Objective: To examine i) how ethical frameworks can be used in concrete cases of parent–doctors’ disagreements for extremely preterm infants born in the grey zone to guide such difficult decision-making; and ii) what challenges stakeholders may encounter in using these frameworks. Design: We did a case analysis of a concrete case of parent–doctor disagreement in the grey zone using two ethical frameworks: the best interest standard and the zone of parental discretion. Results: Both ethical frameworks entailed similar advantages and challenges. (...) They have the potential 1) to facilitate decision-making because they follow a structured method; 2) to clarify the situation because all relevant ethical issues are explored; and 3) to facilitate reaching an agreement because all parties can explain their views. We identified three main challenges. First, how to objectively evaluate the risk of severe disability. Second, parents’ interests should be considered but it is not clear to what extent. Third, this is a value-laden situation and different people have different values, meaning that the frameworks are at least partially subjective. Conclusions: These challenges do not mean that the ethical frameworks are faulty; rather, they reflect the complexity and the sensitivity of cases in the grey zone. (shrink)

This study used a laboratory experiment with monetary incentives to test the impact of three personal factors (moral reasoning, value orientation and risk preference), and three situational factors (the presence/absence of audits, tax inequity, and peer reporting behavior), while controlling for the impact of other demographic characteristics, on tax compliance. Analysis of Covariance (ANCOVA) reveals that all the main effects analyzed are statistically significant and robustly influence tax compliance behavior. These results highlight the importance of obtaining a proper understanding of (...) these factors for developing effective policies for increasing the level of compliance, and indicate that standard enforcement polices based on punishment alone should be supplemented by an information system that would acquaint tax payers with the compliance level of other tax payers; reinforce the concept of fairness of the tax system among tax payers; and develop programs that enhance and appeal to a taxpayer's moral conscience and reinforce social cohesion. (shrink)

Bernadette M Tobin; Development in Virtues, Journal of Philosophy of Education, Volume 20, Issue 2, 30 May 2006, Pages 201–214, https://doi.org/10.1111/j.1467-9.

L’itinéraire de Jeanne Kœhler-Lumière l’a conduite de la philanthropie à la collaboration avec les pouvoirs publics pour la réalisation d’une politique sociale à Lyon après la Première Guerre mondiale. Fille et sœur d’industriels, elle participe aux œuvres mises en place pour le personnel de l’usine familiale, puis élargit son action en faveur de l’enfance à l’échelle de la ville. Cependant, l’ancrage de la famille Lumière dans le camp de la République laïque isole Jeanne Kœhler-Lumière des milieux traditionnels de la philanthropie (...) conservatrice et catholique. La guerre constitue un tournant durant lequel elle s’engage dans les services de santé, travaillant avec des sommités du monde médical lyonnais. Son expérience et sa notabilité lui valent dans les années 1920 d’être sollicitée par la municipalité radicale en quête de compétences pour impulser une politique sociale. Dame d’œuvres puis ambassadrice du social, Jeanne Kœhler-Lumière illustre une forme originale de participation des femmes à la vie politique. (shrink)

Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley’s Moral Distress Scale and Olson’s Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely (...) correlated with perceptions of ethical climate. Each of the HECS factors (peers, patients, managers, hospitals and physicians) was found to be significantly correlated with moral distress. Based on these findings, we highlight insights for practice and future research that are needed to enhance the development of strategies aimed at improving the ethical climate of nurses’ workplaces for the benefit of both nurses and patients. (shrink)

Bernadette M Tobin; An Aristotelian Theory of Moral Development, Journal of Philosophy of Education, Volume 23, Issue 2, 30 May 2006, Pages 195–211, https://doi.

Most people do their utmost to avoid any and every type of suffering; yet, as this experience-based article shows, Newman, early in life, came to realize from his own illnesses that physical suffering can bring the sufferer to an awareness of the presence of God and so be an important part of personal spiritual development.

