The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of (...) family life, and the intensive utilization of resources—combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay.In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to making clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital. (shrink)

This article summarizes a virtual live‐streamed panel event that occurred in August 2020 and was cosponsored by the International Philosophy of Nursing Society (IPONS) and the University of California, Irvine's Center for Nursing Philosophy. The event consisted of a series of three self‐contained panel discussions focusing on the past, present and future of IPONS and was moderated by the current Chair of IPONS, Catherine Green. The first panel discussion explored the history of IPONS and the journal Nursing Philosophy. The second (...) panel involved a reflection on the challenges of doing nursing philosophy in a research‐intensive context of a Canadian university and the history and current movements in nursing philosophy in the Nordic countries. The final panel involved presentations on the future potential for philosophy in/and for nursing, the critical connections between nursing philosophy and nursing theory, dismantling racism in nursing and the potential for process philosophy to help explore nursing's unique efficacy in creating possibilities for health. The panels were followed by a lively Q&A session with participants, of which there were 252 registrants from across the globe. The event underscored the wide and diverse interests of nurses in philosophical discussion and the need for more virtual events and other connective modalities bringing nurses together to discuss and analyze the value and potential of philosophy to better understand and advance nursing theory and practice. (shrink)

Concerns regarding corporate ethics have grown steadily throughout the past decade. In order to remain competitive, many organizational leaders are faced with the challenge of creating an ethical environment within their organization. A model is presented showing the process and elements necessary for the institutionalization of organizational ethics. The transformational leadership style lends itself well to the creation of an ethical environment and is suggested as a means to facilitate the institutionalization of corporate ethics. Finally, the benefits of using transformational (...) leadership are demonstrated through the components of a psychological contract, organizational commitment, and ethical culture to institutionalize organizational ethics. (shrink)

This article explores the notion of ‘perfect’ money that Simmel introduces in The Philosophy of Money. Its aim is twofold: first, to connect this idea to his more general arguments about the nature of society and the ambivalence of modernity, and, second, to assess its relevance for contemporary debates about the future of money, especially following the global financial crisis. I argue that Simmel’s concept of perfect money can be understood as utopian in two senses, conceptual and ethical, that correspond (...) to the two interpretations he develops, in Soziologie, of the idea of a perfect society. This sheds light on an aspect of Simmel’s writings that has attracted relatively little attention, namely his views on the relationship between money and socialism. Characterizing this relationship as a ‘formal affinity’, his remarks resonate with a long tradition of thought on monetary utopias that aim not for the abolition of money but its radical transformation as a means of improving society. This tradition is coming to the fore once again today, as the financial crisis has given new impetus to constructing forms of money – for example, LETS, Time Dollars, mutual credit, peer-to-peer lending and digital currencies such as Bitcoin – that provide viable alternatives to big banks. Understood in conjunction with his account of the ‘tragedy’ of individualism in modernity, such resonances demonstrate the enduring relevance of Simmel’s work to the empirical and theoretical investigation of money. (shrink)

1. The conclusion of Stewart Candlish’s pithy survey of identity theories of truth is that he is not yet convinced that any instance is more than an “historical curiosity”. Candlish in effect presents the would-be identity theorist with a dilemma: identity theories are either substantial, yet intrinsically implausible ); or else they are trivial.

Two features of Paul Horwich's minimalist conception of truth (1990) make it stand out from the deflationary crowd. First, Horwich takes propositions to be the primary vehicles of truth (1990: 17-18, Ch. 6). Second, he claims that an explicit definition of truth applicable to propositions cannot be given (1990: 26-31), and hence that the meaning of 'true' can only be determined by our disposition to assent to the infinitely many (non-paradoxical) instances of the following schema: (E) The proposition that p (...) is true if and only if p (1990:38). In a recent article Donald Davidson (1996) provides an objection to the effect that these two features of Horwich's minimalism conspire to ruin it. In this brief note I aim to show that a convincing reply is available to the minimalist. (shrink)

Suppose that Eleanor is drowsy. Truth's asymmetry is illustrated by the following fact: while we accept that <Eleanor is drowsy> is true because Eleanor is drowsy, we do not accept that Eleanor is drowsy because <Eleanor is drowsy> is true. This asymmetry requires an explanation, but it has been alleged, notably by David Liggins, that the minimalist about truth cannot provide one. This paper counteracts this pessimism by arguing that the minimalist can successfully explain the asymmetry conceptually, rather than metaphysically. (...) It then goes on to defend this account against objections, in the end concluding that explaining truth's asymmetry is no problem for the minimalist. (shrink)

