In the target article, “Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose,” Kenneth D. Marshall and collaborators (2024) highlight important complexities in the care...

Background: Moral courage is required at all levels of nursing. However, there is a need for development of instruments to measure nurses’ moral courage. Objectives: The objective of this study is to develop a scale to measure nurses’ self-assessed moral courage, to evaluate the scale’s psychometric properties, and to briefly describe the current level of nurses’ self-assessed moral courage and associated socio-demographic factors. Research design: In this methodological study, non-experimental, cross-sectional exploratory design was applied. The data were collected using Nurses’ (...) Moral Courage Scale and analysed statistically. Participants and research context: The data were collected from a convenience sample of 482 nurses from four different clinical fields in a major university hospital in Finland for the final testing of the scale. The pilot comprised a convenience sample of 129 nurses. Ethical considerations: The study followed good scientific inquiry guidelines. Ethical approval was obtained from the university ethics committee and permission to conduct the study from the participating hospital. Findings: Psychometric evaluation showed that the 4-sub-scale, 21-item Nurses’ Moral Courage Scale demonstrates good reliability and validity at its current state of development showing a good level of internal consistency for a new scale, the internal consistency values ranging from 0.73 to 0.82 for sub-scales and 0.93 for the total scale, thus well exceeding the recommended Cronbach’s alpha value of >0.7. Principal component analysis and confirmatory factor analysis supported the theoretical construct of Nurses’ Moral Courage Scale. Face validity and expert panel assessments markedly contributed to the relevance of items in establishing content validity. Discussion and conclusion: Nurses’ Moral Courage Scale provides a new generic instrument intended for measuring nurses’ self-assessed moral courage. Recognizing the importance of moral courage as a part of nurses’ moral competence and its assessment offers possibilities to develop interventions and educational programs for enhancement of moral courage. Research should focus on further validation measures of Nurses’ Moral Courage Scale in international contexts. (shrink)

Professional codes of ethics are regarded as elements of nurses' ethical knowledge base and consequently part of their ethics education. However, research focusing on these codes from an educational viewpoint is scarce. This study explored the need and applicability of nursing codes of ethics in modern health care, their importance in the nursing ethics curriculum, and the need for development of their teaching. A total of 183 Finnish nurse educators and 212 nursing students answered three structured questions, with an opportunity (...) to justify their responses, and one open-ended question. Descriptive statistics and content analysis were used to analyse the data. The results suggest that the existence of the codes was seen as important and their applicability mainly as appropriate, despite new challenges posed by modern health care. The codes were regarded as an important part of nurses' ethics education, but current integrated teaching methods require development. (shrink)

Empathy is a form of emotionally charged imaginative perspective‐taking. It is also the unique source of a particular form of understanding, which I will call humane understanding. Humane understanding consists in the direct apprehension of the intelligibility of others’ emotions. This apprehension is an epistemic good whose ethical significance is multifarious. In this paper, I focus on elaborating the sense in which humane understanding of others is non‐instrumentally valuable to its recipients. People have a complex but profound need to be (...) humanely understood. Because we respond to others’ very real need when we pursue this sort of understanding of their emotions, empathy is best understood as itself a way of caring, rather than just a means to promote other caring behavior. (shrink)

Background: Nursing as an ethical practice requires courage to be moral, taking tough stands for what is right, and living by one’s moral values. Nurses need moral courage in all areas and at all levels of nursing. Along with new interest in virtue ethics in healthcare, interest in moral courage as a virtue and a valued element of human morality has increased. Nevertheless, what the concept of moral courage means in nursing contexts remains ambiguous. Objective: This article is an analysis (...) of the concept of moral courage in nursing. Design: Rodgers’ evolutionary method of concept analysis provided the framework to conduct the analysis. Data sources: The literature search was carried out in September 2015 in six databases: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and The Philosopher’s Index. The following key words were used: “moral” OR “ethical” AND “courage” OR “strength” AND “nurs*” with no time limit. After applying inclusion and exclusion criteria, 31 studies were included in the final analysis. Ethical considerations: This study was conducted according to good scientific guidelines. Results: Seven core attributes of moral courage were identified: true presence, moral integrity, responsibility, honesty, advocacy, commitment and perseverance, and personal risk. Antecedents were ethical sensitivity, conscience, and experience. Consequences included personal and professional development and empowerment. Discussion and conclusion: This preliminary clarification warrants further exploring through theoretical and philosophical literature, expert opinions, and empirical research to gain validity and reliability for its application in nursing practice. (shrink)