Approaches to business ethics can be roughly divided into two streams: ‹codes of behavior’ and ‹forms of subjectification’, with code-oriented approaches clearly dominating the field. Through an elaboration of poststructuralist approaches to moral philosophy, this paper questions the emphasis on codes of behaviour and, thus, the conceptions of the moral and responsible subject that are inherent in rule-based approaches. As a consequence of this critique, the concept of a practice-based ‹ethics of responsiveness’ in which ethics is never final but rather (...) always ‹to come’, is investigated. In such an approach the ethical self is understood as being continuously constituted within power/knowledge relations. Following this line, we ask how one can become a responsible subject while also acknowledging certain limits of full responsibility. We thereby explore responsibility as a considered but unconditional openness in response to the other. (shrink)

Dealing with situations where parents’ views about treatment for their child are strongly opposed to doctors’ views is one major area of ethical challenge in paediatric health care. The traditional approach focuses on the child’s best interests, but this is problematic for a number of reasons. The Harm Principle test is regarded by many ethicists as more appropriate than the best interests test. Despite this, use of the best interests test for intervening in parental decisions is still very common in (...) clinical settings and can lead to confusion. In this paper, I propose the Zone of Parental Discretion as a means of putting into practice the key ideas of the Harm Principle, in a clear, step-by-step process. The Zone of Parental Discretion provides a tool for ethical deliberation by clinicians and ethicists about all situations in which parents and doctors disagree about treatment of a child, whether parents are refusing medically recommended treatment, or requesting non-recommended treatment. (shrink)

Summary With regard to the dynamics of human experience and behavior, Gestalt theoretical psychotherapy (GTP) relies mainly on Kurt Lewin’s dynamic field theory of personality. GTP is carried out by including a re-interpretation of Lewin’s theory in some aspects of psychotherapeutic practice in relation to critical realism. Human experience and behavior are understood to be functions of the person and the environment (including the other individuals therein) in a psychic field (life space), which encompasses both of these mutually dependent factors. (...) The anthropological model of this approach is, therefore, not mono-personal but, a priori, structural and relational in nature. It does not one-sidedly focus on the “inner components” of a person, but on the interrelation of the individual and a given environment, which affects experience and behavior. After a brief introduction of these basic concepts, this lecture will focus especially on Lewin’s concept of tension-systems, which may be considered as the Gestalt theoretical counterpart of Freud’s drive theory. Further, we define the basic assumptions which underlie GTP and explain how the person moves through her/his life experience in terms of Gestalt psychology. (shrink)

Transcending the various formal concepts of life, this captivating book offers a unique overview of life's history, essences, and future. "A masterpiece of scientific writing. You will cherish "What Is Life?" because it is so rich in poetry and science in the service of profound philosophical questions".--Mitchell Thomashow, "Orion". 9 photos. 11 line illustrations.

