Background and Objectives Primary care providers (PCPs) report decreased job satisfaction and high levels of burnout, yet little is known about their experience of moral distress. The aim of this study was to gain insight into the experiences of PCPs regarding moral distress including causative factors and proposed mitigation strategies. Methods This qualitative pilot study used semi-structured interviews to identify causes of moral distress in PCPs in an academic family medicine department. Interviews were analyzed using conventional content analysis. Results Of (...) 35 eligible participants, 12 completed the study (34% participation rate). Most were white, female, and had practiced for less than 10 years. Four PCPs had considered leaving their position due to moral distress. Participants identified five causes of moral distress: policies and procedures that conflict with patient needs, the unpredictable nature of primary care, need to “bend the rules,” lack of accountability, and lack of support staff. Six internal conflicts made resolving morally distressing situations difficult: perceived powerlessness, sense of responsibility, socialization to follow orders, emotional toll of the job, competing obligations, and fear of mistakes. Conclusions These findings matched themes in the current literature and identified an unbending infrastructure. This, coupled with the chaotic nature of primary care, resulted in frequent moral distress. Participants offered solutions to reduce and mitigate moral distress (also similar with current literature) and suggested moral distress and burnout are closely linked. (shrink)

Kolbe and de Melo-Martin’s (2023) arguments draw attention to what is most useful about moral distress—identifying its causes is at least as important as measuring its severity. Jameton’s original...

Randolph Bourne was only thirty-two when he died in 1918, but he left a legacy of astonishingly mature and incisive writings on politics, literature, and culture, which were of enormous influence in shaping the American intellectual climate of the 1920s and 1930s. This definitive collection, back in print at last, includes such noted essays as "The War and the Intellectuals," "The Fragment of the State," "The Development of Public Opinion," and "John Dewey's Philosophy." Bourne's critique of militarism and (...) advocacy of cultural pluralism are enduring contributions to social and political thought, sure to have an equally strong impact in our own time. In their introduction and preface, Olaf Hansen and Christopher Lasch provide biographical and historical context for Bourne's work. (shrink)

This book looks at America as Bourne knew it in the last 14 years of the 19th century and the first 18 years of the 20th. He died young at 32. This book shows radical thoughts about democracy and immigration and has inspired many since it was written.

How can we talk meaningfully about the past if it does not exist to be talked about? What gives time its direction? Is time travel possible? This defence of presentism - the view that only the present exists - makes an original contribution to a fast growing and exciting debate.

In neocolonial contexts of globalization, the epistemological terrain of radical diversity poses significant ethical challenges to transnational feminisms. In view of historical associations between knowledge and discourses of love which were conditioned by imperialist brands of humanism and benevolence under colonialism, this paper argues for a deconstructionist approach to conceptualizing love in relation to knowledge and for an ethics that severs the association with benevolence, instead making alterity the basis for its account.

Arthur Prior states that ‘It will be/was/is that p’ is true iff ‘p’ will be/was/is true, and that is all that needs to be said about the matter. This appears to avoid any need to invoke the existence of non-present entities and accounts for tensed truths with very little ontological cost. However, as David Lewis notes, this version of presentism gives the wrong results when applied to numerically quantified tensed propositions. I show how presentism can accommodate numerical quantification by introducing (...) a more appropriate tense operator. Further, I argue that it is implausible to think that we can have a primitive understanding of it; the correct semantics involves quantification over past and future times. I go on to show what kind of ontology can complement this semantic story, whilst remaining presentist in nature. (shrink)

Bridging disciplines have much to teach us about how to combine analytical tools to tackle problems and questions that cross traditional disciplinary boundaries. This article uses examples from the older bridging disciplines of geography and anthropology in order to consider what the relatively young undertaking labeled “interdisciplinary studies” can learn from their long existence. It explains what is meant by the fallacy of nomothetic claim and considers the fruitful production of answers and solutions by viewing process (methodology) not domain (academic (...) turf), as the key to interdisciplinary success. Staking claim to interdisciplinarity is shown to be unproductive while finding the need for interdisciplinary approaches and following the mandates of that need in the pursuit of solutions to problems and questions strengthens both the disciplines and the development of interdisciplinary studies. (shrink)

This article presents experiential reflections on the spiritual tasks for the last stage of human life. These tasks—experiencing escalating losses, accepting growing dependence on others, reframing the meaning of one’s life, and finding purpose even as one slowly lets go of life—are challenging, at least in part because they are counter-cultural for twenty-first century Americans. Exploring the spiritual tasks of aging towards death is necessary and important work for both aging elders and those who accompany them on the last stage (...) of their life’s journey. (shrink)

