Background Encounters of moral distress have long-term consequences on healthcare workers’ physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. Research Objective The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic (...) medical center. Participants & Research Context Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. Research Design Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine’s National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. Ethical Considerations Ethics approval was obtained from the university and medical center institutional review boards. Findings Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. Conclusion Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being. (shrink)

The ability to understand the mental states of others has sometimes been attributed to a domain‐specific mechanism which privileges the processing of these states over similar but nonmental representations. If correct, then others’ beliefs should be processed more efficiently than similar information contained within nonmental states. We tested this by examining whether adults would be faster to process others’ false beliefs than equivalent “false” photos. Additionally, we tested whether they would be faster to process others’ true beliefs about something than (...) their own (matched) personal knowledge about the same event. Across four experiments, we found a small but reliable effect in favor of the first prediction, but no evidence for the second. Results are consistent with accounts positing specialized processes for (false) mental states. The size of the effect does, however, suggest that alternative explanations such as practice effects cannot be ruled out. (shrink)

A barrier to the development and refinement of ethics education in and across health professional schools is that there is not an agreed upon instrument or method for assessment in ethics education. The most widely used ethics education assessment instrument is the Defining Issues Test (DIT) I & II. This instrument is not specific to the health professions. But it has been modified for use in, and influenced the development of other instruments in, the health professions. The DIT contains certain (...) philosophical assumptions (“Kohlbergian” or “neo-Kohlbergian”) that have been criticized in recent years. It is also expensive for large institutions to use. The purpose of this article is to offer a rubric—which the authors have named the Health Professional Ethics Rubric—for the assessment of several learning outcomes related to ethics education in health science centers. This rubric is not open to the same philosophical critiques as the DIT and other such instruments. This rubric is also practical to use. This article includes the rubric being advocated, which was developed by faculty and administrators at a large academic health science center as a part of a campus-wide ethics education initiative. The process of developing the rubric is described, as well as certain limitations and plans for revision. (shrink)

In Making Science, Cole shows how social variables and cognitive variables interact in the evaluation of frontier knowledge.

The concept of resistance has always been central to the reception of Hegel's philosophy. The prevalent image of Hegel's system, which continues to influence the scholarship to this day, is that of an absolutist, monist metaphysics which overcomes all resistance, sublating or assimilating all differences into a single organic 'Whole'. For that reason, the reception of Hegel has always been marked by the question of how to resist Hegel: how to think that which remains outside of or other to the (...) totalizing system of dialectics. In recent years the work of scholars such as Catherine Malabou, Slavoj Žižek, Rebecca Comay and Frank Ruda has brought considerable nuance to this debate. A new reading of Hegel has emerged which challenges the idea that there is no place for difference, otherness or resistance in Hegel, both by refusing to reduce Hegel's complex philosophy to a straightforward systematic narrative and by highlighting particular moments within Hegel's philosophy which seem to counteract the traditional understanding of dialectics. This book brings together established and new voices in this field in order to show that the notion of resistance is central to this revaluation of Hegel. (shrink)

This paper is an exploration of the Thomistic vice of despair, one of two vices opposed to the theological virtue of hope. Aquinas's conception of despair as a vice, and a theological vice in particular, distances him from contemporary use of the term "despair" to describe an emotional state. His account nonetheless yields a compelling psychological portrait of moral degeneration, which I explain via despair's link to its "root," the capital vice of sloth. Cases in which sloth and its offspring (...) vices progress into full-fledged despair raise intersecting issues about whether and how despair might be remediable. I conclude by considering puzzles regarding despair's disordered effects on the intellect and will and weighing three possible means of remedying it. (shrink)

Stanley Klein and Shaun Nichols describe the case of patient R.B., whose memories lacked the sense of “mineness” usually conveyed by memory. Klein and Nichols take R.B.’s case to show that the sense of mineness is merely a contingent feature of memory, which they see as raising two problems for memory-based accounts of personal identity. First, they see it as potentially undermining the appeal of memory-based accounts. Second, they take it to show that the conception of quasi-memory that underpins many (...) memory-based accounts is inadequate. I argue that Klein and Nichols’ characterization of R.B.’s experience is implausible; as a result, the problems that they describe for memory-based accounts of personal identity do not arise. (shrink)

