In a crisis, societal needs take precedence over a patient’s best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. (...) But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When “triaging” or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies. (shrink)

Background: The Voluntary Assisted Dying Act 2017 passed into law in Victoria, Australia, on the 29 November 2017. Internationally, nurses have been shown to be intimately involved in patient care throughout the voluntary assisted dying process. However, there is a paucity of research exploring Australian nurses’ perspectives on voluntary assisted dying and, in particular, how Victorian nurses anticipate the implementation of this ethically controversial legislation will impact their professional lives. Objectives: To explore Victorian nurses’ expectations of the ethical and practical (...) impacts the voluntary assisted dying legislation will have on their professional lives. Research design: This qualitative study analysed nurses’ free text responses collected as part of a larger mixed methods online survey investigating staff views on the Voluntary Assisted Dying Act. Data were collected during the period between the passing of the voluntary assisted dying legislation and the start date and were analysed using inductive content analysis. Participants and research context: Free text survey responses were analysed from 1873 nurses employed across seven Victorian health services located in both metropolitan and regional areas of the state. Ethical considerations: The study obtained research ethics approval and all participants were informed of the voluntary and anonymous nature of their participation. Findings: This study identified three broad areas of Victorian nurses’ professional lives that they expected to be impacted by the implementation of voluntary assisted dying: professional identity, career development and workplace relationships. Conclusion: Participants anticipate diverse and nursing-specific impacts of the implementation of voluntary assisted dying in Victoria. Their insights can inform health services in jurisdictions considering or already implementing voluntary assisted dying, to develop policies, procedures and staff training programmes that safeguard the well-being and legal rights of their nursing staff. (shrink)

It has been said that pragmatism's "merely instrumental" truths fail to motivate radical change whereas absolute ideals make excellent guiding and driving forces for justice. However, in Radical Equations: Math Literacy and Civil Rights, Robert Moses speaks of the radical success of pragmatic principles, used in the Civil Rights Movement, that are continued today in the Algebra Project. This paper applies Dewey's claims about education and community to Moses's own arguments as a means of depicting the role that pragmatic ideals (...) play in achieving radical social change. (shrink)

The history of maternal-fetal therapy is a complex and compelling one. It can be argued that the science and ethics underpinning this field evolved together, with emerging technology spurring on th...

The development of nursing ethics as a field of inquiry has largely relied on theories of medical ethics that use autonomy, beneficence, and/or justice as foundational ethical principles. Such theories espouse a masculine approach to moral decision-making and ethical analysis. This paper challenges the presumption of medical ethics and its associated system of moral justification as an appropriate model for nursing ethics. It argues that the value foundations of nursing ethics are located within the existential phenomenon of human caring within (...) the nurse/patient relationship instead of in models of patient good or rights-based notions of autonomy as articulated in prominent theories of medical ethics. Models of caring are analyzed and a moral-point-of-view (MPV) theory with caring as a fundamental value is proposed for the development of a theory of nursing ethics. This type of theory is supportive to feminist medical ethics because it focuses on the subscription to, and not merely the acceptance of, a particular view of morality. (shrink)

Every day nurses are required to make ethical decisions in the course of caring for their patients. Ethics in Nursing Practice provides the background necessary to understand ethical decision making and its implications for patient care. The authors focus on the individual nurse’s responsibilities, as well as considering the wider issues affecting patients, colleagues and society as a whole. This third edition is fully updated, and takes into account recent changes in ICN position statements, WHO documents, as well as addressing (...) current issues in healthcare, such as providing for the health and care needs of refugees and asylum seekers, bioethics and the enforcement of nursing codes. (shrink)

