Theories of perception have traditionally dismissed the sense of smell as a notoriously variable and highly subjective sense, mainly because it does not easily fit into accounts of perception based on visual experience. So far, philosophical questions about the objects of olfactory perception have started by considering the nature of olfactory experience. However, there is no philosophically neutral or agreed conception of olfactory experience: it all depends on what one thinks odors are. We examine the existing philosophical methodology for addressing (...) our sense of smell: on the one hand appeals to phenomenology that focus on the experiential dimensions of odor perception and on the other approaches that look at odor sources and their material dimensions. We show that neither strategy provides enough information to account for the human sense of smell and argue that the inclusion of the missing dimension of biology, with its concern for the function (or functions) of olfaction, provides the means to develop a satisfactory and empirically informed philosophy of smell. (shrink)

Although moral distress is now a well-recognized phenomenon among all of the healthcare professions, few evidence-based strategies have been published to address it. In morally distressing situations, the “presenting problem” may be a particular patient situation, but most often signals a deeper unit- or system-centered issue. This article describes one institution’s ongoing effort to address moral distress in its providers. We discuss the development and evaluation of the Moral Distress Consultation Service, an interprofessional, unit/system-oriented approach to addressing and ameliorating moral (...) distress. (shrink)

The essence of religion was once widely thought to be a unique form of experience that could not be explained in neurological, psychological, or sociological terms. In recent decades scholars have questioned the privileging of the idea of religious experience in the study of religion, an approach that effectively isolated the study of religion from the social and natural sciences. Religious Experience Reconsidered lays out a framework for research into religious phenomena that reclaims experience as a central concept while bridging (...) the divide between religious studies and the sciences. Ann Taves shifts the focus from "religious experience," conceived as a fixed and stable thing, to an examination of the processes by which people attribute meaning to their experiences. She proposes a new approach that unites the study of religion with fields as diverse as neuroscience, anthropology, sociology, and psychology to better understand how these processes are incorporated into the broader cultural formations we think of as religious or spiritual. Taves addresses a series of key questions: how can we set up studies without obscuring contestations over meaning and value? What is the relationship between experience and consciousness? How can research into consciousness help us access and interpret the experiences of others? Why do people individually or collectively explain their experiences in religious terms? How can we set up studies that allow us to compare experiences across times and cultures? Religious Experience Reconsidered demonstrates how methods from the sciences can be combined with those from the humanities to advance a naturalistic understanding of the experiences that people deem religious. (shrink)

AI has numerous applications and in various fields, including the military domain. The increase in the degree of autonomy in some decision-making systems leads to discussions on the possible future use of lethal autonomous weapons systems (LAWS). A central issue in these discussions is the assignment of moral responsibility for some AI-based outcomes. Several authors claim that the high autonomous capability of such systems leads to a so-called “responsibility gap.” In recent years, there has been a surge in philosophical literature (...) around the concept of responsibility gaps and different solutions have been devised to close or bridge these gaps. In order to move forward in the research around LAWS and the problem of responsibility, it is important to increase our understanding of the different perspectives and discussions in this debate. This paper attempts to do so by disentangling the various arguments and providing a critical overview. After giving a brief outline of the state of the technology of LAWS, I will review the debates over responsibility gaps using three differentiators: those who believe in the existence of responsibility gaps versus those who do not, those who hold that responsibility gaps constitute a new moral problem versus those who argue they do not, and those who claim that solutions can be successful as opposed to those who believe that it is an unsolvable problem. (shrink)

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations (...) and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts. (shrink)

A few weeks ago, a rural hospital administrator phoned with a question posed by his management team. “If you were going to give us some ethics resources,” he queried, “just exactly what would they...