Many countries are experiencing increasing levels of demand for access to assisted reproductive technologies. Policies regarding who can access ART and with what support from a collective purse are highly contested, raising questions about what state responses are justified. Whilst much of this debate has focused on the status of infertility as a disease, we argue that this is something of a distraction, since disease framing does not provide the far-reaching, robust justification for state support that proponents of ART seem (...) to suppose. Instead, we propose that debates about appropriate state responses should consider the various implications for health and broader well-being that may be associated with difficulties starting a family. We argue that the harms and disruption to valued life projects of subfertility-related suffering may provide a stronger basis for justifying state support in this context. Further, we suggest that, whilst ART may alleviate some of the harm resulting from subfertility, population-level considerations can indicate a broader range of interventions aimed at tackling different sources of subfertility-related harm, consistent with broader public health aims. (shrink)

"These essays advance a reinterpretation of pivotal categories such as self-knowing, moral agency, and altruism.

Existing and proposed provisions of the Model Penal Code refer to believing something “recklessly.” In this chapter, we examine the notion of reckless beliefs and determine what that notion cannot be and what it might be.

What accounts for the continued lack of clarity over the legal procedures for the patenting of DNA sequences? The patenting system was built for a "bricks-and-mortar" world rather than an information economy. The fact that genes are both material molecules and informational systems helps explain the difficulty that the patent system is going to continue to have.

For most people a sense of self includes an embodied component: when describing our selves we describe those aspects of our physical bodies which can be easily codified: height, hair colour, sex, eye colour. Even when we consider ourselves we tend not to consider our intellectual cognitive characteristics but our describable anatomy. Wittgenstein's dictum, ‘the human body is the best picture of the human soul’, is relevant here but I would like to go further: the body-part we feel most embodied (...) in is our face, even though it is difficult to describe and so forms little part of how we describe ourselves to others. (shrink)

My particular focus in this article is on getting clearer about what Nietzsche’s experimentalism entails. Some immediate resistance may form in response to this proposal, based on my use of the term experimentalism. As Walter Kaufmann has pointed out in a discussion of experimentalism, Nietzsche himself does not discuss his work using this concept; in the original German, Nietzsche uses the terms “Experiment” and “Versuch.”1 In light of this, two main concerns may be raised about my proposal that experimentalism is (...) worth some of our time and attention: whether it is necessary or helpful to focus discussion on yet another “ism” within Nietzsche scholarship and given that experimentalism is not Nietzsche’s.. (shrink)

In workplace health interventions, engaging management and union decision makers is considered important for the success of the project, yet little research has described the process of making this happen. A case study of a knowledge-transfer process is presented to describe the practices and processes adopted by a knowledge broker who engaged workplace parties in discussions on research on physical and psychosocial factors important for employee health. The process included one-on-one interactions between the knowledge broker and individuals to explain the (...) research, to build trust and credibility, and to explore the applicability of the research to their work (sense making). It also included facilitated group sessions, where the groups explored how the research could solve problems within the workplace (social construction of knowledge). The workplace context offered multiple opportunities that helped and hindered the flow of research. Nevertheless, this intense, sustained, knowledge-transfer intervention noted conceptual, structural, and political knowledge use. (shrink)

Moral perception, as the term is used in moral theory, is the perception of normatively contoured objects and states of affairs, where that perception enables us to engage in practical reason and judgment concerning these particulars. The idea that our capacity for moral perception is a crucial component of our capacity for moral reasoning and agency finds its most explicit origin in Aristotle, for whom virtue begins with the quality of perception. The focus on moral perception within moral theory has (...) made a comeback in the last few decades, especially in the hands of self-proclaimed neo-Aristotelians such as John McDowell, Martha Nussbaum, and Nancy Sherman. For these writers, our perceptual capacities are not static, and the laborious honing of our perceptual skills is a crucial moral task. On this picture, as Nancy Sherman puts it, “How to see becomes as much a matter of inquiry as what to do.”Moral particularists—including but not restricted to the neo-Aristotelians—have emphasized the centrality of moral perception to moral agency and judgment, as a corrective to moral theories that treat deliberation in terms of universal principles as the privileged keystone of moral agency. (shrink)