Background and AimsEnd-of-life discussions can be difficult for seriously ill adolescents and young adults. Researchers aimed to determine whether completing Voicing My CHOiCES —a research-informed advance care planning guide—increased communication with family, friends, or health care providers, and to evaluate the experience of those with whom VMC was shared.MethodsFamily, friends, or HCPs who the AYAs had shared their completed VMC with were administered structured interviews to assess their perception of the ACP discussion, changes in their relationship, conversation quality, and whether (...) the discussion prompted changes in care. Open-ended responses underwent thematic analysis.ResultsOne-month post-completion, 65.1% of AYA had shared VMC completion with a family member, 22.6% with a friend, and 8.9% with an HCP. Among a sample of respondents, family and friends reported a positive change in their relationship with the AYA. Participant descriptions of the experience fell into five themes: positive experience, difficult experience, appreciated a guide to facilitate discussion, provided relief, and created worry/anxiety. Only 1 HCP noted a treatment change. Family, friends, and HCP did not think the AYA would have discussed EoL preferences without completing VMC.ConclusionsVMC has potential to enhance communication about ACP between AYA and their family and friends, though less frequently with HCPs. Participants reported a positive change in their relationship with the AYA after discussing VMC, and described experiencing the conversation as favorable, even when also emotionally difficult. (shrink)

The purpose of this article is to describe the development of a model of moral distress in military nursing. The model evolved through an analysis of the moral distress and military nursing literature, and the analysis of interview data obtained from US Army Nurse Corps officers (n = 13). Stories of moral distress (n = 10) given by the interview participants identified the process of the moral distress experience among military nurses and the dimensions of the military nursing moral distress (...) phenomenon. Models of both the process of military nursing moral distress and the phenomenon itself are proposed. Recommendations are made for the use of the military nursing moral distress models in future research studies and in interventions to ameliorate the experience of moral distress in crisis military deployments. (shrink)

The purpose of this article is to report what can be learned about nurses’ ethical conflicts by the systematic analysis of methodologically similar studies. Five studies were identified and analysed for: (1) the character of ethical conflicts experienced; (2) similarities and differences in how the conflicts were experienced and how they were resolved; and (3) ethical conflict themes underlying four specialty areas of nursing practice (diabetes education, paediatric nurse practitioner, rehabilitation and nephrology). The predominant character of the ethical conflicts was (...) disagreement with the quality of medical care given to patients. A significant number of ethical conflicts were experienced as ‘moral distress’, the resolution of which was variable, depending on the specialty area of practice. Ethical conflict themes underlying the specialty areas included: differences in the definition of adequacy of care among professionals, the institution and society; differences in the philosophical orientations of nurses, physicians and other health professionals involved in patient care; a lack of respect for the knowledge and expertise of nurses in specialty practice; and difficulty in carrying out the nurse’s advocacy role for patients. (shrink)

In the pages that follow I looked closely at two major paintings by Gustave Courbet : the After Dinner at Ornans, perhaps begun in the small town of the title but certainly completed in Paris during the winter of 1848-49; and the Stonebreakers, painted wholly in Ornans just under a year later. The After Dinner and the Stonebreakers are the first in a series of large multifigure compositions--others are the Burial at Ornans and the Peasants of Flagey Returning from the (...) Fair —that mark not only Courbet's maturity as an artist but his emergence as a disruptive force, almost a one-man wrecking crew, in the cultural politics of his time. They are also those works in which his self-declared identity as a Realist first becomes manifest, and probably the chief concern of the most interesting recent scholarship on Courbet has been to try to decode that epithet in social-historical terms, or at any rate to situate his activity as a painter during the years 1848-55 in the context of the social and political struggles that accompanied the creation of the Second Republic and its subversion by Louis Bonaparte.2 At the core of that tradition, motivating and, as it were, mobilizing it, is the demand that the painter succeed in placing in abeyance the primordial convention that paintings are made to be beheld—that he contrive in one way or another to establish the fiction, the meta-illusion, that the beholder does not exist, that there is no one standing before the picture. From Greuze through Gèricault, this was chiefly to be accomplished in and through the medium of visual drama, that is, by representing figures so deeply absorbed in their actions, emotions, and states of mind and furthermore so efficaciously bound together in a single comprehensive dramatic situation that they would strike one as absolutely immured in the world of the painting and a fortiori as oblivious to the very possibility of being viewed. And one way of describing the crisis that I believe overtook French painting by the 1820s and '30s is to say that the dramatic as such came more and more to be revealed as inescapably theatrical—that the array of conventions that once had served to establish the meta-illusion of the beholder's nonexistence now seemed merely to attest to his controlling presence.1. The present essay is adapted from a book-length study, in progress, of Courbet's art. Recent books and articles emphasizing social and political considerations include Linda Nochlin, Gustave Courbet: A Study of Style and Society ; T.J. Clark, "A Bourgeois Dance of Death: Max Buchon on Courbet," Burlington Magazine 111 : 208-12, 282-89, and Image of the People: Gustave Courbet and the Second French Republic, 1848-51 ; Jack LIndsay, Gustave Courbet: His Life and Art ; Klaus Herding, ed., Realismus als Widerspruch: Die Wirklichkeit in Courbets Malerei ; Herding, "Les Lutteurs 'détestables': Critique de style, critique sociale," Histoire et critique de l'art 4-5 : 94-122; and James Henry Rubin, Realism and Social Vision in Courbet and Proudhon .2. For an account of the early evolution of that tradition, see my Absorption and Theatricality: Painting and Beholder in the Age of Diderot , as well as the essays on Courbet cited in n. 3.Michael Fried, professor of humanities and the history of art at the Johns Hopkins University, is the author of Morris Louis and Absorption and Theatricality: Painting and Beholder in the Age of Diderot. He is currently at work on a book on Courbet. (shrink)

