When shared decision making breaks down and parents and medical providers have developed entrenched and conflicting views, ethical frameworks are needed to find a way forward. This article reviews the evolution of thought about the best interest standard and then discusses the advantages of the harm principle (HP) and the zone of parental discretion (ZPD). Applying these frameworks to parental refusals in situations of complexity and uncertainty presents challenges that necessitate concrete substeps to analyze the big picture and identify key (...) questions. I outline and defend a new decision-making tool that includes three parts: identifying the nature of the disagreement, checklists for key elements of the HP and ZPD, and a “think list” of specific questions designed to enhance use of the HP and ZPD in clinical decision making. These tools together will assist those embroiled in complex disagreements to disentangle the issues to find a path to resolution. (shrink)

An anthology that provides new translations and makes available much of the relevant historical literature needed for an exploration of the view that morality is very literally created by God. Contains 41 selections representing discussions of divine command morality in Ancient philosophy, scholastic philosophical theology, the Reformation tradition, the British modern period, and contemporary analytic philosophy. This book includes a bibliography of Latin, French, English, German, and Italian sources on divine command morality.

The debate surrounding the issue of collective moral responsibility is often steeped in metaphysical issues of agency and personhood. I suggest that we can approach the metaphysical problems surrounding the issue of collective responsibility in a roundabout manner. My approach is reminiscent of that taken by P.F. Strawson in "Freedom and Resentment" (1968). Strawson argues that the participant reactive attitudes - attitudes like resentment, gratitude, forgiveness and so on - provide the justification for holding individuals morally responsible. I argue that (...) the framework of the reactive attitudes extends to collectives and provides the justification for holding collectives morally responsible. (shrink)

Ayahuasca is a psychoactive beverage that is mostly used in ritualized settings (Santo Daime rituals, neo-shamanic rituals, and even do-it-yourself-rituals). It is a common practice in the investigated socio-cultural field to call these settings “healing rituals.” For this study, 15 people who underwent ayahuasca (self-)therapy for a particular disease like chronic pain, cancer, asthma, depression, alcohol abuse, or Hepatitis C were interviewed twice about their subjective concepts and beliefs on ayahuasca and healing. Qualitative data analysis revealed a variety of motivational (...) patterns, subjective effects, and user types. Most participants were convinced that ayahuasca had influenced their illness positively or improved their coping with their illness. More importantly, it had enhanced their well being in general. As a result, we concluded that the effects of ayahuasca should not be reduced to a pharmacological model. The substance should be conceptualized as a psychological catalyst that unfolds within different fields of sociocultural ideas. (shrink)

PERRON A and HOLMES D. Nursing Inquiry 2011; 18: 191–204Constructing mentally ill inmates: nurses’ discursive practices in correctionsThe concepts of discourse, subjectivity and power allow for innovative explorations in nursing research. Discourse take many different forms and may be maintained, transmitted, even imposed, in various ways. Nursing practice makes possible many discursive spaces where discourses intersect. Using a Foucauldian perspective, were explored the ways in which forensic psychiatric nurses construct the subjectivity of mentally ill inmates. Progress notes and individual (...) interviews constitute discursive spaces within which nurses construct patients’ subjectivities. Progress notes provide a written (and permanent) form of discourse, while interviews set the space for a more fluid and contextual form of discourse. We identified five types of subjectivities – the (in)visible patient, the patient as risk, the deviant patient, the disturbed patient and the disciplined patient. These subjectivities were rooted in various types of discourses circulating in the selected setting. Despite the multiple discursive dimensions of forensic psychiatric nursing, progress notes remain the main formal source of information regarding nursing care even though it is not representative of the care provided nor is it representative of nurses’ complex discursive practices in corrections. (shrink)

Objective: To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions. Design: Prospective clinical interventional study. Setting: Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland. Participants: Nine junior physicians in postgraduate training. Intervention: Information on the ethics of DNR and implementation of new DNR orders. Measurements and main results: Accurate understanding, interpretation, and use of (...) DNR orders, especially with respect to the patients’ involvement in the decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision. Conclusion: An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

Any worlds semantics for intentionality has to provide a plenitudinous theory of impossibility: For any impossible proposition, it should provide a world where it is true. Hence, also any semantics for impossibility statements that extends Lewis’s concretism about possible worlds should be plenitudinous. However, several such proposals for impossibilist semantics fail to accommodate two kinds of impossibility that, albeit not unheard of, have been largely neglected in the literature on impossible worlds, but that are bound to arise in the Lewisian (...) context. The proposals discussed here stop short of plenitude because they adhere to what Lewis occasionally referred to as ‘ontological truth’, as they lack the semantic ability to misrepresent ontological facts. The paper develops a framework for systematic misrepresentations on the basis of Mares’s situation-based account of impossible ‘worlds’, and which confines ‘ontological truth’ to possibility. It thus illustrates how a plenitude of impossibilities can be achieved. (shrink)

