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Background: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. (...) Results: Synthesis of the scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions. Conclusion: Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended. (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)

In Moral Passages, Kathryn Pyne Addelson presents an original moral theory suited for contemporary life and its moral problems. Her basic principle is that knowledge and morality are generated in collective action, and she develops it through a critical examination of theories in philosophy, sociology and women's studies, most of which hide the collective nature and as a result hide the lives and knowledge of many people. At issue are the questions of what morality is, and how moral theories (...) (whether traditional or feminist) are implemented. Addelson takes up a large number of historical cases and contemporary social problems, including teen pregnancy, contraception and abortion, and gay rights. These cases allow her to see how the knowledge and lives of some people are declared deviant or immoral, while those of others appear to show the public consensus. One case she uses throughout the book is Margaret Sanger's early work on birth control with the anarcho-syndicalist movement--a revisionist history that reveals rather than hides the collective nature of morality and knowledge. Addelson shows how the usual individualist philosophies promote theories which hide the authority of the professionals who make them. A collectivist approach, she argues, must show the part professionals play in collective action. Her aim is to allow professional knowledge makers to be morally and intellectually responsible. Based on Addelson's twenty years of work in feminist philosophy and interactionist sociology as well as her long-standing involvement in women's community organization, Moral Passages investigates how morality and knowledge are collectively enacted in today's world. (shrink)

Though we agree with their argument that language is shaped by domain-general learning processes, Christiansen & Chater (C&C) neglect to detail how the development of these processes shapes language change. We discuss a number of examples that show how developmental processes at multiple levels and timescales are critical to understanding the origin of domain-general mechanisms that shape language evolution.

In his still-authoritative history of science essay, Kuhn showed that scientific discoveries commence with awareness of anomaly that researchers initially struggle to notice. Kuhn drew on a psychological study to illustrate the problem. Bruner and Postman asked people to name playing cards on brief exposure. Most cards were normal, but some were anomalous, such as a red six of spades and a black four of hearts. On brief exposure all participants fitted the anomalous cards unhesitatingly into their existing cognitive scheme, (...) identifying them as, for example, a six of spades or a four of hearts. With longer exposures subjects began to hesitate: ‘That’s a six of... (shrink)

This paper provides an argument for a more socially relevant philosophy of science (SRPOS). Our aims in this paper are to characterize this body of work in philosophy of science, to argue for its importance, and to demonstrate that there are significant opportunities for philosophy of science to engage with and support this type of research. The impetus of this project was a keen sense of missed opportunities for philosophy of science to have a broader social impact. We illustrate various (...) ways in which SRPOS can provide social benefits, as well as benefits to scientific practice and philosophy itself. Also, SRPOS is consistent with some historical and contemporary goals of philosophy of science. We’re calling for an expansion of philosophy of science to include more of this type of work. In order to support this expansion, we characterize philosophy of science as an epistemic community and examine the culture and practices of philosophy of science that can help or hinder research in this area. (shrink)

Culture, health, and medicine intersect in various ways—and not always without friction. This paper examines how liberal multicultural states ought to interact with diverse communities which hold different health-related or medical beliefs and practices. The debate is fierce within the fields of medicine and bioethics as to how traditional medicines ought to be regarded. What this debate often misses is the relationship that medical traditions have with cultural identity and the value that these traditions can have beyond the confines of (...) the clinical setting. This paper will attempt to bring some clarity to the discussion. In so doing, it will delve into some controversial areas: (1) the debate around whether liberal states ought to embrace multiculturalism, (2) the existence and nature of group-differentiated rights, (3) the question of whether healthcare systems ought to embrace medical pluralism, and (4) what this would entail for policymakers, clinicians, and patients. Ultimately, I argue that liberal democratic states with multicultural populations ought to recognize medical pluralism as a matter of respecting group-differentiated and individual human rights. (shrink)

How Doctors Think defines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness. How Doctors Think is divided into four parts. Part one introduces the (...) concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment. (shrink)

