For this second edition, the editors have returned to Austin's original lecture notes, amending the printed text where it seemed necessary.

This book is the one to put into the hands of those who have been over-impressed by Austin 's critics....[Warnock's] brilliant editing puts everybody who is concerned with philosophical problems in his debt.

The subject of this paper, Excuses, is one not to be treated, but only to be introduced, within such limits. It is, or might be, the name of a whole branch, even a ramiculated branch, of philosophy, or at least of one fashion of philosophy. I shall try, therefore, first to state what the subject is, why it is worth studying, and how it may be studied, all this at a regrettably lofty level: and then I shall illustrate, in more (...) congenial but desultory detail, some of the methods to be used, together with their limitations, and some of the unexpected results to be expected and lessons to be learned. Much, of course, of the amusement, and of the instruction, comes in drawing the coverts of the microglot, in hounding down the minutiae, and to this I can do no more here than incite you. But I owe it to the subject to say, that it has long afforded me what philosophy is so often thought, and made, barren of -- the fun of discovery, the pleasures of co-operation, and the satisfaction of reaching agreement. (shrink)

The book uses Zen Buddhism as the opening wedge for an extraordinarily wide-ranging exploration of consciousness.

John Austin's classic work that has had a profound influence on the study of English and American law presents Austin's distinction between "positive law" (i.e.

As there is currently a neo-Aristotelian revival currently taking place within contemporary metaphysics and dispositions, or causal powers are now being routinely utilised in theories of causality and modality, more attention is beginning to be paid to a central Aristotelian concern: the metaphysics of substantial unity, and the doctrine of hylomorphism. In this paper, I distinguish two strands of hylomorphism present in the contemporary literature and argue that not only does each engender unique conceptual difficulties, but neither adequately captures the (...) metaphysics of Aristotelian hylomorphism. Thus both strands of contemporary hylomorphism, I argue, fundamentally misunderstand what substantial unity amounts to in the hylomorphic framework – namely, the metaphysical inseparability of matter and form. (shrink)

‘Unfair to Facts’ is a follow-up on Ch. 5, addressing objections Peter Strawson raised against Austin’s view of truth as a description of the conditions that must be satisfied if we are to say of a statement that it is true. Austin addresses the objection that his description of these conditions is due to a misunderstanding about the use of ‘fact’, arguing, against Strawson, that facts are not pseudo-entities and that the notion of ‘fitting the facts’ is not a useless (...) notion. (shrink)

Though the realm of biology has long been under the philosophical rule of the mechanistic magisterium, recent years have seen a surprisingly steady rise in the usurping prowess of process ontology. According to its proponents, theoretical advances in the contemporary science of evo-devo have afforded that ontology a particularly powerful claim to the throne: in that increasingly empirically confirmed discipline, emergently autonomous, higher-order entities are the reigning explanantia. If we are to accept the election of evo-devo as our best conceptualisation (...) of the biological realm with metaphysical rigour, must we depose our mechanistic ontology for failing to properly “carve at the joints” of organisms? In this paper, I challenge the legitimacy of that claim: not only can the theoretical benefits offered by a process ontology be had without it, they cannot be sufficiently grounded without the metaphysical underpinning of the very mechanisms which processes purport to replace. The biological realm, I argue, remains one best understood as under the governance of mechanistic principles. (shrink)

Once a term used primarily by moral philosophers, “moral distress” is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? “Plight” encompasses not (...) only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of “efficiency,” is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals’ moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim. (shrink)

_The Foundations of Arithmetic_ is undoubtedly the best introduction to Frege's thought; it is here that Frege expounds the central notions of his philosophy, subjecting the views of his predecessors and contemporaries to devastating analysis. The book represents the first philosophically sound discussion of the concept of number in Western civilization. It profoundly influenced developments in the philosophy of mathematics and in general ontology.

