Introduction: Mental health nursing is dependent on nurses’ ability to engage in therapeutic relationships with patients. The ability to manage professional boundaries is equally important, but less explored. This study aims to address the following research questions: How do nurses define their professional, personal, and private roles? What are nurses’ experiences with professional boundaries? What are the implications of nurses’ understanding of these boundaries? Background: Nurse–patient relationships are characterized by asymmetrical power dynamics, which places the responsibility of delineating professional boundaries (...) on the nurse. While ethical codes offer guidance, nurses must identify appropriate boundaries in a dynamic process that relies on the clinical context. Research design: This study used critical discursive psychological analysis to examine data from participant observations, individual interviews, and focus group discussions. Participants and research context: We included 16 nurses working in mental health care in this study, comprising 12 in specialist mental health care and 4 in community mental health care. Ethical considerations: The study was registered with Norwegian Social Science Data Services. Results: Nurses defined professionalism as being an educated caregiver who prioritizes patients’ needs. Professionalism involves personal engagement, while some personal matters remain private. However, nurses experienced challenges in maintaining professional boundaries, facing dilemmas due to the subjective nature of boundaries and patients’ unpredictable responses. Conclusions: While nurses prioritize patients’ needs and best interests, this study demonstrated that personal engagement is considered part of professionalism. However, nurses encounter complex dilemmas in setting professional boundaries. Additionally, these boundaries can either emphasize or de-emphasize the power differential in nurse-patient relationships. (shrink)

According to a Kantian conception truthfulness is characterised as a requirement of respect for the agency of another. In lying we manipulate the other’s rational capacities to achieve ends we know or fear they may not share. This is paradigmatically a failure of respect. In this paper we argue that the importance of truthfulness also lies in significant part in the ways in which it supports our agential need to make sense of the world, other people, and ourselves. Since sense-making (...) is something we do together, and that we can support or undermine, it generates norms of interaction that constitute a further, distinct, mode of recognition and respect for another’s agency. But the requirements of truthfulness and support for sense-making sometimes conflict. Through a series of cases, we analyze why and when a rigid insistence on truthfulness is disrespectful of the other and undermining of their agency. (shrink)

Philosophers of art have had so far little to say about the phenomenon of artists’ statements. Artists’ statements can perform two different functions and often perform both. First, an artist’s statement allows the artist to provide information to viewers that is not necessarily discernible from the work. Second, an artist’s statement can contextualize a work. It can direct the viewer to see, interpret, or appreciate a work in specific ways. Though an artist’s statement cannot compel viewers to have a particular (...) experience of an artwork, it can suggest or guide viewers in a certain direction. This chapter is intended to open up the discussion by pointing out a few areas where our approach to artists’ statements will have a bearing on deeper philosophical questions. (shrink)

Is it ever possible for people to act freely and intentionally against their better judgement? Is it ever possible to act in opposition to one's strongest desire? If either of these questions are answered in the negative, the common-sense distinctions between recklessness, weakness of will and compulsion collapse. This would threaten our ordinary notion of self-control and undermine our practice of holding each other responsible for moral failure. So a clear and plausible account of how weakness of will and self-control (...) are possible is of great practical significance. Taking the problem of weakness of will as her starting point, Jeanette Kennett builds an admirably comprehensive and integrated account of moral agency which gives a central place to the capacity for self-control. Her account of the exercise and limits of self-control vindicates the common-sense distinction between weakness of will and compulsion and so underwrites our ordinary allocations of moral responsibility. She addresses with clarity and insight a range of important topics in moral psychology, such as the nature of valuing and desiring, conceptions of virtue, moral conflict, and the varieties of recklessness (here characterised as culpable bad judgement) — and does so in terms which make their relations to each other and to the challenges of real life obvious. Agency and Responsibility concludes by testing the accounts developed of self-control, moral failure, and moral responsibility against the hard cases provided by acts of extreme evil. (shrink)

