Background: The Measure of Moral Distress – Healthcare Professionals (MMD-HP) is a 27-item survey that quantifies moral distress. The MMD-HP was distributed to healthcare professionals (HPs), and analysis of a free-text response item revealed information-rich descriptions of morally distressing situations. Research question: What are HPs’ perceptions of their experiences of morally distressing situations? Research design: A descriptive, qualitative approach explored respondents’ free-text responses to the following open-ended response item: “If there are other situations in which you have felt moral distress, (...) please write and score them here.” Participants and research context: Eligible participants were HPs ( N = 8206) working in a large, multi-site healthcare system located in a major, urban city in the Southeastern United States. Ethical considerations: The Institutional Review Board provided approval for this research. A survey preamble supplied information, and consent was presumed with survey completion. Findings: Three themes were identified from 282 free-text responses: Theme 1: Compromised Quality of Care, Theme 2: Hostile Work Environment, and Theme 3: Ineffective Leadership. Conclusions: This study is unique because it provided in-depth qualitative analysis of morally distressing situations in a free-text response item across a wide array of HPs within multiple settings. Responses revealed that moral distress impacted the quality of patient care and provided descriptions of powerlessness to act. (shrink)

Clinical ethics consultants provide a range of services in hospital settings and in teaching environments. Training to achieve the skills needed to meet the expectations of employers comes in various forms, ranging from on-the-job training to formal fellowship training programs. We surveyed graduates of clinical ethics fellowships to evaluate their self-reported preparedness for their first job after fellowship training. The results indicated several areas of need, including greater exposure to program-building skills, quality improvement skills, and approaches to working with members (...) of higher administration. These data will be of use to educators as well as to fellows who advocate for elements of training in preparation for their first position. (shrink)

Verbal protocol methodology is used to examine how fourth-grade students construct meaning as they read and respond to two informational social studies texts. Results indicate most students are active readers, often engaging in higher-level comprehension strategies and critical thinking as they read independently. However, critical thinking and comprehension processes are not often captured in their responses to end-of-reading questions (ERQ), which as a result have limited scope and utility for guiding social studies instruction. Results also indicate that when students change (...) their patterns of strategy use for reading and responding to text in response to a change in text, they are more successful on the ERQ than when their strategy use remains stagnant. (shrink)

Kimberly et al. (2005) have examined an important issue surrounding end-of-life decision-making, that of honoring do-not-resuscitate (DNR) orders in the non-medical setting of public schools. Their...

In The Medical Right, Remaking Medicine in Their Image (2007) (Medical Right Report or Report), the Religious Coalition for Reproductive Choice (RCRC) applies the term "Medical Right" to refer to religiously influenced medical, bioethics and health policy organizations of the Religious Right. This extremely important, well researched Report examines how the political agenda of the Religious Right, a political force comprised of fundamentalists primarily in the Protestant and Roman Catholic traditions, impacts reproductive health care. The growing influence of medical associations (...) that apply fundamentalist Christian "biblical values" to research and policy affecting reproductive health care is explored. The Report reveals that many consortiums, think tanks, institutes, and programs apply Religious Right ideology to medical concerns under the mantle of "bioethics" or "biomedical ethics." These groups work with conservative advocacy, outreach, and legal organizations, along with politicians, to advance the policy agendas of the Religious Right. The confluence of conservative politics, fundamentalist religion, and ideologically influenced medicine and science, poses a threat to reproductive health care services, as discussed in detail in the Report. While the Report is comprehensive in its discussion of the Religious Right's involvement in reproductive health issues, it addresses in only a cursory fashion how the Medical Right engages health law and policy governing end-of-life care. The purpose of this paper is to explore this area of concern more thoroughly. (shrink)

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this (...) area. (shrink)

Near the conclusion of the so-called marriage group in the Canterbury Tales sits Chaucer's Squire's Tale, a strange, hybrid narrative of love and betrayal located in the Mongol empire. Surprisingly, however, none of the many modern readers of the tale has made a study of how the Squire's Tale's setting in the East is connected to its view of the subject that dominates Fragments IV and V of the Canterbury Tales: love, power, and the negotiation of a settlement in the (...) prolonged war between the sexes. The omission is especially perplexing when the Squire's Tale is read in combination with its companion narrative, the Franklin's Tale. Indeed, the relation of Squire to Franklin is normally seen as old money to new, aristocrat to parvenu without reference either to the question of female power or to the geographical and cultural oppositions upon which the stories also insist. When the Squire is understood as making a contribution to the conversation initiated by the Wife of Bath and carried on at least through the Franklin's Tale, it is generally on the subject of true nobility, chivalry, or gentillesse—not on the “gentle sex.” Donald Baker even goes so far as to rechristen G. L. Kittredge's marriage group a “gentillesse group” in order to include the Squire in its discussion. (shrink)