The advent of contemporary evolutionary theory ushered in the eventual decline of Aristotelian Essentialism (Æ) – for it is widely assumed that essence does not, and cannot have any proper place in the age of evolution. This paper argues that this assumption is a mistake: if Æ can be suitably evolved, it need not face extinction. In it, I claim that if that theory’s fundamental ontology consists of dispositional properties, and if its characteristic metaphysical machinery is interpreted within the framework (...) of contemporary evolutionary developmental biology, an evolved essentialism is available. The reformulated theory of Æ offered in this paper not only fails to fall prey to the typical collection of criticisms, but is also independently both theoretically and empirically plausible. The paper contends that, properly understood, essence belongs in the age of evolution. (shrink)

Unable to answer the call of our patients: mental health nurses’ experience of moral distress When health practitioners’ moral choices and actions are thwarted by constraints, they may respond with feelings of moral distress. In a Canadian hermeneutic phenomenological study, physicians, nurses, psychologists and non‐professional aides were asked to identify care situations that they found morally distressing, and to elaborate on how moral concerns regarding the care of patients were raised and resolved. In this paper, we describe the experience of (...) moral distress related by nurses working in mental healthcare settings who believed that lack of resources (such as time and staff) leads to dispiritedness, lack of respect, and absence of recognition (for both patients and staff) which severely diminished their ability to provide quality care. The metaphors of flashlight and hammer are used to elaborate nurses’ possible responses to intolerable situations. (shrink)

Although they are continually compositionally reconstituted and reconfigured, organisms nonetheless persist as ontologically unified beings over time – but in virtue of what? A common answer is: in virtue of their continued possession of the capacity for morphological invariance which persists through, and in spite of, their mereological alteration. While we acknowledge that organisms‟ capacity for the “stability of form” – homeostasis - is an important aspect of their diachronic unity, we argue that this capacity is derived from, and grounded (...) in a more primitive one – namely, the homeodynamic capacity for the “specified variation of form”. In introducing a novel type of causal power – a „structural power‟ – we claim that it is the persistence of their dynamic potential to produce a specified series of structurally adaptive morphologies which grounds organisms‟ privileged status as metaphysically “one over many” over time. (shrink)

According to contemporary ‘process ontology’, organisms are best conceptualised as spatio-temporally extended entities whose mereological composition is fundamentally contingent and whose essence consists in changeability. In contrast to the Aristotelian precepts of classical ‘substance ontology’, from the four-dimensional perspective of this framework, the identity of an organism is grounded not in certain collections of privileged properties, or features which it could not fail to possess, but in the succession of diachronic relations by which it persists, or ‘perdures’ as one entity (...) over time. In this paper, I offer a novel defence of substance ontology by arguing that the coherency and plausibility of the radical reconceptualisation of organisms proffered by process ontology ultimately depends upon its making use of the ‘substantial’ principles it purports to replace. (shrink)

The word utiliarianism was coined by Jeremy Bentham in 1781 in a letter to friend in which he said: "A new religion would be an odd sort of thing without a name." While the doctrine never quite became a religion, its thesis, as expressed by Mill in the first essay in this volume-that the good and right are to be defined as that which promotes happiness-became the dominant naturalistic theory of the nineteenth century and provided the moral basis for classical (...) liberalism. (shrink)

Evolutionary developmental biology represents a paradigm shift in the understanding of the ontogenesis and evolutionary progression of the denizens of the natural world. Given the empirical successes of the evo-devo framework, and its now widespread acceptance, a timely and important task for the philosophy of biology is to critically discern the ontological commitments of that framework and assess whether and to what extent our current metaphysical models are able to accommodate them. In this paper, I argue that one particular model (...) is a natural fit: an ontology of dispositional properties coherently and adequately captures the crucial casual-cum-explanatory role that the fundamental elements of evo-devo play within that framework. (shrink)

Although contemporary metaphysics has recently undergone a neo-Aristotelian revival wherein dispositions, or capacities are now commonplace in empirically grounded ontologies, being routinely utilised in theories of causality and modality, a central Aristotelian concept has yet to be given serious attention – the doctrine of hylomorphism. The reason for this is clear: while the Aristotelian ontological distinction between actuality and potentiality has proven to be a fruitful conceptual framework with which to model the operation of the natural world, the distinction between (...) form and matter has yet to similarly earn its keep. In this chapter, I offer a first step toward showing that the hylomorphic framework is up to that task. To do so, I return to the birthplace of that doctrine - the biological realm. Utilising recent advances in developmental biology, I argue that the hylomorphic framework is an empirically adequate and conceptually rich explanatory schema with which to model the nature of organisms. (shrink)

