Background: Complex and expensive treatment options have increased the frequency and emphasis of ethical decision-making in healthcare. In order to meet these challenges effectively, we need to identify how nurses contribute the resolution of these dilemmas. Aims: To identify the values, beliefs and contextual influences that inform decision-making. To identify the contribution made by nurses in achieving the resolution of ethical dilemmas in practice. Design: An interpretive exploratory study was undertaken, 11 registered acute care nurses working in a district general (...) hospital in England were interviewed, using semi-structured interviews. In-depth content analysis of the data was undertaken via NVivo coding and thematic identification. Participants and context: Participants were interviewed about their contribution to the resolution of ethical dilemmas within the context of working in an acute hospital ward. Participants were recruited from all settings working with patients of any age and any diagnosis. Ethical considerations: Ethical approval was obtained from the local National Research Ethics Committee. Findings: Four major themes emerged: ‘best for the patient’, ‘accountability’, ‘collaboration and conflict’ and ‘concern for others’. Moral distress was also evident in the literature and findings, with moral dissonance recognised and articulated by more experienced nurses. The relatively small, single-site sample may not account for the effects of organisational culture on the results; the findings suggested that professional relationships were key to resolving ethical dilemmas. Discussion: Nurses use their moral reasoning based on their beliefs and values when faced with ethical dilemmas. Subsequent actions are mediated though ethical decision-making frames of reference including deontology, consequentialism, the ethics of care and virtue ethics. Nurses use these in contributing to the resolution of these dilemmas. Nurses require the skills to develop and maintain professional relationships for addressing ethical dilemmas and to engage with political and organisational macro- and micro-decision-making. Conclusion: Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemmas. (shrink)

In this article, we discuss how we used institutional ethnography (Institutional ethnography as practice, Rowman & Littlefield, Lanham, MD and 2006) to map out powerful ruling relations that organize nurses’ wound care work. In recent years, the growing number of people living with wounds that heal slowly or not at all has presented substantial challenges for those managing the demands on Canada's publicly insured health‐care system. In efforts to address this burden, Canadian health‐care administrators and policy‐makers rely on scientific evidence (...) about how wounds heal and what treatments are most effective. Advanced wound care exemplifies the growing authorization of particular forms of evidence that change the ways in which nurses come to know about and conduct their work. The focus of this paper's nursing inquiry is a critique of registered nurses’ wound work as it arises within the established uptake of scientific evidence. (shrink)

This article reports the results of an exploratory investigation of a particular area of moral tension experienced by MBA students in a graduate school of business. During the first phase of the study, MBA students'' own perceptions about the moral climate and culture of the business school were examined. The data gathered in this first part of the study indicate that the students recognize that a central part of this culture is constituted by a shared familiarity with a set of (...) institutionally reinforced premises about human behavior and motivation including the ideas that: 1) people are self-interested utility-maximizers, 2) individuals should be unimpeded in their pursuit of their own self-interest through economic transactions, and 3) virtually all human interactionsare economic transactions. The data further indicated that the business students experience a degree of tension between this ethic of self-maximizing and the everyday ethics prevalent in our broader culture, in which altruism and selflessness are central elements. The final section of the study was an effort to see whether and how these institutionally sanctioned premises were integrated into the students'' arguments about the relationship between self-interest and social responsibility. (shrink)

Contrary to Vaesen's argument that humans are unique with respect to nine cognitive capacities essential for tool use, we suggest that although such cognitive processes contribute to variation in tool use, it does not follow that these capacities arenecessaryfor tool use, nor that tool use shaped cognition per se, given the available data in cognitive neuroscience and behavioral biology.

Organ transplantation saves lives, yet thousands die through lack of organs. What lies behind our failure to donate? Janet Radcliffe Richards casts a sharp critical eye on the moral arguments, forcing us to confront the logic and implications of our own position. A book for everyone concerned with clear thinking on moral issues.

Western stereotypes often characterize gender relations in Muslim-majority societies as uniformly traditional and patriarchal. Underlying this imagery is a unidimensional understanding of gender ideology as moving along a single traditional-to-egalitarian continuum. In this study, we interrogate these assumptions by exploring variability across and within Middle Eastern, North African, and South Asian (MENASA) societies in beliefs related to two regionally salient gender principles: women’s chastity and marital patriarchy. Data from a new online survey of Muslim Facebook users show substantial heterogeneity across (...) and within six MENASA societies in support for these principles. These data also reveal a multidimensional structure, in that societies show different configurations of chastity and marital patriarchy beliefs, and each of these gender principles is influenced by respondents’ religious beliefs and gender status in different ways. Although religious absolutism predicts agreement with both gender principles, piety is associated with support for chastity but not for marital patriarchy. Results also show a clear gender divide in attitudes toward hierarchy in marriage but not with respect to chastity. Findings complicate broad-brush depictions of patriarchy in the region and corroborate previous research on the multidimensionality of gender beliefs and the multifaceted attitudinal influences of gender and religious beliefs. (shrink)

