Background There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard “narrow” definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. Research aims To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. Research design (...) A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. Participants Registered nurses from four hospitals within one large healthcare system in Midwest United States. Ethical considerations IRB approval was obtained. Results 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by “other” distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. Conclusions Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed. (shrink)

Background: Pre-licensure ethics nursing education does not adequately prepare and instill confidence in nurses to address ethical issues, and yet ethics education provides nurses with greater confidence to take moral action, which can mitigate the negative effects of moral distress. Objectives: To assess the feasibility and acceptability of a nursing ethics education program that included simulated case-based ethics competencies as a form of evaluation. The program aimed at building nurses’ ethical knowledge and confidence to respond to ethical challenges in practice. (...) Research design: A prospective, longitudinal, correlational, single-cohort feasibility study using an investigator-developed survey and intervention field data. Participants and research context: Registered nurses were recruited from an academic quaternary-care medical center and 9 small- to mid-sized regional hospitals within one health system in the Midwest United States. Ethical considerations: IRB approval was obtained. Participants could complete the educational program regardless of research process participation. Findings: Of 20 participants, 19 (95%) provided post-program surveys and 18 completed competencies. Median (IQR) scores with quartiles for scheduling, timing, and length of sessions were all 10.0 [9.0, 10.0], and participants perceived that the content was interesting, increased knowledge and confidence in ethics, increased skills in providing ethical care, and would recommend the program to colleagues. Of factors, an increase in ethics knowledge had the highest “always agree” (17, 89.5%) response. Most participants reported that ethics competencies were appropriate 9.0 [9.0, 10.0] and sufficiently challenging 10.0 [9.0, 10.0]. Discussion: The education program developed nurses’ ethics knowledge and confidence. The single-cohort feasibility design provided early-stage intervention outcomes; however, a larger randomized controlled trial would substantiate program value. Conclusion: This novel ethics education program was highly feasible and acceptable to hospital-based nurses who reported increased knowledge and confidence in providing ethical care. Simulated case-based ethics competencies were an appropriate evaluation method. (shrink)

Woodward's long awaited book is an attempt to construct a comprehensive account of causation explanation that applies to a wide variety of causal and explanatory claims in different areas of science and everyday life. The book engages some of the relevant literature from other disciplines, as Woodward weaves together examples, counterexamples, criticisms, defenses, objections, and replies into a convincing defense of the core of his theory, which is that we can analyze causation by appeal to the notion of manipulation.

Journal of Religious Ethics, Volume 50, Issue 1, Page 7-19, March 2022.

I, for one, am grateful to Peter Ubel, Karen Scherr, and Angela Fagerlin (2017) for their important and illuminating reflections on medical decision making, particularly in the context of preferenc...

Argues that Wittgenstein's early ethical notion of agreement with the world pivoted to become his later therapeutic notion of agreement with living forms, which satisfies the conditions necessary for a full therapeutic philosophy.

This paper explores the relation of Foucault’s notion of counter-conduct to the Stoic notion of oikeiosis. Initially, oikeisosis is set against Platonic homoiosis, specifically as discussed in the Alcibiades, which provides what Foucault calls the “Platonic model” of conduct. The paper examines what Foucault means by “care of the self” and points to its difference from the Delphic maxim “know yourself” that centered on a principle of homoiosis, or ethical transcendence. Noting how the problematic of care of the self leads (...) to what Foucault calls “the government of conduct,” the paper considers the possibility of “counter-conduct.” Given that Foucault has argued that the autonomy of conduct has been rendered invisible through its “juridification,” this paper proceeds with a genealogy of the codification of morals in natural law theory. This culminates with the sixteenth century return to Stoicism in the person of Grotius. Showing that a certain conception of counter-conduct present in Gerson is transformed in natural law theory into a juridical grounding of the government of conduct, this paper draws out the immanent relation of conduct and counter-conduct in the notion of appropriation. Arguing that Grotius has fundamentally misunderstood the concept of oikeiosis, which he takes from Cicero and which subtends his theory of appropriation, this paper suggests that a return to the early Stoic formulation of oikeiosis allows for a rethinking of the problem of the government of conduct. A certain moralization of action, irreducible to codification that is present in early Stoic thought provides a model of “counter-conduct.” Ultimately, “care of the self,” as it is given in Stoic philosophy, relates the subject of action to the principle of ethical immanence that grounds Foucault’s critique of the subject. (shrink)

_Considers the notable similarities between the thought of Confucius and Wittgenstein._.

