The growth and sustainability of the nursing profession depends on the ability to recruit and retain the upcoming generation of professionals. Understanding the career choice experiences and professional expectations of Millennial nurses (born 1980 or after) is a critical component of recruitment and retention strategies. This study utilized Polkinghorne's interpretive, narrative approach to understand how Millennial nurses explain, account for and make sense of their choice of nursing as a career. The positioning of nursing as a virtuous choice was both (...) temporally and contextually influenced. The decision to enter the profession was initially emplotted around a traditional understanding of nursing as a virtuous profession: altruistic, noble, caring and compassionate. The centricity of virtues depicts one‐dimensional understanding of the nursing profession that alone could prove dissatisfying to a generation of professionals who have many career choices available to them. The narratives reveal how participants' perceptions and expectations remain influenced by a stereotypical understanding of nursing, an image that remains prevalent in society and which holds implications for the future recruitment, socialization and retention strategies for upcoming and future generations of nurses. (shrink)

This article provides an in-depth analysis of a conversational exchange initiated by a customer’s price question in real-life business-to-business sales encounters. The analysis focusses on when the customer requests a price, what that implies as well as how the price discussion is conducted. Marketing literature usually considers product/service price to be an obstacle that the salesperson needs to overcome; we demonstrate that the price question is a positive signal for the salesperson. By requesting the (...) class='Hi'>price, the customer claims sufficient understanding of the offer, recognition of the service value and a readiness to move to the next phase in the meeting. The salesperson initiates an insert expansion to tailor the price to her or his customer and then informs the price in an expanded clausal response to build customer value. The conversation analytic study was based on a dataset of 13 video-recorded B2B sales meetings in Finland. (shrink)

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study (...) was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)

What do consumers do with their used clothing, books, and children’s toys? In this research, we introduce metaphoric “fresh start” messaging as an effective tactic to encourage consumers to engage in environmentally sustainable actions of donating used products for remanufacture or reuse. Drawing on conceptual metaphor theory and construal theory, we contrast metaphoric “fresh start” messaging with dominant “reduce waste” and “recycle” non-metaphoric environmental messages. Across six experimental studies, metaphoric “fresh start” messaging is more effective in increasing environmentally sustainable actions, (...) including used product donations and donation intentions. The effectiveness of metaphoric “fresh start” messaging is grounded in its activation of abstract thinking as “rebirth associations,” thoughts around new beginnings, renewal, and new life. We examine the effectiveness of metaphoric “fresh start” (vs. non-metaphoric environmental) messaging with the use of “fresh start” temporal landmarks (New Year’s Day and Earth Day) and find that metaphoric “fresh start” messaging, with or without these temporal landmarks, is more effective in triggering abstract thinking as “rebirth associations.” Our work substantiates the power of metaphoric “fresh start” messaging in encouraging consumers’ environmentally sustainable actions and has significant implications for the use of conceptual metaphors in marketing messages. (shrink)

This article recommends that the U.S. Securities and Exchange Commission (SEC) not regulate corporate social responsibility (CSR) disclosure. Accounting disclosures, whether voluntary or regulated, increase transparency and credibility for all companies. Regulated disclosure increases costs and results in few gains; thus, this article recommends against CSR disclosure regulation. Varying definitions of CSR and nonuniform disclosure make CSR project analysis difficult for investors and analysts. This article presents a model that defines CSR items such as organizational size, CSR project size, amount (...) invested in the project, and what standard companies use for CSR definition and reporting for easy voluntary disclosure. Based on a review of the literature, this article recommends that CSR disclosure stay voluntary. The model suggests allowing SEC oversight in the collection and verification of information but not regulating CSR disclosure. This article suggests that the SEC issue a CSR “seal of approval,” increasing firm values, stock prices, and firm legitimacy. (shrink)

This study explores consumer expectations and attitudes related to gender-based price discrimination. Although much research has focused on pay inequalities and gender diversity, considerably less attention has been focused on situations in which men and women are charged different prices based on gender. In two studies, expectations and attitudes toward gender-based price discrimination are examined. In Study 1, two scenarios related to prices at hair salon and dry cleaning services were manipulated to measure expectations and attitudes toward gender-based (...) price discrimination. We found that the nature of the service results in expectations of price differences between men and women. We also found men expect gender-based pricing more than women. In Study 2, qualitative research was conducted to reveal the cognitions that men and women experience when exposed to gender-based price discrimination. (shrink)

