"These essays make a splendid book. Ignatieff's lectures are engaging and vigorous; they also combine some rather striking ideas with savvy perceptions about actual domestic and international politics.

Background Over the past few decades, moral distress has been examined in the nursing literature. It is thought to occur when an individual has made a moral decision but is unable to act on it, often attributable to constraints, internal or external. Varying definitions can be found throughout the healthcare literature. This lack of cohesion has led to complications for study of the phenomenon, along with its effects to nursing practice, education and targeted policy development. Objectives The aim of this (...) analysis was to uncover unique definitions of moral distress as found in the nursing literature and to examine the relationship between these definitions. Research Design and Context Morse’s method of concept clarification was applied given the large body of literature which includes definitions, descriptions and measurements of the concept in research. The steps include (a) conducting a literature review; (b) analysing the literature; and (c) identifying, describing, comparing, and contrasting attributes, antecedents and consequences of each category. Findings Each of the 18 included studies described constraints in their definition of moral distress, whether implied or explicitly stated. External constraints are widely described as obstacles outside of the individual, whether institutional, systemic or situational, while internal constraints are located within the individuals themselves and are described as personal limitations, failings or weakness of will. Conclusion Upon reviewing these definitions, we determined that the term ‘internal constraints’ is problematic due to the emphasis of responsibility on the individual experiencing moral distress. We propose an alteration to ‘internal characteristics’ that will assume less responsibility of change from the individual to place a heavier onus on systemic and institutional constraints. (shrink)

We respond to a Letter to the Editor regarding "Principlism and contemporary ethical considerations for providers of transgender health care." We address criticisms by Castle & Klein (2024) of blatant fatphobia related to the ethical elements concerning BMI restrictions for gender-affirming surgery. Our response corrects several mischaracterizations of the article and clarifies our position. My co-authors and I remain focused on advocating for patient-centered, ethically sound, evidence-based, and equitable healthcare policies.

This paper is intended to stimulate debate amongst stakeholders in the international research community on the topic of returning individual genetic research results to study participants. Pharmacogenetics and disease genetics studies are becoming increasingly prevalent, leading to a growing body of information on genetic associations for drug responsiveness and disease susceptibility with the potential to improve health care. Much of these data are presently characterized as exploratory (non‐validated or hypothesis‐generating). There is, however, a trend for research participants to be permitted (...) access to their personal data if they so choose. Researchers, sponsors, patient advocacy groups, ethics committees and regulatory authorities are consequently confronting the issue of whether, and how, study participants might receive their individual results. Noted international ethico‐legal guidelines and public policy positions in Europe and the United States are reviewed for background. The authors offer ‘Points‐to‐Consider’ regarding returning research results in the context of drug development trials based on their knowledge and experience. These considerations include: the clinical relevance of data, laboratory qualifications, informed consent procedures, confidentiality of medical information and the competency of persons providing results to participants. The discussion is framed as a benefit‐to‐risk assessment to balance the potential positive versus negative consequences to participants, while maintaining the integrity and feasibility of conducting genetic research studies. (shrink)

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender (...) diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

