The Hatata Inquiries are two extraordinary texts of African philosophy composed in Ethiopia in the 1600s. Written in the ancient African language of Geʿez (Classical Ethiopic), these explorations of meaning and reason are deeply considered works of rhetoric. They advocate for women's rights and rail against slavery. They offer ontological proofs for God and question biblical commands while delighting in the language of Psalms. They advise on right living. They put reason above belief, desire above asceticism, love above sectarianism, and (...) the natural world above the human. They explore the nature of being as well as the nature of knowledge, the human, ethics, and the human relation with the divine. They are remarkable examples of something many assume doesn't exist: early written African thought. This accessible English translation of the Hatata Inquiries, along with extensive footnotes documenting the cultural and historical context and the work's many textual allusions, enables all to read it and scholars to teach with it. The Hatata Inquiries are essential to understanding the global history of philosophy, being among the early works of rational philosophy. The book includes a translation by Ralph Lee with Mehari Worku and Wendy Laura Belcher of the Hatata Zara Yaqob and the Hatata Walda Heywat. The appendices by Jeremy R. Brown provide information on the scribal interventions in and the differences between the manuscripts of the two Hatatas. The book also includes a map, chronology, summary of the translation principles, and a discussion of the authorship debate about the Hatata Inquiries. (shrink)

The Ḥatäta Zärʾa Yaʿǝqob and Ḥatäta Wäldä Həywät are two remarkable works of philosophy that were until recently virtually unknown to philosophers outside Ethiopia. The first is a philosophical autobiography narrated by the eponymous Zärʾa Yaʿǝqob, a scholar from Aksum in northern Ethiopia, exiled from his home country and forced to take refuge in a mountain cave, where he develops a philosophical system that encompasses a metaphysics of creation, an analysis of the relation between the divine and the human, an (...) account of both epistemology and ethics grounded in the faculty of ləbbuna or ‘reason’, and a strident critique of contemporary social norms. The second text is a much longer companion treatise written by his disciple Wäldä Həywät, and develops the arguments and ideas of Zärʾa Yaʿǝqob into a systematic social ethics. These works, essentially unexamined by philosophers before the past decade, have enjoyed a certain notoriety within the field of Ethiopian-Semitic philology, on account of a century-long controversy concerning their authorship. (shrink)

Wendy Laura Belcher has done her cultural work by queering Mother Walatta Petros's life in this one of a kind book. The struggles of Mother Walatta Petros and her nuns and their heirs' reluctance to enunciate same sex desire is brought out well in this book and its review in Prabuddha Bharata which has not missed an issue from 1896 to date. The book under review establishes Mother Walatta Petros as an African proto-feminist. This is a very (...) well researched book. The genre of the gädl too is very well brought out by Belcher and Kleiner. Medievalists offline and online really do not as yet think African indigenous works as worthy of their consideration. Belcher overcame many roadblocks to write something actually worth reading. Because of constraint of space, the book could not be reviewed more expansively. While the book is one of its kind in its domain; it is still an act of colonial interference within Ethiopian realpolitiks of religions. I have mentioned in the review that African Roman Catholic Cardinals like Cardinal Sarah insist on washing his Church's dirty linen in private. Now, the question is, would say, Wendy Laura Belcher and Kleiner have the guts and their publisher too, to write about paedophilia in the various American Churches? Is it not convenient to impute lesbianism to Mother Walatta Petros and shy away from writing about female desire say, within the global Loreto Convents? This reviewer presumes from this book that all convents are dens of female desire: some can be enunciated by white folks; some cannot. The question is: why queer Ethiopian spirituality when Mother Walatta Petros is no longer alive to defend herself? (shrink)