Austin takes on the problem of other minds, of how to respond to the question ‘how do you know?’, if this question is raised with regard to the thoughts, feelings, sensations, minds of other creatures. This problem has traditionally been understood as the problem of justifying our belief in the existence of other minds. Austin argues that believing in other persons, in authority and testimony, is an essential part of the act of communicating, and as such is an irreducible part (...) of our experience. While we can state certain advantages of communicative performances, there is no justification for our doing them as such. (shrink)

Provides a philosophical analysis of the numerous and distinct conceptions of parenthood. This work considers such issues as the nature and justification of parental rights, the sources of parental obligations, the value of autonomy, and the moral obligations and tensions present within interpersonal relationships.

A number of Artificial Intelligence (AI) ethics frameworks have been published in the last 6 years in response to the growing concerns posed by the adoption of AI in different sectors, including healthcare. While there is a strong culture of medical ethics in healthcare applications, AI-based Healthcare Applications (AIHA) are challenging the existing ethics and regulatory frameworks. This scoping review explores how ethics frameworks have been implemented in AIHA, how these implementations have been evaluated and whether they have been successful. (...) AI specific ethics frameworks in healthcare appear to have a limited adoption and they are mostly used in conjunction with other ethics frameworks. The operationalisation of ethics frameworks is a complex endeavour with challenges at different levels: ethics principles, design, technology, organisational, and regulatory. Strategies identified in this review are proactive, contextual, technological, checklist, organisational and/or evidence-based approaches. While interdisciplinary approaches show promises, how an ethics framework is implemented in an AI-based Healthcare Application is not widely reported, and there is a need for transparency for trustworthy AI. (shrink)

This sequel to the widely read Zen and the Brain continues James Austin's explorations into the key interrelationships between Zen Buddhism and brain research. In Zen-Brain Reflections, Austin, a clinical neurologist, researcher, and Zen practitioner, examines the evolving psychological processes and brain changes associated with the path of long-range meditative training. Austin draws not only on the latest neuroscience research and new neuroimaging studies but also on Zen literature and his personal experience with alternate states of consciousness.Zen-Brain Reflections takes up (...) where the earlier book left off. It addresses such questions as: how do placebos and acupuncture change the brain? Can neuroimaging studies localize the sites where our notions of self arise? How can the latest brain imaging methods monitor meditators more effectively? How do long years of meditative training plus brief enlightened states produce pivotal transformations in the physiology of the brain? In many chapters testable hypotheses suggest ways to correlate normal brain functions and meditative training with the phenomena of extraordinary states of consciousness.After briefly introducing the topic of Zen and describing recent research into meditation, Austin reviews the latest studies on the amygdala, frontotemporal interactions, and paralimbic extensions of the limbic system. He then explores different states of consciousness, both the early superficial absorptions and the later, major "peak experiences." This discussion begins with the states called kensho and satori and includes a fresh analysis of their several different expressions of "oneness." He points beyond the still more advanced states toward that rare ongoing stage of enlightenment that is manifest as "sage wisdom."Finally, with reference to a delayed "moonlight" phase of kensho, Austin envisions novel links between migraines and metaphors, moonlight and mysticism. The Zen perspective on the self and consciousness is an ancient one. Readers will discover how relevant Zen is to the neurosciences, and how each field can illuminate the other. (shrink)

This article reports the findings of a qualitative study that explored the organizational influences on moral distress for health professionals working in pediatric intensive care units across Canada. Participants were recruited to the study from PICUs across Canada. The PICU is a high-tech, fast-paced, high-pressure environment where caregivers frequently face conflict and ethical tension in the care of critically ill children. A number of themes including relationships with management, organizational structure and processes, workload and resources, and team dynamics were identified. (...) This study provides a rare and important multi-disciplinary perspective on this topic and the findings have implications for administrators and leaders who seek to improve the moral climate of healthcare delivery. (shrink)

