Nurse practitioners (NPs) are increasingly called on to provide high‐quality health‐care particularly for people who face significant barriers to accessing services. Although discourses of social justice have become relatively common in nursing and health services literature, critical analyses of how NP roles articulate with social justice issues have received less attention. In this study, we examine the role of NPs from a critical social justice perspective. A critical social justice lens raises morally significant questions, for example, why certain individuals and (...) groups bear a disproportionate burden of illness and suffering; what social conditions contribute to disparities in health and social status; and what social mandate NPs ought to develop in response to these realities. In our analysis, we draw on lessons learned from the initial Canadian experience with the introduction of NPs in the 1970s to consider the renewed and burgeoning interest in NPs in Canada, Australia and elsewhere. As we argue, a critical social justice perspective (in addition to the biomedical foci of NP practice) will be essential to sustaining long‐term, socially responsive NP roles and achieving greater equity in health and health‐care. (shrink)

At the request of the Midwest Bioethics Center (MBC), we surveyed nurses' and physicians' attitudes and needs regarding Hospital Ethics Committees (HECs). The primary objective of this research project was to inform the practices and policies of the Ethics Committee Consortium of the Bioethics Center.Four thousand eight hundred and twenty-nine surveys were distributed to the medical and nursing staff of eight Kansas City metropolitan area hospitals. One thousand and fifty-five surveys were returned, representing a response rate of 21%.

When reasoning about deontic rules (what one may, should, or should not do in a given set of circumstances), reasoners adopt a violation‐detection strategy, a strategy they do not adopt when reasoning about indicative rules (descriptions of purported state of affairs). I argue that this indicative‐deontic distinction constitutes a primitive in the cognitive architecture. To support this claim, I show that this distinction emerges early in development, is observed regardless of the cultural background of the reasoner, and can be selectively (...) disrupted at the neurological level. I also argue that this distinction emerged as a result of selective pressure favouring the evolution of reasoning strategies that determine survival within dominance hierarchies. (shrink)

We show that a popular class of connectionist models (which we label 'first order connectionism') looks unlikely to provide the kind of resources required by the hypothesis. We examine some alternative hybrid models that seem more promising. Finally, we raise a more purely philosophical issue concerning the conditions under which a being can count as a genuine believer or cognizer.".

Donation after circulatory determination of death (DCDD) is an accepted practice in the United States, but heart procurement under these circumstances has been debated. Although the practice is experiencing a resurgence due to the recently completed trials using ex vivo perfusion systems, interest in thoracoabdominal normothermic regional perfusion (TA-NRP), wherein the organs are reanimated in situ prior to procurement, has raised many ethical questions. We outline practical, ethical, and equity considerations to ensure transplant programs make well-informed decisions about TA-NRP. We (...) present a multidisciplinary analysis of the relevant ethical issues arising from DCDD-NRP heart procurement, including application of the Dead Donor Rule and the Uniform Definition of Death Act, and provide recommendations to facilitate ethical analysis and input from all interested parties. We also recommend informed consent, as distinct from typical “authorization,” for cadaveric organ donation using TA-NRP. (shrink)

Next SectionWhilst there has been considerable debate about the fit between moral theory and moral reasoning in everyday life, the way in which moral problems are defined has rarely been questioned. This paper presents a qualitative analysis of interviews conducted with 15 general practitioners (GPs) in South Australia to argue that the way in which the bioethics literature defines an ethical dilemma captures only some of the range of lay views about the nature of ethical problems. The bioethics literature has (...) defined ethical dilemmas in terms of conflict and choice between values, beliefs and options for action. While some of the views of some of the GPs in this study about the nature of their ethical dilemmas certainly accorded with this definition, other explanations of the ethical nature of their problems revolved around the publicity associated with the issues they were discussing, concern about their relationships with patients, and anxiety about threats to their integrity and reputation. The variety of views about what makes a problem a moral problem indicates that the moral domain is perhaps wider and richer than mainstream bioethics would generally allow. (shrink)

Ethics consultants and critical care clinicians reflect on Seattle’s early experience as the United States’ first epicenter of COVID-19. We discuss ethically salient issues confronted at UW Medicin...

