Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, Sjöberg, (...) Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

In this paper I discuss the costs and benefits of confabulation, focusing on the type of confabulation people engage in when they offer explanations for their attitudes and choices. What makes confabulation costly? In the philosophical literature confabulation is thought to undermine claims to self-knowledge. I argue that when people confabulate they do not necessarily fail at mental-state self-attributions, but offer ill-grounded explanations which often lead to the adoption of other ill-grounded beliefs. What, if anything, makes confabulation beneficial? As people (...) are unaware of the information that would make their explanations accurate, they are not typically in a position to acknowledge their ignorance or provide better-grounded explanations for their attitudes and choices. In such cases, confabulating can have some advantages over offering no explanation because it makes a distinctive contribution to people’s sense of themselves as competent and largely coherent agents. This role of ill-grounded explanations could not be as easily played by better-grounded explanations should these be available. In the end, I speculate about the implications of this conclusion for attempting to eliminate or reduce confabulation. (shrink)

I extend my direct virtue epistemology to explain how a knowledge-first framework can account for two kinds of positive epistemic standing, one tracked by externalists, who claim that the virtuous duplicate lacks justification, the other tracked by internalists, who claim that the virtuous duplicate has justification, and moreover that such justification is not enjoyed by the vicious duplicate. It also explains what these kinds of epistemic standing have to do with each other. I argue that all justified beliefs are good (...) candidates for knowledge, and are such because they are exercises of competences to know. However, there are two importantly different senses in which a belief may be a good candidate for knowledge, one corresponding to an externalist kind of justification and the other corresponding to an internalist one. I show how the account solves the new evil demon problem in a more satisfactory way than existing accounts. We end up with a view of knowledge, justification, and rationality that is plausible, motivated, and theoretically unified. (shrink)

We engage with the nature and the value of achievement through a critical examination of an argument according to which biomedical “enhancement” of our capacities is impermissible because enhancing ourselves in this way would threaten our achievements. We call this the argument against enhancement from achievement. We assess three versions of it, each admitting to a strong or a weak reading. We argue that strong readings fail, and that weak readings, while in some cases successful in showing that enhancement interferes (...) with the nature or value of achievement, fail to establish that enhancement poses an unusual threat to achievement. (shrink)

I begin my discussion by considering how to relate Descartes’s more general concern with the conduct of life to the metaphysics and epistemology in the foreground of his philosophical project. I then turn to the texts in which Descartes offers his developed ethical thought and present the case for Descartes as a virtue ethicist. My argument emerges from seeing that Descartes’s conception of virtue and the good owes much to Stoic ethics, a school of thought which saw a significant revival (...) in the seventeenth century. It does, however, deviate from classical Stoicism in critical ways. Towards the end of my discussion, I return to the question of the relation between Descartes’s ethics and his metaphysics and epistemology, and I suggest that the Discourse on the Method for Rightly Conducting Reason and the Meditations on First Philosophy are invested with the virtue ethical considerations of moral education and the regulation of the passions, respectively. (shrink)

Employing the National Institute of Mental Health-funded Prevention of Suicide in Primary Care Elderly Collaborative Trial as a case study, we discuss 2 sets of ethical issues: obtaining informed consent for a clinic-based intervention study and using treatment as usual (TAU) as the control condition. We then address these ethical issues in the context of the debate about the quality improvement efforts of health care organizations. Our analysis reveals the tension between ethics and scientific integrity involved with using TAU as (...) a control condition and the difficulty in designing high-quality research in a community-based setting. (shrink)

The current paper provides an overview of treatment noncompliance at various points in the treatment pathway, especially with respect to treatment for Pelvic-floor Dysfunction. The effects of noncompliance on healthcare are considered, and examples of supporting patients psychologically to increase compliance are discussed. An outline of a method to identify costs of non-compliance, and where such costs most intensely impact the healthcare system, is provided. It is suggested that psychological support is effective in terms of increased compliance and improved healthcare (...) economics. The model is presented for PFD, but the principles developed can be generalised to many aspects of healthcare. (shrink)

It is often said that the institutions of criminal justice ought or—perhaps more often—ought not to rehabilitate criminal offenders. But the term ‘criminal rehabilitation’ is often used without being explicitly defined, and in ways that are consistent with widely divergent conceptions. In this paper, we present a taxonomy that distinguishes, and explains the relationships between, different conceptions of criminal rehabilitation. Our taxonomy distinguishes conceptions of criminal rehabilitation on the basis of (i) the aims or ends of the putatively rehabilitative measure, (...) and (ii) the means that may be used to achieve the intended end. We also explore some of the implications of each conception, some of the payoffs of a taxonomy of the kind we offer, and some areas for future work. (shrink)

