Primary care presents distressful moral problems for nurse practitioners (NPs) who report frustration, powerlessness, changing jobs and leaving advanced practice. The purpose of this grounded theory study was to describe the process NPs use to manage moral problems common to primary care. Twenty-three NPs were interviewed, commenting on hypothetical situations depicting ethical issues common to primary care. Coding was conducted using a constant comparative method. A theory of maintaining moral integrity emerged consisting of the phases of encountering conflict, drawing a (...) line, finding a way without crossing the line, and evaluating actions. The NPs varied in their awareness and the discord encountered in conflict, and in clarity, flexibility and justification of the line drawn. A critical juncture occurred when NPs evaluated how well integrity had been maintained. Some experienced no distress while others experienced self-doubt, regret, outrage and frustration at external constraints, and attempted to reconcile through avoiding, convincing themselves, and compensating. (shrink)

ABSTRACTThis article reveals how nineteenth-century chemists and health reformers tried to eradicate the use of yeast in bread, claiming they had devised healthier and more sanitary ways to raise bread. It describes the alternative technological solutions to baking bread, investigating factors that influenced their development and adaptation in the marketplace. A lack of scientific and cultural consensus surrounding yeast, what it was and what it did, fermented during this period. The conflict over yeast helped create a heterogeneous industrialization of the (...) baking industry, changing processes and ingredients and creating new forms of bakery products. By examining the claims of promoters of rival scientific beliefs and technologies, as well as those of users and social commentators, we can see that technology’s eventual adaptation and impact on society is not predictable at its outset. Exploring the relationship between differing scientific beliefs, cultural understandings and alternative technologies also shows how science and industry cannot be isolated from their social and cultural context. The examination of the nineteenth-century technological development of commonplace commodities such as bread, baking powder and yeast, also reveals and explores a story that has not been told before in the history of science and technology. Why it has not been told is as enlightening as the story itself, revealing as it does our own privileging of what is important in science and history. (shrink)

Concerns that cash payments to people who inject drugs (PWID) to reimburse research participation will facilitate illicit drug purchases have led some ethical authorities to mandate department store/supermarket vouchers as research reimbursement. To examine the relative efficacy of the two forms of reimbursement in engaging PWID in research, clients of two public opioid substitution therapy clinics were invited to participate in a 20–30 min, anonymous and confidential interview about alcohol consumption on two separate occasions, 4 months apart. Under the crossover (...) design, at Time 1, clients of Clinic 1 were offered $A20 cash as reimbursement, while clients of Clinic 2 were offered an $A20 voucher; at Time 2, the form of reimbursement was reversed. Using clinic records to determine the denominator (number of clients dosed), we found that compared with clients offered a voucher, a significantly higher proportion of clients who were offered cash participated in the survey (58% (139/241) vs 74% (186/252); χ2=14.27; p=0.0002). At first participation, respondents most commonly reported planning to purchase food/drinks/groceries (68%), cigarettes (21%) and transport/fuel (11%) with their payments, with those reimbursed in cash more likely to report planning to fund transport/fuel (19% vs 1%; p<.01) and less likely to report planning to purchase food/drinks/groceries (62% vs 76%; p=0.02). Just three out of 155 cash participants reported planning to purchase illicit drugs with their payment. Results demonstrate that modest cash payments enhanced recruitment of this group, an important consideration given the challenges of delineating the parameters of a population defined by illegal activity, seemingly without promoting excessive additional drug use. (shrink)

The incidence of moral distress, compromised moral integrity, and leaving nursing is highest among nurses new to the profession. Understanding perceptions of moral integrity may assist in developing strategies to reduce distress and promote workforce retention. The purpose of this study was to determine how newly graduated baccalaureate prepared nurses perceive moral integrity and how prepared they feel to manage challenges to it. The design was qualitative descriptive using a confidential short answer online survey. Data were analyzed using conventional content (...) analysis. Moral integrity was perceived as acting like, becoming, and being a certain kind of person who was honest, trustworthy, consistently doing and standing up for what is right, despite the consequences but also expected to set aside their values and beliefs and do what others ask, even if this would mean acting contrary to their conscience. The contradiction within this perception needs explanation. (shrink)

Abstract Unlike bioethicists who contend that there is a morality common to all, H. Tristan Engelhardt (1996) argues that, in a pluralistic secular society, any morality that does exist is loosely connected, lacks substantive moral content, is based on the principle of permission and, thus, is a morality between moral strangers. This, says Engelhardt, stands in contrast to a substance-full morality that exists between moral friends, a morality in which moral content is based on shared beliefs and values and exists (...) in communities that tend to be closely knit and religiously based. Of what value does Engelhardt's description of ethics as moral friends and moral strangers have for nursing? In this essay, I attempt to show how Engelhardt's description serves to illustrate how the nursing community historically had been one of moral friends but has gradually become one of moral strangers and, hence, at risk of failing to protect patients in their vulnerability and of compromising the integrity of nursing. Building on Engelhardt's concepts, I suggest we might consider modern nursing like a moral family to the extent that members might at times relate to one another as moral strangers but still possess a desire and a need to reconnect with the common thread that binds us as moral friends. Nursing is a practice discipline. Given the challenges of modern bioethics, an applied ethic is needed to give moral direction to clinicians as we strive to conduct ourselves ethically in the practice of our profession. To that end, nursing should reflect upon and seek to reconnect with the content-full morality that is historically and religiously based. (shrink)

