Background The field of nursing has long been concerned with ethical issues. The history of the nursing profession has a rich legacy of attention to social justice and to societal questions regarding issues of fairness, access, equity, and equality. Some nurses have found that their clinical experiences spur an interest in ethical patient care, and many are now nurse bioethicists, having pursued additional training in bioethics and related fields (e.g., psychology, sociology). Purpose The authors describe how the clinical and research (...) experiences of nurses give them a unique voice in the field of bioethics. Results Authors present reasons for the relative invisibility of nurse bioethicists, compared with physician, theologian, or philosopher bioethicists, as well as current efforts to increase the visibility of nurse bioethicists. They also describe four specific areas where nurse bioethicists have made and continue to make important contributions: as ethics consultants to colleagues in hospitals and other settings; as bioethics researchers or as advisers to researchers conducting trials with human subjects; as educators of trainees, patients and families, healthcare providers, and the public; and in helping to draft humane and ethical policies for the care of vulnerable patients and underserved populations. Conclusion Nurse bioethicists are central to the future goals of healthcare bringing a unique perspective to the day-to-day ethical challenges of both clinical care and research, as well as to the education of health professionals and the public. (shrink)

There has been neglect of systematic conceptual development and empirical investigation within consumer ethics. Scenarios have been a long-standing tool yet their development has been haphazard with little theory guiding their development. This research answers four questions relative to this gap: Do different scenario decision frames encourage different moral reasoning styles? Does the way in which framing effects are measured make a difference in the measurement of the relationship between moral reasoning and judgment by gender? Are true framing effects likely (...) to vary with the situation? and Are true framing effects likely to vary by gender? The conclusions reached were that (1) different scenario frames encourage both types of reasoning, but rule based moral reasoning is dominant regardless of frame, (2) accounting for formal equivalency in the measurement of true framing effects is likely to enhance the interpretation of studies in moral reasoning and judgment, (3) True framing effects are more likely to occur in situations with low to moderate perceived ethicality, and (4) true framing effects are not likely to vary by gender. Explanations as to why these results occurred are discussed. (shrink)

Proponents of numerous recent theories of a person's good hold that a plausible account of the good for a person must satisfy existence internalism. Yet little direct defense has been given for this position. I argue that the principal intuition behind internalism supports a stronger version of the thesis than it might appear--one that effects a "double link" to motivation. I then identify and develop the main arguments that have been or might be given in support of internalism about a (...) person's good, showing how these arguments support this stronger version of internalism. (shrink)

In our everyday lives, we confront a host of moral issues. Once we have deliberated and formed judgments about what is right or wrong, good or bad, these judgments tend to have a marked hold on us. Although in the end, we do not always behave as we think we ought, our moral judgments typically motivate us, at least to some degree, to act in accordance with them. When philosophers talk about moral motivation, this is the basic phenomenon they seek (...) to understand. Moral motivation is an instance of a more general phenomenon—what we might call normative motivation—for our other normative judgments also typically have some motivating force. When we make the normative judgment that something is good for us, or that we have a reason to act in a particular way, or that a specific course of action is the rational course, we also tend to be moved. Many philosophers have regarded the motivating force of normative judgments as the key feature that marks them as normative, thereby distinguishing them from the many other judgments we make. In contrast to our normative judgments, our mathematical and empirical judgments, for example, seem to have no intrinsic connection to motivation and action. The belief that an antibiotic will cure a specific infection may move an individual to take the antibiotic, if she also believes that she has the infection, and if she either desires to be cured or judges that she ought to treat the infection for her own good. All on its own, however, an empirical belief like this one appears to carry with it no particular motivational impact; a person can judge that an antibiotic will most effectively cure a specific infection without being moved one way or another. (shrink)

