Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this paper will focus exclusively on the (...) qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of “Breaking Point,” in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future. (shrink)

A report by the Nuffield Council on Bioethics, contrary to the Declaration of Helsinki, permits most important research initiatives in developing countries.The Ethics of Research Related to Health Care in Developing Countries by the Nuffield Council on Bioethics makes a number of innovative recommendations that depart from codes such as the Declaration of Helsinki. It recommends that standards of care might be relativised to the standard of that nation. It recommends that very good reasons need to be given for not (...) giving post-trial access to medications but recognises that there may be justifiable instances of this. It is the view of the authors that these and other recommendations of the report are sensible pieces of advice given the complexities of the developing world. (shrink)

Concepts such as ‘coercion’ and ‘inducement’ are often used within bioethics without much reflection upon what they mean. This is particularly so in research ethics where they are assumed to imply that payment for research participation is unethical. Wertheimer and Miller advance our thinking about these concepts and research ethics in a significant way, specifically by questioning the possibility of genuine offers ever being coercive. This commentary argues that they are right to question this assumption, however, more needs to be (...) said about the plausible coercive offer cases and to explain the normativity of these cases. (shrink)

Although formal barriers to women’s social and political participation have crumbled, society remains, to a significant degree, gendered in the roles that women and men play. Women’s and men’s choices regarding work and family are largely responsible for maintaining and reinforcing the differences. While feminists recognize the need to criticize women’s choices, too often they focus on restrictive conditions rather than the choices themselves. Kimberly A. Yuracko argues instead that encouraging women to make choices in accordance with a grounded (...) and well-defined conception of perfectionism—a philosopy concerned with human flourishing—is the most effective way to redress persistent gender inequality. To this end, Yuracko seeks not only to expose the perfectionism underlying current choice critiques, but to articulate a concrete set of feminist perfectionist principles that would improve the quality of individual women’s lives and improve the social standing of women as a whole. (shrink)

While the UK Home Office’s proposals to preventively detain people with what it has called dangerous severe personality disorder have been subjected to debate and criticism the deeply troubling jurisprudential issues in these proposals have not yet entered into public debate in a way that their seriousness deserves.1 It is good that a commentator as well known as Professor Szasz is speaking out on this issue.Professor Szasz focuses upon a crucial question by calling into question the medicalisation of terms like (...) dangerousness and mental illness.2 There is a great temptation for legislators and the public to treat these terms as if they are purely scientific terms and to think of risk assessment as a precise science. I don’t share Professor’s Szasz’s worry about how psychiatry is using these terms but I think there are some important questions about how these concepts function in the public sphere.This issue is important enough to justify the use of some rhetorical claims because such claims can serve to bring out what are neglected and important issues. In raising the following objections I am not attempting to refute the message that is in Szasz’s article or to say that he is not making an important point but rather to attempt to sharpen the issues and to suggest ways that we can respond to Professor Szasz’s challenge.Psychiatry has progressed in a number of ways since Professor Szasz wrote The Myth of Mental Illness.3 The science is much better, we have much better medications, and psychiatrists are acutely aware of the tension between treating their patient and their obligations to the public interest.So when Professor Szasz says: “Psychiatrists offer to relieve the disturbed person of the burden of coping …. (shrink)

The U.S. Supreme Court declared procreation to be a fundamental right in the early twentieth century in a case involving Oklahoma's Habitual Criminal Sterilization Act, an act that permitted unconsented sterilization of individuals convicted of certain crimes. The right that the Court articulated in that case is a negative right: it requires that the government not place unjustified roadblocks in the way of people seeking to procreate, but it does not require the government to take positive steps to help people (...) procreate if they wish to. I argue that a positive legal right is morally necessary in the United States, given the profound significance of procreation, the current barriers to access to care, and the related issues of individual and societal justice. I assume at the outset that the right to procreate should be expansive enough to include a right to noncoital reproduction. The absence of a positive right to procreate reflects not just constitutional tradition but also a governmental and societal commitment to a longstanding set of reproductive hierarchies by which those who fall outside of the traditional framing of family too frequently find their procreative dreams hindered. Reconceiving procreative rights to include a positive right would create greater opportunities to argue and lobby for increased access to technologies that are out of reach for many. (shrink)