The recent, influential Social Intuitionist Model of moral judgment (Haidt, Psychological Review 108, 814–834, 2001) proposes a primary role for fast, automatic and affectively charged moral intuitions in the formation of moral judgments. Haidt’s research challenges our normative conception of ourselves as agents capable of grasping and responding to reasons. We argue that there can be no ‘real’ moral judgments in the absence of a capacity for reflective shaping and endorsement of moral judgments. However, we suggest that the empirical literature (...) indicates a complex interplay between automatic and deliberative mental processes in moral judgment formation, with the latter constraining the expression and influence of moral intuitions. We therefore conclude that the psychological literature supports a normative conception of agency. (shrink)

In this commentary on Anneli Jefferson’s Are Mental Disorders Brain Disorders? I endorse her capacitarian approach to responsibility but suggest that the effects of at least some mental/brain disorders on the agent’s psychology show that we cannot neatly separate the epistemic condition from the control condition when assessing agential capacity. I then discuss the labeling issue in the context of rival attributionist accounts of responsibility which hold that agents are responsible if their actions are attributable to them. The incorporation of (...) mental disorders into identity through social processes may open agents with mental or brain disorders open to unfair blame. However, we cannot fully understand the effects of the disorders on agential capacity without closely attending to the social environment that shapes the way the disorder is conceived, enacted, perceived, and responded to over time. (shrink)

It seems to be a truism that whenever we do something - and so, given the omnipresence of trying (Hornsby 1980), whenever we try to do something - we want to do that thing more than we want to do anything else we can do (Davidson 1970). However, according to Frog, when we have will power we are able to try not to do something that we ‘really want to do’. In context the idea is clearly meant to be that (...) what we really want to do and what we most want to do are one and the same. But how is this meant to be so much as possible? It seems to require that our desire not to do what we most want to do is both our strongest desire and not our strongest desire. And that is a blatant contradiction. This is the so-called ‘paradox of self-control’ (Mele 1987). The aim of our paper is to explain how to make sense of the story of Frog and Toad. (shrink)

This article addresses the complex reflections regarding gender relations expressed by women active in the contemporary Islamic revival movements in Europe (especially France and Germany). Much recent research conducted among these groups aims to counter the rather negative accounts prevailing in public discourses on gender and Islam. This literature notably argues that women's conscious turn to Islam is not necessarily a reaffirmation of male domination, but that it constitutes a possibility for agency and empowerment. However, when faced with certain ‘traditionalist’ (...) positions defended by these women, even this well-meaning literature seems precarious, left in a state of uncertainty. Taking this puzzlement as a point of departure, this contribution aims to think about the dilemmas involved in articulating a language for women's dignity and self-realization, which competes with dominant languages of equality, individual rights and autonomy. This project is rendered even more intricate by the fact that these pious Muslim women socialized in Europe have also been partly fashioned by the liberal discourses against which they want to position themselves. (shrink)

Psychopaths have long been of interest to moral philosophers, since a careful examination of their peculiar deficiencies may reveal what features are normally critical to the development of moral agency. What underlies the psychopath's amoralism? A common and plausible answer to this question is that the psychopath lacks empathy. Lack of empathy is also claimed to be a critical impairment in autism, yet it is not at all clear that autistic individuals share the psychopath's amoralism. How is empathy characterized in (...) the literature, and how crucial is empathy, so described, to moral understanding and agency? I argue that an examination of moral thinking in high-functioning autistic people supports a Kantian rather than a Humean account of moral agency. (shrink)

ETUDES DE PHILOLOGIE 38 ETD'HISTOIRE JEANETTE MA BEER Narrative Conventions of Truth in the Middle Ages GENEVE ...

