Aim: Explore nurses’ values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses’ values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the institutional review board (#191046). (...) Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: “Honoring Patient Autonomy without Judgment,” “Honoring with Limitations,” “Not until...,” and “Adamantly against.” Some felt it was a duty to honor the patients’ wishes, set aside own beliefs, and respect patients’ choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse’s role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses’ values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed. (shrink)

Nurses die by suicide at a higher rate than the general population. Previous studies have observed mental health problems, including substance use, as a prominent antecedent before death. The purpose of this study was to explore the characteristics of nurses who died by suicide documented in the death investigation narratives from the National Violent Death Reporting System from 2003 to 2017 using thematic analysis and natural language processing. One thousand three hundred and fifty‐eight subjects met these inclusion criteria. Narratives from (...) 601 subjects were thematically analyzed and 2544 individual narratives were analyzed using natural language processing. The analyses revealed five themes: “mental health treatment,” “poor general health and chronic pain,” “substance use,” “worsening mental health after bereavement,” and “repeating a family member's suicide.” Mental health/substance use, chronic illness, and chronic pain were seen to coexist in a complex, interdependent manner that appeared to be entangled in the nurses' narratives before death. These findings echo the need for reducing the stigmatization of mental health problems in nursing and removing barriers to help‐seeking behaviors as early preventative interventions. Future research is needed to determine if a comprehensive healthcare integration approach to address these entangled problems would reduce suicide vulnerability in nurses and improve their quality of life. (shrink)

This paper details a “metadisciplinary” applied ethics course jointly taught and pioneered by a biologist, psychologist, and ethicist on the subject of Assisted Reproduction. Contrasted with a transdisciplinary approach (whose content involves themes or issues that span traditional disciplinary lines) and a multidisciplinary approach (which involves experts from several disciplines working side by side), a metadisciplinary approach involves both of these former characteristics while incorporating a continuous, critical appreciation for the strengths and weaknesses of the contrasting methods and scopes of (...) each discipline’s methods of inquiry. This paper details the kinds of subjects that lend themselves to metadisciplinary approaches (e.g. applied ethics subjects which are real-world, complex, and studied by various disciplines), staffing guidelines for a smoothly functioning core team, how to plan and prepare the day-to-day of such a course to prevent a diffuse lesson structure, assignment and evaluation guidelines, and an appraisal of the value of such a class. The authors argue that while fundamental research may be conducted along traditional disciplinary lines, solutions to the complex problems of contemporary society require people who are equipped with problem-solving skills whose relevance spans disciplinary boundaries. (shrink)

Research on the use of the Song of Songs in spiritual direction is rare; yet, the Song of Songs (or Canticle of Canticles) is a highly conducive case as it provides in nuce the poetics, lyrics, erotics, and aesthetics of human and divine love which is found nowhere else in Scripture. This article draws on these unique features, integrates the biblical and the experiential, and offers a poetics-praxis paradigm for use in contemporary spiritual praxis. With the poem’s metaphorical vineyard (a (...) figurative term for the beloved herself) serving as hermeneutical key, the beloved’s experience of love is interpreted through a multifaceted reading that is intrinsic to the poem, namely: eros [yearning]; mythos [searching]; mustikos [finding]; and kosmos [birthing]. In following the inner dynamism and dramatic tensions across the eight chapters of the Song, the fourfold reading traces the beloved’s transformation from a neglected vineyard (Can 1:6) to a generative vineyard (Can 8:12). The article concludes that transformation in love is a journey from depletion (the giving away of self) towards deification (the giving of self in love), and suggests tending one’s own vineyard as a living testament to divine love and a living sacrament in the world. (shrink)

A team of philosophers and scientists at Dartmouth College worked for three years to create, train faculty and pilot test an adequate and exportable class in research methods for graduate students of science and engineering. Developing and testing methods for evaluating students’ progress in learning research ethics were part of the project goals. Failure of methods tried in the first year led to the refinement of methods for the second year. These were used successfully in the pilot course and in (...) one university setting external to Dartmouth. The process of development and justification for the final methods are discussed here. (shrink)