The idea that normativity and agency are importantly connected goes back at least as far as Kant. But it has recently become associated with a view called “constitutivism.” Perhaps the best-known critique of constitutivism appears in David Enoch’s article, “Agency, Shmagency,” which is the focus of this chapter. His critique of my article, “Agency and the Open Question Argument,” is briefly addressed, explaining why, contrary to his claims, I do not therein defend a form of constitutivism. It is then explained (...) why his “shmagency challenge” does not effectively expose the real challenge faced by those who might wish to develop constitutivist theories. Finally, the chapter considers why we should take seriously the idea that normativity and agency are importantly connected, an idea that neither Enoch’s challenge nor the challenge articulated for constitutivism here does anything to defeat. Enoch has not shown that normativity won’t come from what is constitutive of agency. (shrink)

The effects of psycholinguistic variables on reading development are critical to the evaluation of theories about the reading system. Although we know that the development of reading depends on both individual differences (endogenous) and item-level effects (exogenous), developmental research has focused mostly on average-level performance, ignoring individual differences. We investigated how the development of word recognition in Chinese children in both Chinese and English is affected by (a) item-level, exogenous effects (word frequency, radical consistency, and curricular grade level); (b) subject-level, (...) endogenous individual differences (orthographic awareness and phonological awareness); and (c) their interactive effect. We tested native Chinese (Putonghua)-speaking children (n = 763) in grades 1 to 6 with both Chinese character and English word identification (lexical) decision tasks. Our findings show that (a) there were effects of both word frequency and age of acquisition in both Chinese and English, but these item-level effects generally weakened with increasing age; (b) individual differences in phonological and orthographic awareness each contributed to successful performance; and (c) in Chinese, item-level effects were weaker for more proficient readers. We contend that our findings can be explained by theoretical models that incorporate cumulative learning as the basis for development of item-level effects in the reading system. (shrink)

In his critique of egoism as a doctrine of ends, G. E. Moore famously challenges the idea that something can be someone. Donald Regan has recently revived and developed the Moorean challenge, making explicit its implications for the very idea of individual welfare. If the Moorean is right, there is no distinct, normative property good for, and so no plausible objectivism about ethics could be welfarist. In this essay, I undertake to address the Moorean challenge, clarifying our theoretical alternatives so (...) that we may better decide what to admit into our moral ontology and better assess what may be at stake in whether objectivists treat good or good for (or neither) as fundamental. I compare the Moorean and welfarist pictures of value, providing an account of the form and function of good for. According to this account expresses a distinct relational value that has its source in the value of persons. Good for value is thus a form of extrinsic value that provides agent-neutral reasons for action, and it plays a pervasive normative role in regulating child rearing, guiding individual life choices, and shaping social policy formation. (shrink)

In this essay, I focus on what appear to be Shapiro’s views about the normativity of law, as well as with his surprising claim that law necessarily has a moral aim. I argue that even if Shapiro offers a more compelling reply to the problem of the normativity of law than Hart offers in The Concept of Law, the moves that he makes appear to be equally available to a defender of Hart’s theory, and so in this respect, the planning (...) theory has no particular advantage over the practice theory. As for the Moral Aim Thesis, it appears to be in tension with Shapiro’s positivism. If he is right that law has a moral aim and law claims moral legitimacy, then he should embrace a richer account of the nature and normativity of law than the one that he has offered. (shrink)

In his book, The Solace: Finding Value in Death through Gratitude for Life, Joshua Glasgow recounts his thoughts as he tried to prepare for a conversation about death with his dying mother, whom he hoped to comfort. After rejecting certain possible sources of solace, he argues that our passing away itself has value, which it derives from the meaningfulness of our lives as a whole, and this value can provide the comfort we may seek. I raise a number of difficulties (...) for and questions about Glasgow’s claims, ultimately concluding that even if our passing away had some value, recognizing thiswould add nothing to the solace we may derive from reflecting on the value of our lives themselves. (shrink)