This article on the potential for patient online records access (ORA) to increase the likelihood of nocebo effects is timely, 1 given the recent introduction of full prospective records access for primary care patients in England. 2 Blease provides a convincing overview of the evidence for the nocebo effect and examines the complex interplay with health inequities. The article proposes two mechanisms for ORA augmenting nocebo effects through: (A) patients reading about possible negative outcomes of treatments and (B) a negative (...) clinician tone or less supportive content in the notes diminishing patient trust and setting up negative expectations. Blease notes a small percentage of those who had used ORA at least once during the previous year in one study reported feeling more worried about their medications, 3 and that those with mental health diagnoses were significantly more prone to this than those without such diagnoses.shrink)

Discussion about the similarities and differences between abortion and multi-fetal pregnancy reduction, including the tug-of-war over naming, highlights ongoing contestation about the relationship between the law, ethics, and women's bodies. Ultimately, the law must root itself in the realities of pregnancy including the physical and social consequences that any pregnancy creates for the woman who carries it.

We are pleased that all the commentators seem to agree that a theory-driven integration across disciplines is a worthwhile endeavor to better understand the social constitution of emotion. In our reply, we first take up the idea of relating affect control theory to cultural priming and suggest links to an ACT-inspired constraint satisfaction explanation of priming. Second, we address reservations concerning ACT’s capability to account for emotions with nonconceptual content and to explain stability and change in affective meanings. Third, we (...) clarify the relation of affect control theory to psychological constructionism, in particular with regard to conceptualizations of culture and society. Finally, we suggest that computational models are an adequate tool to address multilevel issues in the study of emotion. (shrink)

In recent years, scholars have come to understand emotions as dynamic and socially constructed—the product of interdependent cultural, relational, situational, and biological influences. While researchers have called for a multilevel theory of emotion construction, any progress toward such a theory must overcome the fragmentation of relevant research across various disciplines and theoretical frameworks. We present affect control theory as a launching point for cross-disciplinary collaboration because of its empirically grounded conceptualization of social mechanisms operating at the interaction, relationship, and cultural (...) levels, and its specification of processes linking social and individual aspects of emotion. After introducing the theory, we illustrate its correspondence with major theories of emotion construction framed at each of four analytical levels: cultural, interactional, individual, and neural. (shrink)

Psychedelic-Assisted Psychotherapy is being investigated as a treatment for a range of psychiatric illnesses. Current research suggests that the kinds of subjective experiences induced by psychedelic compounds play key roles in producing therapeutic outcomes. To date, most knowledge of therapeutic psychedelic experiences are derived from psychometric assessments with scales such as the Mystical Experience Questionnaire. While these approaches are insightful, more nuanced and detailed descriptions of psychedelic-induced changes to subjective experience are required. Drawing on recent advancements in qualitative methods arising (...) from the interdisciplinary field of phenomenological psychopathology, we propose a systematic and comprehensive investigation into how Psychedelic-Assisted Psychotherapy alters subjective experience. This research program aims to characterise the nature of therapeutic psychedelic experiences by drawing on concepts from philosophical phenomenology. Such characterisations should, moreover, contribute to our understanding of the mechanisms of psychedelic therapy, the role of integration therapy, and related philosophical debates. (shrink)

This book provides an invaluable overview of the competing schools of thought in traditional and contemporary normative international theory and seeks to provide a new basis for doing international political theory and thinking about ethics in world politics today. · Part one explains the role and place of normative theory in the study of international politics before critically examining mainstream approaches in international relations and applied ethics. Here the student is introduced to the central debates between realists and idealists, and (...) cosmopolitans and communitarians. · Part two introduces the conceptual challenges of contemporary perspectives from critical theory, postmodernism and feminism and provides a platform for the author to develop her own Hegelian-Foucauldian approach for doing normative international theory. · In Part three the insights drawn from the first two parts are applied to the study of two key topics in contemporary theoretical debate: the principle of self-determination, and the democratic ideals of political cosmopolitanism. Finally conclusions are made for the future practice of theorizing international politics. Accessibly written and wide-ranging, this text will quickly become essential reading for all students and academics of politics and international relations seeking a deeper understanding of the underlying tensions and future potential of international or global political theory today. (shrink)

