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)

L’ouvrage d’Anne Cova, tiré principalement de la partie inédite de sa thèse doctorale soutenue en 1994, porte sur l’histoire des débats autour d’une question : « la liberté de la maternité », dont les contours s’étendent bien au-delà des discussions entre les féministes et leur opposants, et qui d’une certaine manière reste aussi « brûlante » de nos jours qu’il y a cent ans, soit la période étudiée. Le dépouillement des plus importants périodiques spécialisés publiés entre 1890 et 1939 (Régén...

Moral distress is a phenomenon increasingly recognized in healthcare that occurs when a clinician is unable to act in a manner consistent with his or her moral requirements due to external constraints. We contend that some experiences of moral distress are self-inflicted due to one’s under-assertion of professional authority, and these are potentially avoidable. In this article we outline causes of self-inflicted moral distress and offer recommendations for mitigation.

In their article “A Broader Understanding of Moral Distress,” Campbell, Ulrich, and Grady (2016) correctly assert that moral distress is well established in the nursing literature and is gaining at...

This study surveyed investors to determine the extent to which they preferred ethical behavior to profits and their interest in having information about corporate ethical behavior reported in the corporate annual report. First, investors were asked to determine what penalties should be assessed against employees who engage in profitable, but unethical, behavior. Second, investors were asked about their interest in using the annual report to disclose the ethical performance of the corporation and company officials. Finally, investors were asked if they (...) felt that ethics reports should be audited.The survey results indicate that many shareholders (42%) do not expect a high level of ethical behavior from corporate employees or officers. There is a significant amount of interest in disclosure of ethical issues (72%) and unwillingness to trust management to provide unbiased reports of ethical behavior. If such reports are included with the financial statements, 32 percent of the investors surveyed would prefer to have them audited to provide independent verification. (shrink)

Premier « organe illustré consacré exclusivement à la femme » (p. 23), la revue Femina a longtemps servi de source de renseignements visuels et textuels sur des personnalités et la vie féminines en France pendant une période où les femmes, même connues, n’ont pas laissé tellement de traces dans les archives. La revue reste toutefois méconnue, ignorée comme objet de recherche, selon l’historien américain Leonard Berlanstein, en raison de son apparence luxueuse et des protestations de non-fémin...

Anne O’Byrne: Natality and finitude Content Type Journal Article Category Book Review Pages 1-7 DOI 10.1007/s11007-011-9203-8 Authors Jeffrey Epstein, SUNY Stony Brook, 213 Harriman Hall, Stony Brook, NY 11794-3750, USA Journal Continental Philosophy Review Online ISSN 1573-1103 Print ISSN 1387-2842.

Toward a New Socialism offers a critical analysis of capitalism's failings and the imminent need for socialism as an alternative form of government. Dr. Richard Schmitt joins with Dr. Anatole Anton to compile a volume of essays exploring the benefits and consequences of a socialist system as an avenue of increased human solidarity and ethical principle.

Our results support the idea that adults have access to the principles and parameters of Universal Grammar (UG), contrary to Epstein et al.'s misrepresentation of our work as involvingpartial access toUG. For both LI and L2 acquisition, functional projections appear to develop in a gradual fashion, but in L2 acquisition there ispartial transferin that the lowest projection (VP) is transferred from the speaker's LI.

Inspired by the work of prominent University of Notre Dame political philosophers Catherine Zuckert and Michael Zuckert, this volume of essays explores the concept of natural right in the history of political philosophy. The central organizing principle of the collection is the examination of the idea of natural justice, identified in the classical period with natural right and in modernity with the concept of individual natural rights. Contributors examine the concept of natural right and rights in all the manifold and (...) interdisciplinary dimensions associated with the Zuckerts’ oeuvre. Part I explores the theme of natural right in the ancient and medieval political philosophy of Plato, Xenophon, Aristotle, and St. Augustine. Part II examines the early modern break from the classical tradition in the work of Montaigne, Spinoza, Montesquieu, Locke, and Hegel as well as the legacy of the modern natural rights tradition as explored by Leo Strauss and Pope John Paul II. Part III treats the theme of natural rights from the Puritans through the Founding period in such figures as Thomas Jefferson and Gouverneur Morris and up to the Progressive era with Booker T. Washington and Theodore Roosevelt. Part IV addresses questions of natural justice in literature, including works of Euripides, Cervantes, Shakespeare, Edith Wharton, and Tom Stoppard. "In this collection compiled in honor of Catherine and Michael Zuckert, the contributors address a wonderful variety of serious issues in important literary and philosophic texts. Their topics range from Plato on piety to Stoppard on socialist utopianism, and from Aristotle and Augustine to Euripides, Locke, Hegel, Shakespeare, and Booker T. Washington. The volume stands as an impressive introduction to the liberal arts and a lively introduction to many great issues of liberalism, Christianity, justice, and liberty; it is also a tribute to the Zuckerts' breadth of study, teaching, and influence." —_Robert K. Faulkner, Boston College_. (shrink)

