The goal of this paper is to review and describe the characteristics and outcomes of ethics consultations on a gastrointestinal oncology service and to identify areas for systems improvement and staff education. This is a retrospective case series derived from a prospectively-maintained database of the ethics consultation service at Memorial Sloan Kettering Cancer Center. The study analyzed all ethics consultations requested for patients on the gastrointestinal medical oncology service from September 2007 to January 2016. A total of 64 patients were (...) identified. The most common primary ethical issue was the DNR order, followed by medical futility. The most common contextual issues were dispute/conflict between staff and family, dispute/conflict intra-family, and cultural/ethnic/religious issues. The majority of ethical issues leading to consultation were resolved ; i.e., the patient, surrogate, and/or healthcare team followed the recommendation of the ethics consultant. 22% had a DNR order prior to the ethics consult and 69% had a DNR order after the consult. In this population of patients on a gastrointestinal oncology service, ethics consultations are most often called regarding patients with advanced cancers and the most common ethical conflicts arose between families and the health care team over goals of care at the end of life, specifically related to the DNR order and perceived futility of continued/escalation of treatment. Ethics consultations assisted with conflict resolution. Conflicts might be reduced with improved communication about prognosis and earlier end of life care planning. (shrink)

Background High levels of moral distress in nursing professionals, of which oncology nurses are particularly prone, can negatively impact patient care, job satisfaction, and retention. Aim “Positive Attitudes Striving to Rejuvenate You: PASTRY” was developed at a tertiary cancer center to reduce the burden of moral distress among oncology nurses. Research Design A Quality Improvement (QI) initiative was conducted using a pre- and post-intervention design, to launch PASTRY and measure its impact on moral distress of the nursing unit, using Hamric’s (...) Moral Distress Scale–Revised (MDS-R.) This program consisted of monthly 60-minute sessions allowing nurses to address morally distressing events and themes, such as clinicians giving “false hope” to patients or families. The PASTRY program sessions were led by certified clinicians utilizing strategies of discussion and mind-body practices. Participants Clinical nurses working on an adult leukemia/lymphoma unit. Ethical considerations This was a QI initiative, participation was voluntary, MDS-R responses were collected anonymously, and the institution’s Ethics Committee oversaw PASTRY’s implementation. Findings While improvement in moral distress findings were not statistically significant, the qualitative and quantitative findings demonstrated consistent themes. The PASTRY program received strong support from nurses and institutional leaders, lowered the nursing unit’s moral distress, led to enhanced camaraderie, and improved nurses’ coping skills. Discussion Measurement of moral distress is innately challenging due to its complexity. This study reinforces oncology nurses have measurable moral distress. Interventions should be implemented for a safe and healing environment to explore morally distressing clinical experiences. Poor communication among multidisciplinary team members is associated with moral distress among nurses. Programs like PASTRY may empower nurses to build support networks for change within themselves and institutions. Conclusion This QI initiative shows further research on moral distress reduction should be conducted to verify findings for statistical significance and so that institutional programs, like PASTRY, can be created. (shrink)

Contradicting the long-held belief that Aristotle was the first to discuss individuation systematically, Mary Margaret McCabe argues that Plato was concerned with what makes something a something and that he solved the problem in a ...

Unethical decision-making behavior within organizations has received increasing attention over the past ten years. As a result, a plethora of studies have examined the relationship between gender and business ethics. However, these studies report conflicting results as to whether or not men and women differ with regards to business ethics. In this article, we propose that gender identity theory [Spence: 1993, Journal of Personality and Social Psychology 64, 624–635], provides both the theory and empirical measures to explore the influence of (...) psychological gender traits and gender-role attitudes on ethical perceptions of workplace behaviors. Statistical analyses of the data reveal that based on sex alone, no differences occur between men and women in their ethical perceptions. Yet, when a multidimensional approach to gender is applied, results show that expressive traits and egalitarian gender-role attitudes contribute to both men’s and women’s propensity to perceive unethical workplace behaviors as unethical. The implications of these findings and suggestions for future research are presented. (shrink)

ABSTRACT At the centre of Plato’s Euthydemus lie a series of arguments in which Socrates’ interlocutors, the sophists Euthydemus and Dionysodorus propose a radical account of truth (‘chopped logos’) according to which there is no such thing as falsehood, and no such thing as disagreement (here ‘counter-saying’). This account of truth is not directly refutable; but in response Socrates offers a revised account of ‘saying’ focussed on the different aspects of the verb (perfect and imperfect) to give a rich account (...) of saying, of truth and of knowledge. I argue that Socrates’ response has much to offer, notably in its amplification of the process of saying and cognition, and the development of virtue. (shrink)

Volume 3, Issue 2, June 2019, Page 214-238.

