A classic exposition of Kant's ethical thought.

Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley’s Moral Distress Scale and Olson’s Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely (...) correlated with perceptions of ethical climate. Each of the HECS factors (peers, patients, managers, hospitals and physicians) was found to be significantly correlated with moral distress. Based on these findings, we highlight insights for practice and future research that are needed to enhance the development of strategies aimed at improving the ethical climate of nurses’ workplaces for the benefit of both nurses and patients. (shrink)

AbstractWhile the literature on oncofertility decision-making was central to the bioethics debate on social egg freezing when the practice emerged in the late 2000s, there has been little discussion juxtaposing the two forms of egg freezing since. This article offers a new perspective on this debate by comparing empirical qualitative data of two previously conducted studies on medical and social egg freezing. We re-analysed the interview data of the two studies and did a thematic analysis combined with interdisciplinary collaborative auditing (...) for empirical ethics projects. Despite their different contexts, major similarities in women’s decision-making and reasoning were found. We developed two main common themes. Firstly, women felt a clear need to plan for future options. Secondly, they manipulated decision-times by postponing definitive decisions and making micro-decisions. The comparison highlights that the passage of time and the preservation of future choice seems to permeate all aspects of the patient experiences in both studies. As a result of considering real-world lived experiences, we suggest that there are many overlaps in women’s reasoning about egg freezing regardless of why they are making a decision to freeze. These overlaps are morally relevant and thus need to be further integrated into the existing arguments that have been canvassed in the flourishing egg freezing and fertility preservation debates across the field, and in policy and practice globally. (shrink)

Recent weeks have seen an increased focus on the ethical response to the COVID-19 pandemic. Ethics guidance has proliferated across Britain, with ethicists and those with a keen interest in ethics in their professions working to produce advice and support for the National Health Service. The guiding principles of the pandemic have emerged, in one form or another, to favour fairness, especially with regard to allocating resources and prioritizing care. However, fairness is not equivalent to equity when it comes to (...) healthcare, and the focus on fairness means that existing guidance inadvertently discriminates against people from ethnic minority backgrounds. Drawing on early criticisms of existing clinical guidance (for example, the frailty decision tool) and ethical guidance in Britain, this essay will discuss the importance of including sociology, specifically the relationship between ethnicity and health, in any ethical and clinical guidance for care during the pandemic in the United Kingdom. To do otherwise, I will argue, would be actively choosing to allow a proportion of the British population to die for no other reason than their ethnic background. Finally, I will end by arguing why sociology must be a key component in any guidance, outlining how sociology was incorporated into the cross-college guidance produced by the Royal College of Physicians. (shrink)

In this article I discuss the little examined relationship between time and patient autonomy. Using the findings from a study on the experience of premenopausal cancer patients making fertility preservation decisions during their treatment, I focus on how the patients in the study understood time, and how this understanding interacted with and influenced their decision-making. I then analyse in more depth the importance of time in patient decision-making, and the relationship of time to concepts of patient autonomy and decision-making in (...) the field of bioethics more generally. Focusing on the relational conception of autonomy, I conclude that time is an integral part of patient autonomy which warrants further research, such that it can be better integrated into concepts of patient autonomy, and the policy and guidelines that they inform and influence. (shrink)

Family members do not have an official position in the practice of euthanasia and physician assisted suicide in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could serve as a starting point (...) for further empirical and ethical inquiry. A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families’ experiences and grief after EAS. 4) Family and ‘the good euthanasia death’ according to Dutch physicians. Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making. (shrink)

Introduction. Medical trainees fear disclosing psychological distress and rarely seek help. Social sharing of difficult experiences can reduce stress and burnout. Drawing comics is one way that has been used to help trainees express themselves. The authors explore reasons why some medical trainees chose to draw comics depicting stressful situations that they had never shared with anyone before. Methods. Trainees participated in a comic drawing session on stressors in medicine. Participants were asked if they had ever shared the drawn situation (...) with anyone. Participants who had not previously shared were asked what prevented them and why they shared it now. The authors performed content analysis of the responses. Results. Of two hundred forty participants, forty-six indicated sharing an experience for the first time. Analysis of the responses revealed dedicated time and space was essential to sharing, trainee insecurity was a barrier, and comics were perceived as a safe way to communicate. Discussion. Depicting a stressful situation may be beneficial for trainees who drew an experience they had never shared before. Providing trainees with the opportunity to externalize their experience and create a community for sharing tough experiences may be one way to reduce trainee stress and burnout. (shrink)

