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)

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)

Karl Peters's book Dancing with the Sacred brings together his insights from evolutionary biology and ecology, world religions, and process thought into an integrated autobiographical reflection on his thoughts, teaching, and life. The book simultaneously engages readers in their own reflections about religion and science and reminds them that their reflections are freighted with moral responsibility. For Peters, self‐understanding correlates with understanding the world. The celebration of diversity coincides with the universal concerns that all face living together on this planet. (...) Our future depends on how we live in the present tense. (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)

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)

Displaying her intellectual and literary abilities from a young age, 'Mrs Taylor of Ongar' enjoyed writing all her life. She had eleven children, of whom six survived to adulthood. Her published works began with advice books for her own daughters, produced when increasing deafness made ordinary conversation difficult for her. Given the difficulty of providing advice equally appropriate to girls at all levels of society, this 1815 work is addressed to 'females in the middle ranks'. It is assumed that a (...) girl's aspiration, as well as her destiny, is to be a wife and mother: conduct towards the husband, and the rearing of children, are of prime importance. But there is also a chapter for the husband, pointing out his reciprocal duties to his wife as an equal partner in their relationship. The book offers fascinating insights into the middle-class ideal of domestic happiness. (shrink)

The modern philosophical act, as it appears in the Essays of Montaigne, reorders the world by radically altering the relationship between the mind and the world. Montaigne replaces the premodern philosophical act of contemplation with the modern philosophical act of judgment. While contemplation is the natural end or natural completion and perfection of the mind, judgment is the freedom of the mind from nature. Contemplation is the receptive attitude of the mind toward the world; judgment is the attitude of mastery. (...) Contemplation is the ordering of the human to the divine, while judgment reorders man to man himself. This reordering entails a revaluation of all things in relation to man as man. Judgment eliminates the classical distinction between actions that are good in themselves and actions that are for the sake of production, thereby undermining the hierarchy of leisure and work, the foundation of classical civilization. The liberal order is the new form of human association, which replaces the old order. (shrink)

Ann Whittle offers a fresh approach to questions about whether our actions are free and whether we are morally responsible for them. She argues that the answers to these questions depend on the contexts in which we make claims about our abilities and our control over our actions.

Cet article montre ce que la cooccurrence peut nous apprendre sur la monosémie et comment on peut exploiter l’analyse des cooccurrences de deuxième ordre pour quantifier l’analyse sémantique. Les analyses sont conduites sur un corpus technique (1,7 million d’occurrences) relevant du domaine spécialisé des machines-outils pour l’usinage des métaux. Dans cet article, nous expliquons la méthodologie adoptée pour déterminer le degré de monosémie d’un mot technique à partir de l’analyse du recoupement de ses cooccurrences de deuxième ordre. Dans le but (...) d’affiner les résultats de la mesure de recoupement, nous procédons également à quelques expérimentations qui vont au-delà du simple repérage statistique des cooccurrences et qui font varier différents paramètres, tels que la fenêtre d’observation, le seuil de significativité et la forme graphique ou le lemme des cooccurrences de premier et deuxième ordre. Finalement, nous abordons l’importance de l’intégration des étiquettes morphosyntaxiques dans l’analyse des cooccurrences. (shrink)

One hypothesis of isocortical evolution requires tangential migration of glutaminergic neurons. A second requires invasion of collothalamic afferents into the dorsal pallium, a territory that in sauropsids is solely lemnopallial. A third alternative is noted here – duplication of the original collopallial territory. The duplicated region would be formed by radial migration of excitatory neurons and would maintain its collothalamic innervation.

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)

Is the sense of smell a source of aesthetic perception? Traditional philosophical aesthetics has centered on vision and audition but eliminated smell for its subjective and inherently affective character. This article dismantles the myth that olfaction is an unsophisticated sense. It makes a case for olfactory aesthetics by integrating recent insights in neuroscience with traditional expertise about flavor and fragrance assessment in perfumery and wine tasting. My analysis concerns the importance of observational refinement in aesthetic experience. I argue that the (...) active engagement with stimulus features in perceptual processing shapes the phenomenological content, so much so that the perceptual structure of trained smelling varies significantly from naive smelling. In a second step, I interpret the processes that determine such perceptual refinement in the context of neural decision-making processes, and I end with a positive outlook on how research in neuroscience can be used to benefit philosophical aesthetics. (shrink)

Detecting contract cheating in written submissions can be difficult beyond direct plagiarism detectable via technology. Successfully identifying potential cases of contract cheating in written work such as essays and reports is largely dependent on the experience of assessors and knowledge of student. It is further dependent on their familiarity with the patterns and clues evident in sections of body text and reference materials to identify irregularities. Consequently, some knowledge of what the patterns and clues look like is required. This paper (...) documents how to identify some of the patterns and clues observed in essay and report submissions. Effective assessment design with specific contextual requirements make irregularities easier to detect and interpret. The irregularities identified were confirmed as instances of contract cheating through conversations held with postgraduate students. An essential element of the conversations was the evidence presented for discussion. Irregularities were noted on a pro-forma specifically developed for this purpose. Patterns identified include misrepresented bibliographic data, inappropriate references, irrelevant material and generalised text that did not address the assessment question or grading criteria. The validated patterns formed the basis of identifying potential instances of contract cheating in later submissions. Timely conversations with students before the end of semester are essential to determining whether the patterns and clues link to poor knowledge of academic writing conventions or classified as contract cheating necessitating the application of appropriate penalties under institutional policies and procedures. (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)

Property in money, means of subsistence, machines, and other means of production, does not as yet stamp a man as a capitalist if there be wanting the correlative — the wage-worker, the other man who is compelled to sell himself of his own free-will.

'The church in danger' : latitudinarians, Socinians, and Hobbists -- Animal spirits and living fibres -- Mortalists and materialists -- Journalism, exile, and clandestinity -- Mid-eighteenth-century materialism -- Epilogue : some consequences.

I support Cheshire Calhoun's argument that there is a distinctive type of sexuality injustice addressed to lesbians and gays, but challenge her definitional strategy regarding the concepts of "lesbian" and "gay" and the "universalistic essentialist" distinction that she draws between patriarchy and compulsory heterosexuality. Finally, I take issue with the political implications of her claim that lesbians' and gays' special oppression stems from our exclusion from the legal prerogatives of marriage and parenthood.