Background:Moral distress, moral sensitivity, and moral courage among healthcare professionals have been explored considerably in recent years. However, there is a paucity of studies exploring these topics among baccalaureate nursing students.Aim/objective:The purpose of this study was to explore the relationship between and among moral distress, moral sensitivity, and moral courage of undergraduate baccalaureate nursing students.Research design:The research employed a descriptive-correlational design to explore the relationships between and among moral distress, moral sensitivity, and moral courage of undergraduate nursing students.Participants and research (...) context:A total of 293 baccalaureate Filipino nursing students who have been exposed to various clinical areas participated in the study.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Results indicate that a majority of the nursing students in the clinical areas encounter morally distressing situations that compromise quality patient care. However, despite the fact that they want to do what is in the best interest of their patients, their perception of being the inexperienced among the healthcare team drives the majority of them to ignore morally distressing situations to avoid conflict and confrontation. Another interesting finding is that 79.20% of the respondents hardly consider quitting the nursing profession even if they frequently encounter morally distressing situations. Analysis also shows associations between moral distress intensity and frequency ( r = 0.13, p < 0.05) and moral distress intensity and moral sensitivity ( r = 0.25, p < 0.05). The dimensions of moral courage are also related to both moral distress and moral sensitivity.Conclusion:Results of the study imply that moral distress is a reality among all healthcare professionals including nursing students and requires more consideration by nurse educators. (shrink)

As part of the regulatory review process, both the Food and Drug Administration and Office for Human Research Protections (U.S. Department of Health and Human Services [HHS]...

Volume 19, Issue 11, November 2019, Page 39-41.

This case is about a study of burn patients that included a request to the IRB for a waiver of consent for perianal specimen collection–a request which ultimately was not approved by a reviewing IR...

Informed Consent: What Must Be Disclosed and What Must Be Understood seeks to challenge the “standard view” of consent. It seeks to do so by segregating the “disclosure function” from the “understa...

The American Journal of Bioethics, Volume 12, Issue 6, Page 33-34, June 2012.

We report on the deliberations of an interdisciplinary group of experts in science, law, and philosophy who convened to discuss novel ethical and policy challenges in stem cell research. In this report we discuss the ethical and policy implications of safety concerns in the transition from basic laboratory research to clinical applications of cell-based therapies derived from stem cells. Although many features of this transition from lab to clinic are common to other therapies, three aspects of stem cell biology pose (...) unique challenges. First, tension regarding the use of human embryos may complicate the scientific development of safe and effective cell lines. Second, because human stem cells were not developed in the laboratory until 1998, few safety questions relating to human applications have been addressed in animal research. Third, preclinical and clinical testing of biologic agents, particularly those as inherently complex as mammalian cells, present formidable challenges, such as the need to develop suitable standardized assays and the difficulty of selecting appropriate patient populations for early phase trials. We recommend that scientists, policy makers, and the public discuss these issues responsibly, and further, that a national advisory committee to oversee human trials of cell therapies be established. **NB we did not reccommend a NAC, we think it might be appropriate**. (shrink)

A family of arguments for black hole evaporation relies on conservation laws, defined through symmetries represented by Killing vector fields which exist globally or asymptotically. However, these symmetries often rely on the idealizations of stationarity and asymptotic flatness, respectively. In non-stationary or non-asymptotically-flat spacetimes where realistic black holes evaporate, the requisite Killing fields typically do not exist. Can we 'de-idealize' these idealizations, and subsequently the associated arguments for black hole evaporation? Here, I critically examine the strategy of using 'approximately Killing' (...) fields to de-idealize black hole spacetimes and approximately extend conservation laws to non-idealized cases. I argue that this approach encounters significant challenges, undermining the use of these idealizations to justify the evaporation of realistic -- rather than idealized -- black holes, and raising questions about the justified use of such idealizations. -/- . (shrink)

There is little information about the content of ethics consultations in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance (...) in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is need.. (shrink)