Background The COVID-19 pandemic continues to disrupt every society as SARs-CoV-2 variants surge among the populations. Health care providers are exhausted, becoming ill themselves, and in some instances have died. Indeed, hospitals are struggling to find staff to care for critically ill patients most in need. Previous work has reported on the unending work-related conditions that hospital staff are laboring under and their subsequent mental and physical health strains. Health care providers need support, but it is not clear where that (...) support is to come from. While much research has reported on the COVID-19-related fears of nurses and physicians, fewer studies have focused on supportive features of the hospital work environment and how it may provide relief to front-line health care providers.Purpose This purpose of this study was to explore an often-overlooked resource within hospital systems across the United States—clinical ethicists—and examine their many roles during COVID-19 and the types of ethical issues they addressed with nurses, physicians, administrators, and others.Methods This was a primary analysis of semi-structured, qualitative interviews with 23 clinical ethicists across the United States. The interviews were conducted from November 2020–April 2021 and were audiotaped, transcribed verbatim, and de-identified; both inductive and deductive analyses were used to identify qualitative themes.Results Five major themes were identified: ethical issues that were increasingly more complex, moral distress that was “endemic,” shifting ethical paradigms from the focus on the individual to the population, fostering a supportive environment, and organizational ethics: variation in the value, roles, and policy input of clinical ethicists.Conclusions Our findings report on the integral and expanded role of clinical ethicists at an unprecedented time in our nation, and how they stepped forward to support front-line clinicians in hospitals across the country. (shrink)

Stephen Darwall has recently suggested (following work by Mark Overvold) that theories which identify a person’s good with her own ranking of concerns do not properly delimit the ‘scope’ of welfare, making self-sacrifice conceptually impossible. But whether a theory of welfare makes self-sacrifice impossible depends on what self-sacrifice is. I offer an alternative analysis to Overvold’s, explaining why self-interest and self-sacrifice need not be opposed, and so why the problems of delimiting the scope of welfare and of allowing for self-sacrifice (...) are distinct. If my analysis is correct, desire theories may allow for self-sacrifice however they delimit the scope of welfare. (shrink)

Few bioethicists are educated with a view into nursing. Thus, much of the conceptual and empirical research on ethical issues in nursing practice has been conducted by nurse ethicists themselves and, to a lesser degree, by individuals with a strong interest in nursing ethics. Although this work has internally shaped nursing practice, education, and policy, the broader field of bioethics has seldom examined and acknowledged the everyday ethical concerns of practicing nurses and their important contributions to bioethics discourse. In this (...) special report of the Hastings Center Report —the first to focus on nursing—Christine Grady, Ann Hamric, and I, along with consulting editor Nancy Berlinger, strive to give voice to the contributions of nurses in addressing some of our obstinate everyday ethics and health policy challenges. (shrink)

In this discourse analysis of a social-skills intervention, the narratives of a girl with autism and her female peers were analyzed. Some 162 narratives were identified in 12 hours of video, which documented an eight-week program. Using conversation/talk-in-interaction analysis methods, we determined that over 60% of peers’ narratives were cooperatively completed by group members compared to less than 20% of Cindy’s. In contrast, a majority of Cindy’s narratives were cooperatively sanctioned. Analysis of these unsuccessful narratives revealed that: 1) peers often (...) contest Cindy’s narratives if they are about a restricted interest; 2) Cindy often notices her peers’ resistance but persists with her storytelling activity; and 3) peers’ sanctioning becomes more intense over time. We claim that Cindy’s autism-related behaviors manifest themselves in inflexible interactions that systematically lead to her exclusion. This study emphasizes that storytelling is a fundamental tool that girls use to socialize with one another, which has implications for autism intervention practices. (shrink)

Cross-national traffic of feminist ideas have contributed to a growth of the international women’s movement and has shaped national movements. These processes have only recently become the subject of study and theoretical discussion. The theoretical models that have been developed so far fail to take into account the complex nature of intercultural communication. No attention is paid to problems of interpretation and translation that may occur and how ‘adopters’ use the example of others. Instead, this article proposes an empirically grounded, (...) alternative model of the process, based on the cases of women’s organizations against sexual violence in the Netherlands and Spain. The author’s approach focuses on the processes of communication – the relationship between source and followers and the conditions that facilitate or impede communication – and the conditions that lead to adaptation. (shrink)

