This paper makes the case for a pluralist, contextualist view of nursing ethics. In defending this view, I briefly outline two current perspectives of nursing ethics – the Traditional View and the Theory View. I argue that the Traditional View, which casts nursing ethics as a subcategory of healthcare ethics, is problematic because it (1) fails to sufficiently acknowledge the unique nature of nursing practice; and (2) applies standard ethical frameworks such as principlism to moral problems which tend to alienate (...) or undermine nursing ethical concerns. Alternatively, the Theory View, which aims to build an independent and comprehensive theory of nursing ethics, is also found wanting because it (1) fails to sufficiently acknowledge the heterogeneous nature of nursing practices; (2) overemphasizes the differences and undervalues the similarities between nurses and other health professionals; and (3) assumes that one ethical framework can be meaningfully applied across diverse moral problems and contexts.My alternative, is to argue that nursing ethics inquiry should take a pluralist and critical stance towards available ethical frameworks and the negotiation of the ethical realm. On this view, the search for moral consensus or a unique ethical framework for nursing is replaced by the task of working strategically with multiple frameworks in order to expand the moral agency of nurses and empower them to positively engage with moral uncertainty as an inevitable feature of living a moral life. I conclude by indicating some of the implications that this has for the teaching of nursing ethics. (shrink)

The Covid‐19 pandemic has highlighted many of the difficult ethical issues that health care professionals confront in caring for patients and families. The decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. Our focus is on the implications for nurses, who are the largest global health care workforce but whose perspectives are not always fully considered. This essay discusses three overarching ethical issues that create a myriad of concerns and will likely affect nurses globally (...) in unique ways: the safety of nurses, patients, colleagues, and families; the allocation of scarce resources; and the changing nature of nurses’ relationships with patients and families. We urge policy‐makers to ensure that nurses’ voices and perspectives are integrated into both local and global decision‐making so as to minimize the structural injustices many nurses have faced to date. Finally, we urge nurses to seek sources of support throughout this pandemic. (shrink)

Moral distress has received much attention in the international nursing literature in recent years. In this article, we describe the evolution of the concept of moral distress among nursing theorists from its initial delineation by the philosopher Jameton to its subsequent deployment as an umbrella concept describing the impact of moral constraints on health professionals and the patients for whom they care. The article raises worries about the way in which the concept of moral distress has been portrayed in some (...) nursing research and expresses concern about the fact that research, so far, has been largely confined to determining the prevalence of experiences of moral distress among nurses. We conclude by proposing a reconsideration, possible reconstruction and multidisciplinary approach to understanding the experiences of all health professionals who have to make difficult moral judgements and decisions in complex situations. (shrink)

In the last three decades, considerable theoretical and empirical research has been undertaken on the topic of moral distress among health professionals. Understood as a psychological and emotional response to the experience of moral wrongdoing, there is evidence to suggest that—if unaddressed—it contributes to staff demoralization, desensitization and burnout and, ultimately, to lower standards of patient safety and quality of care. However, more recently, the concept of moral distress has been subjected to important criticisms. Specifically, some authors argue that the (...) standard account of moral distress elucidated by Jameton :542–551, 1984) does not refer to a discrete phenomenon and/or that it is not sufficiently broad and that this makes measuring its prevalence among health professionals, and other groups of workers, difficult if not impossible. In this paper, we defend the standard account of moral distress. We understand it as a concept that draws attention to the social, political and contextual determinants of moral agency and brings the emotional landscape of the moral realm to the fore. Given the increasing pressure on health professionals worldwide to meet efficiency, financial and corporate targets and reported adverse effects of these for the quality and safety of patient care, we believe that further empirical research that deploys the standard account moral distress is timely and important. (shrink)

