Background: For the experience of end-of-life care to be ‘good’ many ethical challenges in various relationships have to be resolved. In this article, we focus on challenges in the nurse–next of kin relationship. Little is known about difficulties in this relationship, when the next of kin are seen as separate from the patient. Research problem: From the perspective of nurses: What are the ethical challenges in relation to next of kin in end-of-life care? Research design: A critical qualitative approach was (...) used, based on four focus group interviews. Participants: A total of 22 registered nurses enrolled on an Oncology nursing specialisation programme with experience from end-of-life care from various practice areas participated. Ethical considerations: The study was approved by the Norwegian Social Science Data Service, Bergen, Norway, project number 41109, and signed informed consent obtained from the participants before the focus groups began. Findings and discussion: Two descriptive themes emerged from the inductive analysis: ‘A feeling of mistrust, control and rejection’ and ‘Being between hope and denial of next of kin and the desire of the patient to die when the time is up’. Deductive reinterpretation of data (in the light of moral distress from a Feminist ethics perspective) has made visible the constraints that certain relations with next of kin in end-of-life care lay upon the nurses’ moral identity, the relationship and their responsibility. We discuss how these constraints have political and societal dimensions, as well as personal and relational ones. Conclusion: There is complex moral distress related to the nurse–next of kin relationship which calls for ethical reflections regarding these relationships within end-of-life care. (shrink)

This article focuses on what both psychoanalysis and anthropology have in common: the emphasis on the researcher's own experience. An ethnographic fieldwork will be used to illustrate how a psychoanalytical approach unfolds the material when studying conditions for learning from experience among teachers in two Norwegian junior high schools, and also the strong methodological implications of this approach. The researcher's struggle to remain open is elaborated. Here "openness" is regarded as something more than a principle for research practice. It is (...) a way to relate both to oneself and the other, to emotions as well as actions, to the inner as well as the external world. (shrink)

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based (...) on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed "medically inappropriate" will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience. (shrink)

Research on the cognitive consequences of bilingualism typically proceeds by labeling participants as “monolingual” or “bilingual” and comparing performance on some measures across these groups. It is well-known that this approach has led to inconsistent results. However, the approach assumes that there are clear criteria to designate individuals as monolingual or bilingual, and more fundamentally, to determine whether a communication system counts as a unique language. Both of these assumptions may not be correct. The problem is particularly acute when participants (...) are asked to classify themselves or simply report how many languages they speak. Participants' responses to these questions are shaped by their personal perceptions of the criteria for making these judgments. This study investigated the perceptions underlying judgments of bilingualism by asking 528 participants to judge the extent to which a description of a fictional linguistic system constitutes a unique language and the extent to which a description of a fictional individual's linguistic competence qualifies that person as bilingual. The results show a range of responses for both concepts, indicating substantial ambiguity for these terms. Moreover, participants were asked to self-classify as monolingual or bilingual, and these decisions were not related to more objective information regarding the degree of bilingual experience obtained from a detailed questionnaire. These results are consistent with the notion that bilingualism is not categorical and that specific language experiences are important in determining the criteria for being bilingual. The results impact interpretations of research investigating group differences on the cognitive effects of bilingualism. (shrink)

ChatGPT launched in November 2022, triggering a global debate on the use of artificial intelligence (AI). A debate on AI-enabled lethal autonomous weapon systems (LAWS) has been underway far longer. Two sides have emerged: one in favor and one opposed to an international law ban on LAWS. This essay explains the position of advocates of a ban without attempting to persuade opponents. Supporters of a ban believe LAWS are already unlawful and immoral to use without the need of a new (...) treaty or protocol. They nevertheless seek an express prohibition to educate and publicize the threats these weapons pose. Foremost among their concerns is the “black box” problem. Programmers cannot know what a computer operating a weapons system empowered with AI will “learn” from the algorithm they use. They cannot know at the time of deployment if the system will comply with the prohibition on the use of force or the human right to life that applies in both war and peace. Even if they could, mechanized killing affronts human dignity. Ban supporters have long known that “AI models are not safe and no one knows how to reliably make them safe” or morally acceptable in taking human life. (shrink)

This article aims to examine existential meaning constructions from an action theoretical perspective in a specific Internet environment: the personal homepage. Personal homepages are on-line multi-media documents addressing the question ‘Who am I?’ Authors of personal homepages provide information on both their personal and public identity. These identity constructions sometimes include reflections on the meaning of life. Answers to questions on the meaning of life reflect the way in which individuals assign ultimate meanings to human life, and consist of three (...) key components: orientation, beliefs, and experience. This paper aims to examine existential meaning constructions from a action theoretical perspective in a specific Internet environment: the personal homepage. Findings are reported of a qualitative content analysis of answers to the meaning of life provided in a sample of 42 personal homepages. We found that most answers to the meaning of life could be interpreted either as ‘divine/religious’, ‘experience centered’, ‘cosmic’, or ‘social utopian’. The answers provided on the homepages showed similarities with findings reported in other studies on existential meaning. In addition, we found that this Internet environment offers new venues for expressing orientation, beliefs, and experience reflecting answers to the meaning of life. (shrink)

