In 1998 I was hired by a local health care system to evaluate the mental health of enrolled patients who requested lethal prescriptions under Oregon's newly implemented Death with Dignity Act. I drove to the trailer home of my first patient, a man in his sixties tethered to an oxygen tank for his chronic pulmonary disease who was recently diagnosed with advanced lung cancer. He told me about his abusive, alcoholic stepfather and how he left his family and church at (...) age sixteen, determined never again to be subjugated in any relationship. But in a life marked by an avoidance of intimate relationships, he corresponded regularly with his nephew and was proud to leave him a small inheritance. He shared with me his .. (shrink)

Since 1991, the Patient Self-Determination Act (PSDA) has required all health care institutions that receive Federal funds to inform patients upon admission of their rights to make decisions about medical care and to execute advance directives. Implementation of the PSDA presents a special challenge for state mental hospitals. The relevance and possible negative therapeutic impact of discussing end of life decisions at the time of an acute psychiatric admission has recently been raised in the literature. Other ethical dilemmas arising from (...) the interplay between mental illness and informed consent for medical treatment, particularly for older patients committed to state mental hospitals, have been highlighted by the PSDA. In this article we discuss some of the issues raised by implementation of the PSDA in this setting. (shrink)

Mandating psychiatric evaluation for patients who request physician‐assisted suicide may not offer the clearcut protection from possible coercion or other abuse that proponents assert. Competence itself is a complex concept and determinations of decisionmaking capacity are not straightforward, nor is the relationship between mental illness and decisionmaking capacity in dying patients clearly understood. And casting psychiatrists as gatekeepers in end‐of‐life decisions poses risks to the profession itself.

Death in the Clinic fills a gap in contemporary medical education by explicitly addressing the concrete clinical realities about death with which practitioners, patients, and their families continue to wrestle. Visit our website for sample chapters!

Background In the US, many patients forgo recommended care due to cost. The ANA Code of Ethics requires nurses to give care based on need. Therefore, US nurses are compelled to practice in a context which breaches their professional ethical code. Research Objectives This study sought to determine if nurses do care for patients who forgo treatment due to cost (PFTDC) and if so, does this result in an experience of moral distress (MD). Research Design Semi-structured interviews were transcribed and (...) analyzed using a qualitative content analysis. Participants and Research Context A convenience sample of 20 nurses in practice for at least one year from a variety of health care setting participated. Ethical Considerations This project was approved by the Michigan State University Biomedical Institutional Review Board. Results There were 19 female and one male nurse-participants, averaging 47 years old with an average of 10 years in practice. 18 reported caring for PFTDC. These 17 nurse-participants experienced a moderate degree of MD as a result, averaging 5.4 of 10 on the Moral Distress Thermometer. In the interviews, the following themes were identified, strategies to help PFTDC, and the broken US health care system which had the subthemes of preference for business over patient-oriented benefit, PFTDC using the emergency department, and limited support for treatment/management of PFTDC. Conclusions The existence of this phenomenon places the profession of nursing in the US in a position of moral compromise and threatens to corrupt the institution of nursing in the US. (shrink)

Nanotechnology: Considering the Complex Ethical, Legal, and Societal Issues with the Parameters of Human Performance Content Type Journal Article Pages 265-275 DOI 10.1007/s11569-008-0047-6 Authors Linda MacDonald Glenn, Albany Medical College/Center Alden March Bioethics Institute Albany NY 12208 USA Jeanann S. Boyce, Montgomery College Dept. of Computer Science and Business 7600 Takoma Avenue Takoma Park MD 20912 USA Journal NanoEthics Online ISSN 1871-4765 Print ISSN 1871-4757 Journal Volume Volume 2 Journal Issue Volume 2, Number 3.

