“It is almost impossible for a working neurologist to think clearly about the functions of the highest centres because the counters of thought, the words he must employ—are often of psychological origin and for the most part meaningless.”.

Background Moral distress was first described by Jameton in 1984, and has been defined as distress experienced by an individual when they are unable to carry out what they believe to be the right course of action because of real or perceived constraints on that action. This complex phenomenon has been studied extensively among healthcare providers, and intensive care professionals in particular report high levels of moral distress. This distress has been associated with provider burnout and associated consequences such as (...) job attrition, with potential impacts on patient and family care. There is a paucity of literature exploring how middle and late career healthcare providers experience and cope with moral distress. Objectives We explore the experience of moral distress and the strategies and resources invoked to mitigate that distress in mid- and late-career healthcare providers practicing in paediatric intensive care, in order to identify ways in which the work environment can build a culture of moral resilience. Research design An exploratory, qualitative quality improvement project utilizing focus group and semi-structured interviews with pediatric intensive care front-line providers. Participants Mid-and-later career (10 + years in practice) pediatric intensive care front line providers in a tertiary pediatric hospital. Research context This work focuses on paediatric intensive care providers in a single critical care unit, in order to explore the site-specific perspectives of health care providers in that context with respect to moral distress coping strategies. Ethical considerations The study was approved by the Quality Management Office at the institution; consent was obtained from participants, and no identifying data was included in this project. Findings Participants endorsed perspective-building and described strategies for positive adaptation including; active, reflective and structured supports. Participants articulated interest in enhanced and accessible formal supports. Discussion Findings in this study resonate with the current literature in healthcare provider moral distress, and exposed ways in which the work environment could support a culture of moral resilience. Avenues are described for the management and mitigation of moral distress in this setting. Conclusion This exploratory work lays the groundwork for interventions that facilitate personal growth and meaning in the midst of moral crises in critical care practice. (shrink)

This article first surveys a significant set of issues that are intertwined in asking whether social classes are real. It distinguishes two different notions of class: class as organized social entities and class as types of individuals based on individual characteristics. There is good evidence for some classes as social entities—ruling classes and underclasses in some societies—but other classes in contemporary society are sometimes best thought of in terms of types, not social entities. Implications are drawn for pluralist accounts of (...) social classification and the individualism-holism dispute. (shrink)

Public debate in Britain surrounding the cloning of Dolly the sheep has primarily focused on the legitimacy of cloning humans, not sheep. This bracketing of the human question relies on a distinction between humans and animals belied by the very constitution of transgenic animals who are made with human DNA, such as Polly. Moreover, the ways in which human beings think about, manipulate and classify animals have distinct cultural consequences, for example in relation to cultural understandings of life, property, kinship (...) and other forms of social interconnection. This article introduces the term 'breedwealth' to examine Dolly as a unique form of property in order to make some of these connections more visible. (shrink)

Recently, technology has impacted upon sports umpiring and refereeing. One effect is that the means to make sound judgments has becoe ‘distributed’ to new groups of people such as TV viewers and commentators. The result is that justice on the sports field is often seen not to be done and the readiness to question umpires' decisions that once pertained only to the players and, in some sports, to the crowd, has spread to anyone who has a television. What is more, (...) the questioning can now be done on good grounds. This change is explained and a way of thinking about it is put forward. The aim is to develop a theory of the relationship between human match officials and technology. Toward this end I offer a new terminology for the kinds of justice that are involved in match officiating. I argue that the introduction of new technology should be done in such a way as to maintain the justice of decisions and that justice is not the same as accuracy. Justice is best served with a restrained use of new technology. (shrink)

Scientific realism is usually a thesis or theses advanced about our best natural science. In contrast, this book defends scientific realism applied to the social and behavioral sciences. It does so, however, by applying the same argument strategy that many have found convincing for the natural sciences, namely, by arguing that we can only explain the success of the sciences by postulating their approximate truth. The particular success that Trout emphasizes for the social sciences is the effective use of statistical (...) testing. Social scientists apply diverse statistical measurement tools to social reality; they are able to refine and improve those measurements over time. The best explanation for such success is that the social sciences give us an approximately true account of some of the laws and entities of the social world. (shrink)

There is a well-developed literature on trust. In his important article Faulkner, 424−429, 2015) distinguishes three-place, two-place and one-place trust predicates. He then argues that our more basic notions of trust are expressed by the one-place and two-place predicates. Three-place trust, contractual trust, is not fundamental. This matters. Having a clear understanding of our concepts of trust is important. The most important assumption of Faulkner’s argument is that the notion of trust expressed by the three-place predicate is not attitudinal; it (...) is a ‘metaphysical hybrid of attitude and action’. I argue that this is wrong. All three notions are attitudinal and no reason exists to deny that the one-place and two-place notions derive from the three-place one. Once one rejects Faulkner’s assumption that the three-place notion can be separated off from the others as a metaphysical hybrid argument for the priority of the one-place and two-place notions collapses. (shrink)

I claim that there are four major strands of argument for externalism and set out to discuss three of them. The four are: (A) That referential thoughts are object-dependent. This I do not discuss. (B) That the semantics of natural kind terms is externalist. (C) That all semantic content, even of descriptive terms, stems from the causal relations of representations to the things or properties they designate in the external world. (D) That, because meaning is a social product and no (...) individual can capture the whole social practice that defines a concept, what the speaker means always outruns what he can know.I briefiy discuss (C) and (D) and conclude that they cannot be correct, because, if they were, the content of every thought would permanently transcend the refiective grasp of all thinkers. Then I discuss (B) and conclude that, though Putnam shows something interesting about natural kind terms -- namely that a real verbal definition requires science -- this has none of the consequences for philosophy of mind that it is normally supposed to have. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work.This work is in the public domain in (...) the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work.As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)