This book contains articles on ignorance in the medical field and where the contributing researchers would like research directed.

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

Background Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL’s experience. Research aim The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress. Research design A qualitative descriptive (...) design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection. Participant and research context Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023. Ethical considerations This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection. Findings UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress. Conclusions The UBCCNL’s experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed. (shrink)

Dominic Smith’s Exceptional Technologies has a specific project, a bridge it is hoping to build, between a philosophy of technology which has become too standardised and a continental tradition tha...

The way health is conceptualized determines the actions taken to protect and promote it and, in turn, the actors responsible for such actions in an increasingly inter-dependent world. This essay presents a brief description of health policies in Peru during the last ten years in order to analyze the implications of paradigms of medical ethics, human rights and quality of care. These paradigms offer distinct ways of formulating, applying and evaluating health policies and understanding the relationship among different actors at (...) various levels. Building upon other detailed analyses of sexual and reproductive health policy in Peru (Coe, 2004; Miranda and Yamin, 2004), as well as critical appraisals of health services models (Gericke, Kurowski, Ranson and Mills, 2005; Krieger, Northridge, Gruskin, Quinn, Kriebel, Davey Smith, Bassett, Rehkopf and Miller, 2003), this article advocates the importance of construing and promoting health as a human right. (shrink)

This is a transcript of Milne's manuscript notes for a talk which he gave to fellow members of the Cambridge University Natural Science Club in his rooms at Trinity College, Cambridge, on February 6, 1922. The notes are deposited in the Bodleian Library, University of Oxford, Special Collections and Western Manuscripts. The background and essential points of Milne's talk are analysed in the article preceding this one. As far as is known, the text has not hitherto been published. Milne's handwriting (...) is difficult to read, and square brackets [...] denote the addition of a word for clarity of meaning. Meg Weston Smith and Simon Rebsdorf have ventured to fill in some chapter titles just in order to help with the separation of the varying content, hence we have made up all the headlines. All italics correspond to underlined words in the original. The Bergson citations and the Eddington passage at the end of the original text have not been transcribed. (shrink)

Ethical mysticism, by S. Coit.--The ethical import of history, by D. S. Muzzey.--The tragic and heroic in life, by W. M. Salter.--Distinctive features of the ethical movement, by A. W. Martin.--Ethical experience as the basis of religious education, by H. Neumann.--"All men are created equal," by G. E. O'Dell.--How far is art an aid to religion? by P. Chubb.--Evolution and the uniqueness of man, by H. J. Bridges.--The spiritual outlook on life, by H. J. Golding.--The ethics of Abu'l Ala al (...) Ma'arri, by N. Schmidt.--Life's unused moral force, by H. Snell.--Is the ideal real? by G. A. Smith.--Some ethical tendencies in the professions, by R. D. Kohn.--On the art of living, by W. Boerner.--The relation of the ethical ideal to social reform, by J. L. Elliott.--Concerning tolerance, by R. F. Dewey.--Ethical culture in Germany after the war, by R. Penzig.--A confession of faith, by S. B. Weston.--"Hearing the witnesses," by J. Gutmann. (shrink)

In this round table response, we discuss some of the problems inherent in insisting on specific consent for an activity that needs to happen rapidly as part of a package of care. The Human Tissue Authority (the UK regulator for human tissue and organs) consider that specific consent is mandatory to assess which antibiotics are appropriate on the neonatal unit, but this insistence may actually limit the autonomy which consent aims to promote. While genetic testing to determine which child will (...) react adversely to particular antibiotics has been available clinically for several years, the research proposed here is to assess whether improving the speed of testing allows decisions to be made before treatment starts. Insisting on specific consent before this activity can take place is likely to delay appropriate care in some cases. On admission to the neonatal unit, the unwell infant is routinely subjected to a range of investigations and treatments. A person with parental responsibility will usually be asked to provide consent to undertake treatments for children who do not have capacity to give consent themselves.1 For the acutely unwell child, consent will usually be sought for a package of care: the urgent nature of neonatal medicine often requires clinicians to make many decisions without explicit consent. Doctors must always act in a child’s best interests: their decisions need to protect the health and well-being of a child and hold the child’s welfare paramount in accordance with the Children Act (1989) and General Medical Council (GMC) guidelines.1 2 Thus, for example, ventilation might be initiated, sedation provided, antibiotics commenced or diagnostic investigations requested without separate consent conversations or …. (shrink)