The Hatata Inquiries are two extraordinary texts of African philosophy composed in Ethiopia in the 1600s. Written in the ancient African language of Geʿez (Classical Ethiopic), these explorations of meaning and reason are deeply considered works of rhetoric. They advocate for women’s rights and rail against slavery. They offer ontological proofs for God and question biblical commands while delighting in the language of Psalms. They advise on right living. They put reason above belief, desire above asceticism, love above sectarianism, and (...) the natural world above the human. They explore the nature of being as well as the nature of knowledge, the human, ethics, and the human relation with the divine. They are remarkable examples of something many assume doesn’t exist: early written African thought. This accessible English translation of the Hatata Inquiries, along with extensive footnotes documenting the cultural and historical context and the work’s many textual allusions, enables all to read it and scholars to teach with it. The Hatata Inquiries are essential to understanding the global history of philosophy, being among the early works of rational philosophy. The book includes a translation by Ralph Lee with Mehari Worku and Wendy Laura Belcher of the Hatata Zara Yaqob and the Hatata Walda Heywat. The appendices by Jeremy R. Brown provide information on the scribal interventions in and the differences between the manuscripts of the two Hatatas. The book also includes a map, chronology, summary of the translation principles, and a discussion of the authorship debate about the Hatata Inquiries. (shrink)

In evolutionary psychology predictions, women’s mate preferences shift between fertile and nonfertile times of the month to reflect ancestral fitness benefits. Our meta-analytic test involving 58 independent reports (13 unpublished, 45 published) was largely nonsupportive. Specifically, fertile women did not especially desire sex in short-term relationships with men purported to be of high genetic quality (i.e., high testosterone, masculinity, dominance, symmetry). The few significant preference shifts appeared to be research artifacts. The effects declined over time in published work, were limited (...) to studies that used broader, less precise definitions of the fertile phase, and were found only in published research. (shrink)

Utilizing examples from recent art, we critique Greta Gaard's argument that an inclusive ecofeminism must account for the role played by erotophobia in oppression. We suggest that while Gaard offers valuable insight into how fear of the erotic contributes to maintaining heteropatriarchal institutions, it fails to account for forms of oppression specific to lesbians. Moreover, Gaard's analysis unwittingly reinforces the conceptual, hence political, economic, and social invisibility of lesbians that, following Marilyn Frye, we argue is not merely consequent to compulsory (...) heterosexuality, but constitutive of it. Lastly, we sketch a lesbian erotic whose potential for generating conceptual dissonance within heteropatriarchal value dualism contains the seeds of a creative "sensibility" out of which a genuinely queer ecofeminism might emerge. (shrink)

RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

Bringing together the expertise of rhetoricians in English and communication as well as media studies scholars, Arguments about Animal Ethics delves into the rhetorical and discursive practices of participants in controversies over the use of nonhuman animals for meat, entertainment, fur, and vivisection. Both sides of the debate are carefully analyzed, as the contributors examine how stakeholders persuade or fail to persuade audiences about the ethics of animal rights or the value of using animals.

The COVID‐19 pandemic has placed extraordinary stress on frontline healthcare providers as they encounter significant challenges and risks while caring for patients at the bedside. This study used qualitative research methods to explore nurses and respiratory therapists' experiences providing direct care to COVID‐19 patients during the first surge of the pandemic at a large academic medical center in the Northeastern United States. The purpose of this study was to explore their experiences as related to changes in staffing models and to (...) consider needs for additional support. Twenty semi‐structured interviews were conducted with sixteen nurses and four respiratory therapists via Zoom or by telephone. Interviews were transcribed verbatim, identifiers were removed, and data was coded and analyzed thematically. Five major themes characterize providers' experiences: a fear of the unknown, concerns about infection, perceived professional unpreparedness, isolation and alienation, and inescapable stress and distress. This manuscript analyzes the relationship between these themes and the concept of moral distress and finds that some, but not all, of the challenges that providers faced during this time align with previous definitions of the concept. This points to the possibility of broadening the conceptual parameters of moral distress to account for providers' experiences of treating patients with novel illnesses while encountering institutional and clinical challenges. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

Wendy Brown's work commands widespread attention and respect, and there has been considerable interest as to how it would develop after "States of Injury." This book will not disappoint.

