Background: In the context of new reimbursement systems like diagnosis-related groups, moral distress is becoming a growing problem for healthcare providers. Moral distress can trigger emotional and physical reactions in nurses and can cause them to withdraw emotionally from patients or can cause them to change their work place. Objective: The aim of this pilot study was to develop an instrument to measure moral distress among acute care nurses in the German-speaking context, to test its applicability, and to obtain initial (...) indications of the instrument’s validity. Method: The study was designed in 2011 as a cross-sectional pilot survey. Conducted on eight units of one university hospital in German-speaking Switzerland, 294 registered nurses were asked to fill out a web-based questionnaire on moral distress. Ethical considerations: The study proposal was approved by the cantonal ethics committee. All participating nurses provided informed consent and were assured of data confidentiality. Results: The survey had a response rate of 55%. The results show the prevalence of statements on the questionnaire indicating situations with the potential to trigger moral distress. The entire range of answers was used in the responses. Most participants found the questionnaire comprehensible, while some criticized the phraseology of certain statements. Many more found the registration process prior to online access to be too time consuming. Nurses confirmed that the results reflect their subjective assessment of their situation and their experience of moral distress. Conclusion: The newly developed moral distress questionnaire appears to produce face validity and is sufficiently applicable for use in our study. The results indicate that moral distress appears to be a relevant phenomenon also in Swiss hospitals and that nurses were experiencing it prior to the introduction of Swiss diagnosis-related groups. (shrink)

I explore how gender can shape the pragmatics of speech. In some circumstances, when a woman deploys standard discursive conventions in order to produce a speech act with a specific performative force, her utterance can turn out, in virtue of its uptake, to have a quite different force—a less empowering force—than it would have if performed by a man. When members of a disadvantaged group face a systematic inability to produce a specific kind of speech act that they are entitled (...) to perform—and in particular when their attempts result in their actually producing a different kind of speech act that further compromises their social position and agency—then they are victims of what I call discursive injustice. I examine three examples of discursive injustice. I contrast my account with Langton and Hornsby's account of illocutionary silencing. I argue that lack of complete control over the performative force of our speech acts is universal, and not a special marker of social disadvantage. However, women and other relatively disempowered speakers are sometimes subject to a distinctive distortion of the path from speaking to uptake, which undercuts their social agency in ways that track and enhance existing social disadvantages. (shrink)

When patients have progressive and incurable dementia, should their advance directives always be followed? Contra Dworkin, Dresser argues that when patients remain able to enjoy and participate in their lives, directives to hasten death should sometimes be disregarded.

Contemporary culture trivializes the "seven deadly sins," or vices, as if they have no serious moral or spiritual implications. Glittering Vices clears this misconception by exploring the traditional meanings of gluttony, sloth, lust, and others. It offers a brief history of how the vices were compiled and an eye opening explication of how each sin manifests itself in various destructive behaviors. Readers gain practical understanding of how the vices shape our culture today and how to correctly identify and eliminate the (...) deeply rooted patterns of sin that are work in their own lives. This accessible book is essential for any reader interested in spiritual disciplines and character formation. Excerpt Very simply, a virtue (or vice) is acquired through practice repeated activity that increases our proficiency at the activity and gradually forms our character. . . . We often need external incentives and sanctions to get us through the initial stages of the process, when our old, entrenched desires still pull us toward the opposite behavior. But with encouragement, discipline, and often a role model or mentor, practice can make things feel more natural and enjoyable as we gradually develop the internal values and desires corresponding to our outward behavior. Virtue often develops, that is, from the outside in. This is why, when we want to reform our character from vice to virtue, we often need to practice and persevere in regular spiritual disciplines and formational practices for a lengthy period of time. (shrink)

Combatting chronic, lifestyle-related disease has become a healthcare priority in the developed world. The role personal responsibility should play in healthcare provision has growing pertinence given the growing significance of individual lifestyle choices for health. Media reporting focussing on the ‘bad behaviour’ of individuals suffering lifestyle-related disease, and policies aimed at encouraging ‘responsibilisation’ in healthcare highlight the importance of understanding the scope of responsibility ascriptions in this context. Research into the social determinants of health and psychological mechanisms of health behaviour (...) could undermine some commonly held and tacit assumptions about the moral responsibility of agents for the sorts of lifestyles they adopt. I use Philip Petit's conception of freedom as ‘fitness to be held responsible’ to consider the significance of some of this evidence for assessing the moral responsibility of agents. I propose that, in some cases, factors outside the agent's control may influence behaviour in such a way as to undermine her freedom along the three dimensions described by Pettit: freedom of action; a sense of identification with one's actions; and whether one's social position renders one vulnerable to pressure from more powerful others. (shrink)