Imagine that Bloggs is faced with a choice between giving a benefit to his child, or a slightly greater benefit to a complete stranger. The benefit is whatever the child or the stranger can buy for $100 — Bloggs has $100 to give away — and it just so happens that the stranger would buy something from which he would gain a slightly greater benefit than would Bloggs's child. Let's stipulate that Bloggs believes this to be, and let's stipulate, as (...) well, that he believes that the consequences of his actions are otherwise identical. He chooses to give the benefit to his child. What do we learn about Bloggs from his choice? We learn that Bloggs cares more about his child than he does about complete strangers. Nor is anyone likely to be surprised by this, for it just goes to show that he is much like the rest of us. He gives preferential treatment to his nearest and dearest when he acts, those with whom he has a special relationship, much as we do. (shrink)

The data in this special issue are both encouraging and discouraging. On the positive side, researchers are making theoretical breakthroughs into the psychology of the academic cheater, which may result in practical interventions. Yet the studies illustrate the sheer magnitude of the problem and the resources needed to address unethical behavior among the younger members of the American academe. In short, this special issue shows that the "Internet revolution" facilitates new types of academic dishonesty (Sisti, this issue; Stephens, Young, & (...) Calabrese, this issue); that academic cheating is often an intentional, planned act that results from a Machiavellian tendency to neutralize moral sanctions against cheating (Harding, Mayhew, Finelli, & Carpenter, this issue); that motivations to cheat differ across students (Davy, Kincaid, Smith, & Trawick, this issue; Wowra, this issue); and that academic cheating is a symptom of a larger problem (Lovett-Hooper, Komarraju, Weston, & Dollinger, this issue; Wowra, this issue). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Caring for Landscapes of Justice in Perilous Settler EnvironmentsMishuana Goemanindians are the "singing remnants" or "graffiti," in the words of Leanne Betasamosake Simpson ("i am graffiti"). The forms this graffiti takes, our inscriptions on the landscape, are as numerous as our Nations, abundant as our ancestors who loved, lived, and passed down knowledge of our lands and histories. "You are the result of the love of thousands," writes Linda (...) Hogan, who beseeches us to listen to the environment surrounding us (159). Deborah Miranda (Coastal Esselen and Chumash) reminds us that we are also the result of violent histories, in her tribal memoir Bad Indians, a book that relishes the tales of her ancestors who resist and act out to survive. This harm, genocide, and settler mapping of worlds also must be attuned to in our surroundings and in "our bodies [that are] bridges over which our descendants cross, spanning unimaginable landscapes of loss" (Miranda 74). Visual cartographic mapping has been part and parcel of the erasure of California Indians, relegated to the small, contained, and past temporal space of a romanticized mission.This paper centers on the NDN Collective's work and the photography of Cara Romero's project Tongvaland and the works of Gabrielino Tongva artist Mercedes Dorame. The setting of these projects is in the sprawling landscape of Los Angeles, or the homelands of the Gabrielino Tongva people, who call it Tovaangar. I will examine the anti-colonial aesthetics and care practices mapped out in the work rather than presenting a "true" Indigenous map or alternative map. Mapping a history of the landscape by creating a "new" narrative or "true" narrative is not enough. As Maori scholar Linda Tuhwi Smith states, "[w]e believe that history is also about justice, that understanding history will enlighten our decisions about the future. Wrong. History is also about power. In fact, history is mostly about power. … [A] thousand accounts of the truth will not alter the fact that indigenous peoples are still marginal [End Page 50] and do not possess the power to transform history into justice" (34). The Gabrielino Tongva, who comprise an estimated 2,300 people, do not possess the population power and cannot access the form of voting or democracy to make the changes needed just by telling their truth. Across California, people know about the raw deal, the embezzlement, the genocide, and the so-called lost treaties. In fact, under Eisenhower, recompense was paid out in small amounts to Tongva families of the dispossessed. Instead, to continue with the words of Smith, "[i]t is also about reconciling and reprioritizing what is really important about the past with what is important about the present" (111). What Romero and the NDN Collective—made up of numerous tribal leaders, scholars, and other artists—did was relay and prioritize how they wanted to be seen in their homelands. These billboards invite us in, in a gift of sharing, or what tribal cultural leader Craig Torres related to me as a spirit of Maxxa, a sharing, gifting, or swapping of knowledge. Dorame's beautiful and critical installations in public art spaces reflect Maxxa—they invite the viewers to think through land from her curious arrangements. As artists, part of their practice is not that of a Western version of a tortured genius but instead is energized by pulling in community and creating a collective practice. They undo settler space together and with us. The cartographic practices of these California Indians' creative arts exemplify communities of care that must be considered when we think through the unmapping of settler terrains. This question requires an approach of radical care. As Hi'ilei Hobart and Tamara Kneese make clear, the notion of care is "inseparable from systemic inequalities and power systems" (Hobart and Kneese 1).The work of the NDN Collective and Dorame counters a settler-based, commercial map of Los Angeles. Indigenous people, relegated by the settler state as expendable and erasable graffiti, confront capitalist and state ordinances at various scales. Rather than understand this as a subjugated positionality, I posit that graffiti is the critique necessary and valuable to understanding interlocking structures of oppression. In the following words of Leanne... (shrink)