Fairtrade-certified products are sold through retailers to consumers who are willing to pay a premium in exchange for assurances that products were produced under acceptable working and environmental conditions, and that farmers were paid a fair market price. While touted as a positive social innovation, the Fairtrade movement has invited critical scrutiny and in its wake, suggestions for improvements in terms of sustainability, transparency, and tangible benefits for producers subsisting in Base of Pyramid markets. In this paper, we uncover (...) the debate swirling around Fairtrade and stipulate as to the theoretical reasoning for why the system should work and why it can fail. Focusing on the coffee industry, a case study of a socially responsible coffee roaster in Kansas City illustrates one of the alternative business models we discuss that seeks to solve the same problems addressed through Fairtrade, albeit through different producer-buyer relationships. (shrink)

Through the lens of the Health Belief Model and Protection Motivation Theory, we analyzed interviews of 36 agricultural advisors in Indiana and Nebraska to understand their appraisals of climate change risk, related decision making processes and subsequent risk management advice to producers. Most advisors interviewed accept that weather events are a risk for US Midwestern agriculture; however, they are more concerned about tangible threats such as crop prices. There is not much concern about climate change among agricultural advisors. Management practices (...) that could help producers adapt to climate change were more likely to be recommended by conservation and Extension advisors, while financial and crop advisors focused more upon season-to-season decision making. We contend that the agricultural community should integrate long-term thinking as part of farm decision making processes and that agricultural advisors are in a prime position to influence producers. In the face of increasing extreme weather events, climatologists and advisors should work more closely to reach a shared understanding of the risks posed to agriculture by climate change. (shrink)

The Prudent Investor Rule creates a potential ethical dilemma for investment advisors selling over-the-counter financial products issued by their firms. The "opportunity" to defraud investors using complex, over-the-counter derivative securities designed for client-specific risk management is much higher than for exchange traded securities. This paper emphasizes the ethical responsibility held by trustees and their organizations to eliminate potential conflict of interests through internal control and monitoring. Independent evaluations of the performance of investment advisors and independent appraisals of complex over-the-counter securities (...) are important in reducing the risks of conflicts of interest. Recent lessons learned from the corporate ethics crisis and requirements of the 2002 Sarbanes Oxley Act would suggest that conflict of interest must be eliminated with third party validation of derivative pricing. By performing due diligence and validation, the trustee is able to satisfy the requirements under the Prudent Investor Rule. (shrink)

Farm to institution programs represent alternative supply chains that aim to organize the activities of local producers with institutions that feed the local community. The current study demonstrates the value of structuration theory :75–80, 1983; The constitution of society: outline of the theory of structuration. University of California Press, Berkeley, 1984) for conceptualizing how FTI agents create, maintain, and change organizational structures associated with FTI and traditional supply chains. Based on interviews with supply chain agents participating in FTI programs, we (...) found that infrastructure, relationships, and pricing were seen as important factors that enabled and constrained FTI organizing. Additionally, we describe how FTI organizing serves to simultaneously reinforce and challenge the practices associated with traditional supply chains. Theoretical and practical implications are discussed as well as directions for future research. (shrink)

In Philosophy, psychoanalysis and the a-rational mind, Brakel focuses her discussion on the nature of primary process, and its relation to a range of philosophical views. While the discussion, and Brakel’s project, is both original and much-needed in the philosophy of psychoanalysis, in the end, I found the book disappointing. The arguments and connections are repeatedly indicative rather than deeply and cogently unified into a coherent whole.

