Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.

Does the sense of smell involve the perception of odor objects? General discussion of perceptual objecthood centers on three criteria: stimulus representation; perceptual constancy; and figure-ground segregation. These criteria, derived from theories of vision, have been applied to olfaction in recent philosophical debates about psychology. An inherent problem with such framing of olfactory objecthood is that philosophers explicitly ignore the constitutive factors of the sensory systems that underpin the implementation of these criteria. The biological basis of odor coding is fundamentally (...) different from the coding principles of the visual system. This article analyzes the three measures of perceptual objecthood against the biological background of the olfactory system. It contrasts the coding principles in olfaction with the visual system to show why these criteria of objecthood fail to be instantiated in odor perception. The argument demonstrates that olfaction affords perceptual categorization without the need to form odor objects. (shrink)

The notion of virtue in general, and courage in particular, has had a hard time integrating itself into the everyday lexicon of bioethics. Following the lead of enlightenment moral philosophy, which concentrates on the theory of right action as opposed to the ancient Greeks' emphasis on the development of good character, bioethics, with some notable exceptions, has tended to relegate consideration of the virtues to the sidelines of moral argument. Recently, however, there have been calls for the necessity of “moral (...) courage” in the context of clinical ethics. As nurses, physicians, and other health care professionals confront a variety of moral contexts in which the virtue of courage is invoked to "do the right thing," stand up for patients' rights, and uphold the ethical standards of their professions, they are increasingly reminded of their moral duty to exhibit courage in the face of institutional obstacles to the proper care of their patients. For example, a nurse's hesitation to approach a physician to request increased sedation for an agitated patient out of fear of retaliation is represented in one article as a lack of courage.In this paper we offer a critical assessment of such invocations of courage. While we find courage to be an indispensable virtue in some challenging contexts, in other settings we find invocations of courage to be both an unfortunate endorsement of an oppressive status quo that can divert attention from the real problems and an undesirable and potentially destructive strategy within health care institutions whose goal is medically excellent and morally good clinical practice. As we shall argue, a call to virtuousness is not always virtuous. (shrink)

Although intersectional analyses of gender have been widely adopted by feminist theorists in many disciplines, controversy remains over their character, limitations, and implications. I support intersectionality, cautioning against asking too much of it. It provides standards for the uses of methods or frameworks rather than theories of power, oppression, agency, or identity. I want feminist philosophers to incorporate intersectional analyses more fully into our work so that our theories can, in fact, have the pluralistic and inclusive character to which we (...) give lip service. To this end, I advocate an intersectional family resemblance strategy that does not create philosophical problems for feminists. I test my approach against María Lugones's argument in “Heterosexualism and the Colonial/Modern Gender System” (Lugones 2007) to determine, in particular, whether we can successfully resist a move to create multiple genders for women. If we can successfully resist this move, then we can answer the objection that intersectionality fragments women both theoretically and politically. I also argue that my approach avoids Lugones's critique of forms of intersectionality that fall within “the logic of purity.”. (shrink)

Background: Intensive care unit nurses are providing care to COVID-19 patients in a stressful environment. Understanding intensive care unit nurses’ sources of distress is important when planning interventions to support them. Purpose: To describe Canadian intensive care unit nurse experiences providing care to COVID-19 patients during the second wave of the pandemic. Design: Qualitative descriptive component within a larger mixed-methods study. Participants and research context: Participants were invited to write down their experiences of a critical incident, which distressed them when (...) providing nursing care. Thematic analysis was used to analyze the data. Ethical considerations: The study was approved by the ethics committee at the researchers’ university in eastern Canada. Results: A total of 111 critical incidents were written by 108 nurses. Four themes were found: (1) managing the pandemic, (2) witness to families’ grief, (3) our safety, and (4) futility of care. Many nurses’ stories also focused on the organizational preparedness of their institutions and concerns over their own safety. Discussion: Nurses experienced moral distress in relation to family and patient issues. Situations related to insufficient institutional support, patient, and family traumas, as well as safety issues have left nurses deeply distressed. Conclusion: Identifying situations that distress intensive care unit nurses can lead to targeted interventions mitigating their negative consequences by providing a safe work environment and improving nurses’ well-being. (shrink)

