are best understood through their ongoing relationships and entanglements. Returning to Pulse Lab Jakarta (PLJ), (...) the site of Johns’ initial inquiry, we offer a reinterpretation of what might be novel about PLJ for development practice. Our claim is that to understand the particular intervention that PLJ represents, and the new modes of practice it produces, it may be helpful to understand PLJ's work in the manner of a ‘modular’ attachment to existing development apparatuses, that combines big data analytics with design thinking. We then develop some reflections and speculations on the forms and novelty of PLJ in light of our redescription of its work in the language of modularity. (shrink)

The principles whereby the reason operates in ethically complicated situations has been subject to long-standing debates in Catholic Philosophy. A classic text which exemplifies this is Aquinas’s consideration of self-defensive killing. In this paper I clarify two central issues in double-effect reasoning debates surrounding this text. Both issues are connected to the seemingly simple but actually complex task of accounting for the “chosen means” of self-defense. The first issue is whether the “chosen means” are also able to be considered a (...) “proximate end,” to which the intention is directed. The second is determining whether the assailant’s death is related to the “chosen means” per se and therefore to the rest of the moral action. Resolving these issues will provide grounds for answering the broader question implicit in the situation of self-defensive killing: what is to be done when human actions would inevitably entail that some evil is instrumentally tied to realizing some good? (shrink)

A brief handout summarizing Andrew Lang's criticisms of Frazer.

Objective correlates—behavioral, functional, and neural—provide essential tools for the scientific study of consciousness. But reliance on these correlates should not lead to the ‘fallacy of misplaced objectivity’: the assumption that only objective properties should and can be accounted for objectively through science. Instead, what needs to be explained scientifically is what experience is intrinsically— its subjective properties—not just what we can do with it extrinsically. And it must be explained; otherwise the way experience feels would turn out to be magical (...) rather than physical. We argue that it is possible to account for subjective properties objectively once we move beyond cognitive functions and realize what experience is and how it is structured. Drawing on integrated information theory, we show how an objective science of the subjective can account, in strictly physical terms, for both the essential properties of every experience and the specific properties that make particular experiences feel the way they do. (shrink)

This paper presents Integrated Information Theory (IIT) 4.0. IIT aims to account for the properties of experience in physical (operational) terms. It identifies the essential properties of experience (axioms), infers the necessary and sufficient properties that its substrate must satisfy (postulates), and expresses them in mathematical terms. In principle, the postulates can be applied to any system of units in a state to determine whether it is conscious, to what degree, and in what way. IIT offers a parsimonious explanation of (...) empirical evidence, makes testable predictions, and permits inferences and extrapolations. IIT 4.0 incorporates several developments of the past ten years, including a more accurate translation of axioms into postulates and mathematical expressions, the introduction of a unique measure of intrinsic information that is consistent with the postulates, and an explicit assessment of causal relations. By fully unfolding a system's irreducible cause-effect power, the distinctions and relations specified by a substrate can account for the quality of experience. (shrink)

Meaningful relationships are centrally important for human functioning. It remains unclear, however, which aspects of meaningful relationships impact wellbeing the most and whether these differ between psychiatric patients and members of the community. Information about relationship attributes and functions were collected in community members and psychiatric patients. Relationship attributes and functions were examined for differences between groups, their impact on wellbeing and symptoms, and the size of network. Community members reported fewer relationships, higher frequency of contact and less desire for (...) change when compared to the psychiatric patients. Nevertheless, both groups reported relatively high levels of fulfilled functions. Quality of the relationship and investment into the relationship was associated with both wellbeing and symptoms for both the community and the patient group. Almost all functions were associated with wellbeing and symptoms for the community group. However, for the patient group, only few functions were associated with wellbeing and no functions were associated with symptoms. Contrary to our hypotheses, the results show that psychiatric patients do not have a deficit in fulfilling relationships. Most people report a well-functioning network of meaningful, high-quality relationships. Patients benefit from meaningful, function-fulfilling relationships just as much as community members. Results are discussed with respect to how targeting relationships can be used clinically. (shrink)