ABSTRACT This paper is intended to stimulate debate amongst stakeholders in the international research community on the topic of returning individual genetic research results to study participants. Pharmacogenetics and disease genetics studies are becoming increasingly prevalent, leading to a growing body of information on genetic associations for drug responsiveness and disease susceptibility with the potential to improve health care. Much of these data are presently characterized as exploratory (non‐validated or hypothesis‐generating). There is, however, a trend for research participants to be (...) permitted access to their personal data if they so choose. Researchers, sponsors, patient advocacy groups, ethics committees and regulatory authorities are consequently confronting the issue of whether, and how, study participants might receive their individual results. Noted international ethico‐legal guidelines and public policy positions in Europe and the United States are reviewed for background. The authors offer ‘Points‐to‐Consider’ regarding returning research results in the context of drug development trials based on their knowledge and experience. These considerations include: the clinical relevance of data, laboratory qualifications, informed consent procedures, confidentiality of medical information and the competency of persons providing results to participants. The discussion is framed as a benefit‐to‐risk assessment to balance the potential positive versus negative consequences to participants, while maintaining the integrity and feasibility of conducting genetic research studies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:IntroductionSpatial, Environmental, and Ecocritical Approaches to Holocaust MemoryEmily-Rose Baker (bio), Michael Holden (bio), Diane Otosaka (bio), Sue Vice (bio), and Dominic Williams (bio)The successful implementation of genocide during the Holocaust depended on the spatial organisation of mass murder. From the concentrated ghettos and camps delimited by walls and barbed wire to the open fields and camouflaged forests where victims were shot en masse, Anne Kelly Knowles et al. (...) argue, specific locations, patterns of migration, deportation and evacuation, and other spatial elements such as scale, were all central to the Nazi regime's creation of a "comprehensive geography of oppression."1 This is hardly surprising given the biopolitical logics and colonial fantasies underpinning Lebensraum ('living space'), the territorial concept guiding the genocidal aims of the Third Reich, which designated zones of life as well as the inverse on the European continent. The Holocaust was also experienced spatially by its victims, who were forced to navigate new (and at times familiar) sites and landscapes as those of genocide, and whose testimonies in the aftermath of the event conjured these very places in detail.In recent years, the spaces of the Holocaust have been variously revisited, reconstructed, and reimagined within Holocaust studies scholarship. As a broader part of the 'spatial turn' in the humanities, Holocaust scholars have increasingly employed spatial perspectives of the event to deepen our understanding of the environments in which the Holocaust took place and the transformation of these spaces over time—particularly in the fields of history and social science.2 While drawing on diverse modes of spatialisation from interdisciplinary perspectives, contributions from these fields have tended to privilege methods we might describe as variously 'forensic,' including mapping, model-making, and investigations of material traces of the past.3 This work has resulted in many significant insights, not only into the [End Page 1] contexts and structures of Nazi genocide and the perpetrator imaginings of space, but also the experiences of victims and survivors.4Another significant body of work has attended to space and culture within Holocaust contexts. From early on in the postwar period, particular locations and buildings became identified with the Holocaust, such as the notorious entrance guard house at Auschwitz-Birkenau, which appears on countless book covers as well as within films and artworks. Engaging with spatial insights and methodologies from the perspective of cultural and memory studies, scholars have attested to the production and mnemonic significance of these and less well-known sites, as well as the symbolic spatial worlds and experiences to which they give rise. These include Paul Jaskot and Gavriel Rosenfeld, who have turned respectively to Holocaust and post-Holocaust architectures as commonly overlooked sites of history and memory. Drawing attention to the construction of Holocaust space, Jaskot shows how reading architecture 'as process' rather than static structures laden with symbolic meaning reveals unique histories of forced labor in which "the goals of the SS intersected with victims' experience."5 Rosenfeld demonstrates the ways in which spaces built in response to Nazi genocide after 1945 have been variously "imbued with Jewish significance" by their users and creators, resulting in the rise to prominence of Jewish-identified architects.6 Along similar lines, Michael Meng's work has explored the ways in which Jews and gentiles interact with ruined synagogues, cemeteries and Jewish districts as important remnants of pre-war Jewish life in the post-war period in German and Polish cities.7Studies such as those noted above have tended to focus on cities and public buildings, as well as state and civic policy. But as the spatial histories and geographies of the Holocaust have helped to show, extermination often took place in rural settings (mostly located in Central and Eastern Europe), such as the killing fields where Jews were shot en masse; the forests where victims hid and were hunted by Germans and local collaborators; or the open spaces of the dissolving Reich through which former concentration camp inmates were forced to march during the final year of the war—sites in which, owing to less contained spatial dynamics, violence played out differently.8These kinds of sites, which are sparsely documented and often simply thought of... (shrink)

Background:Moral distress is a significant concern for nurses as it can lead to burnout and intentions to leave the profession. Pediatric nurses encounter stressful and ethically challenging situations when they care for suspected victims of child maltreatment. Data on pediatric nurses’ moral distress are limited, as most research in this field has been done in adult inpatient and intensive care units.Aim:The purpose of this study was to describe pediatric nurses’ moral distress and evaluate the impact of caring for suspected victims (...) of child maltreatment on nurses’ moral distress, burnout, and intention to leave. Design and method: This descriptive cross-sectional correlational study was conducted in a mid-Atlantic, urban area Magnet pediatric level I trauma center that cares for over 1800 cases of suspected child maltreatment annually. An anonymous electronic survey was sent to all the nurses working at the hospital.Ethical considerations:Institutional Review Board approval was received from the first author’s university and the hospital where the study was conducted.Findings:Overall, nurses ( N = 146) reported low levels of moral distress with a mean score of 59.54 (SD = 49.22) and a range of 0–300 on the Moral Distress Scale Neonatal–Pediatric version. Although the frequency of caring for suspected child maltreatment victims did not affect nurses’ moral distress, caring for victims with fatal maltreatment contributed to nurses’ intention to leave, χ2(1) = 5.35, p = 0.02.Conclusion:The results of this study add to the understanding of moral distress in pediatric nursing. Caring for victims with fatal maltreatment impacts pediatric nurses’ intention to leave. (shrink)