Ghostwriting scandals are pervasive in industry-funded biomedical research, and most responses to them have presumed that they represent a sharp transgression of the norms of scientific authorship. I argue that in fact, ghostwriting represents a continuous extension of current socially accepted authorship practices. I claim that the radically collaborative, decentralized, interdisciplinary research that forms the gold standard in medicine is in an important sense unauthored, and that this poses a serious problem in applied social epistemology. It is no easy matter (...) to find procedural or architectural solutions that can secure epistemic trust and accountability for collaborative publishing in biomedicine. (shrink)

Wilfrid Sellars's iconic exposé of the ‘myth of the given’ taught us that experience must present the world to us as normatively laden, in the sense that the contents of experience must license inferences, rule out and justify various beliefs, and rationalize actions. Somehow our beliefs must be governed by the objects as they present themselves to us. Often this requirement is cashed out using language that attributes agent-like properties to objects: we are described as ‘accountable to’ objects, while objects (...) ‘hold us’ to standards, and so forth. But such language is either deeply anti-naturalistic or trades on a set of metaphors in need of a literal translation. We offer an explanation of how the material features of the world, as received in experience, can rationally constrain our beliefs and practices—one that makes no recourse to this imagery. In particular, we examine the structure of ostensive practices (that is, practices of directing one another's attention to objects and features of the world) and the distinctive role they play in making us jointly beholden to how things actually are. (shrink)

Philosophers have often posited a foundational calling voice, such that hearing its call constitutes subjects as responsive and responsible negotiators of normative claims. I give the name ldquo;transcendental conscience to that which speaks in this founding, constitutive voice. The role of transcendental conscience is not – or not merely – to normatively bind the subject, but to constitute the possibility of the subject's being bound by any particular, contentful normative claims in the first place. I explore the ontological and temporal (...) status of transcendental conscience, using Heidegger's account of conscience in Being and Time as my textual touchstone. I ask what performative structure the call of conscience might have that would enable it to constitute normative responsiveness, and I raise some temporal conundrums surrounding this structure. I argue that it is incoherent to attempt to give a literal, chronological account of the origin of normative grip and response. I suggest that we can best understand the founding calls of conscience, not as literal events occurring in regular time, but as events that can only show up retrospectively, as occurring in an ever-receding, unlocalizable past, and that these calls can only be figured mythically and metaphorically. Appropriating a Derridean term, I claim that the voice of transcendental conscience must be that of a lsquo;ghost, whose call binds us by haunting us – a haunting that is no less transcendentally necessary for its inability to be translated into a literal historical event. (shrink)

Recent theoretical models suggest that the difference between human and nonhuman primate life-history patterns may be due to a reliance on complex foraging strategies requiring extensive learning. These models predict that children should reach adult levels of efficiency faster when foraging is cognitively simple. We test this prediction with data on Meriam fishing, spearfishing, and shellfishing efficiency. For fishing and spearfishing, which are cognitively difficult, we can find no significant amount of variability in return rates because of experiential factors correlated (...) with age. However, for shellfish collecting, which is relatively easy to learn, there are strong age-related effects on efficiency. Children reach adult efficiency more quickly in fishing as compared to shellfish collecting, probably owing to the size and strength constraints of the latter. (shrink)

In the article “On Avoiding Deep Dementia,” Norman Cantor defends a position that I suspect many readers share. In my years writing and speaking on advance directives and dementia, I've found that most people support one of two positions. They are convinced either that advance choices should control the treatment dementia patients receive or that the welfare of a person with dementia should sometimes take priority over earlier choices. As Cantor points out, I support the second position.I agree with several (...) of Cantor's arguments. Where Cantor and I part ways is over the degree of control that advance directives should exert over the care of persons with moderate dementia. Although I don't welcome the prospect of living with dementia, I believe that people with the condition should be represented in the debate over treatment standards. It's not surprising that many, perhaps most, people unaffected by dementia think that their preferences should control the care they would receive as dementia patients. But people taking this position are neglecting the concerns and interests they may have as dementia patients. (shrink)