Alexis de Tocqueville asserted that America had no truly great literature, and that American writers merely mimicked the British and European traditions of the eighteenth and nineteenth centuries. This new edited collection masterfully refutes Tocqueville's monocultural myopia and reveals the distinctive role American poetry and prose have played in reflecting and passing judgment upon the core values of American democracy. The essays, profiling the work of Mark Twain, F. Scott Fitzgerald, John Updike, Edith Wharton, Walt Whitman, Henry James, Willa (...) Cather, Walker Percy, and Tom Wolfe, reveal how America's greatest writers have acted as society's most ardent cheerleaders and its most penetrating critics. Christine Dunn Henderson's exciting new work offers literature as a portal through which to view the philosophical principles that animate America's political order and the mores which either reinforce or undermine them. (shrink)

Background: Intensive care unit nurses are providing care to COVID-19 patients in a stressful environment. Understanding intensive care unit nurses’ sources of distress is important when planning interventions to support them. Purpose: To describe Canadian intensive care unit nurse experiences providing care to COVID-19 patients during the second wave of the pandemic. Design: Qualitative descriptive component within a larger mixed-methods study. Participants and research context: Participants were invited to write down their experiences of a critical incident, which distressed them when (...) providing nursing care. Thematic analysis was used to analyze the data. Ethical considerations: The study was approved by the ethics committee at the researchers’ university in eastern Canada. Results: A total of 111 critical incidents were written by 108 nurses. Four themes were found: (1) managing the pandemic, (2) witness to families’ grief, (3) our safety, and (4) futility of care. Many nurses’ stories also focused on the organizational preparedness of their institutions and concerns over their own safety. Discussion: Nurses experienced moral distress in relation to family and patient issues. Situations related to insufficient institutional support, patient, and family traumas, as well as safety issues have left nurses deeply distressed. Conclusion: Identifying situations that distress intensive care unit nurses can lead to targeted interventions mitigating their negative consequences by providing a safe work environment and improving nurses’ well-being. (shrink)

Feminist analysis of cultural mythology surrounding organ donation offers a critical perspective on current U.S. transplant policy. My argument is three-pronged. First, I argue that organ donation is appropriately understood as a sacrifice. Structurally, donation accords both to general and to specifically Christian archetypes of sacrifice. The characterization of donation as sacrifice resonates in the cultural psyche even though it is absent in public rhetoric. Second, I characterize widespread feminist concerns about the over-glorification of sacrifice. These concerns provide a helpful (...) framework for considering whether the sacrifice of organ donation is over-glorified in our culture. Third, I consider several specific aspects of organ recruitment and organ allocation. Each demonstrates an over-glorification of sacrifice that leads to a dangerous "routinization" of sacrifice. None of these excesses are addressable without due attention to the symbolic import of organ donation and transplantation. I close by suggesting lessons my analysis offers to Christian churches who support donation, to the discourse of bioethics, and to the general public. (shrink)

What if depression, in the Americas at least, could be traced to histories of colonialism, genocide, slavery, exclusion, and everyday segregation and isolation that haunt all of our lives, rather than to biochemical imbalances? This article seeks alternatives to the medical model found in most depression memoirs by considering how the epistemological and methodological struggles faced by a scholar of the African diaspora confronted by the absent archive of slavery are relevant to discussions of political depression. Combining scholarly investigation and (...) personal memoir, Saidiya Hartman’s Lose Your Mother exemplifies feminism’s affective turn not only by bringing personal narrative into scholarship, but by seeking reparation for the past in the affective dynamics of cultural memory rather than in legal reform or state recognition. Stubbornly refusing to find solace in an African past before slavery, though, Hartman provides a model of emotional reparation in which feelings of loss and alienation persist. Her work suggests the relevance of political depression to both the ordinary life of racism and to what gets called clinical depression. (shrink)

Table of Contents: Illustrations Acknowledgments Conventions Introduction 3 Ch. 1 Kinds of Natural Philosophy 14 Ch. 2 Methods of Bookishness 49 Ch. 3 Modes of Argument 82 Ch. 4 Bodin’s Philosophy of Nature 116 Ch. 5 Theatrical Metaphors 153 Ch. 6 The Reception of the Theatrum 180 Epilogue: The Legacies of the Theatrum 225 Notes 233 Bibliography 331 Index 369.