In lieu of an abstract, here is a brief excerpt of the content:Books ReceivedAquinas on Being. By Anthony Kenny. Oxford: Clarendon Press, 2002. Pp. x + 212. Price not given.Before and after Avicenna: Proceedings of the First Conference of the Avicenna Study Group. Edited by David C. Reisman, with the assistance of Ahmed H. al Rahim. Leiden: Brill, 2003. Pp. xix + 302. Price not given.Beside Still Waters: Jews, Christians, and the Way of the Buddha. Edited by Harold (...) Kasimow, John P. Keenan, and Linda Klepinger Keenan. Boston: Wisdom Publications, 2003. Pp. 284. Paper $14.95.The Buddhist Unconscious: The ālaya-vijñāna in the Context of Indian Buddhist Thought. By William S. Waldron. London and New York: RoutledgeCurzon, 2003. Pp. xvi + 269. Price not given.Comparative Political Philosophy: Studies under the Upas Tree. Edited by Anthony J. Parel and Ronald C. Keith. Lanham, Maryland: Lexington Books, 2003. Pp. xxxviii + 260. Paper $26.95.The Confucian Quest for Order: The Origin and Formation of the Political Thought of Xun Zi. By Masayuki Sato. Leiden: Brill, 2003. Pp. xviii + 500. Price not given.Gathering the Meanings: The Compendium of Categories: The Arthaviniścaya Sūtra and Its Commentary Nibandhana. Translated from the Sanskrit by N. H. Samtani. Berkeley: Dharma Publishing, 2002. Pp. xxxiv + 390. Price not given.I Have Arrived, I Am Home: Celebrating Twenty Years of Plum Village Life. By Thich Nhat Hanh. Berkeley: Parallax Press, 2003. Pp. 253. Paper $25.00.Identity and the Moral Life. By Mrinal Miri. New Delhi: Oxford University Press, 2003. Pp. xvii + 132. Hardcover Rs 645.00.Indian Philosophers and Postmodern Thinkers: Dialogues on the Margins of Culture. By Carl Olson. New Delhi: Oxford University Press, 2002. Pp. xv + 331. Hardcover Rs 950.00.Islamic Humanism. By Lenn E. Goodman. New York: Oxford University Press, 2003. Pp. xiii + 273. Price not given.Letting Go: The Story of Zen Master Tōsui. Translated by Peter Haskel. Honolulu: University of Hawai'i Press, 2001. Pp. xv + 167. Hardcover $45.00. Paper $16.95.A Life Journey to the East: Sinological Studies in Memory of Giuliano Bertuccioli (1923-2001). Edited by Antonino Forte and Federico Masini. Kyoto: Scuola Italiana di Studi sull'Asia Orientale, 2002. Pp. xxxv + 280. Price not given.The Measure of Things: Humanism, Humility and Mystery. By David E. Cooper. Oxford: Clarendon Press, 2002. Pp. ix + 372. Price not given. [End Page 277]Mencius, Hume and the Foundations of Ethics. By Xiusheng Liu. Aldershot, Hampshire: Ashgate Publishing Limited, 2003. Pp. vii + 204. Price not given.Monks and Monarchs, Kinship and Kingship: Tanqian in Sui Buddhism and Politics. By Chen Jinhua. Kyoto: Scuola Italiana di Studi sull'Asia Orientale, 2002. Pp. xiii + 310. Price not given.Music in the Sky: The Life, Art, and Teachings of the 17th Gyalwa Karmapa Ogyen Trinley Dorje. By Michele Martin. Ithaca: Snow Lion Publications, 2003. Pp. 351. Paper $18.95, U.K. £12.95.New Confucianism: A Critical Examination. Edited by John Makeham. New York: Palgrave Macmillan, 2003. Pp. 262. Hardcover $55.00.On the Boundaries of Theological Tolerance in Islam: Abū Hāmid Al-Ghāzalī's Faysal al-Tafriqa Bayna al-Islām wa al-Zandaqa. By Sherman A. Jackson. Oxford: Oxford University Press, 2002. Pp. xiv + 156. Hardcover Rs 295.00.Pandita Ramabai's American Encounter: The Peoples of the United States (1889). By Pandita Ramabai and translated and edited by Meera Kosambi. Bloomington: Indiana University Press, 2003. Pp. xi + 284. Hardcover $59.95. Paper $29.95.Parmenides of Elea: A Verse Translation with Interpretative Essays and Commentary to the Text. By Martin J. Henn. Westport, Connecticut: Praeger, 2003. Pp. 147. Hardcover $59.95.Philosophes taoïstes, tome II: Huainan Zi, texte traduit, présenté et annoté sous la direction de Charles le Blanc et de Rémi Mathieu. Paris: Éditions Gallimard, 2003. Pp. lxxxiii + 1182. Hardcover €56,90.The Philosophy and Ethics of the Vīraśaiva Community. By Dan A. Chekki. Lewiston, New York: The Edwin Mellen Press, 2003. Pp. xxv + 287. Hardcover $119.95.Poems of Hanshan. Translated by Peter Hobson with introduction by T. H. Barrett. Walnut Creek, California: AltaMira Press, 2003. Pp. viii + 151. Hardcover $65.00. Paper $19.95.Psychoanalysis and Buddhism: An Unfolding Dialogue. Edited by Jeremy D. Safran. Boston... (shrink)

In Exemplarist Moral Theory of Linda Zagzebski presents an original moral theory based on direct reference to exemplars of goodness, whom we identify through the emotion of admiration. Using examples of heroes, saints, and sages, she shows how narratives of exemplars and empirical work on the most admirable persons can be incorporated into the theory to serve both theoretical and practical purposes.

