Families and clinicians approaching a child’s death in the paediatric intensive care unit (PICU) frequently encounter questions surrounding medical decision-making at the end of life (EOL), including defining what is in the child’s best interest, finding an optimal balance of benefit over harm, and sometimes addressing potential futility and moral distress. The best interest standard (BIS) is often marshalled by clinicians to help navigate these dilemmas and focuses on a clinician’s primary ethical duty to the paediatric patient. This approach does (...) not consider a clinician’s potential duty to the patient’s family. This paper argues that when a child is dying in the PICU, the physician has a duty to serve both the patient and the family, and that in some circumstances, the duty to serve the family becomes as important as that owed to the child. We detail the limitations of the BIS in paediatric EOL care and propose the relational potential standard as an additional ethical framework to guide our decisions. (shrink)

Background There is considerable variation in the functionality of bioethical services in different institutions and countries for children in hospital, despite new challenges due to increasing technology supports for children with serious illness and medical complexity. We aimed to understand how bioethics services address bioethical concerns that are increasingly encountered in paediatric intensive care. Methods A qualitative descriptive design was used to describe clinician’s perspectives on the functionality of clinical bioethics services for paediatric intensive care units. Clinicians who were members (...) of formal or informal clinical bioethics groups, or who were closely involved with the process of working through ethically challenging decisions, were interviewed. Interviews took place online. Resulting transcripts were analysed using thematic analysis. Results From 33 interviews, we identified four themes that described the functionality of bioethics services when a child requires technology to sustain life: striving for consensus; the importance of guidelines; a structure that facilitates a time-sensitive and relevant response; and strong leadership and teamwork. Conclusions Clinical bioethics services have the potential to expand their role due to the challenges brought by advancing medical technology and the increasing options it brings for treatment. Further work is needed to identify where and how bioethics services can evolve and adapt to fully address the needs of the decision-makers in PICU. (shrink)

BackgroundDecision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. A systematic review of reasoning identified the range of reasons clinicians give in the literature when initiating technology dependence in a child, and as a result helps determine the (...) range of influences on these decisions.MethodsMedline, EMBASE, CINAHL, PsychINFO, Web of Science, ASSIA and Global Health Library databases were searched to identify all reasons given for the initiation of technology dependence in a child. Each reason was coded as a broad and narrow reason type, and whether it supported or rejected technology dependence.Results53 relevant papers were retained from 1604 publications, containing 116 broad reason types and 383 narrow reason types. These were grouped into broad thematic categories: clinical factors, quality of life factors, moral imperatives and duty and personal values; and whether they supported, rejected or described the initiation of technology dependence. The majority were conceptual or discussion papers, less than a third were empirical studies. Most discussed neonates and focused on end-of-life care.ConclusionsThere is a lack of empirical studies on this topic, scant knowledge about the experience of older children and their families in particular; and little written on choices made outside ‘end-of-life’ care. This review provides a sound basis for empirical research into the important influences on a child’s potential technology dependence. (shrink)

Many Western nations are emphasizing the importance of population health across health care delivery organizations and education systems. Despite significant momentum to integrate population health into nursing practice, a parallel effort to examine how these efforts impact practicing nurses' views of their professional role and work identity has not occurred. This secondary qualitative analysis, employing an abductive approach, explored processes public health nurses use in creating and maintaining their work identity through three organizing themes: narrative self‐identity, mandated identity, and identity (...) as struggle. The analysis was based on interview data collected from 30 US public health nurses residing in 17 states. ‘Being a real nurse’ describes public health nurses' efforts to balance a contradictory work identity where at times they are expected to focus on populations and at other times, on individuals. The identity work revealed through this study should be further explicated and specific strategies developed for stabilizing a work identity for public health nurses, as well as for any nurse charged with a population health role. (shrink)