The complex way Meno's paradox is presented in the Meno forces reflection on both the external conditions on inquiry—its objects—and its internal conditions—the state of mind of the person who inquires. The theory of recollection does not fully account for the internal conditions—as Plato makes clear in the critique of Meno's puzzle to be found in the Euthydemus. I conclude that in the Euthydemus Plato is inviting us to reject the externalist account of knowledge urged on Socrates by the sophists (...) in favour of a more richly internalist epistemology. (shrink)

Plato gives us two model philosophical figures, apparently in contrast with each other—one is the otherworldly philosopher who sees truth and reality outside the cave and has the knowledge to rule authoritatively within it; the other is the demotic figure of Socrates, who insists that he does not know but only asks questions. I consider Plato’s contrasting idioms of seeing and asking or talking, and argue that the rich account of perception that is represented in the Republic requires both idioms, (...) and both models, to explain the development of epistemic virtue. Furthermore, the conditions he places on the giving and taking of reasons show how Plato takes intellectual virtue to be inseparable from moral virtue. That integrated picture of virtue may—however disposed we may be towards the role of virtue in either ethics or epistemology—have something to say to us about how philosophy might best be carried on. (shrink)

How does Plato view his philosophical antecedents? Plato and his Predecessors considers how Plato represents his philosophical predecessors in a late quartet of dialogues: the Theaetetus, the Sophist, the Politicus and the Philebus. Why is it that the sophist Protagoras, or the monist Parmenides, or the advocate of flux, Heraclitus, are so important in these dialogues? And why are they represented as such shadowy figures, barely present at their own refutations? The explanation, the author argues, is a complex one involving (...) both the reflective relation between Plato's dramatic technique and his philosophical purposes, and the very nature of his late philosophical views. For in these encounters with his predecessors we see Plato develop a new account of the principles of reason, against those who would deny them, and forge a fresh view of the best life - the life of the philosopher. (shrink)

This article deals with Plato's ways of writing. Plato's writing scintillates, most of them, if not all. However, this depends on whether we take the letters to be genuine—of what comes down to us from Plato's hand is in the dialogue form, somehow or other. But should we speak of “the” Platonic dialogue form? After all, the dialogues come in all sorts of different forms: some are dramatic, others merely formalized discussion; some are in direct speech, others narrated ; some (...) seem to have a beginning, a middle, and an end, whereas others begin, or end, in the middle of things. In almost all the dialogues, people talk about big abstract questions: the nature of reality, truth, virtue and knowledge. These conversations come in all sorts of shapes and sizes, but they are often conducted by question and answer, by one-person asking questions to one another. (shrink)

This chapter contains sections titled: Direct Conversations Frames and Framed Fiction and Reporting Socrates on Question and Answer Socratic Aporia The Paradox of Writing Drama and the Ethical Dimension Limitations of the Ethical The Soul's Silent Dialogue Reflection and its Content.

The traditional Christian teaching is that engaging in sexual activity, whether heterosexual or homosexual, outside the marriage of one man and one woman is sinful. In direct contrast, there are those in the Church who quite recently have begun to insist that the traditional teachings concerning sexual sin need to be changed. In particular, the effort is being made to have the Church accept homosexual behavior as not sinful or problematic in any way—at least not for committed homosexuals, as comparable (...) to committed heterosexuals in a marriage. As we all know, this relatively recent view has been promoted heavily in the media and popular culture, and even by our national government. As we make our observations, we will particularly focus on traditional Orthodox Christianity as the fullness of the truth and, thus, the source of the true alternative to this “new” outlook that is gripping much of popular Western culture today. (shrink)

This paper addresses the problem of how scientific knowledge, which is always locally generated, becomes accepted in other sites. The analysis suggests that there are a small number of strategies that enable scientists to resituate knowledge and that these strategies are generic: they are not restricted to specific disciplines or modes of doing science but rather are found in a variety of different forms across the sciences.