Successful marketing efforts and professional sales encounters often depend on consumer involvement in the purchase decision process itself, which in turn may impact firm performance. Despite the importance of consumer involvement, research has yet to fully explain the relationship between consumer personality characteristics and the nature of consumer purchase involvement. This study explores the degree to which consumer perception of salesperson ethical treatment helps explain the relationship between consumer personality characteristics and nature of involvement. Data were collected from a large (...) sample of working adults placed in two scenario-based positive professional sales encounters featuring an important purchase decision. The results indicated that adult consumers’ personality characteristics functioned through judgment of salesperson ethical treatment to affect the nature of purchase involvement. Specifically, consumer judgment of salesperson ethical treatment fully mediated a positive relationship between internal locus of control and cognitive involvement. By comparison, consumer judgment of a salesperson ethical treatment partially mediated the positive relationship between emotional awareness and cognitive involvement. The above findings were similar for informational and relational salesperson customer-orientated scenarios. Key implications for selling professionals and sales organizations are discussed, such as augmenting consumers’ self-assessments to increase their perceptions of salesperson ethics and purchase involvement. The limitations and recommendations for future research are also presented. (shrink)

Dr. Brown, a hospitalist, admits Mark, a patient transferred from a local jail for management of cellulitis. The patient, who was taken into custody two days prior to hospital admission, has a history of intravenous heroin use. Mark explains that he had been prescribed buprenorphine-naloxone maintenance therapy for opioid use disorder for several years prior to being arrested and had not used other opioids during that time. As a policy, the jail where Mark is detained does not prescribe opioid agonists, (...) and his maintenance therapy was stopped upon his arrival there. Dr. Brown discovers that Mark is diaphoretic and appears distressed. Mark's symptoms suggest to Dr. Brown that, in addition to having cellulitis, Mark is actively withdrawing from opioids. Mark tells Dr. Brown that he has felt “horrible” since his buprenorphine-naloxone therapy was stopped and that he now has intense cravings for opioids. He asks Dr. Brown to help alleviate the withdrawal symptoms. Dr. Brown, who is accustomed to treating opioid withdrawal with opioid replacement therapy, wonders if she should initiate ORT for Mark while he is in the hospital. (shrink)

The World Anti-Doping Code (2021) includes a substance on the prohibited list if it meets at least two of the following: (1) it has the potential to enhance or enhances sport performance; (2) it represents an actual or potential health risk to the athlete; (3) it violates the spirit of sport. This paper uses a case study to illustrate points of tension between this code and enhancements that are appropriate to ban; we argue that there are banned drugs (e.g., acetazolamide (...) and dexamethasone) the use of which we have good reason to not only permit but encourage for high-altitude sports. Drawing on lessons from this case study, we propose a reformulation of the Code that requires (1–3) be met but offers preferable ways of unpacking conditions (1) and (3) – and in a way that better preserves how the spirit of sport condition should be indexed to particular sports. Our formulation is inclusive enough to rule in drugs like acetazolamide and dexamethasone as permissible in high-altitude sports while at the same time ruling out problem cases – including many drugs already on the prohibited list. The result is an attempted alignment between the conditions specified and those drugs that should be banned. (shrink)

In spoken interactions, interlocutors carefully plan and time their utterances, minimising gaps and overlaps between consecutive turns. Cross-linguistic comparison has indicated that spoken languages vary only minimally in terms of turn-timing, and language acquisition research has shown pre-linguistic vocal turn-taking in the first half year of life. These observations suggest that the turn-taking system may provide a fundamental basis for our linguistic capacities. The question remains however to what extent our capacity for rapid turn-taking is determined by modality constraints. The (...) avoidance of overlapping turns could be motivated by the difficulty of hearing and speaking at the same time. If so, turn-taking in sign might show greater toleration for overlap. Alternatively, signed conversations may show a similar distribution of turn-timing as spoken languages, thus avoiding both gaps and overlaps. To address this question we look at turn-timing in question-answer sequences in spontaneous conversations of Sign Language of the Netherlands. The findings indicate that although there is considerable overlap in two or more signers' articulators in conversation, when proper allowance is made for onset preparation, post-utterance retraction and the intentional holding of signs for response, turn-taking latencies in sign look remarkably like those reported for spoken language. This is consistent with the possibility that, at least with regard to responses to questions, speakers and signers follow similar time courses in planning and producing their utterances in on-going conversation. This suggests that turn-taking systems may well be a shared cognitive infrastructure underlying all modern human languages, both spoken and signed. (shrink)