Process philosophies tend to emphasise the value of continuous creation as the core of their discourse. For Bergson, Whitehead, Deleuze, and others the real is ultimately a creative becoming. Critics have argued that there is an irreducible element of (almost religious) belief in this re-evaluation of immanent creation. While I don’t think belief is necessarily a sign of philosophical and existential weakness, in this paper I will examine the possibility for the concept of universal creation to be a political and (...) ethical axiom, the result of a global social contract rather than of a new spirituality. I argue here that a coherent way to fight against potentially totalitarian absolutes is to replace them with a virtual absolute that cannot territorialise without deterritorialising at the same time: the Creal principle. (shrink)

Neyman-Pearson methods in statistics distinguish between Type I and Type II errors. Through rigid control of Type I error, the "null" hypothesis typically receives the benefit of the doubt. I compare philosophers' interpretations of this feature of Neyman-Pearson tests with interpretations given in statistics textbooks. The pragmatic view of the tests advocated by Neyman, largely rejected by philosophers, lives on in many textbooks. Birnbaum thought the pragmatic view has a useful "heuristic" role in understanding testing. I suggest that it may (...) have the opposite effect. (shrink)

Growing nursing workforce maldistributions impede rural healthcare access globally. In‐depth exploration of underlying philosophical ideas about rural health in nursing curricular could support recruitment and retention of nurses who are well positioned to support and advocated for health care and services relevant to their communities. Through a lens of positionality, the purpose of this paper is to explore rural health and nursing within the United States and Australia from the perspective of undergraduate students. Recognizing that both countries have ‘first world’ (...) health services, issues of access to services associated with systemic and structural biases were significant features identified by participants. Their perceptions were supported by discussion with attendees of the 26th International Nursing Philosophy Conference from several countries, during a presentation titled ‘What is different about rural health nursing: A philosophical exploration.’ This international consistency suggests that systemic and structural biases are global phenomena. While exposure to rural health and rural nursing may be beneficial for recruitment, preparing nurses for rural practice requires more than educating students to complete clinical tasks. Uncovering collaboration, advocacy and policy development opportunities for nurses in rural communities could move the dial from recruiting rural nurses to fulfill immediate needs to retention of well‐educated and highly skilled nurses. Building a stronger philosophical base for rural healthcare inclusive of all people, honouring their distinguishing characteristics such as age, gender, ethnicity, is long overdue. Positionality can inform how nurses across the globe relate to other countries' governments, cultures, norms, values, expectations, etc., which can influence the advancement of the profession and address social inequities among rural populations. (shrink)

The author posits that the value of individual freedom is best realized within the context of the Moral Imagination concept of philosopher Rudolph Steiner and that when freedom is seen more as a licence for deception and exploitation not only does the greater community suffer but also the party itself suffers character destruction. Thus, laissez-faire capitalism, as exemplified by the mortgage banking meltdown of 2008 and subsequent debt-based unemployment crisis, has not only impoverished millions, destroyed savings and bankrupted long-established investment (...) firms, but also has further bonded the perpetrators to the morally undeveloped self-centredness of Lawrence Kohlberg’s least advanced moral stage (Kohlberg, 1981). Following a discussion of the folly and futility of the consumerist culture, the author argues that the solution lies in practicing the time tested values of caring and social responsibility on the part of government and mortgage bankers coupled with self-restraint and moderation on the part of investors and borrowers. (shrink)

