Background Over the past few decades, moral distress has been examined in the nursing literature. It is thought to occur when an individual has made a moral decision but is unable to act on it, often attributable to constraints, internal or external. Varying definitions can be found throughout the healthcare literature. This lack of cohesion has led to complications for study of the phenomenon, along with its effects to nursing practice, education and targeted policy development. Objectives The aim of this (...) analysis was to uncover unique definitions of moral distress as found in the nursing literature and to examine the relationship between these definitions. Research Design and Context Morse’s method of concept clarification was applied given the large body of literature which includes definitions, descriptions and measurements of the concept in research. The steps include (a) conducting a literature review; (b) analysing the literature; and (c) identifying, describing, comparing, and contrasting attributes, antecedents and consequences of each category. Findings Each of the 18 included studies described constraints in their definition of moral distress, whether implied or explicitly stated. External constraints are widely described as obstacles outside of the individual, whether institutional, systemic or situational, while internal constraints are located within the individuals themselves and are described as personal limitations, failings or weakness of will. Conclusion Upon reviewing these definitions, we determined that the term ‘internal constraints’ is problematic due to the emphasis of responsibility on the individual experiencing moral distress. We propose an alteration to ‘internal characteristics’ that will assume less responsibility of change from the individual to place a heavier onus on systemic and institutional constraints. (shrink)

This article argues that the misalignment of private profit-maximizing objectives with public health needs causes institutional corruption in the pharmaceutical sector and systematically leads firms to act contrary to public heath. The article analyzes how financial incentives generate a business model promoting harmful practices and explores several means of realigning financial incentives in order to foster therapeutic innovation and promote the rational use of medicines.

The emergence of the “4th Industrial Revolution,” i.e. the convergence of artificial intelligence, the Internet of Things, advanced materials, and bioengineering technologies, could accelerate socioeconomic insecurities and anxieties or provide beneficial alternatives to the status quo. In the post-Covid-19 era, the entities that are best positioned to capitalize on these innovations are large firms, which use digital platforms and big data to orchestrate vast ecosystems of users and extract market share across industry sectors. Nonetheless, these technologies also have the potential (...) to democratize ownership, broaden political-economic participation, and reduce environmental harms. We articulate the potential sociotechnical pathways in this high-stakes crossroads by analyzing cellular agriculture, an exemplary 4th Industrial Revolution technology that synergizes computer science, biopharma, tissue engineering, and food science to grow cultured meat, dairy, and egg products from cultured cells and/or genetically modified yeast. Our exploration of this space involved multi-sited ethnographic research in both the cellular agriculture community and alternative economic organizations devoted to open source licensing, member-owned cooperatives, social financing, and platform business models. Upon discussing how these latter approaches could potentially facilitate alternative sociotechnical pathways in cellular agriculture, we reflect upon the broader implications of this work with respect to the 4th Industrial Revolution and the enduring need for public policy reform. (shrink)

Based on our respective research programs (psychiatry, forensic psychiatry, public health, HIV/AIDS, harm reduction) this article aims to use purposely non‐conventional means to present the substantial contribution of poststructuralist perspectives to knowledge development in nursing science in general and in our current research in particular. More specifically, we call on the work of Michel Foucault and Deleuze & Guattari to politicize nursing science using examples from our empirical research programs with marginal and often highly marginalized populations. We discuss the concepts (...) of power, discourse, and resistance to illustrate the essential contribution of poststructuralism to marginal, even “nomadic”, nursing research. (shrink)

The global response to managing the spread of HIV has recently undergone a significant shift with the advent of ‘treatment as prevention’, a strategy which presumes that scaling-up testing and treatment for people living with HIV will produce a broader preventative benefit. Treatment as prevention includes an array of diagnostic, technological and policy developments that are creating new understandings of how HIV circulates in bodies and spaces. Drawing on the work of Michel Foucault, we contextualize these developments by linking them (...) to systems of governance and discursive subjectivation. The goal of this article is to problematize the growing importance of viral suppression in the management of HIV and the use of related surveillance technologies. For people living with HIV, we demonstrate how treatment-as-prevention’s emphasis on individual and collective viral load is transforming the performative dimensions of embodied risk, affect, subjectivity and sex. (shrink)