In our time of increasing reliance on digital media the history of the book has a special role to play in studying the codex form and the persistence of old media alongside the growth of new ones. As a contribution to recent work on the continued use of manuscript in the handpress era, I focus on some examples of manuscripts copied from printed books in the Rylands Library and discuss the motivations for making them. Some of these manuscripts were luxury (...) items signalling wealth and prestige, others were made for practical reasons – to own a copy of a book that was hard to buy, or a copy that could be customized in the process of copying. The act of copying itself was also considered to have devotional and/or pedagogical value. (shrink)

Prior studies have advanced our knowledge of the individual determinants of corporate philanthropy; however, little empirical research has been conducted on how these determinants combine to influence giving. In this study, the authors develop and test an integrated model of the relationship between firm resources and corporate philanthropy as mediated by managerial discretion and managerial values. In addition, the authors offer organizational slack as an alternative measure of organizational resources. As predicted, the results show that firm resources have a positive (...) effect on corporate philanthropy. This effect is fully mediated by managerial discretion and partially mediated by managerial values. (shrink)

A decade ago, conventional wisdom in the medical establishment was that physicians treating chronic pain with opioid analgesics were at a substantial risk of being sanctioned for overprescribing by state medical regulatory boards. Dozens of articles written since have alluded to this risk as an obstacle to effective pain re1ief. In the early 1990s, a number of high profile cases in which physicians were disciplined by regulatory boards for overprescribing to patients with chronic pain were reported in the press. Although (...) the board actions in many of these cases were eventually overturned by state judiciaries, the publicity heightened practitioners’. sensitivity to the regulatory risks associated with prescribing opioids.A review of the available data on state medical board actions nationwide for the period from 1990 to 1996 reveals that the perception of regulatory risk far exceeds the reality. Indeed, relatively few of the disciplinary actions taken for overprescribing by state medical boards in any given year directly concern the treatment of chronic pain—malignant or nonmalignant—in patients. (shrink)

BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

This is a book in feminist theory and social and political philosophy. Many of the chapters are versions of earlier papers published as journal articles and as book chapters. It presents a multi-systems theory of social domination, discussing three main ones: economic class, gender and (social) race. It presents a maerialist feminist theory of gender and sexuality and discusses lesbian identity as well as issues of motherhood.

Two significant, apparently unrelated, trends have emerged in American society and medicine. First, American medicine is reexamining its approach to dying. The Institute of Medicine, the American Medical Association and private funding organizations have recognized that too many dying people suffer from pain and other distress that clinicians can prevent or relieve. Second, this past decade has marked a sharp increase in the number of physicians prosecuted for criminal negligence based on arguably negligent patient care. The case often cited as (...) a watershed is People u. Einaugfer, which involved a New York nursing home patient whose physician was convicted in 1993 of two criminal misdemeanors after he ordered an elderly dialysis patient to be tube fed through a peritoneal dialysis Catheter.How is the growing awareness of dying patients’ pain and the increasing willingness of prosecutors to charge physicians with crimes connected? Pain at the end of life is frequently treated with narcotics, prescription drugs that are closely regulated by state and federal law. That complex web of laws—and a growing fear of legal sanctions—has deterred physicians from prescribing controlled substances. As those legal sanctions move from disciplinary actions to criminal charges, physicians’ fears may expand. (shrink)

The notion of virtue in general, and courage in particular, has had a hard time integrating itself into the everyday lexicon of bioethics. Following the lead of enlightenment moral philosophy, which concentrates on the theory of right action as opposed to the ancient Greeks' emphasis on the development of good character, bioethics, with some notable exceptions, has tended to relegate consideration of the virtues to the sidelines of moral argument. Recently, however, there have been calls for the necessity of “moral (...) courage” in the context of clinical ethics. As nurses, physicians, and other health care professionals confront a variety of moral contexts in which the virtue of courage is invoked to "do the right thing," stand up for patients' rights, and uphold the ethical standards of their professions, they are increasingly reminded of their moral duty to exhibit courage in the face of institutional obstacles to the proper care of their patients. For example, a nurse's hesitation to approach a physician to request increased sedation for an agitated patient out of fear of retaliation is represented in one article as a lack of courage.In this paper we offer a critical assessment of such invocations of courage. While we find courage to be an indispensable virtue in some challenging contexts, in other settings we find invocations of courage to be both an unfortunate endorsement of an oppressive status quo that can divert attention from the real problems and an undesirable and potentially destructive strategy within health care institutions whose goal is medically excellent and morally good clinical practice. As we shall argue, a call to virtuousness is not always virtuous. (shrink)