The explanation of inertia based on “Mach's principle” is briefly revisited and an experiment whereby the gravitational origin of inertia can be tested is described. The test consists of detecting a small stationary force with a sensitive force sensor. The force is presumably induced when a periodic transient Mach effect mass fluctuation is driven in high voltage, high energy density capacitors that are subjected to 50 kHz, 1.3 kV amplitude voltage signal, and threaded by an alternating magnetic flux of the (...) same frequency. An effect of the sort predicted is shown to be present in the device tested. It has the expected magnitude and depends on the relative phase of the Mach effect mass fluctuation and the alternating magnetic flux as expected. The observed effect also displays scaling behaviors that are unique to Mach effects. Other tests for spurious signals suggest that the observed effect is real. (shrink)

Knowledge through what others tell us not only forms a large part of the body of our knowledge but also originates the patterns of appraisal according to which we add beliefs to our present store of knowledge.1 I do not mean merely that what we add is often accepted from persons who have already contributed to our knowledge; beyond that, we have acquired habits of thought, tendencies to suspect and tendencies to approve both other-person-reports and purported perceptions, from our testimonial (...) relationships with others. For instance, who would not hesitate to say he saw a particular acquaintance (John Doe) at a visual distance of half a block, after he had just been told by someone he trusted and someone who ought to have known (e.g., John Doe’s wife) that John Doe had just telephoned from a store two hours travel time away? Yet apart from that report, one might have considered it evident that John Doe was half a block away, just because (ceteris paribus) it looked enough like John Doe; the evidence of our senses can be defeated by the authority we accord to the evidence of testimony. (shrink)

In the years around 1900 one of the most significant practical consequences of new styles of bacteriological thought and practice was the development of preventive vaccines and therapeutic sera. Historical scholarship has highlighted how approaches rooted in the laboratory methods of Robert Koch, Louis Pasteur and their collaborators were transformed in local contexts and applied in diverse ways to enable more effective disease identification, prevention and treatment. Amongst these, the anti-anthrax serum developed by the Italian physician Achille Sclavo (1861–1930) has (...) received little to no attention from historians. This article positions Sclavo's serum as a neglected but significant presence in British microbiology, which achieved widespread uptake amidst a wave of optimism, despite prolonged uncertainty about its mechanism of action and dosage. After being introduced to Britain in 1904 by the enterprising first medical inspector of factories Thomas Morison Legge, within a matter of months the serum became regarded by medical practitioners as an effective treatment of cutaneous anthrax, though access to ‘fresh’ serum and the necessary speedy diagnosis remained problematic. Like the disease anthrax itself, discussion of ‘Sclavo's serum’ was out of all proportion to the relatively low number of cases, reflecting a deep-seated fascination with the wider possibilities afforded by effective serum therapy. (shrink)

This unique collection of readings provides a resource of primary source material, affording a survey of the history and systems of psychology from pre-Socratic thought to the present. Selected for accessibility, the 24 selections are organized to offer a representation of the historical sweep of psychological interpretations. After presenting approaches to the scholarly study of psychology's history, through an excerpt from Thomas Kuhn, the readings introduce the major themes of psychological inquiry in chronological fashion. The selections include the works of: (...) Plato, Aristotle, Augustine, Thomas Aquinas, Rene Descartes, Baruch Spinoza, John Locke, John Stuart Mill, Immanuel Kant, Wilhelm Wundt, Franz Brentano, William James, John Dewey, Sigmund Freud, Ivan Pavlov, John Broadus Watson, B.F. Skinner, Maurice Merleau-Ponty, and Carl Rogers. Features: Introductory essays for each group of readings provide important historical, social, and cultural background and context. Sample questions encourage critical reflection on the issues raised by the authors. Compatibility with most textbooks in the history and systems of psychology. (shrink)

Philosophy studies the relation between random, routine, and reflective thought and action. It is in essence the reflective study of routine. No one can survive a random world, but a routine world will generate the same randomness it is intended to avoid owing to the inevitable errors associated with routines. The prime function of reflective inquiry is to identify and explain the logical foundation of these errors. While governments depend on strict routine to prevent anarchy, it is only with the (...) maintenance and adaptive revision of those routines that they are able to serve that purpose. Thus philosophy is essential even to preserve routine, aside from facilitating the building of better routines. To advance global understanding philosophers need to use informal means to communicate to all people everywhere the distinction between randomness and routine, and the transcending of routine by reflective study. I add a concluding note of advocacy for UNESCO’s Strategy on Philosophy. (shrink)