Controlled Human Infection Model (CHIM) research involves the infection of otherwise healthy participants with disease often for the sake of vaccine development. The COVID-19 pandemic has emphasised the urgency of enhancing CHIM research capability and the importance of having clear ethical guidance for their conduct. The payment of CHIM participants is a controversial issue involving stakeholders across ethics, medicine and policymaking with allegations circulating suggesting exploitation, coercion and other violations of ethical principles. There are multiple approaches to payment: reimbursement, wage (...) payment and unlimited payment. We introduce a new Payment for Risk Model, which involves paying for time, pain and inconvenience and for risk associated with participation. We give philosophical arguments based on utility, fairness and avoidance of exploitation to support this. We also examine a cross-section of the UK public and CHIM experts. We found that CHIM participants are currently paid variable amounts. A representative sample of the UK public believes CHIM participants should be paid approximately triple the UK minimum wage and should be paid for the risk they endure throughout participation. CHIM experts believe CHIM participants should be paid more than double the UK minimum wage but are divided on the payment for risk. The Payment for Risk Model allows risk and pain to be accounted for in payment and could be used to determine ethically justifiable payment for CHIM participants.Although many research guidelines warn against paying large amounts or paying for risk, our empirical findings provide empirical support to the growing number of ethical arguments challenging this status quo. We close by suggesting two ways (value of statistical life or consistency with risk in other employment) by which payment for risk could be calculated. (shrink)

This article takes the 2008–2010 financial crisis as a case study to explore the tension between responsibility and accountability in complex crises. I analyze the patterns of attribution and assumption of responsibility of thirty-three bankers in Wall Street, interviewed from fall 2008 to summer 2010. First, I show that responsibility for complex failures cannot be easily attributed or assumed: responsibility becomes diluted within the collective. Actors can only assume collective responsibility, recognizing that they belong to an institution at fault. Second, (...) I show that blaming is a social process that should be examined contextually, relationally, and dynamically. I build on sociological theories to depart from the normative focus of philosophers, and the cognitive focus of psychologists, who have dominated the study of responsibility so far. (shrink)

In this study, we explore the future of work by examining differences in productivity when teams are composed of only humans or both humans and machine agents. Our objective was to characterize the similarities and differences between human and human–machine teams as they work to coordinate across their specialized roles. This form of research is increasingly important given that machine agents are becoming commonplace in sociotechnical systems and playing a more active role in collaborative work. One particular class of machine (...) agents, bots, is being introduced to these systems to facilitate both taskwork and teamwork. We investigated the association between bots and productivity outcomes in open source software development through an analysis of hundreds of project teams. The presence of bots in teams was associated with higher levels of productivity and higher work centralization in addition to greater amounts of observed communication. The adoption of bots in software teams may have tradeoffs, in that doing so may increase productivity, but could also increase workload. We discuss the theoretical and practical implications of these findings for advancing human–machine teaming research. (shrink)

The reality-virtuality continuum encompasses a multitude of objects, events and environments ranging from real-world multisensory inputs to interactive multisensory virtual simulators, in which sensory integration can involve very different combinations of both physical and digital inputs. These different ways of stimulating the senses can affect the consumer’s consciousness, potentially altering their judgements and behaviours. In this perspective paper, we explore how technologies such as Augmented Reality and Virtual Reality can, by generating and modifying the human sensorium, act on consumer consciousness. (...) We discuss the potential impact of this altered consciousness for consumer behaviour while, at the same time, considering how it may pave the way for further research. (shrink)

In this essay Olivia Newman critically examines two opposing rights claims: the liberal claim that children have a right to become liberal choosers and the fundamentalist claim that children have a right to not become liberal choosers. These positions reflect differing views regarding the value of critically choosing, rather than simply accepting, a way of life. Given their assumptions regarding preference formation, both of these rights appear untenable in light of recent scholarship in psychology: we can neither select a (...) way of life independent of our social milieu, as liberals often imply, nor can we predict how different experiences will affect our preferences, as fundamentalists assume. Nevertheless, each position points to important concerns. Children have a substantive right of exit from constraining social milieus, as liberals purport, as well as a right to respect in public institutions, as fundamentalists insist. When liberals and fundamentalists assert these more modest rights claims, educators can and should strive to satisfy both. (shrink)

