As professionals, nurses are engaged in a moral endeavour, and thus confront many challenges in making the right decision and taking the right action. When nurses cannot do what they think is right, they experience moral distress that leaves a moral residue. This article proposes a theory of moral distress and a research agenda to develop a better understanding of moral distress, how to prevent it, and, when it cannot be prevented, how to manage it.

Children show increasing control of emotions and behavior during their early years. Our studies suggest a shift in control from the brain’s orienting network in infancy to the executive network by the age of 3—4 years. Our longitudinal study indicates that orienting influences both positive and negative affect, as measured by parent report in infancy. At 3—4 years of age, the dominant control of affect rests in a frontal brain network that involves the anterior cingulate gyrus. Connectivity of brain structures (...) also changes from infancy to toddlerhood. Early connectivity of parietal and frontal areas is important in orienting; later connectivity involves midfrontal and anterior cingulate areas related to executive attention and self-regulation. (shrink)

Fetal tissue transplants have now been successful in primates, raising the possibility of treatment for Parkinson's disease and other chronic illnesses. Whether or not abortion is morally justified, use of human fetal tissue for research or therapy is justified in certain circumstances. The rationale, both for permitting transplantation of fetal tissue and for limitations in exercising the technology, is based on the same set of ethical principles that supported restrictive legislation in the past: respect for autonomy and a balancing of (...) harms and benefits that gives priority to those most affected. (shrink)

This paper shows that species are individuals with respect to evolutionary theory in the sense that the laws of the theory deal with species as irreducible wholes rather than as sets of organisms. 'Species X' is an instantiation of a primitive term of the theory. I present a sketch of a proof that it cannot be defined within the theory as a set of organisms; the proof relies not on details of my axiomatization but rather on a generally accepted property (...) of speciation; hence the same argument should work for any axiomatization which captures this generally accepted property of speciation. (shrink)

The part anger plays in motivating political action is frequently noted, but less is said about ways in which anger continues to be a part of how people do politics. This article critically assesses approaches to emotions that emphasize managing anger in accordance with ‘feeling rules’. It reflects on the utility of Marxist notions of conflict as the engine of change for the understanding of how anger operates in political life. This involves understanding the ambivalence of anger and its operation (...) within particular power relations. Shifting sets of conventions have had some continuity in discouraging women in Western nations (particularly white and middle-class women) from showing anger. But clearly, women do get angry and feminists have drawn on anger in acting politically. New Zealand feminist writings from the ‘second wave’ are taken as illustrative of the common difficulties Western feminists faced in dealing with anger. These difficulties were due to trying to juggle social conventions about femininity, the political ideal of sisterhood, and the realities of dealing with other women in often new and experimental political processes. Anger could be personalized and hurtful, but in certain cases its expression was constructive in producing more respectful relations. Exploring these cases makes it clear how anger produces, and is produced by, relations with others. (shrink)

A long-standing tradition presents economic activity in terms of the flow of fluids. This metaphor lies behind a small but influential practice of hydraulic modelling in economics. Yet turning the metaphor into a three-dimensional hydraulic model of the economic system entails making numerous and detailed commitments about the analogy between hydraulics and the economy. The most famous 3-D model in economics is probably the Phillips machine, the central object of this paper.

Personalised medicine has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these challenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells so as to make individualised treatment predictions. We compare this strategy to two main PM strategies—stratified medicine and (...) computational models. Drawing on epistemological work in the philosophy of medicine, we explain why these two methods, while powerful, are neither truly personalised nor, epistemologically speaking, novel strategies. Both are forms of correlational black box. We then argue that the iPSC models would count as a new kind of black box. They would not rely entirely on mechanistic knowledge, and they would utilise correlational evidence in a different way from other strategies—a way that would enable personalised predictions. In arguing that the iPSC models would present a novel method of gaining evidence for clinical practice, we provide an epistemic analysis that can help to inform the practical, regulatory, and ethical challenges of developing an iPSC system. (shrink)

This discussion note responds to Mark Colyvan’s claim that there is no easy road to nominalism. While Colyvan is right to note that the existence of mathematical explanations presents a more serious challenge to nominalists than is often thought, it is argued that nominalist accounts do have the resources to account for the existence of mathematical explanations whose explanatory role resides elsewhere than in their nominalistic content.