This book offers a novel defence of a highly contested philosophical position: biological natural kind essentialism. This theory is routinely and explicitly rejected for its purported inability to be explicated in the context of contemporary biological science, and its supposed incompatibility with the process and progress of evolution by natural selection. Christopher J. Austin challenges these objections, and in conjunction with contemporary scientific advancements within the field of evolutionary-developmental biology, the book utilises a contemporary neo-Aristotelian metaphysics of "dispositional properties", or (...) causal powers, to provide a theory of essentialism centred on the developmental architecture of organisms and its role in the evolutionary process. By defending a novel theory of Aristotelian biological natural kind essentialism, Essence in the Age of Evolution represents the fresh and exciting union of cutting-edge philosophical insight and scientific knowledge. (shrink)

In recent literature in the philosophy of mind and language, one finds a variety of examples that raise serious problems for the traditional analysis of belief as a two-term relation between a believer and a proposition. My main purpose in this essay is to provide a critical test case for any theory of the propositional attitudes, and to demonstrate that this case really does present an unsolved puzzle. Chapter I defines the traditional, propositional analysis of belief, and then introduces a (...) distinction, motivated by the intuitions that underlie Kripke's arguments for direct reference, between purely qualitative and individual propositions. Beliefs typically expressed using proper names, indexicals or demonstratives appear to relate the believer to individual propositions with the entity that may be referred to as subject constituent. Chapter II presents the critical test case . In this and Chapters III-VI it is used to show that the latter sorts of beliefs are not analyzable as dyadically relating the believer to individual propositions. The case constitutes a genuine counterexample to the traditional analysis only if it is possible for a believer to believe an individual proposition with a contingent thing other than herself as a constituent; and the believer in the case is in optimum conditions for believing an individual proposition. In Chapters III, IV, and VI, I criticize views prompted by rejection of , and in Chapter V, I criticize Stalnaker's view, which rejects . Chapter VI also considers the non-traditional, triadic analyses of belief proposed by Kaplan and Richard; they fall prey to the main criticisms of Chapter V. In the Postscript, I give a comparative assessment of approaches to resolving the Two Tubes Puzzle, and I place it in historical context by pointing out the puzzle's similarities to the 'problem of sense data' . Correlatively, I indicate the bearing of Methodological Solipsism on future attempts to solve the puzzle. My conclusion is that although the puzzle remains a puzzle, it gives us reason to supplement, rather than completely abandon, the use of propositions in the analysis of thought; and I say what a supplementing solution must do to remain faithful to the intuitions of Chapter I. (shrink)

Dispositional properties are often referred to as ‘causal powers’, but what does dispositional causation amount to? Any viable theory must account for two fundamental aspects of the metaphysics of causation – the causal complexity and context sensitivity of causal interactions. The theory of mutual manifestations attempts to do so by locating the complexity and context sensitivity within the nature of dispositions themselves. But is this theory an acceptable first step towards a viable theory of dispositional causation? This paper argues that (...) the reconceptualization that the theory entails comes at too high a price, and is an unnecessary step in the wrong direction: these two central aspects concerning the metaphysics of causation can and should be accounted for in a dispositional account of causation without it. (shrink)

Corporate and commercial values are inducing some healthcare organizations to prescribe a customer service model that reframes the provision of nursing care. In this paper it is argued that such a model is incommensurable with nursing conceived as a moral practice and ultimately places nurses at risk. Based upon understanding from ongoing research on compassion fatigue, it is proposed that compassion fatigue as currently experienced by nurses may not arise predominantly from too great a demand for compassion, but rather from (...) barriers to enacting compassionate care. These barriers are often systemic. The paradigm shift in which healthcare environments are viewed as marketplaces rather than moral communities has the potential to radically affect the evolution of nursing as a discipline. (shrink)

