One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated with two academic medical centers to increase confidence in ethical decision-making. Research Question/Aim: To discover how effective the participants perceived the program and if their goals of participation had been met. Research design: A total of 65 end-of-course essays (from three cohorts) were analyzed using modified directed content analysis. In-depth and recursive readings of the essays by faculty were guided by six questions that had been posed to (...) graduates. Ethical considerations: Institutional review board approval was granted for the duration of the program and its reporting period. Confidentiality was maintained via the use of codes for all evaluations including the essays and potentially identifying content redacted. Findings: An umbrella theme emerged: participants had developed ethical knowledge and skills that provided a “moral compass to navigate the many gray areas of decision-making that confront them in daily practice.” Six major themes corresponding to questions posed to the participants included the ability to advocate for good patient care; to support and empower colleagues, patients, and families; they experienced personal and professional transformation; they valued the multimodal nature of the program; and were using their new knowledge and skills in practice. However, they also recognized that their development as moral agents was an ongoing process. Discussion: Findings support that enhancing nurse confidence in their moral agency with a multimodal educational approach that includes mentored practice in ethical decision-making, enhancing communication skills and role-play can mitigate moral distress. A majority found the program personally and professionally transformative. However, they recognized that ongoing ethics discussion involvement and supportive environments would be important in their continued development of ethical agency. Conclusion: Multimodal ethics education programs have potential to be transformative and enhance nurse confidence in their ethical decision-making. (shrink)

How do teachers’ gestures influence students’ learning? This article reviews research investigating the role of gestures in communication, focusing on teachers’ communication with their students, primarily in mathematics and science instruction. We first briefly consider gesture's role in communication more generally as a backdrop for considering teaching as a special context for communication. We then describe teachers’ spontaneous gesturing in teaching contexts, and we consider how teachers’ spontaneous gestures might influence students’ learning. We then consider experimental studies that provide causal (...) support for the effects of teachers’ gestures on students’ learning. We conclude by discussing future directions and implications for educational practice. (shrink)

The empirical literature exploring lawyers and their moral decision making is limited despite the “crisis” of unethical and unprofessional behavior in the bar that has been well documented for over a decade. In particular we are unaware of any empirical studies that investigate the moral landscape of the health lawyer’s practice. In an effort to address this gap in the literature, an interdisciplinary team of researchers at Vanderbilt University designed an empirical study to gather preliminary evidence regarding the moral reasoning (...) of health care attorneys. The primary research question was how health lawyers respond when they encounter ethical or moral dilemmas in their practice for which the law fails to offer a bright-line solution. In exploring this question, we sought to understand better what motivations or influences guide action when health lawyers confront ethical quandaries, and whether there are specific differences, e.g., gender, experience, or religiosity, that are associated with specific responses to situations testing ethical or moral boundaries. (shrink)

A medical narrative from a woman in her 90s describes her childhood bout with diphtheria in Kansas City, Missouri, apparently immediately after vaccination, her confinement in the “pest hospital,” and her treatment with what she understood as a blood transfusion from a donor who was found through a radio appeal. In this essay, we trace the narrative back to the institutions, medical practices, and historical context, examining both the underlying history of medical practice and scientific understanding that is reflected in (...) her experience and also the contexts of that history, including racial and religious attitudes. (shrink)

Background: The factors influencing parents’ willingness to enroll their children in biobanks are poorly understood. This study sought to assess parents’ willingness to enroll their children, and their perceived benefits, concerns, and information needs under different consent and data-sharing scenarios, and to identify factors associated with willingness. Methods: This large, experimental survey of patients at the 11 eMERGE Network sites used a disproportionate stratified sampling scheme to enrich the sample with historically underrepresented groups. Participants were randomized to receive one of (...) three consent and data-sharing scenarios. Results: In total, 90,000 surveys were mailed and 13,000 individuals responded (15.8% response rate). 5737 respondents were parents of minor children. Overall, 55% (95% confidence interval 50–59%) of parents were willing to enroll their youngest minor child in a hypothetical biobank; willingness did not differ between consent and data-sharing scenarios. Lower educational attainment, higher religiosity, lower trust, worries about privacy, and attitudes about benefits, concerns, and information needs were independently associated with less willingness to allow their child to participate. Of parents who were willing to participate themselves, 25% were not willing to allow their child to participate. Being willing to participate but not willing to allow one’s child to participate was independently associated with multiple factors, including race, lower educational attainment, lower annual household income, public health care insurance, and higher religiosity. Conclusions: Fifty-five percent of parents were willing to allow their youngest minor child to participate in a hypothetical biobank. Building trust, protecting privacy, and addressing attitudes may increase enrollment and diversity in pediatric biobanks. (shrink)