Increased international migration of health professionals is weakening healthcare systems in low‐income countries, particularly those in sub‐Saharan Africa. The migration of nurses, physicians and other health professionals from countries in sub‐Saharan Africa poses a major threat to the achievement of health equity in this region. As nurses form the backbone of healthcare systems in many of the affected countries, it is the accelerating migration of nurses that will be most critical over the next few years. In this paper we present (...) a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one's country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health. (shrink)

Articles: Smart, "Quine's Philosophy of science"; Harman, "An Introduction to 'Translation and Meaning', Chapter Two of Word and Object"; Stenius, "Beginning with Ordinary Things"; Chomsky, "Quine's Empirical Assumptions"; Hintikka, "Behavioral Criteria of Radical Translation"; Stroud, "Conventionalism and the Indeterminacy of Translation"; Strawson, "Singular Terms and Predication"; Grice, "Vacuous Names"; Geach, "Quine's Syntactical Insights"; Davidson, "On Saying That"; Follesdal, "Quine on Modality"; Sellars, "Some Problems about Belief"; Kaplan, "Quantifying In"; Berry, "Logic with Platonism"; Jensen, "On the Consistency of a Slight (...) (?) Modification in Quine's New Foundations"; Quine, "Replies"; Publications of W. V. Quine. (shrink)

Strategies to support the psychosocial well-being of older adults living in aged-care are needed; and evidence points toward music listening as an effective, non-pharmacological tool with many benefits to quality of life and well-being. Yet, the everyday listening practices of older adults living in residential aged-care remain under-researched. The current study explored older adults’ experiences of music listening in their daily lives while living in residential aged-care and considered how music listening might support their well-being. Specifically, what might go into (...) autonomous listening activities? 32 Australian residents living in two Australian care facilities participated in semi-structured interviews. The results of a qualitative thematic analysis revealed three themes pertaining to “previous music experiences and interest,” “current music listening,” and “barriers to listening.” While an interest in and access to music did not necessarily result in everyday listening practices, of those participants who did listen to music, perceived benefits included outcomes such as entertainment, enjoyment, relaxation, and mood regulation. Drawing on Ruud’s notion of music as a “cultural immunogen” supporting well-being and Self-Determination Theory, theoretical implications of the findings are addressed, relating to how to create and support music activities in aged-care facilities so that they are engaging, meaningful, and promote emotional regulation, community, and well-being. (shrink)

Categorical loudness scaling (CLS) measures provide useful information about an individual’s loudness perception across the dynamic range of hearing. A probability model of CLS categories has previously been described as a multi-category psychometric function (MCPF). In the study, a representative “catalog” of potential listener MCPFs was used in conjunction with maximum-likelihood estimation to derive CLS functions for participants with normal hearing and with hearing loss. The approach of estimating MCPFs for each listener has the potential to improve the accuracy of (...) the CLS measurements, particularly when a relatively low number of data points are available. The present study extends the MCPF approach by using Bayesian inference to select stimulus parameters that are predicted to yield maximum expected information (MEI) during data collection. The accuracy and reliability of the MCPF-MEI approach were compared to the standardized CLS measurement procedure (ISO16832:2006). A non-adaptive, fixed-level, paradigm served as a “gold-standard” for this comparison. The test time required to obtain measurements in the standard procedure is a major barrier to its clinical uptake. Test time was reduced from approximately 15 minutes to approximately 3 minutes with the MEI-adaptive procedure. Results indicated that the test-retest reliability and accuracy of the MCPF-MEI adaptive procedures were similar to the standardized CLS procedure. Computer simulations suggest that the reliability and accuracy of the MEI procedure were limited by intrinsic uncertainty of the listeners represented in the MCPF catalog. In other words, the MCPF provided insufficient predictive power to significantly improve adaptive-tracking efficiency under practical conditions. Concurrent optimization of both the MCPF catalog and the MEI-adaptive procedure have the potential to produce better results. Regardless of the adaptive-tracking method used in the CLS procedure, the MCPF catalog remains clinically useful for enabling maximum-likelihood determination of loudness categories. (shrink)