Building upon Thornton's (1991) work on teachers as “curricular-instructional gatekeepers,” the author explores what guided the curricular decision-making for one novice teacher concerning controversial issues that center on race, social class, and lesbian, gay, bisexual, and transgender (LGBT) issues. Qualitative case study revealed context, student demographics, and teacher positionality as influencing this teacher's choices regarding these themes in her curriculum. Findings indicated that this teacher was willing and able to challenge racist views in her classroom when she was a student (...) teacher and her students more closely mirrored her own race and social class. When she was a full-time teacher of students who were of a different racial and class background, she was unable to similarly challenge their homophobic beliefs. Implications for teacher education are discussed. (shrink)

Challenges current claims that humans ought to be vegetarians because animals have moral standing.

A significant portion of the scholarship in analytic philosophy of psychiatry has been devoted to the problem of what kind of kind psychiatric disorders are. Efforts have included descriptive projects, which aim to identify what psychiatrists in fact refer to when they diagnose, and prescriptive ones, which argue over that to which diagnostic categories should refer. In other words, philosophers have occupied themselves with what I call “diagnostic kinds”. However, the pride of place traditionally given to diagnostic kinds in psychiatric (...) research has recently come under attack, most notably by a recent initiative of the National Institute of Mental Health, the Research Domain Criteria Project, that seeks to exclude diagnostic categories from experimental designs and focus on other sorts of psychiatric kinds. I argue that philosophical accounts privileging diagnostic kinds must respond to this new line of criticism, and conclude that philosophers need to either counter psychiatrists’ growing suspicion about the hegemony of diagnostic categories in the clinic and the laboratory, or join in redirecting their efforts toward the development of robust accounts of other sorts of psychiatric objects and processes. (shrink)

The article “Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose,” Marshall et al. (2024) highlights the critical issue of care after an opioid overdose. “Revive and Re...

Artificial intelligence (AI) has attracted an increasing amount of attention, both positive and negative. Its potential applications in healthcare are indeed manifold and revolutionary, and within the realm of medical imaging and radiology (which will be the focus of this paper), significant increases in accuracy and speed, as well as significant savings in cost, stand to be gained through the adoption of this technology. Because of its novelty, a norm of keeping humans “in the loop” wherever AI mechanisms are deployed (...) has become synonymous with good ethical practice in some circles. It has been argued that keeping humans “in the loop” is important for reasons of safety, accountability, and the maintenance of institutional trust. However, as the application of machine learning for the detection of lumbar spinal stenosis (LSS) in this paper’s case study reveals, there are some scenarios where an insistence on keeping humans in the loop (or in other words, the resistance to automation) seems unwarranted and could possibly lead us to miss out on very real and important opportunities in healthcare—particularly in low-resource settings. It is important to acknowledge these opportunity costs of resisting automation in such contexts, where better options may be unavailable. Using an AI model based on convolutional neural networks developed by a team of researchers at NUH/NUS medical school in Singapore for automated detection and classification of the lumbar spinal canal, lateral recess, and neural foraminal narrowing in an MRI scan of the spine to diagnose LSS, we will aim to demonstrate that where certain criteria hold (e.g., the AI is as accurate or better than human experts, risks are low in the event of an error, the gain in wellbeing is significant, and the task being automated is not essentially or importantly human), it is both morally permissible and even desirable to kick the humans out of the loop. (shrink)

This paper proposes that public health is the sort of institution that has a role in producing structures of virtue in society. This proposal builds upon work that describes how virtues are structured by the practices of institutions, at the collective or whole-of-society level. This work seeks to fill a gap in public health ethics when it comes to virtues. Mainstay moral theories tend to incorporate some role for virtues, but within public health ethics this role has not been fully (...) articulated. Two recent papers have proposed ways in which the virtues might be incorporated: working from a structural account, Rozier suggests that public health could work to instil virtues, like temperance, in the public in order to achieve its health-related goals; Nihlén Fahlquist suggests that compassion is among three virtues that practitioners of public health should cultivate in order to do their work well. In the end, both accounts recommend incorporating virtues at the level of individuals, among the public and among practitioners. I propose a third kind of role for virtue in public health that focuses on structures. Public health activities take place at the population level, and a public health virtue ethics must also be suitably population-focussed. (shrink)

