We take up the challenge of developing an international network with capacity to survey the world's scientists on an ongoing basis, providing rich datasets regarding the opinions of scientists and scientific sub-communities, both at a time and also over time. The novel methodology employed sees local coordinators, at each institution in the network, sending survey invitation emails internally to scientists at their home institution. The emails link to a ‘10 second survey’, where the participant is presented with a single statement (...) to consider, and a standard five point Likert scale. In June 2023, a group of 30 philosophers and social scientists invited 20,085 scientists across 30 institutions in 12 countries to participate, gathering 6,807 responses to the statement 'Science has put it beyond reasonable doubt that COVID-19 is caused by a virus'. The study demonstrates that it is possible to establish a global network to quickly ascertain scientific opinion on a large international scale, with high response rate, low opt-out rate, and in a way that allows for significant (perhaps indefinite) repeatability. Measuring scientific opinion in this new way would be a valuable complement to currently available approaches, potentially informing policy decisions and public understanding across diverse fields. (shrink)

This book offers a systematic treatment of the requirements of democratic legitimacy. It argues that democratic procedures are essential for political legitimacy because of the need to respect value pluralism and because of the learning process that democratic decision-making enables. It proposes a framework for distinguishing among the different ways in which the requirements of democratic legitimacy have been interpreted. Peter then uses this framework to identify and defend what appears as the most plausible conception of democratic legitimacy. According to (...) this conception, democratic legitimacy requires that the decision-making process satisfies certain conditions of political and epistemic fairness. (shrink)

The debate over rival conceptions of political legitimacy tends to focus on first-order considerations—for example, on the relative importance of procedural and substantive values. In this essay, I argue that there is an important, but often overlooked, distinction among rival conceptions of political legitimacy that originates at the meta-normative level. This distinction, which cuts across the distinctions drawn at the first-order level, concerns the source of the normativity of political legitimacy, or, as I refer to it here, the grounds of (...) political legitimacy. If we focus on the grounds of political legitimacy, there are three main conceptions of political legitimacy: will-based, belief-based, and fact-based conceptions. I present an objection to each of those main conceptions and defend a hybrid account of the grounds of political legitimacy. (shrink)

Political decisions have the potential to greatly impact our lives. Think of decisions in relation to abortion or climate change, for example. This makes political legitimacy an important normative concern. But what makes political decisions legitimate? Are they legitimate in virtue of having support from the citizens? Democratic conceptions of political legitimacy answer in the affirmative. Such conceptions righly highlight that legitimate political decision-making must be sensitive to disagreements among the citizens. But what if democratic decisions fail to track what (...) there is most reason to do? What if a democratically elected government fails to take measures necessary to protect its population from threats related to climate change? Peter argues that the legitimacy of political decisions doesn't just depend on respect for the citizens' will; and defends a novel hybrid conception of political legitimacy, called the Epistemic Accountability conception. According to this conception, political legitimacy also depends on how political decision-making responds to evidence for what there is most reason to do. Grounds for Political Legitmacy starts with an overview of the main ways in which philosophers have thought about political legitimacy, and identifies the epistemic accountability conception as an overlooked alternative. It then develops the epistemic accountability conception of political legitimacy and discusses its implications for legitimate political decision-making. Considering the norms that should govern political debate, it examines the role of experts in politics, and probes the responsibilities of democratically elected political leaders and as well as of citizens. (shrink)

In this paper I defend a pure proceduralist conception of legitimacy that applies to epistemic democracy. This conception, which I call pure epistemic proceduralism, does not depend on procedure-independent standards for good outcomes and relies on a proceduralist epistemology. It identifies a democratic decision as legitimate if it is the outcome of a process that satisfies certain conditions of political and epistemic fairness. My argument starts with a rejection of instrumentalism–the view that political equality is only instrumentally valuable. I reject (...) instrumentalism on two grounds: (i) because it fails to respect reasonable value pluralism and to recognize the constitutive role of democratic procedures for legitimacy in pluralist societies, and (ii) because it neglects the constructive function of democratic decision-making. I then consider two alternatives to pure epistemic proceduralism: David Estlund's version of epistemic proceduralism and a Deweyan account of epistemic democracy. I argue that only pure epistemic proceduralism can make good on both shortcomings of instrumentalism, whereas each of the other two approaches only makes good on one and neglects the other. (shrink)

In recent years there has been a revival of a theory of conscious emotions as analogous in important ways to perceptual experiences. In the standard versions of this view emotions are construed as, potentially, perceptual disclosures of values. The model has been widely debated and criticized. In this paper I reconstruct an early, qualified version of the perceptual model to be found in the classical phenomenological approaches of Scheler and Sartre. After outlining this version of the theory, I examine its (...) prospects against objections prominent in the current debate. (shrink)