Background: Currently preterm births are the leading causes of newborn deaths and newborn mortality in developed countries. Infants born prematurely remain vulnerable to many acute complications and long-term disabilities. There is a growing concern surrounding the moral and ethical implications of the complex and technological care being provided to extremely low birth weight infants in neonatal intensive care units in the developed nations. Research purpose: The purpose of this study was to describe the ethical and moral issues that neonatal intensive (...) care nurses experience when caring for low birth weight preterm infants and their families. Research design: A phenomenological method design was used to describe the lived experiences of nurses with ethical and moral issues encountered in the neonatal intensive care unit. One-on-one, semi-structured interviews using open-ended questions were used to gather data from the participants. Research participants: The setting for this study was a 97-bed neonatal intensive care. A total of 16 female nurses were interviewed. Ethical considerations: Approval to conduct the research study was obtained from the institutional review board of the hospital where the study was conducted. Formal signed consent was obtained from each participant. To ensure confidentiality, each participant was asked to choose a confederate name to be used in the interview and the transcriptions. Findings: The thematic analysis identified five recurring themes: (a) at the edge of viability, (b) infant pain and discomfort, (c) crucial decisions, (d) communicating with parents, and (e) letting go. Conclusion: Neonatal intensive care unit nurses indicated that they often had challenges to their own sense of morality as they struggled to protect the infant from pain and unnecessary discomfort, provide care to an infant and their family whom they thought was faced with a lifetime of challenges and poor health, accepting decisions made by parents, and feeling as if parents were not adequately informed about outcomes. (shrink)

Moral distress (MD), the suffering experienced by professionals due to their restricted moral agency, has become a popular subject of study in the fields of social work and health care. Many of the existing measures of MD are targeted at certain professionals, such as health care workers, and are thus restricted to such contexts. This has challenged the conceptual development and empirical examination of MD as a phenomenon occurring across diverse professional groups in different work settings. This study introduces a (...) general measure of MD, the Moral Distress Instrument (MDI). It is not bound to specific professional contexts, and it aims to enable comparative and cross-disciplinary analyses of MD. The MDI consists of seven items that capture different forms of constrained moral agency and follow-up items measuring the level of distress related to these experiences. The reliability and validity of the MDI is investigated, and its distinctiveness from and associations with burnout are studied among a sample of Finnish social workers (n = 367). The MDI was shown to be a reliable and valid measure among the sample. The measures of MD and burnout were shown to tap separate constructs, although these experiences were strongly associated with each other. (shrink)

What is it about the nature of "soul" that makes it so difficult to adequately capture its complexity in a strictly discursive account? Why do some of the most profound human experiences elude our attempts to theorize them? How can a written document do justice to the dynamic activity of thinking, as opposed to merely presenting a collection of thoughts-as-artifacts? Finally, what can we learn about the activity of philosophizing, and about the human soul, by reflecting on the possibilities and (...) limitations of writing? These concerns, in various forms and in different registers, have preoccupied Michael Davis throughout his distinguished career. This volume is in honor of, and in dialogue with, Davis's work, which spans ancient philosophy and literature, continental philosophy and political philosophy. It includes original essays by numerous distinguished scholars in the fields of philosophy and political science. The remarkable range and caliber of the contributions attest to the breadth and depth of Davis's influence. The essays in Part I of the volume explore the nature of soul through the lens of tragedy. Part II consists of three essays that explore the human longing for perfect knowledge and completion--and the obstacles to the fulfilment of that longing--in relation to the divine. In Part III, the essays address the distinctive challenges of the political sphere and philosophy's relation to it. And while the relationship between philosophy and poetry is an implicit theme throughout the volume, the essays in Part IV focus directly on philosophy's aestheticizing tendencies. Many different philosophical and literary works are discussed throughout these chapters, including ancient works such as Plato's Republic, Euthydemus and Laws, Homer's Iliad, and Euripides' Trojan Women, as well as works by modern philosophers such as Rousseau, Kant, Hegel, Kierkegaard and Nietzsche. In addition, three essays analyze some of Shakespeare's plays in relation to the thought of Plato and Machiavelli. All of the essays are thematically linked by a common thread as they attend to the poetic dimension of philosophical thinking. Michael Davis is Professor of Philosophy at Sarah Lawrence College, where he has taught since 1977 and has been the Sarah Yates Exley Chair in Teaching Excellence (2003-2005). He has also taught on the graduate faculty at Fordham University and the New School for Social Research. He is the author of numerous articles and books, which include: Ancient Tragedy and the Origins of Modern Science; The Poetry of Philosophy: On Aristotle's Poetics; The Politics of Philosophy: A Commentary on Aristotle's Politics; The Autobiography of Philosophy; Rousseau's The Reveries of the Solitary Walker; Wonderlust: Ruminations on Liberal Education; and The Soul of the Greeks: An Inquiry. He is also co-translator (with Seth Benardete) of Aristotle's On Poetics. Contributors include: Abraham Anderson, Jonathan Badger, Robert Berman, Ronna Burger, Kenneth DeLuca, Gwenda-lin Grewal, Scott Hemmenway, Paul Kirkland, Mary Nichols, Denise Schaeffer, Paul Stern, Richard Velkley, Lisa Pace Vetter, Ann Ward, Lee Ward, Catherine Zuckert and Michael Zuckert. About the Editor: Denise Schaeffer is Professor of Political Science at the College of the Holy Cross. She is the author of Rousseau on Education, Freedom and Judgment and contributing co-editor (with Christopher Dustin) of Socratic Philosophy and Its Others. She is co-editor (with Gregory McBrayer and Mary P. Nichols) of the Focus Philosophical Library edition of Plato's Euthydemus, for which she authored the Introduction and co-authored the Interpretive Essay. (shrink)