Generation Y is a cohort of the population larger than the baby boom generation. Consisting of approximately 80 million people born between 1981 and 2000, Generation Y is the most recent cohort to enter the workforce. Workplaces are being redefined and organizations are being pressed to adapt as this new wave of workers is infused into business environments. One critical aspect of this phenomenon not receiving sufficient research attention is the impact of Gen Y ethical beliefs and ethical conduct in (...) workplace contexts. It is widely accepted that distinct generational experiences shape ethical ideologies and ethical ideologies in turn affect the way people function in the workplace. Thus, Gen Y’s unique cohort experiences are likely to shape their ethical ideologies and consequent workplace judgments and actions. In this article, we examine Gen Y’s ethical ideology and study its impact on workplace functioning regarding leadership style, teamwork, and judgments about ethical violations. Our analyses indicate that Gen Y’ers tend toward situationalism (high idealism and high relativism), and their socially connected orientation produces more lenient judgments of collaborative vs. unilateral ethical violations. However, Gen Y’ers do exhibit individual variation. Relativist Gen Y’ers are more tolerant of ethical violations, whereas, Gen Y Idealists are less tolerant of ethical violations. High Idealists also show stronger teamwork and leadership characteristics. In addition, Gen Y’ers possessing servant leader traits exhibit incrementally better teamwork, and greater perceived unacceptability of ethical violations. We conclude by discussing implications of these findings for managing ethical climates and conduct. (shrink)

This paper investigates the impact of kin on child survival in a matrilineal society in Malawi. Women usually live in close proximity to their matrilineal kin in this agricultural community, allowing opportunities for helping behavior between matrilineal relatives. However, there is little evidence that matrilineal kin are beneficial to children. On the contrary, child mortality rates appear to be higher in the presence of maternal grandmothers and maternal aunts. These effects are modified by the sex of child and resource ownership: (...) female children and children in households where women, rather than men, own land suffer higher mortality rates in the presence of maternal kin. These modifiers suggest the detrimental effects of matrilineal kin may result from competition between such kin for resources. There are some positive effects of kin on child survival: the presence of elder siblings of both sexes is correlated with higher survival rates, and there is some weak evidence that paternal grandmothers may be beneficial to a child’s survival chances. There is little evidence that any male kin, whether matrilineal or patrilineal, and including fathers, affect child mortality rates. This study highlights the importance of taking social and ecological context into account when investigating relationships between kin. (shrink)

Pragmatism has enjoyed a major resurgence in Anglo-American philosophy over the course of the last decade or two, and Robert Brandom’s work – particularly his 1994 tome Making it Explicit (MIE) – has been at the vanguard of this resurgence (Brandom 1994).2 But pragmatism comes in several surprisingly distinct flavours. Authors such as Hubert Dreyfus find their roots in certain parts of Heidegger and in phenomenologists such as Merleau-Ponty, and they privilege embodied, preconceptual skills as opposed to discursive practices as (...) the basic sites of meaning and agency (Dreyfus 1991; Dreyfus 1992; Todes 2001). With strong inheritances from Dewey and Wittgenstein, Richard Rorty has championed a pragmatism whose core emphasis is on the rejection of transcendental truth and high metaphysical theorizing (Rorty 1982), and this anti-theoretical banner has been taken up by several prominent ethicists, among others. For his part, Brandom, who purports to offer a systematic theory of language and meaning grounded on a foundation of pragmatic normative relationships between speakers, looks back instead to Sellars and Quine for his stripe of pragmatism. Near the start of MIE, he writes: The explanatory strategy pursued here is to begin with an account of social practices, identify the particular structure they must exhibit in order to qualify as specifically linguistic practices, and then consider what different sorts of semantic contents those practices can confer on states, performances, and expressions caught up in them in suitable ways. (Brandom 1994, xiii) Despite his professed pragmatism, Brandom is no foe of high theory or metanarratives, and he is vastly more interested in language and theoretical reason than in the rest of human bodily activity. For Brandom, inferentially articulated discourse forms an autonomous domain of normativity, while our bodily encounters with the world in perception and in action serve as language entry and exit points respectively.. (shrink)

Psychiatry uncomfortably spans biological and psychosocial perspectives on mental illness, an idea central to Engel's biopsychosocial paradigm. This paradigm was extremely ambitious, proposing new foundations for clinical practice as well as a non-reductive metaphysics for mental illness. Perhaps given this scope, the approach has failed to engender a clearly identifiable research programme. And yet the view remains influential. We reassess the relevance of the biopsychosocial paradigm for psychiatry, distinguishing a number of ways in which it could be (re)conceived.