How do people create coherence? Is it this creation of coherence which makes life understandable? Is not also faith, the belief in God, grounded on such a belief that the universe is understandable, although not to us? Our coherence building is not merely an individual activity, but thoroughly influenced by our education, religion, culture, and the society we live in. These provide us with conventions of thinking and knowledge, they are the building blocks of our construction of coherence. However, sometimes (...) they have become the fossilized ideas never to be questioned. The main question of this article is if linearity in the western tradition of causal thinking is not such a fossilized idea. Starting point is the story of the beginning in Gen. 1, because it is one of the fundamental proteins in the DNA string of the Jewish and Christian linear thinking. The aim of the article is to show how a non-linear approach to our conventions of coherence building may offer a more comprehensive view on causality, and how tales of vision in the Hebrew Bible, and especially in Genesis 1-3, support and broaden this view. (shrink)

Ellen Meiksins Wood is a leading contemporary political theorist who has elaborated an innovative approach to the history of political thought, the social history of political theory .

Ellen Feder's monograph is an attempt to think about the categories of race and gender together. She explains and then employs some critical tools derived from Foucault, in order to advance her main argument: that the institution of the family is the locus of the production of gender and race, and that gender is best understood as a function of a "disciplinary" power that operates within the family, while race is the function of a "regulatory" power acting upon the (...) family from outside. Her interdisciplinary work will be of interest to feminist philosophers and theorists because it plays into a recent expansion of interest in the family, as well as to literary scholars of Foucault, to scholars of race and race theory, and to other feminist scholars in political science, sociology, anthropology, and cultural studies. (shrink)

The annual volume of ethics consultations (ECs) has been a topic of interest in the bioethics literature, in part because of its presumed relationship to quality. To better understand factors associated with EC volume, we used multiple linear regression to model the number of case consultations performed in the last year based on a national survey. We found that hospital bed size, academic affiliation, and urban/rural location were all associated with EC volume, but were not the primary drivers. Instead, these (...) variables affected EC volume through three other variables, all of which relate to ethics staffing: the percentage of case consultations performed by a single individual; whether the survey respondent’s main role at the hospital contained the word “ethics”; and especially, the number of full-time ethics program staff. We conclude that EC is an example of supply-sensitive care, and further research is needed to determine the optimal level of EC activity. (shrink)

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

Coverage error is an important type of error that occurs in survey studies when there is a mismatch between the target population and the sampling frame from which a sample is drawn. Coverage error...

This document presents the Bonn PRINTEGER Consensus Statement: Working with Research Integrity—Guidance for research performing organisations. The aim of the statement is to complement existing instruments by focusing specifically on institutional responsibilities for strengthening integrity. It takes into account the daily challenges and organisational contexts of most researchers. The statement intends to make research integrity challenges recognisable from the work-floor perspective, providing concrete advice on organisational measures to strengthen integrity. The statement, which was concluded February 7th 2018, provides guidance on (...) the following key issues: § 1.Providing information about research integrity § 2.Providing education, training and mentoring § 3.Strengthening a research integrity culture § 4.Facilitating open dialogue § 5.Wise incentive management § 6.Implementing quality assurance procedures § 7.Improving the work environment and work satisfaction § 8.Increasing transparency of misconduct cases § 9.Opening up research § 10.Implementing safe and effective whistle-blowing channels § 11.Protecting the alleged perpetrators § 12.Establishing a research integrity committee and appointing an ombudsperson § 13.Making explicit the applicable standards for research integrity. (shrink)

Microbes are generally thought of as unicellular organisms, but we know that many microbes live as parts of biofilms—complex, surface-attached microbial communities numbering millions of cells. Some authors have recently argued in favour of reconceiving biofilms as biological entities in their own right. In particular, some have claimed that multispecies biofilms are evolutionary individuals : 10126–10132 2015). Against this view, I defend the conservative consensus that selection acts primarily upon microbial cells.

One of the hallmarks of virtue is reliably acting well. Such reliable success presupposes that an agent is able to recognize the morally salient features of a situation, and the appropriate response to those features and is motivated to act on this knowledge without internal conflict. Furthermore, it is often claimed that the virtuous person can do this in a spontaneous or intuitive manner. While these claims represent an ideal of what it is to have a virtue, it is less (...) clear how to make good on them. That is, how is it actually possible to spontaneously and reliably act well? In this paper, we will lay out a framework for understanding how it is that one could reliably act well in an intuitive manner. We will do this by developing the concept of an action schema, which draws on the philosophical and psychological literature on skill acquisition and self-regulation. In short, we will give an account of how self-regulation, grounded in skillful structures, can allow for the accurate intuitions and flexible expertise required for virtue. While our primary goal in this paper is to provide a positive theory of how virtuous intuitions might be accounted for, we also take ourselves to be raising the bar for what counts as an explanation of reliable and intuitive action in general. (shrink)