The purpose of this study was to examine individual and organizational antecedents and consequences of safety-related moral disengagement. Using Conservation of Resources theory, social exchange theory, and psychological contract breach as a theoretical foundation, this study tested the proposition that higher job insecurity is associated with greater levels of subsequent safety-related moral disengagement, which in turn is related to reduced safety performance. Moreover, we examined whether perceived organizational and supervisor support buffered or intensified the impact of job insecurity on moral (...) disengagement. Using a two-wave lagged design, anonymous survey data collected from N = 389 working adults in the U.S. supported the hypothesized moderated mediation model. Specifically, the conditional indirect effects of job insecurity on safety performance via moral disengagement were intensified as levels of perceived organizational and supervisor support increased. These results suggest that the threat of job insecurity may prompt employee moral disengagement; this effect is even stronger among employees who perceived higher levels of organizational and supervisor support. We interpret these counterintuitive findings in light of increasingly insecure contemporary work arrangements and how these may give rise to potentially unethical safety-related decision making and behavior. (shrink)

People with mental illness are subjected to stigma and discrimination and constantly face restrictions in the exercise of their political, civil and social rights. Considering this scenario, mental health, ethics and human rights are key approaches to advance the well-being of persons with mental illnesses. The study was conducted to review the scope of the empirical literature available to answer the research question: What evidence is available regarding human rights and ethical issues regarding nursing care to persons with mental illnesses? (...) A scoping review methodology guided by Arksey and O’Malley was used. Studies were identified by conducting electronic searches on CINAHL, PubMed, SCOPUS and Hein databases. Of 312 citations, 26 articles matched the inclusion criteria. The central theme which emerged from the literature was “Ethics and Human Rights Boundaries to Mental Health Nursing practice”. Mental health nurses play a key and valuable role in ensuring that their interventions are based on ethical and human rights principles. Mental health nurses seem to have difficulty engaging with the ethical issues in mental health, and generally are dealing with acts of paternalism and with the common justification for those acts. It is important to open a debate regarding possible solutions for this ethical dilemma, with the purpose to enable nurses to function in a way that is morally acceptable to the profession, patients and members of the public. This review may serve as an instrument for healthcare professionals, especially nurses, to reflect about how to fulfil their ethical responsibilities towards persons with mental illnesses, protecting them from discrimination and safeguarding their human rights, respecting their autonomy, and as a value, keeping the individual at the centre of ethical discourse. (shrink)

According to the proponents of Developmental Systems Theory and the Causal Parity Thesis, the privileging of the genome as “first among equals” with respect to the development of phenotypic traits is more a reflection of our own heuristic prejudice than of ontology - the underlying causal structures responsible for that specified development no more single out the genome as primary than they do other broadly “environmental” factors. Parting with the methodology of the popular responses to the Thesis, this paper offers (...) a novel criterion for ‘causal primacy’, one that is grounded in the ontology of the unique causal role of dispositional properties. This paper argues that, if the genome is conceptualised as realising dispositional properties that are “directed toward” phenotypic traits, the parity of ‘causal roles’ between genetic and extra-genetic factors is no longer apparent, and further, that the causal primacy of the genome is both plausible and defensible. (shrink)

The moral distress of psychologists working in psychiatric and mental health care settings was explored in an interdisciplinary, hermeneutic phenomenological study situated at the University of Alberta, Canada. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychologists described specific incidents in which they felt their integrity had been compromised by such factors as institutional and interinstitutional demands, team conflicts, and interdisciplinary disputes. They described dealing with the resulting moral distress by such means as (...) silence, taking a stance, acting secretively, sustaining themselves through work with clients, seeking support from colleagues, and exiting. Recognizing moral distress can lead to a significant shift in the way we perceive moral choices and understand the moral context of practice. (shrink)

When nurses have active and untreated addictions, patient safety may be compromised and nurse-health endangered. Genuine responses are required to fulfil nurses' moral obligations to their patients as well as to their nurse-colleagues. Guided by core elements of relational ethics, the influences of nursing organizational responses along with the practice environment in shaping the situation are contemplated. This approach identifies the importance of consistency with nursing values, acknowledges nurses interdependence, and addresses the role of nursing organization as moral agent. By (...) examining the relational space, the tension between what appears to be opposing moral responsibilities may be healed. Ongoing discourse to identify authentic actions for the professional practice issue of nursing under the influence is called upon. (shrink)