Two significant, apparently unrelated, trends have emerged in American society and medicine. First, American medicine is reexamining its approach to dying. The Institute of Medicine, the American Medical Association and private funding organizations have recognized that too many dying people suffer from pain and other distress that clinicians can prevent or relieve. Second, this past decade has marked a sharp increase in the number of physicians prosecuted for criminal negligence based on arguably negligent patient care. The case often cited as (...) a watershed is People u. Einaugfer, which involved a New York nursing home patient whose physician was convicted in 1993 of two criminal misdemeanors after he ordered an elderly dialysis patient to be tube fed through a peritoneal dialysis Catheter.How is the growing awareness of dying patients’ pain and the increasing willingness of prosecutors to charge physicians with crimes connected? Pain at the end of life is frequently treated with narcotics, prescription drugs that are closely regulated by state and federal law. That complex web of laws—and a growing fear of legal sanctions—has deterred physicians from prescribing controlled substances. As those legal sanctions move from disciplinary actions to criminal charges, physicians’ fears may expand. (shrink)

The essence of religion was once widely thought to be a unique form of experience that could not be explained in neurological, psychological, or sociological terms. In recent decades scholars have questioned the privileging of the idea of religious experience in the study of religion, an approach that effectively isolated the study of religion from the social and natural sciences. Religious Experience Reconsidered lays out a framework for research into religious phenomena that reclaims experience as a central concept while bridging (...) the divide between religious studies and the sciences. Ann Taves shifts the focus from "religious experience," conceived as a fixed and stable thing, to an examination of the processes by which people attribute meaning to their experiences. She proposes a new approach that unites the study of religion with fields as diverse as neuroscience, anthropology, sociology, and psychology to better understand how these processes are incorporated into the broader cultural formations we think of as religious or spiritual. Taves addresses a series of key questions: how can we set up studies without obscuring contestations over meaning and value? What is the relationship between experience and consciousness? How can research into consciousness help us access and interpret the experiences of others? Why do people individually or collectively explain their experiences in religious terms? How can we set up studies that allow us to compare experiences across times and cultures? Religious Experience Reconsidered demonstrates how methods from the sciences can be combined with those from the humanities to advance a naturalistic understanding of the experiences that people deem religious. (shrink)

Virginia Held argues that feminism has a distinct contribution to make to morality, one that will transform theory and society by beginning from the experiences of women and children. Her main thesis is that the mother-child relation should be taken as the primary moral relation and the model, at least initially, for all other relations in society. She spends the first four of the ten chapters of this book arguing for the distinctness of feminist moral theory; then chapters 5-7, chapter (...) 10, and the epilogue discussing the difference that taking the mother-child relationship as the paradigm for morality would make to theory and society; chapters 8 and 9 criticizing what she takes to be her major nonfeminist competitors, especially contractualist liberal theory. Regrettably, none of these projects are, I think, particularly successful or enlightening in their failure. (shrink)

My aim … is to show that the celestial machine is likened not to a kind of divine living being but rather to a clockwork. I consider the human body to be a machine … Although it may exaggerate to say that Descartes fathered the mechanization of biology, it is true that his Treatise of Man provided the first systematic development of the idea that a complete understanding of all the phenomena of life, including all abilities and behaviour of animals, (...) can be achieved by viewing living things as machines. To make this out, Decartes had to learn to think about living things in a new way. My first aim here is to identify the fundamental conceptual innovations at work in Descartes’ attempt to extend the new mechanics to include biology. My second aim is to locate the point at which Descartes’ mechanical imagination runs out. This requires study of Descartes’ scientific work on sense. (shrink)