Models as Mediators discusses the ways in which models function in modern science, particularly in the fields of physics and economics. Models play a variety of roles in the sciences: they are used in the development, exploration and application of theories and in measurement methods. They also provide instruments for using scientific concepts and principles to intervene in the world. The editors provide a framework which covers the construction and function of scientific models, and explore the ways in which they (...) enable us to learn about both theories and the world. The contributors to the volume offer their own individual theoretical perspectives to cover a wide range of examples of modelling, from physics, economics and chemistry. These papers provide ideal case-study material for understanding both the concepts and typical elements of modelling, using analytical approaches from the philosophy and history of science. (shrink)

The inner ache: an experiential perspective on IonelinessThis paper examines the various theoretical approaches that have informed both the conceptualizations and the research approaches to investigations of loneliness. A focus on phenomenological and existential perspectives of loneliness can assist in an understanding of what is essentially a subjective distressing experience. The elderly, particularly those residing in nursing homes, are vulnerable to feelings of existential loneliness because following busy lives, often they are left without meaningful roles. Concomitant to this sense of (...) loss of meaning is an alteration in the perception of lived time. It is the purpose of this paper to stimulate research into what is a common but profoundly distressing experience. (shrink)

Mary Hesse's well-known work on models and analogies gives models a creative role to play in science, which rests on developing certain analogical properties considered neutral between the two fields. Case study material from Irving Fisher's work (The Purchasing Power of Money, 1911), in which he used analogies to construct models of monetary relations and the monetary system, highlights certain omissions in Hesse's account. The analysis points to the importance of taking account of the negative properties in the analogies (...) and to certain differences between "ready-made" analogies (models of systems based on existing analogical structures) and "designed" analogies (models built up from separate analogical features). (shrink)

Modelling became one of the primary tools of mathematical economic research in the twentieth century, but when we look at examples of how nonanalogical models were first built in economics, both the process of making representations and aspects of the representing relation remain opaque. Like early astronomers, economists have to imagine how the hidden parts of their world are arranged and to make images, that is, create models, to represent how they work. The case of the Edgeworth Box, a model (...) widely used for theoretical work in twentieth-century economics, provides a good example to explore the process of making mathematical representations of the economy. It shows how, in making these new representations, conceptual elements were developed which could not have been represented in the older verbal forms of economics. (shrink)

Philosophers of science studying scientific practice often consider it a methodological requirement that their conceptualization of "model" closely connects with the understanding and use of models by practicing scientists. Occasionally, this connection has been explicitly made (Hutten 1954, Suppes 1961, Morgan and Morrison 1999, Bailer-Jones 2002, Lehtinen and Kuorikoski 2007, Kuorikoski 2007, Morgan 2012a). These studies have been dominated by a focus on the—relatively similar forms of—mathematical models in physics and economics. Yet it has become increasingly evident that the way (...) models are conceptualized is very different in some other sciences, where philosophers' accounts of models' characteristics and .. (shrink)

During the last two centuries, the way economic science is done has changed radically: it has become a social science based on mathematical models in place of words. This book describes and analyses that change - both historically and philosophically - using a series of case studies to illuminate the nature and the implications of these changes. It is not a technical book; it is written for the intelligent person who wants to understand how economics works from the inside out. (...) This book will be of interest to economists and science studies scholars. But it also aims at a wider readership in the public intellectual sphere, building on the current interest in all things economic and on the recent failure of the so-called economic model, which has shaped our beliefs and the world we live in. (shrink)

This article explores the characteristics of research sites that scientists have called “natural experiments” to understand and develop usable distinctions for the social sciences between “Nature’s or Society’s experiments” and “natural experiments.” In this analysis, natural experiments emerge as the retro-fitting by social scientists of events that have happened in the social world into the traditional forms of field or randomized trial experiments. By contrast, “Society’s experiments” figure as events in the world that happen in circumstances that are already sufficiently (...) “controlled” to be open for direct analysis without reconstruction work. (shrink)

Critiques of case studies as an epistemic genre usually focus on the domain of justification and hinge on comparisons with statistics and laboratory experiments. In this domain, case studies can be defended by the notion of “infirming”: they use many different bits of evidence, each of which may independently “infirm” the account. Yet their efficacy may be more powerful in the domain of discovery, in which these same different bits of evi- dence must be fully integrated to create an explanatory (...) account with internal validity. (shrink)

The provocative paper by John Forrester ‘If p, Then What? Thinking in Cases’ (1996) opened up the question of case thinking as a separate mode of reasoning in the sciences. Case-based reasoning is certainly endemic across a number of sciences, but it has looked different according to where it has been found. This article investigates this mode of science – namely thinking in cases – by questioning the different interpretations of ‘If p?’ and exploring the different interpretative responses of what (...) follows in ‘Then What?’. The aim is to characterize how ‘reasoning in, within, with, and from cases’ forms a mode of scientific investigation for single cases, for runs of cases, and for comparative cases, drawing on materials from a range of different fields in which case-based reasoning appears. (shrink)