Psychedelic-assisted Psychotherapy combines the use of psychedelic compounds, such as psilocybin, with psychotherapy. PAP has shown some promise as a novel treatment for Major Depressive Disorder, and empirical research suggests that its efficacy turns on the altered states induced by psychedelic compounds. In this paper we draw on the literature of phenomenology to explain the therapeutic potential of psychedelic experiences. Svenaeus characterises mental illness as a form of suffering that entails three distinct but related experiences of alienation or “unhomelike being-in-the-world”: (...) illness suffering, which relates to embodiment; existential suffering, which relates to self-narratives, and political suffering, which relates to social relationships. Ratcliffe further characterises the experience of MDD in phenomenological terms as a loss of pre-intentional possibility that manifests as excessive noematic feeling in the experience of embodiment, restrictive narratives in the construction of self, and disconnectedness in experience of the social world. We contend that PAP ameliorates the suffering associated with MDD by inducing and consolidating a state of broadened pre-intentional possibility—one that entails sudden, profound and enduring changes in embodiment, self-narratives, and social experience. We argue further that this phenomenological account is consistent with a bio-psycho-social model of mental health and illness, and we frame it as an argument supporting the plausibility of recent claims about treatment success. This helps to justify ongoing future empirical research in this setting. (shrink)

When the state aims to prevent responsible and dangerous actors from harming its citizens, it must choose between criminal law and other preventive techniques. The state, however, appears to be caught in a Catch-22: using the criminal law raises concerns about whether early inchoate conduct is properly the target of punishment, whereas using the civil law raises concerns that the state is circumventing the procedural protections available to criminal defendants. Andrew Ashworth has levied the most serious charge against civil preventive (...) regimes, arguing that they evade the presumption of innocence. After sketching out a substantive justification for a civil, preventive regime, I ask what Ashworth’s challenge consists in. It seems that there is broad disagreement over the meaning and requirements of the presumption of innocence. I thus survey the myriad possibilities and extract two claims that have potential bearing on preventive regimes. One claim is that of substantive priority—the criminal law comes first when assessing blame. This is the claim at the root of objections to pretrial detention based on consideration of the crime charged. The second strand of argument is one of procedural symmetry. This is the concern that with respect to citizen/state relations, certain procedures are required, including, for example, proof beyond a reasonable doubt as to the offense or defense. Having extracted these claims, I then assess their applicability with respect to the preventive regime defended. I first conclude that the criminal law must share blame and censure with other fora, and thus, the criminal law only has substantive priority when criminal proceedings have been instituted. I then survey whether procedural symmetry is required, specifically assessing whether the preventive regime I defend requires proof beyond a reasonable doubt. My tentative conclusion is that proof beyond a reasonable doubt is warranted. (shrink)

Change is inevitable, and increasingly rapid and continuous in healthcare as organizations strive to adapt, improve and innovate. Organizational change challenges healthcare providers because it restructures how and when patient care delivery is provided, changing ways in which nurses must carry out their work. The aim of this doctoral study was to explore frontline nurses’ experiences of living with rapid and continuous organizational change. A critical hermeneutic approach was utilized. Participants described feeling voiceless, powerless and apolitical amidst rapid and continuous (...) organizational changes which fuelled apathy, cynicism and disengagement from the organization. However, critical analysis of the data showed that nurses actively engaged with power, voice and politics through resistant and transgressive behaviours in micro‐ethical moments of practice. There is a need to reconceptualize the concepts of voice, power and politics in nursing as there is dissonance between nurses’ beliefs about these concepts and what they are enacting in practice. Recognizing their enactment of power, voice and political agency at the micro‐level may empower nurses. Empowerment would mitigate the high levels of reports of powerlessness experienced in practice during organizational changes. (shrink)