Despite establishing the gendered construction of infertility, most research on the subject has not examined how individuals with such reproductive difficulty negotiate their own sense of gender. I explore this gap through 58 interviews with women who are medically infertile and involuntarily childless. In studying how women achieve their gender, I reveal the importance of the body to such construction. For the participants, there is not just a motherhood mandate in the United States, but a fertility mandate—women are not just (...) supposed to mother, they are supposed to procreate. Given this understanding, participants maintain their gender by denying their infertile status. They do so through reliance on essentialist notions, using their bodies as a means of constructing a gendered sense of self. Using the tenets of transgender theory, this study not only informs our understanding of infertility, but also our broader understanding of the relationship between gender, identity, and the body, exposing how individuals negotiate their gender through physical as well as institutional and social constraints. (shrink)

Agrifood scholars commonly adopt “a matter of fact way of speaking” to talk about the extent of neoliberal rollout in the food sector and the viability of “alternatives” to capitalist food initiatives. Over the past few decades this matter of fact stance has resulted in heated debate in agrifood scholarship on two distinct battlegrounds namely, the corporate food regime and the alternative food regime. In this paper I identify some of the limitations of speaking in a matter of fact way (...) and of focusing on capitalist and neoliberal economies as the yardstick by which to assess all food economy initiatives. Using stories of bananas in Australia and the Philippines I advocate for a new mode of critical inquiry in food scholarship that focuses on matters of concern. Following Bruno Latour I use the term critical inquiry to refer to research methods and thinking practices that multiply possible ways of being and acting in the world. The new mode of critical inquiry I propose centers on enacting three broad research matters of concern. These are gathering and assembling economic diversity human actancy and nonhuman actancy. I argue that through becoming critical minds in the Latourian sense researchers can play a key role in enacting economic food futures in the Anthropocene. (shrink)

Nursing is a complicated and multifaceted profession that sets high demands in preparing nursing students for the profession. In today's education, the emphasis is often on knowledge and skills, that is, epistemology. In caring science another approach is sought, an approach based on human sciences in which knowledge will serve a more profound understanding, that is, the ontology. Consequently, the question of what this ‘understanding’ in clinical education is and how it is promoted in clinical nursing education becomes important to (...) clarify. Therefore, the aim here is to explicate the phenomenon of understanding in clinical education as experienced by third‐year undergraduate nursing students ready for graduation. This study, with a hermeneutic approach, is based on a secondary analysis of focus group interviews with undergraduate nursing students. The analytical expansion of the original material suggests three interrelated themes that illuminate the phenomenon of understanding in clinical education. These findings are deepened and enriched through philosophical abstraction. In the process of understanding, episteme, techne and phronesis can be viewed as inherent parts of the structure of thought in nursing. The perspective advanced in this study adds new aspects to the phenomenon of understanding and its meaning and significance in the dynamic process of formation and becoming in clinical education. The focus in clinical nursing education should be on learning reflective, critical thinking and the ways of being a nurse, rather than drilling students on particular skills. In the rapidly changing world of the 21st century, an understanding‐based education is needed as a more meaningful and authentic approach. Therefore, an ontological turn in nursing education, through which the main focus shifts from a traditional epistemology to an epistemology in the service of ontology, is suggested. Further studies are needed in the development and implementation of an understanding‐based, interpretative education in nursing. (shrink)

Recent UK reports have revealed extensive evidence of unethical care practices. Older and vulnerable patients in some British health services have experienced appalling and avoidable suffering. Explanations for, and solutions to, these care failures have been proposed with wide-ranging recommendations. Many of these have direct implications for clinical ethics with additional frameworks for ethical values proposed, a heightened awareness of the moral culture of organisations acknowledged and a renewed interest in the ethics component of professional education debated. In this paper, (...) I suggest that we integrate insights from the slow movement into clinical ethics practice. Distinctions are made between fast and slow healthcare practice and between fast and slow ethics. I argue that, whilst there is a place for both, slow ethics enables us to assume a more positive stance in relation to ‘crisis’, and requires that we learn from past accounts and scholarship and consider the role of clinical ethics in sustaining caring cultures. (shrink)

