This investigation develops in three steps. First, we seek to complexify the opioid crisis in a way that helps us to see how the issues of misguided desire and misplaced attachments are fundamentally important for a theological account of opioid addiction.1 Second, acknowledging the connections between pain and opioid addiction, we explore some of the ways in which our understanding of pain can influence our understanding of and responses to opioid use. Finally, we offer some tentative reflections on the theological (...) and ecclesial dimensions of the opioid crisis which hold the potential to influence the nature of a Christian response to the issues. Having laid out these steps, we argue for the church’s calling, where she complexifies the narratives about the opioid crisis and provides individuals suffering from opioid use “homeful” encounters with God and the community. (shrink)

Spirituality is a highly contested concept. Within the nursing literature, there are a huge range and diversity of definitions, some of which appear coherent whereas others seem quite disparate and unconnected. This vagueness within the nursing literature has led some to suggest that spirituality is so diverse as to be meaningless. Are the critics correct in asserting that the vagueness that surrounds spirituality invalidates it as a significant aspect of care? We think not. It is in fact the vagueness of (...) the concept that is its strength and value. In this paper, we offer a critique of the general apologetic that surrounds the use of the language of spirituality in nursing. With the critics, we agree that the term ‘spirituality’ is used in endlessly different and loose ways. Similarly, we agree that these varied definitions may not refer to constant essences or objects within people or in the world. However, we fundamentally disagree that this makes spirituality irrelevant or of little practical utility. Quite the opposite; properly understood, the vagueness and lack of clarity around the term spirituality is actually a strength that has powerful political, social, and clinical implications. We develop an understanding of spirituality as a way of naming absences and recognizing gaps in healthcare provision as well as a prophetic challenge to some of the ways in which we practise health care within a secular and sometimes secularizing context such as the National Health Service. (shrink)

This paper explores and develops a theological perspective on taking and receiving medication. It argues that the task of prescribing and administering psychopharmaceutical drugs is a thoroughly theological enterprise and should be looked at and practiced accordingly. The paper presents a theological anthropology that opens up space for rethinking the role of medication not only in relation to therapeutic intervention, but in relation to the chief end of human beings: to glorify God and live with God forever. Drawing on theology (...) and the narratives of people living with mental health challenges, the paper seeks to facilitate a movement from neurons to souls: a movement that realigns the goals of prescribing and opens up space to rethink the nature of “symptoms” and the ultimate intentions of the psychopharmacological enterprise. (shrink)

What do we mean when we call something or someone evil? The word "evil" tends to conjure up images of demons, devils, and horrifying crimes, things that you and I couldn't possibly get involved with! But is that true? Is evil really something that only wicked people who are "quite unlike ourselves" get up to? Could it be that you and I are not only capable of doing evil things, but are already involved with such things? This book explores the (...) hidden nature of evil and draws out the ways in which all of us, knowingly or otherwise, are caught up in webs of evil that bring about disastrous consequences, often to the weakest and most vulnerable amongst us. We need to find ways of learning to see evil and resisting it by all means possible. If we can't see evil, we can't resist it. If we can't resist it, we get sucked into it. (shrink)

I am grateful to Anastasia Scrutton for opening up a very important area for thought, reflection, and practice. Her paper presents a fascinating argument for an understanding of depression that is framed as a potentially spiritually transformative experience with positive therapeutic implications. In doing so, she offers a way for theologians, philosophers, and practitioners to effectively perceive, understand, and engage with the spiritual dimensions of the experience of depression. As such, she has made an important contribution to the ongoing and (...) often fraught conversations around the role of spirituality in understanding mental health issues. The models she outlines neatly encapsulates a broad range of... (shrink)

Following an initial study of the needs of healthcare providers (HCP) regarding the introduction of Medical Assistance in Dying (MAiD), and the subsequent development of an assisted dying program, this study sought to determine the efficacy and impact of MAiD services following the first two years of implementation. The first of three aims of this research was to understand if the needs, concerns and hopes of stakeholders related to patient requests for MAiD were addressed appropriately. Assessing how HCPs and families (...) perceived the quality of MAiD services, and determining if the program successfully accommodated the diverse needs and perspectives of HCPs, rounded out this quality evaluation. This research implemented a mixed-methods design incorporative of an online survey with Likert scale and open-ended questions, as well as focus groups and interviews with staff and physicians, and interviews with MAiD-involved family members. There were 356 online surveys, as well as 39 participants in six focus groups with HCP, as well as fourteen interviews with MAiD-involved family members. Participants indicated that high-quality MAiD care could only be provided with enabling resources such as policies and guidelines to ensure safe, evidence-based, standardized care, as well as a specialized, trained MAiD team. Both focus group and survey data from HCPs suggest the infrastructure developed by the hospital was effective in delivering high-quality MAiD care that supports the diverse needs of various stakeholders. This study may serve as a model for evaluating the impact and quality of services when novel and ethically-contentious clinical practices are introduced to healthcare organizations. (shrink)