A cultural studies textbook that deals with issues of methodology, as well as mapping out the history and theories and ideas in cultural studies. The book examines the work of Raymond Williams, Lacan and Hoggart, among others, and explores notions of subculture, psychoanalysis, Marxist thought, narrative, autobiography, fiction, subjectivity, language, history and representation. The book focuses on the past, present and future of cultural studies, with the aim of providing readers with a clear overview of the central ideas within the (...) area, developing current debates and possible future avenues. (shrink)

Collaborative learning has become increasingly prevalent throughout all disciplines in higher education, but these types of situations may prove challenging for quiet students who may prefer m...

Brain-Computer Interface is a set of technologies that are of increasing interest to researchers. BCI has been proposed as assistive technology for individuals who are non-communicative or paralyzed, such as those with amyotrophic lateral sclerosis or spinal cord injury. The technology has also been suggested for enhancement and entertainment uses, and there are companies currently marketing BCI devices for those purposes as well as health-related purposes. The unprecedented direct connection created by BCI between human brains and computer hardware raises various (...) ethical, social, and legal challenges that merit further examination and discussion. To identify and characterize the key issues associated with BCI use, we performed a scoping review of biomedical ethics literature, analyzing the ethics concerns cited across multiple disciplines, including philosophy and medicine. Based on this investigation, we report that BCI research and its potential translation to therapeutic intervention generate significant ethical, legal, and social concerns, notably with regards to personhood, stigma, autonomy, privacy, research ethics, safety, responsibility, and justice. Our review of the literature determined, furthermore, that while these issues have been enumerated extensively, few concrete recommendations have been expressed. We conclude that future research should focus on remedying a lack of practical solutions to the ethical challenges of BCI, alongside the collection of empirical data on the perspectives of the public, BCI users, and BCI researchers. (shrink)

The incredible complexity of the United States health care system can be connected to three simple outcomes: access, affordability, and quality. We should measure our progress against these three measures. While historic progress on access was made through implementation of the Affordable Care Act, the next area of focus for more results across all three measures is delivery system reform.

Bioartists Oron Catts and Ionat Zurr define many of their tissue-based artworks as semi-living, and use an ethical framework to contextualize their care for these semi-living creations, claiming that their work inspires reflection on our responsibilities toward the continuum of life. There are ways in which Catts and Zurr’s relation to the semi-living does meet the standards of an ethics of care, as defined in particular by political scientist Joan Tronto, but only within certain constraints—namely, the performative and participatory spaces (...) of their installations. When their claims, as they frequently do, extend beyond these circumstances, their statements become mired in contradictions and inconsistencies, even as their work points to an original artistic practice that provokes thought about the nature of the body, of life, and of the living. (shrink)

In comparison with classroom settings that are more accessible to the scrutiny of researchers and institutional monitoring, the one-to-one setting of instrumental and vocal studio teaching has been...

Functionalism in the philosophy of mind is the doctrine that what makes something a mental state of a particular type does not depend on its internal constitution, but rather on the way it functions, or the role it plays, in the system of which it is a part. This doctrine is rooted in Aristotle's conception of the soul, and has antecedents in Hobbes's conception of the mind as a “calculating machine”, but it has become fully articulated (and popularly endorsed) only (...) in the last third of the 20th century. Though the term ‘functionalism’ is used to designate a variety of positions in a variety of other disciplines, including psychology, sociology, economics, and architecture, this entry focuses exclusively on functionalism as a philosophical thesis about the nature of mental states. (shrink)

Defenders of pragmatic theories of knowledge (such as contextualism and sensitive invariantism) argue that these theories, unlike those that invoke a single standard for knowledge, comport with the intuitively compelling thesis that knowledge is the norm of assertion and practical reason. In this paper, I dispute this thesis, and argue that, therefore, the prospects for both “high standard” approach, and contend that if one abandons the thesis that knowledge is the norm of assertion and practical reason, the most serious arguments (...) against it lose force. (shrink)

Background: Improved techniques and life sustaining technology in the neonatal intensive care unit have resulted in an increased probability of survival for extremely premature babies. The by-product of the aggressive treatment is iatrogenic pain, and this infliction of pain can be a cause of suffering and distress for both baby and nurse. Research question: The research sought to explore the caregiving dilemmas of neonatal nurses when caring for extremely premature babies. This article aims to explore the issues arising for neonatal (...) nurses when they inflict iatrogenic pain on the most vulnerable of human beings – babies ≤24 weeks gestation. Participants: Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia. Ethical consideration: Ethical processes and procedures set out by the ethics committee have been adhered to by the researchers. Findings: A qualitative approach was used to analyse the data. The theme ‘inflicting pain’ comprised three sub-themes: ‘when caring and torture are the same thing’, ‘why are we doing this!’ and ‘comfort for baby and nurse’. The results show that the neonatal nurses were passionate about the need for appropriate pain relief for extremely premature babies. Conclusion: The neonatal nurses experienced a profound sense of distress manifested as existential suffering when they inflicted pain on extremely premature babies. Inflicting pain rather than relieving it can leave the nurses questioning their role as compassionate healthcare professionals. (shrink)