In Constructing the World, Chalmers seeks to articulate and defend an important epistemic accessibility thesis, the Scrutability of Truth, which is crucial to Chalmers’ rationalist approach to meaning and modality. Chapters 3 and 4 of the book are devoted to persuading us that the move from weaker to stronger forms of Scrutability is intuitively plausible. In these comments, I want to question this move. The plausibility of strong forms of Scrutability hinges on controversial views about epistemic norms for answering ‘what (...) is x?’ questions that semantic externalists have good reason to reject. (shrink)

Although moral case deliberation (MCD) is evaluated positively as a form of clinical ethics support (CES), it has limitations. To address these limitations our research objective was to develop a thematic CES tool. In order to assess the philosophical characteristics of a CES tool based on MCDs, we drew on hermeneutic ethics and pragmatism. We distinguished four core characteristics of a CES tool: (a) focusing on an actual situation that is experienced as morally challenging by the user; (b) stimulating moral (...) inquiry into the moral concepts, questions and routines in the lived experience of the CES tool user; (c) stimulating moral learning by exploring other perspectives; and (d) incorporating contextual details. We provide an example of a CES tool developed for moral dilemmas over client autonomy. Our article ends with some reflections on the normativity of the CES tool, other application areas and the importance of evaluation studies of CES tools. (shrink)

There is currently a gap in our understanding of how figures produced by mechanical imaging techniques play evidential roles: several studies based on close examination of scientific practice show that imaging techniques do not yield data whose significance can simply be read off the image. If image-making technology is not a simple matter of nature re-presenting itself to us in a legible way, just how do the images produced provide support for scientific claims? In this article I will first show (...) that there is a distinct question about the semiotics of mechanically produced images that has not yet been answered. I show that my account of visual representations can do so, and I argue that the role of convention involved in my account is compatible with the view that visual representations produced through mechanized imaging techniques can play genuine evidential roles in scientific reasoning. (shrink)

Moral disengagement is the process by which individuals mitigate the consequences of their own violations of moral standards. Although MD is understood to be co-determined by culture norms, no study has yet explored the extent to which MD applied to safety at work fosters safety violations, nor the role of organizational culture as a predictor of JS-MD. The current study seeks to address this gap in the literature by examining individual- and organizational-level factors that explain why employees fail to report (...) workplace accidents. We tested a latent variable structural model positing organizational culture typologies as predictors of JS-MD, which in turn is expected to mediate the relationship with accident underreporting. Using data from 1033 employees in 28 Italian organizations, findings suggest that bureaucratic safety culture was related to lower levels of JS-MD, whereas technocratic safety culture was related to greater JS-MD. In turn, JS-MD positively predicted employee accident underreporting and fully mediated the relationship between culture and underreporting. Theoretical and practical implications are discussed in light of the increasing focus on underreporting as well as the adverse individual and organizational consequences of failing to report workplace accidents. (shrink)

Illustrated with sumptuously detailed panel-style artwork and based on the Eastern philosophies of the Tao Te Ching, a lyrical picture book explores the eternal question of how to promote world peace and shares inspiring quotes from famous peacemakers while counseling readers on how to find peace within oneself.

We often think of normal childhood as a progressive development towards a fixed—and often tacitly individualistic and masculine—model of what it is to be an adult. By contrast, phenomenologists, psychoanalysts, sociology of childhood, and feminist thinkers have set out to offer richer accounts both of childhood development and of mature existence. This paper draws on accounts of childhood development from phenomenologist Maurice Merleau-Ponty and object relations theorist D. W. Winnicott in order to argue that childhood development takes place in “transitional (...) spaces”; explores typical gendered patterns in the formation of selfhood that “split” relationality and separateness into the “feminine” and the “masculine”; and offers a phenomenology of perception, love, and objectivity in order to show the manner in which, contra individualistic and masculine visions of adulthood, maturity requires an embrace rather than eschewal of ambiguity, and the capacity to continue to dwell in the transitional space between relatedness and separateness. (shrink)

Previous studies have shown a robust bias to express the goal path over the source path when describing events. Motivated by linguistic theory, this study manipulated the causal structure of events and measured the extent to which adults and 3.5- to 4-year-old English-speaking children included the goal and source in their descriptions. We found that both children's and adults’ encoding of the source increased for events in which the source caused the motion of the figure compared to nearly identical events (...) in which the source played no such causal role. However, a goal bias persisted overall for both causal and noncausal motion events. These findings suggest that although the goal bias in language is highly robust, properties of the source influence its likelihood of being encoded in language, thus shedding light on how properties of an event can influence the mapping of event components into language. (shrink)