The 2011 tsunami had a devastating effect on the east coast of Japan. Particularly poignant were the century-old markers on hillsides warning against building anywhere below. Nevertheless, such wisdom from traditional knowledge was disregarded because of the perceived invulnerability of the modern. This paper attempts to garner such traditional empirical knowledge regarding the siting of towns and cities by considering the Chinese art/science of fengshui or dili, the original purpose of which was to site human habitation in the most favourable (...) places for long term survival. This knowledge is then used to consider the placement of cities created by modernity, those founded on and flourishing through the advent of globalisation, such as Hong Kong, Shanghai, St Petersburg, and Sydney. (shrink)

As COVID-19 swept across the globe, ethicists everywhere took up a call to arms to advise and guide the medical profession through an unprecedented event. "Fairness" quickly became the word de jour in this pandemic. But when it comes to health "fair" is a four-letter word. It is of no surprise to feminist bioethicists, but fairness, equality, and equity are not equivalent. As we have seen revealed again and again over the last two years, the social and structural determinants that (...) contribute to good health are not fairly distributed amongst the population. Instead, where we live and work, how much money we have, our education, gender, and ethnicity all contribute to how accessible healthcare services are, our... (shrink)

The companion piece to this article, “Situating Moral Justification,” challenges the idea that moral epistemology's mission is to establish a single, all-purpose reasoning strategy for moral justification because no reasoning practice can be expected to deliver authoritative moral conclusions in all social contexts. The present article argues that rethinking the mission of moral epistemology requires rethinking its method as well. Philosophers cannot learn which reasoning practices are suitable to use in particular contexts exclusively by exploring logical relations among concepts. Instead, (...) in order to understand which reasoning practices are capable of justifying moral claims in different types of contexts, we need to study empirically the relationships between reasoning practices and the contexts in which they are used. The article proposes that philosophers investigate case studies of real-world moral disputes in which people lack shared cultural assumptions and/or are unequal in social power. It motivates and explains the proposed case study method and illustrates the philosophical value of this method through a case study. (shrink)