BackgroundThe role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues.MethodsWe conducted seven (...) day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly.ResultsBroad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research.ConclusionBecause no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record for purposes other than clinical care. This could be done, for example, through a web-based patient portal to their electronic health record. Researchers and policy makers should continue to engage the public to promote greater public understanding of the research process and to look for feasible alternatives to existing approaches to project-specific consent for observational research. (shrink)

This study assessed the attitudes and needs of physicians and health professional staff at a tertiary care hospital in Canada regarding the introduction of physician assisted dying (PAD) during 2015–16. This research aimed to develop an understanding of the wishes, concerns and hopes of stakeholders related to handling requests for PAD; to determine what supports/structures/resources health care professionals (HCP) require in order to ensure high quality and compassionate care for patients requesting PAD, and a supportive environment for all healthcare providers (...) across the moral spectrum. This study constituted a mixed methods design with a qualitative descriptive approach for the study’s qualitative component. A total of 303 HCPs working in a tertiary care hospital completed an online survey and 64 HCPs working in hospital units with high mortality rates participated in 8 focus group discussions. Both focus group and survey data coalesced around several themes to support the implementation of PAD following the decriminalization of this practice: the importance of high quality care; honoring moral diversity; supporting values (such as autonomy, privacy, beneficence); and developing resources, including collaboration with palliative care, education, policies and a specialized team. This study provided the foundational evidence to support the development of the PAD program described in other papers in this collection, and can be a model for gathering evidence from stakeholders to inform the implementation of PAD in any healthcare organization. (shrink)

Abstract:This study examined the relationship between the individual difference variables of personal moral philosophy, locus of control, Machiavellianism, and just world beliefs and ethical judgments and behavioral intentions. A sample of 602 marketing practitioners participated in the study. Structural equation modeling was used to test hypothesized relationships. The results either fully or partially supported hypothesized direct effects for idealism, relativism, and Machiavellianism. Findings also suggested that Machiavellianism mediated the relationship between individual difference variables and ethical judgments/behavioral intentions.

This experimental study evaluated the influence of stated organizational concern for ethical conduct upon managerial behavior. Using an in-basket to house the manipulation, a sample of 113 MBA students with some managerial experience reacted to scenarios suggesting illegal conduct and others suggesting only unethical behavior. Stated organizational concern for ethical conduct was varied from none (control group) to several other situations which included a high treatment consisting of a Code of Ethics, an endorsement letter by the CEO and specific sanctions (...) for managerial misconduct. Only in the case of suggested illegal behavior tempered by high organizational concern were managers influenced by organizational policy to modify the morality of their actions. However, the responses to the illegal scenarios were significantly more ethical than the reactions given to the unethical (but not illegal) situations. The implications of these findings are then discussed. (shrink)

This study is the most comprehensive account to date of modern treatments of the love commandment. Gene Outka examines the literature on agape from Nygren's Agape and Eros in 1930. Both Roman Catholic and Protestant writings are considered, including those of D'Arcy, Niebuhr, Ramsey, Tillich, and above all, Karl Barth. The first seven chapters focus on the principal treatments in the theological literature as they relate to major topics in ethical theory. The last chapter explores further the basic normative (...) content of agape and discusses some of the most characteristic problems. "The book is in my judgment the best recent work in religious ethics. Outka brings together analytic moral philosophy and theological ethics, providing a masterly survey of views and issues arising in the past forty years.... I can think of few books of interest to scholars in both philosophy and theology, but Outka's is one. Unlike some scholars who are at home in continental theology, Outka is also at home in secular analytic philosophy; he brings them together in a mutually illuminating way."--Donald Evans "Outka has mastered this vast literature on love, and has brought a critical and clarifying analysis to bear upon it. This is a most important book on a most important subject, and brings the whole discussion into a new phase."--John Macquarrie "The first thing to be said about Outka's book quite simply is that it is excellent; in fact, it is probably the very best available book about contemporary Christian ethical theory."--The Humanities Association Review. (shrink)