This original analysis examines the three leading traditional solutions to the dilemma of divine foreknowledge and human free will--those arising from Boethius, from Ockham, and from Molina. Though all three solutions are rejected in their best-known forms, three new solutions are proposed, and Zagzebski concludes that divine foreknowledge is compatible with human freedom. The discussion includes the relation between the foreknowledge dilemma and problems about the nature of time and the causal relation; the logic of counterfactual conditionals; and the differences (...) between divine and human knowing states. An appendix introduces a new foreknowledge dilemma that purports to show that omniscient foreknowledge conflicts with deep intuitions about temporal asymmetry, quite apart from considerations of free will. Zagzebski shows that only a narrow range of solutions can handle this new dilemma. A compelling contribution to the field, The Dilemma of Freedom and Foreknowledge will appeal to students and scholars of theistic philosophy and the philosophy of religion. (shrink)

xxiii + 293. Price £50.00 h/b). Thinking About Knowing. By JAY F. ROSENBERG. (Oxford UP, 2002. Pp. viii + 257. Price £30.00 h/b). Epistemology is currently enjoying a renaissance. To a large extent, this has been sparked by some exciting new proposals, such as the contextualist theories advanced by Stewart Cohen, Keith DeRose, David Lewis and Michael Williams, the modal conceptions of knowledge offered by Fred Dretske and Robert Nozick, and the virtue epistemologies put forward by John Greco, (...) Ernest Sosa and Linda Zagzebski, to name but three currently popular views. Increasingly, however, this rebirth in epistemological theorising has been driven less by the production of new theories and more by the application of the latest batch of novel proposals to other areas of philosophy. A good illustration of this from the selection of books under review here is the contemporary debate regarding the vexed relationship between content externalism and self-knowledge that is the 2 focus of the volume of essays edited by Susana Nuccetelli. Here we have a controversy that has blended some of the most innovative aspects of recent epistemological theorising with issues in the philosophy of mind and language, with the emphasis being on the so-called ‘McKinsey paradox’ concerning the putative incompatibility of content externalism and privileged self-knowledge. Whilst early responses to this supposed paradox concentrated on the formulation of the content externalist thesis whilst treating the epistemic concepts at issue as, essentially, primitives, more recent work in this area has drawn-out some of the epistemological implications of this debate and looked at how these implications fit in with recent movements in epistemology. Many of the articles collected in this volume are instances of this ‘second phase’ of the debate. In particular, it is tremendously useful to have the new articles by Martin Davies and Crispin Wright which revisit a previous exchange between the pair where some of the epistemological morals of the McKinsey debate were first extracted.. (shrink)

Citizenship presents two faces. Within a political community it stands for inclusion and universalism, but to outsiders, citizenship means exclusion. Because these aspects of citizenship appear spatially and jurisdictionally separate, they are usually regarded as complementary. In fact, the inclusionary and exclusionary dimensions of citizenship dramatically collide within the territory of the nation-state, creating multiple contradictions when it comes to the class of people the law calls aliens--transnational migrants with a status short of full citizenship. Examining alienage and alienage law (...) in all of its complexities, The Citizen and the Alien explores the dilemmas of inclusion and exclusion inherent in the practices and institutions of citizenship in liberal democratic societies, especially the United States. In doing so, it offers an important new perspective on the changing meaning of citizenship in a world of highly porous borders and increasing transmigration. As a particular form of noncitizenship, alienage represents a powerful lens through which to examine the meaning of citizenship itself, argues Linda Bosniak. She uses alienage to examine the promises and limits of the "equal citizenship" ideal that animates many constitutional democracies. In the process, she shows how core features of globalization serve to shape the structure of legal and social relationships at the very heart of national societies. (shrink)

An ethic for wrongdoers -- Repaying moral debts : self-punishment and restitution -- Changing one's heart, changing the past : repentance and moral transformation -- Reforming relationships : the reconciliation theory of atonement -- Forgiveness, self-forgiveness, and redemption -- Making amends for crime : an evaluation of restorative justice -- Collective atonement : making amends to the Magdalen penitents.