In epistemology and in philosophy of language there is fierce debate about the role of context in knowledge, understanding, and meaning. Many contemporary epistemologists take seriously the thesis that epistemic vocabulary is context-sensitive. This thesis is of course a semantic claim, so it has brought epistemologists into contact with work on context in semantics by philosophers of language. This volume brings together the debates, in a set of twelve specially written essays representing the latest work by leading figures in the (...) two fields. All future work on contextualism will start here. Contributors: Kent Bach, Herman Cappelen, Andy Egan, Michael Glanzberg, John Hawthorne, Ernest Lepore, Peter Ludlow, Peter Pagin, Georg Peter, Paul M. Pietroski, Gerhard Preyer, Jonathan Schaffer, Jason Stanley, Brian Weatherson, Timothy Williamson. (shrink)

A conception of legitimacy is at the core of normative theories of democracy. Many different conceptions of legitimacy have been put forward, either explicitly or implicitly. In this article, I shall first provide a taxonomy of conceptions of legitimacy that can be identified in contemporary democratic theory. The taxonomy covers both aggregative and deliberative democracy. I then argue for a conception of democratic legitimacy that takes the epistemic dimension of public deliberation seriously. In contrast to standard interpretations of epistemic democracy, (...) however, the conception I put forward avoids procedure-independent standards of correctness. Instead, it relies on a procedural social epistemology and defines legitimacy entirely in terms of the fairness of procedures. I call this conception of democratic legitimacy `Pure Epistemic Proceduralism'. I shall argue that it should be preferred over `Rational Epistemic Proceduralism', the conception of legitimacy that underlies the standard interpretation of epistemic democracy. Key Words: legitimacy • deliberative democracy • epistemic democracy • social epistemology. (shrink)

Political legitimacy is a virtue of political institutions and of the decisions—about laws, policies, and candidates for political office—made within them. This entry will survey the main answers that have been given to the following questions. First, how should legitimacy be defined? Is it primarily a descriptive or a normative concept? If legitimacy is understood normatively, what does it entail? Some associate legitimacy with the justification of coercive power and with the creation of political authority. Others associate it with the (...) justification, or at least the sanctioning, of existing political authority. Authority stands for a right to rule—a right to issue commands and, possibly, to enforce these commands using coercive power. An additional question is whether legitimate political authority is understood to entail political obligations or not. Most people probably think it does. But some think that the moral obligation to obey political authority can be separated from an account of legitimate authority, or at least that such obligations arise only if further conditions hold. (shrink)

Conscientious objections (CO) can be disruptive in a variety of ways and may disadvantage patients and colleagues who must step-in to assume care. Nevertheless, nurses have a right and responsibility to object to participation in interventions that would seriously harm their sense of integrity. This is an ethical problem of balancing risks and responsibilities related to patient care. Here we explore the problem and propose a nonlinear framework for exploring the authenticity of a claim of CO from the perspective of (...) the nurse and of those who must evaluate such claims. We synthesized the framework using Rest’s Four Component Model of moral reasoning along with tenets of the International Council of Nursing’s (ICN) Code of Ethics for Nurses and insights from relevant ethics and nursing ethics literature. The resulting framework facilitates evaluating potential consequences of a given CO for all involved. We propose that the framework can also serve as an aid for nurse educators as they prepare students for practice. Gaining clarity about the sense in which the concept of conscience provides a defensible foundation for objecting to legally, or otherwise ethically, permissible actions, in any given case is critical to arriving at an ethical and reasonable plan of action. (shrink)

Collective deliberation is fuelled by disagreements and its epistemic value depends, inter alia, on how the participants respond to each other in disagreements. I use this accountability thesis to argue that deliberation may be valued not just instrumentally but also for its procedural features. The instrumental epistemic value of deliberation depends on whether it leads to more or less accurate beliefs among the participants. The procedural epistemic value of deliberation hinges on the relationships of mutual accountability that characterize appropriately conducted (...) deliberation. I will argue that it only comes into view from the second-person standpoint. I shall explain what the second-person standpoint in the epistemic context entails and how it compares to Stephen Darwall’s interpretation of the second-person standpoint in ethics. (shrink)