Nursing is a complicated and multifaceted profession that sets high demands in preparing nursing students for the profession. In today's education, the emphasis is often on knowledge and skills, that is, epistemology. In caring science another approach is sought, an approach based on human sciences in which knowledge will serve a more profound understanding, that is, the ontology. Consequently, the question of what this ‘understanding’ in clinical education is and how it is promoted in clinical nursing education becomes important to (...) clarify. Therefore, the aim here is to explicate the phenomenon of understanding in clinical education as experienced by third‐year undergraduate nursing students ready for graduation. This study, with a hermeneutic approach, is based on a secondary analysis of focus group interviews with undergraduate nursing students. The analytical expansion of the original material suggests three interrelated themes that illuminate the phenomenon of understanding in clinical education. These findings are deepened and enriched through philosophical abstraction. In the process of understanding, episteme, techne and phronesis can be viewed as inherent parts of the structure of thought in nursing. The perspective advanced in this study adds new aspects to the phenomenon of understanding and its meaning and significance in the dynamic process of formation and becoming in clinical education. The focus in clinical nursing education should be on learning reflective, critical thinking and the ways of being a nurse, rather than drilling students on particular skills. In the rapidly changing world of the 21st century, an understanding‐based education is needed as a more meaningful and authentic approach. Therefore, an ontological turn in nursing education, through which the main focus shifts from a traditional epistemology to an epistemology in the service of ontology, is suggested. Further studies are needed in the development and implementation of an understanding‐based, interpretative education in nursing. (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)

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 history of note?taking has only begun to be written. On the one hand, the basic functions of selecting, summarizing, storing and sorting information garnered from reading, listening, observing and thinking can be identified in most literate contexts in some form or other. On the other hand, Renaissance humanists emphasized with unprecedented success the virtues of stockpiling notes on large scales and for the long term, thanks to the availability of paper and a new abundance of books, but also to (...) their ability to transmit their own keen motivation to avoid any future loss of learning. We continue to share many early modern ideals for insuring the collection and retrievability of information and have built on early modern practices that facilitate the accumulation and the organization of information, including collaborative work and the use of rearrangeable slips. (shrink)

This article discusses explanatory theories of normative concepts and argues for a set of criteria of adequacy by which such theories may be evaluated. The criteria offered fall into four categories: ontological, theoretical, pragmatic, and moral. After defending the criteria and discussing their relative weighting, this article uses them to prune the set of available explanatory theories of oppression. Functionalist theories, including Hegelian recognition theory and Foucauldian social theory, are rejected, as are psychoanalytic theory and social dominance theory. Finally, the (...) article defends structural rational choice theory as the most promising methodology for explaining oppression. Key Words: oppression • explanation • rational choice theory. (shrink)

The co-instantiation thesis is pivotal to a significant solution to the problem of causal exclusion. But this thesis has been subject to some powerful objections. In this paper, I argue that these difficulties arise because the thesis lacks the necessary metaphysical framework in which its claims should be interpreted and understood. Once this framework is in place, we see that the co-instantiation thesis can answer its critics. The result is a rehabilitated co-instantiation solution to the troubling problem of causal exclusion. (...) But questions remain concerning the viability of certain of its applications. (shrink)

Wales uses languages with both regular (Welsh) and irregular (English) counting systems. Three groups of 6- and 8-year-old Welsh children with varying degrees of exposure to the Welsh language—those who spoke Welsh at both home and school; those who spoke Welsh only at home; and those who spoke only English—were given standardized tests of arithmetic and a test of understanding representations of two-digit numbers. Groups did not differ on the arithmetic tests, but both groups of Welsh speakers read and compared (...) 2-digit numbers more accurately than monolingual English children. A similar study was carried out with Tamil/English bilingual children in England. The Tamil counting system is more transparent than English but less so than Welsh or Chinese. Tamil-speaking children performed better than monolingual English-speaking children on one of the standardized arithmetic tests but did not differ in their comparison of two-digit numbers. Reasons for the findings are discussed. (shrink)