We have argued elsewhere that moral responsibility over time depends in part upon the having of psychological connections which facilitate forms of self-control. In this chapter we explore the importance of mental time travel - our ordinary ability to mentally travel to temporal locations outside the present, involving both memory of our personal past and the ability to imagine ourselves in the future - to our agential capacities for planning and control. We suggest that in many individuals with dissociative disorders, (...) forms of amnesia, or other frontal lobe damage, our capacity for mental time travel is impaired, resulting in commensurate losses to agency autonomy, and a forensic condition essential for holding persons responsible: in legal terms, the capacity for mens rea. (shrink)

Ethical issues arise when musicians perform and record “cover” versions of songs. In this paper I discuss performances of Blues music by professional musicians who do not have strong cultural ties to this material. I begin with a discussion of musical authenticity and appropriation, and then discuss some of the surrounding ethical issues, drawing on James O. Young’s defense of profound cultural offense. Could harm arise from cross-cultural musical covers, and if so, is this harm always a relevant consideration for (...) musicians? What do musicians owe to people who came before them and upon whose cultural traditions they are building? (shrink)

Although precision medicine cuts across a large spectrum of professions, interdisciplinary and cross-sectorial moral deliberation has yet to be widely enacted, let alone formalized in this field. In a recent research project on precision medicine, we designed a dialogical forum (i.e. ‘the Ethics Laboratory’) giving interdisciplinary and cross-sectorial stakeholders an opportunity to discuss their moral conundrums in concert. We organized and carried out four Ethics Laboratories. In this article, we use Simone de Beauvoir’s concept of moral ambiguity as a lens (...) to frame the participants’ experience with fluid moral boundaries. By framing our approach through this concept we are able to elucidate irremediable moral issues that are collectively underexplored in the practice of precision medicine. Moral ambiguity accentuates an open and free space where different types of perspectives converge and can inform each other. Based on our study, we identified two dilemmas, or thematic interfaces, in the interdisciplinary moral deliberations which unfolded in the Ethics Laboratories: (1) the dilemma between the individual and the collective good; and (2) the dilemma between care and choice. Through our investigation of these dilemmas, we show how Beauvoir’s concept of moral ambiquity not only serves as a fertile catalyst for greater moral awareness but, furthermore, how the concept can become an indispensable part of the practices of and the discourse about precision medicine. (shrink)

Variations in human skin pigmentation are obvious, but how have skin colour differences evolved? Although clearly a polymorphic trait, the number and identity of key variants has remained unclear. Investigation of pigmentation phenotypes in model organisms provides a route to identify these genes and showed MC1R to be one key locus. Now, cloning of a classic zebrafish mutant, golden, identifies slc24a5 as a gene involved in fish skin pigmentation.1 Strikingly this study identifies the human orthologue, SLC24A5, as likely to make (...) a major contribution to the pale skin colouration of Western Europeans. BioEssays 28: 578–582, 2006. © 2006 Wiley Periodicals, Inc. (shrink)

Encouraging and supporting people to take responsibility for their health is a laudable forward-looking goal of a public health system. Holding people responsible for conditions such as diabetes, heart disease, obesity, and addiction, that may have resulted from their past actions, is more controversial, particularly when it is used as a basis to deny or restrict treatment that would otherwise have been provided. In this chapter I will draw upon retributive theories of punishment to argue that restricting access to health (...) care to persons who are deemed to have contributed to their health condition, say by smoking, drinking, poor diet or lack of exercise, is inevitably to engage in a form of retributive blame and punishment and that the system-wide justifications that might be offered for such practices fail. Denial or limitation of treatment on other than medical grounds will frequently constitute excessive rather than proportional punishment for past actions. Moreover, determining and meting out such sanctions is beyond the proper scope of health care professionals and undermines the virtues proper to their roles. (shrink)

A person suffering a mental illness or disorder may differ dramatically from his or her previous well self. Family and close friends who knew the person before the onset of illness tend to regard the illness as obscuring their loved one's true self and see the goal of treatment as the restoration of that self. ‘He is not really like this,’ they will say with increasing desperation. Treatment teams and others, who have no acquaintance with the person when well, respond (...) to what they see in front of them and do sometimes make harmful judgments of character based on the person's presentation when ill. (shrink)

