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)

In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used a qualitative description approach. Participants were recruited using purposive sampling between October 2020 to May 2021 from pediatric critical care units in a (...) western Canadian province. We conducted individual semi-structured interviews via Zoom. A total of 10 registered nurses participated in the study. Four main themes were identified: (1) “I’m sorry, there’s nothing else”: increasing supports for patients and families; (2) “someone will commit suicide”: improving supports for nurses: (3) “Everyone needs to be heard”: improving patient care communication; and (4) “I didn’t see it coming”: providing education to mitigate moral distress. Most participants stated they wanted an intervention to improve communication among the healthcare team and noted changes to unit practices that could decrease moral distress. This is the first study that asks nurses what is needed to minimize their moral distress. Although there are multiple strategies in place to help nurses with difficult aspects of their work, additional strategies are needed to help nurses experiencing moral distress. Moving the research focus from identifying moral distress towards developing effective interventions is needed. Identifying what nurses need is critical to develop effective moral distress interventions. (shrink)

Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario’s protocols were presented to the public in a democratic deliberation during the summer of 2022. Objectives (1) To explore the perspectives of Quebec and Ontario (...) citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. Methods This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. Results A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value – a less acceptable tiebreaker. Conclusion Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria. (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.

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)

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)

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

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)

Introduction Future HIV vaccine efficacy trials with adolescents will need to ensure that participants comprehend study concepts in order to confer true informed assent. A Hepatitis B vaccine trial with adolescents offers valuable opportunity to test youth understanding of vaccine trial requirements in general. Methods Youth reviewed a simplified assent form with study investigators and then completed a comprehension questionnaire. Once enrolled, all youth were tested for HIV and confirmed to be HIV-negative. Results 123 youth completed the questionnaire (mean age=15 (...) years; 63% male; 70% Hispanic). Overall, only 69 (56%) youth answered all six questions correctly. Conclusions Youth enrolled in a Hepatitis B vaccine trial demonstrated variable comprehension of the study design and various methodological concepts, such as treatment group masking. (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 study is unique in that it presents the first empirically developed framework for use as a tool for measuring historical empathy. The Historical Empathy Measurement Tool (HEMT) was developed using a design-based research method with three iterative macrocycles of design, experiment, and retrospective analysis. The study involved question responses from 276 students in grade 8 studying WWI trench warfare. The research resulted in a framework of seven levels. (0) Non-response, (1) Facts, (2) Assumptions and Deficits, (3) General Comparison of (...) the Past and Present, (4) Emotional Comparison of the Past and Present, (5) Understanding Motives, Behaviors, Thoughts, & Emotions in the Past, and (6) Acknowledgement of Differences from those in the Past. The inter-rater reliability at the end of macrocycle three was 95%. (shrink)

Mentoring literature explores the dark side of mentoring as factors such as gender and race and how they affect the overall mentoring experience. The sociocultural context of the nursing and midwifery professions presents unique characteristics warranting a qualitative exploration of negative mentoring experiences. We aimed to characterise the dark side of mentoring based on informal mentoring relationships occurring among nurses and midwives working in hospitals. Utilising semistructured interviews in a qualitative descriptive design and reflexive thematic analysis, we examined the perceptions (...) of 35 nurses and midwives from three public hospitals located in the Western, Northern and North‐western regions of Uganda. Findings emerged in four overarching themes mentoring process deficits, mentoring relational problems, organisational challenges in mentoring and implications of negative mentoring experiences. Our study findings underscore that, while mentoring is frequently beneficial, it can also be interspersed with negative experiences arising from relational dynamics, particular mentoring processes and the overarching hospital environment. Notably, nurses and midwives actively transformed these challenges into opportunities for growth and self‐improvement, while introspectively examining their roles in contributing to these negative experiences. Such a proactive approach highlights their resilience and steadfast commitment to professional development, even in the face of adversity. (shrink)

Plasminogen activator inhibitor‐1 (PAI‐1) is a physiological inhibitor of urokinase (uPA), a serine protease known to promote cell migration and invasion. Intuitively, increased levels of PAI‐1 should be beneficial in downregulating uPA activity, particularly in cancer. By contrast, in vivo, increased levels of PAI‐1 are associated with a poor prognosis in breast cancer. This phenomenon is termed the “PAI‐1 paradox”. Many factors are responsible for the upregulation of PAI‐1 in the tumor microenvironment. We hypothesize that there is a breast cancer (...) predisposition to a more aggressive stage when PAI‐1 is upregulated as a consequence of Metabolic Syndrome (MetS). MetS exerts a detrimental effect on the breast tumor microenvironment that supports cancer invasion. People with MetS have an increased risk of coronary heart disease, stroke, peripheral vascular disease and hyperinsulinemia. Recently, MetS has also been identified as a risk factor for breast cancer. We hypothesize the existence of the “PAI‐1 cycle”. Sustained by MetS, adipocytokines alter PAI‐1 expression to promote angiogenesis, tumor‐cell migration and procoagulant microparticle formation from endothelial cells, which generates thrombin and further propagates PAI‐1 synthesis. All of these factors culminate in a chemotherapy‐resistant breast tumor microenvironment. The PAI‐1 cycle may partly explain the PAI‐1 paradox. In this hypothesis paper, we will discuss further how MetS upregulates PAI‐1 and how an increased level of PAI‐1 can be linked to a poor prognosis. BioEssays 29:1029–1038, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