How do young children learn how to talk about ethical concepts, such as fairness and equity? The current research assesses the effects of philosophy-based anti-bias lessons aimed at three to five-year-olds in a laboratory preschool and explores the relationship between socioemotional skills, language development, and understanding of ethical concepts. The constructivist curriculum was grounded in storybook lessons with corresponding activities. In a pre-posttest design, we interviewed children before and after lessons in fairness education that included book reading, related games, and (...) philosophical discussions. We found that children showed a significant increase in comprehension of equity-related terms and skin color awareness, and we found a positive relationship between children’s observed levels of community membership skills and their receptive vocabulary. In addition, receptive vocabulary skills predicted participant’s skin color awareness and their ability to tell a fairness narrative involving skin color following the lessons. The current study provides a framework for teachers to integrate ethical reasoning into a preschool curriculum and identifies some abilities occurring earlier than predicted by Jean Piaget. Given the divisive political climate surrounding anti-bias education, we hope that the present study encourages educators to put social emotional learning at the forefront of preschool pedagogy. (shrink)

This major essay collection takes a fresh look at how differences among people matter for music and musical thought.

Illness narratives invite practitioners to understand how biomedical and traditional health information is incorporated, integrated, or otherwise internalized into a patient’s own sense of self and social identity. Such narratives also reveal cultural values, underlying patterns in society, and the overall life context of the narrator. Most illness narratives have been examined from the perspective of European-derived genres and literary theory, even though theorists from other parts of the globe have developed locally relevant literary theories. Further, illness narratives typically examine (...) only the experience of illness through acute or chronic suffering (and potential recovery). The advent of biomedical disease prevention methods like post- and pre-exposure prophylaxis (PEP and PrEP) for HIV, which require daily pill consumption or regular injections, complicates the notion of an illness narrative by including illness prevention in narrative accounts. This paper has two aims. First, we aim to rectify the Eurocentrism of existing illness narrative theory by incorporating insights from African literary theorists; second, we complicate the category by examining prevention narratives as a subset of illness narratives. We do this by investigating several narratives of HIV prevention from informants enrolled in an HIV prevention trial in Kenya and Uganda in 2022. (shrink)

Health-worker migration, commonly called "medical brain drain", refers to the mass migration of trained and skilled health professionals from low-income to high-income countries. This is currently leaving a significant number of poor countries, particularly in sub-Saharan Africa, with critical staff shortages in the healthcare sector. A broad consensus exists that, where medical brain drain exacerbates such shortages, it is unethical, and this review presents the main arguments underpinning this view. Notwithstanding the general agreement, which policies are justifiable on ethical grounds (...) to tackle brain drain and how best to go about implementing them remains controversial. The review offers a discussion of the specific ethical issues that have to be taken into account when deciding which policy measures to prioritise and suggests a strategy of policy implementation to address medical brain drain as a matter of urgency. (shrink)

A recent target article in the American Journal of Bioethics (AJOB) considered the right of transgender (trans) children to access pubertal suppression (Priest 2019). We were concerned by publicati...

Communicative Understandings of Women's Leadership Development: From Ceilings of Glass to Labyrinth Paths, edited by Elesha L. Ruminski and Annette M. Holba, weaves the disciplines of communication studies, leadership studies, and women's studies to offer theoretical and practical reflection about women's leadership development in academic, organizational, and political contexts. This work claims a space for women's leadership studies and acknowledges the paradigmatic shift from discussing women's leadership using the glass ceiling to what Eagly and Carli identify as the labyrinth of (...) leadership. (shrink)

Editors’ Note:As a matter of policy, the editors believe that publishing several reviews of selected texts is a valuable exercise which will enable a cross-section of views to be aired. The recently published second edition of the National Academy of Sciences’ report “On Being a Scientist” was considered an appropriate text for such treatment. The reviewer, Kenneth D. Pimple, Ph.D., is a Research Associate at the Poynter Center for the Study of Ethics and American Institutions and a Visiting Lecturer in (...) the American Studies Program, both at Indiana University. He has been involved with training faculty members to teach ethics since 1989 and is the project director of “Teaching Research Ethics: A Workshop at Indiana University,” with funding from the Department of Education’s Fund for the Improvement of Postsecondary Education. Her interests include nerve development and regeneration. Her research is in the area of analytical chemistry and emphasizes spectroscopic techniques. (shrink)