A recent surge of research has begun to examine music participation and well-being; however, a particular challenge with this work concerns theorizing around the associated well-being benefits of musical participation. Thus, the current research used Self-Determination Theory to consider the potential associations between basic psychological needs (competence, relatedness, and autonomy), self-determined autonomous motivation, and the perceived benefits to well-being controlling for demographic variables and the musical activity parameters. A sample of 192 Australian residents (17-85, Mage = 36.95), who were currently (...) participating in a musical activity at the time, completed an online questionnaire. Results indicated that females were more likely to perceive benefits to their well-being; and that how important an individual considers music in their life was positively related to perceived well-being. Importantly, the analyses also revealed that the basic needs of competency and relatedness were related to overall perceived well-being as well as specifically social, cognitive, and esteem dimensions of well-being. Autonomous motivation demonstrated significant associations with both an overall well-being score as well as four of five specific well-being subscales measured. Collectively, the findings indicate that Self-Determination Theory offers a useful theoretical framework to understanding the relationship between musical participation and well-being. Further, the pattern of findings reiterates the positive associations between musical participation and one’s psychosocial well-being, with broad implications for people involved in the facilitation of musical activity. (shrink)

A key focus for agri-food scholars today pertains to emerging “alternative food movements,” particularly their long-term viability, and their potential to induce transitions in our prevailing conventional global agri-food systems. One under-studied element in recent research on sustainability transitions more broadly is the role of disruptive events in the emergence or expansion of these movements. We present the findings of a case study of the effect of a sudden acute food safety crisis—bovine spongiform encephalopathy, or mad cow disease—on alternative beef (...) production in the Province of Alberta, Canada. Employing the conceptual lens of Sustainability Transition Theory, we explore the perspectives of conventional and alternative beef producers, treating alternative beef production as a niche operating within the dominant regime of global industrial agri-business. Three key findings are presented here. First, food safety risks and disruptive events can emerge as a direct consequence of the socio-ecological contradictions embedded in industrial agriculture, representing an opportunity for expansion of agricultural niches. Second, certain features of socio-economic regimes can also contribute to niche emergence, such as an economic system that disenfranchises beef-producing families. Finally, our study highlights the high level of diversity among niche agents and the complex and nuanced nature of their support for the niche. (shrink)

Abstract:Open neural tube defects or myelomeningoceles are a common congenital condition caused by failure of closure of the neural tube early in gestation, leading to a number of neurologic sequelae including paralysis, hindbrain herniation, hydrocephalus and neurogenic bowel and bladder dysfunction. Traditionally, the condition was treated by closure of the defect postnatally but a recently completed randomized controlled trial of prenatal versus postnatal closure demonstrated improved neurologic outcomes in the prenatal closure group. Fetal surgery, or more precisely maternal-fetal surgery, raises (...) a number of ethical issues that we address including who the patient is, informed consent, surgical innovation and equipoise as well maternal assumption of risk. As the procedure becomes more widely adopted into practice, we suggest close monitoring of new fetal surgery centers, in order to ensure that the positive results of the trial are maintained without increased risk to both the mother and fetus. (shrink)