AI for social good is a thriving research topic and a frequently declared goal of AI strategies and regulation. This article investigates the requirements necessary in order for AI to actually serve a public interest, and hence be socially good. The authors propose shifting the focus of the discourse towards democratic governance processes when developing and deploying AI systems. The article draws from the rich history of public interest theory in political philosophy and law, and develops a framework for ‘public (...) interest AI’. The framework consists of (1) public justification for the AI system, (2) an emphasis on equality, (3) deliberation/ co-design process, (4) technical safeguards, and (5) openness to validation. This framework is then applied to two case studies, namely SyRI, the Dutch welfare fraud detection project, and UNICEF’s Project Connect, that maps schools worldwide. Through the analysis of these cases, the authors conclude that public interest is a helpful and practical guide for the development and governance of AI for the people. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:ABORTION AS A SACRAMENT: MIMETIC DESIRE AND SACRIFICE IN SEXUAL POLITICS Bernadette Waterman Ward SUNY-Oswego "If men got pregnant, abortion would be a sacrament." That familiar taunt is mostly aimed at Roman Catholics to humiliate them for their purportedly religious and anti-rational opposition to abortion. It is conventional to sniffthat the "religious assumptions" on which disapproval of abortion is "typically based" are "highly questionable" (Chambers 1). But the (...) cultural theories of René Girard suggest that it is because men don't get pregnant that abortion already is a sacrament. The key elements of sacrificial religion, as Girard defines it, are the presence of intolerable tension that must lead to social disruption; the choice of a victim who cannot strike back to absorb the community's violence; and the concealment ofthe function ofthe sacrifice, which employs actual violence for the purpose of stabilizing institutional violence. Abortion in America is upheld not as medical or even political policy, but as, in fact, a religious sacrifice. Girard's definition ofreligion requires neither a moral code nor a divinity nor a metaphysical grounding. The cult of Dionysus, to name only one example, evidently endorsed nothing we would recognize as a general code of morality; Buddhism, a far more august example, does not focus on a divinity; animism proposes no universal metaphysics. As to sacraments, Bernadette Waterman Ward19 Thomas Aquinas, following St. Augustine, did not scruple to call nonChristian sacrifices sacraments oftheir religions, "Whether true or false."' Scapegoating defines religious sacrifice. It protects the sacrificing community and promotes its unity—so long as all believe that the scapegoat must suffer. Often the victim is called an enemy to some established order; sacrifice is always conservative, even if it upholds an inherently unstable system. Because powerlessness, not real disruptive power, is the criterion for becoming a scapegoat, sacrifice requires a strong shared illusion. Classical religions provide unopposable gods to choose the tragically necessary victims, allowing strong ambivalence to surround the sacrifice itself. Ifthis is not present, the death or banishment takes on a different character—more political than religious, though Girard notes a fundamental unity between those two methods ofcontrolling mimetic violence. Mimetic violence originates in illusion surrounding a rivalry. Often there is an object involved, such as territory or wealth or political rank, but the object, which seems important, is actually irrelevant. The rivalry can continue, seeking new objects, whatever concrete acquisitions either party makes or loses. General, aimless rivalry dominates a social world of fragile, undefined selves in which anyone can be a model for imitation, and therefore anyone can be a threat to one's sense ofself. What an imitator actually seeks is to have whatever is desirable; most desirable ofall, perhaps, is the ability to know what is desirable, a mysterious quality that is constantly attributed to others; Girard calls this quality "being." From the nursery we are each other's disciples, wanting each other's toys not because of their inherent virtue so much as because someone else has seen some virtue in them. As human desire has no real single object, it has no closure; envy and revenge threaten others in a widening net of destruction. In the classic scenario, the model whose "being" has become matter for imitation finds himself in competition for the object, and attacks the rival, who returns in kind. A disciple who can rally aspire to the model's status can become a dangerous, even a deadly rival; in imagination, and sometimes in reality, they turn each other intp monsters. Yet as the desire has no single object, neither has the rage: the violence can be easily transferred to another object than one's rival. Sometimes those who are uneasy about their status in relation to one another can cement a powerful unity by focusing blame on some common target: a scapegoat. The Orwellian scenario is in fact the normal scenario: individuals caught in the maelstrom of social instability 'Summa Theologiae, 3a.61.1 31. 20Abortion as a Sacrament seek to avoid victimization by diverting the violence into blame and destruction directed, first of all, against someone else—and, if possible, against someone who cannot strike back: a sacrifice. Not all sacrificial religious... (shrink)

In this paper, we develop a typology of auditors’ virtues through in-depth interviews with nine exemplars of the audit community.We compare this typology with prescribed auditors’ virtues as represented in the applicable Code of Professional Conduct. Ourcomparison shows that the Code places a primary emphasis on mandatory virtues including the virtues of “independent,” “objective,”and “principled.” While the non-mandatory virtues, which involve “going beyond the minimum” and “putting the public interest foremost,” were identified by our exemplars as essential to the auditor’s (...) role, they received little or no emphasis in the Rules of Professional Conduct. We find this particularly alarming, given that the exemplars interviewed for this study viewed these virtues are essential to the auditors’ role. If the audit profession wishes to uphold public confidence by encouraging the possession of non-mandatory auditors’ virtues, our research suggests that non-mandatory auditors’ virtues should be explicitly described and included in rules of professional conduct. (shrink)