Feminism was born in controversy and it continues to flourish in controversy. The distinguished contributors to this volume provide an array of perspectives on issues including: universal values, justice and care, a feminist philosophy of science, and the relationship of biology to social theory.

Regarding Equality offers an innovative and controversial analysis of the relationship between equality and pluralism. Tackling an issue central to modern political thought, Freeberg highlights the struggle to characterize citizens as equals while respecting their moral, religious, and cultural diversity. The work ably contrasts and critiques the prevailing models for balancing equality with pluralism from thinkers Amartya Sen, Martha Nussbaum, John Rawls, Amy Gutmann, Dennis Thompson, Michael Oakeshott, and Drucilla Cornell. From these liberal, democratic, and conservative approaches to equality (...) and pluralism, Freeberg builds a theory of responsive regard: reciprocal civility between citizens that forms a chastened conception of what we share as free and equal persons. This work will greatly add to political theorists' and philosophers' arsenals of concepts for egalitarian and democratic theory. (shrink)

Nurses have moral obligations incurred by membership in the profession to participate knowingly in health policy advocacy. Many barriers have historically hindered nurses from realizing their potential to advance health policy. The contemporary political context sets additional challenges to policy work due to polarization and conflict. Nursing education can help nurses recognize their role in advancing health through political advocacy in a manner that is consistent with disciplinary knowledge and ethical responsibilities. In this paper, the authors describe an exemplar of (...) Elizabeth Barrett's “Power as Knowing Participation in Change” theory as a disciplinary lens within a doctoral nursing health policy course. Barrett (radically) emphasizes “power as freedom” instead of “power as control.” This approach is congruent with nursing disciplinary values and enhances awareness of personal freedom and building collaborative relationships in the policy process. The theory was used in concert with other traditional policy content and frameworks from nursing and other disciplines. We discuss the role of nursing ethics viewed as professional responsibility for policy action, an overview of Barrett's theory, and the design of the course. Four student reflections on how the course influenced their thinking about policy advocacy are included. While not specific to policymaking, Barrett's theory provides a disciplinary grounding to increase students' awareness of freedom and choices in political advocacy participation. Our experience suggests that Barrett's work can be fruitful for enhancing nurses' awareness of choices to participate in change across settings. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Wuthering Heights: The Romantic AscentMartha NussbaumI“If I were in heaven, Nelly,” she said, “I should be extremely miserable.”“I dreamt, once, that I was there.... [H]eaven did not seem to be my home; and I broke my heart with weeping to come back to earth; and the angels were so angry that they flung me out, into the middle of the heath on the top of Wuthering Heights, where I (...) woke sobbing for joy.” 1Cathy’s soul cannot live in the Christian heaven. For her soul, she explains, is the same as Heathcliff’s soul, and the heavenly soul of Linton is as different from theirs “as a moonbeam from lightning, or frost from fire” (p. 95). Much later, as she lies on her deathbed, now the wife of Edgar Linton, thinking the Linton thought that what she wants is an escape into “that glorious world” of paradise and peace, Heathcliff watches her with burning eyes. At last she calls to him:In her eagerness she rose and supported herself on the arm of the chair. At that earnest appeal he turned to her, looking absolutely desperate. His eyes, wide and wet, at last flashed fiercely on her; his breast heaved convulsively. An instant they held asunder, and then how they met I hardly saw, but Catherine made a spring, and he caught her, and they were locked in an embrace from which I thought my mistress would never be released alive: in fact, to my eyes, she seemed directly insensible. He flung himself into the nearest seat, and on my approaching hurriedly to ascertain if she had fainted, he gnashed at me, and foamed like a mad dog, and gathered her to him with greedy jealousy. I did not feel as if I were in the company of a creature of my own species: it appeared that he would not understand, though I spoke to him; so I stood off, and held my tongue, in great perplexity.(pp. 188–89) [End Page 362]Brontë’s description alludes to the imagery of the Christian ascent tradition. As in Augustine and Dante, love is a flame that animates the eyes, a lightning bolt that pierces the fog of our obtuse daily condition; as in that tradition, love’s energy causes the lover to leap away from the petty egoism of the daily into an ecstatic and mutually loving embrace. But we know we are far from the world of the Christian ascent, even its erotic Augustinian form. Cathy’s spring is not an upward, but a horizontal movement—not toward heaven, but toward her beloved moors and winds, severed from which she would find heaven miserable; not toward God but toward Heathcliff, the lover of her soul. Nor is there redemption into heaven in this work; there is, if anything, a redemption from a world dominated by the imagination of heaven, into a world that the pious Ellen Dean can recognize only as an animal world, a world inhabited by creatures of a different species, who probably do not understand language, so thoroughly are they identified with the energy of the body. A few hours after Cathy’s death Heathcliff, as Ellen Dean tells us, in a sudden “paroxysm of ungovernable passion,” dashes his head against the knotted trunk of a tree, splashing the bark with blood, “and, lifting up his eyes, howled, not like a man, but like a savage beast being goaded to death with knives and spears” (p. 197). It is in his world alone, it would seem, that flame is truly found. As Cathy said to Edgar Linton, “Your cold blood cannot be worked into a fever: your veins are full of ice-water; but mine are boiling, and the sight of such chillness makes them dance.”Brontë’s novel situates itself within a long tradition of writing about love and its ascent or purification. This tradition, inaugurated by Socrates’ description of the ladder of love in Plato’s Symposium, is continued by later Platonists, and radically reformulated by Christian thinkers, who stress, against Plato, the soul’s receptivity and vulnerability to the inscrutable operations of grace. In both the Platonic and... (shrink)

