ABSTRACT This paper argues for a hidden way in which speech constitutes harm by enacting harmful norms. The paper then explores the potential legal consequences of uncovering such instances of harm constitution. In particular, the paper argues that some public racist speech constitutes harm and is thus harmful enough to warrant legal remedy. Such utterances are actionable, it is contended, because they enact discriminatory norms in public spaces.

This study examined the relationship between moral distress intensity, moral distress frequency and the ethical work environment, and explored the relationship of demographic characteristics to moral distress intensity and frequency. A group of 106 nurses from two large medical centers reported moderate levels of moral distress intensity, low levels of moral distress frequency, and a moderately positive ethical work environment. Moral distress intensity and ethical work environment were correlated with moral distress frequency. Age was negatively correlated with moral distress intensity, (...) whereas being African American was related to higher levels of moral distress intensity. The ethical work environment predicted moral distress intensity. These results reveal a difference between moral distress intensity and frequency and the importance of the environment to moral distress intensity. (shrink)

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based (...) on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed "medically inappropriate" will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience. (shrink)

Here is Lukcs among his friends, lovers, and peers in those important years before 1918, when he converted to Communism and Marxism at the age of thirty-nine.

Debates the difficult moral issues of today such as abortion and euthanasia. Explores the nature of ethics and how we make moral decisions.

This discussion note responds to Mark Colyvan’s claim that there is no easy road to nominalism. While Colyvan is right to note that the existence of mathematical explanations presents a more serious challenge to nominalists than is often thought, it is argued that nominalist accounts do have the resources to account for the existence of mathematical explanations whose explanatory role resides elsewhere than in their nominalistic content.

Background: Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives (to implement research protocols and advance science), setting (research facilities), and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether (...) research nurses experience unique ethical challenges distinct from those experienced by nurses in traditional patient-care settings. Research objectives: The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice. Research design: The study utilized a qualitative descriptive design with individual interviews. Participants and research context: Participating nurses (N = 12) self-identified as having experienced ethical challenges during screening. The majority were Caucasian (90%), female (83%), and worked in outpatient settings (67%). Approximately 50% had > 10 years of research experience. Ethical considerations: The human subjects review board approved the study. Written informed consent was obtained. Findings: Predominant themes were revealed: (1) the inability to provide a probable good, or/do no harm, and (2) dual obligations (identity as a nurse vs a research nurse). The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship. Discussion: Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science. Conclusion: Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

In the Philippines, all transplant centers are mandated by the Department of Health (DOH) to have a Hospital Transplant Ethics Committee (HTEC) to ensure that donations are altruistic, voluntary and free of coercion/commercial transactions. This study was undertaken primarily to describe the organizational and functional profile of existing HTECs and identify areas for improvement. This is a descriptive cross‐sectional study. There was variation in their logistical arrangements (support from hospital, filing systems, office spaces), operations (length and frequency of meetings, number (...) of referrals) and membership (composition, qualifications, occupation, training). The approval rate for donor‐recipient pairs is high with the majority of cases made by living non‐related donors. Appropriate reasons were cited for rejection. The perception of HTECs is that they are competent and confident in their decision‐making. However, there is a need to standardize HTEC composition, provide operating procedures and additional training which can be done by the DOH. (shrink)

Photographer Keithan captures on film the rural landscape's aging and historic barns. But rather than a sad chronicle of America's rural decline, she presents a visual story of endurance and perseverance, of a way of life that continues to thrive. The b&w photographs from each of Michigan's 80 counties are enriched by her narrative, often including histories from the barn owners themselves.

McGowan here responds to essays written in critical engagement with her lead essay (Just Words: On Speech and Hidden Harm: An Overview and an Application). She here responds to Caroline West, Ishani Maitra, Jeremy Waldron, Robert Mark Simpson, Lawrence Lengbeyer, Louise Richardsoon-Self, Laura Caponetto and Bianca Cepollaro.

Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue (...) that ‘disease’ should be considered a vague concept with a non-classical structure. On this view, overdiagnosed cases are ‘borderline’ cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a pre ́cising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)

M. M. McCabe presents a selection of her essays which explore the Platonic method of conversation: how it may inform our understanding both of Plato and of his predecessors and successors, and how its centrality accounts for the connections between argument, knowledge, and virtue in the texts McCabe examines.

It is with sincere appreciation that I commend this edited collection to readers of the AJTP. The collection meets the task of promoting lively discussion that addresses the interface between theology and philosophy, especially as shaped by empiricist, naturalist, process, and pragmatist traditions. As the most recent volume in the series Toward Ecological Civilization, it delivers papers from the Tenth International Whitehead Conference and Ninth International Forum on Ecological Civilization, held in Claremont, California, June 2015, thereby delivering on a second (...) focus for the AJTP: the development of liberal religious thought in America.The authors gathered in this collection take seriously the earnest and... (shrink)

A virtue ethics look at Dolly Parton's magnificence and greatness of soul. Dolly isn't an exemplar so much as the one who we must "bless rather than praise," and so becomes the focus of broad public honor and even love.

A defense of the thoughtfulness of domestic work, with help from Heidegger.

This paper challenges contemporary portrayals in the nursing literature of the spaces within which care of patients in hospital settings is conducted. Within the wider discourse of fiscal restraint on health care spending, professional nursing has cast its disciplined eyes on details of the nurse‐patient relationship for the ostensible purpose of repairing that which is treated as individual failings of nurses to practise in ways prescribed by nursing theories. Set aside in this approach to the so‐called ‘problems’ of nursing practice (...) has been an examination of the conditions within which nurses come in contact with patients, and a critical recognition that such contacts represent skilled accomplishments of social action. In this paper, these conditions are treated as resources available to both nurses and patients to generate accounts for the nurse's presence as well as the nurse's absence. Examples from an ethnographic study of nursing practice are used to illustrate how the spaces operating between nurses and patients are not empty voids but aresocialspaces through which particular meanings about nursing care can be conveyed. (shrink)

A long-standing tradition presents economic activity in terms of the flow of fluids. This metaphor lies behind a small but influential practice of hydraulic modelling in economics. Yet turning the metaphor into a three-dimensional hydraulic model of the economic system entails making numerous and detailed commitments about the analogy between hydraulics and the economy. The most famous 3-D model in economics is probably the Phillips machine, the central object of this paper.

After the Supreme Court overturned Roe in Dobbs v. Jackson Women’s Health Organization, legal commentators and bioethicists asked whether other constitutional rights were on the chopping block (Coh...

Based on ethnographic fieldwork with panhandlers who provide services while asking for money, informal interviews with pedestrians who have interacted with them, and formal interviews with twenty people who regularly interact with panhandlers, this article unpacks the relationship between temporality and ambiguity of meaning in exchange. In line with previous research, I find that providing a service while asking for money allows panhandlers to manage stigma by recasting their relationship with pedestrians who give as a market exchange. More surprisingly, I (...) find that this kind of recasting makes giving less compelling for the pedestrians in fleeting encounters with panhandlers: they resist service provision in fleeting encounters with panhandlers on the grounds that the exchange is experienced as a coldly rational quid pro quo. In contrast, pedestrians who have long-term relationships with panhandlers experience the interaction as a gift exchange and the service as an expression of gratitude and subservience. The development of an open-ended temporal horizon and of a cycle of exchange, I argue, allows the service and the money given to operate as boundary objects, enabling panhandlers and pedestrians to attach different meanings to the exchange of money for services. This emergent ambiguity allows them to carry out interaction and exchange successfully. Contrary to models of interaction and everyday economic transactions that frame shared definitions of the situation as necessary for successful and repeated interactions, I find that ambiguity and polysemy may be productive and sustaining in interactions between participants from distinct social worlds. (shrink)