While researchers have examined the types of ethical issues that arise in long-term care, few studies have explored long-term care nurses’ experiences of moral distress and fewer still have examined responses to initial moral distress. Using an interpretive description approach, 15 nurses working in long-term care settings within one city in Canada were interviewed about their responses to experiences of initial moral distress, resources or supports they identified as helpful or potentially helpful in dealing with these situations, and factors that (...) hindered nurses in their responses. Using a thematic analysis process, three major themes were identified from the nurses’ experiences: (i) the context of the situation matters; (ii) the value of coming together as a team; and (iii) looking for outside direction. The work of responding to initial moral distress was more fruitful if opportunities existed to discuss conflicts with other team members and if managers supported nurses in moving their concerns forward through meetings or conversations with the team, physician, or family. Access to objective others and opportunities for education about ethics were also identified as important for dealing with value conflicts. (shrink)

Jean-Luc Nancy is one of the leading contemporary thinkers in France today. Through an inventive reappropriation of the major figures in the continental tradition, Nancy has developed an original ontology that impacts the way we think about religion, politics, community, embodiment, and art. Drawing from a wide range of his writing, Marie-Eve Morin provides the first comprehensive and systematic account of Nancy’s thinking, all the way up to his most recent work on the deconstruction of Christianity. Without losing sight (...) of the heterogeneity of Nancy’s work, Morin presents a concise articulation of the organizing concepts, which structure Nancy’s body of work. The guiding thread is that of an essential rift at the heart of any “self” by which this self is exposed and relates to itself and other selves. Nancy’s ontology undercuts dichotomies between individual and community, interior and exterior, matter and spirit, thing and thought, not in the name of mere deconstruction, but in seeking to open a thinking of the “limit” or the “edge” as the locus of sense. While Nancy’s work has often been presented in relation to Heidegger or Derrida, Morin demonstrates the originality of Nancy’s work and argues that, despite the variety of its preoccupations and topics, it possesses its own rigorous internal logic. This book will be of interest to students and scholars of philosophy and related fields who seek a systematic and critical understanding of one of the most original contemporary thinkers. (shrink)

La correspondance de Pline le Jeune, publiée au II e siècle de notre ère, regorge de références à la mission de l’avocat. Bien que l’activité d’avocat ne soit pas la seule exercée par l’auteur, elle occupe une partie très importante de son temps, comme il le reconnaît lui-même, et remplit une fonction essentielle au sein de la société romaine. En assurant la défense des droits des femmes et des hommes qui le sollicitent, l’avocat s’assure de placer la justice et le (...) droit au cœur de la société et participe ainsi au renforcement du lien social. Une telle mission ne peut, selon Pline le Jeune, être confiée qu’à des hommes dont les qualités humaines sont supérieures et qui appartiennent de facto à la noblesse romaine. L’avocat plinien s’illustre par une noblesse de rang et d’âme. (shrink)