This article briefly outlines some of the key problems with the way in which the moral realm has traditionally been understood and analysed. I propose two alternative views of what is morally interesting and applicable to nursing practice and I indicate that instability has its upsides. I begin with a moral tale – a 'Good Samaritan' story – which raises fairly usual questions about the nature of morality but also the more philosophically fundamental question about the relationship between subjectivity and (...) moral agency. I then consider this relationship from the perspectives of two twentieth century philosophers: Emmanuel Levinas and Michel Foucault. Levinas' basic point is that the experience of ethical subjectivity is made possible through others: the demand to respond to the existence of others is the basic social structure that precedes individual freedom. If Levinas posits intersubjectivity as a fundamental or primitive feature of the moral realm, Foucault poses an even more basic question: how have moral subjects and relations of obligation been constituted? The aim of ethical inquiry, for Foucault, is to describe the network of discourses, institutions, relations, and practices through which certain kinds of subjects are constituted and constitute themselves, e.g. as a kind of person who can act morally. Finally, I consider some recent research in philosophy of nursing which illustrates how Levinasian and/or Foucauldian perspectives can deepen understanding of nurses' moral practices, specifically, the work of Norwegian public health nurses, Canadian pediatric nurses, and Irish midwives. I suggest that in spite of the instability of morality in general and the particular ethical challenges that face nurses, there are grounds for hope and possible strategies for living in unstable times. (shrink)

Why the narrative self? -- Contemporary interest in narrative theory -- Is the self real or illusory? -- Dennett's brand of naturalism -- The heterophenomenological method (HM) -- Consciousness and the self -- The naturalist narrative self -- Puzzle cases -- The HM and the narrative self -- The limitations of Dennett's account -- The limits of language -- Epistemological fragility -- Ontological fragility -- Naturalism and phenomenology -- Confronting naturalism -- Phenomenology and hermeneutics -- The detour of interpretation -- (...) Reflexivity -- The problem of personal identity -- The number of selves, identity relations and truth -- The capable self and its narrative identity -- Narrative identity and aristotelian muthos -- Narrative recounting of human lives -- LPSE-identity and literary puzzle cases -- Certainty, knowledge and attestation -- Narrative attestation -- Fact and fiction -- Narrative attestation -- The limitations of Ricoeur's account -- Selective appeals to literary and psychoanalytic discourses -- Focus on the self-examining self -- The ontological status of the narrative self -- The epistemological status of the narrative self -- The practical self -- Why the narrative self? (shrink)

Although clinical ethics support services are becoming increasingly prevalent in Europe and North America, they remain an uncommon feature of the Irish healthcare system and Irish health professionals lack formal support when faced with ethically challenging cases. We have developed a variant on existing clinical ethics decision-making tools which is designed to build capacity and confidence amongst Irish practitioners and enable them to confront challenging situations in the absence of any dedicated support structure. The tool provided below follows a transparent (...) stepwise procedure which avoids an overcomplicated analysis while remaining sensitive to the complexity of the issues addressed. The novelty of the tool lies in the explicit association it makes between each step in the process and one or more responsibilities based on established norms of ethical decision-making in the public domain. (shrink)

In April 2004 the Irish Government commissioned Judge Maureen Harding Clark to compile a report to ascertain the rate of caesarean hysterectomies at Our Lady of Lourdes Hospital in Drogheda, Republic of Ireland. The report came about as a result of complaints by midwives into questionable practices that were mainly (but not solely) attributed to one particular obstetrician. In this article we examine the findings of this Report through a feminist lens in order to explore what a feminist reading of (...) the Report and the events that led to the inquiry will bring to light. We consider how sex and gender feature in the Lourdes case, draw attention to the deeply gendered asymmetries of power and privilege that existed between the men and women at the centre of this inquiry, and explore the impact such asymmetries had on this particular situation. (shrink)

Background The impact of healthcare ethics educational interventions on participants’ ethical development is rarely reported on and assessed; even less attention is paid to educational interventions that focus on end-of-life ethical issues. Aim To evaluate the impact of the Ethical Framework for End-of-Life Care Study Sessions Programme on the moral development of healthcare staff who are delivering end-of-life care. Methods The EOLCSS was delivered to 20 multi-disciplinary health care staff in Ireland in May 2013. Effect on moral reasoning was measured (...) pre and post education using the Defining Issues Test 2. Inferential statistics were used to examine the relationships between change in DIT2 scores and demographic variables. Results Participants experienced moral reasoning development following receipt of EOLCSS. Age and previous ethics education contributed to the observed changes in moral reasoning. Conclusions Receipt of the EOLCSS may contribute to moral reasoning development in practicing healthcare professionals. (shrink)