Inequality causes a variety of social ills, which give egalitarians reasons for concerns of justice. In particular, inequality is deemed to undermine people’s fundamental moral capacity of self-respect. In this paper, we explore the complex relationship between inequality and self-respect from a philosophical and an empirical angle, arguing that a theory of justice should take both into account. To this purpose, we first clarify the normative objection to inequality from the alleged erosion of self-respect. Then, we elaborate on empirical findings (...) showing the crucial role that ‘relative deprivation’ plays in the causal mechanism that connects inequalities to the erosion of self-respect. We conclude that this role is best understood in philosophical terms as a form of deprivation that affects thesignificance that people attach to the value of the choices they make. (shrink)

Farmers’ markets (FMs) represent a crucial player in urban food systems, being the interconnection of local agricultural production and consumption, and serving as spaces for both economic exchange and community building. Despite their transformative potential, there is a scarcity of research that comprehensively investigates the dynamics of FMs network structure and the influence of the actors shaping FMs. The present article delves into the network of relationships within FMs in the Italian city of Bologna. This study adopts the Social Network (...) Analysis (SNA) methodology applied with the Net-Map tool. The research objectives are to visualise the underlying network structure, map the dynamics, and identify the key actors who play pivotal roles in Bologna’s FMs and their level of influence. The research carried out interviews with ten FMs stakeholders, revealing the network of relationships between 54 actors, divided into three categories—civil society, food economy and public administration. Actors were linked by a total of 428 relationships across three types of networks: support, economic, and hindering. Findings indicate a strong support network structure characterised by varying degrees of centrality among different actors. Farmers emerge as a central node due to their pivotal role in providing fresh, local produce. Additionally, local institutions contribute significantly to FMs resilience and growth. Our research demonstrates the importance of recognising the embeddedness of FMs within the local context. By understanding the network structure and influential actors in FMs, policymakers can devise more effective policies for promoting local agriculture, and enhancing the sustainability of urban–rural exchanges. In conclusion, the present study offers valuable insights into the network dynamics of FMs, highlighting their crucial role in the sustainable development of urban and local food systems. (shrink)

The concept of voluntariness permeates the ethics and politics of migration and is commonly used to distinguish refugees from migrants. Yet, neither the precise nature and conditions of voluntariness nor its ethical significance for migrant rights and state obligations has received enough attention. The articles in this collection move the debate forward by demonstrating the complex ethical judgments involved in delineating voluntary from forced migration and in drawing out its political and institutional implications. In addition to highlighting the interplay between (...) the voluntary and nonvoluntary elements of migration over time and across different sites of the migration journey, they provide a nuanced account of the various conditions of voluntariness and they challenge common ideas about its normative political consequences. (shrink)

Michael Blake holds that liberal states are precluded from introducing compulsory medical service to improve access to health care under conditions of critical health worker shortage. "Emergency circumstances" are the only exception when the suspension of liberty may be justified. I argue that there are three problems with Blake's emergency justification of compulsory service. First, his concept of emergency is vague. Second, his account does not really rely on emergency as much as liberty. Third, his conception of permissible restrictions of (...) liberty is too narrow. I argue that liberties may be limited to some degree, temporarily, for the sake of attaining the capacities necessary for the exercise of liberties and for safeguarding the social conditions of the right to health. I conclude that in poor societies, temporarily delaying emigration through a highly qualified compulsory medical service can sometimes be justified. (shrink)

European Journal of Philosophy, Volume 30, Issue 2, Page 503-514, June 2022.

The author analyses the development of the views of A. Sirácky from the second half of the 1960s on the role of philosophy and its relationship to the newly established sociology. It was a period, when the most part of the humanities felt themselves free and independent. During the normalisation period this process was violently interrupted. The author's point is, that A. Sirácky as a representative of Slovak intellectual elite also took part in this process, enforced from outside. In spite (...) of certain criticism against Marxist dogmatism he himself in his conception pursued consequently a dogma, according to which both sociology and philosophy are ideological disciplines. (shrink)