Recent efforts in a range of scientific fields have emphasised research and methods concerning individual differences and individualisation. This article brings together various scientific disciplines—ecology, evolution, and animal behaviour; medicine and psychiatry; public health and sport/exercise science; sociology; psychology; economics and management science—and presents their research on individualisation. We then clarify the concept of individualisation as it appears in the disciplinary casework by distinguishing three kinds of individualisation studied in and across these disciplines: Individualisation ONE as creating/changing individual differences (the (...) process that generates differences between individuals: intrapopulation or intraspecific variation/heterogeneity); Individualisation TWO as individualising applications (the tailoring or customising of something—information, treatment, a product or service, etc.—for an individual or specific group of individuals); and Individualisation THREE as social changes influencing autonomy, risk, and responsibilities (the process discussed under the rubric of sociological individualisation theory). Moreover, we analyse conceptual links between individualisation and individuality, and characterise different sorts of individuality that the disciplines study. This paper aims to promote interdisciplinary research concerning individualisation by establishing a common conceptual-theoretical basis, while leaving room for disciplinary differences. (shrink)

Contributing to both ageing research and queer-feminist scholarship, this article introduces feminist philosopher Margrit Shildrick’s queer notion of the monstrous to the subject of ageing and the issue of dealing with frailty within ageing research. The monstrous, as a norm-critical notion, takes as its point of departure that we are always already monstrous, meaning that the western ideal of well-ordered, independent, unleaky, rational embodied subjects is impossible to achieve. From this starting point the normalizing and optimizing strategies of ageing research (...) – here exemplified through the concept of successful ageing and the treatment of Alzheimer’s disease – can be problematized. The notion of the monstrous instead suggests a view on ageing and ‘monstrous’ embodiment which provides room for other, different ways of being recognized as an embodied subject, and for dealing with difference, vulnerability and frailty. (shrink)

This article addresses how bodily integrity has been mobilised in the context of genital cutting of male infants and the extent to which the concept is taken into account in legal decision-making in the United Kingdom. While bioethicists have debated whether interventions on children's bodies are more appropriately determined on the basis of hypothetical consent or in the child's best interest, it is clear that in law the relevant test is whether interventions are in the child's best interest. As the (...) issue of nonconsensual genital cutting of infants has become more contested, courts have been asked to adjudicate on the best interests of infants in situations where their caregivers disagree about procedures. Although this body of jurisprudence remains (surprisingly) small, in this article we argue that, while there are now discernible trends in such cases (e.g. deferring decision-making until the child has the requisite capacity to decide, engaging with certain human rights norms), too often judicial reasoning about a child's best interests remains largely empty of reasoned content, and in certain respects is regressing. Using the recent case of Re P to exemplify this logic, and drawing on our previous work advocating the value of embodied integrity, we argue that judges should adopt a more substantive framework of values in judging the child's corporeal and other interests in such cases. This would move best interests assessments beyond a mere formalistic exercise and lead to better reasoned legal judgements. (shrink)

The indexical word “I” has traditionally been assumed to be an overt analogue to the concept of self, and the best model for understanding it. This approach, I argue, overlooks the essential role of cognitive phenomenology in the mastery of the concept of self. I suggest that a better model is to be found in a different kind of representation: phenomenal concepts or more generally phenomenally grounded concepts. I start with what I take to be the defining feature of the (...) concept of self, namely its “super-reflexivity”: to use this concept is not just to think of oneself, but to think of oneself as the thinker of the present thought. I call this familiar observation the “Thinker Intuition”. I review some shortcomings of the indexical model of the concept of self, which is the classical account of the Thinker Intuition. I go on to propose a different account, the “phenomenal model”, according to which the concept of self is a phenomenally grounded concept, anchored in a generic kind of cognitive phenomenolog... (shrink)