Michel Foucault’s _History of Sexuality_ has been one of the most influential books of the last two decades. It has had an enormous impact on cultural studies and work across many disciplines on gender, sexuality, and the body. Bringing a new set of questions to this key work, Ann Laura Stoler examines volume one of _History of Sexuality_ in an unexplored light. She asks why there has been such a muted engagement with this work among students of colonialism for whom (...) issues of sexuality and power are so essential. Why is the colonial context absent from Foucault’s history of a European sexual discourse that for him defined the bourgeois self? In _Race and the Education of Desire, _Stoler challenges Foucault’s tunnel vision of the West and his marginalization of empire. She also argues that this first volume of _History of Sexuality_ contains a suggestive if not studied treatment of race. Drawing on Foucault’s little-known 1976 College de France lectures, Stoler addresses his treatment of the relationship between biopower, bourgeois sexuality, and what he identified as “racisms of the state.” In this critical and historically grounded analysis based on cultural theory and her own extensive research in Dutch and French colonial archives, Stoler suggests how Foucault’s insights have in the past constrained—and in the future may help shape—the ways we trace the genealogies of race. _Race and the Education of Desire_ will revise current notions of the connections between European and colonial historiography and between the European bourgeois order and the colonial treatment of sexuality. Arguing that a history of European nineteenth-century sexuality must also be a history of race, it will change the way we think about Foucault. (shrink)

BackgroundWhen rationing health care, a commonly held view among ethicists is that there is no ethical difference between withdrawing or withholding medical treatments. In reality, this view does not generally seem to be supported by practicians nor in legislation practices, by for example adding a ‘grandfather clause’ when rejecting a new treatment for lacking cost-effectiveness. Due to this discrepancy, our objective was to explore physicians’ and patient organization representatives’ experiences- and perceptions of withdrawing and withholding treatments in rationing situations of (...) relative scarcity.MethodsFourteen semi-structured interviews were conducted in Sweden with physicians and patient organization representatives, thematic analysis was used.ResultsParticipants commonly express internally inconsistent views regarding if withdrawing or withholding medical treatments should be deemed as ethically equivalent. Participants express that in terms of patients’ need for treatment withholding and withdrawing should be deemed ethically equivalent. However, in terms of prognostic differences, and the patient-physician relation and communication, there is a clear discrepancy which carry a moral significance and ultimately makes withdrawing psychologically difficult for both physicians and patients, and politically difficult for policy makers.ConclusionsWe conclude that the distinction between withdrawing and withholding treatment as unified concepts is a simplification of a more complex situation, where different factors related differently to these two concepts. Following this, possible policy solutions are discussed for how to resolve this experienced moral difference by practitioners and ease withdrawing treatments due to health care rationing. Such solutions could be to have agreements between the physician and patient about potential future treatment withdrawals, to evaluate the treatment’s effect, and to provide guidelines on a national level. (shrink)

Detecting contract cheating in written submissions can be difficult beyond direct plagiarism detectable via technology. Successfully identifying potential cases of contract cheating in written work such as essays and reports is largely dependent on the experience of assessors and knowledge of student. It is further dependent on their familiarity with the patterns and clues evident in sections of body text and reference materials to identify irregularities. Consequently, some knowledge of what the patterns and clues look like is required. This paper (...) documents how to identify some of the patterns and clues observed in essay and report submissions. Effective assessment design with specific contextual requirements make irregularities easier to detect and interpret. The irregularities identified were confirmed as instances of contract cheating through conversations held with postgraduate students. An essential element of the conversations was the evidence presented for discussion. Irregularities were noted on a pro-forma specifically developed for this purpose. Patterns identified include misrepresented bibliographic data, inappropriate references, irrelevant material and generalised text that did not address the assessment question or grading criteria. The validated patterns formed the basis of identifying potential instances of contract cheating in later submissions. Timely conversations with students before the end of semester are essential to determining whether the patterns and clues link to poor knowledge of academic writing conventions or classified as contract cheating necessitating the application of appropriate penalties under institutional policies and procedures. (shrink)

Despite the fact that ethics consultations are an accepted practice in most healthcare organizations, many clinical ethicists continue to feel marginalized by their institutions. They are often not paid for their time, their programs often have no budget, and institutional leaders are frequently unaware of their activities. One consequence has been their search for concrete ways to evaluate their work in order to prove the importance of their activities to their institutions through demonstrating their efficiency and effectiveness.