Saunders & van Brakel set out to review color science research and to topple the belief that color-vision neurophysiology sets strong deterministic constraints on the cognitive processing of color. Although their skeptism and mission are worthwhile, they fail to give proper treatment to (1) findings that dramatically support some positions they aim to tear down, (2) existing research that anticipates criticisms presented in their target article, and (3) the progress made in the area toward understanding the phenomenon. At the very (...) minimum these oversights weaken the credibility of their arguments and leave the reader to wonder why their discussion ignores what is clearly omitted. (shrink)

NICE, the draft fertility guideline and dodging the big question: should fertility treatment be provided by the NHS?In August of this year the National Institute for Clinical Excellence made its draft guideline on fertility treatment available for consultation.1 As has been widely reported in the media the draft guideline recommends that the National Health Service should provide publicly funded fertility treatment in a consistent way across England and Wales. The guideline recommends that three cycles of IVF should be available when (...) “The woman is within the optimal range for in vitro fertilisation and there is an appropriately diagnosed cause of infertility of any duration, or unexplained infertility of at least three years’ duration .Those who need fertility treatment will celebrate the guideline, as will many fertility clinics. The guideline does not, however, address key questions that will be obvious to many. Is fertility treatment the kind of thing that ought to be available on the NHS? Will the inevitable increase in demand mean that resources are directed away from other services? Is fertility treatment really the same kind of intervention as heart or hip replacement surgery?My view is that there are good reasons for doing what we can to help people access fertility services. Most of us will start a family and for those of us who do it is probably the most important of all of our life projects. Given that social status and wealth can be significant obstacles to many of the things that people would like to do with their lives, the fact that most of us are able to pursue this important life project is good from an egalitarian …. (shrink)

Starting with the first time they turned on a television or saw a billboard, this generation of teens, more than any generation before, has been inundated with the message, "If I can have that or look more like that, then I will be happy." Get Happy is a breath of fresh air for teenagers to help them become happy with who they are and what they have today rather than waiting for the next big thing. Teen advocate and author (...) class='Hi'>Kimberly Kirberger, along with her son, Jesse, enlightens readers with the idea that happiness is a choice, and it is available to us whenever we decide we want it. Kirberger uncovers the lies the media, our educational system, and even our well-intentioned friends and family tell us about happiness. Happiness can only be found in the here and now, not in what the future may bring. Get Happy Guide is all about letting go of our past and stepping into our present. It's about not being a victim and about learning how to gain control over our emotions. Poems, cartoons, and insightful stories are peppered throughout with examples of how other teenagers have found their own sense of happiness. (shrink)

Current evidence suggests that the efficacy of psychedelic therapy depends, in part, on the character of psychedelic experiences themselves. One pronounced aspect of psychedelic experiences is alterations to the experience of time, including reports of timelessness or transcending time. However, how we should interpret such reports remains unclear, and this lack of clarity has philosophical and clinical implications. For instance, “true” timelessness may be considered antithetical to having any experience at all, and descriptions of experiences involving “timelessness” are known to (...) be diverse and of varying clinical significance. In this article, we utilize a phenomenological approach to the study of temporality to highlight ambiguities in current constructs used to assess psychedelic experiences. In doing so, we advance some preliminary phenomenological accounts of psychedelic therapy’s mechanisms of action, such as psychedelic temporality acting as a kind of counterpoint for depressive temporality. We conclude by outlining how a dedicated phenomenological research program can provide a nuanced map of psychedelic temporality, guiding future research in a manner that addresses both philosophical and clinical ambiguities. (shrink)

Discussions of non-racialism in South Africa and discussions of post-racialism in the United States are sufficiently similar to invite the question as to whether South African thinkers could help to develop new ways of thinking about post-racialism and its potential in the United States. Biko's ideas are rarely taken up in the United States, yet they are relevant to contemporary discussions in critical philosophy of race. This article begins with an evaluation of the typology of non-racialism provided by Rupert Taylor (...) and the historical study of non-racialism provided by Julie Frederikse, distinguishing different understandings of non-racialism. The second section presents Biko's understanding of non-racialism, arguing that Biko's understanding of which is embedded in his account of Black Consciousness, and not a variant of racial eliminativism. The final section focuses on the striking similarities between understandings of non-racialism and post-racialism using a distinction it introduces between principled and progressive forms of both these terms. Ultimately, this article makes the case for a progressive understanding of post-racialism, which has yet to be articulated and is too easily dismissed in the United States. (shrink)

