Background: Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses’ ethical care provision. Conscientious objection is one such strategy for addressing nurses’ personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education. Research aim: To analyze the concepts of conscience and conscientious objection in the context of nurses. Design: Concept analysis using the method by Walker and (...) Avant. Research context: Data were retrieved from Philosopher’s Index, PubMed, and CINAHL with no date restrictions. Ethical consideration: This analysis was carried out per established, scientific guidelines. Findings: Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear. Discussion and conclusion: This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts. (shrink)

Background: While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession. Research question: The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario? Research design: Interpretive phenomenological methodology was used to gain an in-depth (...) understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process. Participants and research context: Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months. Ethical considerations: This study was conducted in accordance with Health Science Research Ethics Board approval and all participants gave consent. Findings: Six themes emerged from data analysis: encountering the problem, knowing oneself, taking a stand, alone and uncertain, caring for others, and perceptions of support. Discussion: This study offers an initial understanding of what it is like to be a nurse making a conscientious objection in clinical practice. Implications for nursing practice, education, policy, and further research are discussed. Conclusion: Addressing ethical issues in nursing practice is complex. The need for education across nursing, healthcare disciplines and socio-political sectors is essential to respond to nurses’ ethical concerns giving rise to objections. Conscience emerged as an informant to nurses’ conscientious objections. The need for morally inclusive environments and addressing challenging ethical questions as well as the concept of conscience are relevant to advancing nursing ethics and ethical nursing practice. (shrink)

Despite iterative learning design being increasingly implemented, such approaches are often delineated by well-defined periods of design/implementation. However, second-order cybernetics, which suggests a participatory approach to learning design, involves responsively adapting learning environments to meet students’ needs, treating them as agentic participants in the classroom. In our mixed methods study, we investigate whether such a process can facilitate egalitarian participation and collaborative interactions in a technology-assisted classroom. We use the example of a graduate psychology class of 17 students and suggest (...) that adaptation of live-chat activities by a participant observer on the Reddit social media platform that supplemented the in-person lecture dynamically, using a network analysis and qualitative ethnography as a modelling facility mimicked the ongoing feedback loops of social media platforms, enabling students to use social media with a critical eye, and engage in productive collaboration. Our quantitative results present network graphs for weekly eigen centrality to understand the egalitarian nature of the network, and transitivity to understand the likelihood for collaboration between more than two agents. Our qualitative results elaborate selected Reddit posts, and weekly field notes to explain how redesigning the chat weekly helped augment lecture-based discussion with the instructor and critique of student presentations, spurring egalitarian participation through a space-place dialectic. Students also provided end-semester feedback that was analyzed using inductive coding, to design future courseware. (shrink)

College graduates, especially teachers, often feel alienated when starting their careers as they may lack robust support systems to help them address daily difficulties. Researchers study online learning communities as a model to address this missing support system; however, very little research exists on the benefits of embedding these learning communities into Science, Technology, Engineering, and Mathematics (STEM) teacher candidates’ (TC) coursework. In this design case, we identified that a sustained Reddit social media learning community (SMLC) embedded within a technology (...) integration course created a robust support system for STEM TCs preparing for their careers. In this SMLC, TCs discussed and solved technological and professional problems, kept up to date with new technologies and methodologies, and accessed a network of peers with similar interests. The potential of such SMLCs goes far beyond technology integration and STEM, and applying the insights from this design case might address a wide range of problems many college students, not only STEM TCs, face when beginning their careers. The design decisions we implemented in crafting our course and SMLC are documented in this paper. We also present our findings and recommendations to understand the impact and practical implications for designing effective and sustainable SMLCs. (shrink)

The purpose of medical humanities is to improve the delivery of effective health care through a better understanding of disease in society, and in the individual. The interfaces between the science of medicine and the arts, philosophy, sociology and law interpret causes and effects of disease. The field of medical ethics is the most prominent offspring of this wider debate, yet the context of disease in the life of the individual and of society is profound and far-reaching. The influences of (...) medicine on the humanities and vice versa are all around, yet only recently have they been recognised in the wider world of health care. How can you encapsulate the essence of medical humanities and teach it to health professionals? Medical Humanities is designed to fill the need for a clear, well illustrated text that both provides the principles for the individual reader, and encourages discussion. The issues are explored in four main sections. Based on a highly successful seminar, and with contributions from leading writers, thinkers, and teachers, this book provides a comprehensive and authoritative reference for what is becoming a professional requirement in medicine. It will be invaluable for clinicians and students alike. (shrink)