This article examines how immigrant careworkers relate dynamically with the Norwegian gender regime. While the importation of careworkers contributes both to the practical maintenance and to the undermining on a more ideological level of the Norwegian gender regime, it also brings in new constellations and possibilities. In this article examples from two studies are discussed in the light of institutional and intersectional perspectives. It describes features of the Norwegian gender regime that are especially relevant to carework, and the highly gendered (...) distribution and sharing of carework across the public and private domains. One central Norwegian form of care institution, the nursing home, then comes into focus. Making use of empirical examples from fieldwork and interviews, the article discusses how, as immigrant careworkers increasingly staff these institutions, new light is thrown on existing power structures, while at the same time these structures may be challenged through the fluidity of situational and relational gendering processes. (shrink)

In recent years there has been an expansion of scientific work on consciousness. However, there is an increasing necessity to integrate evolutionary and interdisciplinary perspectives and to bring affective feelings more centrally into the overall discussion. Pursuant especially to the theorizing of Endel Tulving , Panksepp and Vandekerckhove we will look at the phenomena starting with primary-process consciousness, namely the rudimentary state of autonomic awareness or unknowing consciousness, with a fundamental form of first-person ‘self-experience’ which relies on affective experiential states (...) and raw sensory and perceptual mental existences, to higher forms of knowing and self-aware consciousness. Since current scientific approaches are most concerned with the understanding of higher declarative states of consciousness, we will focus on these vastly underestimated primary forms of consciousness which may be foundational for all forms of higher ‘knowing consciousness’. (shrink)

Motivation plays an important role in students’ school behavior, and research has established that students’ learning environment experiences such as teachers’ behavior toward them contribute to their motivation and behavior at school. Self-determination theory offers an interesting frame of reference in the study of the relationship between students’ learning experiences at school and their school behavior. Considering three basic psychological needs, the SDT points to the importance of nutriments and support in the social environment in order to allow growth in (...) motivation, engagement, and well-functioning. In addition, thwarting these needs is supposed to contribute to maladaptive functioning. Teachers can play an important role in the fulfillment of students’ basic psychological needs by delivering support ; however, controlling instructional behavior, chaos in the classroom, and teacher rejection and neglect are supposed to be a treat to the fulfillment of students’ basic psychological needs. In the current innovative longitudinal study, teachers’ need-supportive behavior as well as teachers’ thwarting of these needs are considered and their relationship with students’ academic engagement and procrastination behavior is studied. In addition, attention is paid to differential effects of teachers’ behavior with regard to boys and girls. Participants were 566 students belonging to 20 mathematics/English grade 1 secondary education classes in the Netherlands. Multilevel analyses revealed evidence for the importance of both teachers’ need-supportive and need-thwarting behaviors in relation to students’ academic engagement and procrastination behavior. In addition, the findings revealed that teachers’ need-supportive behavior is more important for students’ academic engagement, while teachers’ need-thwarting behavior has larger effects on students’ procrastination behavior. Furthermore, evidence was found that boys often seemed to be more sensitive to their teachers’ behavior than girls. The findings highlight the importance of both teachers’ need-supportive and need-thwarting behaviors in daily classrooms and contribute to deepen our insight into and understanding of factors leading to adaptive and maladaptive functioning of boys and girls in relation to learning tasks at school. (shrink)

In December 1967, Louis Washkansky, a grocer living in South Africa, became the first person to awaken after a heart transplant. Some accounts say that his first words were, “I am the new Frankenstein.” Others claim that Christiaan Barnard, his transplant surgeon, uttered these. Much as people have long mixed up who Frankenstein is—creature or creator?—in Mary Shelley's novel, so patient and surgeon, repaired and repairer, are confused in retellings of this post‐op Frankensteinian moment. Whether Washkansky identified with Frankenstein's monster (...) or not, he was probably feeling a bit monstrous after taking the donor heart of Denise Darvall into his chest. I know I was, over thirty years later, standing naked before a mirror and gazing at my shorn and bloated torso for the first time since a kidney transplant. My boundaries had been rearranged: a crescentic scar marked the frontier between me and not‐me. (shrink)