Governing Animals explores the role of the liberal state in protecting animal welfare. Examining liberal concepts such as the social contract, property rights, and representation, Kimberly K. Smith argues that liberalism properly understood can recognize the moral status and social meaning of animals and provides guidance in fashioning animal policy.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 91-92 [Access article in PDF] Jaspers and Defining Phenomenology John McMillan IT IS POSSIBLE TO DISTINGUISH a number of positions that you might take on the importance of phenomenology for the study of the mind. The strongest position is to think that phenomenology is sufficient for understanding the mind. This is a position that would be very hard to defend and it (...) is unlikely that Gupta and Kay want to endorse such a view. It is clear that Jaspers did not believe this; although he thought that first-person experience was undervalued, his project was an attempt to make sense of different kinds of explanation, all of which contribute to our understanding of the mind.A second position is to deny that phenomenology gives us anything that is of use in understanding the mind and psychopathology. Philosophers have developed a number of such positions, from the eliminativism of Churchland (1981) to the heterophenomenology of Daniel Dennett (1989, 1991).A third position is to hold that phenomenology is one of the methods that are useful for understanding the mind and psychopathology. Along with neuroscience and other more behavioral approaches to behavior, phenomenology is an important component of an adequate understanding of the mind. This position appears to be that endorsed by Jaspers, Gupta, Kay, and the authors they discuss. It is also the position that Grant Gillett and I defend in Consciousness and Intentionality (2001). Gupta and Kay's paper presents an argument about where the boundaries between phenomenology and other approaches to the mind and psychopathology ought to be drawn. Gupta and Kay, following Jaspers, think that the boundaries of the phenomenological ought to be drawn around those approaches that employ empathy and the presuppositionless stance and do not include objective phenomena.Given that the paper is primarily about what phenomenology means and that it endorses the way that Jaspers used the term, it is fairly important that we have a definition from Jaspers. Gupta and Kay give a description of some of Jaspers's methods for getting at subjective phenomena, but do not give an account of what Jaspers thinks the aim of phenomenology is. In other words, one way to classify something as phenomenological is its methods and another is by what the point of the exercise is. In General Psychopathology, Jaspers (1997) says that phenomenology is an empirical method for investigating "individual psychic experience" (p. 55). We can think of this as a claim about the objective of phenomenology and then consider the merits of different phenomenological methodologies in terms of their success in achieving this objective. This opens up the possibility that a theory may be genuinely phenomenological because it has a plausible method for getting at psychic lived experience but does not use all of the methods advocated by Jaspers.Gupta and Kay are correct that Jaspers does stress the importance of the presuppositionless [End Page 91] stance, the importance of empathy and the importance of not simply relying on objective phenomena. However, it is not obvious why an approach to understanding the mind or psycho- pathology must satisfy these conditions to be phenomenological. Imagine the following kind of situation: when I am observed to hit my big toe against a brick and give a yelp, it is possible to infer something about my psychic lived experience. There is not much is room for doubt about my first-person experience and, although you might ask me questions about my pain, they are unlikely to add much to what you can simply read from my behavior. This example may appear a little crude because the first-person experience in this case is not especially complex and is not that interesting as a entrance to the inner workings of an individual's mental life. It is not hard to come up with other examples where we can read the first-person experience from behavior in a fairly accurate and informative way. A father gazing at his young child while she is sleeping in his arms may be having a number of thoughts that we would not know about... (shrink)