Stakeholder theory has largely been anthropocentric in its focus on human actors and interests, failing to recognise the impact of nonhumans in business and organisations. This leads to an incomplete understanding of organisational contexts that include key relationships with nonhuman animals. In addition, the limited scholarly attention paid to nonhumans as stakeholders has mostly been conceptual to date. Therefore, we develop a stakeholder theory with animals illustrated through two ethnographic case studies: an animal shelter and Nordic husky businesses. We focus (...) our feminist reading of Driscoll and Starik’s (J Bus Ethics 49:55–73, 2004) stakeholder attributes for nonhumans and extend this to include affective salience built on embodied affectivity and knowledge, memories, action and care. Findings reveal that nonhuman animals are important actors in practice, affecting organisational operations through human–animal care relationships. In addition to confirming animals are stakeholders, we further contribute to stakeholder theory by offering ways to better listen to nontraditional actors. (shrink)

CHAPTER ONE Political Theory as a Signifying Practice Political theory has been a heroic business, snatching us from the abyss a vocation worthy of giants. ...

Disaster response is a highly collaborative and critical process that requires the involvement of multiple emergency responders (ERs), ideally working together under a unified command, to enable a rapid and effective operational response. Following the 9/11 and 11/13 terrorist attacks and the devastation of hurricanes Katrina and Rita, it is apparent that inadequate communication and a lack of interoperability among the ERs engaged on-site can adversely affect disaster response efforts. Within this context, we present a scenario-based terrorism case study to (...) highlight the challenges of operational disaster command and response. In this article, which is based on the French emergency response doctrine, we outline a semantics-based common operational command system that is designed to guarantee an efficient information flow among ERs. Our focus is on offering to all ERs, a real-time operational picture of the situation in order to enable multilevel coordination among firefighters, police, healthcare units, public authorities, and other stakeholders. Our approach consolidates information to promote timely sharing of data among ERs. The proposed system is based on an ontology that has been developed to represent the different types of knowledge on the part of ERs, providing a shared vocabulary that covers a variety of interoperability concerns. (shrink)

The statistical interpretation introduced by Born in mid-1926 is not the interpretation now associated with his name. Born's own understanding of that interpretation is revealed by looking at some of its roots in Born's earlier work with Franck on collisions, his collaboration with Jordan on that topic, his contributions to matrix mechanics, his attempt in collaboration with Wiener at an operator formulation of quantum mechanics, and at the exposition of the interpretation in Born's first papers on a wave mechanical treatment (...) of collisions. (shrink)

Culture is surely important in human learning. But the relation between culture and psychological mechanism needs clarification in three areas: (1) All learning takes place in real time and through real-time mechanisms; (2) Social correlations are just a kind of learnable correlations; and (3) The proper frame of reference for cognitive theories is the perspective of the learner.

Now available from Rowman & Littlefield, the third edition of this introductory critical thinking text features streamlined chapters, Think for Yourself activities, and a complete glossary of critical thinking terms.

This article considers why truth-telling is so difficult in institutions, and deceit and paltering are so common. Drawing on recent examples of churches and charities exposed for covering up the truth about abuse, the article explores the institutional barriers to truthfulness and considers how they might be removed.

Abstract In light of the complexity of unfolding disasters, the diversity of rapidly evolving events, the enormous amount of generated information, and the huge pool of casualties, emergency responders (ERs) may be overwhelmed and in consequence poor decisions may be made. In fact, the possibility of transporting the wounded victims to one of several hospitals and the dynamic changes in healthcare resource availability make the decision process more complex. To tackle this problem, we propose a multicriteria decision support service, based (...) on the Analytic Hierarchy Process (AHP) method, that aims to avoid overcrowding and outpacing the capacity of a hospital to effectively provide the best care to victims by finding out the most appropriate hospital that meets the victims’ needs. The proposed approach searches for the most appropriate healthcare institution that can effectively deal with the victims’ needs by considering the availability of the needed resources in the hospital, the victim’s wait time to receive the healthcare, and the transfer time that represents the hospital proximity to the disaster site. The evaluation and validation results showed that the assignment of hospitals was done successfully considering the needs of each victim and without overwhelming any single hospital. (shrink)

That contempt and dishonor are closely related has been shown not only in recent discussions of the subject, but also in Aristotle's investigation of emotions in the judiciary. In this paper, I will discuss the ways in which the ancient Greeks—and, in particular, the polis of Athens—institutionalized what Bell calls “apt contempt” (i.e., contempt as a response to actual and serious faults of character which stems from the contemnor's concern for the values at stake) through the legal penalty of atimia (...) (“dishonor”). Not only does Athenian evidence prove Bell's point that contempt can be “apt”—it also represents an early case study of a community that formalized such “apt” contempt in law and in the formal enactment of collectively approved social norms. And yet, the Greeks were also aware of the potential ambivalence of notions such as “contempt” and “dishonor.” This ambivalence is likely to have been one of the factors that catalyzed a differentiation, within the semantic field of atimia, between “dishonoring” ( atiman/ atimoun) and “disrespecting” ( atimazein)—between “apt” and “inapt” contempt. (shrink)