During a period in which institutions have been refashioned to meet the demands of a complex social and political economy, the No Child Left Behind Act (NCLB) has helped to alter the public educational system. As scholars and researchers examine the material effects of NCLB, efforts to improve the educational system and its effects must also explore the relationship between policy and racial ideologies including discursive fantasies. This article examines the relationship between NCLB and racial fantasies of Black youth as (...) problematic others in order to help education reform scholarship and advocacy examine the violence of NCLB. (shrink)

Past research (Lawson, 2004; Nonis & Swift, 2001) has revealed a correlation between academic and business ethics. Using a sample survey, this study extends this inquiry by examining the role of dispositional variables (neuroticism, extraversion, and conscientiousness) and academic honesty on business ethics perceptions. Results indicate that (1) neuroticism and conscientiousness were positively related to more ethical perceptions in a work context, and (2) academic honesty partially mediated the relationship between conscientiousness and business ethics. Implications to business practitioners and educators (...) are discussed as well as directions for future research. (shrink)

Jean-Paul Sartre was one of the most important philosophers of the twentieth century. His influence extends beyond academic philosophy to areas as diverse as anti-colonial movements, youth culture, literary criticism, and artistic developments around the world. Beginning with an introduction and biography of Jean-Paul Sartre by Matthew Eshleman, 42 chapters by a team of international contributors cover all the major aspects of Sartre's thought in the following key areas: Sartre's philosophical and historical context Sartre and phenomenology Sartre, existentialism and ontology (...) Sartre and ethics Sartre and political theory Aesthetics, literature and biography Sartre's engagements with other thinkers. The Sartrean Mind is the most comprehensive collection on Sartre published to date. It is essential reading for students and researchers in philosophy, as well as for those in related disciplines where Sartre's work has continuing importance such as literature, French studies, and politics. (shrink)

Clarifying the effects of biliteracy on cognitive development is important to understanding the role of cognitive development in L2 learning. A substantial body of research has shed light on the cognitive factors contributing to biliteracy development. Yet, not much is known about the effect of the degree of exposure to biliteracy on cognitive functions. To fill this research void, we measured three categories of biliteracy skills jointly and investigated the effects of biliteracy skill performance in these three categories on cognitive (...) skills in Chinese L1 children who were exposed to English as L2 beginning at age 3 or in grade 3. In this cross-sectional study, 10 parallel Chinese and English language, reading, and cognitive–linguistic measures were administered to emerging Chinese–English bilingual children in grade 3 and grade 6. The results revealed that early exposure to Chinese–English biliteracy enhanced cognitive skills but with a cost of a slight delay in performance on Chinese L1 language skills in grade 3. Importantly, the present findings suggest that, in addition to universal and developmental processes, the cumulative effect of early and sustained bi-scriptal exposure enhances working memory and attention in school children. (shrink)

Contextual learning pervades our perception and cognition and plays a critical role in adjusting to aversive and stressful events. Our ability to memorise spatial context has been studied extensive...

The Covid‐19 pandemic has highlighted many of the difficult ethical issues that health care professionals confront in caring for patients and families. The decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. Our focus is on the implications for nurses, who are the largest global health care workforce but whose perspectives are not always fully considered. This essay discusses three overarching ethical issues that create a myriad of concerns and will likely affect nurses globally (...) in unique ways: the safety of nurses, patients, colleagues, and families; the allocation of scarce resources; and the changing nature of nurses’ relationships with patients and families. We urge policy‐makers to ensure that nurses’ voices and perspectives are integrated into both local and global decision‐making so as to minimize the structural injustices many nurses have faced to date. Finally, we urge nurses to seek sources of support throughout this pandemic. (shrink)