Background: Lack of compassion is claimed to result in poor and sometimes harmful nursing care. Developing strategies to encourage compassionate caring behaviours are important because there is evidence to suggest a connection between having a moral orientation such as compassion and resulting caring behaviour in practice. Objective: This study aimed to articulate a clearer understanding of compassionate caring via nurse educators’ selection and use of published texts and film. Methodology: This study employed discourse analysis. Participants and research context: A total (...) of 41 nurse educators working in universities in the United Kingdom (n = 3), Ireland (n = 1) and Canada (n = 1) completed questionnaires on the narratives that shaped their understanding of care and compassion. Findings: The desire to understand others and how to care compassionately characterised educators’ choices. Most narratives were examples of kindness and compassion. A total of 17 emphasised the importance of connecting with others as a central component of compassionate caring, 10 identified the burden of caring, 24 identified themes of abandonment and of failure to see the suffering person and 15 narratives showed a discourse of only showing compassion to those ‘deserving’ often understood as the suffering person doing enough to help themselves. Discussion: These findings are mostly consistent with work in moral philosophy emphasising the particular or context and perception or vision as well as the necessity of emotions. The narratives themselves are used by nurse educators to help explicate examples of caring and compassion (or its lack). Conclusion: To feel cared about people need to feel ‘visible’ as though they matter. Nurses need to be alert to problems that may arise if their ‘moral vision’ is influenced by ideas of desert and how much the patient is doing to help himself or herself. (shrink)

Most readers of ancient Greek psychology will agree that the Philebus is where we find Plato’s best attempt to theorize about bodily pain.1 But they will probably also agree that the account he develops there has no real chance of being true, and so should not have much appeal to us today — at least insofar as we are philosophers rather than historians. It’s this second conviction that I want to challenge in what follows. More specifically, I want to argue (...) for two connected claims about the merits of Plato’s account: first, that despite its flaws — which are significant — it is stronger and more subtle than most commentators have yet realized; and second, that it anticipates in interesting ways a view that has become both increasingly popular and increasingly controversial in the last couple of decades: the view that pains — like beliefs, desires, hopes, and fears — are mental states with representational content. I will call this view representationalism. (shrink)

The Research Topic “On poverty and its eradication” was inspired by the International Day for the Eradication of Poverty, first commemorated in Paris in 1987 and formally designated by the United Nations. This day is dedicated to renewing the commitment to universal human development, enabling all individuals to achieve their highest potential, and reflecting on how poverty hinders this progress. The urgency of addressing poverty has increased after the COVID-19 pandemic, which exacerbated existing issues and highlighted the critical need for (...) effective poverty eradication strategies. The studies included in this Research Topic aim to expand knowledge about poverty, its causes, consequences, and connections to crises, inequality, and fairness, and to assess policy measures for poverty reduction. The included contributions use various theoretical, empirical, quantitative, and qualitative approaches to drive sociological and policy-related discussions and initiatives, promoting fair and inclusive societies. (shrink)

The inclusion of jus post bellum in just war theory may be justified. But, according to Evans, it becomes problematic when confronted with tenets of "just occupation," namely that sovereignty or self-determination should be restored to the occupied people as soon as is reasonably possible.

This book offers a clear and coherent guide to contemporary feminism for students of women's studies, gender studies, sociology, social theory and literary ...

In the Philebus Plato argues that every rational human being, given the choice, will prefer a life that is moderately thoughtful and moderately pleasant to a life that is utterly thoughtless or utterly pleasureless. This is true, he thinks, even if the thoughtless life at issue is intensely pleasant and the pleasureless life at issue is intensely thoughtful. Evidently Plato wants this argument to show that neither pleasure nor thought, taken by itself, is sufficient to make a life choiceworthy for (...) us. But there is some disagreement among commentators about whether or not he also wants the argument to show why. Is the argument designed to establish that we should reject thoughtless and pleasureless lives because some pleasures and some thoughts are goods? Or is it silent on this issue? Many interpreters take the first option, claiming that Plato uses the argument to attack both the hedonist view that only pleasures are goods and the intellectualist view that only thoughts are goods. My aim in this paper is to show that the second option is at least as attractive as the first, both exegetically and philosophically. (shrink)