In lieu of an abstract, here is a brief excerpt of the content:Could Understanding Harm?Iskra Fileva, PhD (bio) and Linda A.W. Brakel, MD (bio)We would like to thank the editors for organizing this symposium and our commentators—Marga Reimer and James Phillips—for the thought-provoking feedback. Although we had thought about the ideas we discuss from many different angles, our commentators raised several interesting issues we had not considered. We are grateful for the opportunity to continue the conversation.Reply to ReimerAs Professor (...) Reimer notes, we advocate an approach to self-constitution that we dub “understanding first.” On this approach, non-moral and non-normative understanding of the origin of maladaptive traits must precede moral evaluation and attempts to free oneself—or as we say “prune”—undesirable traits. Professor Reimer presents several interesting cases meant both to extend and test the limits of our proposal. We appreciate this approach and respond to each case in turn.Genes and AlcoholismSuppose Alejandro, an adult raised by adoptive parents, struggles with alcohol addiction. He learns that his biological parents died of alcoholic liver disease and comes to believe that his alcohol problem is caused by a genetic propensity toward alcohol abuse. One can ask: “Does an understanding first approach have the potential to undermine the sense of agency that is necessary for the effective treatment of maladaptive traits?”Answer: It can be explained to Alejandro that genetic proclivities are just that—proclivities—that can be overridden. In fact, behavior can alter our very genes—although not at the sequence level— changes known as “epigenetic.” And the liver disease of the biological parents can serve as a cautionary tale. If even in light of these considerations, Alejandro’s tendency to see genetic propensities as deterministic persists, it is worth asking why. There is no evidence that “genes are destiny,” so the disposition to see them that way must have a psychological explanation. What is the explanation? A self-destructive desire? Fear of freedom? This exploration can itself be empowering. [End Page 211]Adaptive ForgettingSuppose Beata, who has an eating disorder, was molested by her own father when she was a child. Subsequently, her father shot himself and now she has no recollection of the molestation. However, Beata’s eating disorder is largely a result of those experiences. It is quite possible that if Beata were to recall being molested, that would do more harm than good. In this connection, one can ask together with Reimer: “Does an understanding first approach have the potential to undermine an adaptive ‘forgetting’ of root causes of maladaptive traits?”Answer: Here, understanding the history, instead of forgetting it, might allow Beata to gain insight into and empathize with possible motives that may have led to becoming obese. For example, she might have the phantasy that if she had been obese and unattractive, she could have prevented the molestation—hence, become that way now to prevent it from happening again, and more wishfully reverse it. (In unconscious goings-on time is thought to be in the “unexamined present” (Brakel 2009, p. 63; 2015, p. 131; 2022, p. 4; 2023, p. 404.) One benefit of this is that in gaining this type of recognition, Beata might find it easier to change her behavior that she otherwise would not have; it was never her responsibility to prevent her own molestation, and there is no reason whatsoever for her to now make herself unattractive to her deceased father, and very little reason to remain obese in an attempt to deter current day men.Ego-Syntonic Maladaptive TraitsClaire is a concert pianist and alcoholic. Importantly, Claire does not see her own desire for alcohol as destructive but rather, as something constitutive of her own identity. “I wouldn’t be myself without alcohol,” she says. Reimer asks whether our approach would “work for cases where the agent sees a maladaptive trait as constitutive of their identity?”Answer: Although no approach can guarantee success, our claim is that our approach has a better chance than the main alternative known as the pruning view. Since Claire, by stipulation, is not inclined to see her own drinking as a problem, a... (shrink)

"First Published in 1992, Routledge is an imprint of Taylor & Francis, an informa company.".

The present study aims to examine the context of academic dishonesty of research students in a public university setting in Bangladesh. In this regard, the researchers conducted interviews with the concerned authorities of the university, i.e., Chairpersons of the Departments, Deans of the Faculties, Proctor of the University, and Director of Students Guidance and Counselling Cell in order to get an impression about the current practice of academic dishonesty by the students of that university; factors influencing these activities and recommendations (...) to uphold academic integrity among the students. The results showed that though there were several instances of academic integrity violation, negligible actions were taken against them due to the absence of an established policy on academic dishonesty. At the same time, the nonexistence of a course on academic integrity and research ethics in the curriculum is also responsible for this scenario. To mitigate this issue, all the concerned authorities strongly recommended formulating a central policy on academic dishonesty for promoting academic integrity and achieving university ranking success in global competitiveness. (shrink)