George Boole collected ideas for the improvement of his Mathematical analysis of logic(1847) on interleaved copies of that work. Some of the notes on the interleaves are merely minor changes in explanation. Others amount to considerable extension of method in his mathematical approach to logic. In particular, he developed his technique in solving simultaneous elective equations and handling hypotheticals and elective functions. These notes and extensions provided a source for his later book Laws of thought(1854).

Depuis une quinzaine d'années, on assiste à l'émergence en France d'un modèle de débat public relativement original. Son institutionnalisation progressive, par la création de la Commission nationale du débat public, correspond à la volonté d'intégrer des acteurs différents autour d'une discussion au plus près des instances d'exécution de la politique publique. Elle est révélatrice d'une tension entre deux modes de conception de la communication en politique, l'une délibérative et l'autre instrumentale. Ainsi, bien que la création de la CNDP corresponde incontestablement (...) à un élargissement de la palette des modalités d'expression démocratique et contribue à la diffusion d'une « culture du débat » en France, il reste que son ancrage dans le processus décisionnel reste problématique et encore contesté par de nombreux élus.Past fifteen years have seen the emergence in France of a model of public debate relatively original. Its progressive institutionalization by creating the National Commission for public debate is the desire to integrate different actors around a closer discussion of the enforcement of public policy. It reveals a tension between two modes of communication design in politics, one deliberative and the other instrumental. Thus, although the creation of the CNDP undoubtedly corresponds to a broadening of the range of conditions for democratic expression and contributes to the spread of a "culture of debate" in France, the fact remains that its anchoring in the decision-making process remains problematic and still contested by many elected officials. (shrink)

Profinite groups are Galois groups. The effective study of infinite Galois groups was initiated by Metakides and Nerode [8] and further developed by LaRoche [5]. In this paper we study profinite groups without considering Galois extensions of fields. The Artin method of representing a finite group as a Galois group has been generalized by Waterhouse [14] to profinite groups. Thus, there is no loss of relevance in our approach.The fundamental notions of a co-r.e. profinite group, recursively profinite group, and the (...) degree of a co-r.e. profinite group are defined in §1. In this section we prove that every co-r.e. profinite group can be effectively represented as an inverse limit of finite groups. The degree invariant is shown to behave very well with respect to open subgroups and quotients. The work done in this section is basic to the rest of the paper.The commutator subgroup, the Frattini subgroup, thep-Sylow subgroups, and the center of a profinite group are essential in the study of profinite groups. It is only natural to ask if these subgroups are effective. The following question exemplifies our approach to this problem: Is the center a co-r.e. profinite group? Theorem 2 provides a general method for answering this type of question negatively. Examples 3,4 and 5 are all applications of this theorem. (shrink)

In each of Parts 1A, IB and II of the Philosophy Tripos, there is an Essay paper in which you are asked to write for three hours on a single topic. In these notes I offer some suggestions about how to tackle this paper, and try to answer some Frequently Asked Questions. The notes are based (in the second half, very closely indeed) on notes written by Jane Heal -- I'm very grateful to her for allowing me to snaffle some (...) of her best suggestions, though she is not responsible for the final result. Do note, though, that the result is still just one view ... Consult other supervisors/directors of studies for additional advice. (shrink)

Our massive tampering with the world's interdependent web of life-coupled with the environmental damage inflicted by deforestation, species loss, and climate change-could trigger widespread adverse effects, including unpredictable collapses of critical biological systems whose interactions and dynamics we only imperfectly understand. Uncertainty over the extent of these effects cannot excuse complacency or delay in facing the threats ... We the undersigned, senior members of the world's scientific community, hereby warn all humanity of what lies ahead. A great change in our (...) stewardship of the earth and the life on it is required, if vast human misery is to be avoided and our global home on this planet is not to be irretrievably mutilated. (Union of Concerned Scientists, 1992). (shrink)