Background The COVID-19 pandemic has forced rapid and widespread change to standards of patient care and nursing practice, inevitably leading to unprecedented shifts in the moral conditions of nursing work. Less is known about how these challenges have affected nurses’ capacity to meet their ethical responsibilities and what has helped to sustain their efforts to continue to care. Research objectives 1) To explore nurses’ experiences of striving to fulfill their ethical responsibilities of care during the COVID-19 pandemic and 2) to (...) explore what has fostered nurses’ capacity to fulfill these responsibilities. Research Design A generic qualitative approach was used incorporating concepts coming from fundamental features of care. Participants Twenty-four Canadian Registered Nurses from a variety of practice settings were interviewed. Ethical Considerations After receiving ethics approval, signed informed consent was obtained before participants were interviewed. Findings Four themes were identified. 1) Challenges providing good care in response to sudden changes in practice. 2) Tensions in juggling the responsibility to prevent COVID-19 infections with other competing moral responsibilities. 3) Supports to foster nurses’ capacity to meet their caring responsibilities. 4) The preservation of nurses’ moral identity through expressions of gratitude and health improvement. Discussion Infection control measures and priorities set in response to the pandemic made at distant population and organizational levels impacted nurses who continued to try to meet the ideals of care in close proximity to patients and their families. Despite the challenges that nurses encountered, the care they received themselves enabled them to continue to care for others. Nurses benefited most from the moral communities they had with their colleagues and occasionally nurse leaders, especially when they were supported in a face-to-face manner. Conclusion: Moral community can only be sustained if nurses are afforded the working conditions that make it possible for them to support each other. (shrink)

At the core of political liberalism is the claim that political institutions must be publicly justified or justifiable to be legitimate. What explains the significance of public justification? The main argument that defenders of political liberalism present is an argument from disagreement: the irreducible pluralism that is characteristic of democratic societies requires a mode of justification that lies in between a narrowly political solution based on actual acceptance and a traditional moral solution based on justification from the third-person perspective. But (...) why should we take disagreements seriously? This – epistemic question – has not received the attention it deserves so far. I argue that the significance of public justification can be explained through the possibility of reasonable disagreement. In a reasonable disagreement, the parties hold mutually incompatible beliefs, but each is justified to hold the belief they do. I shall use the notion of a reasonable disagreement to explain the possibility of an irreducible pluralism of moral and religious doctrines and, on that basis, why the justification of political institutions has to be public. (shrink)

A new puzzle of modal recombination is presented which relies purely on resources of first-order modal logic. It shows that naive recombinatorial reasoning, which has previously been shown to be inconsistent with various assumptions concerning propositions, sets and classes, leads to inconsistency by itself. The context sensitivity of modal expressions is suggested as the source of the puzzle, and it is argued that it gives us reason to reconsider the assumption that the notion of metaphysical necessity is in good standing.

Does political decision-making require experts or can a democracy be trusted to make correct decisions? This question has a long-standing tradition in political philosophy, going back at least to Plato’s Republic. Critics of democracy tend to argue that democracy cannot be trusted in this way while advocates tend to argue that it can. Both camps agree that it is the epistemic quality of the outcomes of political decision-making processes that underpins the legitimacy of political institutions. In recent political philosophy, epistemic (...) democrats have embraced this instrumentalist way of thinking about democracy. In this chapter, I argue that the attempt to defend democracy on epistemic instrumentalist grounds is self-undermining. I also develop an alternative – procedural – epistemic defence of democracy. I show that there is a prima facie epistemic case for democracy when there is no procedure-independent epistemic authority on the issue to be decided. (shrink)

Background: Explicating nurses’ moral identities is important given the powerful influence moral identity has on the capacity to exercise moral agency. Research objectives: The purpose of this study was to explore how nurses narrate their moral identity through their understanding of their work. An additional purpose was to understand how these moral identities are held in the social space that nurses occupy. Research design: The Registered Nurse Journal, a bimonthly publication of the Registered Nurses’ Association of Ontario, Canada, features a (...) regular column entitled, ‘In the End … What Nursing Means to Me …’ These short narratives generally include a story of an important moment in the careers of the authors that defined their identities as nurses. All 29 narratives published before June 2015 were analysed using a critical narrative approach, informed by the work of Margaret Urban Walker and Hilde Lindemann, to identify a typology of moral identity. Ethical considerations: Ethics approval was not required because the narratives are publicly available. Findings: Two narrative types were identified that represent the moral identities of nurses as expressed through their work: (1) making a difference in the lives of individuals and communities and (2) holding the identities of vulnerable individuals. Discussion: Nurses’ moral identities became evident when they could see improvement in the health of patients or communities or when they could maintain the identity of their patients despite the disruptive forces of illness and hospitalization. In reciprocal fashion, the responses of their patients, including expressions of gratitude, served to hold the moral identities of these nurses. Conclusion: Ultimately, the sustainability of nurses’ moral identities may be dependent on the recognition of their own needs for professional satisfaction and care in ways that go beyond the kind of acknowledgement that patients can offer. (shrink)