This chapter presents the advantages of the use of functional regions of interest along with its specific concerns, and provides a reference to Karl J. Friston related to the subject. Functionally defined ROI help to test hypotheses about the cognitive functions of particular regions of the brain. fROI are useful for specifying brain locations and investigating separable components of the mind. The chapter provides an overview of the common and uncommon misconceptions about fROI related to assumptions of homogeneity, factorial designs (...) versus independent localizers, a summary measure, and the naming of fROI. (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)

Background: Since presenteeism is related to numerous negative health and work-related effects, measures are required to reduce it. There are initial indications that how an organization deals with health has a decisive influence on employees’ presenteeism behavior.Aims: The concept of health-promoting collaboration was developed on the basis of these indications. As an extension of healthy leadership it includes not only the leader but also co-workers. In modern forms of collaboration, leaders cannot be assigned sole responsibility for employees’ health, since the (...) leader is often hardly visible or there is no longer a clear leader. The study examines the concept of health-promoting collaboration in relation to presenteeism. Relationships between health-promoting collaboration, well-being and work ability are also in focus, regarding presenteeism as a mediator.Methods: The data comprise the findings of a quantitative survey of 308 employees at a German university of applied sciences. Correlation and mediator analyses were conducted.Results: The results show a significant negative relationship between health-promoting collaboration and presenteeism. Significant positive relationships were found between health-promoting collaboration and both well-being and work ability. Presenteeism was identified as a mediator of these relationships.Conclusion: The relevance of health-promoting collaboration in reducing presenteeism was demonstrated and various starting points for practice were proposed. Future studies should investigate further this newly developed concept in relation to presenteeism. (shrink)

We can understand objectivity, in the broadest sense of the term, as epistemic accountability to the real. Since at least the 1986 publication of Sandra Harding’s The Science Question in Feminism, so-called standpoint epistemologists have sought to build an understanding of such objectivity that does not essentially anchor it to a dislocated, ‘view from nowhere’ stance on the part of the judging subject. Instead, these theorists have argued that a proper understanding of objectivity must recognize that different agential standpoints offer (...) different access to objective truths, with some standpoints holding better epistemic potential than others. As Harding puts it, standpoint epistemology calls for “a critical evaluation of which social situations tend to generate the most objective knowledge claims” so as to identify those standpoints that “produce empirically more accurate descriptions and theoretically richer explanations” (1991, 142, 149). Which standpoints enable the most objectivity with respect to a particular inquiry is, for the standpoint theorists, always an empirical at least as much as a conceptual question; it requires attention to the actual, material relationship between knowers, knowledge practices, and objects known. Standpoint epistemology was developed primarily by self-identiªed feminist epistemologists. Virtually all developments of standpoint episte-. (shrink)

Berkeley holds that vision, in isolation, presents only color and light. He also claims that typical perceivers experience distance, figure, magnitude, and situation visually. The question posed in New Theory is how we perceive by sight spatial features that are not, strictly speaking, visible. Berkeley’s answer is “that the proper objects of vision constitute an universal language of the Author of nature.” For typical humans, this language of vision comes naturally. Berkeley identifies two sorts of objects of vision: primary (light (...) and colors) and secondary (distance, figure, magnitude, and situation). Berkeley also appeals to a third class of a different sort: visible figure, magnitude, and situation, constituting the vocabulary of the language of vision. By considering two perceivers who lack this vocabulary we may better understand this third category and the difference between those who must learn the language of vision and those for whom it is a natural endowment. (shrink)

In Western societies, height is positively correlated with reproductive success (RS) for men but negatively correlated with RS for women. These relationships have been attributed to sexual selection: women prefer tall men, and men prefer short women. It is this success in the marriage market which leads to higher RS for tall men and short women. We have already shown that the relationship between height and RS for women is quite different in a non-Western context. In a subsistence farming community (...) in rural Gambia, height is positively correlated with reproductive success for women, largely owing to the higher survival of the children of tall women. Here, the relationship between height and reproductive success is analyzed for men in the same community. For these Gambian men, there is no significant relationship between height and the number of children they produce, although tall men do contract more marriages than shorter men. We conclude that environmental context needs to be taken into account when analyzing human reproductive behavior. (shrink)

In this chapter, DeYoung looks at the culturally and historically recognized virtue of courage. She specifically questions how we should think of all the pictures of courage and where we might look for Christlike examples of courage. To do this, DeYoung explores courage as it relates to fear and love and then delves into how courage can be a Christian practice.