This study used fMRI to investigate the neural substrates of moral cognition in health resource allocation decision problems. In particular, it investigated the cognitive and emotional processes that underpin utilitarian approaches to health care rationing such as Quality Adjusted Life Years. Participants viewed hypothetical medical and nonmedical resource allocation scenarios which described equal or unequal allocation of resources to different groups. In addition, participants were assigned to 1 of 2 treatments in which they either did or did not receive advanced (...) instructions about the principles of utilitarianism. In all cases, participants were asked to judged the proposed allocations as “fair” or “unfair.” More brain activity was observed within the superior parietal lobe, angular gyrus, middle temporal gyrus, and bilateral caudate nucleus when participants viewed scenarios depicting equal divisions of resources. Conversely, unequal resource divisions were associated with more activity in the inferior frontal gyrus and insula cortex. Furthermore, instructions about the principles of utilitarianism led to significant activation differences within the inferior frontal gyrus and the middle frontal gyrus. Significant differences in activity were also found within the inferior frontal cortex and anterior insula between medical and nonmedical scenarios. The implications for cognitive control mechanisms and the cognitive and neural bases of utilitarian ethical judgment are discussed. (shrink)

This new anthology of early modern philosophy enriches the possibilities for teaching this period by highlighting not only metaphysics and epistemology, but also new themes such as virtue, equality and difference, education, the passions, and love. It contains the works of forty-three philosophers, including traditionally taught figures such as Descartes, Spinoza, Leibniz, Locke, Berkeley, Hume, and Kant, as well as less familiar writers such as Lord Shaftesbury, Anton Amo, Julien Offray de La Mettrie, and Denis Diderot. It also highlights the (...) contributions of women philosophers, including Margaret Cavendish, Anne Conway, Gabrielle Suchon, Sor Juana Inéz de la Cruz, and Emilie Du Châtelet. (shrink)

The name of the third author was incomplete in the initial online publication. The original article has been corrected.

COVID 19 has highlighted with lethal force the need to re-imagine and re-design the provisioning of human resources for health, starting from the reality of our radical interdependence and concern for global health and justice. Starting from the structured health injustice suffered by migrant workers during the pandemic and its impact on the health of others in both destination and source countries, I argue here for re-structuring the system for educating and distributing care workers around what I call a global (...) ecological ethic. Rather than rely on a system that privileges nationalism, that is unjust, and that sustains and even worsens injustice, including health injustice, and that has profound consequences for global health, a global ecological ethic would have us see health as interdependent and aim at “ethical place-making” across health ecosystems to enable people everywhere to have the capability to be healthy. (shrink)

The Frame Problem is the problem of how one can design a machine to use information so as to behave competently, with respect to the kinds of tasks a genuinely intelligent agent can reliably, effectively perform. I will argue that the way the Frame Problem is standardly interpreted, and so the strategies considered for attempting to solve it, must be updated. We must replace overly simplistic and reductionist assumptions with more sophisticated and plausible ones. In particular, the standard interpretation assumes (...) that mental processes are identical to certain kinds of computational processes, and so solving the Frame Problem is a matter of finding a computational architecture that can effectively represent relations of semantic relevance. Instead, we must take seriously the possibility that the way in which intelligent agents use information is inherently different. Whereas intelligent agents are plausibly genuinely causally sensitive to semantic properties as such (to what they perceive, desire, believe intend, etc.), computational systems can only be causally sensitive to the formal features that represent these properties. Indeed, it is this very substitution of formal generalizations for genuinely semantic ones that is responsible for the way current AI systems are brittle, inflexible, and highly specialized. What we need is a more sophisticated way of investigating the relationship between computational information processing and genuinely semantic information use, so that these two senses of using information are not conflated, but instead the question of how they are related to one another can be studied directly. I apply the generative methodology I have developed elsewhere for cognitive science and AI research (Miracchi, 2017, 2019a) to show how the Frame Problem can be appropriately updated. (shrink)

Charity Scott brought health law to Georgia State College of Law in the fall of 1987. Through her faculty appointment, along with her boundless energy and intellectual curiosity, she set herself on an odyssey. She began by teaching a single general health law class. This beginning led to the development of a full curriculum in the field, complete with experiential learning opportunities and a certificate in health law program. In addition to creating learning and career opportunities in health law for (...) law students, her development of the Center for Health, Law and Society created academic opportunities for leading health law faculty. (shrink)

How will we as feminists theorize these borders? How will we as beings whose very bodies are objects of globalization theorize a border which we dwell within? Ofelia Shutte asks whether it is “possible for Western feminism to disentangle itself from the historical forces of Western colonialism and from the erasure of otherness that such forces entail? (Shutte 2000, 59) I ask whether it is possible for feminism, Western or non-Western, Northern or Southern, to utilize the theoretical and political resource (...) that others, who are “othered” on both sides of the border, offer to feminist struggle. (shrink)