This volume presents new essays on art, mind, and narrative inspired by the work of the late Peter Goldie, who was Samuel Hall Professor of Philosophy at the University of Manchester until 2011. Divided into three sections - Narrative Thinking; Emotion, Mind, and Art; and Art, Value, and Ontology - the book presents fascinating new philosophical work on these intertwined subjects. Topics covered include the role of narrative thinking in our lives, the nature of our imaginative engagement with fiction, the (...) emotions and their role in motivating action, and the nature of conceptual art. (shrink)

This article analyses the nature of mental imagery in metaphoric thought as envisaged by the contemporary theory of metaphor in Cognitive Linguistics (Lakoff, Cambridge University Press, 1993). Our study of metaphor in the field of marine biology draws on two crucial aspects of mental imagery, namely dynamicity and pervasiveness. Image metaphors and behaviour-based metaphors have generally been regarded as two different types of resemblance metaphor. In our view, the dynamicity of certain mental images highlights inherent similarities between these two types (...) of metaphor, and makes the differences between them more apparent than real. For this reason, we propose a more refined description of resemblance metaphors in terms of the static or dynamic nature of the mental images underlying them. Our study also underlines the fact that mental images permeate all classes of metaphor, and that the pervasiveness and dynamicity of mental images affords insights into both resemblance metaphors and non-resemblance metaphors. (shrink)

The HealthyFood program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members. Members receiving the lowest cash back level were randomized to one of six arms: Arm 1 : 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% cash back, (...) personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items. Of the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean difference in percent healthy spending was between Arm 1 and Arm 2, and the largest mean difference in percent unhealthy spending was also between Arm 1 and Arm 2, but no differences were statistically significant after correction for multiple comparisons. None of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors. NCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015. (shrink)

In this paper, we claim that we can only seek to eradicate the stigma associated with the contemporary opioid overdose epidemic when we understand how opioid stigma and the epidemic have co-evolved. Rather than conceptualizing stigma as a parallel social process alongside the epidemiologically and physiologically defined harms of the epidemic, we argue that the stigmatized history of opioids and their use defines the epidemic. We conclude by offering recommendations for disrupting the burden of opioid stigma.

Scholars who debate the cause of and solutions for the decline in civic engagement have suggested that Americans have increasingly withdrawn from community organizations, reducing their political activity such as voting and interest in the political world, and generally failing to place the common good over individual self-interest. Their analyses are steeped in a tradition that is largely gender blind and consequently ignores care work. We infuse feminist analyses of paid labor and citizenship, which emphasize the merits and burdens of (...) care work, into the civic engagement debate. We argue that care work, predominantly performed by women, paradoxically limits, enhances, and even constitutes a vital form of civic activity. We call for a fuller slate of social policies that will both redistribute the burden of care work and reinvigorate civic engagement. (shrink)

La filosofía ha reflexionado a menudo acerca de la naturaleza de la burocracia, de su lógica y método, de sus consecuencias. En este artículo se quiere presentar cómo la inimputable y, por ello, irrazonable lógica burocrática se fundamenta en una psicopatológica religiosa, “mística”. Para mostrar esta temática nos servimos de lo que han escrito Max Weber en su Economía y sociedad y Hannah Arendt en Los orígenes del totalitarismo, ya que nos parecen los autores que más han comprendido y señalado (...) el fundamento místico-religioso de la lógica burocrática. Por ello, en un primer punto mostraremos en qué consiste según estos autores la lógica del pensamiento burocrático y, en un segundo punto, señalaremos el fundamento patológico-religioso de esta lógica. (shrink)

The relationship between first and second language literacy was examined by identifying the skills and processes developed in the first language that were transferred to the second language. The performance of 40 university students from The People's Republic of China, Hong Kong, Vietnam and Australia were compared on a series of tasks that assessed phonological awareness and reading and spelling skills in English. The results indicated that the Hong Kong students (with non-alphabetic first language literacy) had limited phonological awareness compared (...) to those students with alphabetic first language literacy. The reading and spelling tasks showed no differences between the groups on real word processing. However, the students from Hong Kong had difficulty processing nonwords because of their poor phonological awareness. The results supported the hypothesis that people learning English as a second language (ESL) transfer their literacy processing skills from their first language to English. When the phonological awareness required in English had not been developed in the first language, ESL students were limited to a whole-word, visual strategy. The findings indicate that students from non-alphabetic written language backgrounds might have difficulties with new, or unfamiliar words when attending universities where English is the medium of instruction. (shrink)