While bioethics as a field has concerned itself with methodological issues since the early years, there has been no systematic examination of how ethics is incorporated into research on the Ethical, Legal and Social Implications of the Human Genome Project. Yet ELSI research may bear a particular burden of investigating and substantiating its methods given public funding, an explicitly cross-disciplinary approach, and the perceived significance of adequate responsiveness to advances in genomics. We undertook a qualitative content analysis of a sample (...) of ELSI publications appearing between 2003 and 2008 with the aim of better understanding the methods, aims, and approaches to ethics that ELSI researchers employ. We found that the aims of ethics within ELSI are largely prescriptive and address multiple groups. We also found that the bioethics methods used in the ELSI literature are both diverse between publications and multiple within publications, but are usually not themselves discussed or employed as suggested by bioethics method proponents. Ethics in ELSI is also sometimes undistinguished from related inquiries. (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)

In 2022, the U.S. Supreme Court removed constitutional protection from the individual's right to end a pregnancy. In Dobbs v. Jackson Women's Health Organization, the Court invalidated previous rulings protecting that right as part of the individual liberty and privacy interests embedded in the U.S. Constitution. Now, many observers are speculating about the fate of other rights founded on those interests. The Dobbs ruling conflicts with the Court's 1990 Cruzan decision restricting the government's power to interfere with personal medical choices. (...) The language and reasoning in Dobbs and Cruzan offer guidance on how the Court might address future cases involving the right to refuse life‐sustaining treatment. The decisions also point to policy strategies for preserving that right. (shrink)

The postmodern criticism of music analysis remains unwittingly preoccupied with a false image of ‘the Whole’, or with the construction of unity precisely through privileging its opposite. At the centre of this discourse there often emerges a split between two things—analysis/aesthetics, part/whole, subject/object—where the question then becomes one of reconciliation: how can the analytical methods be subsumed into aesthetic discussions of subjectivity to better represent the ‘thing itself’? This problem is now a cross-disciplinary one, with criticism favouring the application of (...) ‘external’ disciplines to complement the ‘internal’ act of music analysis. This article takes Žizek’s comments on the difference between modernism and postmodernism as alienation and separation as its starting point in order to reconsider the effects of the supposedly postmodern concept of interdisciplinarity for music analysis. Through a critique of existing musico-psychoanalytic literature, it demonstrates the ways in which the interdisciplinary relation currently seems to occupy the space of an objet petit a in scholarship that is therefore marked by a failure restricted to the principles of alienation. If read alongside Žižek’s phenomenology of the subject however, rather than become a fetishized unity, this relation could be seen to construct the space for a self-reflexive musical subject, able to avoid false reconciliation through critical self- awareness, and could also therefore hold greater significance for an interdisciplinary musicology. (shrink)

The absent Arendt -- Arendt reading Aristotle -- Arendt reading Kant -- Arendt relating to Karl Jaspers -- Arendt thinking through Heidegger -- Arendt along with the existentialists -- Arendt as atypical -- Arendt in anticipation.

Over recent decades scholars have begun explicitly to acknowledge the importance of visual display in the formation of the fifteenth-century Burgundian “Theater State.” This remarkably apposite term, coined in the early 1980s by Wim Blockmans and Walter Prevenier, encapsulates the centrality of ceremony and ostentatious self-projection to both the political process of state building and the more personal imperative of identity construction in the Burgundian Netherlands under Duke Philip the Good . The specific sorts of display associated with the Theater (...) State in previous studies have tended to be larger-scale ceremonial events with an inherent performativity—rigorously staged entries, sharply choreographed jousts, elaborately themed dinners, joyously restrained wedding ceremonies, or grimly festive funeral processions—though the individual aspects of their makeup, that is, the texts written to accompany them, the images produced to illustrate them, or the costumes worn to celebrate them, all add to the lavish effect. But the role of these smaller-scale articulations of luxury in the shaping of a courtly identity in Burgundy has been infrequently discussed by critics; and the part played by literature and the material book in the fostering and sustaining of this spectacular culture has gone largely unacknowledged. (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)