So there will be no mistake, I don’t deny, why would I wish to, that a thematic of racial difference is crucial to the overall plot of Almayer’s Folly. What I claim is that that thematic falls short of significantly determining or even, to use Brown’s word, appreciably “complicating” the problematic of erasure that surfaces in the closing chapters. It’s as though the rest of the novel is there chiefly to stage those chapters and their dramatization of erasure; something similar (...) takes place in Powell’s narrative of spying into Captain Anthony’s cabin toward the end of Chance and even, to a lesser degree, in the climactic encounter between Winnie Verloc and her husband in chapter 11 of The Secret Agent. It’s worth noting, too, that the opening paragraphs of A Personal Record, Conrad’s autobiographical account of the beginnings and origins of his “writing life,” describe the circumstances under which “the tenth chapter of ‘Almayer’s Folly’ was begun.”8 This in itself suggests that Conrad has a special stake in the last three chapters of his first novel, and one of my aims in “Almayer’s Face” was to discover what that stake may have been.9 8. Joseph Conrad, A Personal Record , pp. 72: my emphasis.9. Again, so there will be no mistake, I would distinguish Almayer’s Folly sharply in this respect from, for example, The Nigger of the “Narcissus,” in which effects of erasure are disseminated throughout the text and in which the title character’s blackness is crucial to their production. Michael Fried, J. R. Herbert Boone Professor of Humanities at the Johns Hopkins University, is currently at work on books on Manet and on literary “impressionism.” His most recent book is Courbet’s Realism. (shrink)

There is no topic that attracts more attention, more energy and time and devotion, than love. As long as there's been recorded history, love has taken center seat as the inspiration for countless paintings, instigator of wars, muse of untold poets and musicians. And just as poetry, art and music have the ability to communicate something about love that is difficult to articulate with words, the same is true of mathematics. Of course, mathematics can't easily help us translate the emotional (...) side of love, emotions rarely behave in a neatly ordered, rational and easily predictable way. It is difficult to quantify the rollercoaster of romance or to define how lovers might feel via a set of simple equations. But that doesn't mean that mathematics isn't crucial to understanding love. Love, like most things in life, is full of patterns. And mathematics is ultimately the study of patterns, from predicting the weather to the fluctuations of the stock market, the movement of planets or the growth of cities. These patterns twist and turn and warp and evolve just as the rituals of love do. In [this book, the author] takes the listener on a fascinating journey through the patterns that define our love lives, tackling some of the most common yet complex questions pertaining to love: What's the chance of us finding love? What's the chance that it will last? How does online dating work, exactly? When should you settle down? How can you avoid divorce? When is it right to compromise? Can game theory help us decide whether or not to call? From evaluating the best strategies for online dating to defining the nebulous concept of beauty, Dr. Fry proves, with great insight, wit and fun, that math is a surprisingly useful tool to negotiate the complicated, often baffling, sometimes infuriating, always interesting, patterns of love. (shrink)

Presents a plethora of approaches to developing human potential in areas not conventionally addressed. Organized in two parts, this international collection of essays provides viable educational alternatives to those currently holding sway in an era of high-stakes accountability.