While acknowledging Hannah Arendt's keen philosophical and political insights, Kathryn T. Gines claims that there are some problematic assertions and oversights regarding Arendt’s treatment of the "Negro question." Gines focuses on Arendt's reaction to the desegregation of Little Rock schools, to laws making mixed marriages illegal, and to the growing civil rights movement in the south. Reading them alongside Arendt's writings on revolution, the human condition, violence, and responses to the Eichmann war crimes trial, Gines provides a systematic analysis (...) of anti-black racism in Arendt’s work. (shrink)

The nineteenth-century British historian Lucy Aikin's ambitious four-part poem Epistles on Women (1810) marks both her first important contribution to women's historiography and a compelling example of Enlightenment feminist historiography. To some extent, Aikin is building on the work of male Enlightenment historians who had evaluated the status of women in different times and places and correlated it to social progress. However, she not only restricts her focus exclusively to women, but also makes a concerted effort to resolve some of (...) the tensions apparent in previous accounts of the relationship between women and social progress. Especially striking is her mediation of two distinct historical models of femininity, which I have called the republican and commercial models of femininity, the outlines of both of which we can trace in the work of male Enlightenment historians. By suggesting that through proper education women might combine the best aspects of each model, Aikin strategically advances the project of controversial feminists like Catherine Macaulay and Mary Wollstonecraft, who had taken inspiration from the republican model of femininity in their demands for improvements to female education. ☆ Revised for the History of European Ideas, October 2, 2004 by Kathryn Ready. (shrink)

Concerns over the organising of food are widespread, stemming from unsustainable production practices that focus on extractive ‘use’ of resources that privilege wealth creation over planetary flourishing, care and well-being. We propose a conceptual framework based on _ecologies of care_ to assist in the re-entanglement of food systems. The concept of ecologies of care brings together theoretical understandings of relationality, ecology and care, along with an Aotearoa New Zealand indigenous Māori perspective. We examine how food production can be underpinned by (...) interdependent webs of relationships (whanaungatanga), stewardship (kaitiakitanga), and care and support (manaakitanga) with healthy land and healthy people at the core of organising. (shrink)

The authors examine the nature of the relationship between social science and philosophy and address the sort of work social science should do, and the role and sorts of claims that an accompanying philosophy should engage in. In particular, the authors reintroduce the question of ontology, an area long overlooked by philosophers of social science, and present a cricital engagement with the work of Roy Bhaskar. The book argues against the excesses of philosophising and commits itself to a philosophical approach (...) more deeply grounded in the social sciences. (shrink)

Through an analysis of personal histories, we reflect on changes in disability discourses in educational contexts since the 1970s. We argue that educational systems are deeply resistant to critical discourse of disability even while espousing social justice principles. We simultaneously recognize the disconnection between disability, education, and the lived experiences of disabled children, and the way in which their experiences are framed. We call for a more integrated discourse between academic theories of disability, professional systems, and children’s lived experiences in (...) order to better care for children and their families, and to address injustice in education systems. (shrink)

During a year when there is much tumult around the world and in the United States in particular, it might be surprising to encounter a paper about patience and argumentation. In this paper, I explore the notion of deep disagreement, with an eye to moral and political contexts in particular, in order to motivate the idea that patience is an argumentative virtue that we ought to cultivate. This is particularly so because of the extended nature of argumentation and the slow (...) rate at which we change our minds. I raise a concern about how calls for patience have been misused in the past and argue that if we accept patience as an argumentative virtue, we should hold people in positions of power, in particular, to account. (shrink)

The Anthropocene marks a moment of wild destratification of the planet that requires analysis of the relations between geologic forces and social practices. Deleuze and Guattari’s concept of strata is examined in order to develop a geophilosophy for the Anthropocene. Establishing a model of strata that conjoins earth and social flows together into planes of interrelated production highlights how the fossil substratum subtends contemporary forms of social relations. Stratifications, it is argued, are planes of social reproduction that both constrain and (...) are expressive of possible modes of expression (and thus political freedom). If power, according to Foucault, is a relation between forces, geosocial strata conceptualizes how stratifications organize and capture forces into political geology. Concentrating on diagramming moments of crossing strata, it is suggested that Anthropocene geopolitics needs to be located at the intersection of geosocial formations and processes of fossilization, rather than through a new assemblage of planetary scale. (shrink)