Vaccine hesitancy is a growing threat to public health. The reasons are complex but linked inextricably to a lack of trust in vaccines, expertise and traditional sources of authority. Efforts to increase immunization uptake in children in many countries that have seen a fall in vaccination rates are two-fold: addressing hesitancy by improving healthcare professional-parent exchange and information provision in the clinic; and, secondly, public health strategies that can override parental concerns and values with coercive measures such as mandatory and (...) presumptive vaccination. It is argued that such conflicting, parallel approaches seriously risk undermining trust that is crucial for sustaining herd immunity. Although public health strategies can be ethically justified in limiting freedoms, a parent-centered approach seldom acknowledges how it is impacted by contemporaneous coercive measures. In addition, the clinical encounter is not well suited to helping parents consider the public dimensions of vaccination, despite these being important for trust formation and informed decision-making. Efforts to address vaccine hesitancy require more consistent engagement of parental and citizen views. Along with evidence-based information, debates need to be informed by ethical support that equips parents and professionals to respond to the private and public dimensions of vaccination in a more even-handed, transparent manner. Efforts to address vaccine hesitancy need to avoid simple reliance on either parental values or coercive public policies. To do this effectively requires increasing citizen engagement on vaccination to help inform a parent-centered approach and legitimize public policy measures. In addition, cultivating a more ethically consistent strategy means moving beyond the current silos of health ethics - clinical and public health ethics. (shrink)

This article draws attention to the transformation of the Swiss physician Johann Georg Zimmermann’s (1728–1795) work on national pride. First published as Von dem Nationalstolze in 1758, this work attracted trans-European interest and consequently appeared in substantially revised editions in 1760 and 1768. One notable addition in the new editions was a chapter on national pride felt by the subjects of monarchies, which could be taken as indicating a monarchist turn in Zimmermann’s thinking. However, as the article contends, Zimmermann’s work (...) can be read not only as a treatise making claims about the national pride of various countries but also as a text which, in so doing, attempted to encourage liberty and patriotic virtue in different societies. As such, it can be interpreted as representing a variation of republicanism that focussed solely on reforming the thinking of individuals. This argument is based on an analysis of the evolution of Zimmermann’s work, his correspondence, contemporary reviews, and a set of unpublished draft prefaces. As this evidence indicates, Zimmermann aspired to promote a republican attitude wherever his readers were situated. However, appreciating this ‘internalised republicanism’ requires that his writing is examined as a process involving the reactions of his expanding audience. (shrink)

In this paper, we argue that the intentionality at play in skilled performance is not only inherently normative but also inherently affective. We take a radically embodied approach to the mind in which we conceive of cognitive agents as sensorimotor systems moved to maintain their biological and sociocultural identity, whose perception is direct and occurs in terms of affordances. Within this framework, we define skilled performance as the enactment of action and perception patterns in which the agent is intentionally oriented (...) towards specific features in the environment. We propose that skillful intentionality is guided by normative constraints involving the material and social conditions of the agent but is ultimately determined by the intrinsic purpose of maintaining the agent’s identity, and skilled intentionality is inherently affective because it is a specific occurrence arising from a general sense of care to maintain one’s identity which is realized by orienting oneself towards the right aspects of the environment in the right way. Skilled performance thus requires agents to establish a normative and affective intentionality towards aspects of their material environment. We show that, since sociocultural practices shape human identities, sociocultural practices play a crucial role in shaping human intentionality of skilled performance both in their normative and affective dimensions. Maintaining a human identity, we argue, amounts to routinely carrying out activities that form a historical pattern which is shared with and recognized by others. (shrink)

The University of Perugia's Archivio storico preserves a sixteenth-century manuscript of the imprese of the Accademia degli Insensati, an institution which is well-known for its important members and affiliates in the ecclesiastical and poetic circles of Perugia and Rome. Largely unpublished, the manuscript collects forty-three imprese of academicians, drawn by different artists and miniaturists, including that of the painter and theorist Federico Zuccari. In later life Zuccari proudly made use of his Insensato nickname of Il Sonnacchioso, but here his impresa (...) is unexpectedly given as Il Desioso. This article argues that the Il Desioso impresa represents Zuccari's application to join the Accademia. Drawn by the artist himself, featuring his device of the sugarloaf and accompanied by a prose description in his own hand, the impresa can be dated by comparisons with other works made around the time of Zuccari's move from Florence to Rome. It reflects a number of the theoretical ideas from this period of his life, concerning the role of Academies, the education of the artist, and classical culture. (shrink)

A regime of private property is, by nature, morally controversial. Property in physical, external, finite, non-shareable resources has one irreducible and undeniable consequence: if it is given to...