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: as a salutary reminder of the extent to which thereality even of the human body is constructed; and as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy''s traditional questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and the (...) body familiar in daily experience. Toulmin''s epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate. (shrink)

Objective: To increase our understanding of moral distress experienced by neonatal registered nurses when directly or indirectly involved in the decision-making process of resuscitating infants who are born extremely premature. Design: A secondary qualitative analysis was conducted on a portion of the data collected from an earlier study which explored the ethical decision-making process among health professionals and parents concerning resuscitation of extremely premature infants. Setting: A regional, tertiary academic referral hospital in Ontario offering a perinatal program. Participants: A total (...) of 15 registered nurses were directly or indirectly involved in the resuscitation of extremely premature infants. Methods: Interview transcripts of nurses from the original study were purposefully selected from the original 42 transcripts of health professionals. Inductive content analysis was conducted to identify themes describing factors and situations contributing to moral distress experienced by nurses regarding resuscitation of extremely premature infants. Ethical considerations: Ethical approval was obtained from the research ethics review board for both the initial study and this secondary data analysis. Results: Five themes, uncertainty, questioning of informed consent, differing perspectives, perceptions of harm and suffering, and being with the family, contribute to the moral distress felt by nurses when exposed to neonatal resuscitation of extremely premature infants. An interesting finding was the nurses’ perceived lack of power and influence in the neonatal resuscitation decision-making process. Conclusion: Moral distress continues to be a significant issue for nursing practice, particularly among neonatal nurses. Strategies are needed to help mediate the moral distress experienced by nurses, such as debriefing sessions, effective communication, role clarification, and interprofessional education and collaboration. (shrink)

Given the current context of the experience of migration on schools in England and Europe, and the competing policies and approaches to social integration in schools, there is a need to understand the connection between language development and social integration as a basis for promoting appropriate policies and practices. This volume explores the complex relationship between language, education and the social integration of newcomer migrant children in England, through an in-depth analysis of case studies from schools in the East of (...) England. The authors set this evidence against the background of policy debates in the wider international setting, including a critical discussion of assumptions underlying national narratives of mainstreaming and assimilation. In the light of an absence of national guidelines for appropriate practice in schools, the authors outline a model of inclusive pedagogy for English as an additional language and a framework of home-school communication to promote effective EAL parental engagement in schools. (shrink)

Recent years have seen the rise of anti-politics as a political phenomenon but beyond this new rejection of the political class there has long existed, an albeit marginal, deeper challenge to the political itself. Identifying the work of Derrida as 'a politics' and that of Baudrillard as 'transpolitics' this book charts the convergences and divergences in their respective approaches. Among the topics treated are questions of the media and representation.

The Fitzgerald-Lorentz contraction hypothesis, proposed as an explanation of the Michelson-Morley result, fails to account for the Kennedy-Thorndike result. Hence, Grünbaum argues, the hypothesis has been falsified. However, the contraction hypothesis as formulated by Lorentz is false for the very fundamental reason that it entails a contradiction, namely, the consequence that light waves must have a variable velocity along what by definition is taken to be a rest length. Furthermore, the attempt to resolve this contradiction by coupling the Fitzgerald-Lorentz contraction (...) with the hypothesis that clock rates are a function of velocity, is open to a sound, methodological objection. The Michelson-Morley result is fully satisfied, provided only that the lengths of the interferometer arms, in the longitudinal and transverse positions, are thought to be related to one another in a certain ratio, and this ratio may be interpreted as a contraction in both arms. Since this twofold contraction hypothesis suffices to explain both the Michelson-Morley and the Kennedy-Thorndike results, and since it entails no contradiction, there is no need to correct both the length of rods and the rate of clocks. Therefore, the combined clock-rod hypothesis, and with it the Fitzgerald-Lorentz contraction hypothesis, must be rejected. (shrink)