In this paper, I combine sources from environmental psychology with insights from the everyday aesthetics literature to explore the concept of ‘everyday heritage’, formerly introduced by Saruhan Mosler. Highlighting the potential of heritage in its everyday context shows that symbolic, aesthetic, and broadly conceived affective factors may be as important as architectural, historical, and artistic issues when it comes to conceiving of heritage value. Indeed, there seems to be more to a heritage site than its official inscription on the UNESCO (...) register. A place is included as part of our heritage primarily because it matters to us. People live in, form relationships with, and derive existential and affective meanings from it. Above and beyond its official significance, a heritage site is thus a living dimension that plays a vital role in the everyday life and social practices of people, who transform it into a place of human significance. (shrink)

Joan McGregor argues that “colleges and universities should adopt as part of their core mission the development of skills of civil discourse” rather than engaging in the practice of restricting controversial speakers from making presentations on campuses. I agree with McGregor concerning the need for increased civil discourse. However, this does not mean universities should welcome speakers to publicly present any material they wish without restriction or oversight. In this paper, I make three main arguments: (i) Colleges and universities have (...) a duty to protect members of the campus community from the harm and exclusion resulting from hateful or harmful speech, in the same way that they must protect them from sexual assaults and concussions. (ii) In the vast majority of cases, this duty can be fulfilled by holding speakers to standards of discourse that prevail in academic debate, and insisting on a number of procedural requirements. (iii) We should be wary of conservative arguments framed in terms of free speech, because they can be deployed to undermine important functions of the university in a democratic society, namely, to teach students how to be discerning citizens, and to protect thinkers willing to be critical of the government and the ruling classes. (shrink)

This paper considers a problem for Bayesian epistemology and proposes a solution to it. On the traditional Bayesian framework, an agent updates her beliefs by Bayesian conditioning, a rule that tells her how to revise her beliefs whenever she gets evidence that she holds with certainty. In order to extend the framework to a wider range of cases, Jeffrey (1965) proposed a more liberal version of this rule that has Bayesian conditioning as a special case. Jeffrey conditioning is a rule (...) that tells the agent how to revise her beliefs whenever she gets evidence that she holds with any degree of confidence. The problem? While Bayesian conditioning has a foundationalist structure, this foundationalism disappears once we move to Jeffrey conditioning. If Bayesian conditioning is a special case of Jeffrey conditioning, then they should have the same normative structure. The solution? To reinterpret Bayesian updating as a form of diachronic coherentism. (shrink)

In this paper, the authors consider the intersections of philosophy and education. Extending the concept of a minor pedagogy first presented by Mazzei and Smithers (Citation2020), the authors reorient thinking toward more equitable and just pedagogy as a cultivation of difference. This paper has three major sections. In the first two, the authors review Deleuze and Guattari’s (Citation1986, Citation1987) concept of the minor, and then connect this to the concept of a minor pedagogy. The final section explores the work of (...) a minor pedagogy as continuous variation with the potential to engender difference. Given that racialized neoliberal efficiency and accountability movements have perpetuated injustice across generations, the work of educational practice that contests this must be practice that slips from these major grips to produce new, more just, worlds. Minor pedagogy produces educational justice through everyday shifts in the conditions of our collective possibility, shifts that manifest difference in ways that reject re-form in the pursuit of the not yet. (shrink)

Philosophers and physicians alike tend to discuss the physician-patient relationship in terms of physician privilege and patient autonomy, stressing the duty of the physician to respect the autonomy and the variously elaborated rights of the patient. The authors of this article argue that such emphasis on rights was initially productive, in a first generation of debate on medical ethical issues, but that it is now time for a second generation effort that will stress the importance of the unique experiential aspects (...) of the physician-patient relationship — mutual trust, suffering and healing. We attempt here to initiate this second-generation discussion, presenting the first generation's philosophical background, criticizing it from the perspective of clinical experience, and seeking a synthesis in the relational qualities of patient and physician interacting in a medical context. (shrink)