This paper develops an inventory and conceptual map of espoused organizational values. We suggest that espoused values are fundamentally different to other value forms as they are collective value statements that need to coexist as a basis for organizational activity and performance. The inventory is built from an analysis of 3112 value items espoused by 554 organizations in the UK and USA in both profit and not-for-profit sectors. We distil these value items into 85 espoused value labels, and these are (...) assessed in terms of their similarity and difference through judgements made by 53 experienced individuals. The resulting conceptual map facilitates the evaluation of values which are espoused at the organizational level, as opposed to aggregations of personal values, an important distinction that is often ignored in the literature. This analysis identifies a number of distinct areas of emphasis occupied by espoused values. In particular, the richness of value labels that relates to broader ethical issues may be aimed at external stakeholder management, but also may have an increasing influence on organizational behaviour as they are embedded into organizational practices. By advancing our understanding of espoused values, through an analysis of those being used in practice, we provide a means by which future research into organizational values and ethical issues can progress. (shrink)

The concept of emotional intelligence has grown in popularity over the last two decades, generating interest both at a social and a professional level. Concurrent developments in nursing relate to the recognition of the impact of self‐awareness and reflexive practice on the quality of the patient experience and the drive toward evidence‐based patient centred models of care. The move of nurse training into higher education heralded many changes and indeed challenges for the profession as a whole. Traditionally, nurse education has (...) been viewed as an essentialist education, the main emphasis being on fitness for practice and the statutory competencies. However, the transfer into the academy confronts the very notion of what constitutes this fitness for practice.Many curricula now make reference in some way to the notion of an emotionally intelligent practitioner, one for whom theory, practice and research are inextricably bound up with tacit and experiential knowledge. In this paper we argue that much of what is described within curriculum documentation is little more than rhetoric when the surface is scratched. Further, we propose that some educationalists and practitioners have embraced the concept of emotional intelligence uncritically, and without fully grasping the entirety of its meaning and application. We attempt to make explicit the manner in which emotional intelligence can be more realistically and appropriately integrated into the profession and conclude by suggesting a model of transformatory learning for nurse education. (shrink)

What can we learn about the world from engaging with fictional time-series--stories involving time travellers, recurring and rewinding time, and foreknowledge of the future? Do they show us radical alternative possibilities concerning the nature of time, or do they show that even the impossible can be represented in fiction? Neither, so this book argues. Defending the view that a fiction represents a single possible world, the authors show how apparent representations of radically different time-series can be explained in terms of (...) how worlds are represented without there being any fictional world which has such a time-series. In this way, the book uses the complexities of fictional time to get to the core of the relation between truth in fiction and possibility. It provides a logic and metaphysics to deal with the fact that fictions can leave certain features of their fictional worlds indefinite, and draws comparisons and connections between fictional and scientific representations and hypotheses. (shrink)

Is there any difference between playing video games in which the player’s character commits murder and video games in which the player’s character commits pedophilic acts? Morgan Luck’s “Gamer’s Dilemma” has established this question as a puzzle concerning notions of permissibility and harm. We propose that a fruitful alternative way to approach the question is through an account of aesthetic engagement. We develop an alternative to the dominant account of the relationship between players and the actions of their characters, and (...) argue that the ethical difference between so-called “virtual murder” and “virtual pedophilia” is to be understood in terms of the fiction-making resources available to players. We propose that the relevant considerations for potential players to navigate concern (1) attempting to make certain characters intelligible, and (2) using aspects of oneself as resources for homomorphic representation. (shrink)

This essay suggests that while Antony Duff's model of criminal punishment as secular penance is pregnant with possibilities for theological reception and reflection, it proceeds by way of a number of separations that are brought into question by the penitential traditions of Christianity. The first three of these—between justice and mercy, censure and invitation, and state and victim, constrain the true communicative character of his account of punishment. The second set of oppositions, between sacrament and virtue, interior character and external (...) action, and formal and moral reconciliation, subject the model of state punishment as secular penance to problematic liberal and libertarian constraints. A postsecular analogy, outlining a theology of the invitational nature of divine judgment, and drawing on Thomas Aquinas's account of penance as both sacrament and virtue, is proposed. (shrink)

The Principle of Procreative Beneficence (PB) holds that when a couple plans to have a child, they have significant moral reason to select, of the possible children they could have, the child who is most likely to experience the greatest wellbeing – that is, the most advantaged child, the child with the best chance at the best life.1 PB captures the common sense intuitions of many about reproductive decisions. PB does not posit an absolute moral obligation – it does not (...) dictate what people must do. Instead it holds that there is a significant moral reason to select the best child, but one that must be weighed against other reasons.Recent research suggests that it may become possible to derive gametes (eggs and sperm) from human stem cells in vitro, a process which we will term in vitro gametogenesis (IVG). The ability to create large numbers of eggs or sperm through IVG greatly increases our capacity to select the best child possible. (shrink)

This article introduces and defines the Health in All Policies concept and examines existing state legislation, with a focus on California. The article starts with an overview of HiAP and then analyzes the status of HiAP legislation, specifically addressing variations across states. Finally, the article describes California's HiAP approach and discusses how communities can apply a HiAP framework not only to improve health outcomes and advance health equity, but also to counteract existing laws and policies that contribute to health inequities.