Conscientious objection has become a divisive topic in recent bioethics publications. Discussion has tended to frame the issue in terms of the rights of the healthcare professional versus the rights of the patient. However, a rights-based approach neglects the relational nature of conscience, and the impact that violating one’s conscience has on the care one provides. Using medical assistance in dying as a case study, we suggest that what has been lacking in the discussion of conscientious objection thus far is (...) a recognition and prioritising of the relational nature of ethical decision-making in healthcare and the negative consequences of moral distress that occur when healthcare professionals find themselves in situations in which they feel they cannot provide what they consider to be excellent care. We propose that policies that respect the relational conscience could benefit our healthcare institutions by minimising the negative impact of moral distress, improving communication among team members and fostering a culture of ethical awareness. Constructive responses to moral distress including relational cultivation of moral resilience are urged. (shrink)

Kinship was one of the key areas of research interest among anthropologists in the nineteenth century, one of the most hotly debated areas of theory in the early and mid-twentieth century, and yet an area of waning interest by the end of the twentieth century. Since then, the study of kinship has experienced a revitalization, with concomitant disputes over how best to proceed. This special issue brings together recent studies of kinship by scientific anthropologists employing evolutionary theory and quantitative methods. (...) We argue that the melding of the evolutionary theoretical perspective with quantitative and ethnographic methodologies has strengthened and reinvigorated the study of kinship by synthesizing and extending existing research via rigorous analyses of evidence. (shrink)

Background: Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives (to implement research protocols and advance science), setting (research facilities), and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether (...) research nurses experience unique ethical challenges distinct from those experienced by nurses in traditional patient-care settings. Research objectives: The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice. Research design: The study utilized a qualitative descriptive design with individual interviews. Participants and research context: Participating nurses (N = 12) self-identified as having experienced ethical challenges during screening. The majority were Caucasian (90%), female (83%), and worked in outpatient settings (67%). Approximately 50% had > 10 years of research experience. Ethical considerations: The human subjects review board approved the study. Written informed consent was obtained. Findings: Predominant themes were revealed: (1) the inability to provide a probable good, or/do no harm, and (2) dual obligations (identity as a nurse vs a research nurse). The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship. Discussion: Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science. Conclusion: Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

Demonstrates the dramatic interplay of elements that comprise the concepts of norm, bisexuality, and development.

Medical ethics committees are increasingly called on to assist doctors, patients, and families in resolving difficult ethics issues. Although committees are becoming more sophisticated in the substance of medical ethics, little attention has been given to the processes these committees use to facilitate decision-making. In 1990, the National Institute for Dispute Resolution in Washington, D.C., provided a planning grant from its Innovation Fund to the Institute of Public Law of the University of New Mexico School of Law to look at (...) what ethics committees can learn from facilitation and mediation techniques. The study's thesis was that, if adapted for use by medical ethics committees, facilitation and mediation techniques can be helpful to those bodies in case review consultations and in other internal committee processes. This article reports on that project. (shrink)

Little is known about how certain patient characteristics can affect the timing of an ethics consultation, which has been hypothesized to affect patient length of stay. This study assessed how specific patient characteristics affect the timing of an ethics consultation, namely, age (over 65 years), race, Medicaid status, the presence of a living will, the presence of a health care proxy, and the absence of decisional capacity. Moving beyond the typical case-series evaluation of an ethics consultation service, this study used (...) an innovative approach to model how predisposing, enabling, and need factors affect health behavior and subsequently affect health outcomes for patients who received an ethics consultation at a Catholic health care system in Oklahoma. (shrink)

A collaboration between distinguished physicists and philosophers of physics, this important anthology surveys the deep implications of Bell's nonlocality theorem.

Fifteen to twenty years ago one might have been forgiven for thinking that both the philosophy and history of science constituted specialized academic backwaters, far removed from debates in the forefront of either philosophic or public attention. But times have changed; science and technology have in many ways and in many guises become central foci of public debate, whether through concern over nuclear safety, the massive price to be paid for continued research in areas such as high energy physics, the (...) cost of high technology medicine, the spectre of genetic engineering, or the wonders of information processing and the computer revolution. At the same time that there is public questioning of the authority of expert scientific pronouncements and debate about the wisdom of courses of action proposed in the name of technology and progress, there is political pressure to direct eduction in an increasingly scientific and technological direction. But even so, in this country, the history and philosophy of science remain peripheral disciplines, not only in relation to the total academic scene but even in relation to philosophy, which is itself being academically marginalized. (shrink)

O cuidado espiritual é considerado um aspecto intrínseco às boas práticas de cuidados paliativos. Contudo, este é um desafio a profissionais de saúde. Há carência de propostas cientificamente embasadas e não religiosas para identificar e atender as necessidades existenciais/espirituais de pacientes e familiares. Este artigo tem como objetivo apresentar uma ferramenta de cuidado espiritual denominada Modelo Diamante ou _Ars Moriendi_, desenvolvida por um pesquisador holandês que a concebeu a partir de elementos extraídos de sua pesquisa empírica. O modelo é teoricamente (...) baseado em estruturas antropológicas não morais e não religiosas e está aberto a pessoas de uma variedade de origens culturais e religiosas. Tanto capelães quanto equipes multidisciplinares podem usar essa ferramenta hermenêutica. Ela ajuda a melhor compreender e atender as necessidades espirituais de pacientes e familiares nas dimensões que envolvem autonomia, sofrimento, relacionamentos, questões pendentes e esperança. A apresentação do Modelo Diamante ao público brasileiro também é um convite para testá-lo e avaliá-lo em estudos futuros que investiguem a espiritualidade em cuidados paliativos no Brasil. (shrink)