To avoid the deadends, I redeploy[52] the idea that integral human freedom (and understanding) has two modes. One is "natural" and the other "supernatural," though dividing the matter that way supposes the "natural" is the residue after the integrated whole is lost, because the supernatural[53] contains the natural "eminently" the way olympic winning routines envelop the qualifying skills.[54] In my account, humans were never "merely" objects in nature at all-- that is, objects, alongside stones and tigers and dinosaurs, that are (...) entirely consequences of matter and biotic life, or explicable the way trees and volcanos are. Humans never had a "completion"-- a fulfilment-- that can be defined by conditions of earthly life or attained by "flourishing," as other living things do.[55]. (shrink)

Focusing mainly on respect for autonomy, particularly autonomous choices and actions in bioethical decisions, I examine several complexities of enacting this respect through the case of a fourteen-year-old boy who died after being allowed to refuse a necessary blood transfusion on religious grounds. I argue that thicker concepts of autonomy, closely connected with relational autonomy, direct our attention to aspects of respect for autonomy that are often neglected or underappreciated in much bioethical theory and practice. In particular, they illuminate the (...) interpretive complexity of respecting autonomous choices by focusing attention on the relational context of individuals’ decisions, on respect for individuals’ social-cultural beliefs and values, and on the temporality of selves, as expressed in their past consent or future consent as well as in—and sometimes in contradiction to—their present consent or dissent. However, it is important not to convert the illuminating and valuable insights from theories of relational autonomy into necessary conditions of autonomous choices and actions and hence of respect for autonomy. (shrink)

If the contemporary rebirth of the ontological argument had its conception in Norman Malcolm's discovery of a second Anselmian argument it had its full-term delivery as a healthy philosophical progeny with Alvin Plantinga's sophisticated modal version presented in the tenth chapter of The Nature of Necessity. This latter argument has been the centre of a huge body of literature over the last fifteen years, and deservedly so. One is impressed that this version of Anselm's jewel is valid and sound if (...) any is. (shrink)

After briefly sketching common-morality principlism, as presented in Principles of Biomedical Ethics, this paper responds to two recent sets of challenges to this framework. The first challenge claims that medical ethics is autonomous and unique and thus not a form of, or justified or guided by, a common morality or by any external morality or moral theory. The second challenge denies that there is a common morality and insists that futile efforts to develop common-morality approaches to bioethics limit diversity and (...) prevent needed moral change. This paper argues that these two critiques fundamentally fail because they significantly misunderstand their target and because their proposed alternatives have major deficiencies and encounter insurmountable problems. (shrink)

Tom Beauchamp and I were asked by the editors of The Journal of Medicine and Philosophy to prepare “intellectual autobiographies,” with particular attention to sources and influences on our work, including but not limited to Principles of Biomedical Ethics. Of course, it is artificial and even impossible to try fully to separate the “intellectual” from other aspects of our lives. So, while emphasizing the “intellectual” aspects of my autobiography, I have attended to other aspects, too. The huge debts of gratitude (...) I owe also mix the “intellectual” and other aspects of life. (shrink)

This book explores, in rich and rigorous ways, the possibilities and limitations of “thick” autonomy in light of contemporary debates in philosophy, ethics, and bioethics. Many standard ethical theories and practices, particularly in domains such as biomedical ethics, incorporate minimal, formal, procedural concepts of personal autonomy and autonomous decisions and actions. Over the last three decades, concerns about the problems and limitations of these “thin” concepts have led to the formulation of “thick” concepts that highlight the mental, corporeal, biographical and (...) social conditions of what it means to be a human person and that enrich concepts of autonomy, with direct implications for the ethical requirement to respect autonomy. The chapters in this book offer a wide range of perspectives on both the elements of and the relations between “thin” and “thick” concepts of autonomy as well as their relative roles and importance in ethics and bioethics. This book offers valuable and illuminating examinations of autonomy and respect for autonomy, relevant for audiences in philosophy, ethics, and bioethics. (shrink)