This paper begins by examining several potentially unethical recent marketing practices. Since most marketing managers face ethical dilemmas during their careers, it is essential to study the moral consequences of these decisions. A typology of ways that managers might confront ethical issues is proposed. The significant organizational, personal and societal costs emanting from unethical behavior are also discussed. Both relatively simple frameworks and more comprehensive models for evaluating ethical decisions in marketing are summarized. Finally, the fact that organizational commitment to (...) fostering ethical marketing decisions can be accomplished by top management leadership, codes of ethics, ethics seminars/programs and ethical audits is examined. (shrink)

The role of imagery in encoding event-based prospective memories has yet to be fully clarified. Herein, it is argued that imagery augments a cue-to-context association that supports event-based prospective memory performance. By this account, imagery encoding not only improves prospective memory performance but also reduces interference to intention-related information that occurs outside of context. In the current study, when lure words occurred outside of the appropriate responding context, the use of imagery encoding strategies resulted in less interference when compared with (...) a standard event-based intention condition. This difference was eliminated when participants were not given a specific context to associate their intention . These results support a cue-to-context association account of how imagery operates in certain event-based prospective memory tasks. (shrink)

Research findings on addiction are contradictory. According to biographical records and widely used diagnostic manuals, addicts use drugs compulsively, meaning that drug use is out of control and independent of its aversive consequences. This account is supported by studies that show significant heritabilities for alcoholism and other addictions and by laboratory experiments in which repeated administration of addictive drugs caused changes in neural substrates associated with reward. Epidemiological and experimental data, however, show that the consequences of drug consumption can significantly (...) modify drug intake in addicts. The disease model can account for the compulsive features of addiction, but not occasions in which price and punishment reduced drug consumption in addicts. Conversely, learning models of addiction can account for the influence of price and punishment, but not compulsive drug taking. The occasion for this target article is that recent developments in behavioral choice theory resolve the apparent contradictions in the addiction literature. The basic argument includes the following four statements: First, repeated consumption of an addictive drug decreases its future value and the future value of competing activities. Second, the frequency of an activity is a function of its relative (not absolute) value. This implies that an activity that reduces the values of competing behaviors can increase in frequency even if its own value also declines. Third, a recent experiment (Heyman & Tanz 1995) shows that the effective reinforcement contingencies are relative to a frame of reference, and this frame of reference can change so as to favor optimal or suboptimal choice. Fourth, if the frame of reference is local, reinforcement contingencies will favor excessive drug use, but if the frame of reference is global, the reinforcement contingencies will favor controlled drug use. The transition from a global to a local frame of reference explains relapse and other compulsive features of addiction. (shrink)

This volume centers on debates about how far moral judgments bind across traditions and epochs. Nowadays such debates appear especially volatile, both in popular culture and intellectual discourse: although there is increasing agreement that the moral and political criteria invoked in human rights documents possess cross-cultural force, many modern and postmodern developments erode confidence in moral appeals that go beyond a local consensus or apply outside a particular community. Often the point of departure for discussion is the Enlightenment paradigm of (...) a common morality, in which it is assumed that certain unchanging beliefs inhere in the structure of human reason. Whereas some thinkers continue to defend this paradigm, others modify it in diverse ways without abandoning entirely the attempt to address a universal audience, and still others jettison virtually all of its distinguishing features. Exhibiting a range of positions Western participants take in these debates, this volume seeks to advance the substance of the debates themselves without prejudging the outcome. Rival assessments of the Enlightenment paradigm are offered from various philosophical and theological points of view. In addition to the editors, the contributors include Robert Merrihew Adams, Annette C. Baier, Alan Donagan, Margaret A. Farley, Alan Gewirth, David Little, Richard Rorty, Jeffrey Stout, and Lee H. Yearley. (shrink)

Recent work by Jaegwon Kim and others suggest that functionalism leaves mental properties causally inefficacious in some sense. I examine three lines of argument for this conclusion. The first appeals to Occam's Razor; the second appeals to a ban on overdetermination; and the third charges that the kind of response I favor to these arguments forces me to give up "the homogeneity of mental and physical causation". I show how each argument fails. While I concede that a positive theory of (...) mental causation is desirable, there is no reason to think that functionalism renders such a theory unattainable. (shrink)