Robust technology infrastructure is needed to enable learning health care systems to improve quality, access, and cost. Such infrastructure relies on the trust and confidence of individuals to share their health data for healthcare and research. Few studies have addressed consumers’ views on electronic data sharing and fewer still have explored the dual purposes of healthcare and research together. The objective of the study is to explore factors that affect consumers’ willingness to share electronic health information for healthcare and research. (...) This study involved a random-digit dial telephone survey of 800 adult Californians conducted in English and Spanish. Logistic regression was performed using backward selection to test for significant associations of each explanatory variable with the outcome variable. The odds of consent for electronic data sharing for healthcare decreased as Likert scale ratings for EHR impact on privacy worsened, odds ratio = 0.74, 95% CI [0.60, 0.90]; security, OR = 0.80, 95% CI [0.66, 0.98]; and quality, OR = 0.59, 95% CI [0.46–0.75]. The odds of consent for sharing for research was greater for those who think EHR will improve research quality, OR = 11.26, 95% CI [4.13, 30.73]; those who value research benefit over privacy OR = 2.72, 95% CI [1.55, 4.78]; and those who value control over research benefit OR = 0.49, 95% CI [0.26, 0.94]. Consumers’ choices about electronically sharing health information are affected by their attitudes toward EHRs as well as beliefs about research benefit and individual control. Design of person-centered interventions utilizing electronically collected health information, and policies regarding data sharing should address these values of importance to people. Understanding of these perspectives is critical for leveraging health data to support learning health care systems. (shrink)

We are currently seeing a revival of interest in Aquinas's moral thought among Christian ethicists, both Protestant and Catholic. Although recent studies of his moral thought have touched on a number of topics, the majority of these have focused on his account of the virtues and their place in the Christian life. Probing the questions of the relation of virtue and law, the role of reason and will, and the place of the passions in Aquinas's moral theology, I will examine (...) recent studies by Diana Cates, Pamela Hall, Simon Harak, James Keenan, Daniel Nelson, Daniel Westberg, and Paul Waddell. In different ways these studies return us repeatedly to the vexed and unresolved question of the scope of human freedom. (shrink)

Japanese pop idols occupy an ambiguous position in the broader popular music landscape, straddling a line between fiction and non-fiction, simultaneously characterological yet physically instantiated. As idealized representations of the girl or boy next door, idols serve as both ‘image characters’ who can be used to sell a variety of products, as well as ‘quasi companions’ meant to provide fans with a manufactured sense of intimacy. Using a joint quantitative and qualitative approach, this article analyses the lyrics of female idol (...) groups. Specifically, I demonstrate how the combination of first- and second-person pronouns and sentence-final expressions are utilized to construct both female-coded and male-coded gendered personae, revealing that idol lyrics engage in the process of cross-gender performance. As a result, through their performance of these personae, female idol groups explicitly reinforce a binary imagination of normative gender expressions, allowing such idol groups to capitalize on idealized heterosexual adolescence through affective resonance and nostalgia. (shrink)

... and the baby has a large VSD. Otherwise appears well, gaining weight, smiling. No apnea, never been on ventilator. Local cardiac surgeon refused to operate, saying that surgery would be inappropriate. Have reached out to other centers, and some state that they never perform what they said was “futile” heart surgery on children with Trisomy 18, while other sites say they have and will continue to perform these operations. Can someone explain to me what is going on? In the (...) realm of medical care—given enough patients, clinicians, and time—conflict is inevitable. Someone will want to do something, such as give a drug or start a new form of technologic support, and someone else will think that this is a... (shrink)

The French feminist philosopher Michèle Le Doeuff has taught us something about “the collectivity,” which she discovers in women’s struggle for access to the philosophical, but also about “the unknown” and “the unthought.” It is the unthought which will matter most to what I intend to say today about a fundamental ignorance on which speaker vulnerability is built. On International Women’s Day, it seems appropriate to speak about – or, at least, to evoke – the silencing which has been imposed (...) on women by an oppressive form of ignorance. My question is: how do our resounding voices as women – on 8 March 2016 – avoid what feminist philosophers have distinguished as wilful forms of silencing? Silencing exploits vulnerability; and speaker vulnerability is an exposure either to violence or affection, in its dependence on an audience. My response seeks to undo the silencing of women by transforming an ignorance of vulnerability into a distinctively ethical avowal. To see the significance of this undoing, we will consider how our contemporary global world reduces vulnerability to an openness to violence, ignoring what has been unthought: an openness to affection. A wilful ignorance of vulnerability develops not as a lack of knowledge but its disavowal – on which various forms of oppression are built. An active disavowal of thinking (the unthought) is the other side of a striving for invulnerability; and this striving is encouraged by a social world which remains ignorant of its own wounding, as well as its own potential for ethical relations in vulnerability. Like la mauvaise foi of the French existentialist, invulnerability is a form of self-deception; and those who claim it embrace ignorance of their own and others’ vulnerability too. (shrink)