The most well-known goal of non-invasive prenatal testing (NIPT) is still to determine whether or not a fetus has trisomy 21. Since women often terminate the pregnancy upon a positive result, there is concern that the use of NIPT contributes to discrimination against persons with disabilities. If this concern is justified, it could have an impact on the wider social acceptability of existing testing practices and their potential further expansion. This paper demonstrates four different versions of the discrimination worry, indicates (...) how international policy papers have reacted to them, and identifies the ethically most relevant feature of the concern. (shrink)

Dominance hierarchies are ubiquitous in the societies of human and non-human animals. Evidence from comparative, developmental, and cognitive psychological investigations is presented that show how social dominance hierarchies shaped the evolution of the human mind, and hence, human social institutions. It is argued that the pressures that arise from living in hierarchical social groups laid a foundation of fundamental concepts and cognitive strategies that are crucial to surviving in social dominance hierarchies. These include recognizing and reasoning transitively about dominance relations, (...) fast-track learning of social norms (permissions, prohibitions, and obligations), detecting violations of social norms (cheating), monitoring reciprocal obligations, and reading the intentions of others. (shrink)

Although we theorize that nurses ‘make a difference’ to patient outcomes and speculate that this happens because nurses ‘care’, there is so far little evidence to support this nebulous claim. Efforts to promote care as the defining characteristic of nursing, and an ‘ethic of care’ as the ethical basis of nursing, have sparked debate within the discipline. This debate has resulted in a polarization that has effectively stalled productive discourse on the issues. Moreover, the focus on care has been at (...) the expense of understanding the true nature of the relationship between caring and the broader base of ethical knowledge that underpins nursing and that must underpin nursing if it is a viable practice profession. This paper used the framework of philosophical argument to explore the moral and ethical foundations of nursing from the perspective of personal and public morals, and responsive nurse–patient relationships as the reflection of ethical nursing knowledge. The foundation of ethical nursing knowledge is the personal moral sense that resides within the individual and that nurses hold in common with others. Personal moral knowledge is transformed into disciplinary ethical knowledge specific to nursing through disciplinary consensus. Responsive relationships are conceptualized in the nursing literature as founded on three essential elements: respect, trust, and mutuality. These three elements are grounded in ethical nursing knowledge; therefore responsive nurse–patient relationships reflect both personal moral knowledge and disciplinary ethical knowledge. By facilitating the articulation of ethical nursing knowledge in practice, responsive relationships connect theory, ethical knowledge, and clinical outcomes. (shrink)

The Michigan Department of Community Health stores almost 4 million dried blood spot specimens in the Michigan Neonatal Biobank. DBS are collected from newborns under a mandatory public health program to screen for serious conditions. At 24 to 36 hours of age, a few drops of blood are taken from the baby’s heel and placed on a filter paper card. The card is sent to the state public health laboratory for testing. After testing, MDCH retains the spots indefinitely for the (...) personal use of the patient and also, pursuant to a 2000 law, for possible research. (shrink)

The article explores the problem of preferable technological changes in the context of work. To this end, it addresses the ‘why’ (motives and values) and the ‘how’ (organizational forms) of automation from a normative perspective. Concerning the ‘why,’ automation processes are currently mostly driven by values of economic efficiency. Yet, since automation processes are part of the basic structure of society, as is the division of labor, considerations of justice apply to them. As for the ‘how,’ the article suggests ‘fair (...) hybrid cooperation’ as an alternative ideal to guide automation priorities. It is achieved when the division of labor between humans and machines does not hinder, and preferably enables, workers’ experience of certain primary qualities in their work activity. By analogy with Rawls’ primary goods, these are qualities that it is necessary for every worker to experience in order to pursue their life plans: security, self-direction, self-development, dignity, and recognition. According to this criterion, the tasks to automate first are those hindering these contributive primary qualities. This provides us with a normative vocabulary and a standard to orient automation decisions but also to assess existing organizational forms and envisage alternative cooperative imaginaries. To illustrate how the ideal may play out in the real world, the article concludes with a ‘fair hybrid cooperation test’ and a nurse bots case for meaningful work. (shrink)

Understanding the causes of maize landrace loss in farmers’ field is essential to design effective conservation strategies. These strategies are necessary to ensure that genetic resources are available in the future. Previous studies have shown that this loss is caused by multiple factors. In this longitudinal study, we used a collection of 93 maize landrace accessions from Morelos, Mexico, and stored at the International Maize and Wheat Improvement Center (CIMMYT) Maize Germplasm Bank, to trace back to the original 66 donor (...) families after 50 years and explore the causes for why they abandoned or conserved their seed lots. We used an actor-centered approach, based on interviews and focus group discussions. We adopt a Multi-Level Perspective framework to examine loss as a process, accommodating multiple causes and the interactions among them. We found that the importance of maize landrace cultivation had diminished over the last 50 years in the study area. By 2017, 13 families had conserved a total of 14 seed lots directly descended from the 1967 collection. Focus group participants identified 60 accessions that could still be found in the surrounding municipalities. Our findings showed that multiple interconnected changes in maize cultivation technologies, as well as in maize markets, other crop markets, agricultural and land policies, cultural preferences, urbanization and climate change, have created an unfavorable environment for the conservation of maize landraces. Many of these processes were location- and landrace-specific, and often led to landrace abandonment during the shift from one farmer generation to the next. (shrink)

Volume 20, Issue 3, March 2020, Page 6-8.