Literature, for Sartre, it could be said, is not so much an object of theory as the focus of a question. The notion of 'committed literature' is less prescriptive than it is interrogative: the title of the text most commonly associated with 'littérature engagée' is, after all, a question about literature itself, and the nature of 'commitment' lends itself much more to a practice of contestation than to implementation of any particular programme. In what follows, I shall be examining some (...) of the ways in which Sartre makes literature synonymous with a question. And I shall be arguing that the very terms in which literature is presented as a form of self-contestation make biography, rather than theory, the arena in which the notion of literature is most extensively opened up. (shrink)

This article proposes a way of opening up the concept of genius to renewed understanding by analysing it in relation to the ‘others’ that are represented by melancholy, imposture and the reader. Discussions where genius is defined oppositionally are contrasted with those where such others are integral to the account of the phenomenon. The argument is based on a reading of three of the founding texts of the literature on genius, Aristotle's Problemata XXX, 1, Plato's Ion and Kant's Critique of (...) Judgement. (shrink)

Clinical research is increasingly conducted in settings that include private physicians’ offices, clinics, community hospitals, local institutes, and independent research centers. The migration of such research into this new, non–academic environment has brought new cadres of researchers into the clinical research enterprise and also broadened the pool of potential research participants. Regulatory approaches for protecting human subjects who participate in research have also evolved. Some institutions retain their own Institutional Review Boards (IRBs), but Independent IRBs, community hospital IRBs and community–based (...) IRBs also fulfill oversight responsibilities. This article sheds light on this evolving world by discussing the findings gleaned from two studies: a study of the decision making processes used by members who serve on different kinds of IRBs and a study of the decision making processes employed by research participants. The article then discusses how the key findings may inform proposed revisions to the Common Rule. (shrink)

Does the sense of smell involve the perception of odor objects? General discussion of perceptual objecthood centers on three criteria: stimulus representation; perceptual constancy; and figure-ground segregation. These criteria, derived from theories of vision, have been applied to olfaction in recent philosophical debates about psychology. An inherent problem with such framing of olfactory objecthood is that philosophers explicitly ignore the constitutive factors of the sensory systems that underpin the implementation of these criteria. The biological basis of odor coding is fundamentally (...) different from the coding principles of the visual system. This article analyzes the three measures of perceptual objecthood against the biological background of the olfactory system. It contrasts the coding principles in olfaction with the visual system to show why these criteria of objecthood fail to be instantiated in odor perception. The argument demonstrates that olfaction affords perceptual categorization without the need to form odor objects. (shrink)

This article explores and examines the fundamental need for nurses to include the promotion of the spiritual dimension of the health of human beings as well as the physical, mental and social facets if they truly wish to engage in holistic care. The author attempts to define the phenomenon of spirituality, aware of the dilemma that many individuals face when thinking and reflecting on this very personal and intangible issue.To be spiritual is to become fully human, the article argues, and (...) the reverse is also true. Spirituality in health is inextricable in each person’s search for the discovery of the truth about self and the meaning and purpose of life. Healthy communities are the product of healthy individuals who sow spiritual seeds such as unconditional positive regard, acceptance, respect and dignity for the benefit and advancement of individuals and humankind as a whole.The global nature of the phenomenon of spirituality is also shown by using examples of people who demonstrate compassion and communion with other human beings, in other countries in times of suffering, war and disaster. Compassion and empathy is expressed and experienced for victims of earthquakes that happen miles from home and far removed from personal or religious beliefs. Yet at such times we are all connected in the tapestry of life by our own human spirituality and earthiness.Abstract themes like compassion and justice are treated in the text within the context of spirituality. The author argues that being just and fair means that all patients have the right to achieve spiritual healing regardless of their belief systems, culture or creed. The works of some spiritual philosophers are used to reflect on this integral aspect of human caregiving.Historical symbols of spirituality are examined. The need for nurses to explore and reflect on the paradoxical concepts involved in their own spirituality is highlighted. Nurses are the essential providers of care and, therefore, the paper argues, guardians of that essential humanity that ensures that patients never become less than full human beings, whatever their condition, faith, culture or belief, or whoever they may be. The author contends that this responsibility is uniquely essential to being a nurse. (shrink)