Personification has received little philosophical attention, but Daniel Nolan has recently argued that it has important ramifications for the relationship between fictional representation and possibility. Nolan argues that personification involves the representation of metaphysically impossible identities, which is problematic for anyone who denies that fictions can have impossible content. We develop an account of personification which illuminates how personification enhances engagement with fiction, without need of impossible content. Rather than representing an identity, personification is something that is done with representations—a (...) matter of use rather than content—and involves only a comparison of possibilities. We illustrate our account using the personification of death in the film Meet Joe Black, and show that there are no grounds for taking it to be fictionally true that there is a metaphysically impossible identity between Death and death. (shrink)

We thank the commentators for their thoughtful engagement with our paper.1 In different ways, they make the same substantial point: our suggested interventions are not enough to solve the problems of organisational failure. On this we wholeheartedly agree. Organisational failure in healthcare is complex and multifaceted, it cannot be solved by one intervention in medical education. We did not intend to imply that our proposals alone would solve organisational failure, and this positioning misconstrues the aims of our paper. We had (...) more modest ambitions, we wanted to shift the analytical emphasis away from the individual and explore the implications raised by our analysis for our piece of the jigsaw—medical education. Having stepped away from such grand claims, the commentators make some valid points to which we would like to respond more specifically. Jesudason makes the distinction that normalisation of deviance (NoD) is well suited to understand institutional misfeasance but not malfeasance.2 We are inclined to agree; NoD can do some things but not all. Likewise, …. (shrink)

Courts and legislatures are increasingly being called upon to restrict the autonomy of pregnant women by requiring them to behave in ways that others determine are best for the fetuses they carry. The state should not attempt to transform pregnant women into ideal baby‐making machines. Pregnant women make decisions about their behavior in the context of the rest of their lives, with all the attendant complexities and pressures. Our interest in helping future children by improving prenatal care would best be (...) furthered by helping pregnant women to make informed, less constrained choices, not by punishing women or depriving them of choices altogether. (shrink)

A recent paper(1) describing the stage‐specific loss of ubiquitin (UBQ) and ubiquitinated proteins (UBQ‐Ps) during pollen development has raised some interesting questions regarding our understanding of the regulation of protein turnover during cellular differentiation and the specialized development of the pollen grain. The authors, Callis and Bedinger(1), describe experiments in which the profiles of free and protein‐conjugated ubiquitin were examined during pollen development. UBQ and UBQ‐Ps were immunologically detected in extracts of microspores and maturing pollen of maize at six developmental (...) stages. Their results remarkably demonstrate that UBQ and UBQ‐Ps decline to barely detectable levels during the final stages of pollen development. (shrink)

Most of us would want to say that it is true that Socrates taught Plato. According to realists about past facts,1 this is made true by the fact that there is, located in the past, i.e., earlier than now, at least one real event that is the teaching of Plato by Socrates. Presentists, however, in denying that past events and facts exist2 cannot appeal to such facts to make their past-tensed statements true. So what is a presentist to do?

Concerns regarding corporate ethics have grown steadily throughout the past decade. In order to remain competitive, many organizational leaders are faced with the challenge of creating an ethical environment within their organization. A model is presented showing the process and elements necessary for the institutionalization of organizational ethics. The transformational leadership style lends itself well to the creation of an ethical environment and is suggested as a means to facilitate the institutionalization of corporate ethics. Finally, the benefits of using transformational (...) leadership are demonstrated through the components of a psychological contract, organizational commitment, and ethical culture to institutionalize organizational ethics. (shrink)

Drawing from our interdisciplinary qualitative study of LGBTI conservative Christians and their allies, we name an especially toxic form of shame—what we call sacramental shame—that affects the lives of LGBTI and other conservative Christians. Sacramental shame results from conservative Christianity's allegiance to the doctrine of gender complementarity, which elevates heteronormativity to the level of the sacred and renders those who violate it as not persons, but monsters. In dispensing shame as a sacrament, nonaffirming Christians require constant displays of shame as (...) proof that LGBTI church members love God and belong in the community. Part of what makes this shame so harmful is that parents and pastors often dispense it with sincere expressions of care and affection, compounding the sense that one's capacity to give and receive love is damaged. We foreground LGBTI Christian movements to overcome sacramental shame by cultivating nonhubristic pride, and conclude by discussing briefly their new understandings of love and justice that could have far‐reaching benefits. (shrink)