The physical nearness, or proximity, inherent in the nurse–patient relationship has been central in the discipline as definitive of the nature of nursing and its moral ideals. Clearly, this nearness is in service to those in need of care. This proximity, however, is not unproblematic because it contributes to two of the most prolonged difficulties, both for individual nurses and the discipline of nursing — moral distress and moral ambiguity. In this paper we explore proximity using both a moral and (...) geographical lens and offer some insights regarding this practice reality. We examine the effect of proximity to patients on nurses’ moral responsiveness, particularly as it affects nurses’ moral distress. Proximity is paradoxical in this regard because, while it propels nurses to act, it can also propel nurses to ignore or abandon. Likewise, we argue that nursing's tendency to define itself in relation to the closeness of the nurse–patient relationship leads to problems of moral ambiguity. Our recommendations include moving others closer to the bedside and thus to the work of nursing in the literal and theoretical sense. (shrink)

According to an often repeated definition, economics is the science of individual choices and their consequences. The emphasis on choice is often used – implicitly or explicitly – to mark a contrast between markets and the state: While the price mechanism in well-functioning markets preserves freedom of choice and still efficiently coordinates individual actions, the state has to rely to some degree on coercion to coordinate individual actions. Since coercion should not be used arbitrarily, coordination by the state needs to (...) be legitimized by the consent of its citizens. The emphasis in economic theory on freedom of choice in the market sphere suggests that legitimization in the market sphere is “automatic” and that markets can thus avoid the typical legitimization problem of the state. In this paper, I shall question the alleged dichotomy between legitimization in the market and in the state. I shall argue that it is the result of a conflation of choice and consent in economics and show how an independent concept of consent makes the need for legitimization of market transactions visible. Footnotes1 For helpful comments and suggestions I am most grateful to Marc Fleurbaey, Alain Marciano, Herlinde Pauer-Studer, Thomas Pogge, Hans Bernhard Schmid, to seminar or conference participants in Aix-Marseille, Tutzing, Paris, and Amsterdam, and to two anonymous referees. (shrink)

The main aim of this paper is to identify a type of fact-given warrant for action that is distinct from reason-based justification for action and defend the view that there are two types of practical warrant. The idea that there are two types of warrant is familiar in epistemology, but has not received much attention in debates on practical normativity. On the view that I will defend, normative facts, qua facts, give rise to entitlement warrant for action. But they do (...) not, qua facts, give rise to reason-based warrant. Normative practical reasons, I will argue, are true propositions that represent fact-based favouring and that are made true by normative facts. (shrink)

It may be the case that the most challenging moral problem of the twenty‐first century will be the relationship between the individual moral agent and the practices and institutions in which the moral agent is embedded. In this paper, we continue the efforts that one of us, Joan Liaschenko, first called for in 1993, that of using feminist ethics as a lens for viewing the relationship between individual nurses as moral agents and the highly complex institutions in which they do (...) the work of nursing. Feminist ethics, with its emphasis on the inextricable relationship between ethics and politics, provides a useful lens to understand the work of nurses in context. Using Margaret Urban Walker's and Hilde Lindemann's concepts of identity, relationships, values, and moral agency, we argue that health care institutions can be moral communities and profoundly affect the work and identity and, therefore, the moral agency of all who work within those structures, including nurses. Nurses are not only shaped by these organizations but also have the power to shape them. Because moral agency is intimately connected to one's identity, moral identity work is essential for nurses to exercise their moral agency and to foster moral community in health care organizations. We first provide a brief history of nursing's morally problematic relationship with institutions and examine the impact institutional master narratives and corporatism exert today on nurses’ moral identities and agency. We close by emphasizing the significance of ongoing dialogue in creating and sustaining moral communities, repairing moral identities, and strengthening moral agency. (shrink)

We review the status of bouncing cosmologies as alternatives to cosmological inflation for providing a description of the very early universe, and a source for the cosmological perturbations which are observed today. We focus on the motivation for considering bouncing cosmologies, the origin of fluctuations in these models, and the challenges which various implementations face.

Advance care planning is a process that encourages people to identify their values, to reflect upon the meanings and consequences of serious illness, to define goals and preferences for future medical treatment and care, and to discuss these goals with family and health-care providers. Advance care planning is especially important for those who are chronically ill, as patients and their families face a variety of complex healthcare decisions. Participating in advance care planning has been associated with improved outcomes; yet, despite (...) over 25 years of public awareness campaigns, research, and interventions developed to increase participation, advance care planning completion rates for people with chronic illnesses are no different than those in the general public (approximately 25%). Advance care planning has traditionally used an individualistic approach to autonomy, which puts forward an understanding of agents as independent, rational and self-interested persons. Because this individualistic approach has been largely unsuccessful in improving advance care planning uptake, a re-examination of the philosophical underpinnings of this practice and an exploration of alternative frameworks is warranted. In offering this exploration, we briefly outline two current perspectives on autonomy: the individualistic view and the relational view as articulated by feminist philosophers. Using a critical examination of the theoretical and empirical work on this topic, we argue that the individualistic view of autonomy does not sufficiently capture the relational and social complexities of the decision-making process of advance care planning. To offer a counterpoint, we examine the relational view of autonomy and suggest that this perspective is better aligned with the process of advance care planning. Specifically, we demonstrate that a relational model of autonomy is well suited to exploring advance care planning for four main reasons: (1) it recognizes the importance of relationships, (2) it reflects the fluctuating nature of autonomy in chronic illness, (3) it recognizes vulnerability, and (4) it is consonant with empirical work examining the advance care planning process. (shrink)