We all live our daily lives surrounded by the products of technology that make what we do simpler, faster, and more efficient. These are benefits we often just take for granted. But at the same time, as these products disburden us of unwanted tasks that consumed much time and effort in earlier eras, many of them also leave us more disengaged from our natural and even human surroundings. It is the task of what Gene Moriarty calls focal engineering to (...) create products that will achieve a balance between disburdenment and engagement: “How much disburdenment will be appropriate while still permitting an engagement that enriches one’s life, elevates the spirit, and calls forth a good life in a convivial society?” One of his examples of a focally engineered structure is the Golden Gate Bridge, which “draws people to it, enlivens and elevates the human spirit, and resonates with the world of its congenial setting. Humans, bridge, and world are in tune.” These values of engagement, enlivenment, and resonance are key to the normative approach Moriarty brings to the profession of engineering, which traditionally has focused mainly on technical measures of evaluation such as efficiency, productivity, objectivity, and precision. These measures, while important, look at the engineered product in a local and limited sense. But “from a broader perspective, what is locally benign may present serious moral problems,” undermining “social justice, environmental sustainability, and health and safety of affected parties.” It is this broader perspective that is championed by focal engineering, the subject of Part III of the book, which Moriarty contrasts with “modern” engineering in Part I and “pre-modern” engineering in Part II. (shrink)

The political systems of the Roman Republic were based almost entirely on tradition, “the way of the ancestors”, rather than on a written constitution. While the founders of the American Republic looked to ancient Rome as a primary model for their enterprise, nevertheless, in line with the rationalist spirit of their age, the American founders attempted to create a rational set of rules that would guide the conduct of American politics, namely, the US Constitution.These two examples offer a striking case (...) of the ideal types, famously delineated by Michael Oakeshott in “Rationalism in Politics” and elsewhere, between politics as a practice grounded in tradition and politics as a system based on principles flowing from abstract reasoning.This book explores how the histories of the two republics can help us to understand Oakeshott’s claims about rational versus traditional politics. Through examining such issues we may come to understand better not only Oakeshott’s critique of rationalism, but also modern constitutional theory, issues in the design of the European Union, and aspects of the revival of republicanism. (shrink)

This book exhibits the centrality of hope in Kant's critical philosophy, and brings into question the rationality of that hope, and how the question of that rationality can be raised. The question of the rationality of hope is further explored through Kierkegaard's writing.

Medical assistance in dying (MAiD) in Canada is a complex, novel interprofessional practice governed by stringent legal criteria. Often, patients need assistance navigating the system, and MAiD providers/assessors struggle with the administrative challenges of MAiD. Resultantly, the role of the MAiD care coordinator has emerged across the country as a novel practice dedicated to supporting access to MAiD and ensuring compliance with regulatory requirements. However, variability in the roles and responsibilities of MAiD care coordinators across Canada has highlighted the need (...) for accountability and standardization for this practice. This manuscript constitutes a first attempt to describe this emerging role, through discussion of proposed standards of practice, as well as roles and responsibilities, and ethical duties of this emergent professional practice. We detail the core commitments of MAiD care coordinators to patients, providers/assessors and institutions involved in the MAiD process. We address the core competencies that inform the unique skillset required by MAiD care coordinators to facilitate high-quality care, while highlighting the moral and ethical considerations embedded in this work. To illustrate the complexity of the MAiD care coordinator role, case examples involving ethical dilemmas encountered in practice are included. Finally, a code of ethics is proposed to serve as a guide for appropriate professional practice and conduct. This manuscript is intended to illustrate the importance of transparency and accountability for this new role that provides service to vulnerable patients and families; this is especially critical as the ethical complexity of MAiD is likely to increase with future changes in legislation opening MAiD access to new populations. (shrink)

While self-report data is a staple of modern psychological studies, they rely on participants accurately self-reporting. Two constructs that impede accurate results are insufficient effort responding and response styles. These constructs share conceptual underpinnings and both utilized to reduce cognitive effort when responding to self-report scales. Little research has extensively explored the relationship of the two constructs. The current study explored the relationship of the two constructs across even-point and odd-point scales, as well as before and after data cleaning procedures. (...) We utilized IRTrees, a statistical method for modeling response styles, to examine the relationship between IER and response styles. To capture the wide range of IER metrics available, we employed several forms of IER assessment in our analyses and generated IER factors based on the type of IER being detected. Our results indicated an overall modest relationship between IER and response styles, which varied depending on the type of IER metric being considered or type of scale being evaluated. As expected, data cleaning also changed the relationships of some of the variables. We posit the difference between the constructs may be the degree of cognitive effort participants are willing to expend. Future research and applications are discussed. (shrink)