This paper explores how the "environmental turn" for the last 25 years has been shaping remembrance of the destruction of Europe's Jewish populations. I argue that climate change is not just one more catastrophe to pass into the broad analogical field of the Holocaust. In fact, international Holocaust consciousness and understandings of what we now call the Anthropocene have long been intertwined and mutually constitutive. The paper starts in the 1990s with acclaimed writers Anne Michaels and W.G. Sebald, who sought (...) to recast the Holocaust's significance to modernity against a long backdrop of geologic time. Their memorial fiction, which grounds the history of the Holocaust in the eroding landscapes of Europe, reflects a growing and urgent global concern for the vulnerability of the environment and a sense of man's responsibility for preserving human and biological life. The paper then moves through more contemporary examples of the sublimation of Holocaust memory in discourse about global warming—evident in terms like "climate change denial" and calls to "bear witness" to mass extinction events. For better or worse, journalists and scholars who write about environmental activism frequently call on memory of World War II and genocide in order to redefine what constitutes "grievable life." Example authors include historian Timothy Snyder, who has predicted that climate change may lead to new genocidal wars over Lebensraum ; scientist James Lovelock, who has urged nation states to consider how to limit the coming influx of climate refugees; theorist Bruno Latour, who has argued, via Nazi philosopher Carl Schmitt, that we must "name our enemies" in the new climate wars; and essayist Ari Brostoff who has attempted to think climate catastrophe through Walter Benjamin's meditations on the angel of history. The implicit question in all of their work is this: What histories and philosophical traditions can help us redefine humanity's entangled relationship to nature in order to take political responsibility for saving life on Earth? In other words, the Anthropocene requires "a usable past"—but what will that usable past be? (shrink)

LANGUAGE NOTE | Document text in English ; abstract also in Chinese. 本文介紹生物倫理學與公共健康倫理學領域，並描述兩者之間的關係；文章尾聲將展望公共健康倫理學論未來既廣泛又多變的方向。本文首先簡介公共健康倫理學的本質，以及如何把其與比之更廣闊的生物倫理學作出區分，因此 需要提出公共健康倫理學的定義，以助釐清公共健康倫理的重點。隨後，本文簡述公共健康倫理學文獻的一些最新進展，包括圍繞新冠病毒、大流行病、抗菌素抗藥性、「生活方式」疾病及正義等道德問題。本文同時論及就干預 公共健康的「合法範圍」所提出的觀點之間於政治及形而上學的角力。其後本文探討公共健康倫理學所面臨的挑戰，包括其複雜又多元的性質。而且公共健康實踐高度政治化，其政治化的原因是因為公共健康影響整個人口及社區 ，而很多關於公共健康的決策由政治人物而非公共健康專家所作出。此外，公共健康倫理也因為公共健康的範圍擴展至納入非政府公共健康行動者而面臨進一步的挑戰。本文最後闡述有關公共健康的一些未來方向，包括「公共健 康觀」的出現，以作為為人熟知的健康與社會問題的形而上學框架、把該領域的認知和道德基礎去殖民化以涵蓋更廣泛的知識，以及一些包括美德在内的公共健康倫理學的理論發展。筆者建議讀者把文章視為對公共健康倫理學領 域的一部分介紹，並鼓勵他們閲讀本文所引用的論文，並以這些論文作為進入所涵蓋主題的大量文獻之門徑。公共健康倫理學是一個相對年輕的領域，而該領域有著巨大的成長及發掘更多新概念的潛力。 This essay begins by introducing the fields of bioethics and public health ethics and describing the relationship between them. It ends with some glimpses into the wide-ranging and discourse-changing directions of the literature on public health ethics. To open, the paper describes the field of public health ethics and how it is differentiated from the wider field of bioethics. This requires a brief description of public health to (...) clarify the nature of public health ethics. The essay then provides a brief overview of a few recent developments in the public health ethics literature, including the moral issues raised by COVID-19 and pandemics, anti-microbial resistance, ‘lifestyle’ diseases and justice. The paper also touches on the political and metaphysical tensions in views on what counts as a ‘legitimate area’ of intervention for public health. The essay then turns to a couple of challenges in the field of public health ethics, specifically the complex and multi-disciplinary nature of the field and the fact that public health practice is a highly political area. Public health is political both in the sense that it affects entire populations or communities and in the sense that many decisions about public health are made by politicians rather than public health experts. A further challenge to public health ethics is the question of what counts as ‘public health’, as the scope has been broadened to include non-governmental public health actors. Finally, the essay describes some future directions for research in public health ethics, including ‘public health view’ becoming a metaphysical framing for familiar health and social issues and decolonising the epistemic and moral foundations of the field to include a wider set of knowledge sources and values. There are also some theoretical developments that integrate virtue into public health ethics. The reader should take this essay as a partial introduction to the field, and they are highly encouraged to read the papers that are cited here and to use those papers as a gateway into the large literature on the topics covered. Public health ethics is a relatively young field, with an enormous potential for growth and new ideas. (shrink)

Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, (...) we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice. (shrink)

Military reproductive health policies affect large numbers of women. In 2006 servicewomen numbered nearly 350,000 and comprised 14.5% of active-duty forces and 17.4% of the reserve force. In addition, approximately 165,000 female dependents of active duty military personnel and 157,000 female dependents of reserve duty personnel are between the ages of 12 and 22 and are eligible for military health care services. Dependents of military personnel are eligible for military health care coverage until age 21, or up to the age (...) of 23 if considered a full-time student.About 10% of active duty female servicemembers become pregnant each year. Pregnant servicewomen are considered non-deployable and are usually not assigned to overseas commands. Pregnant women in the Army, the service branch with the greatest number of women on active duty, can choose to remain on active duty, request temporary leave from service, or request separation from service. Separation options include either discharge, honorable or uncharacterized depending on rank, or transfer to individual ready reserve. (shrink)

In the ethics of public health, questions of virtue, that is, of what it means for public health to act excellently, have received little attention. This omission needs remedy first because achieving improvements in population-wide health can be in tension with goals like respect for the liberty, self-determination, or non-oppression of various individuals or groups. A virtue-ethics approach is flexible and well-suited for the kind of deliberation required to resolve or mitigate such tension. Public health requires practically wise and careful (...) thinking, which virtue ethics brings with it. Furthermore, too tight a focus on delivering outcomes in determining how public health should act has, in some cases, actually undermined its ability to achieve those consequences. However, the main concern about incorporating virtue into public health in a pluralistic society is likely to be that virtue is generally teleological, and we would surely need some widely agreed upon idea of something like flourishing or the common good for this to work. In this paper, I propose that for public health to express virtue in its work, it must express a commitment to justice as it goes about its business promoting and protecting the health of the population. Justice is both a contributor toward better health for groups in society, and a worthwhile goal in its own right. I will sketch an argument that justice as non-oppression – not merely health equity – is the right telos toward which excellent public health should aim in a pluralist society. (shrink)

New readings of Chaucer's dream visions, demonstrating his philosophical interests and learning.

This study examines the use of an explicit, reflective method for teaching the difference and relationship between scientific theories and laws to ninth-grade students. Students reflected individually and then as a whole class on theories and laws using a Venn diagram, both before and after reading short articles describing features of theories and laws that provided an explicit challenge to their naïve prior conceptions. In small groups, they chose a theory or law, researched it, constructed a poster, and did a (...) gallery walk. Examination of students’ Venn diagrams and answers to a single question from VNOS-C given as both a pre- and post-test showed that prior to the lesson, all students except for one held more naïve views of both the difference between theories and laws and the nature of scientific theories. After the lesson, more than a third of them had improved their conceptions to more informed, and nearly a quarter understood that there is not a hierarchical relationship between scientific theories and laws. (shrink)

Elizabeth A. McGibbon and Josephine B. Etowa, Anti-racist health care practice, Toronto: Canadian Scholars’ Press, 2009, reviewed by Kathryn L. Mackay.