Structured interviews were held with 149 registered nurses in seven countries in America, Asia, Australia and Europe concerning the feeding of severely demented patients who do not accept food. The most common reasons for nurses being willing to change their decision to feed or not to feed were an order from the medical head, a request from the patient's husband and/or the staff meeting. There was a connection between the willingness to feed and the ranking of ethical principles. Nurses who (...) were most prone to feed the patient most often gave a high rank to the ethical principle of sanctity of life, while those who primarily chose not to feed the patient gave a high rank to the ethical principle of autonomy. All nurses stressed the ethical principle of beneficence. Des interviews structurés ont eu lieu avec 149 infirmiers/ères dans sept pays en Amérique, Asie, Australie et Europe concernant l'alimentation des malades gravement dément qui refusent de manger. La raison la plus générale pour des infirmiers/ères d'être prêt à changer leures décisions de donner à manger ou non sont: un ordre du médecin, la demande du mari de la malade ou de la réunion du personnel. Il y avait un lien entre la volonté de nourir et le rang des principes éthiques. Les infirmiers/ères les plus enclins de nourir la malade le plus souvent donnaient un rang supérieur au principe éthique de la sainteté de vie, pendant que ceux et celles qui choisissaient de ne pas nourrir la malade donnaient un rang supérieur au principe éthique de l'autonomie. Tous insistaient sur l'importance du principe éthique de la bienfaisance. Konstruktive Interviews wurden mit 149 ausgebildeten Krankenschwestern und Pfleger in sieben Ländern in Amerika, Asien, Australien und Europa gehalten über die Ernährung von schwer von Dementia praecox leidenden Patienten, die das Essen verweigern. Die gewöhnlichsten Gründe des Pflegepersonals für die Bereitwilligkeit, ihre Entscheidung, zu ernähren oder nicht, zu ändern, waren Anordnungen vom medizinischen Chef, Anfragen vom Ehemann der Patientin und/oder einer Personalsitzung. Es bestand ein Zusammenhang zwischen der Bereitwilligkeit zur Ernährung und dem Rang der ethischen Prinzipien. Die Pflegenden, die sich am meisten neigten, die Patientin zu ernähren, gaben dem ethischen Prinzip der Heiligkeit des Lebens einen hohen Rang, während die, die meistens vorzogen, die Patientin nicht zu ernähren, gaben dem ethischen Prinzip der Autonomie einen hohen Rang. Alle Pflegenden legten grossen Wert auf das ethische Prinzip der Wohltätigkeit. (shrink)

The EEG and MEG studies cited in the target article found reduced gamma band power following pseudowords in comparison with words. Pulvermüller interprets this power difference in terms of reverberating lexical cell assemblies. An alternative interpretation in terms of latency jitter in the gamma band following pseudowords is proposed that does not appeal to lexical cell assemblies.

Nesse artigo pretendo desenvolver um ponto bastante central de uma famosa discordância entre Quine e Davidson, uma disputa conheci-da na literatura como “a questão proximal x distal”. Em poucas palavras, enquanto Quine adota uma posição proximal, segundo a qual devemos localizar o conteúdo empírico das sentenças de observação já nas termina-ções neuronais dos falantes, Davidson prefere uma localização distal para esse conteúdo, pressupondo assim a existência de objetos no mundo. Essa discussão é de suma relevância para a compreensão (...) do debate em torno do “terceiro dogma do empirismo”, proposto por Davidson e recusado por Quine, bem como para a compreensão da posição semântica de Quine como um todo. (shrink)

This paper details a “metadisciplinary” applied ethics course jointly taught and pioneered by a biologist, psychologist, and ethicist on the subject of Assisted Reproduction. Contrasted with a transdisciplinary approach (whose content involves themes or issues that span traditional disciplinary lines) and a multidisciplinary approach (which involves experts from several disciplines working side by side), a metadisciplinary approach involves both of these former characteristics while incorporating a continuous, critical appreciation for the strengths and weaknesses of the contrasting methods and scopes of (...) each discipline’s methods of inquiry. This paper details the kinds of subjects that lend themselves to metadisciplinary approaches (e.g. applied ethics subjects which are real-world, complex, and studied by various disciplines), staffing guidelines for a smoothly functioning core team, how to plan and prepare the day-to-day of such a course to prevent a diffuse lesson structure, assignment and evaluation guidelines, and an appraisal of the value of such a class. The authors argue that while fundamental research may be conducted along traditional disciplinary lines, solutions to the complex problems of contemporary society require people who are equipped with problem-solving skills whose relevance spans disciplinary boundaries. (shrink)

Davidson attacks the intelligibility of conceptual relativism, i.e. of truth relative to a conceptual scheme. He defines the notion of a conceptual scheme as something ordering, organizing, and rendering intelligible empirical content, and calls the position that employs both notions scheme-content dualism. He argues that such dualism is untenable since: not only can we not parcel out empirical content sentence per sentence but also the notion of uninterpreted content to which several schemes are relative, and the related notion of (...) a theory ”fitting the evidence’, can be shown to lack intelligibility too. Davidson argues further that belief in incommensurable schemes or non-intertranslatable languages is possible only on violating a correct understanding of interpretability : if we succeed in interpreting someone else then we have shown there is no need to speak of two conceptual schemes, while if we fail ”there is no ground for speaking of two.’. (shrink)