In crafting our paper on addressing the ethical challenges in HIV prevention research with people who inject drugs,1 we had hoped to stimulate further discussion and deliberation about the topic. We are pleased that three commentaries on our paper have begun this process.2 3 4 The commentaries rightly bring up important issues relating to community engagement and problems in translating research into practice in the fraught environments in which PWID face multiple risks. These risks include acquisition of HIV as well (...) as criminalisation, stigma and lack of access to needed healthcare, prevention and social services. We take this opportunity to respond to the excellent points raised by the commentators. All of the commentaries support our emphasis on robust community engagement with PWID and other stakeholders in designing and conducting HIV prevention research, but urge us to go farther. Wolfe highlights the difficulty of even engaging with community members in oppressive settings, where authorities severely restrict civil liberties of PWID so that even discussing issues related to drug use and enforcement may place individuals at risk. To overcome such limitations, he appropriately suggests interviewing confidentially those who have previously been detained in closed settings as part of the community engagement process. Similarly, Wolfe observes that critical issues can be overlooked with a narrow focus on study procedures if contextual factors before, during or after a study are ignored. For example, he cites the risk of overdose for study participants who have been abstinent during a study and subsequently resume injecting when the study concludes. These kinds of risks may not be obvious …. (shrink)

Xunzi's philosophy provides a rich resource for understanding how ethical relationships between humans and nature can be articulated in terms of harmony. In this paper, I build on his ideas to develop the concept of reciprocal harmony, which requires us to reciprocate those who make our lives liveable. In the context of the environment, I argue that reciprocal harmony generates moral obligations towards nature, in return for the existential debt that humanity owes towards heaven and earth. This can be used (...) as a normative basis for an environmental ethic that enables humanity and nature to flourish together. (shrink)

This book is born out of two contradictions: first, it explores the making of meaning in a musical form that was made to lose its meaning at the turn of the nineteenth century; secondly, it is a history of a music that claims to have no history - absolute music. The book therefore writes against that notion of absolute music which tends to be the paradigm for most musicological and analytical studies. It is concerned not so much with what music (...) is, but with why and how meaning is constructed in instrumental music and what structures of knowledge need to be in place for such meaning to exist. From the thought of Vincenzo Galilei to that of Theodore Adorno, Daniel Chua suggests that instrumental music has always been a critical and negative force in modernity, even with its nineteenth-century apotheosis as 'absolute music'. (shrink)

Eyal et al have recently argued that researchers should consider conducting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human challenge studies to hasten vaccine development. We have conducted (J. L.) and overseen (L. D.) human challenge studies and agree that they can be useful in developing anti-infective agents. We also agree that adults can autonomously choose to undergo risks with no prospect of direct benefit to themselves. However, we disagree that SARS-CoV-2 challenge studies are ethically appropriate at this time, for (...) 3 reasons: (1) current scientific knowledge of SARS-CoV-2 infection is insufficient to manage risks; (2) autonomous decision making, while necessary, does not override concerns about risk; and (3) undertaking challenge studies now would imperil confidence in the research enterprise, potentially undermining the global response to the coronavirus disease 2019 (COVID-19) pandemic. (shrink)

Dans les stations de tourisme de montagne, les intersaisons correspondent à des creux d’activité durant lesquels les offres d’emploi alternatives sont peu nombreuses. Les saisonniers se trouvent donc confrontés à une période de chômage cyclique. Cette situation « intermédiaire », réunissant une forme d’incertitude de la relation d’emploi ainsi qu’une relative prévisibilité des périodes de recrutement n’est pas sans susciter certaines controverses. Dans ce contexte, comment sont vécues les phases de chômage saisonnier dans ces territoires? Ces séquences temporelles correspondent-elles à (...) un « temps mort » ou à un temps pluriel? Comment se négocie le temps pour soi dans le cadre d’embauches à contre-rythmes des temps sociaux dominants? Dans le cadre de cette forme d’emploi intermittente, le temps de chômage peut-il être conçu comme un temps de construction de la carrière professionnelle? Cet article s’intéresse aux formes d’adaptation aux rythmes d’emploi et de chômage des saisonniers en montagne et montre comment ces périodes hors-emploi participent de l’intériorisation de rythmicités spécifiques. (shrink)