An underexamined insight of W. E. B. Du Bois’s John Brown is that John Brown worked for much of his life to cultivate democratic relationships with the Black Americans with and for whom he worked. Brown did so through practicing deference and deliberation, and by seeking authorization. However, Brown’s commitment to these practices faltered at a crucial moment in decision making: when he raided Harpers Ferry absent widespread support. Examining this aspect of John Brown brings into relief an overlooked tragic (...) choice Brown made: To act in accordance with his own substantive vision of what justice required, Brown eschewed democratic ideals and practices that grounded the distinctive relations of equality he had cultivated with the Black communities with and for whom he worked. (shrink)

The Anger of Achilles, Robert Graves’ 1959 translation of Homer’s Iliad, has been variously dismissed by classical scholars as an ‘outrageous sortie into the field of translation’ and a work of ‘sheer egotism’, marred by its author’s ‘scattered yapping’. And yet, it can be read with greater understanding if we approach it not merely as a literary anomaly, but as a refraction of Graves’ experience of ‘Shell Shock,’ or PTSD, following his front line service during the First World War. This (...) paper proposes that the act of translation can itself be cathartic, creating a formalized textual space in which the translation of traumatic memory into narrative memory becomes viable, and that Graves used Homer’s epic as a tool to access his own occluded, traumatic past. By comparing The Anger of Achilles to R. Lattimore’s relatively literal translation of the Iliad, it will illuminate the ways in which the former is deeply rooted in Graves’s experience of combat, his ensuing neurasthenia, and the personal Myth by which he made sense of both – the matriarchal mythopoetics of The White Goddess. (shrink)

This article reviews empirical and conceptual material from two distinct research traditions: on the science-technology relation and on industrial innovation. It aims both to shed new light on an old debate—the distinction between scientific and technological knowledge—and to refine our conceptualizations of the knowledge used by companies in the course of research and development leading to innovation. On the basis of three empirical studies, a composite categorization of different types of knowledge used in innovation is proposed, as part of a (...) broader framework encompassing two further taxonomic dimensions. It is hoped that this typology and framework might provide useful research tools in furthering our understanding of the knowledge transfers and transformations that occur in the course of innovation. It could also prove useful for organizations and groups facing difficult strategic choices about technology. (shrink)

This article seeks to open up a new avenue for feminist technology studies—gender-aware research on engineers and engineering practice—on the grounds that engineers are powerful symbols of the equation between masculinity and technology and occupy significant roles in shaping new technologies. Drawing on the disparate evidence available, the author explores four themes. The first asks why the equation between masculinity and technology is so durable when there are such huge mismatches between image and practice. The second examines this mismatch in (...) the detail of engineering knowledge and practice to reveal that fractured and contradictory constructions of masculinity frequently coexist. The third theme addresses the suggestion that women and men might bring different styles to engineering. Finally, the author explores subjective experiences of engineering to argue that engineers’ shared pleasures in and identification with technology both define what it means to be an engineer and provide appealing symbols of power that act to compensate for a perceived lack of power or competence in other arenas. (shrink)

Introducción al dosier “Pensar históricamente la democracia”.

The authors of this book show that the failure of public health arises, not from a failure of contemporary medicine, but from a failure of the philosophical assumptions upon which it rests. They suggest an alternative approach to health care that derives from a ecological and holistic philosophy of nature.

The exhibition Space/Sight/Self was designed to study the role of portraiture in contemporary art as a nexus of three issues identity, vision, and place. The goal was to produce a portrait, as it were, of contemporary portraiture. This catalog documents the exhibition and helps to facilitate viewers' reflections and responses about the spaces, sights, and selves that enable us to construct and question our identity.".