Perry Anderson, Edward Palmer Thompson, David Harvey, Moishe Postone, Derek Sayer, Simon Clarke, Robert Brenner, Ellen Meiksins Wood et David McNally : neuf penseurs importants dont l'influence grandissante marque un renouveau de l'apport de l'oeuvre de Marx et de ses successeurs au champ des sciences sociales. Chaque chapitre décrit le parcours intellectuel de l'une de ces figures et analyse sa contribution à une pensée en mouvement, offrant ainsi pour la première fois au public francophone un tour d'horizon des (...) différentes formes du marxisme anglo-saxon contemporain. Hétérogène, ce courant de pensée résolument antidogmatique est traversé de tendances communes telles la critique du réductionnisme économique et une sensibilité accrue aux processus historiques des rapports de domination. Historiens, sociologues, politologues, géographes ou philosophes, les auteurs ici réunis ont chacun à leur manière contribué au vaste chantier théorique de la pensée marxiste et du matérialisme historique, qui continue de s'étendre, un siècle et demi après sa fondation. (shrink)

This article motivates and develops a reductive account of the structure of certain physical quantities in terms of their mereology. That is, I argue that quantitative relations like "longer than" or "3.6-times the volume of" can be analyzed in terms of necessary constraints those quantities put on the mereological structure of their instances. The resulting account, I argue, is able to capture the intuition that these quantitative relations are intrinsic to the physical systems they’re called upon to describe and explain.