Should immigrants have fewer cultural and language rights than citizens and long-settled groups, and if so, on what moral ground? In the first part of the paper, we develop a novel critique of Kymlicka’s account of voluntary cultural rights alienation, arguing that it is only plausible in the context of emigration, not immigration. We argue that the choice to immigrate cannot be considered voluntary without it being sufficiently clear to the migrant what her rights and duties will be in the (...) new society. If so, then voluntariness cannot morally ground a particular rights regime in the destination country. Any such rights regime must be justified on independent moral grounds. Secondly, we argue that voluntariness can play a different role in a normative argument for cultural rights-differentiation between citizens and denizens. It can i) mitigate the overall injustice of differential treatment; and it can ii) instantiate the justice of how rules apply to the immigrant in a reasonably just society. Thirdly, we sketch an alternative moral grounding of cultural and language rights differentiation that rests, not on voluntariness, but on a contextual analysis of the relevant interests involved. While the protection of these relevant interests gives us reasons to prioritize the language(s) of long-settled groups in many cases, there is no general case for restricting the full recognition of language and culture to long-settled groups. (shrink)

The immigration debate in political theory has produced a series of accounts that justify the state’s right to exclude potential immigrants, where the right of self-determination figures prominently. We challenge two prominent accounts of the self-determination-based right to exclude and defend a circumscribed right to exclude and a corollary duty to admit immigrants, based on our ‘people relationship goods’ account of self-determination. Our conception reconciles the moral claims of global opportunity migrants with the well-being and non-alienation interests of the locals. (...) It therefore provides a principled answer to the philosophical question underlying pressing political conflicts today, namely what is the permissible scope of exclusion by self-determining political communities, in light of weighty global moral demands of inclusion. (shrink)

In this article, we defend a normative theory of prenatal equality of opportunity, based on a critical revision of Rawls's principle of fair equality of opportunity . We argue that if natural endowments are defined as biological properties possessed at birth and the distribution of natural endowments is seen as beyond the scope of justice, Rawls's FEO allows for inequalities that undermine the social conditions of a property-owning democracy. We show this by considering the foetal programming of disease and the (...) possibility of germ-line modifications. If children of lower socioeconomic background are more likely to develop in a poor foetal environment and germ-line enhancements are available only to the rich, initial inequalities between the rich and the poor would grow, and yet FEO would be satisfied. In order to avoid the problem, we propose a revised FEO principle omitting any reference to the comparison of natural endowments. Our revised FEO requires that institutions mitigate social class effect from reproduction and gestation to the greatest extent compatible with parental freedoms and the value of the family. (shrink)

Showing that a radical feminist analysis cuts across class, race, sexuality, region, and religion, the varied contributors in this collection reveal the global reach of radical feminism and analyze the causes and solutions to patriarchal oppression.

In our article, we argue, following Nelson Goodman and Arthur Danto, that in contrast to the essentialist conception of authenticity, it is more fertile to consider authentic patterns not as the inner core of the person, but as a case of metaphorical exemplification. According to our approach, if we accept that authentic style is a metaphorical exemplification, then, based on Richard Rorty’s concepts of language and metaphor, style can be seen as an exaptation or reuse of symbols previously adapted through (...) cultural selection to other specific functions. To support this approach, we proceed as follows. First, using Goodman’s and Danto’s model, we argue that authentic style can best be grasped through metaphorical exemplification. We then show that the metaphorical use of linguistic, pictorial, and other symbols is the result of exaptation. According to our results, the authentic style is the exaptation of symbols previously adapted to culturally selected functions. We then separate authenticity from creativity through the concepts of style and manner—borrowed from Danto—and we point out that whether a particular symbol is authentic or not is not affected by whether creative or mechanical mental processes are responsible for its creation. Finally, we examine the relationship between authenticity and autonomy, and we show that in an environment that promotes autonomous decisions and authentic style, agents that originally generated inauthentic symbols may be able to produce authentic ones. (shrink)

Two competing intuitions have dominated the debate over facial tissue transplantation. On one side are those who argue that relieving the suffering of those with severe facial disfigurement justifies the medical risks and possible loss of life associated with this experimental procedure. On the other are those who say that there is little evidence to show that such transplants would have longterm psychological benefits that couldn’t be achieved by other means and that without clear benefits, the risk is simply too (...) great. Ethicists on both sides have called for more analysis of the link between the face and personal identity in order to get a better grasp on potential gains and losses. This paper responds to that call by looking at contemporary philosophical analyses of the relation between organ transplants and personal identity and between the human face, human dignity, and human vulnerability. It is argued that the face matters not because it is the unique marker of our identity, but because of its role in the intersubjective constitution of moral identity and human dignity. (shrink)