The current ethical structure for collaborative international health research stems largely from developed countries' standards of proper ethical practices. The result is that ethical committees in developing countries are required to adhere to standards that might impose practices that conflict with local culture and unintended interpretations of ethics, treatments, and research. This paper presents a case example of a joint international research project that successfully established inclusive ethical review processes as well as other groundwork and components necessary for the conduct (...) of human behavior research and research capacity building in the host country. (shrink)

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)

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)

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)

This chapter argues that violence is and has always been a crucial component in the origin and maintenance of oppression. It explores how violence and the threat of violence constrain the actions of groups, harming the victims and benefiting the correlative privileged social groups. It argues that women as a group are oppressed materially through violence, and that there is a credible, psychologically effective threat of greater harm that is transmitted by the obvious material harm that they do suffer.

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)

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.

That there is no substance causation is often treated as the default position. My aim in this paper is primarily one of burden shifting: opponents of substance causation must do more to defend their position. After outlining the thesis I wish to defend, I present a simple argument for substance causation, arguing that opponents of substance causation owe us an explanation of why this argument is unsound. I end by answering objections to the view that substances can be causes.

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)

At the UN, important projects laying down transnational corporations' (TNCs) human rights responsibilities have been launched without ever clarifying the relevant theoretical foundations. One of the consequences is that the human rights principles in projects like the 2000 UN Global Compact and the 2003 Norms on the Responsibilities of Transnational Corporations and Other Business Enterprises with Regard to Human Rights can be understood in different ways, which should not cause surprise given that their authors come from diverse backgrounds, including economics (...) and public policy. An examination of these projects and the views of their authors reveals that, although they are superficially linked to international human rights law, they go well beyond it and attempt to deal with corporate social responsibility issues in ways that elude neat classification as fitting neatly in either legal or non-legal categories. Too little attention has been paid to how in the course of developing these projects the legal and ethical dimensions have become entwined and how lines have gotten blurred. Meanwhile, there has been recognition that these UN projects have emerged simply as ad hoc responses to practical concerns about the sustainability of globalization. The lack of any foundational theory or normative framework should be addressed; it is time to bring together specialists from different fields concerned with the human rights responsibilities of corporations to see if it is possible to define a coherent overarching theory for these UN projects. (shrink)

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)

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)

Dancing with Iris engages with Iris Marion Young's prolific writings in political theory and in phenomenology. Contributors discuss her work from a variety of disciplines, including philosophy, political science, human rights law, cultural geography and dance studies.

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)

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)

The notion of representation figures centrally both in Descartes’ scientific theorizing about sense in humans and in his conceptual speculations about the nature of human cognition.Descartes’ philosophical innovation in the Dioptrics is the claim that sensing in humans is a kind of representing rather than a kind of resembling. This provides the cornerstone for his attack on traditional theories of sense, and it underwrites his own position that sensing is a kind of thinking, ascribable to the rational soul rather than (...) to any Aristotelean sensitive soul. (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)

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)

Representational drift is a phenomenon of increasing interest in the cognitive and neural sciences. While investigations are ongoing for other sensory cortices, recent research has demonstrated the pervasiveness in which it occurs in the piriform cortex for olfaction. This gradual weakening and shifting of stimulus-responsive cells has critical implications for sensory stimulus–response models and perceptual decision-making. While representational drift may complicate traditional sensory processing models, it could be seen as an advantage in olfaction, as animals live in environments with constantly (...) changing and unpredictable chemical information. Non-topographical encoding in the olfactory system may aid in contextualizing reactions to promiscuous odor stimuli, facilitating adaptive animal behavior and survival. This article suggests that traditional models of stimulus–(neural) response mapping in olfaction may need to be reevaluated and instead motivates the use of dynamical systems theory as a methodology and conceptual framework. (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)

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.

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)

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)