In the paper “An archeology of corruption in medicine”, Miles Little, Wendy Lipworth, and Ian Kerridge present an account of corruption and describe its prevalent forms in medicine. In presenting an individual-focused account of corruption found within “social entities”, Little et al. argue that these entities are corruptible by nature and that certain individuals are prone to take advantage of the corruptibility of social entities to pursue their own ends. The authors state that this is not preventable, so the way (...) to remedy corruption is via management and, where necessary, punishment. This commentary will briefly lay out the key features and functions of corruption as presented by Little et al., before providing a critical discussion that will focus on whether corruptibility is a necessary feature of social entities. I will propose that it is not a necessary feature, though it may frequently arise where individualistic values are unchecked. Corruption can be prevented within social entities by enhancing structures that direct toward virtue and which promote and reward cooperation instead of competition. (shrink)

In their analysis of how much fetal genetic information prospective parents should be able to access, Bayefsky and Berkman determine that parents should only be able to access information th...

ABSTRACT This paper explores how children (aged 7–11) in the UK are educated about sustainability and climate change, through exploring a sample of 155 learning resources from public, private and third sector organisations. Using qualitative content analysis, key codes captured a) how sustainability was represented; b) how responsibilities for sustainability are imagined and allocated within society; and c) how children are encouraged to act for sustainability. The paper shows how sustainability resources represent children as powerful agents of social change charged (...) with the responsibility and means to change their (and their close relatives’) behaviour within the household and school. Drawing on critical debates about sustainability education, I argue these representations are problematic because they do not equip children with an understanding of the political and moral economies that shape their actions (or inactions) as citizens, nor provide them with opportunities to develop collaborative competencies. (shrink)

The human right to health, insofar as it is widely recognized, is typically thought to include the right to fair access to adequate healthcare, but the operating conception of healthcare in this context has been under-defined. This lack of conceptual clarity has often led in practice to largely Western cultural assumptions about what validly constitutes “healthcare” and “medicine.” Ethnocentric and parochial assumptions ought to be avoided, lest they give justification to the accusation that universal human rights are mere tools for (...) Western imperial agendas. At the same time, a right to healthcare that is not also explicitly the right to effective healthcare rapidly loses meaning. This paper strives to provide an account of medicine with the flexibility to accommodate cultural difference in forms of practice, while also aiding in the articulation of a minimum for medical systems to meet the standards set out in a human right. (shrink)

The first time I bought something at the Japanese clothing retailer Uniqlo, I casually handed the cashier my credit card, barely grasped in one hand, while I riffled through my bag with the other. He received it reverently with both hands and a slight bow of the head. It was handed back to me in the same manner, held between the fingers and thumbs of both hands like an important document and presented in one fluid movement with a graceful downward (...) slope. I had paid extra to have my item gift wrapped—a scarf for my sister-in-law for Christmas—and that too was a ritual of careful ornamentation. The result was a delightful origami of polyester cloth instead of paper, wrapped and tied around the scarf without the use of tape or visible seams, creating a package that was more attractive than the simple black scarf it held.I was reminded of my Uniqlo purchase when Han discussed “the intense formalism and aestheticism that... dominates everyday ritual practices in Japan.” Japanese parcels are his favorite example of this overabundance of the signifier—a case where the envelope outshines the item inside. The signifier so overwhelms the signified that it displaces the very longing for meaning. For Han, “the liturgy of emptiness dispels the capitalist economy of the commodity.” Han must not have shopped at Uniqlo.“Ritual” is a notoriously difficult concept to pin down, and our longing to define it is often tied up with our sense of its loss or absence. In Han's elliptical chapters, “ritual” shifts referents, entangled variously with other ideas that are meant to define it or sit near it: play, rites of passage, aestheticism, and formalism. Ritual is most definitely not work, productivity, or commodity. If ritual is best known as the absence of work, production, and commodities, it becomes hard to see the work that rituals themselves can do, or their own productive power. Indeed, there are almost no rituals named or encountered in the book except through historical distance and nostalgia.It is not Han's experience of Japanese parcels that is offered as a counter to the commodity logic of our age, but Roland Barthes's. Ritual is already assumed to be lost, shrouded in the mists of ages past or civilizations frozen in time, accessible primarily through white European nostalgia, mediated by Han's own pronouncements of judgment on our deritualized present. But nostalgia for ritual and a longing to capture its affects was one of the first levers for the global economy propelled by early modern European colonialism. Our assumption that ritual is already always lost obscures the way our very longing for it works upon us. Surely the executives of Uniqlo knew all of this, implicitly, when they trained their American workforce in the careful rules of ornamentation and empty signifiers and convinced me to cough over a few extra dollars to purchase the “magnificent envelope.”. (shrink)