Although undergraduate engineering ethics courses often include the development of moral sensitivity as a learning objective and the use of active learning techniques, teaching centers on the transmission of cognitive knowledge. This article describes a complementary assignment asking students to perform an ethics “experiment” on themselves that has a potential to enhance affective learning and moral imagination. The article argues that the focus on cognitive learning may not promote, and may even impair, our efforts to foster moral sensitivity. In contrast, (...) the active learning assignments and exercises, like the ethics “experiment” discussed, offer great potential to expand the scope of instruction in engineering ethics to include ethical behavior as well as knowledge. Engineering ethics education needs to extend beyond the narrow range of human action associated with the technical work of the engineer and explore ways to draw on broader lifeworld experiences to enrich professional practice and identity. (shrink)

This study analysed teaching of nurses’ codes of ethics in basic nursing education in Finland. A total of 183 educators and 214 students responded to a structured questionnaire. The data was analysed by SPSS. Teaching of nurses’ codes was rather extensive. The nurse-patient relationship was highlighted. Educators assessed their teaching statistically significantly more extensive than what students’ perceptions were. The use of teaching and evaluation methods was conventional, but differences between the groups concerning the use of these methods were statistically (...) significant. Students’ knowledge of and their ability to apply the codes was mediocre. Most educators and students assessed educators’ knowledge of the codes as adequate for teaching. These educators also taught the codes more extensively and these students perceived the teaching as more extensive. Otherwise educators’ and students’ socio-demographic variables had little association with the teaching. Research should focus on the organization and effectiveness of ethics education, and on educators’ competence. (shrink)

This book analyses Hannah Arendt's conception of storytelling and endows it with relevance in historical and political thinking.

Our collective enthusiasm for empathy reflects a sense that it is deeply valuable. I show that empathy bears a complex and surprisingly problematic relation to another social epistemic phenomenon that we have reason to value, namely testimonial trust. My discussion focuses on empathy with and trust in people who are members of one or more oppressed groups. Empathy for oppressed people can be a powerful tool for engendering a certain form of testimonial trust, because there is a tight connection between (...) empathy and a approval of another's outlook. I then argue that the qualities of empathy that make it such a powerful tool for bridging differences and building trust also have a problematic upshot: they make it the case that reliance on empathy will sometimes have a distorting effect upon the ways we extend testimonial trust. (shrink)

We thank the authors of the five commentaries for their careful and highly constructive consideration of our paper,1 which has enabled us to develop our proposal. Participation in research has traditionally been viewed as altruistic. Over time, payments for inconvenience and lost wages have been allowed, as have small incentives, usually in kind. The problem, particularly with controlled human infection model (CHIM) research or ‘challenge studies’, is that they are unpleasant and time-consuming. Researchers want to offer carrots to incentivise participation (...) (as Fernandez Lynch and Largent suggest2). We are proposing that research participation be viewed as a job with the full suite of financial entitlements of fairly remunerated work, including payment for risk and labour law protections. This would be a significant shift from current practice and standards. Ambuehl, Ockenfels and Roth have grasped this basic point and have beautifully elaborated how a fair price could be arrived at using economic theory. They build on our proposal helpfully and suggest ‘(1) salary for time involvement that is adjusted to account for the amount of discomfort experienced during participation, (2) insurance against ex post adverse outcomes and (3) ex ante compensation for risks that cannot be compensated ex post (such as death).’3 This effectively addresses Fernandez Lynch and Largent’s2 concern (echoed by Jamrozik and Selgelid4) that compensation for risk is inappropriate for harms which do not eventuate. However, because death cannot be compensated for, there must be payment for risk of death, as Ambuehl, Ockenfels and Roth convincingly argue.3 Indeed, the three-part model suggested by Ambuehl, Ockenfels and Roth makes us realise that job model would be a better title for our model than a payment for risk model. The alternative to a properly remunerated job model is the original altruistic model. However, this …. (shrink)