Does it matter that the hearts of 'brainstem dead' patients may persist in beating spontaneously? Hostile reactions, to the Danish inclusion of cardiac criteria in the determination of death, betray reductionist views of human life at the core of 'brainstem' conceptions of death. Such views (whether centred on neurological function or on abstractions concerning 'personhood') supplant the richness of human life and death with the poverty of essentialism: and mask the lethal nature of beating-heart organ retrieval. The affirmation of cardiac (...) criteria for death is not an alternative form of essentialism as some critics suppose, but part of an understanding of human life and death which rejects essentialism altogether. The spontaneously persistent heartbeat does not constitute human life, but most certainly counts for it. (shrink)

“Run-in” and “washout” periods involving the withholding of medication are widely used in drug research trials in pursuit of both patient safety and scientific reliability. Such no-medication periods can be justified ethically provided that they are apparent to patients, who can thereby properly consent to undergoing them. Less widespread, but still common, is the practice of “single blinding” no-medication periods, concealing them from patients by means of placebo. Whilst all placebos involve a measure of concealment, their use is typically justified (...) in drug research trials by their preserving the uncertainty generated by the random allocation of different treatments within a drug trial; and by the researchers openly declaring both the randomisation process and the chances of receiving placebo. In the single blind placebo “run-in” or “washout”, neither of these conditions is met.This paper considers three possible defences of the practice of using single blind placebo “run-ins” or “washouts” and finds them all to fail; the practice appears ethically unjustified. (shrink)

Throughout the world, research ethics committees are relied on to prevent unethical research and protect research subjects. Given that reliance, the composition of committees and the manner in which decisions are arrived at by committee members is of critical importance. There have been Instances in which an inadequate review process has resulted in serious harm to research subjects. Deficient committee review was identified as one of the factors In a study in New Zealand which resulted in the suffering and death (...) of many women diagnosed with carcinoma in situ. (shrink)

Recruiting patients into clinical research is essential for the advancement of medical knowledge. However, when the physician undertaking the care of the patient is also responsible for recruitment into clinical research, a situation arises of an inter-role breach of confidentiality which is distinguishable from other conflicts of interest. Such discord arises as the physician utilizes confidential information obtained within the therapeutic relationship beyond its primary objective, and safeguards ought to be observed in order to avert this important, and generally overlooked, (...) problem. The moral worth of the pledge of confidentiality is based not on its innate value but on its being a promise on which subsequent interactions and disclosures are founded. Within the patient-doctor interaction, confidentiality is an important facet of the promised fidelity and, as such, a loose interpretation of the notion threatens the essence of the relationship, and any violation thereof requires compelling moral justification. To avoid conflict, patients' confidential information ought not be used for the purpose of recruitment, which needs to be undertaken through general education and non-directed appeals, and a preliminary consent to be approached for research should be obtained from the patient prior to her being identified as a suitable research subject. Securing this prior consent would avoid one source of potential, albeit unintended, coercion. (shrink)

ABSTRACT: This article discusses, principally from an English perspective, globalisation, global citizenship and two forms of education relevant to those developments (global education and citizenship education). We describe what citizenship has meant inside one nation state and ask what citizenship means, and could mean, in a globalising world. By comparing the natures of citizenship education and global education, as experienced principally in England during, approxim-ately, the last three decades, we seek to develop a clearer understanding of what has been done (...) and what might be done in the future in order to develop education for global citizenship. We suggest that up to this point there have been significant differences between the characterisations that have been developed for global education and citizenship education. These differences are revealed through an examination of three areas: focus and origins; the attitude of the government and significant others; and the adoption of pedagogical approaches. We suggest that it would be useful to look beyond old barriers that have separated citizenship education and global education and to form a new global citizenship education. Their separation has in the past only perpetuated the old understandings of citizenship and constructed a constrained view of global education. (shrink)

ABSTRACTFrom his Problem of Genesis in Husserl’s Philosophy to the address given on the fiftieth anniversary of Le monde diplomatique just before he died in 2004, Derrida made constant ref...