Research ethics consultation is increasingly recognized as a potentially valuable mechanism for addressing the depth and breadth of ethical issues that arise in research related to human health and well-being. However, fundamental questions remain, including: What is “research ethics consultation”? And what is its justification beyond the purposes already served by existing entities? We examine how a research ethics consultation service may differ from or complement the role of an institutional review board by offering a definition of research ethics consultation (...) and by exploring the potential scope of a consultation service in terms of types of clients served, questions addressed, and advice provided at various stages of the research process. We then consider the relationship between research ethics consultation services and IRBs, as well as the issues that may arise between them, including possible conflicts of interest. (shrink)

ABSTRACTRecent research suggests that impaired emotion regulation may play an important role in the development of youth psychopathology. However, little research has explored the effects of ER strategies on affect in early adolescents. In Study 1, we examined if early adolescents are able to use distraction and whether the effects of this strategy are similar to talking to one’s mother. In Study 2, we compared the effects of distraction, cognitive reappraisal, acceptance, and rumination. In both studies, participants received instructions on (...) how to regulate their emotions after a standardised negative mood induction. In general, the results indicated that distraction, but also cognitive reappraisal and acceptance, had promising short-term effects on positive and negative affect in early adolescents. These findings suggest that targeting adaptive ER skills, such as distraction, acceptance, and cognitive reappraisal, may be an important strategy to prevent or treat psychological pro... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Healing Power of an Ethics ConsultLaura J. HoeksemaOur interdisciplinary team was inhaling and exhaling conflict, frustration, anger, confusion, guilt, and feelings of helplessness as we cared for a 21-year-old woman who was dying. We had regular disagreements about how our team should best care for her. She was receiving hospice care and had complex medical, psychosocial, physical, and emotional needs. She was frequently transitioning between hospice care at (...) home, living with different family members at different times, and hospice care in the hospital due to uncontrolled symptoms. This led to her having an inpatient hospice team made up of me—her physician—and a nurse, social worker, and chaplain and also an outpatient hospice team with a different physician, nurse, social worker, and chaplain. All of us cared for her regularly in our respective settings. Members of the two care teams advocated passionately for what they thought was best for her. At times, team members were advocating strongly for conflicting interventions. Every member of both teams experienced moral distress related to some aspect of her care.How could we move forward in a unified way to provide her with the best care possible when there was uncertainty and disagreement within the teams about whether we were providing her with ethically appropriate care?Several questions arose about her care:• What is our responsibility in protecting a vulnerable patient when there is concern she’s being taken advantage of by others?• How do we address concerns about possible opioid diversion? Was a dying patient not receiving the pain medication she needed because someone else was using it?• How do we address household members smoking in the presence of someone on oxygen?• Do we honor a dying patient’s wish to live in an environment that we’re concerned is unsafe for her and our staff?• When team members receive contradictory information from a patient, how do we develop a common understanding of the situation?• Was it appropriate for our team to spend hours and hours caring for her each day which prevented us from caring for other patients who also needed our support?• What is our responsibility in relation to supporting her family with their financial and legal concerns?We placed an ethics consult to help us think through the answers to these questions and address the intense moral distress of team members. After listening to us share our experiences, the ethicists acknowledged the complexities of caring for her and affirmed that we were doing a good job. This acknowledgment from someone not directly involved in caring for the patient was meaningful. Having colleagues, who weren’t impacted by the emotional intensity of caring for her, empathize with us helped us gain some perspective in the swirling tornado of our emotions.Moral distress was running rampant. Some team members were distressed that we were giving the patient too much autonomy to make decisions they felt put her at risk. Others felt we should restrict her autonomy significantly to protect her. Some were distressed by family members smoking near her when she was on oxygen. Others were distressed that the investment of time in caring for her was so great that we couldn’t care for other patients in ways they deserved. Team members were very passionate about their beliefs about what was right and wrong as we cared for her. [End Page 21]The ethics consultants addressed the conflicting ethical values and helped us feel more comfortable with the plan of care we developed together. We were asked thoughtful questions to help draw out sources of moral distress. We were given new ways of thinking about conflicting ethical values, which helped us understand the underlying reasons for the conflict our team was experiencing. Highlighting the ethical values that were in conflict and helping each of us understand that the specific aspects of her care that we found distressing were related to our personal values, helped decrease the intensity of disagreements and frustration. The ethicist’s ability to share this knowledge with our team was powerful. Our team realized that we weren’t frustrated or upset with each other. We came to understand that because of the... (shrink)