A considerable body of evidence now documents, beyond reasonable doubt, biological and health risk factors for crime and violence. Nevertheless, intervention and prevention efforts with offenders have avoided biological interventions, in part due to past misuses of biological research and the challenges that biological predispositions to crime raise. This article reviews the empirical literature on two biological intervention approaches, omega-3 supplementation and transcranial direct current stimulation. Emerging research on these relatively benign interventions suggests that increased omega-3 intake through dietary intervention (...) and prefrontal upregulation using non-invasive brain stimulation may show some initial promise in reducing antisocial behavior. The ethical issues related to mandated and offered biological interventions within the criminal justice system are discussed. (shrink)

The aim of this article is to revisit public happiness as Arendt develops it explicitly in On Revolution—and implicitly elsewhere throughout her oeuvre—in order to philosophically evaluate its ability to beget a political-theoretical framework able to relate politics to an “affective realignment,” alternative to the hegemonic paradigms of “againstness” and “resistance.” I will analyze the Arendtian theoretical framework regarding action, freedom, and happiness in its relation to the thinker’s political ontology, testing its ability to restore for us a political imaginary (...) that is generative and affirmative. Can Arendt can help us understand the political momentum of the present and by so doing help us reassess the political, freeing it from the depoliticized quagmire of these overtly neoliberal times? (shrink)

Are there limits to what it is morally okay to imagine? More particularly, is imaginatively inhabiting morally suspect perspectives something that is off-limits for truly virtuous people? In this paper, I investigate the surprisingly fraught relation between virtue and a familiar form of imaginative perspective taking I call empathy. I draw out a puzzle about the relation between empathy and virtuousness. First, I present an argument to the effect that empathy with vicious attitudes is not, in fact, something that the (...) fully virtuous person can indulge in. At least one prominent way of thinking about the psychology of the virtuous person excludes the possibility that the virtuous could emotionally apprehend the world in a less than virtuous way, and empathizing with vicious outlooks does seem to run afoul of that restriction. Then, I develop an argument that runs in the contrary direction: virtue in fact requires empathy with vicious outlooks, at least in some situations. There is reason to think that a crucial part of being virtuous is ministering effectively to others’ needs, and there is also reason to think that other people may need to be empathized with, even if their emotional outlooks are at least minorly vicious. Finally, I outline two different solutions to this puzzle. Both solutions hold some promise, but they also bring new challenges in their train. (shrink)

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube (...) feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care. (shrink)

A sensibility is, on a rough first pass, an emotional orientation to the world. It shapes how things appear to us, evaluatively speaking. By transfiguring things’ evaluative appearances, a change in sensibility can profoundly alter one’s overall experience of the world. I argue that some forms of sensibility change entail (1) risking one’s knowledge of what experiences imbued with one’s prior sensibility were like, and (2) surrendering one’s grasp on the intelligibility of one’s prior emotional apprehensions. These costs have consequences (...) for Laurie Paul’s ‘problem of transformative experience.’ Paul has argued that when we are poised to become someone new, our inexperience generates problems for authentic choice about our own futures. By reckoning with the epistemic losses involved in sensibility change, I show that this problem must not be confined to novel transformations. Prior experience does not guarantee the knowledge or understanding necessary for choosing authentically (in Paul’s sense). If the problem Paul highlights is indeed a problem _at all,_ then, it is a still more pervasive and intractable one than it has been taken to be. (shrink)

This is a creative-commons licensed guide. Its purpose is to provide students with an understanding of some ways in which they might contribute to philosophical conversation. It is also available for free use via my website.

Étudier les actes de requête dans les discours prononcés aux Nations Unies s’avère d’une utilité certaine dans le travail de caractérisation de ce sous-genre diplomatique. La formulation indirecte des actes de langage et les procédés linguistiques qui éloignent les sources potentielles de confrontation révèle des discours contraints par l’exercice de la « politesse », au service de l’impératif institutionnel de valorisation du consensus. Ces discours qui s’éloignent du fonctionnement du langage ordinaire transfèrent la prise en charge de l’énonciation aux États-membres (...) qui sont ici de véritables locuteurs et qui partant parlent en leur propre nom. L’on observe alors l’impact d’un contexte socio-discursif sur le fonctionnement de langue. Les requêtes formulées dans ces discours reflètent les problématiques qui préoccupent les États membres, puisque dans bien des cas, une requête peut être l’aveu d’un manque. Les verbes illocutoires donnent un bon aperçu des « façons de parler » et témoignent d’ores-et-déjà d’une routinisation des pratiques langagières. (shrink)