In settler societies, upward social mobility by Indigenous people is seen in the growth of successful professional and entrepreneurial classes where both wealth creation and social power are significant resources. Yet, public and academic discourses perpetuate the belief that social mobility impacts negatively on Indigenous people by placing cultural identity in conflict with capitalist business practices. Using data from an international comparison consisting of interviews with 220 Indigenous entrepreneurs in research sites across three countries, this article shows that the belief (...) is unfounded and reveals how this duality creates an impossible tension when Indigenous cultural identity is framed as “at risk” because of social mobility. A discursive colonial mind-set remains a central, enduring and problematic organizing principle of the field of Indigenous social mobility, one that requires a shift in the kinds of research questions that are asked and the ways in which social mobility is ultimately defined. (shrink)

Should we remove whole organs from living donors only in the case where they are genetically related to the intended recipients of such organs? The practice in a majority of European nations is to apply such a restriction. Yet this restriction obviously limits the availability of already scarce donor organs, and curtails the opportunities for altruistic action on the part of those who, in any given case, are not genetically related to the recipient. The author argues that we have a (...) duty to maximise procurement of organs, and that we should respect the 'genetic relative' restriction only in response to compelling moral reasons. The author considers the principal objections to non-related donation and shows them to be misdirected. He concludes that non-related donation should be welcomed where clinically appropriate and truly voluntary. (shrink)

Patient-based outcome measures are increasingly important in health care evaluations, often through the use of paper-based questionnaires. The likely impact of questionnaires upon patients is not often considered and therefore, the balance of benefit and harm not fully explored. Harms that might accrue for research staff are even less frequently considered. This paper describes the use of postal questionnaires within a study of breast disease management in primary care. Questionnaire responses are used to describe the nature of discomfort or harms (...) that may occur in such studies. Ethical issues raised by the harms are discussed in relation to the benefits of the study. Practical suggestions for reducing harm to patients are proposed. A secondary consideration, discomfort to the researcher, is also identified and suggestions made to reduce its effect. Finally, the role of research questionnaires as a study intervention is discussed. (shrink)

Genetic counseling is viewed as a therapeutic interrelationship between genetic counselors and their clients. In a previous relational ethics research project, various themes were identified as key components of relational ethics practice grounded in everyday health situations. In this article the relational ethics approach is further explored in the context of genetic counseling to enhance our understanding of how the counselor-client relationship is contextually developed and maintained. Qualitative interviews were conducted with six adult clients undergoing genetic counseling for predictive testing. (...) Engagement, dialogue and presence were revealed as relevant to genetic counselor-client relationships. A relational ethics approach in genetic counseling challenges the concept of nondirectiveness and may enhance the outcome of counseling for both counselor and client. (shrink)

Near the beginning of the Cratylus (385e-387d) Plato's Socrates argues, against his friend Hermogenes, that the standards of correctness for our use of names in speech are in no way up to us. Yet this conclusion should strike us, at least initially, as bizarre. After all, how could it not be up to us whether to call our children by the names of our parents, or whether to call dogs “dogs“? My aim in this paper will be to show that, (...) although Plato's argument does not succeed in establishing this apparently bizarre conclusion, it may well succeed in establishing an equally momentous conclusion: that the standards of correctness for our use of concepts in thought are in no way up to us. (shrink)

Nearly all of us would accept that at least some of our thoughts – desires, beliefs, and intentions, for example – can be causally responsible for movements in our bodies. Starting in antiquity, and especially since Descartes, philosophers have deployed this claim as the pivotal premise in an increasingly popular line of argument against dualism. The purpose of this paper is to show that, in the Phaedo, Socrates uses this very same claim as the pivotal premise in a surprisingly powerful (...) two-part argument for dualism. (shrink)

Feminist scholars have long critiqued the fashion industry’s ultra-thin beauty standards as harmful to women. Combining data from three qualitative studies of women’s clothing retailers—of bras, plus-size clothing, and bridal wear—we shift the analytical focus away from glamorized media images toward the seemingly mundane realm of clothing size standards, examining how women encounter, understand, and navigate these standards in their daily lives. We conceptualize clothing size standards as “floating signifiers,” given their lack of consistency within and across brands and the (...) extent to which women engage in identity work and body work in relation to them. Our findings indicate that the instability of these unregulated standards allows some women—particularly those with bodies located closest to the boundaries between size categories—to claim conformity to body ideals and to access some of the associated psychological, social, and material privileges. However, even as individual women may benefit by distancing themselves from stigmatized size categories, this pattern renders women’s body acceptance tenuous while simultaneously reinforcing hierarchies among women based on body size and shape. (shrink)

In this book the author argues that human musical understanding is rooted in the traditions of culture and that experience of music depends crucially on what the individual brings to it.