There is consistent and strong empirical evidence for social inequalities in health, as a vast and fast growing literature shows. In recent years, these findings have helped to move health equity high on international research and policy agendas. This paper examines how the empirical identification of social inequalities in health relates to a normative judgment about health inequities and puts forward an approach which embeds the pursuit of health equity within the general pursuit of social justice. It defends an indirect (...) approach to health equity, which views social inequalities in health as unjust in so far as they are the result of an unjust basic structure of society in Rawls’ sense. (shrink)

The recent literature on the epistemology of disagreement focuses on the rational response question: how are you rationally required to respond to a doxastic disagreement with someone, especially with someone you take to be your epistemic peer? A doxastic disagreement with someone also confronts you with a slightly different question. This question, call it the epistemic trust question, is: how much should you trust our own epistemic faculties relative to the epistemic faculties of others? Answering the epistemic trust question is (...) important for the epistemology of disagreement because it sheds light on the rational response question. My main aim in this paper is to argue—against recent attempts to show otherwise—that epistemic self-trust does not provide a reason for remaining steadfast in doxastic disagreements with others. (shrink)

Seventeen specially written essays by eminent philosophers and linguists appear for the first time in this anthology, all with the central theme of logical form -- a fundamental issue in analytic philosophy and linguistic theory. Logical Form and Language brings together exciting new contributions from diverse points of view, which illuminate the lively current debate about this topic.

This theoretical paper proposes a new perspective to understand the moral distress of nurses more fully, using virtue ethics. Moral distress is a widely studied subject, especially with respect to the determination of its causes and manifestations. Increasing the theoretical depth of previous work using ethical theory, however, can create new possibilities for moral distress to be explored and analyzed. Drawing on more recent work in this field, we explicate the conceptual framework of the process of moral distress in nurses, (...) proposed by Ramos et al., using MacIntyrean virtue ethics. Our analysis considers the experience of moral distress in the context of a practice, enabling the adaptation of this framework using virtue ethics. The adoption of virtue ethics as an ethical perspective broadens the understanding of the complexity of nurses’ experiences of moral distress, since it is impossible to create a ready model that can cover all possibilities. Specifically, we describe how identity, social context, beliefs, and tradition shape moral discomfort, uncertainty, and sensitivity and how virtues inform moral judgments. Individuals, such as nurses, who are involved in a practice have a narrative history and a purpose ( telos) that guide them in every step of the process, especially in moral judgment. It is worth emphasizing that the process described is supported by the formation of moral competence that, if blocked, can lead to moral distress and deprofessionalization. It is expected that nurses seek to achieve the internal good of their practice, which legitimizes their professional practice and supports them in moral decision-making, preventing moral distress. (shrink)

BackgroundWith the enactment of Bill C-7 in Canada in March 2021, people who are eligible for medical assistance in dying (MAiD), whose death is reasonably foreseeable and are at risk of losing decision-making capacity, may enter into a written agreement with their healthcare provider to waive the final consent requirement at the time of provision. This study explored healthcare providers’ perspectives on honouring eligible patients’ request for MAiD in the absence of a contemporaneous consent following their loss of decision-making capacity. (...) MethodA critical qualitative methodology, using a feminist ethics theoretical lens with its focus on power and relationality, was used to examine how socio-political and environmental contexts influenced healthcare providers' moral agency and perspectives. Semi-structured interviews were conducted with 30 healthcare providers (13 physicians, six nurse practitioners, nine nurses and two social workers) from across Canada who provide MAiD-related care.ResultsThemes identified include; (1) balancing personal values and professional responsibilities, (2) anticipating strengths and limitations of the proposed waiver of final consent amendment, (3) experiencing ethical influences on decisions to enter into written agreements with eligible patients, (4) recognizing barriers to the enactment of MAiD in the absence of a contemporaneous consent and (5) navigating the potential for increased risks and burden.DiscussionTo our knowledge, this is the first study in Canada to explore healthcare providers’ perspectives on waiving the final consent for MAiD using a written agreement. Most participants supported expanding eligible people’s access to MAiD following loss of capacity, as they believed it would improve the patients’ comfort and minimize suffering. However, the lack of patients’ input at the time of provision and related ethical and legal challenges may impact healthcare providers’ moral agency and reduce some patients’ access to MAiD. Providers indicated they would enter into written agreements to waive final consent for MAiD on a case-by-case basis. This study highlights the importance of organizational, legal and professional support, adequate resources, clear policies and guidelines for the safety and wellbeing of healthcare providers and to ensure equitable access to MAiD. (shrink)