A causal-comparative, mixed methods design was used to study a partnership between a university and school district formed with the goal of improving history teachers’ United States history content knowledge to raise student engagement and achievement. Data were collected from middle and high school history teachers including teacher interviews, classroom observations, and student work. Student engagement surveys and academic performance data were also collected. Student academic performance was positively impacted and changes in classroom practice were found in the treatment group. (...) However, differences in student engagement between groups were not found to be statistically significant. (shrink)

This essay addresses the new phenomenon of network warfare as a realisation of modernity's inner potential and surprising capacities rather than its failure. A feature of the complex capillaries of global governance, network warfare has been endemic for some time in many border regions of the world and reflects an increasing conflation of development and security.

Background: Spasticity following a stroke occurs in about 30% of patients. The mechanisms underlying this disorder, however, are not well understood. Method: This review aims to define spasticity, describe hypotheses explaining its development after a stroke, give an overview of related neuroimaging studies as well as a description of the most common scales used to quantify the degree of spasticity and finally explore which treatments are currently being used to treat this disorder.

My paper focuses on the pursuit of philosophical self-perfection. The starting point of my reflections is my experience with contemporary philosophy. Mainstream contemporary phi-losophy counsels the rational capacities of arguing and reasoning without affecting the philo-sopher′s ethical stance. I argue that this failure is due to the presuppositions made by contem-porary philosophical rationality: the agnostic belief in humankind as source of all existing sense. This agnosticism blinds one to a teleologically defined horizon of truth which is essen-tial for the philosophical (...) streaming for self-perfection. In order to regain the possibility of philosophical self-perfection I am looking for a reversion in faith. I find help in Pascal′s theory of liturgy. At the end of my proposal I try to show how a teleological horizon of truth in the Christian tradition enables philosophical self-perfection which has been abandoned by the agnostic contemporary philosophy. (shrink)

In Wittgenstein on Rules and Private Language, Saul Kripke articulates a form of scepticism about meaning. Even though there is considerable disagreement among critics about the reasoning in which the sceptic engages, there is little doubt that he seeks to offer constraints for an adequate account of the facts that constitute the meaningfulness of expressions. Many of the sceptic's remarks concern the nature of the guidance involved in a speaker's meaningful uses of expressions. I propose that we understand those remarks (...) as seeking to give shape to the idea that to use an expression under the guidance of one's understanding is to have a reason for that use, which one's understanding allows one to discern and act on. Any philosophical elucidation of meaning must adequately capture the rational nature of our linguistic acts. (shrink)

In this introductory essay, I articulate a puzzle that is central for our understanding of ourselves as minded beings bound to live finite lives. I argue that our finitude is not something that can be set aside for the purposes of the philosophical inquiry into the mind. Grappling with it is an essential component of this inquiry.

When categories of actors are discredited, epistemic inequalities produce testimonial or hermeneutic injustices. These injustices manifest themselves in the absence of recognition of the knowledge of others and in the fact that their ability to understand is called into question. Moreover, although they are subjected to exogenous norms in which they do not find themselves, the people subjected to these injustices find it difficult to assert this and to identify their own norms. These two types of injustice alter the quality (...) of care relationships, particularly in terms of relational ethics, by eroding the trust between caregivers and patients. In order to counteract these, a pedagogical experiment based on democratic and epistemic logics was proposed to health students. This experiment has three pillars: teaching on the partnership between health professionals and patients, patients as teachers or mentors and patients as colleagues. These three pillars are presented as interrelated, one not going without the other. On the democratic level, the aim is to rebalance the power relationships. Thus, it is patients who recruit patients and the latter have a status. At the epistemic level, the aim is to rebalance knowledge relationships, which involves questioning knowledge and standards in terms of their consequences on patients, or more precisely on the “patient experience”. Two different and complementary pedagogical programs have been implemented to create a pedagogical experience within a medical faculty (Sorbonne Paris Nord University) located in the city of Bobigny, which is now called the “Bobigny experience”. The aim of the first is to use the “patient perspective” to resolve clinical situations, while the second is to use narrative medicine to combine the experiences of students and patients on specific topics. (shrink)