BlOMQVIST K, THEANDER E, MOWIDE I and LARSSON V. Nursing Inquiry 2010; 17: 317–323 What happens when you involve patients as experts? a participatory action research project at a renal failure unitAlthough there is a trend towards developing health care in a patient‐centred direction, changes are usually planned by the professionals without involving the patients. This paper presents an ongoing participatory action research project where patients with chronic renal failure, nurses at a specialist renal failure unit, a hospital manager (...) and a researcher worked together to develop patient‐centred care. The project combined the expertise of patients in their own experiences of living with a chronic condition with the professional expertise of nurses, the manager and the researcher. As the workload on the unit was uneven, the development work needed to be low in intensity but long‐term. Based on a number of dialogues in focus groups, four main development areas were identified; access to test results, prerequisites for postponing the progress of the illness, general awareness and understanding of living with chronic renal failure, and family‐focused care. A number of changes have been planned or implemented, such as developing a prototype for a web‐based feed‐back system, expanding patient education to newly diagnosed patients, steering the nurses' role towards a guiding and family‐focused function, and planning a digital story‐telling workshop. Involving committed people who have the mandate to change practices were prerequisites for success. (shrink)

This article situates breastfeeding politics in the context of intimate citizenship, where women's capability to care in a range of social spaces is at stake. Drawing on the work of Lefebvre and Fenster, the article considers the extent to which recent breastfeeding promotion work by the Health Promotion Agency in Northern Ireland has sought to reconceive of social spaces in ways that have the potential to improve intimate citizenship for breastfeeding women.

First, I briefly recapitulate the main points of Rosen’s article, namely, that the word “Being” does not adequately signify the paradoxical unification of subject and object and that the Klein bottle can serve as a more appropriate sign -vehicle than the word. I then propose to apply his insight more widely; however, in order to do that, it is first necessary to identify infra- and exostructures of language, including culture, category structure, logic, metaphor, semantics, syntax, concept, and sign vehicles, that (...) preserve the status quo and keep subject and object disjunct. After analyzing those infra/exostructures, I engage a complementary process of integrating them, coagula, in order to spark ideas for innovating ways in which more of those facets of language can embrace paradox. (shrink)

Der Perspektive der Betroffenen kommt im medizinethischen Fachdiskurs der Gegenwart eine grundlegende Bedeutung zu. Im Fall der Demenz wird der Zugang zu ihr allerdings durch krankheitsbedingte Abbauprozesse zunehmend erschwert. Neben anderen künstlerisch-ästhetischen Annäherungen ist in den letzten 15 Jahren auch eine Fülle an Spielfilmen zu verzeichnen, die sich mit der Erfahrung der Demenz beschäftigen. Der Beitrag geht der Frage nach, inwieweit solche filmischen Gestaltungen neue Zugänge zum Demenzerleben eröffnen und was Film als Medium und Kunstform somit für die ethische Auseinandersetzung (...) mit Demenz zu leisten vermag. Dabei werden drei prominente filmästhetische Zugangswege eingehender untersucht, an ausgewählten Beispielen erläutert und unter ethischen Gesichtspunkten erörtert. Es zeigt sich, dass die ethischen Potenziale eines reflektierten Umgangs mit filmischen Annäherungen an die Demenz längst nicht ausgeschöpft sind. (shrink)

Erratum to: Naturalism, fallibilism, and the a priori Content Type Journal Article Category Erratum Pages 1-1 DOI 10.1007/s11098-012-9889-4 Authors Lisa Warenski, USA Journal Philosophical Studies Online ISSN 1573-0883 Print ISSN 0031-8116.

This paper considers the ways in which discourses of abortion and discourses of national identity were constructed and reproduced through the events of the X case in the Republic of Ireland in 1992. This case involved a state injunction against a 14-year-old rape victim and her parents, to prevent them from obtaining an abortion in Britain. By examining the controversy the case gave rise to in the national press, I will argue that the terms of abortion politics in Ireland shifted (...) from arguments based on rights to arguments centred on national identity, through the questions the X case raised about women's citizenship status, and women's position in relation to the nation and the state. Discourses of national identity and discourses of abortion shifted away from entrenched traditional positions, towards more liberal articulations. (shrink)

Congenial information is often judged to be more valid than uncongenial information. The present research explores a related possibility concerning the process by which people label a claim as fundamentally factual or opinion. Rather than merely being more skeptical of uncongenial claims, uncongenial claims may be metacognitively categorized as more opinion than factual, while congenial claims may be more likely to be categorized as factual. The two studies reported here attempt to trace a preliminary outline of how claims are categorized (...) as fact, opinion, or some mix of the two in the context of mundane claims, contentious political issues, and conspiracy theories. The findings suggest that claims are more likely to be labeled factual to the extent that one subjectively agrees with the content of the claim. Conspiracy theories appear to occupy a middle-ground between fact and opinion. This metacognitive approach may help shed light on popular debate about conspiracy theories, as well as seemingly intractable political disagreements more generally, which may reflect fundamental differences in the perceived epistemic foundations of claims rather than simple disagreement over the facts of the matter. Given limitations of the stimuli and participant samples, however, it remains to be seen how generalizable these findings are. (shrink)

Volume 19, Issue 9, September 2019, Page W1-W2.