Some situations appear to make moral demands on us – they call for a certain response. How can we account for such paradigmatic moral experiences? And what normative properties or relations are involved? This paper argues that we can account for such moral experiences in terms of moral affordances, where moral affordances are opportunities for fitting action. The paper demonstrates that the concept of affordances helps to generate new insight in moral inquiry, especially in relation to the moral significance of (...) fittingness. (shrink)

The Routledge Companion to Metaphysics is an outstanding, comprehensive and accessible guide to the major themes, thinkers, and issues in metaphysics. The Companion features over fifty specially commissioned chapters from international scholars which are organized into three clear parts: History of Metaphysics Ontology Metaphysics and Science. Each section features an introduction which places the range of essays in context, while an extensive glossary allows easy reference to key terms and definitions. The Routledge Companion to Metaphysics is essential reading for students (...) of philosophy and anyone interested in surveying the central topics and problems in metaphysics from causation to vagueness and from Plato and Aristotle to the present-day. (shrink)

Background: Family members and healthcare providers play an integral role in a person’s assisted dying journey. Their own needs during the assisted dying journey are often, however, unrecognized and underrepresented in policies and guidelines. Circumstances under which people choose assisted dying, and relational contexts such as the sociopolitical environment, may influence the experiences of family members and healthcare providers. Ethical considerations: Ethics approval was not required to conduct this review. Aim: This scoping review aims to identify the relational influences on (...) the experiences of family members and healthcare providers of adults who underwent assisted dying and of those unable to access assisted dying due to the loss of capacity to consent. Methods: A literature search was conducted in four databases, including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. The search retrieved 12,074 articles, a number narrowed down to 172 articles for full-text screening. Thirty-six articles met the established inclusion criteria. A feminist relational framework guided the data analysis. Results: Five key themes on the influences of family members’ and healthcare providers’ experiences throughout the assisted dying process were synthesized from the data. They include (1) relationships as central to beginning the process, (2) social and political influences on decision making, (3) complex roles and responsibilities of family members and healthcare providers, (4) a unique experience of death, and (5) varying experiences following death. Conclusion: The feminist relational lens, used to guide analysis, shed light on the effect of the sociopolitical influences and the relationships among patients, families, and healthcare providers on each other’s experiences. Addressing the needs of the family members and healthcare providers is vital to improving the assisted dying process. Including families’ and healthcare providers’ needs within institutional policies and enhancing collaboration and communication among those involved could improve the overall experience. (shrink)

Background: While witnessing and providing aggressive care have been identified as predominant sources of moral distress, little is known about what nurses “know” to be the “right thing to do” in these situations. Research objectives: The purpose of this study was to explore what nurses’ moral knowledge is in situations of perceived overly aggressive medical care. Research design: A critical narrative approach was used. Participants: A total of 15 graduate nursing students from various practice areas participated. Findings: Four narrative types (...) were identified, including “Wait and see: medical uncertainty,” “Deflected responsibilities to respond to dying, death, or futility,” “Divergent understandings, responsibilities, and temporalities,” and “Privileged medical understandings and responsibilities.” Discussion: The knowledge of differentially situated persons is acknowledged in dissimilar ways, the time required to determine that enough has been done is perceived differently, and how moral responsibilities are understood also varies. Conclusions: A better understanding of how social roles influence how time, knowledge, and responsibility are related to the provision of aggressive care is needed. (shrink)

Excellence and frontier research have made inroads into European research policymaking and structure political agendas, funding programs and evaluation practices. The two concepts travelled a long way from the United States and have derived from contexts outside of science. Following their conceptual journey, we ask how excellence and frontier research have percolated into European science and higher education policies and how they have turned into lubricants of competition that buttress an ongoing reform process in Europe.

The volume concludes with a specially-written reply by Sen, in which he responds to his critics and provides a rich commentary on the preceding essays.