Book reviewed in this article: Case Studies in Nursing Ethics. By Robert M. Veatch and Sara T. Fry.

This paper raises a worry about the non-identity intuition. As one part of the non-identity problem, the non-identity intuition tells us that when choosing between bringing a person with a good life into existence and bringing a person with a great life into existence, we have moral reason to bring the person with a great life into existence. But there is a worry to be had about the non-identity intuition. Because the non-identity intuition compares future persons exclusively in regard to (...) their well-being, the non-identity intuition values future persons solely for the well-being enjoyed by each of them. Therefore, or so the worry goes, the non-identity intuition fails to be compatible with what it means to value persons for their own sake. (shrink)

Although pride has been central to philosophical and religious discussions of emotion for thousands of years, it has largely been neglected by psychologists. However, in the past decade a growing body of psychological research on pride has emerged; new theory and findings suggest that pride is a psychologically important and evolutionarily adaptive emotion. In this article we review this accumulated body of research and argue for a naturalist account of pride, which presumes that pride emerged by way of natural selection. (...) In this view, pride is prevalent in human life because of the functional and adaptive role it has played in the attainment, maintenance, and communication of social status throughout our evolutionary history. (shrink)

The COVID-19 pandemic has presented a global threat to physical and mental health worldwide. Research has highlighted adverse impacts of COVID-19 on wellbeing but has yet to offer insights as to how wellbeing may be protected. Inspired by developments in wellbeing science and guided by our own theoretical framework, we examined the role of various potentially protective factors in a sample of 138 participants from the United Kingdom. Protective factors included physical activity, tragic optimism, gratitude, social support, and nature connectedness. (...) Initial analysis involved the application of one-sample t-tests, which confirmed that wellbeing in the current sample was significantly lower compared to previous samples. Protective factors were observed to account for up to 50% of variance in wellbeing in a hierarchical linear regression that controlled for a range of sociostructural factors including age, gender, and subjective social status, which impact on wellbeing but lie beyond individual control. Gratitude and tragic optimism emerged as significant contributors to the model. Our results identify key psychological attributes that may be harnessed through various positive psychology strategies to mitigate the adverse impacts of hardship and suffering, consistent with an existential positive psychology of suffering. (shrink)

It is often said that consequentialism violates the separateness of persons. But what does this mean? Existing interpretations are often unclear, or let consequentialism off easy: because they target amendable parts of the consequentialist framework, they can be sidestepped by more subtle versions of the theory. Consequentialism's opponents, however, might hope for a stronger interpretation––one which suggests that the separateness of persons objection presses a distinct and powerful charge against consequentialist theory. This paper proposes such an interpretation. It starts from (...) the fact that, unlike other moral theories, consequentialism determines how to act by looking at features such as states of affairs or outcomes. Yet, crucially, states of affairs or outcomes often make reference to, or extend across, more than one person. Thus, they implicitly and necessarily group together different individuals. In the proposal of this paper, it is this part of consequentialism which violates the separateness of persons. (shrink)

Common-sense morality seems to tell us that a rescuer who can save either one individual or five other individuals from death has a duty to save the greater number. But contractualism, a moral theory on which principles must be justifiable to individuals, seems to imply that it is permissible to save the one. This is because a commitment to individual justification blocks the possibility of appealing to the aggregate amount of lives saved. Does contractualism really have this implication? If so, (...) should we side with the common-sense approach, or is there any reason to side with the contractualist? In this paper, I first examine a new argument from Jay Wallace which claims to reconcile contractualism with a duty to save the greater number. I find the argument to be unsuccessful. I then suggest that common-sense morality doesn't support a duty to save the greater number as straightforwardly as it might initially seem as it might initially seem. I introduce two mundane cases in which the permissibility of saving either the lesser or greater number is intuitively plausible, and I offer some reasons to think that the permissibility of saving the lesser number coheres with our value judgements more generally. (shrink)