This article studies the conceptions of social justice of women active in transnational migrant politics over a period of roughly 20 years in the Netherlands. The novel focus on migrant women reveals that transnational politics is almost completely male-dominated and -directed. Two of the exceptions found in this article include a leftist and a Kurdish women organization supporting the communist cause in the 1980s and the Kurdish struggle in the 1990s in Turkey, respectively. In both organizations gender equality was subordinated (...) to broader ideologies of political parties in their homeland. Leftist activists in the cold war era supported a narrow definition of the "politics of redistribution," while and Kurdish activists, combined classical features of the latter with those of traditional identity politics. (shrink)

“Faculty of Language: the ‘Assembly-Only Hypothesis’ and Domain Specificity”. The faculty of language was always considered as the paradigm of a cognitive capacity that illustrates the property of domain specificity. In the minimalist-biolinguistic approach, this property seems to blur. However, the reason usually cited, does not seem adequate from the point of view of the conceptual coherence of the notion of domain specificity. In this paper I will distinguish between a sense of specificity of domain that is interesting or useful (...) for cognitive research and another vacuous one. I will show that if the analysis of the notion of domain specificity is conceptually coherent and the available empirical evidence is accepted, then these constitute the reasons why domain specificity cannot be attributed to the faculty of language under the assembly-only hypothesis. (shrink)

This essay series attempts to stimulate the debate about the moral challenges that internationalisation confronts us with, both in the Netherlands and abroad, and in particular for Artist-in-Residencies (AIRs). The publication is a reflection on how the crisis is reconsidering our international ambitions, starting from a post-COVID society. Internationalisation is an inevitable reality, inherent to the art landscape. The current time calls for a critical reflection on major issues such as climate inequality, plurality and the Western-dominant canon. 0With contributions and (...) critical insights by Jeanne van Heeswijk, Jack Segbars, Erik Hagoort, Pascal Gielen, Cecilia Bengtsson, Merlijn Twaalfhoven, Hicham Khalidi, reinaart vanhoe and Suzanne van der Beek. Thanks to Jan van Eyck Academie, Mondriaan Fonds, Prins Bernhard Cultuurfonds en het Amsterdams Fonds voor de Kunst for their support. (shrink)

Background: Nurses exposed to community health nursing commonly encounter situations that can be morally distressing. However, most research on moral distress has focused on acute care settings and very little research has explored moral distress in a community health nursing setting especially among nursing students. Aim: To explore the moral distress experiences encountered by undergraduate baccalaureate nursing students in community health nursing. Research design: A descriptive qualitative design was employed to explore the community health nursing experiences of the nursing students (...) that led them to have moral distress. Participants and research context: The study included 14 senior nursing students who had their course in Community Health Nursing in their sophomore year and stayed in the partner communities in their junior year for 6 and 3 weeks during their senior year. Ethical considerations: Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants. Findings: Nursing students are vulnerable and likely to experience moral distress when faced with ethical dilemmas. They encounter numerous situations which make them question their own values and ideals and those of that around them. Findings of the study surfaced three central themes which included moral distress emanating from the unprofessional behavior of some healthcare workers, the resulting sense of powerlessness, and the differing values and mindsets of the people they serve in the community. Conclusion: This study provides educators a glimpse of the morally distressing situations that often occurs in the community setting. It suggests the importance of raising awareness and understanding of these situations to assist nursing students to prepare themselves to the “real world,” where the ideals they have will be constantly challenged and tested. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