In the case discussion, ‘Equity in Public Health Ethics: The Case of Menu Labelling Policy at the Local Level’ , Mah and Timming state that menu labelling would ‘place requirements for information disclosure on private sector food businesses, which, as a policy instrument, is arguably less intrusive than related activities such as requiring changes to the food content’. In this commentary on Mah and Timming’s case study, I focus on discussing how menu-labelling policy permits governments to avoid addressing the heart (...) of the problem, which is high-calorie, high-sodium restaurant food. Menu labelling policy does not address food content in a way that is meaningful for change, instead relying on individuals to change their behaviour given new information. Besides having questionable efficacy, this raises concerns about moralizing food choices. (shrink)

In this article, I focus on two problematic aspects of British health-promotion campaigns regarding feeding children, particularly regarding breastfeeding and obesity. The first of these is that health-promotion campaigns around “lifestyle” issues dehumanize mothers with their imagery or text, stemming from the ongoing undervaluing and objectification of mothers and women. Public health-promotion instrumentalizes mothers as necessary components in achieving its aims, while at the same time undermining their agency as persons and interlocutors by tying “mother” to particular images. This has (...) a double effect: first, it excludes mothers who do not fit the campaign picture of a mother; second, it encloses those who do fit the picture into an objectified image of motherhood that is defined by and subject to the dominant white, heteropatriarchal gaze. The second problem is that campaigns place unjustified demands on mothers, which stem from a misinterpretation of the maternal duty to benefit. I argue that nutrition-related health concerns regarding children are improperly framed as individual failures of maternal duty, rather than as failures of a system to function correctly. These arguments ultimately support shifting the focus of responsibility for issues around childhood nutrition away from mothers and back toward policymakers. (shrink)

This recent collection of essays, edited by Glen Pettigrove and Christine Swanton, presents interesting takes on virtues, old and new. Very much to the credit of the various authors and the editors...

A commentary on “‘Aid in Dying’ in the Courts,” by Stephen R. Latham, in the May-June 2015 issue.

In addressing social issues, organizations have a responsibility to promote diverse participation, yet often struggle to harness the benefits of racial and gender diversity. Using a community-based participatory research design, with data collected over an 18 month field study, we examined how a social change organization, FoodLab, facilitated diverse collaboration. FoodLab aimed to grow a good food economy in Detroit, Michigan, through working with their members, local food entrepreneurs. We found that recurrent episodes of practicing dialogue catalyzed collaborative action around (...) multiple issues, including shared kitchens, licensing, and membership. Practicing dialogue included intentional convening, participatory devices, and collective language. While leaders set up the initial procedures and rules, leaders and members, together, enacted these structures. Through high quality interactions, participants developed additional resources, knowledge, motivation, and relationships. Across episodes of practicing dialogue, traces of high quality interactions supported sustained effort around social issues. Our findings demonstrate the dynamic aspects of organizational structure and individual action in working towards diverse collaborative action. (shrink)

The purpose of this study is to describe ways in which elementary students access information from various components of informational social studies texts in schools. Although the time devoted to elementary social studies has decreased considerably in recent years, a renewed focus on content-area literacy skills, driven by state standard initiatives, presents us with the opportunity to regain lost social studies instructional time by integrating social studies content during literacy instructional time. However, it is not entirely clear what this instructional (...) time should entail. This paper describes how third-, fourth-, and fifth-grade children navigate various aspects of the written and graphical elements of informational social studies reading materials. Results indicate that when students are unable to correctly answer questions about the content of the reading materials, they primarily attempt to do so in one of four ways: (1) responding without the use of a discernable strategy; (2) extracting random information from the passage; (3) relying on prior knowledge; or, (4) extracting information from the correct aspect of text that is not responsive to the question. Based on researcher-developed reading assessments as data sources, we explain the challenges children encounter and make recommendations for elementary social studies instruction. (shrink)

This paper draws on nearly two decades of research on health consumer and patients’ organizations in the United Kingdom. In particular, it addresses questions of representation and legitimacy in the health policy process. HCPOs claim to represent the collective interests of patients and others such as relatives and carers. At times they also make claims to represent the wider public interest. Employing Pitkin’s classic typology of formalistic, descriptive, symbolic, and substantive representation, the paper explores how and in what sense HCPOs (...) represent their constituencies. We found that policymakers themselves are less concerned with formal mechanisms adopted by groups and are more concerned with credibility, in particular whether HCPOs carry the confidence of their constituents. While some concerns about legitimacy remain, particularly in relation to funding from commercial interests, we argue that HCPOs bring a unique perspective to the policy process and to focus purely on formalistic representation provides only a partial understanding of their representative role and a constrained view of their collective moral claims. (shrink)

Although it is clear that i-frame approaches cannot stand alone, the impact of s-frame changes can plateau. Combinations of these approaches may best reflect what we know about behavior and how to support behavioral change. Interactions between i-frame and s-frame thinking are explored here using two examples: alcohol consumption and meat consumption.