The feature article by Delany, Feldman, Kameniar and Gillam on the deliberative structure of a local Australian clinical ethics consultation programme is important for several reasons. It underscores Walker’s ‘moral spaces’ within healthcare settings and it increases conceptual freedom in dialogue through the bottom-up approach described.1 We concur with their commitment to the advancement of this form of clinical ethics deliberation and agree with many of the notions in the article. Due to limited space, we confine our commentary to the (...) topics of (1) the goal of consultations and (2) the didactic aspect of consultations. We unequivocally second the authors’ critical stance towards principled resolutions and salute their wish to enhance clinicians’ moral understandings. However, our angle is somewhat different. The conceptual freedom of which they speak is, in our view, limited by the premise that clinical ethics issues must be ‘solved’ by a consensus decision. In our experience with cases, it may be more appropriate to seek mutual rather than shared understanding due to the inherent need to balance conflicting values. This approach opens for a dialogue that is not restrained by the imperative of reaching moral consensus. It may better serve to enhance the moral agency of clinical staff and it leaves the decision with …. (shrink)

This study examines cheating behaviors among 422 business students at two public Association to Advance Collegiate Schools of Business-accredited business schools. Specifically, we examined the simultaneous influence of attitudinal characteristics and motivational factors on reported prior cheating behavior, the tendency to neutralize cheating behaviors, and likelihood of future cheating. In addition, we examined the impact of in-class deterrents on neutralization of cheating behaviors and the likelihood of future cheating. We also directly tested potential mediating effects of neutralization on cheating behavior. (...) Using structural equations modeling procedures, we conducted an assessment of the validity of a modified version of the K. J. Smith, Davy, Rosenberg, and Haight model of cheating behavior and its antecedents. The modified model included motivation as a potential predictor of cheating behavior. Results supported the differentiation of the theoretical constructs within the specified process model. Furthermore, tests of the aforementioned theoretical model indicated a significant positive relation between extrinsic motivation and prior cheating and a significant negative relation between both intrinsic motivation and academic performance, and prior cheating. Finally, prior cheating had a significant positive relation, whereas deterrents had a significant negative relation to likelihood of future cheating. (shrink)

The topic of this article is the relationship of street art to both the street and the artworld. I take it as significant that philosophers have turned their attention to “street art” and not, say, “urban outdoor art” or “site-specific art in urban settings.” The “street” in street art seems to imply more than a location or geographic modifier. I consider the further significance of the “street” in street art, and the view, argued or assumed, of the street when philosophers (...) discuss street art. My second target in this article is what I have called the “discontinuity thesis.” This is the idea, defended or assumed in some of the most important philosophical writing about street art, that street art represents a radical break with the artworld and is “antithetical” to it. I argue that the discontinuity thesis is mistaken, and that to understand the larger institutional context of street art we must examine the sociology of artworlds. Street art has followed a familiar process and pioneering street artists are best seen as “mavericks” in Howard Becker’s sense. I argue that seeing street artists in this way can help better understand and appreciate their work. (shrink)

An adequate account of musical understanding must be sufficiently detailed and nuanced so as to be able to make sense of the experience of listeners with diverse musical and cultural backgrounds. It should also help us begin to understand the wide variety of responses to music, including the responses of those who hear music as having semantic content. I approach these issues in the more general philosophical context of aesthetic understanding. As an approach to my own position, I examine the (...) accounts of aesthetic understanding offered by Nelson Goodman, Roger Scruton, and Peter Kivy. Because each can be seen as broadly within the Kantian tradition, I also undertake an examination of Kant's aesthetics. ;My account of what it is to understand music and of how this understanding is achieved draws upon a phenomenological analysis of listening. I argue that a continuum of two levels of understanding music can be distinguished. At the lowest level, "recognitional understanding," the listener can hear a series of tones as a rhythmic and melodic gestalt, and understand a minimum of expressive and gestural characteristics. The second level, "enhanced understanding," requires greater sensitivity to the music's expressive character, being able to place the music in an appropriate historical context, and some awareness of musical form. Beyond these two levels but presupposing them is a third, which I call "interpretive understanding." Listening to music, we sometimes get the sense that the music is "profound" or has something to say, if only we could grasp it. ;For musical understanding of any sort, involvement with the music is crucial. I develop an account of involvement with music which stresses the similarities between following a musical performance and following or constructing a narrative. I conclude by suggesting the ways in which my account of musical understanding captures some of the strengths of the accounts already discussed , and consider some objections which might be made against it. (shrink)