Purpose/methods: This study investigated the relationship between ethics education and training, and the use and usefulness of ethics resources, confidence in moral decisions, and moral action/activism through a survey of practicing nurses and social workers from four United States (US) census regions. Findings: The sample (n = 1215) was primarily Caucasian (83%), female (85%), well educated (57% with a master's degree). no ethics education at all was reported by 14% of study participants (8% of social workers had no ethics education, (...) versus 23% of nurses), and only 57% of participants had ethics education in their professional educational program. Those with both professional ethics education and in-service or continuing education were more confident in their moral judgments and more likely to use ethics resources and to take moral action. Social workers had more overall education, more ethics education, and higher confidence and moral action scores, and were more likely to use ethics resources than nurses. Conclusion: Ethics education has a significant positive influence on moral confidence, moral action, and use of ethics resources by nurses and social workers. (shrink)

Scholars have a history of crossing intellectual borders (Abbott, 2001). In particular, educators draw from a diversity of intellectuals upon which to base our understanding of, for example, schools and society, curriculum content, teaching, and learning. In addition to icons such as Marx, James, Freud, and Dewey, the works of the Frankfurt School (e.g., Horkheimer, Adorno, Marcuse), Foucault, Gilligan, Derrida, Gramsci, West, Arendt, and Fraser, just to name a few, have been used to guide our scholarship and practice. However, with (...) the exception of few scholars (e.g., Peters & Ghiraldelli, 2001), one of America's most controversial scholars,1 Richard Rorty, has been largely ignored. This situation is unfortunate .. (shrink)

Background: Caring for patients with serious illness may severely strain clinicians causing distress and probable poor patient outcomes. Unfortunately, clinician distress and its impact historically has received little attention. Research purpose: The purpose of this article was to investigate the nature of clinician distress. Research design: Qualitative inductive dimensional analysis. Participants and research context: After review of 577 articles from health sciences databases, a total of 33 articles were eligible for analysis. Ethical considerations: This study did not require ethical review (...) and the authors adhered to appropriate academic standards in their analysis. Findings: A narrative of clinician distress in the hospital clinician in the United States emerged from the analysis. This included clinicians’ perceptions and sense of should or the feeling that something is awry in the clinical situation. The explanatory matrix consequence of clinician distress occurred under conditions including: the recognition of conflict, the recognition of emotion, or the recognition of a mismatch; followed by a process of an inability to feel and act according to one’s values due to a precipitating event. Discussion: This study adds three unique contributions to the concept of clinician distress by (1) including the emotional aspects of caring for seriously ill patients, (2) providing a new framework for understanding clinician distress within the clinician’s own perceptions, and (3) looking at action outside of a purely moral lens by dimensionalizing data, thereby pulling apart what has been socially constructed. Conclusion: For clinicians, learning to recognize one’s perceptions and emotional reactions is the first step in mitigating distress. There is a critical need to understand the full scope of clinician distress and its impact on the quality of patient-centered care in serious illness. (shrink)

It is not an exaggeration to say that Allan Gibbard is one of the most significant contributors to philosophy over the last five decades. Gibbard's work covers an impressive number of subfields within philosophy, including ethics, philosophy of language, decision theory, epistemology, and metaphysics. It also engages with, and makes significant contributions to, work from the natural and social sciences. This volume is not a collection of artifacts from past decades of philosophy. Instead, it is a collection of essays that (...) each make a significant contribution to contemporary work in philosophy. This reflects the fact that Gibbard's work has not only had a massive influence on past discussion in philosophy but also continues to influence new directions of philosophical research. With contributions from: Sara Aronowitz, Simon Blackburn, Paul Boghossian, David Braddon-Mitchell, Nate Charlow, Stephen Darwall, Jamie Dreier, Billy Dunaway, Melissa Fusco, Sona Ghosh, Allan Gibbard, Bill Harper, Paul Horwich, Zoë Johnson King, Tristram McPherson, Howard Nye, Lauren Olin, Caleb Perl, David Plunkett, Peter Railton, Connie Rosati, Mark Schroeder, Alex Silk, Daniel J. Singer, Brian Skyrms, and Seth Yalcin. (shrink)

Istarted my nursing career as a pediatric nurse working with children and their families at the Children's Hospital National Medical Center in Washington, DC. My first position was a staff nurse on a busy surgical floor called 4 Blue. To some degree, and as I reflect on that time, one is never truly prepared as a newly minted nurse or physician for the realities of becoming a clinician. So it was for me. I initially worked a rotational schedule of two (...) weeks of days and two weeks of nights where textbook pediatric cases became everyday experiences. Caring for the most complex of childhood illnesses included patients with osteosarcoma, Wilms tumor, neuroblastoma, short gut syndrome, biliary... (shrink)

Moral distress is indeed distressing for those who experience it and whose sense of integrity can be shaken by exposure to events or situations that test their core values and ethical belief system...