In a recent article in this journal, James Christensen, Tom Parr and David Axelsen argue that millionaire salaries are unjust and women have no grounds of fairness to unjust salaries in parity with men. They accept that disrespect is expressed toward women when they are paid less than men because of their gender. Their argument largely replicates a similar argument developed earlier by Anca Gheaus. By drawing on the distinction between ideal and nonideal theory, we argue that Christensen et al. (...) and Gheaus hold women to unacceptably high standards of justice and arguably higher standards than men are held to. (shrink)

This volume is the first collection of original essays on the related issues of gender and feminism approached phenomenologically.

Background: While sustainability is a key concept in many different domains today, it has not yet been sufficiently emphasized in the healthcare sector. Earlier research shows that ethical values and evidence-based care models create sustainability in care practice. Objective: The aim of this study was to gain further understanding of the ethical values central to the realization of sustainability in care and to create an ethical practice model whereby these basic values can be made perceptible and active in care practice. (...) Research design: Part of the ongoing “Ethical Sustainable Caring Cultures” research project, a hermeneutical application research design was employed in this study. Participants: Dialogues were used, where scientific researchers and co-researchers were given the opportunity to reflect on ethical values in relation to sustainability in care. Findings: An ethical practice model with ethos as its core was created from the results of the dialogues. In the model, ethos is encircled by the ethical values central to sustainability: dignity, responsibility, respect, invitation, and vows. Discussion: The model can be used as a starting point for ethical conversations that support carers’ reflections on the ethical issues seen in day-to-day care work and the work community, allowing ethical values to become visible throughout the entire care culture. Conclusion: It is intended as a tool whereby carers can more deeply understand an organization’s common basic values and what they entail in regard to sustainability in care. (shrink)

An onslaught of ethically questionable actions by top government, business, and religious leaders during the 1980s has brought the issue of ethics in decision making to the forefront of public consciousness. This study examines the ethical orientation of university students in four decision-making situations. The dependent variable — ethical orientation toward work-related decisions — is measured through student responses to questions following four work-related vignettes. Possible responses to each vignette are structured to permit categorization of respondents into two broad orientations: (...) egoistic and ethical. Independent variables are academic major, ethics in business orientation, gender, and religiosity. Generally, students tended to choose an ethical orientation over an egoistic orientation in each vignette. Business majors were generally no less likely to choose an ethical orientation toward work-related decisions than nonbusiness majors. Respondents characterized by moral unity (belief in the consistency between general ethical principles and work-related ethical standards) were more likely to have an ethical orientation toward work-related decisions than those subscribing to the amoral theory of business. Females showed a consistent tendency to be more ethically oriented toward work-related decisions than males. Finally, respondents high on religiosity tended to be more ethically oriented. (shrink)

The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) requires as a condition of accreditation that every health care institution -- hospital, nursing home, or home care agency -- have a standing mechanism to address ethical issues. Most organizations have chosen to fulfill this requirement with an interdisciplinary ethics committee. The best of these committees are knowledgeable, creative, and effective resources in their institutions. Many are wellmeaning but lack the information, experience, and skills to negotiate adequately the complex ethical (...) issues that arise in clinical and organizational settings. Handbook for Health Care Ethics Committees is the first resource designed to address the range of work performed by ethics committees as part of their multiple responsibilities, including education, case consultation, and policy development. It features an eight-chapter curriculum reviewing the content of contemporary health care bioethics and discussing the ethical foundations of clinical practice, with each subsequent section focusing on a set of ethical issues that commonly arise in the clinical setting. Through case studies, the authors explore issues such as informed consent and refusal, decision making and decisional capacity, truth telling, decision-making concerns of minors, end-of-life issues, palliation, justice in and access to health care services, and organizational ethics. They offer sample policies and procedures, draft guidelines and protocols, and key legal cases. Providing both a strong theoretical foundation and practical applications, this handbook will be essential reading for every member of a health care ethics committee. (shrink)