In lieu of an abstract, here is a brief excerpt of the content:diacritics 30.2 (2000) 25-42 [Access article in PDF] What is Political Feeling? Bernadette Meyler Anthony Cascardi. Consequences of Enlightenment. Cambridge: Cambridge UP,1999. As disaffection with poststructuralism increases, but new paradigms have not yet emerged, theorists have begun to reconsider the ties that current thought maintains with the tradition it critiques, in particular, its affiliations with the Enlightenment. Focus has inevitably fallen on the writings of Immanuel Kant, which (...) in the act of codifying Enlightenment rationality simultaneously initiated its dissolution. Disputes tend to arise, however, over the precise nature and cause of the hairline fracture that prevents Kant's Critiques from attaining the unity to which they aspire. Even greater controversy centers on the advisability of possible responses: should we set the bones, break open the gap, or provide an entirely new limb? In Consequences of Enlightenment, Anthony Cascardi undertakes a detailed discussion of how various theoretical schools interpret the fissure, and the problems posed by their accounts. Not simply remaining content with this critique of critiques, Cascardi presents his own stance, advising that we embrace Kant's recourse to "feeling" in the Critique of Judgment as an inevitable entailment of the Kantian system. Whereas Horkheimer and Adorno's Dialectic of Enlightenment argues that the opposition between Kantian reason and Nietzschean irrationalism represents the undoing of the Enlightenment, Cascardi responds that Kant's own writings encompass the duality. As an essential moment of what he terms the Enlightenment's "aesthetic critique," the resistance that feeling poses to "the unity of experience"--or to the unity of the Critique of Pure Reason and the Critique of Practical Reason--should be embraced. Cascardi further maintains that this "should" entails political consequences, although his text does not itself fully elaborate a vision of what these might be.The fact that such a rich suggestion remains relatively undeveloped is perhaps inevitable in a book of such comprehensive scope. Consequences of Enlightenment is a text that seems to call the reader to the task of continuing the multiple projects that Cascardi has initiated. I will attempt to articulate what those endeavors might be, and to propose points in his work upon which future inquiry could be focused. Because Cascardi's goals are two-pronged--to examine twentieth-century thinkers' Kantian inheritance and to engage directly with the "aesthetic critique" of Kant--it is sometimes difficult to ascertain whether Consequences of Enlightenment attributes certain positions to Kant or to his interpreters. Although this difference might not seem significant given Cascardi's claims about the persistence of Kantian aporias in the work of his inheritors, returning to Kant may allow us to ask how we should proceed in developing the political potentials of aesthetic critique. Two principal questions arise in this regard. The first inquires whether and how one can think aesthetics with politics; in other words, [End Page 25] what is political feeling? The second question provides a more limited point of entry into the same problem by focusing on the Critique of Judgment itself; what politics are entailed respectively by the beautiful and the sublime?Cascardi discusses the Kantian sublime only twice in detail during the course of Consequences of Enlightenment, once in chapter 4, "Communication and Transformation: Aesthetics and Politics in Habermas and Arendt," and for the second time, and most provocatively, in chapter 7, "Feeling and/as Force." In treating Hannah Arendt, who, in her 1970 Lectures on Kant's Political Philosophy, attempted to derive a Kantian account of the political from the Critique of Judgment, Cascardi explains that she tried to complete the Enlightenment by erroneously "turning from the indeterminacy of the aesthetic in Kant to a politics that designates democratic community as its field or object-domain"; he then asserts that, "Specifically, the politics that Arendt would claim to derive from Kant's aesthetics is a democratic politics of the beautiful..." [156]. Subsequently elaborating on the reasons that Arendt overemphasized the beautiful, seemingly at the expense of the sublime, Cascardi writes, "Arendt's tendency to privilege the beautiful over the sublime must be seen as part of her larger effort to construct a rational politics. For this effort, she takes... (shrink)

Recent Developments Content Type Journal Article Pages 113-119 DOI 10.1007/s11673-011-9300-8 Authors Bernadette Richards, University of Adelaide, Adelaide, South Australia Bill Madden, School of Law, University of Western Sydney, Sydney, NSW, Australia Tina Cockburn, School of Law, Queensland University of Technology, Brisbane, Qld, Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 8 Journal Issue Volume 8, Number 2.

Scholars have proposed a number of courses and programs intended to improve the ethical behavior of scientists in an attempt to maintain the integrity of the scientific enterprise. In the present study, we conducted a quantitative meta-analysis based on 26 previous ethics program evaluation efforts, and the results showed that the overall effectiveness of ethics instruction was modest. The effects of ethics instruction, however, were related to a number of instructional program factors, such as course content and delivery methods, in (...) addition to factors of the evaluation study itself, such as the field of investigator and criterion measure utilized. An examination of the characteristics contributing to the relative effectiveness of instructional programs revealed that more successful programs were conducted as seminars separate from the standard curricula rather than being embedded in existing courses. Furthermore, more successful programs were case based and interactive, and they allowed participants to learn and practice the application of real-world ethical decision-making skills. The implications of these findings for future course development and evaluation are discussed. (shrink)