Pretty much everyone knows that our genes have at least something to do with how able or how high achieving we are. Some believe that we should not speak of this common knowledge, nor inquire into how genetic influence works or what it might mean. If we do not keep an open mind to the fact of genetic influence on academic achievement, however, then we cannot explore its possible implications. And if we do not consider the implications, then we cannot, (...) as a society, harness any potential benefits or avoid possible pitfalls. So that's what this essay is about—exploring what behavioral genetics research might be able to offer to educational theory, policy, and practice.We cannot yet use biological information to make accurate predictions for all children. We do know, however, that academic achievement is heritable, which is to say that differences between individuals are influenced by differences in their DNA. If genes are part of the problem for some pupils (to take the negative spin on this), then it seems likely that studying them could be part of a solution. And that's what behavioral geneticists are trying to do—to chart and understand pathways from DNA to behavior and to identify interventions that can maximize outcomes for all. The fact is, though, that we have an awfully long way to go. (shrink)

Can moments of spiritual atonement (the Holy Grail Experience) be explained away as heightened awareness and other more mundane worldly phenomena? The author posits that part of the puzzle can be accounted for by the following factors: hypnotic phenomena such as time distortion, time orientation, fantasy proneness, absorption and a movement from dissociation to association. Knowledge about sensory modalities, internal dialogues and peripheral sensing, and about meditation and awareness, may also help to verbalise this magical moment of “grace”. Writings on (...) conversion experiences and mysticism may also assist us in investigating this phenomenon, when time stands still, and when for brief moments in life we become absorbed in the wonderment of life at its zenith - a taste of eternity. Contextual elements of prior social isolation and sensory deprivation are investigated as possible contributions to this unique phenomenon. In this conceptual article, the author explores the Holy Grail experience from both spiritual and secular viewpoints. Indo-Pacific Journal of Phenomenology , Volume 6, Edition 1 May 2006. (shrink)

Every so often a book comes along that transforms one’s perspective on a major development in the history of science. Kenneth Caneva’s is one of them. Built upon decades of immersion in the primary...

The inclusion of more women’s works on introductory syllabi in philosophy has been suggested as one possible strategy to increase the proportion of philosophers that are female. Objections to this strategy often reflect the assumption that attention to the identity of authors is irrelevant to philosophy and detrimental to other pedagogical goals such as fairly and accurately representing the canon, and offering selections on the basis of their philosophical quality rather than the identities of their authors. I suggest the extent (...) to which one perceives it important to include women on introductory syllabi, one’s “gender perception,” may be affected by one’s largely unconscious, and unchosen, habits of moral perception; I appeal to Peggy DesAutel’s distinction between two types of moral perceiver to suggest that the differences between advocates and critics of more inclusive curriculum are not merely differences in values, but reflect fundamental and unchosen biases which result in receptivity to different considerations as to the reasons to change the way we introduce philosophy to newcomers. I provide evidence that inclusive curriculum may benefit all students, and suggest alternative approaches to representing the importance of those benefits to philosophers whose habits of moral perception may incline them to receptivity to principled rules and fairness rather than affective considerations. (shrink)