This paper defends the possibility of dirty hands against the longstanding skepticism that an action cannot be simultaneously right and wrong and that dirty hands cases are therefore impossible. While skeptics are right to recognize that prima facie reasons against violating moral duties may be overridden, they are wrong to deny that actions required by necessity may nevertheless remain wrong. Dirty hands cases capture the simultaneous necessity of disregarding moral duties in certain circumstances and the reprehensibility of wronging people even (...) in cases in which this is all-things-considered permissible. Rather than indicating any deficiency in our moral reasoning, the capacity to accommodate the possibility of dirty hands, along with the reality of moral conflict, is a strength of a moral theory. (shrink)

In order to be held responsible, it is not enough that you’ve done something blameworthy, someone else must also have the standing to hold you responsible. But a number of critics have claimed that this concept of ‘standing’ doesn’t hold up to scrutiny and that we should excise it from our analyses of accountability practices. In this paper, I examine James Edwards’ (2019) attempt to define standing. I pose objections to some key features of Edwards’ account and defend an alternative. (...) Reflecting on examples of meddling blame and privacy norms, I argue, helps us see that the concept of standing is useful after all. (shrink)

Recent political philosophers have argued that criteria of social justice that defend distributing resources to individuals on the basis of the disadvantages of their natural endowments are disrespectful and disparaging. Clearly influenced by the social model of disability, Elizabeth Anderson and Thomas Pogge have recently defended criteria of social justice that distribute resources to people with disabilities on the basis of eliminating discrimination, not making up for so-called natural disadvantage. I argue that it is implausible to suggest that just entitlements (...) for people with disability can be secured solely by eliminating discrimination. Resources for people with disabilities must sometimes be justified on the grounds that some natural endowments pose disadvantages even in societies that do not discriminate. I argue further that there need be nothing at all disrespectful about this way of explaining disadvantage; nor have proponents of the social model of disability or political philosophers provided any compelling reasons for supposing that it is disrespectful. There is thus no motivation for Anderson's and Pogge's attempts to secure justice for people with disabilities by appealing solely to the imperative to eliminate discrimination. (shrink)

Increasingly, philosophers who write about moral responsibility and accountability practices invoke the concept of “standing,” a term they claim to borrow from legal contexts. Yet critics point out that these philosophers have been maddeningly unclear about what standing is. Worse yet, no single account of the concept of “standing” seems to accommodate its current usage. This essay presents a thin account of standing, defends its usefulness in philosophical analyses of accountability practices, and develops further conceptual tools for thinking about standing.

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)

Wrong beliefs, known by some as ‘alternative facts’, have proliferated lately in important areas of human life, including social, political, and public health domains. This can be and has been damaging. This brief article proposes an epistemological category classification of these wrong beliefs, with the following mappings: a) ‘No-Information’ marked by willful blindness produces ‘Empty Beliefs’; b) ‘Mis-Information’ yields ‘Mis(taken) Beliefs’; and c) ‘Dis-Information’ predicated on blatant distortions produces ‘Dis(torted) Beliefs’. This simple classification system, is perhaps epistemologically satisfying, and moreover (...) could have positive policy implications. (shrink)

Global climate change threatens the health, economic prospects, and basic food and water sources of people. A wide range of changes in household energy behaviour is needed to realise a sustainable energy transition. We propose a general framework to understand and encourage sustainable energy behaviours, comprising four key issues. First, we need to identify which behaviours need to be changed. A sustainable energy transition involves changes in a wide range of energy behaviours, including the adoption of sustainable energy sources and (...) energy-efficient technology, investments in energy efficiency measures in buildings, and changes in direct and indirect energy use behaviour. Second, we need to understand which factors underlie these different types of sustainable energy behaviours. We discuss three main factors that influence sustainable energy behaviours: knowledge, motivations, and contextual factors. Third, we need to test the effects of interventions aimed to promote sustainable energy behaviours. Interventions can be aimed at changing the actual costs and benefits of behaviour, or at changing people’s perceptions and evaluations of different costs and benefits of behavioural options. Fourth, it is important to understand which factors affect the acceptability of energy policies and energy systems changes. We discuss important findings from psychological studies on these four topics, and propose a research agenda to further explore these topics. We emphasise the need of an integrated approach in studying the human dimensions of a sustainable energy transition that increases our understanding of which general factors affect a wide range of energy behaviours as well as the acceptability of different energy policies and energy system changes. (shrink)