Several personality dispositions with common features capturing sensitivities to negative social cues have recently been introduced into psychological research. To date, however, little is known about their interrelations, their conjoint effects on behavior, or their interplay with other risk factors. We asked N = 349 adults from Germany to rate their justice, rejection, moral disgust, and provocation sensitivity, hostile attribution bias, trait anger, and forms and functions of aggression. The sensitivity measures were mostly positively correlated; particularly those with an egoistic (...) focus, such as victim justice, rejection, and provocation sensitivity, hostile attributions and trait anger as well as those with an altruistic focus, such as observer justice, perpetrator justice, and moral disgust sensitivity. The sensitivity measures had independent and differential effects on forms and functions of aggression when considered simultaneously and when controlling for hostile attributions and anger. They could not be integrated into a single factor of interpersonal sensitivity or reduced to other well-known risk factors for aggression. The sensitivity measures, therefore, require consideration in predicting and preventing aggression. (shrink)

This essay explores the theorization of moral valuation outlined in Stefan Bargheer’s Moral Entanglements: Conserving Birds in Britain and Germany when extended to the climate crisis. It considers, first, how ‘nature’ is valued when it confronts people and societies as a source of threat, rather than of recreation or resources. Second, the essay critically examines the role of moral discourse in the collective work of addressing climate change and its relationship to practice.

Feminism is an antiauthoritarian movement that has sought to unmask many traditional “authorities” as ungrounded. Given this, it might seem as if feminists are required to abandon the concept of authority altogether. But, we argue, the exercise of authority enables us to coordinate our efforts to achieve larger social goods and, hence, should be preserved. Instead, what is needed and what we provide for here is a way to distinguish legitimate authority from objectionable authoritarianism.

Telephone survey of 293 TV viewers in Minneapolis-St. Paul investigated how viewers evaluate ethical issues and problematic content in TV news and entertainment programs, and attitudes toward methods of controlling TV content. In rating eight hypothetical news and entertainment scenarios, viewers appeared more willing to accept ethical breaches in entertainment than in news programs. In evaluating the severity of general problems in TV programming, most viewers considered violence, adult themes, and a lack of family values to be big problems. Different (...) methods of controlling potentially problematic content were evaluated, with viewers overwhelmingly endorsing a system of ratings or warnings, as well as restricting content to certain times or channels. Governmental regulation as a form of controlling TV content was strongly rejected. This article demonstrates the usefulness and appropriateness of empirical research in involving the audience in an active role in the study of media ethics. (shrink)

An innovative examination of the ways in which dance and philosophy inform each other, Dance and Philosophy brings together authorities from a variety of disciplines to expand our understanding of dance and dance scholarship. Featuring an eclectic mix of materials from exposes to dance therapy sessions to demonstrations, Dance and Philosophy addresses centuries of scholarship, dance practice, the impacts of technological and social change, politics, cultural diversity and performance. Structured thematically to draw out the connection between different perspectives, this books (...) covers: - Philosophy practice and how it corresponds to dance - Movement, embodiment and temporality - Philosophy and dance traditions in everyday life - The intersection between dance and technology - Critical reflections on dance Offering important contributions to our understanding of dance as well as expanding the study of philosophy, this book is key to sparking new conversations concerning the philosophy of dance. (shrink)