Within recent years, an increasing number of people and researchers in the Global North have become interested in psychedelic substances and their therapeutic application. While much of the current media attention and research effort mainly concentrate on the therapeutic potential and actions of the individual's acute psychedelic experience, this article explores the user-perceived, therapeutic dynamics of psychedelics in a more long-term perspective by charting the lived experiences and practices of ‘integration’ among psychedelic users in Denmark. Based on ethnographic fieldwork from (...) November 2020 to June 2021, I offer a dual typology of self-related integration as narrative and experiential-somatic. Combining the two, I argue that psychedelic integration in contemporary Denmark can be viewed as a processual self-transformation of the users' experiential orientation where understandings and/or modes of being from the acute psychedelic experience are woven into, prolonged, and/or embodied in their everyday existence. (shrink)

L'œuvre de Michel Foucault, à l'écart des modes intellectuelles de son temps, et à la croisée de la philosophie et de l'histoire, ne propose ni vision globale du monde ni théorie générale de la société.

This detailed commentary of Gellius' accounts of his teacher Taurus reconstructs the picture of this Middle Platonic philosopher as teacher and man and conveys interesting insights into the practice of philosophical teaching in the second century A.D. A collection of all testimonies and fragments of Taurus is added.

This dissertation develops a Kantian philosophical framework for understanding our individual obligations under public law. Because we have a right to do anything that is not wrong, the best interpretation of Immanuel Kant's Universal Principle of Right tracks the two ways--material and formal--in which actions can be wrong. This interpretation yields surprising insights, most notably a novel formulation of Kant's standard for formal wrongdoing. Because the wrong-making property of a formally wrong action does not depend on whether or not the (...) action in question has been prohibited by statute, Kant's legal philosophy is consistent with a natural law theory of public crime. Moreover, because the law can obligate us only by establishing a universal external incentive to obey its commands, statutes that impose only fines on nominal violators do not constrain our lawful options. Instead, if they are otherwise just, such statutes must be regarded as rightful permissive laws, according to which we may incur liabilities through our voluntary choices. (shrink)

Abstract: Interpretations of the Tractatus divide into what might be called a metaphysical and an anti-metaphysical approach to the work. The central issue between the two interpretative approaches has generally been characterised in terms of the question whether the Tractatus is committed to the idea of ‘things’ that cannot be said in language, and thus to the idea of a distinctive kind of nonsense: nonsense that is an attempt to say what can only be shown. In this paper, I look (...) at this dispute from a different perspective, by focusing on the treatment of the concept of internal relations. By reference to the work of Peter Hacker, Hidé Ishiguro and Cora Diamond, I show how this concept is understood quite differently in each of the two interpretative traditions. I focus particularly on how Wittgenstein's idea of the ‘internal relation of depicting that holds between language and the world’ (Tractatus 4.014) might be understood within the two interpretative approaches. I offer some reasons in support of the anti-metaphysical treatment of the concept. (shrink)

The topic of this special issue of Synthese is hyperintensionality. This introduction offers a brief survey of the very notion of hyperintensionality followed by a summary of each of the papers in this collection. The papers are foundational studies of hyperintensionality accompanied by ample philosophical applications.Hyperintensionality concerns the individuation of non-extensional entities such as propositions and properties, relations-in-intension and individual roles, as well as, for instance, proofs and judgments and computational procedures, in case these do not reduce to any of (...) the former. Hyperintensional individuation is frequently also referred to as ‘fine-grained’ or sometimes simply ‘intensional’ individuation, when ‘intensional’ is not understood in the specific sense of possible-world semantics or in the pejorative sense of flouting various logical rules of extensional logic. A principle of individuation qualifies as hyperintensional as soon as it is finer than necessary .. (shrink)

First Published in 1995. Routledge is an imprint of Taylor & Francis, an informa company.