Who carries the burden of proof in analytic philosophical debates, and how can this burden be satisfied? As it turns out, the answer to this joint question yields a fundamental challenge to the very conduct of metaphysics in analytic philosophy. Empirical research presented in this book indicates that the vastly predominant goal pursued in analytic philosophical dialogues lies not in discovering truths or generating knowledge, but merely in prevailing over one’s opponents. Given this goal, the book examines how most effectively (...) to allocate and discharge the burden of proof. It focuses on premises that must prudently be avoided because a burden of proof on them could never be satisfied, and in particular discusses unsupportable bridge premises across inference barriers, like Hume’s barrier between ‘is’ and ‘ought’, or the barrier between the content of our talk or thought, and the world beyond such content. Employing this content/world barrier for a critical assessment of mainstream analytic philosophical methods, this book argues that we must prudently avoid invoking intuitions or other content of thought or talk in support of claims about the world beyond content, that is, metaphysically significant claims. Yet as content-located evidence is practically indispensable to metaphysical debates throughout analytic philosophy, from ethics to the philosophy of mathematics, this book reaches the startling conclusion that all such metaphysical debates must, prudently, be terminated. (shrink)

Importance Informed consent is essential to ethical, rigorous research and is important to recruitment and retention in cancer trials.Objective To examine cancer clinical trial (CCT) participants’ perceptions of informed consent processes and variations in perceptions by cancer type.Design and Setting and Participants Cross-sectional survey from mixed-methods study at National Cancer Institute–designated Northeast comprehensive cancer center. Open-ended and forced-choice items addressed: (1) enrollment and informed consent experiences and (2) decision-making processes, including risk-benefit assessment. Eligibility: CCT participant with gastro-intestinal or genitourinary, hematologic-lymphatic (...) malignancies, lung cancer, and breast or gynecological cancer (N = 334).Main Outcome Measures Percentages satisfied with consent process and information provided; and assessing participation’s perceptions of risks/benefits. Multivariable logistic or ordinal regression examined differences by cancer type.Results Most patient-participants felt well informed by the consent process (more than 90% overall and by cancer type) and. most (87.4%) reported that the consent form provided all the information they wanted, although nearly half (44.8%) reported that they read the form somewhat carefully or less. More than half (57.9%) said that talking to research staff (i.e., the consent process) had a greater impact on participation decisions than reading the consent form (2.1%). A third (31.1%) were very sure of joining in research studies before the informed consent process (almost half of lung cancer patients did—47.1%). Most patients personally assessed the risks and benefits before consenting. However, trust in physicians played an important role in the decision to enroll in CCT.Conclusions and Relevance Cancer patients rely less on written features of the informed consent process than on information obtained from the research staff and their own physicians. Research should focus on information and communication strategies that support informed consent from referring physicians, researchers, and others to improve patient risk-benefit assessment and decision-making. (shrink)

BackgroundAdolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents’ experience of challenges identified by adolescents ages 10–19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania. MethodsAn exploratory descriptive qualitative (...) design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10–19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis.ResultsQualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame.ConclusionLack of adolescents’ involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania. (shrink)

Using information collected from a convenience sample of graduate and undergraduate students affiliated with a Midwestern university in the United States, this study determined the extent to which gender is related to consumers’ moral philosophies and ethical intentions. Multivariate and univariate results indicated that women were more inclined than men to utilize both consequence-based and rule-based moral philosophies in questionable consumption situations. In addition, women placed more importance on an overall moral philosophy than did men, and women had higher intentions (...) to behave ethically. The marketing and practical implications of these findings are discussed, and the limitations of the research are presented along with several suggestions for future inquiry, which could advance current understanding of consumer ethics. (shrink)