We discuss how analysis of contemporary artworks has shaped philosophical theories about the concept of art, the ontology of art, and artistic media. The rapid expansion, during the contemporary period, of the kinds of things that can count as artworks has prompted a shift toward procedural definitions, which focus on how artworks are selected, and away from definitions that focus exclusively on artworks’ features or effects. Some contemporary artworks challenge the traditional art–ontological dichotomy between physical particulars and repeatable entities whose (...) occurrences are physical particulars. And nontraditional techniques and materials employed in contemporary art violate the boundaries of conventional media, prompting a rethinking of what artistic medium might be. (shrink)

Screening for prostate cancer with the prostate-specific antigen blood test is controversial, as evidence to date has not demonstrated such screening does more good than harm. While the potential benefit of PSA screening on reducing prostate cancer mortality has not been documented in randomized trials, many risks of PSA screening have been well documented. These risks include a substantially higher risk of a prostate cancer diagnosis over a screenee’s lifetime, false-positive and false-negative test results, possible complications from biopsies done in (...) response to suspicious test results, and substantial risks of side effects from subsequent prostate cancer treatments. Nevertheless, PSA screening is widespread in the United States, and many physicians in a national survey reported supporting routine PSA screening as well as getting PSA tests themselves, despite the lack of evidence. (shrink)

La justicia social tiene sus fundamentos políticos en el pensamiento de Nancy Fraser en el carácter económico de la sociedad, pero no la comprende con exclusividad, dado que existen dos dimensiones más que la complementan, el reconocimiento cultural y la representación política. En este contexto de estado de emergencia, surge la necesidad de comprender holísticamente el sentido de la justicia social y aplicarlo a la realidad peruana. De esta manera podemos evidenciar las falencias que existen dentro de cada dimensión, y (...) las medidas que el estado peruano ha tomado dentro de cada dimensión para contrarrestar o en su defecto solucionar el impacto de la pandemia. Durante la exposición de los tópicos abordaremos detalladamente que comprende la autora en cuestión acerca de los términos redistribución, reconocimiento y representación, dentro del marco de la Justicia Social y buscaremos extrapolar estas nociones teóricas a la realidad peruana dentro de la coyuntura de la pandemia, las manifestaciones de las particularidades. El presente trabajo saca a relucir no solo la improvisación de las medidas que no satisfacen las necesidades básicas que demandan cada dimensión, sino ofrece, a su vez, una crítica hacia la comprensión política de nuestras autoridades, las cuales no apuntan a alcanzar este estado de justicia social. Dicho estado de justicia tiene como horizonte un verdadero reconocimiento sostenido en cambios estructurales, para ello ineludiblemente se tiene que abordar el problema de la crisis económica, que se expresa en la desigualdad de condiciones y la falta de oportunidades. La justicia social siempre ha representado un ideal de sociedad, hasta el punto de concebirlo como un horizonte inalcanzable. Asociar la justicia con la igualdad o equidad no forma parte de la perspectiva política del país y esto se evidencia en el carácter amortiguador de los decretos legislativos establecidos por el Estado. Sin embargo, la ayuda del Estado no llega a todos los sectores de la población, y si es que llega, es asumida por el propio ciudadano mediante el retiro de su CTS o AFP. La realidad es distinta cuando se trata de las empresas, quienes tienen la potestad de despedir sin goce de haber a sus trabajadores bajo la modalidad de suspensión perfecta de labores. Dicha medida, es “perfecta” para la empresa quien no solo goza de este beneficio sino también puede acceder a un financiamiento de parte del Estado. En la sociedad la figura de la empresa se posiciona como indispensable, debido a que movilizan la economía al otorgar puestos de trabajo. Sin embargo, la integridad de los trabajadores no se ha visto como prioridad para dichas empresas, puesto que se concibe la fuerza de trabajo como un rubro que puede remplazarse con facilidad. De esta manera se evidencia una notable intención por no impartir con equidad mayores beneficios para aquellos que realmente están en una situación de desventaja. Por otro lado, los actos de corrupción acentúan la necesidad de una justicia social no como utopía sino como una obligación moral que se convierte en una exigencia patriótica. Aunque apuntemos a un reconocimiento de nuestras condiciones de existencia, dentro de nuestras particularidades, y a partir de este reconocimiento poder tener representación en las instancias a las que nos correspondan participar no existirá un verdadero reconocimiento sin una verdadera redistribución. (shrink)