The purpose of this essay is to explore, and clarify, some key features in Aquinas’ account of the virtue of temperance, with an eye to answering some common objections raised against a positive evaluation of temperance. In particular, I consider three features of Aquinas’ understanding of temperance: First, the role of the rational mean in temperance; second, the role of rightly ordered passions in temperance; and third, the ‘despotic’ control of reason over the passions in temperance. Along the way I (...) consider three common objections to Aquinas’ account of temperance: the objection that temperance can be misused for evil, the objection that temperance devalues effort, and the objection that temperance devalues strong passions and thereby implicitly devalues the goodness of sexuality. In responding to these objections on behalf of Aquinas, I take the opportunity to clarify and slightly extend Aquinas’ account of temperance. (shrink)

Taking the formal analogies between black holes and classical thermodynamics seriously seems to first require that classical thermodynamics applies in relativistic regimes. Yet, by scrutinizing how classical temperature is extended into special relativity, I argue that the concept falls apart. I examine four consilient procedures for establishing the classical temperature: the Carnot process, the thermometer, kinetic theory, and black-body radiation. I argue that their relativistic counterparts demonstrate no such consilience in defining the relativistic temperature. As such, classical temperature doesn’t appear (...) to survive a relativistic extension. I suggest two interpretations for this situation: eliminativism akin to simultaneity, or pluralism akin to rotation. (shrink)

Genomic sequencing is becoming more common both in clinical practice and as a routine aspect of much research. Over the last 15 years there has been ongoing discussion about the implications of gen...

Volume 20, Issue 10, October 2020, Page 82-83.

The American Journal of Bioethics, Volume 12, Issue 10, Page 18-20, October 2012.

Methodologies of poststructuralist theory and critical social theory may be appropriated for nursing research and practice. Researchers using either methodology employ an analysis of power to explore experiences in various fields, and raise issues diat are highly relevant to nursing. However, the two methodologies differ and, often, die respective dieories are sharply opposed. In diis paper, die differences bodi from widiin and between each approach are explored, showing dieir tensions and limits. I contend that a reflexive approach to discourse analysis (...) provides insight into some of die methodological challenges diat arise in die context of bodi dieories. It is argued diat die differences between poststructuralism and critical social dieory seem likely to be mellowed by encounters diat treat each other with respect. To some extent, such encounters may tend to converge die two positions. (shrink)

Volume 19, Issue 10, October 2019, Page 97-98.

Programs in quantum gravity often claim that time emerges from fundamentally timeless physics. In the semiclassical time program time arises only after approximations are taken. Here we ask what justifies taking these approximations and show that time seems to sneak in when answering this question. This raises the worry that the approach is either unjustified or circular in deriving time from no–time.

As medicine and science advance, new ethical questions emerge. Over time, deliberation and analysis result in a somewhat settled approach to a problem. Often the settled approach is based on group...

Narrative has proven itself a continuous as well as adaptable means for environmentally oriented expression. Its role goes beyond the mediation of pre-existing knowledge imported into the realm of storytelling from other domains; rather, influential models of the natural world tend to circulate as storyworlds. This special issue of SubStance proceeds from the premise that narratives are not only a sequence of signs encoding a story but also “invisible, elusive representations that exist only in the mind”. Narrative forms generate and (...) transfer environmental knowledge; moreover, any specifically narrative concerns are important contributing factors to the models of agency, change... (shrink)

Visual feedback regulation during movement is not fully captured in Plamondon's kinematic theory. However, numerous studies indicate that visual response-produced feedback is a powerful determinant of performance and kinematic characteristics of target-directed movement.