Each of the antiretroviral drugs that are currently used to stop the progression of HIV infection causes its own specific side effects. Despite the expansion, multiplication, and simplification of treatment options over the past decade, side effects continue to affect people living with HIV. Yet, we see a clear disconnect between the way side effects are normalized, routinized, and framed in clinical practice and the way they are experienced by people living with HIV. This paper builds on the premise that (...) new approaches are needed to understand side effects in a manner that is more reflective of the subjective accounts of people living with HIV. Drawing on the work of Deleuze and Guattari, it offers an original application of the theory of ‘assemblage’. This theory offers a new way of theorizing side effects, and ultimately the relationship between the body and antiretroviral drugs (as technologies). Combining theory with examples derived from empirical data, we examine the multiple ways in which the body connects not only to the drugs but also to people, things, and systems. Our objective is to illustrate how this theory dares us to think differently about side effects and allows us to originally (re)think the experience of taking antiretroviral drugs. (shrink)

Nurse practitioners (NPs), as advanced practice nurses, have evolved over the years to become recognized as an important and growing trend in Canada and worldwide. In spite of sound evidence as to the effectiveness ofNPs in primary care and other care settings, role implementation and integration continue to pose significant challenges. This article utilizes postcolonial theory, as articulated by Homi Bhabha, to examine and challenge traditional ideologies and structures that have shaped the development, implementation and integration of theNProle to this (...) day. Specifically, we utilize Bhabha's concepts of third space, hybridity, identity and agency in order to further conceptualize the nurse practitioner role, to examine how the role challenges some of the inherent assumptions within the healthcare system and to explore how development of each to these concepts may prove useful in integration of nurse practitioners within the healthcare system. Our analysis casts light on the importance of a broader, power structure analysis and illustrates how colonial assumptions operating within our current healthcare system entrench, expand and re‐invent, as well as mask the structures and practices that serve to impede nurse practitioner full integration and contributions. Suggestions are made for future analysis and research. (shrink)

Moral distress is an experience of profound moral compromise with deeply impactful and potentially long‐term consequences to the individual. Critical care areas are fraught with ethical issues, and end‐of‐life care has been associated with numerous incidences of moral distress among nurses. One such area where the dichotomy of life and death seems to be at its sharpest is in the pediatric intensive care unit. The purpose of this study was to understand the moral distress experiences of pediatric intensive care nurses (...) when caring for pediatric patients at the end of life. A secondary analysis was undertaken of seven transcripts from registered nurses across six Canadian pediatric intensive care units and produced three themes: under prioritization of child patient dignity, burden of insider knowledge, and environmental constraints on nursing roles and responsibilities. When caring for patients at the end of life, nurses experienced moral distress when a dignified death was not realized. Furthermore, despite interprofessional collaboration efforts in Canada, the concept of silo mentality persists and contributes to moral distress. Organizational involvement is needed to address moral distress in pediatric intensive care nurses both to achieve a dignified death for child patients and in addressing silo mentality. (shrink)

Research has shown that context influences how sincere a smile appears to observers. That said, most studies on this topic have focused exclusively on situational cues (e.g. smiling while at a party versus smiling during a job interview) and few have examined other elements of context. One important element concerns any knowledge an observer might have about the smiler as an individual (e.g. their habitual behaviours, traits or attitudes). In this manuscript, we present three experiments that explored the influence of (...) such knowledge on ratings of smile sincerity. In Experiments 1 and 2, participants rated the sincerity of Duchenne and non-Duchenne smiles after having been exposed to cues about the smiler’s tendency to reciprocate (this person always, never or occasionally returns favours). In Experiment 3 they performed the same task but with cues about the smiler’s love of learning (this person always, never or occasionally enjoys learning new tasks). The results show that cues about the smiler’s reciprocity tendency influenced participants’ ratings of smile sincerity and did so in a stronger manner than cues about the smiler’s love of learning. Overall, these results both strengthen and broaden the literature on the role of context on judgements of smile sincerity. (shrink)

The myth that sexual violence is perpetrated by strangers in dark alleyways has long since been debunked; the vast majority of sexual assaults are committed by someone known to the victim. This article examines how individuals and communities nevertheless experience epistemic and moral barriers when reacting to reports of sexual violence levelled against community members, friends, and loved ones. Love can, for example, cloud our moral and epistemic oughts when responding to sexual violence, through such avenues as mutual identity constitution (...) and epistemic partiality, which then contribute to discourse and practices that normalize sexual violence. I draw on Miriam Toews’ 2018 novel, Women Talking, to demonstrate that this social framework can be inverted through the very emotions that in part generate it, namely love and care. I argue that we can catalyze the drive to preserve our relationships with loved ones and community members who perpetrate harm by foregrounding moral accountability and transformation, atonement and amends, as preconditions of continued relationships. The upshot of this is the development of new moral norms and practices that deconstruct the widespread and casual nature of sexual violence. Importantly, this article and the course of action it explores is aimed at individuals whose wellbeing is not jeopardized through accountability projects. (shrink)

Volume 20, Issue 10, October 2020, Page 26-29.