It has been well documented that children perceive robots as social, mental, and moral others. Studies on child-robot interaction may encourage this perception of robots, first, by using a Wizard of Oz set-up and, second, by having robots engage in self-description. However, much remains unknown about the effects of transparent teleoperation and self-description on children’s perception of, and relationship formation with a robot. To address this research gap initially, we conducted an experimental study with a 2 × 2 between-subject design (...) in which 168 children aged 7–10 interacted with a Nao robot once. Transparency about the teleoperation procedure decreased children’s perceptions of the robot’s autonomy and anthropomorphism. Self-description reduced the degree to which children perceived the robot as being similar to themselves. Transparent teleoperation and self-description affected neither children’s perceptions of the robot’s animacy and social presence nor their closeness to and trust in the robot. (shrink)

-/- Background: Nurses who provide aggressive care often experience the ethical challenge of needing to preserve the hope of seriously ill patients and their families without providing false hope. -/- Research objectives: The purpose of this inquiry was to explore nurses’ moral competence related to fostering hope in patients and their families within the context of aggressive technological care. A secondary purpose was to understand how this competence is shaped by the social–moral space of nurses’ work in order to capture (...) how competencies may reflect an adaptation to a less than ideal work environment. -/- Research design: A critical qualitative approach was used. -/- Participants: Fifteen graduate nursing students from various practice areas participated. -/- Ethical considerations: After receiving ethics approval from the university, signed informed consent was obtained from participants before they were interviewed. -/- Findings: One overarching theme ‘Mediating the tension between providing false hope and destroying hope within biomedicine’ along with three subthemes, including ‘Reimagining hopeful possibilities’, ‘Exercising caution within the social–moral space of nursing’ and ‘Maintaining nurses’ own hope’, was identified, which represents specific aspects of this moral competency. -/- Discussion: This competency represents a complex, nuanced and multi-layered set of skills in which nurses must be well attuned to the needs and emotions of their patients and families, have the foresight to imagine possible future hopes, be able to acknowledge death, have advanced interpersonal skills, maintain their own hope and ideally have the capacity to challenge those around them when the provision of aggressive care is a form of providing false hope. -/- Conclusion: The articulation of moral competencies may support the development of nursing ethics curricula to prepare future nurses in a way that is sensitive to the characteristics of actual practice settings. (shrink)

The history of nursing in the home: revealing the significance of place in the expression of moral agencyThe relationship between place and moral agency in home care nursing is explored in this paper. The notion of place is argued to have relevance to moral agency beyond moral context. This argument is theoretically located in feminist ethics and human geography and is supported through an examination of historical documents (1900–33) that describe the experiences and insights of American home care/private duty nurses (...) or that are related to nursing ethics. Specifically, the role of place in inhibiting and enhancing care, justice, good relationships, and power in the practice of private duty nurses is explored. Several implications for current nursing ethics come out of this analysis. (i) The moral agency of nurses is highly nuanced. It is not only structured by nurses’ relationships to patients and health professionals, i.e. moral context, it is also structured by the place of nursing care. (ii) Place has the potential to limit and enhance the power of nurses. (iii) Some aspects of nursing's conception of the good, such as what constitutes a good nurse–patient relationship, are historically and geographically relative. (shrink)

The growth and sustainability of the nursing profession depends on the ability to recruit and retain the upcoming generation of professionals. Understanding the career choice experiences and professional expectations of Millennial nurses (born 1980 or after) is a critical component of recruitment and retention strategies. This study utilized Polkinghorne's interpretive, narrative approach to understand how Millennial nurses explain, account for and make sense of their choice of nursing as a career. The positioning of nursing as a virtuous choice was both (...) temporally and contextually influenced. The decision to enter the profession was initially emplotted around a traditional understanding of nursing as a virtuous profession: altruistic, noble, caring and compassionate. The centricity of virtues depicts one‐dimensional understanding of the nursing profession that alone could prove dissatisfying to a generation of professionals who have many career choices available to them. The narratives reveal how participants' perceptions and expectations remain influenced by a stereotypical understanding of nursing, an image that remains prevalent in society and which holds implications for the future recruitment, socialization and retention strategies for upcoming and future generations of nurses. (shrink)

This paper is concerned with the formulation and analysis of an epidemic model of COVID-19 governed by an eight-dimensional system of ordinary differential equations, by taking into account the first dose and the second dose of vaccinated individuals in the population. The developed model is analyzed and the threshold quantity known as the control reproduction number R0\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\mathcal {R}_{0}$$\end{document} is obtained. We investigate the equilibrium stability of the system, and the COVID-free equilibrium (...) is said to be locally asymptotically stable when the control reproduction number is less than unity, and unstable otherwise. Using the least-squares method, the model is calibrated based on the cumulative number of COVID-19 reported cases and available information about the mass vaccine administration in Malaysia between the 24th of February 2021 and February 2022. Following the model fitting and estimation of the parameter values, a global sensitivity analysis was performed by using the Partial Rank Correlation Coefficient (PRCC) to determine the most influential parameters on the threshold quantities. The result shows that the effective transmission rate (α)\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$(\alpha )$$\end{document}, the rate of first vaccine dose (ϕ)\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$(\phi )$$\end{document}, the second dose vaccination rate (σ)\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$(\sigma )$$\end{document} and the recovery rate due to the second dose of vaccination (η)\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$(\eta )$$\end{document} are the most influential of all the model parameters. We further investigate the impact of these parameters by performing a numerical simulation on the developed COVID-19 model. The result of the study shows that adhering to the preventive measures has a huge impact on reducing the spread of the disease in the population. Particularly, an increase in both the first and second dose vaccination rates reduces the number of infected individuals, thus reducing the disease burden in the population. (shrink)