El realismo intencional acérrimo quiere dos cosas que, según intentaré mostrar, son difíciles de lograr conjuntamente: estados con contenido semánticamente interpretable y que tengan rol causal en la producción de la conducta. Si bien no hay dificultades para obtener, el problema es con. La estrategia del RIA consiste en postular la existencia de leyes intencionales causales. El problema es que esas leyes son de un estatus dudoso, al punto que muchos consideran que no son posibles y ni siquiera necesarias. Según (...) el RIA, si no se puede obtener conjuntamente y se desprenderían dos consecuencias indeseables: si los estados intencionales no tienen rol causal qua intencionales significaría que no se es realista acerca de las creencias y deseos; y que no sean posibles las leyes intencionales implicaría que no se puede tener una psicología científica. En la primera parte del trabajo me ocuparé de exponer las tesis del RIA y mostraré que no puede cumplir conjuntamente con las exigencias y. En la segunda parte me ocuparé de defender la idea de que del hecho de que no se pueda conciliar y no se sigue un eliminativismo acerca de los estados intencionales ni la imposibilidad de que la psicología sea una ciencia. The Hairy Intentional Realism aims for two things that I shall try to show are difficult to jointly obtain: states with an interpretable semantic content, and with causal role in the production of behavior. There is no difficulty in obtaining, the problem is with. HIR's strategy consists in the postulation of causal intentional laws. The problem is that these laws have a doubtful status to the point that many consider them not possible and not even necessary. According to HIR, if and cannot be jointly obtained, two unwanted consequences emerge: if intentional states do not have a causal role qua intentional, that would mean ceasing to be realistic about them; and if intentional laws are not possible that would imply that we could not have a scientific psychology. In the first part of this paper I shall exhibit HIR's main theses and I shall show that it cannot accomplish the two demands. Second, I shall defend the idea that because of the fact that and cannot be reconciled, neither an eliminativism about intentional states, nor the impossibility that psychology is a science can follow. (shrink)

Transformations under way in Indian cities have begun to alter the opportunities for democratic participation among the urban poor. Highlighting efforts to promote globally oriented urban developments in Mumbai, this article examines the state’s engagement with groups directly impacted by these efforts. Based on ethnographic research and interviews with key stakeholders in the Dharavi Redevelopment Project, the article traces the character of such engagements over the project’s four-year planning process. It finds that the state undertook an unusually inclusive process, consulting (...) with resident and activist groups at points throughout this period. The article posits that this novel engagement is an unintended consequence of pressures to promote rapid development and ease investor concerns. Situating this case in the recent literature on political shifts in the globalizing Indian city, it concludes that the state may be engaging more with the urban poor than many of these accounts suggest. (shrink)

This article seeks to advance ethical dialogue on choosing standards of prevention in clinical trials testing improved biomedical prevention methods for HIV. The stakes in this area of research are high, given the continued high rates of infection in many countries and the budget limitations that have constrained efforts to expand treatment for all who are currently HIV-infected. New prevention methods are still needed; at the same time, some existing prevention and treatment interventions have been proven effective but are not (...) yet widely available in the countries where they most urgently needed. The ethical tensions in this field of clinical research are well known and have been the subject of extensive debate. There is no single clinical trial design that can optimize all the ethically important goals and commitments involved in research. Several recent articles have described the current ethical difficulties in designing HIV prevention trials, especially in resource limited settings; however, there is no consensus on how to handle clinical trial design decisions, and existing international ethical guidelines offer conflicting advice. This article acknowledges these deep ethical dilemmas and moves beyond a simple descriptive approach to advance an organized method for considering what clinical trial designs will be ethically acceptable for HIV prevention trials, balancing the relevant criteria and providing justification for specific design decisions. (shrink)

Volume 20, Issue 4, May 2020, Page 111-113.

The laws of classical logic are taken to be logical truths, which in turn are taken to hold objectively. However, we might question our faith in these truths: why are they true? One general approach, proposed by Putnam [8] and more recently Dickson [3] or Maddy [5], is to adopt empiricism about logic. On this view, logical truths are true because they are true of the world alone – this gives logical truths an air of objectivity. Putnam and Dickson both (...) take logical truths to be true in virtue of the world’s structure, given by our best empirical theory, quantum mechanics. This assumes a determinate logical structure of the world given by quantum mechanics. Here, I argue that this assumption is false, and that the world’s logical structure, and hence the related ‘true’ logic, is underdetermined. This leads to what I call empirical conventionalism. (shrink)