The Republic of Ireland has some of the most restrictive abortion legislation in the world which grants to the ‘unborn’ an equal right to life to that of the pregnant woman. This article outlines recent developments in the public discourse on abortion in Ireland and explains the particular cultural and religious context that informs the ethical case for access to abortion services. Our perspective rests on respect for two very familiar moral principles – autonomy and justice – which are at (...) the centre of social and democratic societies around the world. This article explains the context for the deployment of these concepts in order to support the claim that the current legislation and its operationalisation in clinical practice poses serious risks to the health, lives and well-being of pregnant women, tramples on their autonomy rights and requires of them a self-sacrifice that is unreasonable and unjust. (shrink)

This title offers an ethical framework for end-of-life decision making in healthcare settings. Its objective is to foster and support ethically and legally sound clinical practice in end-of-life treatment and care in Ireland.

Background:A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population.Research aim:To identify challenges in implementing the ‘Let Me Decide’ advance care planning programme in long-term-care.Research design:This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families.Participants and research context:long-term-care residents in two nursing homes and one community hospital.Ethical considerations:The local research ethics committee granted ethical approval.Findings:Following implementation, over (...) 50% of all residents had completed some form of end-of-life care plan. Of the 70 residents who died in the post-implementation period, 14% had no care plan, 10% (with capacity) completed an advance care directive and lacking such capacity, 76% had an end-of-life care plan completed for them by the medical team, following discussions with the resident (if able) and family. The considerable logistical challenge of releasing staff for training triggered development of an e-learning programme to facilitate training.Discussion:The challenges encountered were largely concerned with preserving resident’s autonomy, avoiding harm and suboptimal or crisis decision-making, and ensuring residents were treated fairly through optimisation of finite resources.Conclusions:Although it may be too late for many long-term-care residents to complete their own advance care directive, the ‘ Let Me Decide’ programme includes a feasible and acceptable option for structured end-of-life care planning for residents with variable capacity to complete an advance care directive, involving discussion with the resident (to the extent they were able) and their family. While end-of-life care planning was time-consuming to deliver, nursing staff were willing to overcome this and take ownership of the programme, once the benefits in improved communication and enhanced peace of mind among all parties involved became apparent in practice. (shrink)

Metaphysics, morals and science -- The classics : value -- The neo-classics : utility -- The Keynesian revolution -- Development and under-development -- What are the rules of the game?

The authors developed this textbook in response to an increasing interest in ethics, and a growing number of courses on this topic that are now being offered in educational leadership programs. It is designed to fill a gap in instructional materials for teaching the ethics component of the knowledge base that has been established for the profession. The text has several purposes: First, it demonstrates the application of different ethical paradigms (the ethics of justice, care, critique, and the profession) through (...) discussion and analysis of real-life moral dilemmas that educational leaders face in their schools and communities. Second, it addresses some of the practical, pedagogical, and curricular issues related to the teaching of ethics for educational leaders. Third, it emphasizes the importance of ethics instruction from a variety of theoretical approaches. Finally, it provides a process that instructors might follow to develop their own ethics unit or course. * Part I provides an overview of why ethics is so important, especially for today's educational leaders, and describes a multiparadigm approach essential to practitioners as they grapple with ethical dilemmas. * Part II deals with the dilemmas themselves. Ethical dilemmas written by the authors' graduate students bring readers face-to-face with the kinds of dilemmas faced by practicing administrators in urban, suburban, and rural settings in an era full of complexities and contradictions. * Part III focuses on pedagogy and provides teaching notes for the instructor. The authors discuss the importance of self-reflection on the part of both instructors and students, and model how they thought through their own personal and professional ethical codes as well as reflected upon the critical incidents in their lives that shaped their teaching and frequently determined what they privileged in class. (shrink)

Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making would be better understood (...) as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)

In this new textbook two Catholic ethicists with extensive teaching experience present a moral theology based on vision. David Matzko McCarthy and James M. Donohue draw widely from the Western philosophical tradition while integrating biblical and theological themes in order to explore such fundamental questions as What is good? The fourteen chapters in Moral Vision are short and thematic. Substantive study questions engage with primary texts and encourage students to apply theory to everyday life and common human experiences. The (...) book is accessibly written and flexible enough to fit into any undergraduate or seminary course on ethics. (shrink)

Philosophers often assume that we can somehow quantitatively measure how good things are for people. But what does such talk mean? And what are the measures? In *Weighing Goods* John Broome offers one treatment of these questions. In his later *Weighing Lives* he offers a different treatment. This article discusses both positions but advocates a third. But while the three positions disagree about matters of meaning, they agree about the form of the measures. Roughly speaking, they are such that the (...) goodness of a lottery for an individual is equal to its expected goodness for her. (shrink)

In spite of feminist recognition that hierarchical organizations are an important location of male dominance, most feminists writing about organizations assume that organizational structure is gender neutral. This article argues that organizational structure is not gender neutral; on the contrary, assumptions about gender underlie the documents and contracts used to construct organizations and to provide the commonsense ground for theorizing about them. Their gendered nature is partly masked through obscuring the embodied nature of work.jobs and hierarchies, common concepts in organizational (...) thinking, assume a disembodies and universal worker. This worker is actually a man; men's bodies, sexuality, and relationships to procreation and paid work are subsumed in the image of the worker. Images of men's bodies and masculinity pervade organizational processes, marginalizing women and contributing to the maintenance of gender segregation in organizations. The positing of gender-neutral and disembodied organizational structures and work relations is part of the larger strategy of control in industrial capitalist societies, which, at least partly, are built upon a deeply embedded substructure of gender difference. (shrink)

A holobiont is a composite organism consisting of a host together with its microbiome, such as a coral with its zooxanthellae. To explain the often intimate integration between hosts and their microbiomes, some investigators contend that selection operates on holobionts as a unit and view the microbiome’s genes as extending the host’s nuclear genome to jointly comprise a hologenome. Because vertical transmission of microbiomes is uncommon, other investigators contend that holobiont selection cannot be effective because a holobiont’s microbiome is an (...) acquired condition rather than an inherited trait. This disagreement invites a simple mathematical model to see how holobiont selection might operate and to assess its plausibility as an evolutionary force. This paper presents two variants of such a model. In one variant, juvenile hosts obtain microbiomes from their parents (vertical transmission). In the other variant, microbiomes of juvenile hosts are assembled from source pools containing the combined microbiomes of all parents (horizontal transmission). According to both variants, holobiont selection indeed causes evolutionary change in holobiont traits. Therefore, holobiont selection is plausibly an effective evolutionary force with either mode of microbiome transmission. The modeling employs two distinct concepts of inheritance, depending on the mode of microbiome transmission: collective inheritance whereby juveniles inherit a sample of the collected genomes from all parents, as contrasted with lineal inheritance whereby juveniles inherit the genomes from only their own parents. A distinction between collective and lineal inheritance also features in theories of multilevel selection. (shrink)