In this groundbreaking work, Ellen Meiksins Wood rewrites the history of political theory, from Plato to Rousseau. Treating canonical thinkers as passionately engaged human beings, Wood examines their ideas not simply in the context of political languages but as creative responses to the social relations and conflicts of their time and place. She identifies a distinctive relation between property and state in Western history and shows how the canon, while largely the work of members or clients of dominant classes, (...) was shaped by complex interactions among proprietors, labourers and states. Western political theory, Wood argues, owes much of its vigour, and also many ambiguities, to these complex and often contradictory relations. In this new edition, incorporating both volumes, the book takes us from classical antiquity to the age of enlightenement. In the first volume, Wood traces the development of the Western tradition from classical antiquity through to the Middle Ages in the perspective of social history--a significant departure not only from the standard abstract history of ideas but also from other contextual methods. In the second volume, Wood moves on to explore the formation of the modern state, the rise of capitalism, the Renaissance and Reformation, the scientific revolution and the Age of Enlightenment. In her focus on canonical thinkers through the ages, Wood illuminates a rich and provocative legacy of political ideas unmatched in Western history"--Publisher's website. (shrink)

Myriad Genetics holds a patent on testing for the hereditary breast and ovarian cancer genes, BRCA1 and BRCA2, and therefore has a forced monopoly on this critical genetic test. Myriad launched a Direct-to-Consumer (DTC) marketing campaign in the Northeast United States in September 2007 and plans to expand that campaign to Florida and Texas in 2008. The ethics of Myriad's patent, forced monopoly and DTC campaign will be reviewed, as well as the impact of this situation on patient access and (...) care, physician liability, and the future of DTC campaigns for genetic testing. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

In this discussion, we ponder the discourse about the ‘body of the Divine’ in the Indian tradition. Beginning with the Vedas, we survey the major eras and thinkers of that tradition, considering various notions of the Supreme Divine Being it produced. For each, we ask: is the Divine embodied? If so, then in what way? What is the nature of the body of the Divine, and what is its relationship to human bodies? What is the value of the body of (...) the Divine to the spiritual aspirant? We consider, where relevant, which views are pantheistic and which might be considered panentheistic. Panentheism is connected with discourse on the world as the body of God. It has origins in medieval Christian theology with anticipatory traces in Plato’s Timeaus. Under pantheism, were the world to end—were it to collapse or disappear irreversibly, perhaps, into a huge black hole—then God would disintegrate without a remainder as well; for in this view the Divine Spirit is the universe. The same is not true under panentheism which posits a more complex relationship between the Divine and the world. According to panentheism, God pervades the world—God is in the world—and at the same time, God sustains the world—the world is in God. This allows that God be greater than, transcendent of and independent of the world. In our conclusion we remark on how the views we have surveyed link to, resonate with, or dis-compare with the current—should one say revivified—interest in intellectual quarters with panentheism. (shrink)

When reflecting on the nature of skilled action, it is easy to fall into familiar dichotomies such that one construes the flexibility and intelligence of skill at the level of intentional states while characterizing the automatic motor processes that constitute motor skill execution as learned but fixed, invariant, bottom-up, brute-causal responses. In this essay, I will argue that this picture of skilled, automatic, motor processes is overly simplistic. Specifically, I will argue that an adequate account of the learned motor routines (...) that constitute embodied skills cannot be given in a purely bottom-up, brute-causal fashion. Rather, motor control is intelligent all the way down. To establish this, I will first review two recent accounts of skill, Stanley and Krakauer and Papineau, which characterize the automatic motor control responsible for the fine-grained movements constitutive of motor skill as brute, low-level phenomena. I will then isolate five key features that should apply to skilled motor control, if these accounts are correct. Together, the accounts posit that motor control is: ballistic, invariant, independent of general action trajectories, Insensitive to semantic content, and independent of personal-level intentions. In the final section of this paper, I will appeal to optimal control theory for empirical evidence to challenge the commitment to skilled action as qualified by the above features. (shrink)

Interest in teaching business ethics classes on college campuses has increased dramatically during the past decade. In the United States, virtually all graduate and undergraduate business programs teach business ethics in some form. While current pedagogy relies primarily on factual recounting of actual workplace incidents and actual and hypothetical case studies, calls for multidisciplinary approaches to teaching business ethics have not yet produced significant pedagogical change. We propose the use of fiction (novels, dramas, and short stories) to enrich current teaching (...) materials. This paper illustrates the tremendous power of stories which deal with ethical dilemmas in business to illuminate moral issues in ways that lead to a clearer understanding of ethical theory. The fiction cited in this paper is all drawn from American literature. It seems likely that similar sources could be found in the literature of other countries. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)