A wealth of literature and best practices on Responsible Research and Innovation (RRI) document how it can be implemented in projects. However, each project is too specific to simply replicate existing patterns. Especially in early projects with a high degree of uncertainty, where indicators and measures cannot be applied, the so-called provenance assessment as a methodological change of perspective makes it possible to assess the procedural quality of research by means of narratives. A clear picture of the challenges for European (...) bio-economy projects is sought by mapping the broader debate on "RRI in practice" in the context of biotechnology. The SUSPHIRE project is used as a case study to show how project-specific narratives integrate and signify RRI. By unpacking various concepts of "responsibility" that are already present in the project narrative at an early stage, I will show how this assessment differs significantly from other attempts to "do RRI". It is precisely in the absence of other criteria that the assessment of provenance can bring to the fore the specific form(s) of responsibility inherent in the development of projects. (shrink)

This article examines the Canadian case, focusing on the ways in which the political rationalities that have informed the Canadian variants of post-war social liberalism and neoliberalism have opened and then closed spaces for the articulation and institutionalization of gender-based equality claims-making. The article recounts how the Canadian welfare state underwrote a unique gender equality infrastructure inside the state and a thick field of gender organizations in civil society and later how this potent political and symbolic node of social liberalism (...) became a critical field of contestation for those promoting neoliberal political rationalities. The article describes a protracted war of position in which the gendered politics and identities of the 20th century have been displaced and marginalized, but not fully consumed by neoliberal idioms, representations and policy interventions. (shrink)

The study examines gradation as a central mode of 18th century thought. Originally a structural notion in the natural sciences, gradation underwent a change in the 17th century to become a major descriptive trope for gradually intensifying patterns of change. As a trope that extends across disciplinary boundaries, gradation became an important aesthetic concept of the period in areas as diverse as rhetoric, aesthetics, dramatic art, and music."--Provided by publisher.

This paper focuses on the specific topic of oniric and prophetic praenotio, which Pomponazzi discussed in his main works. Pomponazzi aims at proving that dreams and prophecies are not inspired by Christian God, angels or demons, but are natural phaenomena, depending on divine, impersonal providence (fatum), which guarantees through astral movement the eternal preservation of human species.

This paper examines the ontological fragility from the perspective of the metaphysics of creation as interpreted by Jean Ladrière, in view of some contemporary philosophical developments concerning the status of the ontological ground of being and the concept of event. Starting with some clarifications about the meaning of the term “fragility”, it then shows that ontological fragility as a structural property of the created being is related to the fact that it does not coincide with the source of its being. (...) This means that the creating being does not have the capacity to secure its own being from the recurring possibility of its nonexistence. The created being is the one that is looking for its fulfillment in a definitive secure home. (shrink)

An eighth grade student from Oregon delves into the meaning of art.

Louis Perron Le discours cosmologique actuel permet-il d’affirmer le caractère théophanique du cosmos, au sens où celui-ci pourrait être considéré comme le lieu de la manifestation visible et immédiate de Dieu? Plus généralement : est-il en mesure d’ouvrir un chemin vers la foi? Contrairement à un discours récurrent, l’auteur, s’appuyant sur l’oeuvre de Jean Ladrière, défend la thèse qu’il n’existe pas de voie royale conduisant de la science à la foi. Celle-ci peut cependant recueillir l’image scientifique du monde et (...) lui conférer une signification propre, moyennant un parcours herméneutique s’appuyant sur l’articulation des différents registres de sens et dont la médiation philosophique constitue le passage obligé. (shrink)

This paper examines whether and to what extent the overall business strategy influences the firm’s mismanagement of sustainability. Specifically, an empirical measure for the mismanagement of sustainability is developed by exploiting the newly available materiality guidelines for US firms to define industry-specific material sustainability issues. Using this measure, this paper shows that mismanagement of sustainability can represent unethical business behavior when firms intentionally perform better on immaterial issues than on material issues by diverting stakeholders’ attention from the firm’s low overall (...) sustainability performance. This paper assumes that the right business strategy can prevent such unethical actions. Based on Miles and Snow’s organizational theory, this paper distinguishes between Prospector and Defender business strategies. By employing multiple firm-level panel regressions, the findings suggest that Prospector-type firms are more likely to mismanage sustainability issues compared to Defender-type firms intentionally. The results give implications for researchers, regulators and standard setters, auditors, sustainability practitioners, and scholars. (shrink)