Australia's policy of mandatory indefinite detention of those seeking asylum and arriving without valid documents has led to terrible human rights abuses and cumulative deterioration in health for those incarcerated. We argue that there is an imperative to research and document the plight of those who have suffered at the hands of the Australian government and its agents. However, the normal tools available to those engaged in health research may further erode the rights and well being of this population, requiring (...) a rethink of existing research ethics paradigms to approaches that foster advocacy research and drawing on the voices of those directly affected, including those bestowed with duty of care for this population. (shrink)

This article summarizes the multitude of empirical studies that test ethical decision making in business and suggests additional research necessary to further theory in this area. The studies are categorized and related to current theoretical ethical decision making models. The studies are related to awareness, individual and organizational factors, intent, and the role of moral intensity in ethical decision making. Summary tables provide a quick reference for the sample, findings, and publication outlet. This review provides insights for understanding organizational ethical (...) decision constructs, where ethical decision making theory currently stands, and provides insights for future empirical work on organizational ethical decision making. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Tribute to an Altruistic EditorWerdie van Staden, MD, PhDThis editorial celebrates the altruistic work of Professor John Sadler during his tenure as editor of Philosophy, Psychiatry, and Psychology. Since its founding about 31 years ago, he has done this behind-the-scenes work, principally to the benefit of our scholarly community, creating a space and opportunity for excellence in advancing the common interests of philosophers, psychiatrists, psychologists and the people they (...) serve professionally. Much of this dedication and efforts never reach the limelight whilst the journal enjoys increasing visibility and impact, ranking currently seventh among 328 philosophy journals and featuring on the 94th percentile. We may attribute this achievement to the authors of PPP, but behind this success story, John has been the vital oxygen in the breathing and energy production of PPP.Our senior editors who have been working under John's leadership for some time, attest as follows in reversed alphabetical order: Michael Wong writes,I once wondered how a psychiatric ethicist like John operates as a journal chief editor? Does he always ask three questions for every submission? Could I publish it? Would I publish it? Should I publish it? I found out very soon after I joined PPP as a Senior Editor that John is actually an editor of empathy and compassion, if there is indeed such an entity in academic publishing, who also has an objective and critical mind. He impresses me that he feels the vulnerability of those who submit a manuscript for peer scrutiny and sees the imbalance of the power relationship between the author and the reviewers. This perceptiveness however never distracts him from spotting the inconvenient truth that a submission still has a lot more to work on before it is ready for publication. I am truly grateful to John for the privilege to have worked with him and to learn from the maestro how to appreciate the effort every author puts into his or her work and how to convey unambiguous yet constructive critique in a collegial manner that does nothing but to further research and scholarship. John, your generosity and leadership will always be missed.Tim Thornton writesMy most striking experience of John's editorship of PPP came at the start of my connection with the journal. In 2014, I inherited from Bill Fulford – the founding editor – the role of UK editor of what was, at the time, a dual UK-USA edited journal. 2014 was a bad year for me – my parents both died and I spent a term living in a dark cell in a castle in the University of Durham – and I leant very heavily on John's help, assisted by the very capable Linda Muncy. Editing an interdisciplinary journal seemed to me at the time an almost [End Page 93] impossible task. Balancing clinical, philosophical and relevant other reviews was difficult and time consuming. One paper – a very fine submission taking a theologically informed look at depression – had been in the review process seemingly forever though its author was very understanding of the delays. But John (and Linda) graciously and practically accommodated my apprenticeship. John wisely pressed for both the move to a modern electronic submission system and the recruitment of more senior editors. Both of these seem necessary for the smooth running of a modern journal and are a marked contrast with the time when even using a spreadsheet and a Psion Organiser seemed the height of technology.But the mark of a good editor is not just practical and technological but rather making difficult decisions balancing widening access to publication with high academic standards. This is a particular challenge for philosophy and mental healthcare but one that John has managed with aplomb.Derek Strijbos writesHe was a central figure in the international academic field of philosophy and psychiatry ever since I was introduced to the topic by my supervisors here in the Netherlands, about 20 years ago. I met John at several conferences during the past decade, one of which was in Amsterdam in 2015, about scientism in psychiatry. I clearly remember the interesting conversation we had during dinner, in which explained his view on values in psychiatry... (shrink)