Undercover marketing targets potential customers by concealing the commercial nature of an apparently social transaction. In a typical case an individual approaches a marketing target apparently to provide some information or advice about a product in a way that makes it seem like they are a fellow consumer. In another kind of case, a friend displays a product to you, and encourages its purchase, but fails to disclose their association with the marketing firm. We focus on this second type of (...) case and argue that the constitutive dispositions of friendship that provide for the development and maintenance of intimacy also render friends especially vulnerable to undercover marketing techniques and so to the exploitation of friendship for commercial ends. We show how this is corrupting both of the friendship and the commercial agent. (shrink)

A life-threatening illness such as cancer can bring about much existential suffering and a disconnect to self in spite of surviving cancer. In my recent research project, I interviewed 14 long-term cancer survivors on being post cancer. Contrary to common assumptions about long-term survivorship, my interviewees reported grave existential difficulties in finding a firm footing in their sense of self, fostering a variety of stories of despair. This article examines long-term cancer survivors’ suffering from the vantage point of selfhood and (...) provides a philosophical interpretation of the reintegration of the self by illuminating their stories of despair through the Danish philosopher Søren Kierkegaard’s seminal work The Sickness Unto Death. The participating survivors described how the cancer experience had quaked old perceptions of self, instigating them to question the depth of their self-understanding before the cancer and who they really were. In relating to themselves, they realized the dynamic process of becoming who they are by continuing to balance opposing poles within the self. This act of relating to self revealed the limit of the autonomous self in the creation of selfhood. The article intends to illustrate how a philosophical reading of selfhood and suffering in survivorship can inform medicine and inspire models for follow-up cancer care for long-term survivors. (shrink)

The tears of Odysseus -- History : music gives voice to the ineffable -- Tears, chills, and broken bones -- The music itself -- Explaining strong emotional responses to music I -- Explaining strong emotional responses to music II -- The sublime, revisited -- Conclusion : values.

It is often claimed that the existence of psychopaths undermines moral rationalism. I examine a recent empirically based argument for this claim and conclude that rationalist accounts of moral judgement and moral reasoning are perfectly compatible with the evidence cited.

This article introduces _the Ethics Laboratory_ as an inter-sectorial and cross-disciplinary dialogical forum which can be viewed as an educational tool for moral learning. _The Ethics Laboratory_ represents a platform for the informal, collaborative investigation, in strict confidentiality, of ethical questions that have social consequences and/or legal concerns and bridges boundaries between research communities, institutions and patients. Its methodological structure proposes an experimental, open-ended way of unpacking implied assumptions, underlying values, comparable notions and observations from different professional fields. In connection (...) with a large social science project on precision medicine, we conducted four Ethics Laboratories followed by eight interviews with a selected number of participants. Through these interviews we learnt how this exploratory dialogical forum heighten moral awareness on issues that are shared among stakeholders who work to implement precision medicine in Denmark. Though the framework was developed specifically to foster ethical reflection within precision medicine, its dialogical structure lends itself to other professional areas and can easily be adopted and carried out. (shrink)

A diagnosis of schizophrenia is often taken to denote a state of global irrationality within the psychiatric paradigm, wherein psychotic phenomena are seen to equate with a lack of mental capacity. However, the little research that has been undertaken on mental capacity in psychiatric patients shows that people with schizophrenia are more likely to experience isolated, rather than constitutive, irrationality and are therefore not necessarily globally incapacitated. Rational suicide has not been accepted as a valid choice for people with schizophrenia (...) due in part to a belief that characteristic irrationality prevents autonomous decision-making. Since people with schizophrenia are often seen to lack insight into the nature of their disorder, both psychiatric and ethical perspectives generally presume that suicidal acts result directly from mental illness itself and not from second-order desires. In this article, I challenge notions of global irrationality conferred by a diagnosis of schizophrenia and argue that, where delusional beliefs are unifocal, schizophrenia does not necessarily lead to a state of mental incapacity. I then attempt to show that people with schizophrenia can sometimes be rational with regard to suicide, where this decision stems from a realistic appraisal of psychological suffering. (shrink)