BackgroundThe increased risk of developing attention-deficit hyperactivity disorder (ADHD) in extremely preterm infants is well-documented. Better understanding of perinatal risk factors, particularly those that are modifiable, can inform prevention efforts.MethodsWe examined data from the Extremely Low Gestational Age Newborns (ELGAN) Study. Participants were screened for ADHD at age 10 with the Child Symptom Inventory-4 (N = 734) and assessed at age 15 with a structured diagnostic interview (MINI-KID) to evaluate for the diagnosis of ADHD (N = 575). We studied associations (...) of pre-pregnancy maternal body mass index (BMI), pregestational and/or gestational diabetes, maternal smoking during pregnancy (MSDP), and hypertensive disorders of pregnancy (HDP) with 10-year and 15-year ADHD outcomes. Relative risks were calculated using Poisson regression models with robust error variance, adjusted for maternal age, maternal educational status, use of food stamps, public insurance status, marital status at birth, and family history of ADHD. We defined ADHD as a positive screen on the CSI-4 at age 10 and/or meeting DSM-5 criteria at age 15 on the MINI-KID. We evaluated the robustness of the associations to broadening or restricting the definition of ADHD. We limited the analysis to individuals with IQ ≥ 70 to decrease confounding by cognitive functioning. We evaluated interactions between maternal BMI and diabetes status. We assessed for mediation of risk increase by alterations in inflammatory or neurotrophic protein levels in the first week of life.ResultsElevated maternal BMI and maternal diabetes were each associated with a 55–65% increase in risk of ADHD, with evidence of both additive and multiplicative interactions between the two exposures. MSDP and HDP were not associated with the risk of ADHD outcomes. There was some evidence for association of ADHD outcomes with high levels of inflammatory proteins or moderate levels of neurotrophic proteins, but there was no evidence that these mediated the risk associated with maternal BMI or diabetes.ConclusionContrary to previous population-based studies, MSDP and HDP did not predict ADHD outcomes in this extremely preterm cohort, but elevated maternal pre-pregnancy BMI, maternal diabetes, and perinatal inflammatory markers were associated with increased risk of ADHD at age 10 and/or 15, with positive interaction between pre-pregnancy BMI and maternal diabetes. (shrink)

Various branches of Complementary and Integrative Medicine (CIM) are growing fast in Western Pennsylvania, similar to other parts of the United States and the world. Little or no knowledge is available about what healthcare providers know and how they think and act regarding CIM. Such knowledge is important for planning for education about CIM and its ethical ramifications for future generations of healthcare providers. In this study, after a qualitative study and literature review, a questionnaire was developed to assess the (...) knowledge, attitude, and use of CIM among health-majoring undergraduate students of PennWest University. The content validity of the questionnaire was confirmed by a panel of experts, and its reliability was assessed by the test-retest method. The weighted agreements for individual questions ranged from 87% to 95%, with kappa ranging from 0.57 to 0.81. The Cronbach’s Alpha for the scale was 0.90. the questionnaire was completed by health-major students of PennWest University. To analyze the collected data, we used the Student’s t test and the chi-square test with a significant level of 0.05. The participants showed high percentages of familiarity with and use of CIM. Also, they expressed a favorable attitude toward CIM. They also agreed with the necessity of more education about CIM to be included in the curricula. This study concludes that there is a need to incorporate more education on CIM into the curricula of health-related disciplines, with a special focus on the ethical aspects, including the mandate for avoiding untested remedies and following evidence-based clinical practice. (shrink)

Fallibilists claim that one can know a proposition on the basis of evidence that supports it even if the evidence doesn't guarantee its truth. Jessica Brown offers a compelling defence of this view against infallibilists, who claim that it is contradictory to claim to know and yet to admit the possibility of error.