According to standard philosophical analyses, only victims can forgive. There are good reasons to reject this view. After all, people who are neither direct nor indirect victims of a wrong frequently feel moral anger over injustice. The choice to foreswear or overcome such moral anger is subject to most of the same sorts of considerations as victims’ choices to forgive. Furthermore, bystanders’ reactions to their experiences of moral anger often reflect either virtues or vices that are of a piece with (...) what we normally describe as a forgiving or unforgiving disposition. In this paper, I reject the view that only victims can forgive by comparing the experience and regulation of moral anger by victims and bystanders. The virtues of victims and bystanders with regard to moral anger are so similar that there is no good reason to apply different labels. However, the recognition of forgiveness in bystanders offers us more than simple consistency. It also leads us to think about the role moral bystanders play in the maintenance of the moral community, as well as the ways in which this role can be abused or overstepped. (shrink)

Although tissue plasminogen activator (tPA) is the only medication approved by the United States Food and Drug Administration (FDA) for acute ischemic stroke, there is no consensus about the need for informed consent for its use. As a result, hospitals throughout the U.S. have varying requirements regarding obtaining informed consent from patients for the use of tPA, ranging from no requirement for informed consent to a requirement for verbal or written informed consent. We conducted a study to (1) determine current (...) beliefs about obtaining patients’ informed consent for tPA among a large group of stroke clinicians and (2) identify the ethical, clinical, and organizational factors that influence tPA consent practices. Semi-structured interviews were conducted by trained and experienced investigators and research staff to identify key barriers to implementing acute stroke services. Part of the interview explored current beliefs and practices around informed consent for tPA.This was a multicenter study that included 38 Veterans Health Administration (VHA) hospital locations. Participants were 68 stroke team clinicians, serving primarily on the neurology (35 percent) or emergency medicine (41 percent) service. We conducted thematic analysis based on principles of grounded theory to identify codes about consent for tPA. We used interpretive convergence to ensure consistency among the individual investigators’ codes and to ensure that all of the investigators agreed on coding and themes.We found that 38 percent of the stroke clinicians did not believe any form of consent was necessary for tPA, 47 percent thought that some form of consent was necessary, and 15 percent were unsure. Clinicians who believed tPA required informed consent were divided on whether consent should be written (40 percent) or verbal (60 percent). We identified three factors describing clinicians’ attitudes about consent: (1) legal and policy factors, (2) ethical factors, and (3) medical factors.The lack of consensus regarding consent for tPA creates the potential for delays in treatment, uneasiness among clinicians, and legal liability. The identified factors provide a potential framework to guide discussions about developing a standard of care for acquiring the informed consent of patients for the administration of tPA. (shrink)

As medical technology becomes more sophisticate the ability to manipulate nature and manage disease forces the dilemma of when can becomes ought. Indeed, most bioethical discourse is framed in terms of balancing the values and interests and the benefits and burdens that inform principled decisions about how, when, and whether interventions should occur. Yet, despite advances in science and technology, one caregiver mandate remains as constant and compelling as it was for the earliest shaman—the relief of pain. Even when cure (...) is impossible, the physician's duty of care includes palliation. Moreover, the centrality of this obligation is both unquestioned and universal, transcending time and cultural boundaries.Although universally acknowledged, pain is a complex phenomenon for both the patient and the caregiver, influenced as much by personal values and cultural traditions as by physiological injury and disease. (shrink)

Jean Hampton argues that we can detect exploitation in personal relationships by thinking about what we would agree to were we to set aside the emotional benefits we receive from those relationships. Hampton calls her account "feminist contractarianism," but it has recently been critiqued as decidedly unfeminist, on the grounds that it is hostile to women's interests and women's values. Furthermore, Hampton's requirement that we imaginatively distance ourselves from our emotional connections to our loved ones--the key element in her contractarian (...) test--is simply ad hoc. In this essay, I will evaluate these objections and offer a new justification for Hampton's test. I conclude that feminist contractarianism is not only a useful tool for detecting exploitation in the family, it is also deserving of its feminist label. (shrink)