After briefly presenting Ronald Giere's (1979, 1980) recent counterfactual characterization of population-level causation, I present two counterexamples to the characterization. The difficulty discussed stems from nonaccidental correlations that can obtain between causally effective and causally neutral factors.

After summarizing Weber's description of the 'ethic of ultimate ends' and the 'ethic of responsibility', the assumptions underlying his classification are examined, especially the relationship of violent and non-violent means to politics and to political responsibility. It is argued that the two assumptions underlying the classification have been demonstrated by events since his 1918 lecture to be invalid. Therefore the classification itself no longer has validity. Its rejection has political implications and requires fresh attention to the problems of political ethics. (...) The outline of a possible alternative classification of political ethics, focused on their view of means and ends, is tentatively offered as a stimulus to further thought. (shrink)

In this book, author Gene Fendt shows how Plato's Republic provides a liturgical purification for the political and psychic delusions of democratic readers, even as Socrates provides the same for his interlocutors at the festival of Bendis. Each of the several characters is analyzed in accord with Book Eight's 6 geometrically possible kinds of character showing how their answers and failures in the dialogue exhibit the particular kind of movement and blindness predictable for the type.

This paper brings Lyotard into connection with the discussions of Socrates in REPUBLIC concerning general libidinal economy and its relation to the logos in human beings. Since desire is always the desire to be amoral -- not to recognize the person as subject, but rather recognizing it as a market for the capital gain of desire, it is to be suspected that desire within the subject is the cause of so-called differends between subjects. This is what Republic is about.

Camus is defined by many as an absurdist philosopher of revolt. The Plague, however, shows him working rigorously through a well-known division between ancient and modern ethics concerning the relation of reason, feeling and happiness. For Aristotle, the virtues are stable dispositions including affective and intellectual elements. For Kant, one’s particular feelings are either that from which we must abstract to judge moral worth, or are a constant hindrance to proper moral activity. Further, Kant claims “habit belongs to the physical (...) nature of the determination of the will,” which seems to imply habit cannot be a moral determination at all. A related disagreement regards virtue and happiness. Aristotle’s happiness is “an activity of the soul in accord with virtue.” For Kant and other moderns, happiness is an ideal of imagination, “a maximum of well-being in my present, and in every future, state,” all the elements of which “are without exception empirical.” Thus happiness seems more the constant counterweight to moral action than its fulfillment. Kant and Aristotle agree, however, in their judgment of many characters and actions, as is illustrated in The Plague. The novel provides realistic insights into a philosophical agreement between these supposed oppositions. In particular, I show how both philosophers would agree in their judgements concerning both the relative goodness and relative happiness of Joseph Grand and Raymond Rambert. The illustration of this agreement proves Camus is valorizing a traditional ethic. (shrink)

The question of whether (and, within the believing communities, the agreement that) scripture is a source and canon for moral discernment and judgment must be distinguished from the question of what this source provides or how this canon functions as a norm.1.

This article describes and reflects upon Australia's extensive, federally-mandated, environmental education program. This program is based on a National Conservation Strategy which went into effect in 1989. But the program has massive support on the state and local levels as well. In addition to traditional classroom study of the environment and environmental issues, Audtralian Students do composting, re-vegetation of local canyons, and other hands-on activities. In many areas of the students' deatiledreports become the data base for the government's environmental monitoring (...) program. A remarkable aspect of environmental education in Australia is the web of groups and individuals who are involved: local farmers, Aboriginal peoples, banks, local nurseries, and all levels of government, along with environmental organizations like Greening Astraila and Landcare.In contrast to Australia, the United States lacks a systematic educational program focused on the environment. The article concludes by summarizing the strengths of the Australian program and criticizing the American failure to establish such a program. Reasons for this failure are suggested. Finally, a general contrast is offered, showing the differences between two philosophies of education—the Technocratic Philosophy of Education vs. the Holistic Philosophy of Education. (shrink)