This sequel to the widely read Zen and the Brain continues James Austin's explorations into the key interrelationships between Zen Buddhism and brain research. In Zen-Brain Reflections, Austin, a clinical neurologist, researcher, and Zen practitioner, examines the evolving psychological processes and brain changes associated with the path of long-range meditative training. Austin draws not only on the latest neuroscience research and new neuroimaging studies but also on Zen literature and his personal experience with alternate states of consciousness.Zen-Brain Reflections takes up (...) where the earlier book left off. It addresses such questions as: how do placebos and acupuncture change the brain? Can neuroimaging studies localize the sites where our notions of self arise? How can the latest brain imaging methods monitor meditators more effectively? How do long years of meditative training plus brief enlightened states produce pivotal transformations in the physiology of the brain? In many chapters testable hypotheses suggest ways to correlate normal brain functions and meditative training with the phenomena of extraordinary states of consciousness.After briefly introducing the topic of Zen and describing recent research into meditation, Austin reviews the latest studies on the amygdala, frontotemporal interactions, and paralimbic extensions of the limbic system. He then explores different states of consciousness, both the early superficial absorptions and the later, major "peak experiences." This discussion begins with the states called kensho and satori and includes a fresh analysis of their several different expressions of "oneness." He points beyond the still more advanced states toward that rare ongoing stage of enlightenment that is manifest as "sage wisdom."Finally, with reference to a delayed "moonlight" phase of kensho, Austin envisions novel links between migraines and metaphors, moonlight and mysticism. The Zen perspective on the self and consciousness is an ancient one. Readers will discover how relevant Zen is to the neurosciences, and how each field can illuminate the other. (shrink)

Organisms and other biological entities are mistake-prone: they get things wrong. The entities of pure physics, such as atoms and inorganic molecules, do not make mistakes: they do what they do according to physical law, with no room for error except on the part of the physicist or their theory. We set out a novel framework for understanding biology and its demarcation from physics – that of mistake-making. We distinguish biological mistakes from mere failures. We then propose a rigorous definition (...) of mistakes that, although invoking the concept of function, is compatible with various views about what functions are. The definition of mistake-making is agential, since mistakes do not just happen ¬– at least in the sense analysed here – but are made. This requires, then, a notion of biological agency which we set out as a definition of the Minimal Biological Agent. The paper then considers a series of objections to the theory presented here, along with our replies. Two key features of our theory of mistakes are, first, that it is a supplement to, not a replacement for, existing general frameworks within which biology is understood and practised. Secondly, it is designed to be experimentally productive. Hence we end with a series of case studies where mistake theory can be shown to be useful in the potential generation of research questions and novel hypotheses of interest to the working biologist. (shrink)

Efforts to address algorithmic harms have gathered particular steam over the last few years. One area of proposed opportunity is the notion of an “algorithmic audit,” specifically an “internal audit,” a process in which a system’s developers evaluate its construction and likely consequences. These processes are broadly endorsed in theory—but how do they work in practice? In this paper, we conduct not only an audit but an autoethnography of our experiences doing so. Exploring the history and legacy of a facial (...) recognition dataset, we find paradigmatic examples of algorithmic injustices. But we also find that the process of discovery is interwoven with questions of affect and infrastructural brittleness that internal audit processes fail to articulate. For auditing to not only address existing harms but avoid producing new ones in turn, we argue that these processes must attend to the “mess” of engaging with algorithmic systems in practice. Doing so not only reduces the risks of audit processes but—through a more nuanced consideration of the emotive parts of that mess—may enhance the benefits of a form of governance premised entirely on altering future practices. (shrink)

Traditionally, physicians and parents made decisions about children’s health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children — of diverse levels of cognitive development — are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning (...) children’s ‘best interest’. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families. (shrink)