Ann Radcliffe foi uma autora de extrema importância para a literatura britânica da virada do século XVIII para o XIX. Como se sabe, foi a autora mais bem paga da década de 1790. Os Mistérios de Udolpho, seu romance mais conhecido, foi dos mais influentes no que diz respeito à ficção gótica. Isso fica evidente, por exemplo, quando observamos que Jane Austen o coloca em destaque em boa parte da trama de seu Abadia de Northanger, de maneira que se pode (...) dizer que Udolpho representa, ao longo dessa obra, o exemplo mais bem acabado da ficção gótica da época. Walter Scott, por sua vez, como nos lembra Ellen Moers. (shrink)

Socialism from a feminist perspective is not an all or nothing blueprint, but rather a vision of degrees of power/freedom that people in a particular society have in economic, political, social and personal relations. Examples are discussed of societies which are more or less socialist in their class, racial/ethnic, and gender equality, power and freedom. Historical changes in affective economic relations of care, love and affection inform such class, race/ethnic, gender and sexual differences. Three types of transitional strategies are relevant (...) for social movements working toward socialism. (shrink)

“Humanism” is a term that has designated a remarkably disparate set of ideologies. Nonetheless, strains of religious, secular, existential, and Marxist humanism have tended to circumscribe the category of the human with reference to the themes of reason, autonomy, judgment, and freedom. This essay examines the emergence of a new humanistic discourse in feminist theory, one that instead finds its provocation in the unwilled passivity and vulnerability of the human body, and in the vulnerability of the human body to suffering (...) and violence. Grounded in a descriptive ontology that privileges figures such as exposure, dispossession, vulnerability, and “precariousness,” this new humanism is a corporeal humanism. This essay probes both the promise and the limitations of this emergent humanism with particular reference to recent work by feminist philosophers Judith Butler and Adriana Cavarero. (shrink)

This article provides a critical realist take on comparative methodology. Heeding the call for greater attention to the ontological presuppositions inherent in all methods, it first outlines comparative methods as they have traditionally been conceived and practised. Discerning two important aspects of these approaches - their notion of causality and their reliance on inductive inferences - the discussion moves on to consider their applicability within a critical realist social science. Arguing that the ontological presuppositions of traditional approaches to comparative methodology (...) are not compatible with the ontology of critical realism, it seeks to specify some initial steps in the direction of designing a new approach securing this compatibility. Important to this new approach is theoretical, or abductive, comparison and the need to be context-sensitive. (shrink)

Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.

The literature on aging has grown exponentially in recent years, accompanied by a slew of reports providing data detailing progress, challenges, and opportunities in caring for the aging. Yet such reports too often omit the lived experience of older persons and in‐depth discussion of the particular challenges and opportunities that arise within what Janelle S. Taylor calls “moral laboratories.” The Evening of Life: The Challenges of Aging and Dying Well, a volume edited by Joseph E. Davis and Paul Scherz and (...) to which Taylor is a contributor, helps fill this gap. With expert analyses from social scientists, philosophers, and health care professionals, the book contains evocative stories that facilitate reflection on the complexity, ambiguity, and diversity of being in later years. (shrink)