Perry Hendricks’ original impairment argument for the immorality of abortion is based on the impairment principle (TIP): if impairing an organism to some degree is immoral, then ceteris paribus, impairing it to a higher degree is also immoral. Since abortion impairs a fetus to a higher degree than fetal alcohol syndrome (FAS) and giving a fetus FAS is immoral, it follows that abortion is immoral. Critics have argued that the ceteris paribus is not met for FAS and abortion, and (...) so we proposed the Modified Impairment Principle (MIP) to avoid these difficulties. Dustin Crummett has responded, arguing that MIP is open to various counterexamples which show it to be false. He also shows that MIP can generate moral dilemmas. Here, we propose a modification to MIP that resolves the issues Crummett raises. Additionally, Alex Gillham has criticized our appropriation of Don Marquis’ ‘future like ours’ reasoning about the wrongness of impairment. We show that his objections have minimal implications for our argument. (shrink)

When reflecting on the nature of skilled action, it is easy to fall into familiar dichotomies such that one construes the flexibility and intelligence of skill at the level of intentional states while characterizing the automatic motor processes that constitute motor skill execution as learned but fixed, invariant, bottom-up, brute-causal responses. In this essay, I will argue that this picture of skilled, automatic, motor processes is overly simplistic. Specifically, I will argue that an adequate account of the learned motor routines (...) that constitute embodied skills cannot be given in a purely bottom-up, brute-causal fashion. Rather, motor control is intelligent all the way down. To establish this, I will first review two recent accounts of skill, Stanley and Krakauer and Papineau, which characterize the automatic motor control responsible for the fine-grained movements constitutive of motor skill as brute, low-level phenomena. I will then isolate five key features that should apply to skilled motor control, if these accounts are correct. Together, the accounts posit that motor control is: ballistic, invariant, independent of general action trajectories, Insensitive to semantic content, and independent of personal-level intentions. In the final section of this paper, I will appeal to optimal control theory for empirical evidence to challenge the commitment to skilled action as qualified by the above features. (shrink)

Although it is clear that the Chief Executive may be impeached while in office, it is generally thought that a sitting President cannot suffer criminal indictment while in office. There are two general arguments in support of this position. The first argument notes that criminal indictment of the President would so interfere with the duties of the office as to constitute a violation of the Constitution. The second argument simply refers to the express language of the Constitution providing that the (...) remedy for intolerable occupation of the office is impeachment and conviction. While the Constitution does not expressly preclude indictment and prosecution, it is argued that the Constitution only so allows upon impeachment and conviction. This essay aspires to more fully explore the two alleged constitutional prohibitions against the criminal indictment of the occupant of the Office of the President and to argue that each suffers sufficiently to render each doubtful as a ground for guaranteeing Presidential immunity. (shrink)

The essays in this volume--written by prominent philosophers, political scientists, and legal scholars--address these questions and explore related issues.

In this essay I examine how we use indexicals. The key function of indexicals, I claim, is to help the audience --- that is the hearers or readers of the utterance with whom the speaker intends to be communicating---to find supplementary channels of information about the object to which the indexical refers. To keep the discussion manageable, I will oversimplify the epistemology of conversation. I ignore the fact that people sometimes lie and sometimes make mistakes. I talk freely about what (...) one learns and the information one gets from an utterance. (shrink)

This essay steps back from the more detailed regulatory discussions in other contributions to this roundtable on “Competing Visions for Cyberspace” and highlights three broad issues that raise ethical concerns about our activity online. First, the commodification of people—their identities, their data, their privacy—that lies at the heart of business models of many of the largest information and communication technologies companies risks instrumentalizing human beings. Second, concentrations of wealth and market power online may be contributing to economic inequalities and other (...) forms of domination. Third, long-standing tensions between the security of states and the human security of people in those states have not been at all resolved online and deserve attention. (shrink)

Myriad Genetics holds a patent on testing for the hereditary breast and ovarian cancer genes, BRCA1 and BRCA2, and therefore has a forced monopoly on this critical genetic test. Myriad launched a Direct-to-Consumer (DTC) marketing campaign in the Northeast United States in September 2007 and plans to expand that campaign to Florida and Texas in 2008. The ethics of Myriad's patent, forced monopoly and DTC campaign will be reviewed, as well as the impact of this situation on patient access and (...) care, physician liability, and the future of DTC campaigns for genetic testing. (shrink)

The starting point for eliminating the virus of white supremacy ideology from our culture must be in our educational system. This book is intended as a vaccine to help eliminate the damage and to prevent future generations from being infected.