Efforts to professionalize the field of bioethics have led to the development of the Healthcare Ethics Consultant-Certified (HEC-C) Program intended to credential practicing healthcare ethics consultants (HCECs). Our team of professional ethicists participated in the inaugural process to support the professionalization efforts and inform our views on the value of this credential from the perspective of ethics consultants. In this paper, we explore the history that has led to this certification process, and evaluate the ability of the HEC-C Program to (...) meet the goals it has set forth for HCECs. We describe the benefits and weaknesses of the program and offer constructive feedback on how the process might be strengthened, as well as share our team’s experience in preparing for the exam. (shrink)

Abstract:We analyzed data from a survey of employees of a large military base in order to assess possible differences in the whistle-blowing process due to type of wrongdoing observed. Employees who observed perceived wrongdoing involving mismanagement, sexual harassment, or unspecified legal violations were significantly more likely to report it than were employees who observed stealing, waste, safety problems, or discrimination. Further, type of wrongdoing was significantly related to reasons given by employees who observed wrongdoing but did not report it, across (...) all forms of wrongdoing. However, the primary reason that observers did not report it was that they thought nothing could be done to rectify the situation. Finally, type of wrongdoing was significantly related to the cost of the wrongdoing, the quality of the evidence about the wrongdoing, and the comprehensiveness of retaliation against the whistle-blower. These findings suggest that type of wrongdoing makes a difference in the whistle-blowing process, and it should be examined in future research. (shrink)

Two major reasons feminists are concerned with science relate to science's social effects: that science can be a powerful ally in the struggle for equality for women; and that all too frequently science has been a generator and perpetuator of inequality. This concern with the social effects of science leads feminists to a different mode of appraising science from the purely epistemic one prized by most contemporary philosophers of science. The upshot, I suggest, is a new program for philosophy of (...) science, a program for a socially responsible philosophy of science. (shrink)

A version of this paper was given as the Inaugural Steven Edwards Memorial Lecture at the 25th conference of the International Philosophy of Nursing Society 16th August 2022. Using the literary meaning of ‘whither’, that is ‘to what place’, this paper will explore the role of philosophy in nursing, past, present, and future. The paper will begin with some thoughts on the history of nursing philosophy, its development as a subject and the scholarly activities that have led to where it (...) sits today. The establishment of the journal Nursing Philosophy, the Annual Nursing Philosophy Conference, the International Philosophy of Nursing Society (IPONS) and their influence on nursing both in the academy and in practice will be discussed. The concept of nursing philosophy as a discipline will be considered, and how this fits with nursing theory, and nursing knowledge. Philosophical questions central to understanding contemporary nursing in a globalised world will be explored and the use of analytical philosophy and philosophical method in addressing such questions. The paper will conclude by looking to the future; what the role of philosophy might be in shaping nursing as a discipline and in the preparation of future practitioners. (shrink)

Background In the wake of mandates for biomedical research to increase participation by members of historically underrepresented populations, community engagement (CE) has emerged as a key intervention to help achieve this goal.Methods Using interviews, observations, and document analysis, we examine how stakeholders in precision medicine research understand and seek to put into practice ideas about who to engage, how engagement should be conducted, and what engagement is for.Results We find that ad hoc, opportunistic, and instrumental approaches to CE exacted significant (...) consequences for the time and resources devoted to engagement and the ultimate impacts it has on research. Critical differences emerged when engagement and research decisionmaking were integrated with each other versus occurring in parallel, separate parts of the study organization, and whether community members had the ability to determine which issues would be brought to them for consideration or to revise or even veto proposals made upstream based on criteria that mattered to them. CE was understood to have a range of purposes, from instrumentally facilitating recruitment and data collection, to advancing community priorities and concerns, to furthering long-term investments in relationships with and changes in communities. These choices about who to engage, what engagement activities to support, how to solicit and integrate community input into the workflow of the study, and what CE was for were often conditioned upon preexisting perceptions and upstream decisions about study goals, competing priorities, and resource availability.Conclusions Upstream choices about CE and constraints of time and resources cascade into tradeoffs that often culminated in “pantomime community engagement.” This approach can create downstream costs when engagement is experienced as improvised and sporadic. Transformations are needed for CE to be seen as a necessary scientific investment and part of the scientific process. (shrink)