The United States, along with other nations and international organizations, has developed an elaborate system of ethical norms and legal rules to govern biomedical research using human subjects. These policies govern research that might provide direct health benefits to participants and research in which there is no prospect for participant health benefits. There has been little discussion, however, about how well these rules would apply to research designed to improve participants’ capabilities or characteristics beyond the goal of good health. When (...) mentioned at all in the literature, this so-called enhancement research, as opposed to research aimed at diagnosing, preventing, curing, or treating illnesses or medical conditions, is usually dismissed without explanation. (shrink)

Williams and DeSteno (2010) and Gladkova (2010) question the validity, utility, and theoretical support for the bifurcation of pride into hubristic and authentic facets. Though these commentators highlight unanswered questions and important directions for future research, we argue that the broad, evolutionarily informed framework for the two facets, presented in our target article nonetheless provides the best fit and explanation for the existing pattern of evidence. We offer several empirical suggestions for future studies addressing the questions raised by the commentators, (...) and emphasize the need for emotion researchers to hew closely to empirical data in developing theoretical accounts. (shrink)

Emerging adult newlywed couples often experience many demands on their time, and three common problems may surface as couples try to balance these demands—problems related to finances, sleep, and sex. We used two waves of dyadic data from 1,001 emerging adult newlywed couples to identify four dyadic latent profiles from husbands’ and wives’ financial management behaviors, sexual satisfaction, and sleep quality: Flounderers, Financially Challenged Lovers, Drowsy Budgeters, and Flourishers. We then examined how husbands’ and wives’ marital satisfaction, in relation to (...) profile membership, varied at a later wave. We found that Financially Challenged Lovers and Flourishers had significantly higher marital satisfaction than Drowsy Budgeters and Flounderers. Whereas, Financially Challenged Lovers and Flourishers did not differ in terms of marital satisfaction, Drowsy Budgeters seemed to have slightly higher marital satisfaction than Flounderers for wives only. However, we did not find evidence that these connections meaningfully differed by sex. Implications for the efforts of clinicians and educators are discussed. (shrink)

How can mental properties bring about physical effects, as they seem to do, given that the physical realizers of the mental goings-on are already sufficient to cause these effects? This question gives rise to the problem of mental causation (MC) and its associated threats of causal overdetermination, mental causal exclusion, and mental causal irrelevance. Some (e.g., Cynthia and Graham Macdonald, and Stephen Yablo) have suggested that understanding mental-physical realization in terms of the determinable/determinate relation (henceforth, 'determination') provides the key to (...) solving the problem of MC: if mental properties are determinables of their physical realizers, then (since determinables and determinates are distinct, yet don't causally compete) all three threats may be avoided. Not everyone agrees that determination can do this good work, however. Some (e.g., Douglas Ehring, Eric Funkhauser, and Sven Walter) object that mental-physical realization can't be determination, since such realization lacks one or other characteristic feature of determination. I argue that on a proper understanding of the features of determination key to solving the problem of MC these arguments can be resisted. (shrink)

When subjects violate epistemic standards or norms, we sometimes judge them blameworthy rather than blameless. For instance, we might judge a subject blameworthy for dogmatically continuing to believe a claim even after receiving evidence which undermines it. Indeed, the idea that one may be blameworthy for belief is appealed to throughout the contemporary epistemic literature. In some cases, a subject seems blameworthy for believing as she does even though it seems prima facie implausible that she is morally blameworthy or professionally (...) blameworthy. Such cases raise the question of whether one can be blameworthy for a belief in a specifically epistemic sense rather than in some already recognised sense, such as being morally or professionally blameworthy. A number of authors have recently argued that there is a moral or social sense in which one ought to conform one’s beliefs to the evidence. In this paper, I argue that even while accepting that there are moral and social norms governing belief, there are cases in which a subject is blameworthy for a belief but isn’t plausibly morally or socially blameworthy. If this latter view is correct, then we may need to develop a new account of blame which can be applied to beliefs which are not morally or socially blameworthy. (shrink)

In Clark’s thoughtful analysis of the evolution of the two facets of pride, he suggests that the concurrent existence of hubristic and authentic pride in humans represents a “persistence problem,” wherein the vestigial trait (hubristic pride) continues to exist alongside the derived trait (authentic pride). In our view, evidence for the two facets does not pose a persistence problem; rather, hubristic and authentic pride both likely evolved as higher-order cognitive emotions that solve uniquely human—but distinct— evolutionary problems. Instead of being (...) conceptualized as serial homologues, with one the vestigial form of the other, we argue that hubristic and authentic pride are both derived homologues of a vestigial proto-pride emotion that existed in our shared ancestry with other primates. (shrink)