One of the fundamental objectives of Philosophy for Children is the cognitive development of elementary and secondary school pupils. In this text, we examine to what extent the age of the children and the number of years of praxis in P4C influence the development of their critical thinking. To do so we used, as an analysis grid, the model of the developmental process of dialogical critical thinking that emerged from the analysis of transcripts of exchanges among pupils aged 4 to (...) 12 years . The content analyzed was the “philosophical” exchanges among pupils. Participants were 13 groups of pupils from preschool to the end of elementary school. These groups originated from two schools, one in Quebec and one in Ontario. At the time the data were collected, the Quebec school groups had one year of P4C praxis, whereas the Ontario school groups had two years of praxis. Results indicate that children’s age and number of years of philosophical praxis are among the factors that influence the developmental process of critical thinking. (shrink)

The American Journal of Bioethics, Volume 12, Issue 9, Page 57-59, September 2012.

We read Marshall et al.’s paper with great interest but were left with many questions and concerns (Marshall et al., in press). As a group of public health researchers and practitioners (nursing, s...

The Development of Critical Thinking in Students: to What Extent the Practice of Philosophical Dialogue is Sufficient to Itself? Among the reasons that are advanced by the advocates of philosophy for children and teenagers to include it in the school curriculum, the development of critical thinking occupies a prominent place. However, it is rarely discussed if the critical thinking skills that are developed in the philosophy classes are used in other contexts. It is this question this text wants to tackle. (...) Firstly, we will clarify what we mean by critical thinking by presenting the main theories of this concept. We will then examine some of the results obtained in research, particularly the one of Daniel, aiming at study its development by the practice of philosophical dialogue. Finally, we will raise some issues around how a “general” form of critical thinking can be developed in this context by presenting some of the data we have collected in our research. We conclude by underlying few elements that should be taken into consideration to develop critical thinking in youth through philosophical dialogue. (shrink)

Très ambitieuse, l'entreprise épistémologique exposée dans ce livre «est générale et non régionale, descriptive plutôt que normative, décrit le savoir par des modèles structuralistes logico-diachroniques, et s'appuie sur une théorie matérialiste critique de la connaissance ». L'auteur entend couvrir toute l'histoire de la pensée, et il emprunte des concepts fondamentaux à Freud, Marx, Piaget, Barthes et Foucault, sans se priver cependant de modifier ces concepts de façon à les rendre intégrables dans la synthèse qu'il tente de réaliser.

I have tried to show how criticism of aboriginal orthodoxy in discourse and measures taken by the current Conservative government and private commentators have set in motion a process of contempt, risking the harm associated with colonialism. Another critique of aboriginal orthodoxy, as presented by Jean-Jacques Simard, claims that First Nations are entitled to a certain level of self-government in defence of the rights of the abstract person: “it is first and foremost simply as human beings that all Amerindians possess (...) the same rights as anyone else….” Yet this option ignores the history of First Nations’ relationships with French Canadians, English Canadians and the British. While appeal to the abstract person can protect people from a threat, it cannot eliminate that threat. It seems clear that contempt towards aboriginals is still present and that their emancipation without an honourable historical justification would also lead to the exacerbation of racism against aboriginals. To make mutual recognition possible between aboriginal and non-aboriginal, we need to have shared criteria for evaluation. It would seem, therefore, that if we were willing to integrate First Nations into the Canadian constitutional order by fully recognizing them, we must find a common project. If the Canadian government were to move more in the direction of an ecological vision of development rather than in the direction of a predatory capitalism based on infinite economic growth, I believe it would be easier to secure First Nations’ sense of belonging to Canada and to agree on models for joint territorial management. That awakening rings a bell we must hear: if seniority on the land and the role played by national groups in the founding of Canada are erased by a unitary, multicultural and monarchist vision of the country, the odds are high that Canadians of diverse origins will eventually suffer the blows of renewed authoritarianism and contempt. (shrink)