Current advances in connectivity, sensor technology, computing power and the development of complex algorithms for processing health-related data are paving the way for the delivery of innovative long-term health care services in the future. Such technological developments will, in particular, assist the elderly and infirm to live independently, at home, for much longer periods. The home is, in fact, becoming a locus for health care innovation that may in the future compete with the hospital. However, along with these advances come (...) valid privacy and security questions arising from the fact that the data collected and transmitted through these technologies could also allow for individual monitoring as well as unauthorized access to critical diagnostic and other health data. (shrink)

Three female physicians were interviewed as part of a comprehensive investigation into the narratives of female and male physicians and nurses, concerning their experience of being in ethically difficult care situations in the care of elderly people. The interviewees expressed great concern for the low status of care for elderly people, and the need to fight for the specialty and for the care and rights of their patients. All the interviewees’ narratives concerned problems relating to perspectives of both action ethics (...) and relational ethics. The main focus was on problems concerning the latter perspective, expressed as profound concern and respect for the individual patient. Secondary emphasis was placed on relationships with relatives and other professionals. The most common themes in an action ethics perspective were too little treatment and the lack of health services for older patients, together with overtreatment and death with dignity. These results were discussed in the light of Løgstrup’s ethics, which emphasize that human life means expressing oneself, in the expectation of being met by others. Both Ricoeur’s concept of an ethics of memory and Aristotle’s virtue ethics are presented in the discussion of too little and too much treatment. (shrink)

I consider a grand, yet neglected proposal put forward by Shoemaker—a functionalist theory of all properties. I argue that two possible ways of developing this proposal meet with substantial objections. However, if we are prepared to endorse an ontology of tropes, one of these functionalist analyses can be developed into an original and informative theory of properties.

Political oeconomy in the 18th century operated in the absence of the conception of an autonomous social order articulated in the later concepts of `the economy' and `society'. Without a self-sustaining mechanism oriented to stability and endogenous economic growth, national prosperity and social order were assumed to depend upon the detailed interventions in economic life that are characteristic of mercantilism and the police of the poor. Smith's theory that autonomous economic growth underpinned a stable order of social interdependencies based upon (...) the division of labour allowed him to move beyond or modify these assumptions. It freed him from the ideas that constant interference in the relationship between agriculture and manufacturing was necessary in order to guarantee food security and that social order and national prosperity depended upon enforcing constraints upon the interests of wage earners. (shrink)

The agricultural communicator is a key link in transmitting information to farmers. If agricultural communicators' ethics are compromised, the resulting biases in news production could have serious detrimental effects on the quality of information conveyed to farmers. But, to date, agricultural communicators' perceptions of ethical problems they encounter at work has not been examined. This study looks at the dimensions of ethical concerns for topics area (agricultural) journalists as defined by practitioners. To determine these dimensions, we sent open ended questionnaires (...) (50 percent response rate) to members of two professional agricultural journalist associations: the Newspaper Farm Editors of America and the American Agricultural Editors' Association.Agricultural communicators overwhelmingly focus on one specific threat to objectivity—advertising pressure. Both NFEA and AAEA respondents indicated that agricultural journalists' responses to advertising pressure adversely affected the entire profession. The responses indicated that agricultural writers were concerned with the different types of pressures and the effects of advertising pressure on the industry as a whole. NFEA and AAEA respondents mentioned both indirect pressure, “freebies,” conferences, trips and press releases from advertising or public relations sections of agri-business firms, and direct pressures from advertisers, salesmen and publishers. The respondents were clearly more comfortable when newspaper policy protected them from advertising pressure and when they had techniques to reduce this pressure. The editors' and reporters' perceptions of advertising pressure clearly indicates that advertising abuses are a clear and present danger and one worthy of far more attention than it has previously received. (shrink)

Three periods in the development of Whitehead's thought are generally recognized : ()-: The period of the writing of Universal Algebra, ...

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)

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)

My aim … is to show that the celestial machine is likened not to a kind of divine living being but rather to a clockwork. I consider the human body to be a machine … Although it may exaggerate to say that Descartes fathered the mechanization of biology, it is true that his Treatise of Man provided the first systematic development of the idea that a complete understanding of all the phenomena of life, including all abilities and behaviour of animals, (...) can be achieved by viewing living things as machines. To make this out, Decartes had to learn to think about living things in a new way. My first aim here is to identify the fundamental conceptual innovations at work in Descartes’ attempt to extend the new mechanics to include biology. My second aim is to locate the point at which Descartes’ mechanical imagination runs out. This requires study of Descartes’ scientific work on sense. (shrink)