Paton, Margaret It was the unfamiliar word dewfall that kept my attention and the relation of dewfall to God's Spirit. It will fall on the bread and wine like dew falling. What is it that connects God's Spirit with dew falling that makes it so memorable for me? It is because in the midst of Mass dewfall is a symbol of the powerful outpouring of God's love for Christ crucified and for me, as I praise Him for His goodness. (...) There is also the sheer beauty of dew when it is first seen in the morning that can overwhelm me with its pristine freshness and purity of shimmering brightness with not a mark of a footprint on it. Dew can freshen our spirits, making them receptive. However, the question remains, What does dew have to do with the Spirit of God? What is the likeness between dewfall and the Spirit of God? (shrink)

School principals world-wide report high levels of strain and attrition resulting in a shortage of qualified principals. It is thus, crucial to identify psychosocial risk factors that reflect principals’ occupational wellbeing. For this purpose, we used the Copenhagen Psychosocial Questionnaire (COPSOQ-II), a widely used self-report measure covering multiple psychosocial factors identified by leading occupational stress theories. We evaluated the COPSOQ-II regarding factor structure and longitudinal, discriminant, and convergent validity using latent structural equation modeling in a large sample of Australian school (...) principals (N = 2,049). Results reveal that confirmatory factor analysis produced marginally acceptable model fit. A novel approach we call set exploratory structural equation modeling (ESEM-set), where cross-loadings were only allowed within a priori defined sets of factors, fit well, and was more parsimonious than a full ESEM. Further multitrait-multimethod models based on the set-ESEM confirm the importance of a principal’s psychosocial risk factors; Stressors and depression were related to demands and ill-being, while confidence and autonomy were related to wellbeing. We also show that working in the private sector was beneficial for showing a low psychosocial risk, while other demographics have little effects. Finally, we identify five latent risk profiles (high risk to no risk) of school principals based on all psychosocial factors. Overall the research presented here closes the theory application gap of a strong multi-dimensional measure of psychosocial risk-factors. (shrink)

PurposeContinuous patient-reported outcomes to identify and address patients’ needs represent an important addition to current routine care. The aim of this study was to identify and determine important dimensions of health-related quality of life in routine oncological care.MethodsIn a cross-sectional qualitative study, interviews and focus groups were carried out and recorded. The interviewees were asked for their evaluation on HrQoL in general and specifically regarding cancer treatment. The material was transcribed and analyzed using qualitative content analysis based on Mayring. The (...) results were reviewed in an expert discussion.ResultsInterviews with patients and clinicians, as well as five focus groups with clinicians were conducted. Initially, nine deductive and two inductive categories on HrQoL were built. Four categories were excluded following the qualitative content analysis because they were hardly or not at all mentioned by participants. Following on from the analysis of the expert discussion, one dimension was added, and two further categories were excluded. The resulting system consisted of six dimensions: emotional health, physical ailments, autonomy, social functionality, dignity, and resources.ConclusionThe identified dimensions of HrQoL in routine oncological care were found to differ from those used in existing HrQoL measurements for patients. Further research is needed to test and evaluate the presented structure in a larger sample of cancer patients to further assess its psychometric properties. (shrink)

Navigating disagreements among surrogate decision makers remains one of the most common consults seen by clinical ethicists. Sometimes these consults occur because there are disagreements among sur...

Critical posthumanism is an invitation to think differently about knowledge and educational relationality between humans and the more-than-human. This philosophical and political shift in subjectivity builds on, and is entangled with, poststructuralism and phenomenology. In this paper we read diffractively through one another the theories of Finnish architect Juhani Pallasmaa and feminist posthumanists Karen Barad and Rosi Braidotti. We explore the implications of the so-called ‘ontological turn’ for early childhood education. With its emphasis on a moving away from the dominant (...) role of human vision in educational research we show how videoing and photographing works as an apparatus in an analysis of data from an inner-city school in Johannesburg, South Africa. We are struck by children’s seeing with the ‘eyes of their skin’ and ‘seeing’ with/in the world, as their obvious distress is felt when a small tree sapling has been mowed down in a nearby park. We analyse the event with the help of a variation on Deleuze’s notion of ‘becoming-child’: ‘becoming-little’, and Anna Tsing’s ‘the arts of noticing’. ‘Becoming-little’ as a methodology disrupts the adult/child binary that positions ‘little’, younger humans as inferior to their ‘bigger’ fully human counterparts. We exemplify ‘becoming-little’ through 4 and 5 year-olds’ learning with the little tree and adopt Barad’s temporal diffraction to ‘see’ what is in/visible in the park: the extractive, exploitative, colonising mining practices of White settlers. These are still part of the land on which the park was created but are in/visible beneath the ‘skin’ of the earth. (shrink)