Recent studies reveal some of the neurophysiological mechanisms involved in drug addiction. This prompts some theorists to claim that drug addiction diminishes responsibility. Stephen Morse however rejects this claim. Morse argues that these studies show that drug addiction involves neither compulsion, coercion, nor irrationality. He also adds that addicted people are responsible for becoming addicted and for failing to take measures to manage their addiction. After summarizing relevant neuroscience of addiction literature, this chapter engages critically with Morse to argue that (...) a subgroup of addicted people does meet plausible criteria for compulsion, coercion, or irrationality; that few addicted people are fully responsible for becoming addicted; and that some addicted people can be at least partly excused for failing to manage their addiction. Pickard and Lacey’s “responsibility without blame” approach is also suggested as a fruitful basis for future work in this field. (shrink)

Recent advancements in therapeutic and diagnostic medicine, along with the creation of large biobanks and methods for monitoring health technologies, have improved the prospects for preventing, treating, and curing illness. These same advancements, however, give rise to a plethora of ethical questions concerning good decision-making and best action. These ethical questions engage policymakers, practitioners, scientists, and researchers from a variety of fields in different ways. Collaborations between professionals in the medical and health sciences and the social sciences and humanities often (...) take an asymmetrical form, as when social scientists use ethnographic approaches to study the moral issues and practices of physicians. The ethics laboratory described in this article is a cross-sectoral and inter-disciplinary forum for collaborative investigation on important moral topics. It offers an experimental way of unpacking implied assumptions, underlying values, and comparable notions from different professional healthcare fields. The aim of this article is to present the ethics laboratory’s methodology. The article offers a model and a hermeneutical framework that rests on a dialogical approach to ethical questions. The model and the framework derive from a Danish research project, _Personalized Medicine in the Welfare State_. This article uses personalized medicine as a point of reference, though it offers an argument for the applicability of the model more broadly. (shrink)

Within the Givenness Hierarchy framework of Gundel, Hedberg, and Zacharski (1993), lexical items included in referring forms are assumed to conventionally encode two kinds of information: conceptual information about the speaker’s intended referent and procedural information about the assumed cognitive status of that referent in the mind of the addressee, the latter encoded by various determiners and pronouns. This article focuses on effects of underspecification of cognitive status, establishing that, although salience and accessibility play an important role in reference processing, (...) the Givenness Hierarchy itself is not a hierarchy of degrees of salience/accessibility, contrary to what has often been assumed. We thus show that the framework is able to account for a number of experimental results in the literature without making additional assumptions about form-specific constraints associated with different referring forms. (shrink)

In this chapter I argue that there is a normative aspect to self-control that is not captured by the purely procedural account to be drawn from dual process theories of cognition – which we only uncover when we consider what self-control is for and why it is valuable. For at least a significant sub-group of addicts their loss of control over their drug use may not be due to a lack or depletion of cognitive resources. Rather it may be that (...) they have little confidence in their ability to exert control over their circumstances and shape the life they would value having and the person they would value being. (shrink)

Dissociative Identity Disorder (DID) (formerly known as Multiple Personality Disorder) is a condition in which a person appears to possess more than one personality, and sometimes very many. Some recent criminal cases involving defendants with DID have resulted in "not guilty" verdicts, though the defense is not always successful in this regard. Walter Sinnott-Armstrong and Stephen Behnke have argued that we should excuse DID sufferers from responsibility, only if at the time of the act the person was insane (typically delusional); (...) otherwise the presumption should be that persons with DID are indeed responsible for their actions. We find their interpretation of DID and of the way in which the requirements for criminal insanity relate to this condition worrying and likely to result in injustice to DID sufferers. Our thesis is that persons with DID cannot be responsible for their actions if the usual features of the condition are present. A person with DID is a single person in the grip of a very serious mental disorder. By focusing on the features of DID which have, as we argue, the effect of deluding the patient, we try to show that such a person is unable to fulfill the ordinary conditions of responsible agency (namely, autonomy and self-control). (shrink)