The fairness of agricultural markets is frequently invoked, especially by farmers. But fairness is difficult to define and measure. In this paper we link fairness and power with the concept of constrained choice to develop a framework for assessing fairness in agricultural markets. We use network exchange theory to define power from the dependencies that exist in agricultural networks. The structure of agricultural networks and the options that agricultural producers have to participate in agricultural networks affect the degree to which (...) they are dependent on others within the network. Dependency, in turn, affects the choices that agricultural producers have. We consider both the number and nature of these choices. We argue that constraining or limiting choices—both in number and type—violates principles of justice. Importantly, network exchange theory provides a method for assessing constraints in choices and, hence, the fairness of agricultural markets. Such an assessment could potentially lead to new policies that safeguard the liberties of marketplace participants. We present a brief case to illustrate how this framework can inform on the fairness of agricultural markets and conclude with considerations of what this means for policy, particularly in the arena of anti-trust. (shrink)

Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in (...) the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH. (shrink)

This paper elaborates a theory of ‘unbecoming’ to explore how a queering of the subject might transform oppressive social conditions. In this analysis of the subject’s deconstructive relation to the law I take up the interpellation scenario forwarded by Louis Althusser and Judith Butler’s theory of performativity to argue that being ‘unbecoming’ potentially not only alters subjectivity, it also alters the very law that hails the subject into being. First, I deconstruct both subject and law in their relation to each (...) other as performatives, for it is at this threshold of undecidability that the possibilities for political transformation emerge. Second, I demonstrate the creative and transformative political force of queer performativity to show that our agency as political beings lies not merely in affirmative representations of identity. Political agency also emerges in the creative force of a becoming that is also an unbecoming, where in and through our abjection from the social order we critique and transform it. (shrink)

This article examines the claim that Duns Scotus’s position on the will’s freedom changed between his early Lectura teaching to his late Reportatio lectures on Distinction 25 of Book II of the Sentences. Stephen Dumont in “Did Duns Scotus Change His Mind on the Will?” suggests that Scotus moves closer to the position of Henry of Ghent on the will. The Franciscan had criticized that position in his earlier teaching. In order to demonstrate that Scotus’s voluntarism continues to be moderate, (...) the author first explicates the notion of a rational will in Scotist thought, by means of the two affections of the will and the position outlined in Scotus’s Questions on the Metaphysics of Aristotle Book IX, Q. 15. Following this, a textual comparison of Lectura II, D. 25 with Reportatio II, D. 25 shows that there is indeed a shift, but not toward a more exaggerated form of voluntarism. Rather, close reading of these texts reveals that, in his early teaching, Scotus did not think the will was the rational potency, and did not identify its freedom with rationality. In the later Parisian teaching he presents the will as the sole rational potency, thereby diminishing the role of the intellect, but not that of rationality. The textual evidence of Ordinatio II, D. 6, Questions on the Metaphysics, Lectura II, D. 25 and Reportatio II, D. 25 show that Scotus’s final teaching on the will integrates rationality into the functioning of freedom, and does not align him with Henry’s position, despite similarity of language. (shrink)

Narrative Science examines the use of narrative in scientific research over the last two centuries. It brings together an international group of scholars who have engaged in intense collaboration to find and develop crucial cases of narrative in science. Motivated and coordinated by the Narrative Science project, funded by the European Research Council, this volume offers integrated and insightful essays examining cases that run the gamut from geology to psychology, chemistry, physics, botany, mathematics, epidemiology, and biological engineering. Taking in shipwrecks, (...) human evolution, military intelligence, and mass extinctions, this landmark study revises our understanding of what science is, and the roles of narrative in scientists' work. This title is also available as Open Access. (shrink)

This article examines the participation of women in the 1985 labor strike at Wheeling-Pittsburgh Steel. The author views the strike as a deeply gendered act of protest where the issues, strategies, tactics, and resources used by women workers differ from those used by men, and simultaneously, as the occupational site that provided workers an opportunity to affirm, to modify, and to contest their understandings of gender. Paradoxically, women both challenge and conform to normative gender scripts for protest. They resisted the (...) efforts of men to impose a gender division of labor and sought to mobilize the community in support of the strike. (shrink)