Holobionts are multicellular eukaryotes with multiple species of persistent symbionts. They are not individuals in the genetic sense— composed of and regulated by the same genome—but they are anatomical, physiological, developmental, immunological, and evolutionary units, evolved from a shared relationship between different species. We argue that many of the interactions between human and microbiota symbionts and the reproductive process of a new holobiont are best understood as instances of reciprocal scaffolding of developmental processes and mutual construction of developmental, ecological, and (...) evolutionary niches. Our examples show that mother, fetus, and different symbiotic microbial communities induce or constitute conditions for the development and reproduction of one another. These include the direct induction of maternal or fetus physiological changes, the restructuring of ecological relations between communities, and evolutionary selection against undesirable competitors. The mutual scaffolding and niche constructing processes start early—prior to amniotic rupture. We are evolutionarily, physiologically, and developmentally integrated holobiont systems, strung together through mutual reliance and mutual construction. Bringing the processes of niche construction and developmental scaffolding together to interpret holobiont birth conceptually scaffolds two new directions for research: in niche construction, identifying the evolutionary implications of organisms actively constructing multiple overlapping niches and scaffolds, and in Evolutionary Developmental Biology, characterizing evolutionary and ecological processes as developmental causes. (shrink)

Family members do not have an official position in the practice of euthanasia and physician assisted suicide in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could serve as a starting point (...) for further empirical and ethical inquiry. A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families’ experiences and grief after EAS. 4) Family and ‘the good euthanasia death’ according to Dutch physicians. Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making. (shrink)

Farmers perceive and appraise climate change, related risks and opportunities as well as adaptation measures differently. Such differences are not well understood and rarely considered in extension services, outreach activities and agricultural policies. We aim to develop empirically based farmer types, who differ in their socio-cognitive and emotional processes towards droughts, their expected drought impacts, their appraisal of drought adaptation measures, and their previous and intended implementation of such measures. The Model of Private Pro-Active Adaptation to Climate Change provides the (...) theoretical foundation for a three-phase procedure of semi-structured interviews, a standardized survey and a qualitative workshop. The principal component analysis reveals eight socio-cognitive and emotional processes of relevance for forming the famer types of drought adaptation: perceived opportunities resulting from droughts, perceived effectiveness of drought adaptation measures, negative affect towards droughts, perceived work effort and perceived social approval of drought adaptation measures, fatalism, trust in public measures, and perceived self-efficacy. Cluster analyses of these processes yield four types of Austrian farmers. The social implementers perceive themselves as capable, and drought adaptation measures as effective, socially approved, and effortless. The unaffected profiteers have hardly been affected by droughts and perceive beneficial impacts due to a decline in precipitation. The trusting fearfuls have already experienced severe drought impacts and express intense negative affect towards droughts. The passive fatalists focus on avoidance and do neither trust in important others nor in public measures. The identified farmer types of drought adaptation may support the design of climate and agricultural policy instruments and of tailor-made education and communication programs, for instance to increase self-efficacy and reduce fatalism. (shrink)

Croire ne peut s’appréhender sans son corollaire, douter. Le doute revêt des formes diverses que l’on retrouve en particulier chez les couples en thérapie. Dans ce cadre, pour tenter d’en approcher l’origine et la nature, l’auteur s’appuie sur les concepts d’identification projective, intrusive, adhésive, et de contenance développés par Meltzer. Dans cette perspective, un lien peut être fait entre la relation de couple et celle du bébé à son premier objet. La thérapie de couple est envisagée comme une tentative pour (...) chacun de passer du doute destructeur au doute positif, constructeur, permettant un véritable croire en l’autre et au couple. (shrink)

There is a growing call for greater public involvement in establishing science and technology policy, in line with democratic ideals. A variety of public participation procedures exist that aim to consult and involve the public, ranging from the public hearing to the consensus conference. Unfortunately, a general lack of empirical consideration of the quality of these methods arises from confusion as to the appropriate benchmarks for evaluation. Given that the quality of the output of any participation exercise is difficult to (...) determine, the authors suggest the need to consider which aspects of the process are desirable and then to measure the presence or quality of these process aspects. To this end, a number of theoretical evaluation criteria that are essential for effective public participation are specified. These comprise two types: acceptance criteria, which concern features of a method that make it acceptable to the wider public, and process criteria, which concern features of the process that are liable to ensure that it takes place in an effective manner. Future research needs to develop instruments to measure these criteria more precisely and identify the contextual and environmental factors that will mediate the effectiveness of the different participation methods. (shrink)