Summary With regard to the dynamics of human experience and behavior, Gestalt theoretical psychotherapy (GTP) relies mainly on Kurt Lewin’s dynamic field theory of personality. GTP is carried out by including a re-interpretation of Lewin’s theory in some aspects of psychotherapeutic practice in relation to critical realism. Human experience and behavior are understood to be functions of the person and the environment (including the other individuals therein) in a psychic field (life space), which encompasses both of these mutually dependent factors. (...) The anthropological model of this approach is, therefore, not mono-personal but, a priori, structural and relational in nature. It does not one-sidedly focus on the “inner components” of a person, but on the interrelation of the individual and a given environment, which affects experience and behavior. After a brief introduction of these basic concepts, this lecture will focus especially on Lewin’s concept of tension-systems, which may be considered as the Gestalt theoretical counterpart of Freud’s drive theory. Further, we define the basic assumptions which underlie GTP and explain how the person moves through her/his life experience in terms of Gestalt psychology. (shrink)

In the highly contentious abortion arena, the new oral abortifacient technology RU486 is one among many actors. This article offers an arena analysis of the heterogeneous constructions of RU486 by various actors, including scientists, pharmaceutical compa nies, medical groups, antiabortion groups, women's health movement groups, and others who have produced situated knowledges. Conceptually, we find not only that the identity of the nonhuman actor-RU486 -is unstable and multiple but also that, in practice, there are other implicated actors—the downstream users and (...) consumers of the technology. If we try to follow all the actors, we find a fuller and more historicized arena, and, ironically, we too can be construed as implicated actors in it. (shrink)

This paper explores the pragmatic foundations of unreliable narration (UN), a narrative technique highly popular in western literary texts. It sets out by giving a critique of the competing theoretic frameworks of UN, namely the seminal Boothian concept and more recent constructivist approaches. It is argued that both frameworks neglect a pragmatic perspective as the most viable way for identifying and analysing UN. Such a pragmatic model is then developed on the basis of theories of cooperation, such as the Gricean (...) maxims, relevance theory, and politeness. The emerging definition of UN treats a narrator as unreliable if he or she violates the cooperative principle without intending an implicature. This model is tested against three prototypical UNs: Christie's The Murder of Roger Ackroyd, Ishiguro's The Remains of the Day, and Poe's The Tell-Tale Heart. These sample analyses yield a typology of UN: while pragmatic deviation is shown to be the intrinsic feature of the phenomenon, unreliable narrators vary according to their degree of intentionality. Finally, two recurring issues in the UN debate are briefly discussed: the existence of textual clues of UN, and the role of the reader in constructing unreliability. (shrink)

Bernadette M Tobin; Development in Virtues, Journal of Philosophy of Education, Volume 20, Issue 2, 30 May 2006, Pages 201–214, https://doi.org/10.1111/j.1467-9.

La notion de médiation culturelle s'est institutionnalisée dans le monde culturel et dans le monde universitaire. Son analyse concerne la situation de médiation et le système de médiations comme répertoire d'actions, ce qui engage deux dimensions: la dimension historique et la dimension politique. Il est donc nécessaire, tant dans la recherche que dans les formations, de maintenir une distance critique envers certaines conceptions mythiques de la notion.The concept of cultural mediation has become an institutionalized part of the worlds of both (...) culture and the university. Analysis of the concept covers the context of mediation and the general system of mediations, understood as a repertoire of actions. This brings into play two dimensions, historical and political. It is therefore necessary to maintain a critical distance from certain mythologizing versions of this notion, as much in research as in education and training. (shrink)