Lack of guidance and regulation for authorizing medical cannabis for conditions involving the health and neurodevelopment of children is ethically problematic as it promulgates access inequities, risk-benefit inconsistencies, and inadequate consent mechanisms. In two virtual sessions using participatory action research and consensus-building methods, we obtained perspectives of stakeholders on ethics and medical cannabis for children and youth. The sessions focused on the scientific and regulatory landscape of medical cannabis, surrogate decision-making and assent, and the social and political culture of medical (...) cannabis. We found that evidence-gathering and data dissemination, pressures on clinical relationships, and the lack of integration of culturally diverse perspectives and Indigenous knowledges were key areas of concern. Participants emphasized the importance of utilizing adaptive study designs, highlighted the importance of trust-building between clinicians, patients and caregivers, and discussed barriers including historical and ongoing stigmatization of medical cannabis. We conclude that continued public consultation and strength-based research that integrate diverse perspectives are critical steps forward. (shrink)

Today, the ‘pluriverse’ is considered to be a radical new concept capable of decolonising political thought. However, it is not only decolonial scholarship that has taken up the concept of the pluriverse; far-right intellectuals, too, have been cultivating a decolonial imaginary based on the idea of the pluriverse. This article compares the way the concept of the pluriverse appears in certain strands of Latin American decolonial theory exemplified by Walter Mignolo, on the one hand, and the ethnopluralism of the European (...) New Right represented by Alain de Benoist and Alexander Dugin, on the other. Despite Mignolo’s pluriverse being an ‘open pluriverse’ of entanglement between peoples, while the European New Right’s is a ‘closed pluriverse’ of ethnic separation, I argue that these uses of the pluriverse are nevertheless underpinned by a shared analytical and normative framework. This framework is defined by a simple refrain: that what oppresses the world is ontological and epistemological sameness, and what will liberate it is ontological and epistemological difference. I argue that this schema, which misapprehends imperialism as a form of epistemic domination geared purely towards homogenisation, rather than as a set of material relationships that also produce (e.g. racial, sexual, and class) difference, does not provide a solid foundation for contesting colonial relations. (shrink)

Research Ethics, Volume 18, Issue 2, Page 132-150, April 2022. Limited research has been done among pregnant people participating in investigational drug trials. To enhance the ethical understanding of pregnant people’s perspectives on research participation, we sought to describe motives and risk perceptions of participants in a phase 1 trial of ledipasvir/sofosbuvir treatment for chronic Hepatitis C virus during pregnancy. Pregnant people with chronic HCV infection enrolled in an open-label, phase 1 study of LDV/SOF participated in semi-structured, in-depth interviews to (...) explore their reasons for participation and experiences within the study. Pregnant people took 12 weeks of LDV/SOF and were interviewed at enrollment and at the end of study. We recorded the interviews, transcribed them verbatim, coded them using NVivo software, and performed inductive thematic analysis. Nine women completed the study yielding 18 interview transcripts. We identified two themes regarding motives and one regarding risk perception. Motives— Women conceptualized study participation as part of the caregiving role they associate with motherhood; participating was viewed as an act of caregiving for their infants, their families, themselves, and other pregnant women with chronic HCV. Women also noted that they faced multiple barriers to treatment prior to pregnancy that created a desire to receive therapy through trial participation. Risk perception— Women acknowledged personal and fetal risk associated with participation. Acceptance of risk was influenced by women’s concepts of motherhood, preexisting knowledge of HCV and medical research, family members, intimate partners, or by the study design. Women enrolled in a phase 1 trial for chronic HCV therapy during pregnancy acknowledged risks of participation and were motivated by hopes for fetal and personal benefit and by lack of prenatal access to treatment. Ethical inclusion of pregnant people in research should acknowledge structural factors that contribute to vulnerability and data deficiencies for treatment in pregnancy. (shrink)