Some children living with life-shortening medical conditions may wish to attend school without the threat of having resuscitation attempted in the event of cardiopulmonary arrest on the school premises. Despite recent attention to in-school do-not-attempt-resuscitation (DNAR) orders, no assessment of state laws or school policies has yet been made. We therefore sought to survey a national sample of prominent school districts and situate their policies in the context of relevant state laws. Most (80%) school districts sampled did not have policies, (...) regulations, or protocols for dealing with student DNARs. A similar majority (76%) either would not honor student DNARs or were uncertain about whether they could. Frequent contradictions between school policies and state laws also exist. Consequently, children living with life-shortening conditions who have DNARs may not have these orders honored if cardiopulmonary arrest were to occur on school premises. Coordinated efforts are needed to harmonize school district, state, and federal approaches in order to support children and families' right to have important medical decisions honored. (shrink)

Increased emphasis has been placed on teaching ethics in business schools. A recent meta-analysis of business ethics instruction indicated that instructional programs have a minimal impact on improving ethical behaviors (Waples et al. 2008). One of the newest trends in MBA education is gamification which allows instructors to employ video game concepts to engage students in serious business problems. Educators are attempting to harness a similar sort of power exhibited by games like FarmVille or Call of Duty and translate this (...) power into improved educational outcomes. This trend leads to the question; can gamification improve ethical learning outcomes? Using a single cohort of MBA students, ethics instruction in the MBA program was gamified and then operationalized in the students’ first required class and last required class. Although the sample was limited to a single cohort of students, results were promising, indicating improvement in ethical decision making and warranting further study. (shrink)

The relationship between technology, philosophy, and politics is both contentious and vital to our understanding of human nature and the ways human beings interact with one another in society; Francis Bacon outlined the wild potential and great danger of this relationship. Francis Bacon's New Atlantis in the Foundation of Modern Political Thought explores Bacon’s role as a founder of modern political science and the place of his New Atlantis in the founding of modern political thought.

This book analyses the problems of current just war theory, and offers a more stable justificatory framework for non-intervention in international relations. The primary purpose of just war theory is to provide a language and a framework by which decision makers and citizens can organize and articulate arguments about the justice of particular wars. Given that the majority of conflicts that threaten human security are now intra-state conflicts, just war theory is often called on to make judgments about wars of (...) intervention. This book aims to critically examine the tenets of just war theory in light of these changes, and formulate a new theory of intervention and just cause. For Michael Walzer, the leading scholar of just war theory, armed humanitarian intervention is permissible only in cases of genocide, ethnic cleansing, widespread massacres, or enslavement. This book shows why this threshold is too restrictive in light of the progressive shift away from interstate conflict as well as the emerging norms of 'sovereignty as responsibility' and the 'responsibility to protect'. _Justice, Intervention and Force in International Relations_ aims to establish a new, stable foundation for non-intervention and a revised threshold for 'just cause'. In addition, this book demonstrates that over-reliance on the just cause category distorts understanding, analysis, and public discussion of the justice or injustice of resorting to war. This new book will be of much interest to students of ethics, security studies, international relations and international law. Kimberley Hudson is Assistant Professor of Political Science at American International College, and has a Phd in International Relations from Brown University. (shrink)

A commentary on “The Ethics of Anonymous Gamete Donation: Is There a Right to Know One's Genetic Origins?,” by Inmaculada de Melo‐Martin, and “Autonomous Choice and the Right to Know One's Genetic Origins,” by Vardit Ravitsky, bothin the January‐February 2014 issue.

Martin Heidegger’s influence on the thought of Hannah Arendt has been frequently noted, but the precise nature of Arendt’s critique of her mentor is less understood. Kim Maslin argues that Arendt’s work attempted to transform fundamental ontology for responsible use in the public realm.

Eugenicists in the 1930s and 1940s emphasised our moral responsibilities to future generations and the importance of positively selecting traits that would benefit humanity. In 1935 Herbert Brewer recommended ‘Eutelegenesis’ so that that future generations are not only protected from hereditary disease but also become more intelligent and fraternal than us. The development of these techniques for human use and animal husbandry was the catalyst for the cross fertilization of moral ideas and the development of a critical procreative morality. While (...) eugenicists argued for a new critical morality, religious critics argued against artificial insemination because of its potential to damage important moral institutions. The tension between critical and conservative procreative morality is a feature of the contemporary debates about reproductive technologies. This and some of the other aspects of the early and contemporary debates about artificial insemination and reproductive technologies are discussed in this article. (shrink)