Objective:To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions.Design:Prospective clinical interventional study.Setting:Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland.Participants:Nine junior physicians in postgraduate training.Intervention:Information on the ethics of DNR and implementation of new DNR orders.Measurements and main results:Accurate understanding, interpretation, and use of DNR orders, especially with respect to the patients’ involvement in the (...) decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision.Conclusion:An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

In the wake of the most recent financial crisis, corporations have been criticized as being self-interested and unmindful of their relationship to society. Indeed, the blame is sometimes placed on the corporate legal form, which can exacerbate the tension between duties to shareholders and interests of stakeholders. In comparison, the Benefit Corporation (BC) is a new legal business entity that is obligated to pursue public benefit in addition to the responsibility to return profits to shareholders. It is legally a for-profit, (...) socially obligated, corporate form of business, with all the traditional corporate characteristics combined with societal responsibilities. Considering the history and perception of shareholder primacy in United States law, it is argued that this new business structure is an ethical step toward empowering socially committed commercial entities. The contribution of this research is to provide a fundamental base of knowledge about the new legal form of business, the BC, upon which further study may rely. First, the legal history of the corporation is briefly reviewed in order to provide context to the relationship of the corporate form to society, including exploration of the premise that shareholder wealth maximization is its best and only purpose. Second, the BC is described in detail, and state statutes are compared. Third, the BC is placed within the context of corporate social responsibility. Finally, opportunities for future research are discussed. (shrink)

This paper examines the impact of integrated reporting on the integration of environmental, social, and governance issues into the business model and the related economic and ESG performance changes. To investigate these internal and external transformational effects of IR, important differences between IR and alternative ESG reporting strategies are worked out. Using three matched samples of companies from around the world for the sample period 2002–2011, IR companies are matched with companies applying no ESG reporting, stand-alone ESG reporting, or ESG (...) reporting in the annual report. The results suggest that IR is a superior mechanism only for the integration of ESG issues into the core business model when comparing IR with the ESG reporting strategies of no ESG reporting and ESG reporting in annual reports. In comparison with, stand-alone ESG reporting, the results indicate that IR is negatively associated with the ESG integration level and with the economic and ESG performance. Moreover, this negative impact is lower for companies that have already implemented ESG management tools prior to the initiation of IR and is stronger for companies residing in countries with legal requirements for the disclosure of ESG information. A separate change analysis reveals that companies do not benefit from a switch from stand-alone ESG reporting to IR. Thus, this paper provides empirical evidence that contradicts the general notion of IR as a superior reporting mechanism, as the benefits of IR are driven by several factors. (shrink)

Reports of children participating in hunger strikes while detained in offshore detention centres raise interrelated ethical issues and recognizable challenges for the medical decision-makers at these sites. A composite case study, informed by reports in the public domain, is employed to explore the unique challenges of consent and decision-making in these circumstances and the perennial issues inherent in adolescents’ developing capacity and autonomy. We present an amalgamated case of a fourteen-year-old adolescent who refused to consent to medical reversal of her (...) hunger strike protest. The medical team became the final arbiter when her parents, who were also in detention, could not agree with each other even after mediation. The case explores the complexity of evaluating the adolescent’s capacity to provide informed consent while influenced by the opinions of co-detainees in this extreme setting. We argue that the parents and the child had compromised decisional capacity due to the effects of detention. The challenges to the medical team are recognized and discussed. The team members faced a difficult dilemma and considered the competing values of the multiple cultural and ethical factors. Each team member integrated his or her own roles, duties, and discipline-specific professional guidelines with the primary goal of mitigating potential harms. (shrink)

For most of us, learning to communicate is as effortless as breathing, and like air, communication skills are elemental; integral to our human existence in this world. Our communicative competencies might be seen as a bridge, facilitating our relationship with the world we are immersed in. But what happens when a child has difficulty learning to communicate effectively? What happens when their most basic messages of hunger or thirst fail to be understood or they are unable to jointly share in (...) everyday experiences of curiosity, joy, frustration, or anger? In these situations, it is the role of the Speech-Language Pathologist (SLP) to span the distance between a child and their family, a child and the world, building a route for life experiences and understandings to cross over. An SLP often begins with assessment and after a brief interaction, an SLP may come to a ‘naming’ such as delay or disorder. While the caring professional may intend this naming to be helpful in better understanding a child or facilitating access to valuable support, this naming may also place an immeasurable weight upon the child and their family. The act of naming is therefore an ethical concern. Through observation and interviews, this paper presentation explores SLP’s experiences of coming to a diagnosis through the human lens of phenomenological inquiry. It seeks to enhance thoughtful and conscientious practice by considering the ‘ethical experience of caring responsibility’ as applied to SLP (van Manen, 2016). (shrink)

The Administration of Buddhism in China: A Study and Translation of Zanning and the Topical Compendium of the Buddhist Clergy, by Albert Welter. Cambria Press, 2018. 722pp., Hb. $154.99. ISBN-13: 9781604979428.