Explorations of a trust approach for nursing ethicsTrust has long been acknowledged as central to nurse–patient relationships. It, however, has not been fully explored nor‐matively. That is, trust must be examined from a perspective that encompasses not only reliability and competence, but also good will within nursing relationships. In this paper, we explore how a trust approach, based on Annette Baier’s work on trust in feminist ethics, could help inform future developments in nursing ethics. We discuss the limitations of other (...) approaches such as those based on contracts, paternalism, and care. By drawing out central features of Baier’s theory, we demonstrate how it can help overcome the problems of these previous models. In doing so, we emphasise the importance of combining the ethics of care and justice, acknowledging vulnerability and the potential for evil in nursing relationships, and politically situating the ethical concerns of nursing. (shrink)

Background: While there have been studies exploring moral habitability and its impact on the work environments of nurses in Western countries, little is known about the moral habitability of the work environments of nurses and midwives in resource-constrained settings. Research objective: The purpose of this research was to examine the moral habitability of the work environment of nurses and midwives in Ghana and its influence on their moral agency using the philosophical works of Margaret Urban Walker. Research design and participants: (...) A critical moral ethnography was conducted through the analysis of interviews with 30 nurses and midwives, along with observation, and documentary materials. Ethical considerations: After receiving ethics approval, signed informed consent was obtained from participants before data collection. Results: Five themes were identified: (1) holding onto the values, identities, and responsibilities of being a midwife/nurse; (2) scarcity of resources as limiting capacity to meet caring responsibilities; (3) gender and socio-economic inequities shaping the moral-social context of practice; (4) working with incoherent moral understandings and damaged identities in the context of inter- and intra-professional relationships; and (5) surviving through adversity with renewed commitment and courage. Discussion: The nurses and midwives were found to work in an environment that was morally uninhabitable and dominated by the scarcity of resources, overwhelming and incoherent moral responsibilities, oppressive conditions, and workplace violence. These situations constrained their moral agency and provoked suffering and distress. The nurses and midwives negotiated their practice and navigated through morally uninhabitable work environment by holding onto their moral values and commitments to childbearing women. Conclusion: Creating morally habitable workplaces through the provision of adequate resources and instituting interprofessional practice guidelines and workplace violence prevention policies may promote safe and ethical nursing and midwifery practice. (shrink)

Many studies have examined clinical and institutional moral problems in the practice of nurses that have led to the experience of moral distress. The causes and implications of moral distress in nurses, however, have not been understood in terms of their implications from the perspective of virtue ethics. This paper analyzes how nurses reach for the telos of their practice, within a context of moral distress. A qualitative case study was carried out in a private hospital in Brazil. Observation and (...) semi‐semistructured interviews were conducted with 13 nurse participants. With the aid of ATLAS.ti software, the data were analyzed by using thematic content analysis using virtue ethics to theorize the findings. These nurses experienced a loss of their nursing identity as they encountered an ambiguous telos and the domination of institutional values. In their reach for the telos of their practice, nurses found an environment permeated by ethical challenges, which not only created moral distress but also created professional invisibility, a phenomenon referred to as ‘invisibility of the self’. (shrink)

Medical futility is often defined as providing inappropriate treatments that will not improve disease prognosis, alleviate physiological symptoms, or prolong survival. This understanding of medical futility is problematic because it rests on the final outcomes of procedures that are narrow and medically defined. In this article, Walker's `expressivecollaborative' model of morality is used to examine how certain critical care interventions that are considered futile actually have broader social functions surrounding death and dying. By examining cardiopulmonary resuscitation and life-sustaining intensive care (...) measures as moral practices, we show how so-called futile interventions offer ritualistic benefit to patients, families, and health care providers, helping to facilitate the process of dying. This work offers a new perspective on the ethical debate concerning medical futility and provides a means to explore how the social value of treatments may be as important in determining futility as medical scientific criteria. (shrink)

Spontaneously broken symmetries are often called hidden or secret symmetries. They are symmetries in the laws of nature that do not show up in observable phenomena. This raises the basic epistemological question: Is there reason to believe that these hidden symmetries are real features of nature rather than artifacts of theorizing. This paper clarifies the epistemic status of spontaneously broken symmetries. It presents the details of an argument by analogy that suggests the spontaneously broken gauge symmetry of electroweak interactions, and (...) the subsequent hypothetico-deductive testing of the hypothesis. It is a story of how dubious means can lead to a credible end. (shrink)