This volume of the Thinker’s Guide Library uncovers current well-intentioned educational trends that inefficiently fragment energy and resources in our K-12 education systems. Critiquing the basic idea behind each of these fads illuminates their real motivations and provides for holistic use.

Recognizing the different needs & desires of women & acknowledging the multiplicity of feminist approaches, this work offers a debate on existing & emergent technologies that share the goal of improving women's lives.

This paper provides a revisionist account of the authority and power of the criminal mugshot. Dominant theories in the field have tended to focus on the ways in which mugshots have been used as a way of disciplining criminal bodies and rendering them docile. It is argued here that additional emphasis could usefully be placed on stories of resistance in which the monological production site of the prison or police station transforms into a dialogical site, in which the objects of (...) police photography can acquire agency. These issues are explored with particular reference to a set of photographs of English suffragettes acquired by the police for surveillance purposes. The suffragette’s refusal to comply with requests to have their photographs taken is used as a case study through which to examine the ways in which conventions about the form of the mugshot can be subverted, ideas about the types of people who were the object/subject of mugshots disrupted and the assumption of documentary neutrality undermined. (shrink)

The motivation of the study is to explore the nexus tourism-led sustainable human capital development in Brazil, Russia, India, China, and South Africa for the period 1984–2019. The study applied several econometrical techniques for exposing the empirical association between tourism and HCD, such as the conventional and structural break unit root test, the combined cointegration test, long-run and short-run coefficients detected through implementing the Augmented Autoregressive Distributed Lagged, and directional causality by following Toda-Yamamoto with Fourier function. The unit-roots test established (...) variables are integrated in mixed order, wherein variables are stationary at a level or after the first difference. The estimated test statistics from the combined cointegration test and AARDL confirmed the long-run association between tourism, gross capital formation, financial development, and HCD. Tourism revealed a positive and statistically significant tie with HCD in the long run. Moreover, the joint effects of interactive terms TOR*GCF and TOR*FD established a positive and statistically significant relationship with HCD. In addition, the causality test revealed the feedback hypothesis available between tourism and HCD in all sample countries except India. In conclusion, the role of tourism development is critically important for sustainable HCD in BRICS. Therefore, in case of a policymaking concern, it is inevitable to address the tourism issues with care for capitalizing on the benefits for tourism development. (shrink)

Background. Imposter syndrome, associated with self-doubt and fear despite clear accomplishments and competencies, is frequently detected in medical students and has a negative impact on their well-being. This study aimed to predict the students’ IS using the machine learning ensemble approach. Methods. This study was a cross-sectional design among medical students in Bangladesh. Data were collected from February to July 2020 through snowball sampling technique across medical colleges in Bangladesh. In this study, we employed three different machine learning techniques such (...) as neural network, random forest, and ensemble learning to compare the accuracy of prediction of the IS. Results. In total, 500 students completed the questionnaire. We used the YIS scale to determine the presence of IS among medical students. The ensemble model has the highest accuracy of this predictive model, with 96.4%, while the individual accuracy of random forest and neural network is 93.5% and 96.3%, respectively. We used different performance matrices to compare the results of the models. Finally, we compared feature importance scores between neural network and random forest model. The top feature of the neural network model is Y7, and the top feature of the random forest model is Y2, which is second among the top features of the neural network model. Conclusions. Imposter syndrome is an emerging mental illness in Bangladesh and requires the immediate attention of researchers. For instance, in order to reduce the impact of IS, identifying key factors responsible for IS is an important step. Machine learning methods can be employed to identify the potential sources responsible for IS. Similarly, determining how each factor contributes to the IS condition among medical students could be a potential future direction. (shrink)