This article provides the first complete edition of the eighteen quodlibetal questions ascribed to Adenulf of Anagni (†1289) with an introductory study concerning the life and works of this author. Although the analysis of the texts reveals a strong dependence of Adenulf on the Summa Halensis, Thomas Aquinas and Gerard of Abbeville and a modest degree of originality, these questions represent an important source for the rising Thomism and the reception of the most prominent 13th-century figures.

The early history and teachings of two Japanese "new religions" that originated in the late Tokugawa and early Meiji periods are described. The focus is on views of the mind/heart in the writings of Inoue Masakane (considered the founder of Misogi-kyō) and Itō Rokurōbei (founder of Maruyama-kyō); particular attention is given to the question of Neo-Confucian influence.

The dominant theory of elite power, grounded in Weberian bureaucracy, has analyzed elites in terms of stable positions at the top of enduring institutions. Today, many conditions that spawned these stable ‘command posts’ no longer prevail, and elite power thus warrants rethinking. This article advances an argument about contemporary ‘influence elites’. The way they are organized and the modus operandi they employ to wield influence enable them to evade public accountability, a hallmark of a democratic society. Three cases are presented, (...) first to investigate changes in how elites operate and, second, to examine varying configurations in which the new elites are organized. The cases demonstrate that influence elites intermesh hierarchies and networks, serve as connectors, and coordinate influence from multiple, moving perches, inside and outside official structures. Their flexible and multi-positioned organizing modes call for reconsidering elite theory and grappling with the implications of these elites for democratic society. (shrink)

Although there have been a number of recent discussions about the emotions that we bring with us to our epistemic endeavors, there has been little, if any, discussion of the emotions we bring with us to epistemic appraisal. This paper focuses on a particular set of emotions, the reactive attitudes. As Peter F. Strawson and others have argued, our reactive attitudes reveal something deep about our moral commitments. A similar argument can be made within the domain of epistemology. Our "epistemic (...) reactive attitudes" reveal our epistemic commitments. Reflection on the role they play in our practice of epistemic appraisal can contribute to a number of different debates in contemporary epistemology, including the nature of epistemic norms and epistemic responsibility. (shrink)

Background There has been little attention paid to research on the outcomes of clinical ethics support or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes. Objective To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation, prior to MCD participation, and to compare results between respondents. Methods This mixed-methods study used (...) both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions. Results 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were ‘more open communication’, ‘better mutual understanding’, ‘concrete actions’, ‘see the situation from different perspectives’, ‘consensus on how to manage the situation’ and ‘find more courses of action’. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents. Conclusions Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD. (shrink)

The idea of agency has long been used in the nursing literature in the study of nurses' roles regarding the patients they take care of, but it has not often been used to study its relationship with nurses themselves and their status in the healthcare system. The purpose of this article is to analyze how the idea of agency is used in nursing research to better understand how we might advance our thinking around nurses' agency to shape nursing and healthcare (...) with an emancipatory intent. Based on the results of a literature review focused on the study of conceptions, treatments, and applications of the concept of agency in nursing, we present a critical discussion to reflect on the need to consistently define the idea of nurses' agency, to guide research concerned with this topic in theoretical frameworks with emancipatory and social change tenets, and to make a call to develop the idea of agency as a central one to rework nurses' relationship with themselves. The idea of agency provides a valuable analytical framework for the study of a wide range of issues around nurses' status in healthcare organizations and in the healthcare system while offering a means for nurses' emancipation. (shrink)

"Teaching after all is about knowing children well" -- from A Letter to Teachers "Perrone has given us a gift, a book worth reading over many times, an important reflection on his many years of close observation of schools and school people, parents, teachers, children, and their communities." -- Deborah W. Meier, principal, Central Park East Secondary School Simple, elegant and full of common sense, these reflections on the art of teaching address the deepest concerns teachers have for their work (...) with children and young people. (shrink)

This article unfolds in three stages. First, it locates the emergence of modern conceptions of social justice in industrializing Europe, and especially in the discovery of the “social,” which provided a particular idiom for the liberal democratic politics for most of the twentieth century. Second, the article links this particular conception of the social to the political rationalities of the postwar welfare state and the identity of the social citizen. Finally, the article discusses the myriad ways in which this legacy (...) of the social and social justice has been disrupted, although not yet fully displaced, by the economic orthodoxies and individualization that inform the contemporary neoliberal governing project in Canada. The result, the article concludes, has been the institutionalization of insecurity, which demands the renewal of a social way of seeing and a politics of social justice on local and global scales. (shrink)