Background Moral distress was first described by Jameton in 1984, and has been defined as distress experienced by an individual when they are unable to carry out what they believe to be the right course of action because of real or perceived constraints on that action. This complex phenomenon has been studied extensively among healthcare providers, and intensive care professionals in particular report high levels of moral distress. This distress has been associated with provider burnout and associated consequences such (...) as job attrition, with potential impacts on patient and family care. There is a paucity of literature exploring how middle and late career healthcare providers experience and cope with moral distress. Objectives We explore the experience of moral distress and the strategies and resources invoked to mitigate that distress in mid- and late-career healthcare providers practicing in paediatric intensive care, in order to identify ways in which the work environment can build a culture of moral resilience. Research design An exploratory, qualitative quality improvement project utilizing focus group and semi-structured interviews with pediatric intensive care front-line providers. Participants Mid-and-later career (10 + years in practice) pediatric intensive care front line providers in a tertiary pediatric hospital. Research context This work focuses on paediatric intensive care providers in a single critical care unit, in order to explore the site-specific perspectives of health care providers in that context with respect to moral distress coping strategies. Ethical considerations The study was approved by the Quality Management Office at the institution; consent was obtained from participants, and no identifying data was included in this project. Findings Participants endorsed perspective-building and described strategies for positive adaptation including; active, reflective and structured supports. Participants articulated interest in enhanced and accessible formal supports. Discussion Findings in this study resonate with the current literature in healthcare provider moral distress, and exposed ways in which the work environment could support a culture of moral resilience. Avenues are described for the management and mitigation of moral distress in this setting. Conclusion This exploratory work lays the groundwork for interventions that facilitate personal growth and meaning in the midst of moral crises in critical care practice. (shrink)

The subject of this essay is the classical problem of induction, which is sometimes attributed to David Hume and called “the Humean Problem of Induction.” Here, I examine a certain sort of Neo-Aristotelian solution to the problem, which appeals to the concept of natural kinds in its response to the inductive skeptic. This position is most notably represented by Howard Sankey and Marc Lange. The purpose of this paper is partly destructive and partly constructive. I raise two questions. The first (...) is: Are the natural kind solutions to the problem successful? The first thesis of this paper is that they are not, and I will show how and why they fail. And the second question I raise here is: Is there nonetheless some alternative Neo-Aristotelian solution to the problem which is successful and can overcome the shortcomings endemic to the Sankey-Lange account? The second thesis is that there is, and I’ll attempt to sketch one. My stance here may be summarized by saying that, while I agree with Sankey and Lange that the problem of induction can be adequately resolved, and while I am on the whole sympathetic with the Aristotelian spirit of their account, I am, for all that, dissatisfied with the letter of them. Nothing short of a more thoroughgoing Aristotelianism about the epistemology of induction will do. (shrink)

The problem of explanatory asymmetry remains a serious challenge for non-causal accounts of explanation. This paper proposes a novel solution, and it does so by appealing to the theoretical context in which an explanation is offered. The paper develops the problem of explanatory asymmetry for non-causal dependency accounts of explanation, focusing specifically on Alexander Reutlinger’s Counterfactual Theory of Explanation and recent work by Marc Lange and Lina Jansson. It defends the idea that nomological possibility with respect to a global theory (...) is the right constraint on explanation, and it shows how this breaks the apparent symmetry in counterfactual dependence that is the source of the problem. This solution appeals to theoretical context, and the paper develops and defends the version of contextualism in explanation that is required. (shrink)

Resenha do livro The Ethics of Environmentally Responsible Health Care.

Quão próxima está a ética do cuidado com a saúde da ética da responsabilidade ambiental? Enxergamos os problemas ambientais e também os problemas de saúde das pessoas, mas conseguimos ver realmente uma ligação entre eles?