Frege begins Die Grundlagen der Arithmetik, the work that introduces the project which was to occupy him for most of his professional career, with the question, 'What is the number one?' It is a question to which even mathematicians, he says, have no satisfactory answer. And given this scandalous situation, he adds, there is small hope that we shall be able to say what number is. Frege intends to rectify the situation by providing definitions of the number one and the (...) concept of number. But what, exactly, is required of a definition? Surely it will not do to stipulate that the number one is Julius Caesar - that would change the subject. It seems reasonable to suppose that an acceptable definition must be a true statement containing a description that picks out the object to which the numeral '1' already refers. And, similarly, that an acceptable definition of the concept of number must contain a description that picks out precisely those objects that are numbers - those objects to which our numerals refer. Yet, while Frege writes a great deal about what criteria his definitions must satisfy, the above criteria are not among those he mentions. Nor does he attempt to convince us that his definitions of '1' and the other numerals are correct by arguing that these definitions pick out objects to which these numerals have always referred. Yet, while Frege writes a great deal about what criteria his definitions must satisfy, the above criteria are not among those he mentions. Nor does he attempt to convince us that his definitions of ‘1’ and the other numerals are correct by arguing that these definitions pick out objects to which these numerals have always referred. There is, as we shall see shortly, a great deal of evidence that Frege’s definitions are not intended to pick out objects to which our numerals already refer. But if this is so, how can these definitions teach us anything about our science of arithmetic? And what criteria must these definitions satisfy? To answer these questions, we need to understand what it is that Frege thinks we need to learn about the science of arithmetic. (shrink)

This book proposes a new theory of the origins of human language ability and presents an original account of the early evolution of language. It explains why humans are the only language-using animals, challenges the assumption that language is a consequence of intelligence, and offers a new perspective on human uniqueness. The author draws on evidence from archaeology, linguistics, cognitive science, and evolutionary biology. Making no assumptions about the reader's prior knowledge he first provides an introductory but critical survey of (...) all sources of evidence for language evolution. He then considers what language itself reveals about its own and human origins and evolution. He shows that certain central aspects of language do not, unexpectedly, reflect what they are used for, are maladapted for their function. He considers why this should be, and argues that these odd aspects of language reveal important clues about its evolutionary origin. The Origins of Complex Language fulfils the promise of its title. In doing so it turns upside down conventional theories about the relation between cognition and expression, truth and reference, and the co-evolution of mind and body. Original in conception, brilliantly executed, stylishly written, this book will attract a wide range of readers interested in the evolution and origins of language. (shrink)

In this article, the author addresses two feminist issues: first, how to conceptualize intersectionality, the mutual reproduction of class, gender, and racial relations of inequality, and second, how to identify barriers to creating equality in work organizations. She develops one answer to both issues, suggesting the idea of “inequality regimes” as an analytic approach to understanding the creation of inequalities in work organizations. Inequality regimes are the interlocked practices and processes that result in continuing inequalities in all work organizations. Work (...) organizations are critical locations for the investigation of the continuous creation of complex inequalities because much societal inequality originates in such organizations. Work organizations are also the target for many attempts to alter patterns of inequality: The study of change efforts and the oppositions they engender are often opportunities to observe frequently invisible aspects of the reproduction of inequalities. The concept of inequality regimes may be useful in analyzing organizational change projects to better understand why these projects so often fail and why they succeed when this occurs. (shrink)

En 1994, Sue Rodriguez se suicide avec l’aide d’un médecin après une intense bataille judiciaire en Cour suprême du Canada dont l’objet était la décriminalisation du suicide assisté. À la suite de ce suicide, aucune accusation criminelle ne fut portée contre la ou les personnes ayant présumément aidé Sue Rodrigues à mettre fin à ses jours, et ce malgré le fait que le suicide assisté est un acte criminel au Canada. Cette non-intervention du droit pénal est examinée en fonction du (...) rôle que l’affaire Rodriguez a pu jouer dans la transformation des moralités au Canada. Dans ce livre, le suicide assisté de Sue Rodriguez est envisagé comme un « crime » utile (au sens durkheimien du terme), car il met en évidence une inconsistance entre les moralités dominantes inscrites dans le droit pénal et les conditions sociales qui ont rendu ce « crime » possible. Apparenté au crime de Socrate, le « crime » de Sue Rodriguez est analysé comme un héraut annonciateur de nouvelles moralités, comme un prélude préparant directement la voie à des changements dans le poids accordé aux moralités dominantes. Dans ce contexte, le rôle du droit pénal comme mode privilégié de régulation morale est remis en question. (shrink)