Vocabulary size has been suggested as a useful measure of “verbal abilities” that correlates with speech recognition scores. Knowing more words is linked to better speech recognition. How vocabulary knowledge translates to general speech recognition mechanisms, how these mechanisms relate to offline speech recognition scores, and how they may be modulated by acoustical distortion or age, is less clear. Age-related differences in linguistic measures may predict age-related differences in speech recognition in noise performance. We hypothesized that speech recognition performance can (...) be predicted by the efficiency of lexical access, which refers to the speed with which a given word can be searched and accessed relative to the size of the mental lexicon. We tested speech recognition in a clinical German sentence-in-noise test at two signal-to-noise ratios (SNRs), in 22 younger (18–35 years) and 22 older (60–78 years) listeners with normal hearing. We also assessed receptive vocabulary, lexical access time, verbal working memory, and hearing thresholds as measures of individual differences. Age group, SNR level, vocabulary size, and lexical access time were significant predictors of individual speech recognition scores, but working memory and hearing threshold were not. Interestingly, longer accessing times were correlated with better speech recognition scores. Hierarchical regression models for each subset of age group and SNR showed very similar patterns: the combination of vocabulary size and lexical access time contributed most to speech recognition performance; only for the younger group at the better SNR (yielding about 85% correct speech recognition) did vocabulary size alone predict performance. Our data suggest that successful speech recognition in noise is mainly modulated by the efficiency of lexical access. This suggests that older adults’ poorer performance in the speech recognition task may have arisen from reduced efficiency in lexical access; with an average vocabulary size similar to that of younger adults, they were still slower in lexical access. (shrink)

Henri Bergson's philosophy has attracted increasing feminist attention in recent years as a fruitful locus for re-theorizing temporality. Drawing on Luce Irigaray's well-known critical description of metaphysics as phallocentrism, Hill argues that Bergson's deduction of duration is predicated upon the disavowal of a sexed hierarchy. She concludes the article by proposing a way to move beyond Bergson's phallocentrism to articulate duration as a sensible and transcendental difference that articulates a nonhierarchical qualitative relation between the sexes.

We show that there is a computable procedure which, given an ∀∃-sentence ${\varphi}$ in the language of the partially ordered sets with a top element 1 and a bottom element 0, computes whether ${\varphi}$ is true in the Medvedev degrees of ${\Pi^0_1}$ classes in Cantor space, sometimes denoted by ${\mathcal{P}_s}$.

This essay aims to elucidate how multiple voices and traditions should interact with one another in the practice of ethics. First, it explores some of the major ways in which questions of bodily autonomy function in secular feminist and Jewish bioethical discourses. It then uses case studies to illuminate ways each discourse's concepts of bodily autonomy can be deeply problematic, and argues that the strengths in each discourse can serve as important correctives for the weaknesses in the other. It suggests (...) that some formal features of rabbinic texts can serve as a model for a discourse of constant and animated mutual correction. Finally, it examines two case studies in light of this model. (shrink)

Aanerud's project is to develop an account of white antiracist mothering, using a model of maternal duty to raise antiracist white children. The author sets this project in the context of historic constructions of white mothering in the twentieth century and then contrasts the need for an exploration of white mothers raising white children against the literature of white mothers’ raising children of color and mothers of color raising their own children, Once this distinction is made, Aanerud uses Collins's account (...) of racial ethnic mothering as a springboard into her discussion of antiracist white mothering of white children. (shrink)

Based on fieldwork in Newmarket, England, and Kentucky, this paper examines the acts of looking that take place at international thoroughbred horse auctions. Racehorse caretakers employ bloodstock agents to select the yearling thoroughbred who will make the best racehorse as a 2-year-old and, hopefully, successful stallion or broodmare after retiring from the track as a 4- or 5-year old. The paper assesses the criteria used to assess yearlings: pedigree, conformation, and "that something extra."The paper concludes that the ambiguous status of (...) the bloodstock agent derives from the liminal task the agent performs, communicating with a young, nonhuman animal to discover the animal's essential properties. Selecting yearlings depends upon a process of divination that mitigates against the characterization of western thought as "rational" and opposed to decision-making processes conventionally thought of as "non-normal" or irrational. (shrink)

Biologists have replaced the metaphor of “genetic transmission” with a detailed account of the molecular mechanisms underlying the phenomenon which Darwin referred to as “like produces like.” Cultural evolution theorists, in contrast, continue to appeal to “imitation” or “copying.” The notion of ritual and instrumental stances does not resolve this issue, and ignores the institutions in which people live.