Using a new typology based on information available from the Labour Force Survey, the authors analyse how job quality evolved in Québec for both women and men over the last decade (1997-2007). Results show that family situation and educational attainment are two important factors in the determination of gender inequality in the labour market. The analysis emphasizes the very significant decline in gender differences with regard to job quality (from 23% to 35% according to groups), especially for persons without children (...) and individuals who achieved higher education. The changes represent a definite progress in the status of women in general, although some indicators also reveal degradation with respect to job quality in some of the sub-groups. (shrink)

The American Journal of Bioethics, Volume 11, Issue 11, Page 42-43, November 2011.

This research involves a review of the submissions to a 2005/06 Australian Government Inquiry into Corporate Social Responsibility. The Inquiry was established to investigate whether corporate social responsibilities and accountabilities should be regulated, or left to be determined by market forces. Our results show that the business community overwhelming favour an anti-regulation approach whereby corporations should be left with the flexibility to determine their social responsibilities and associated accountabilities and ‘enlightened self-interest’ should be retained as the guiding mechanism for social (...) responsibility initiatives. In stark contrast, the submissions from social and environmental organisations and individuals provided counter-arguments in favour of a pro-regulation view. Ultimately Government embraced the ‘free market perspective’ promoted by the business community and decided against the introduction of national legislation pertaining to corporate social responsibilities. (shrink)

The history of women in sociology is explored here through the correspondence written by Sophonisba P. Breckinridge to Marion Talbot in the summer of 1936. Their loving letters reveal the ideas and practices of feminist pragmatism and the female world of love and ritual located in Chicago in the twentieth century. This world of professional women flourished around the social settlement Hull House and the University of Chicago during the founding years of sociology. Their lives and social thought challenge our (...) understanding of the emergence of sociology at the University of Chicago, and their ideas remain a rich resource for analyzing society today. (shrink)

This article offers a Marxist reading of Wittgenstein and juxtaposes his famous dictum that philosophy ‘leaves everything as it is’ with the idea of transformative action. I seek to align the later philosophy of Wittgenstein with Marx’s 11th thesis on Feuerbach. I advance an unorthodox view interpreting Wittgenstein as an advocate for social and political reform. Wittgenstein’s philosophy encourages us to imagine alternatives and contemplate concrete possibilities for changing the world. The debate operates within the philosophy of education and draws (...) inspiration from related inquiries in political thought and, more specifically, from Marxist connections with Wittgenstein. (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.

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)

The canonical version of possible worlds semantics for story prefixes is due to David Lewis. This paper reassesses Lewis's theory and draws attention to some novel problems for his account.

This article describes the benefits of including institutional leadership in a faculty fellowship program where faculty were tasked with implementing a curricular innovation at their home institution. These benefits included: serving as an ally, advocate, and defender for the faculty fellow; seeing the bigger picture and how the fellowship can be leveraged to benefit the institution in other ways; and assisting to ensure the fellowship project will be ongoing at their institution.

Whether, and to what degree, do patents granted on human genes cast a shadow of uncertainty over genomics and its applications? Will owners of patents on individual genes or clusters of genes sue those performing whole-genome analyses on human samples for patent infringement? These are related questions that have haunted molecular diagnostics companies and services, coloring scientific, clinical, and business decisions. Can the profusion of whole-genome analysis methods proceed without fear of patent infringement liability?Whole-genome sequencing is proceeding apace. Academic centers (...) have been performing whole-genome and -exome sequencing in research for at least five years, and academic clinical laboratories with national reach have been doing sequencing for clinical applications for almost as long. Companies have also been offering WGS and WES as a clinical service for a few years now. So far as we know, no one has been sued for infringement of “gene patents” for performing WGS. (shrink)

LeRoy Walters was a central figure in debates about federal policy regarding genetics and biotechnology—a neutral, publicly engaged philosopher and religious studies academic who put his skills to work in national service. His career spanned the emergence of biotechnology as a field in the 1970s until his retirement. His interests reached from moral philosophical theory to Holocaust studies to practical concerns about public policy in genetics. We focus here on the role of bioethics in policy related to the advent of (...) human gene transfer, the Human Genome Project, and the emergence of biotechnology as a commercial enterprise. We focus on his role as an academic influencing the government strand of the “triple helix”... (shrink)