This latest volume in the Oxford Readings in Feminism series presents the results of the multi-disciplinary feminist exploration of the distinction between public and private. Contributors demonstrate the significance of the distinction in feminist theory, its articulation in the modern and late modern public sphere, and its impact on identity politics within feminism in recent years. Feminism, the Public and the Private offers an essential perspective on feminist theory for students and teachers of women's and gender studies, cultural studies, history, (...) political theory, geography and sociology. (shrink)

In this important volume Habermas outlines the views which form the basis of his critical theory of modern societies. The volume comprises five interlocking essays, which together define the contours of his theory of communication and of his substantive account of social change. ′What is Universal Pragmatics?′ is the best available statement of Habermas′s programme for a theoryof communication based on the analysis of speech acts. In the following two essays Habermas draws on the work of Kohlberg and others to (...) develop a distinctive account of moral consciousness and normative structures. ′Toward a Reconstruction of historical Materialsim′ takes these issues further, offering a wide–ranging reconstruction of Marx′s historical materialsim understood as a theory of social evolution. The final essay focuses on the question of legitimacy and on the legitimation problems faced by modern states. This book is essential reading for anyone concerned with the key questions of social and political theory today. (shrink)

Not only can the influence of Gottlob Frege be found in contemporary work in logic, the philosophy of mathematics, and the philosophy of language, but his projects—and the very terminology he employed in pursuing those projects—are still current in contemporary philosophy. This is undoubtedly why it seems so reasonable to assume that we can read Frege' s writings as if he were one of us, speaking to our philosophical concerns in our language. In Joan Weiner's view, however, Frege's words (...) can be accurately interpreted only if we set that assumption aside. Weiner here offers a challenging new approach to the philosophy of this central figure in analytic philosophy. Weiner finds in Frege's corpus, from Begriffsschrift on, a unified project of remarkable ambition to which each of the writings in that corpus makes a distinct contribution—a project whose motivation she brings to life through a careful reading of his Foundations of Arithmetic. The Frege that Weiner brings into clear view is very different from the familiar figure. Far from having originated one of the standard positions on the nature of reference, Frege turns out not to have had positive doctrines on anything like what contemporary philosophers mean by "reference." Far from having served as a standard-bearer for those who take the realists' side of contemporary disputes with anti-realists, Frege turns out to have had no stake in either side of the controversy. Through Weiner's lens, Frege emerges as a thinker who has principled reasons for challenging the very assumptions and motivations that animate philosophers to dispute these doctrines. This lucidly written and accessible book will generate controversy among all readers with an interest in epistemology, philosophy of language, history of philosophy, and the philosophy of mathematics. (shrink)

The Question of the Self Perhaps the clearest access to the question of the self in Dogen lies in the fascicle of Shobogenzo entitled "Genjo-koan. ...

Sovint el humans ens hem somiat déus. I Déu n'hi do si hem fet coses admirables: ciència, organització social, art,...motius n'hi ha per estar orgullosos. La vida, però, també ens mostra amb insistència la cara més fosca de nosaltres mateixos, i en aquests moments el més fàcil és passar de l'orgull a la desesperança més absoluta. El camí, però, no pot ser el de l'abandonament. Ni déus ni bèsties! Els déus no trien i, sense esforç ni dubtes, coneixen i realitzen (...) sempre el millor. Els animals, empresonats en la seva naturalesa, tampoc no trenquen gaire el cap a decidir què faran amb les seves vides. Nosaltres no tenim la sort dels uns ni la dels altres, i ens toca amb feines i treballs anar bastint la nostra realitat, aquella que nosaltres farem. Per això existeix l'ètica. "Coneix-te a tu mateix", ordenava l'oracle: només amb les nostres llums i amb les nostres ombres, amb l'instint, amb la ràbia, amb el sentiment, amb la paraula, amb la raó; només coneixent i assumint tot allò que som, tindrem la possibilitat, tal vegada, de construir un món més humà. (shrink)

"The spiritual needs and interests of both men and women have changed enough to merit a new edition of this superbly crafted, scholarly study of Sophia." -- Janet Forsythe Fishburn.