We congratulate Fox and her colleagues (2007) for contributing to the published empirical literature on ethics consultation in United States hospitals. Their study demonstrates the continued wide v...

Surveillance is a core function of all public health systems. Responses to the COVID-19 pandemic have deployed traditional public health surveillance responses, such as contact tracing and quarantine, and extended these responses with the use of varied technologies, such as the use of smartphone location data, data networks, ankle bracelets, drones, and big data analysis. Applying Foucault’s (1979) notion of the panopticon, with its twin focus on surveillance and self-regulation, as the preeminent form of social control in modern societies, we (...) examine the increasing levels of surveillance enacted during this pandemic and how people have participated in, and extended, this surveillance, self-regulation, and social control through the use of digital media. Consideration is given to how such surveillance may serve public health needs and/or political interests and whether the rapid deployment of these extensive surveillance mechanisms risks normalizing these measures so that they become more acceptable and then entrenched post-COVID-19. (shrink)

This article describes a qualitative content analysis of 37 elementary examples of social studies Inquiry Design Models (C3 Teachers, 2023a), conducted with the purpose of identifying the core student skills necessary to successfully engage in these inquiries. Prior research identifies core inquiry teaching skills for teachers across content areas and grade bands, but there has been little research on the demands placed on elementary students in social studies inquiry. In this study, we identify 33 broad skills, each of which are (...) observable and teachable. Four of these skills occurred in high frequency: generation of new ideas ( n = 152), writing process ( n = 110), linking evidence with claims ( n = 65), and discussion ( n = 63). These most frequently occurring skills all required higher-level and/or critical thinking. Implications for preservice and in-service teacher education are discussed. (shrink)

Changes in health care have created a variety of new roles and opportunities for nurses in advanced practice. One of these changes is the increasing number of advanced practice nurses carrying out independent consultation. Differences in goals between business and health care may create ethical dilemmas for nurse consultants. The purpose of this article is to describe possible ethical pitfalls that nurse consultants may encounter and strategies to prevent or solve these dilemmas. Three themes related to nursing codes of ethics (...) will be discussed: the duty to uphold human rights, the duty to fulfill commitments, and the duty to practice the profession competently. (shrink)

Though we agree with their argument that language is shaped by domain-general learning processes, Christiansen & Chater (C&C) neglect to detail how the development of these processes shapes language change. We discuss a number of examples that show how developmental processes at multiple levels and timescales are critical to understanding the origin of domain-general mechanisms that shape language evolution.

Background: Although attention to healthcare ethics in rural areas has increased, specific focus on rural palliative care is still largely under-studied and under-theorized. The purpose of this study was to gain a deeper understanding of the values informing good palliative care from rural individuals' perspectives. Methods: We conducted a qualitative ethnographic study in four rural communities in Western Canada. Each community had a population of 10, 000 or less and was located at least a three hour travelling distance by car (...) from a specialist palliative care treatment centre. Data were collected over a 2-year period and included 95 interviews, 51 days of field work and 74 hours of direct participant observation where the researchers accompanied rural healthcare providers. Data were analyzed inductively to identify the most prevalent thematic values, and then coded using NVivo. Results: This study illuminated the core values of knowing and being known, being present and available, and community and mutuality that provide the foundation for ethically good rural palliative care. These values were congruent across the study communities and across the stakeholders involved in rural palliative care. Although these were highly prized values, each came with a corresponding ethical tension. Being known often resulted in a loss of privacy. Being available and present created a high degree of expectation and potential caregiver strain. The values of community and mutuality created entitlement issues, presenting daunting challenges for coordinated change. Conclusions: The values identified in this study offer the opportunity to better understand common ethical tensions that arise in rural healthcare and key differences between rural and urban palliative care. In particular, these values shed light on problematic health system and health policy changes. When initiatives violate deeply held values and hard won rural capacity to address the needs of their dying members is undermined, there are long lasting negative consequences. The social fabric of rural life is frayed. These findings offer one way to re-conceptualize healthcare decision making through consideration of critical values to support ethically good palliative care in rural settings. (shrink)