What is the relation between scientific explanation and understanding? The thesis investigates a notion of understanding that is believed to be central to scientific explanation. The role of understanding in explanation is double: it is both an essential component, as well as a criterion, by which we select bona fide explanations from non-explanations. The model of explanation that is outlined in the thesis is a version of the unificationist model of explanation. In the thesis, this model is compared to Hempel's (...) covering law model. The two models share some assumptions, but as it turns out, the unificationist model has more resources and is better suited to meet some of the objections that have been thought to be detrimental to the covering law model. The final part of the thesis is an investigation of theory reduction. The contention is that reduction is best accounted for as a sort of explanation, and it is argued that as such, it is best understood within the framework of the unificationist model of explanation that is outlined in the first part of the thesis. (shrink)

Welcome to the world of cutting-edge math, physics, and neuroscience, where the search for the ultimate vacuum, the point of nothingness, ground zero of theory, has rendered the universe deep, rich, and juicy. "Modern physics has animated the void," says K. C. Cole in her entrancing journey into the heart of Nothing. Every time scientists and mathematicians think they have reached the ultimate void, new stuff appears: a black hole, an undulating string, an additional dimension of space or time, (...) repulsive anti-gravity, universes that breed like bunnies. Cole's exploration at the edge of everything is as animated and exciting as the void itself. Take Cole's hand on this adventure into the unknown, and you'll come back informed, amused, and excited. (shrink)

Alyne da Silva Pimentel Teixeira died of postpartum hemorrhage following the stillbirth of a 27-week-old fetus on November 16, 2002 in Rio de Janeiro, Brazil. Her death led in 2011 to the first decision of an international treaty body holding a government accountable for a preventable maternal death. The decision, Alyne da Silva Pimentel Teixeira v. Brazil, was given by the Committee on the Elimination of Discrimination against Women, established to monitor compliance by member states with the UN Convention on (...) the Elimination of All Forms of Discrimination against Women. The decision upheld a complaint, filed in 2007 against the state and government of Brazil, finding discrimination in the field of health care for Alyne’s avoidable maternal death, in breach of the Women’s Convention. (shrink)

This paper examines and contextualizes rituals and beliefs surrounding the cat demon. While the demon has been briefly discussed or referenced in earlier scholarship, there as yet exists no systematic attempt to understand how it is treated in various sources. The paper approaches the complex of practices and ideas associated with the cat demon as a unique and richly informative cultural phenomenon that is suggestive of tensions relating to gender and class. The paper begins with a close examination of materials (...) surrounding the most famous and well-documented case of cat demon practice, that involving Dugu Tuo, the half- brother of Empress Dugu of the Sui, before turning to medico-religious approaches and, finally, to transformations of the supernatural or demonic cat in post-Tang materials. (shrink)

In January 2016, a long-delayed Medicare change took effect. The Medicare program will now reimburse doctors for time they spend talking with patients about end-of-life care. This is the move that Sarah Palin and other Affordable Care Act critics said would authorize government “death panels” to decide whether older Americans should live or die. Today virtually no one buys into Palin's death panel rhetoric. But many people do think the Medicare change is a big deal. Representative Earl Blumenauer, a Democrat (...) from Oregon who sponsored the original ACA reimbursement proposal, lauded the Medicare provision as “a turning point in end-of-life care.” Others are not so sure about that. After all, laws promoting advance care planning have existed for decades. The federal Patient Self-Determination Act of 1990 and the many court decisions and state laws supporting advance care planning have had relatively little impact. Similarly, legal recognition of physician orders for life-sustaining treatment as advance planning instruments have not produced the improvements that were predicted. And from a broad perspective, advance care planning is a small piece of the puzzle. The effort to improve end-of-life care must take into account the limitations of advance decision-making, as well as the overriding importance of the general standard of care for terminally ill patients. (shrink)