Accession Number: ATLA0001713191; Hosting Book Page Citation: p 836-849.; Language(s): English; General Note: Bibliography: p 849.; Issued by ATLA: 20130825; Publication Type: Essay.

This paper takes up Avtar Brah's (1999) invitation to write back to the issues she raises in her mapping of the production of gendered, classed and racialised subjectivities in west London. It addresses two topics that, together, illuminate racialised and gendered interpellation and psychosocial processes. The paper is divided into two main sections. The first draws on empirical research on the transition to motherhood conducted in east London to consider one mother's experience of giving birth in the local maternity hospital. (...) The maternity ward constituted a site where racialised difference became salient, leading her to construct her maternal identity by asserting her difference from Bangladeshi mothers and so self-racialising, as well as ‘othering’ Bangladeshi mothers. The paper analyses the ways in which her biography may help to explain why her experience of the maternity hospital interpellates her into racialised positioning. The second section focuses on media responses to the riots in various English cities in August 2011. It examines the ways in which some media punditry racialised the riots and inclusion in the British postcolonial nation. The paper analyses three sets of commentaries and illuminates the ways in which they racialise the debate in essentialising ways, reproducing themes that were identified in the 1980s as ‘new racism’ and apportioning blame for the riots to ‘black gangster culture’. While these media pronouncements focus on racialisation, they are intersectional in implicitly also invoking gender and social class. The paper argues that the understanding of the mother's self-racialisation is deepened by a consideration of the racialised discourses that can be evoked (and are contested) in periods of social unrest. The paper thus draws on part of the methodology of ‘The Scent of Memory’ in layering media readings and biographical narratives to analyse the contemporary psychosocial space of racialisation. (shrink)

Death and the Disinterested Spectator examines the nature of philosophy in light of philosophy's claim to be a preparation for death.

The history of note?taking has only begun to be written. On the one hand, the basic functions of selecting, summarizing, storing and sorting information garnered from reading, listening, observing and thinking can be identified in most literate contexts in some form or other. On the other hand, Renaissance humanists emphasized with unprecedented success the virtues of stockpiling notes on large scales and for the long term, thanks to the availability of paper and a new abundance of books, but also to (...) their ability to transmit their own keen motivation to avoid any future loss of learning. We continue to share many early modern ideals for insuring the collection and retrievability of information and have built on early modern practices that facilitate the accumulation and the organization of information, including collaborative work and the use of rearrangeable slips. (shrink)

Background: The foundation of all nursing practice is respect for human rights, ethical value and human dignity. In perioperative practice, challenging situations appear quickly and operating theatre nurses must be able to make different ethical judgements. Sometimes they must choose against their own professional principles, and this creates ethical conflicts in themselves. Objectives: This study describes operating theatre nurses’ experiences of ethical value conflicts in perioperative practice. Research design: Qualitative design, narratives from 15 operating theatre nurses and hermeneutic text interpretation. (...) Ethical consideration: The study followed ethical principles in accordance with the Helsinki Declaration and approval was granted by the local university ethics committee. Findings: The result showed that value conflicts arose in perioperative practice when operating theatre nurses were prevented from being present in the perioperative nursing process, because of current habits in perioperative practice. The patient’s care became uncaring when health professionals did not see and listen to each other and when collaboration in the surgical team was not available for the patient’s best. This occurred when operating theatre nurses’ competence was not taken seriously and was ignored in patient care. Conclusion: Value conflicts arose when operating theatre nurses experienced that continuity of patient care was lacking. They experienced compassion with the patient but still had the will and ability to be there and take responsibility for the patient. This led to feelings of despair, powerlessness and of having a bad conscience which could lead to dissatisfaction, and even resignations. (shrink)