Jean Dominique Bauby, former editor of Elle, suffereda stroke to his brain stem that left him with locked-in syndrome. Subsequently, through blinking his left eye, he writes his memoirof this experience, The Diving Bell and the Butterfly. Thispaper explores the meaning of embodiment, especially as one'sbody bears upon one's personal identity. It explores the variouschallenges and threats to selfhood that result from Bauby'sexperience and recounts how Bauby rises to the challenge throughhis memory and imagination.

The ethical obligation to provide a reasonably safe discharge option from the inpatient setting is often confounded by the context of homelessness. Living without the security of stable housing is a known determinant of poor health, often complicating the safety of discharge and causing unnecessary readmission. But clinicians do not have significant control over unjust distributions of resources or inadequate societal investment in social services. While physicians may stretch inpatient stays beyond acute care need in the interest of their patients (...) who are experiencing homelessness, they must also consider the implications of using an inpatient hospital bed for someone without the attendant level of medical need. Caring for patients in an inpatient setting when they no longer require acute care means fewer beds for acute care patients. And when a patient who is experiencing homelessness declines a medically safer option such as a skilled nursing facility, then clinicians may be faced with the sole option of discharge to the street, which raises troubling questions of nonmaleficence and social justice. Here we investigate the different forms of injustice that play out when patients are discharged to the street, and offer a map of the interwoven ethical responsibilities of clinicians, hospitals, and skilled nursing facilities. (shrink)

The target article by Camisha Russell continues the important discussion about race, racism and bioethics that has appeared in AJOB for the past few years. Russell critically examines how un...

Étude du matériel d'une tombe de la fin du protoattique ancien (contenant une oinochoé, une coupe, une tasse, une loutrophore, un dé et une table à jeu miniature) et de tombes de la fin du VIIe siècle avec un cratère ovoïde, des amphores, et un petit dinos à têtes d'influence corinthienne.

The volume is dedicated to the work of Chajim H. Steinthal (1823-1899), who in the second half of the nineteenth century was a prominent philosophical linguist and also an eminent teacher of the "Science of Judaism." Together with Moritz Lazarus he founded the discipline of "Voelkerpsychologie" ("psychology of nations").

The article explores the normative concerns raised for gig workers by algorithmic management (AM), by embracing an ethnographically sensitive approach to philosophical inquiry. Inspired by Michel de Certeau’s concept of ‘tactics’, the article suggests interpreting workers’ attempts to ‘trick the algorithm’ and escape some of AM’s constraints as ways to reclaim agency, in the absence of suitable organizational conditions for its affirmative exercise. The kind of agency specifically deployed by workers in cooperative settings is referred to as ‘contributive agency’, broadly (...) defined as workers’ control over their contribution in multiple dimensions – epistemic, relational, participatory and protective. Contributive agentic capacities are not mere properties of agents, but organizationally mediated capacities that can be more or less enabled or constrained depending on the contributive context. It is argued that below a certain threshold, AM’s agency-constraining features are objectionable and desirable agency-enabling organizational conditions are identified in the four dimensions. (shrink)

Classifying human beings according to race and ethnicity may seem straightforward to some but it, in fact, belies a difficult process. No standard procedure exists for categorizing according to race and ethnicity, calling into question the variables’ use in research. This article explores the use of race and ethnicity variables in the nursing research literature. Content analysis was conducted of a sample of 337 original research studies published in Nursing Research from the years 1952, 1955, and then every 5 years (...) through to 2000. Of the 337 research articles reviewed, 167 mentioned race, ethnicity, or their 81 code words or phrases. Out of the 167 articles, 153 used race or ethnicity to describe the study sample, and 45 of the 167 articles included race or ethnicity as an element of data analysis. Throughout the sample, there was substantial inconsistency related to race and ethnicity categorization, meanings of the terms, and use of these variables. Specificity related to conceptual assumptions, definitions, and context was missing and, as a result, data interpretation and understanding are suspect. The integrity of nursing knowledge requires that nurse researchers recognize and address the difficulties inherent in using race and ethnicity in health research. (shrink)

Competent patients’ refusals of nursing care do not yet have the legal or ethical standing of refusals of life-sustaining medical therapies such as mechanical ventilation or blood products. The case of a woman who refused turning and incontinence management owing to pain prompted us to examine these situations. We noted several special features: lack of paradigm cases, social taboo around unmanaged incontinence, the distinction between ordinary versus extraordinary care, and the moral distress experienced by nurses. We examined this case on (...) the merits and limitations of five well-known ethical positions: pure autonomy, conscientious objection, paternalism, communitarianism, and feminism. We found each lacking and argue for a ‘negotiated reliance’ response where nurses and others tread as lightly as possible on the patient’s autonomy while negotiating a compromise, but are obligated to match the patient’s sacrifice by extending themselves beyond their usual professional practice. (shrink)