Background: The concept of moral distress has been the subject of nursing research for the past 30 years. Recently, there has been a call to move from developing an understanding of the concept to developing interventions to help ameliorate the experience. At the same time, the use of the term moral distress has been critiqued for a lack of clarity about the concepts that underpin the experience. Discussion: Some researchers suggest that a closer examination of how socio-political structures influence healthcare (...) delivery will move moral distress from being seen as located in the individual to an experience that is also located in broader healthcare structures. Informed by new thinking in relational ethics, we draw on research findings from neuroscience and attachment literature to examine the reciprocal relationship between structures and agents and frame the experience of moral distress. Conclusion: We posit moral distress as a form of relational trauma and subsequently point to the need to better understand how nurses as moral agents are influenced by—and influence—the complex socio-political structures they inhabit. In so doing, we identify this reciprocity as a framework for interventions. (shrink)

SummaryA sample of 104 British parents with criminal convictions had an average fertility of 3·91 children as compared with 2·21 for the general population. The result suggests that fertility for criminal behaviour is dysgenic involving an increase in the genes underlying criminal behaviour in the population.

One of the core goals of Digital Health Technologies (DHT) is to transform healthcare services and delivery by shifting primary care from hospitals into the community. However, achieving this goal will rely on the collection, use and storage of large datasets. Some of these datasets will be linked to multiple sources, and may include highly sensitive health information that needs to be transferred across institutional and jurisdictional boundaries. The growth of DHT has outpaced the establishment of clear legal pathways to (...) facilitate the collection, use and transfer of potentially sensitive health data. Our study aimed to address this gap with an ethical code to guide researchers developing DHT with international collaborative partners in Singapore. We generated this code using a modified Policy Delphi process designed to engage stakeholders in the deliberation of health data ethics and governance. This paper reports the outcomes of this process along with the key components of the code and identifies areas for future research. (shrink)

Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and other health care practitioners (...) have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care. (shrink)

“The Role of the Individual in Evolution” is a prescient yet neglected 1941 work by the 20th century’s most important paleontologist, George Gaylord Simpson. In a curious intermingling of explanation and critique, Simpson engages questions that would become increasingly fundamental in modern biological theory and philosophy. Did individuality, adaptation, and evolutionary causation reside at more than one level: the cell, the organism, the genetically coherent reproductive group, the social group, or some combination thereof? What was an individual, anyway? In this (...) introduction, we highlight two points in a wider historical context. First, recognizing the political context of Simpson’s writing profoundly deepens our understanding of the development of his science as the Modern Evolutionary Synthesis infused biology. Second, this story illuminates the emergence of debates around what would eventually come to be called multilevel selection theory. The organism-centered concept of biological individuality defended by Simpson is situated in relation to the then-emerging Synthesis, in which he was a renowned player, and also in relation to the views he opposed: the “metaphysical” ideas of paleontologists such as Henry Fairfield Osborn, who claimed that some evolutionary trends derived from potentialities already implanted in the germplasm; and the organicist ideas of Ralph W. Gerard and the Chicago School of ecologists, which he derided as all too congenial to totalitarianism. We find parallels between the ways that Simpson thought then about human individuality under totalitarianism and the way he thought about individuality in evolution; not that any causal relationship linked the two, but that commonalities of hierarchical structure exist between single entities and groups in both instances. We then trace the subsequent development of Simpson’s political and philosophical takes on the role of the individual in evolution through the 1960s and lightly sketch out the later fate of the organicist ideas of the Chicago School. Simpson’s paper, originally published in the Journal of the Washington Academy of Sciences, is available as supplementary material in the online version of this article, as part of the "Classics in Biological Theory" collection. (shrink)