In 2012, chief nursing officers (CNO) in England published a policy on compassion in response to serious criticisms of patients’ care. Because their objective is fundamentally to shape nursing, this study argues, following Popper, that the policy should be analysed. An appraisal tool, developed from Popper, Gadamer, Jauss and Thiselton, is the framework for this analysis. The CNO policy document identified six values and behaviours, termed ‘6Cs’, required by all nurses, midwives and care staff. The document contains no data, references (...) or acknowledgements, but is similar to the 6Cs defined by the Canadian nursing nun, Sister M. Simone Roach, in her theory of caring published 30 years earlier. Roach considered caring and the components of it, including compassion, to be moral virtues, an inner motivation to care. This study suggests that without explicit reference to Roach's ideas, and her underlying theoretical base, the CNO requirement has the effect of turning virtues into commodities and a form of external control, described by Ritzer as a McDonaldized dehumanization. This study, which has international relevance beyond England and the UK, suggests that the CNO revise their policy by acknowledging Roach's 6Cs and openly discuss the implications of her work for their policy. (shrink)

Northern researchers and service providers espousing modernist theories of development in order to understand and aid countries and peoples of the South ignore their own non-universal starting points of knowledge and their own vested interests. Universal ethics are rejected in favor of situated ethics, while a modified empowerment development model for aiding women in the South based on poststructuralism requires building a bridge identity politics to promote participatory democracy and challenge Northern power knowledges.

Too many visitors to the Silver State never see Ann Ronald and Stephen Trimble's Nevada: teal sky and a sea of purple sage, mountain mahogany and a crimson mass of claret cup cactus, a dust-blown sunset of vermilion, orange, and gold. More colorful than a neon display on Las Vegas Boulevard, Nevada is one vast landscape of tint and shadow and aesthetic dimension. In Earthtones, Ronald and Trimble provide a guide to understanding a challenging landscape. Their love for the land (...) shines through in six vivid personal essays and sixty-seven boldly emotional color photographs. In independent but interwoven visions, Ronald and Trimble cherish the same Nevada, an astonishing place to anyone familiar with the mistaken stereotypes Nevada suffers. After sharing the surprises of this collaboration, readers too will cherish a Nevada filled with earthtone treasures. (shrink)

Simone Weil’s concept of gravity (la pesanteur) has received attention from philosophers and interested readers at least since the 1947 publication of La Pesanteur et fa grâce. “Gravity” is a key concept in Weil’s moral and spiritual psychology, and despite the attention Weil’s writings have received, there is ample need for a study that draws together Weil’s scattered references to gravity and demonstrates their cohesion. This article develops a treatment of gravity that seeks to clarify one of the major scientific (...) analogies Weil uses to develop her notion of moral gravity. It is hoped that this approach will furnish a point of departure for interpreting Weil’s obscure and often fragmentary remarks on gravity. In addition, something important can be said about both the difficulties and the promise of Weil’s analogy, and this article offers a few critical comments towards that end. (shrink)

Clinical research is increasingly conducted in settings that include private physicians’ offices, clinics, community hospitals, local institutes, and independent research centers. The migration of such research into this new, non–academic environment has brought new cadres of researchers into the clinical research enterprise and also broadened the pool of potential research participants. Regulatory approaches for protecting human subjects who participate in research have also evolved. Some institutions retain their own Institutional Review Boards (IRBs), but Independent IRBs, community hospital IRBs and community–based (...) IRBs also fulfill oversight responsibilities. This article sheds light on this evolving world by discussing the findings gleaned from two studies: a study of the decision making processes used by members who serve on different kinds of IRBs and a study of the decision making processes employed by research participants. The article then discusses how the key findings may inform proposed revisions to the Common Rule. (shrink)

Although moral distress is now a well-recognized phenomenon among all of the healthcare professions, few evidence-based strategies have been published to address it. In morally distressing situations, the “presenting problem” may be a particular patient situation, but most often signals a deeper unit- or system-centered issue. This article describes one institution’s ongoing effort to address moral distress in its providers. We discuss the development and evaluation of the Moral Distress Consultation Service, an interprofessional, unit/system-oriented approach to addressing and ameliorating moral (...) distress. (shrink)