Many Western nations are emphasizing the importance of population health across health care delivery organizations and education systems. Despite significant momentum to integrate population health into nursing practice, a parallel effort to examine how these efforts impact practicing nurses' views of their professional role and work identity has not occurred. This secondary qualitative analysis, employing an abductive approach, explored processes public health nurses use in creating and maintaining their work identity through three organizing themes: narrative self‐identity, mandated identity, and identity (...) as struggle. The analysis was based on interview data collected from 30 US public health nurses residing in 17 states. ‘Being a real nurse’ describes public health nurses' efforts to balance a contradictory work identity where at times they are expected to focus on populations and at other times, on individuals. The identity work revealed through this study should be further explicated and specific strategies developed for stabilizing a work identity for public health nurses, as well as for any nurse charged with a population health role. (shrink)

Cet article, dans une perspective sémiopragmatique, interroge la disposition graphique des textes comme élément d'interface avec le lecteur. Il s'agit plus précisément d'examiner comment les signes organisateursde l'écrit - cadres, bords et marges- interviennent dans l'acte de lecture.What does the graphic organization of texts have to do with the mental construction of the reader ? How do indexical signs give him a direction ? Between semiotics and psychology, they remind us that the body and perception are important even through the (...) use of codified social models. (shrink)

In this commentary, we raise two issues. First, we argue that in any species, the comparative study of metacognitive abilities must be approached from a developmental perspective and not solely from the adult end state. This makes it possible to explore the trajectories by which different species reach their phenotypic outcome and whether different cognitive systems interact over developmental time. Second, using our research comparing different genetic disorders in humans, we challenge the authors' claim that it is unparsimonious to interpret (...) the same performance in humans and animals in qualitatively different ways, because even the same overt behaviour in different groups of humans can be sustained by different underlying cognitive processes. (shrink)

Examines the various explanations that have been given for Los Angeles Mayor Tom Bradley's losses in the 1982 and 1986 California gubernatorial campaigns. The authors offer important advice for all black candidates running against whites for office today.

The reference to man as animal rationale has traditionally been used to highlight rationality as marking a qualitative gap between human beings and animals. This assumption has been questioned in a similar way by the approaches of Alasdair MacIntyre and John Dewey, who agree that before we can make adequate sense of man’s rationality, we have to draw attention to animality as the common trait of human and nonhuman living beings. However, while MacIntyre takes human dependence to show ‘why human (...) beings need the virtues,’ Dewey considers it as a starting point to argue for the necessity of what he calls ‘natural piety.’ In my paper I shall elaborate some implications of this di_erence, guided by the question whether Dewey’s answer contributes to a re-invention of religious categories into the naturalistic view on rationality and morality. (shrink)

In an earlier article published in this journal I challenge Reydon and Scholz’s (2009) claim that Organizational Ecology is a non-Darwinian program. In this reply to Reydon and Scholz’s subsequent response, I clarify the difference between our two approaches denoted by an emphasis here on the careful application of core Darwinian principles and an insistence by Reydon and Scholz on direct biological analogies. On a substantive issue, they identify as being the principal problem for Organizational Ecology, namely, the inability to (...) identify replicators and interactors “ of the right sort” in the business domain; this is also shown to be easily addressed with reference to empirical studies of business populations. (shrink)

The parable of the widow and the unjust judge is unique to Luke. It forms part of three other parables shedding light on the coming of the Son of Man. It also bears striking resemblances with the parable of the friend at midnight, but unlike the friend of midnight, persistence is a focal point for interpreting the parable. There is an intersection between the parable of the unjust judge and resilience theory. Resilience may be understood as the ability to have (...) positive, better-than-expected outcomes in the face of adversity. The widow persists and manages to persuade the judge to aid her plight. Accordingly, this article explored the intersections between resilience theory and the parable of the unjust judge as an interpretive aid.Contribution: This article explored a multidisciplinary approach to Luke 18:1–8. Resilience theory was incorporated with exegesis, thereby offering another hermeneutical lens to the text that enriches our understanding. (shrink)

Cet article présente une série d’épigrammes hellénistiques généralement peu étudiées et quelques témoignages littéraires et épigraphiques attestant le culte d’Aphrodite en tant que protectrice de la navigation. Les temples de la déesse occupaient souvent une position littorale, non parce qu’ils étaient des lieux où la « prostitution sacrée » était pratiquée, mais plutôt en raison de l’association d’Aphrodite avec la mer et de son rôle de patronne des marins. La protection qu’elle accordait était destinée à tous les navigateurs, y compris (...) la marine et les commerçants, et est attestée dans toute la Méditerranée, depuis la période archaïque jusqu’à la période hellénistique. De plus, les textes examinés révèlent un lien métaphorique entre les rôles d’Aphrodite comme protectrice de la navigation d’une part et comme déesse de la sexualité d’autre part. (shrink)