Background There has been growing interest in the use of incentives to increase the uptake of health-related behaviours and achieve desired health outcomes at the individual and population level. However, the use of incentives remains controversial for ethical reasons. An area in which incentives have been not only proposed but used is HIV prevention, testing, treatment and care—each one representing an interconnecting step in the "HIV Cascade." Methods The main objective of this qualitative case study was to document the experiences (...) of health care and service providers tasked with administrating incentivized HIV testing, treatment, and care in British Columbia, Canada. A second objective was to explore the ethical and professional tensions that arise from the use of incentives as well as strategies used by providers to mitigate them. We conducted interviews with 25 providers and 6 key informants, which were analyzed using applied thematic analysis. We also collected documents and took field notes. Results Our findings suggest that incentives target populations believed to pose the most risk to public health. As such, incentives are primarily used to close the gaps in the HIV Cascade by getting the "right populations" to test, start treatment, stay on treatment, and, most importantly, achieve viral suppression. Participants considered that incentives work because they "bring people through the door." However, they believed the effectiveness of incentives to be superficial, short-lived and one-dimensional—thus, failing to address underlying structural barriers to care and structural determinants of health. They also raised concerns about the unintended consequences of incentives and the strains they may put on the therapeutic relationship. They had developed strategies to mitigate the ensuing ethical and professional tensions and to make their work feel relational rather than transactional. Conclusions We identify an urgent need to problematize the use of incentives as a part of the "HIV Cascade" agenda and interrogate the ethics of engaging in this practice from the perspective of health care and service providers. More broadly, we question the introduction of market logic into the realm of health care—an area of life previously not subject to monetary exchanges. (shrink)

Le présent essai examine d'abord les notions newtoniennes d'espace et de temps absolus en elles-mêmes et dans leurs relations réciproques, puis ensuite dans leurs rapports avec d'autres notions connexes comme celles de lieu et de mouvement, en prenant pour base le Scholium qui fait suite aux définitions formulées au début des Principia mathematica philosophiae naturalis. La seconde partie analyse les arguments et precédés utilisés par Newton pour identifier des mouvements absolus, et prouver ainsi que de tels mouvements existent. La troisième (...) partie montre en quel sens il faut entendre que ces mouvements sont « absolus », et pourquoi on ne peut en tirer une preuve ultérieure de l'existence d'un temps et d'un espace absolus et subsistants. (shrink)

Schools located in underpriviledged areas have to deal with different factors, like the dropout rate among students and teachers; the culture of action, the culture of oral and a «carpe diem» culture; the low literacy rates; the type of children's knowledges — sometimes different from those promoted at school — and the learning difficulties of pupils... In light of these factors, few states have decided to adopt measures to support pupils and teachers in these communities. In this sense, several studies (...) examine the potential role of philosophy for children (P4C), but none examines, in this kind of environment, the integration of P4C in the context of a teaching field experience program. Insofar several novice teachers start their career in these environments, it could be helpful to enrich our comprenhension on this subject. This paper presents results from an exploratory study on this issue, which led to raise questions about the bachelor of education program, at least in our university. (shrink)

Nous nous proposons, dans cet article, d'examiner l'aspect philosophique de la pensée de Piaget sur la causalité, ainsi que sa critique des conceptions de Hume et de Kant. Mais une étape préalable s'jmpose d'abord, soit l'analyse des fondements empiriques de la pensée piagétienne. Nous ferons cette analyse en faisant un usage le plus discret possible du vocabulaire plutôt technique de Piaget.

Pour Répondre à la question qui constitue le titre de cet essai, il faut d'abord répondre à une autre question, à savoir: qu'est-ce que la philosophie de la nature? De quoi parlons-nous au juste quand nous parlons de philosophie de la nature?

Les Œuvres respectives de Piaget et de Kuhn sont des études sur l'évolution d'un certain type de connaissance: la connaissance enfantine chez Piaget, la physique et la chimie chez Kuhn. Dans les deux cas, on essaie d'analyser les facteurs qui déterminent les changements des contenus de la connaissance, et les relations qui existent entre ces divers contenus successifs. Il nous semble qu'une comparaison de ces deux études révèle des convergences intéressantes pour la théorie de la connaissance.

Ethics & Behavior, Volume 21, Issue 3, Page 260-261, May-June 2011.

To the author, A. Comte is the man who first conceived positive science as filling the gap between perception and conceptualization, who opened the era of positive social science by showing that any scientific research is embedded in a sociology, and built for the first time a Pragmatique anthropologique. The purpose of the book is to promote a better knowledge of a philosophy which, though very modern in character, is too often misunderstood.

Le premier chapitre traite des théories de l’auto-organisation de Varela et d’Atlan. Pour Varela, les êtres vivants sont des machines autopoiétiques. Ils régénèrent constamment le réseau d’activités et d’organes qui les a produits, ont chacun une organisation, une structure et une individualité, et sont opérationnellement clos; ce sont des unités concrètes sans input ni output, spatio-temporellement reconnaissables dans un milieu donné, et saisies comme telles par l’analyse de leurs composants. Varela généralise ce modèle au système nerveux, donc en fait à (...) l’activité cognitive, et aussi au système immunitaire, de même qu’à l’ontogenèse de la cellule et à l’évolution des espèces, qui seraient selon lui parallèles. Il en tire une théorie de l’identité de la connaissance et de l’action, du subjectif et de l’objectif. (shrink)