Appeals to justice are made both to support and to refute the moral permissibility of euthanasia. This article provides a sketch of the major justice-basedarguments and proposes that a communitarian and virtue ethic underlies the ethos of nursing and leads to the conclusion that euthanasia is the opposite of justice. Justice says that nursing should reject euthanasia and remain true to the wisdom that has consistently informed the traditions and practices of the nursing community through history—practices inspired by charity, dependent (...) on prudence, and strengthened and sustained by the practice of virtue. National Catholic Bioethics Quarterly 9.2 (Summer 2009): 279–292. (shrink)

The term "false memories" has been used to refer to suggestibility experiments in which whole events are apparently confabulated and in media accounts of contested memories of childhood abuse. Since 1992 psychologists have increasingly used the term "false memory" when discussing memory errors for details, such as specific words within word lists. Use of the term to refer to errors in details is a shift in language away from other terms used historically (e.g., "memory intrusions"). We empirically examine this shift (...) in language and discuss implications of the new use of the term "false memories." Use of the term presents serious ethical challenges to the data-interpretation process by encouraging over-generalization and misapplication of research findings on word memory to social issues. (shrink)

The wisdom of meditation requires the movement of energy. This energy is the mount or steed of consciousness and experientially all but indistinguishable from knowing itself. These energies must be part of what we consider when we look into the living practices of Buddhist communities. Using this bodily dynamism or energy as an organizing principle, the author points out three things. First, this often overlooked or under‐analyzed category is important for a fuller picture of Buddhist religious life. Second, its importance (...) by no means undermines, and in fact extends, the significance of the philosophical import of Buddhist literature. Third, the significance of “energy” is not limited to esoteric Buddhism. To aid this discussion, the author introduces and explores the new term “energetic sensibility” as a way of referring to the cluster of important Buddhist terms associated with the viscerally energetic or dynamic dimension of persons and their practices. (shrink)

Each contributor to this book has used personal experience as the basis from which to frame his individual sociological perspectives. Because they have personalized their work, their accounts are real, and recognizable as having come from 'real' persons, about 'real' experiences. There are no objectively-distanced disembodied third person entities in these accounts. These writers are actual people whose stories will make you laugh, cry, think, and want to know more.

BackgroundJunior medical doctors have a key role in discussions and decisions about treatment and end-of-life care for people with dementia in hospital. Little is known about junior doctors’ decision-making processes when treating people with dementia who have advance care directives, or the factors that influence their decisions. To describe among junior doctors in relation to two hypothetical vignettes involving patients with dementia: their legal compliance and decision-making process related to treatment decisions; the factors influencing their clinical decision-making; and the factors (...) associated with accurate responses to one hypothetical vignette. MethodA cross-sectional survey of junior doctors, including trainees, interns, registrars and residents, on clinical rotation in five public hospitals located in one Australian state. The anonymous, investigator-developed survey was conducted between August 2018 and June 2019. Two hypothetical vignettes describing patients with dementia presenting to hospital with an ACD and either: bacterial pneumonia; or suspected stroke were presented in the survey. Participants were asked to indicate whether they would commence treatment, given the ACD instructions described in each vignette.ResultsOverall, 116 junior doctors responded. In Vignette 1, 58% of respondents selected the legally compliant option. Participants who chose the legally compliant option perceived ‘following patient wishes’ and ‘legal requirements to follow ACDs’ as equally important reasons for complying with the ACD. The most common reason for not selecting the legally compliant option in Vignette 1 was the ‘ACD is relevant in my decision-making process, but other factors are more relevant’. In Vignette 2, 72% of respondents indicated they would commence treatment and 18% selected they would not commence treatment.. Similar reasons influenced participant decision-making in Vignette 2, a less legally certain scenario.ConclusionsThere are critical gaps in junior doctors’ compliance with the law as it relates to the implementation of ACDs. Despite there being differences in relation to the legal answer and its certainty, clinical and ethical factors guided decision-making over and above the law in both vignettes. More education and training to guide junior doctors’ clinical decision-making and ensure compliance with the law is required. (shrink)

Human beings as objects, and we are objects inter alia, offer information, even knowledge. And yet, in a society marked by pervasive identity prejudice, even objects do not offer neutral facts. Here, I argue that the harms imposed on those who suffer testimonial injustices cannot be sufficiently understood through the ethical lens of objectification. Such persons are not simply objectified, not simply treated as mere sources of information rather than as informants. Even as objects (not mere objects), they are often (...) unable to testify on their own behalf or testify to true facts of the matter. Rather than follow Miranda Fricker’s argument that testimonial injustices are acts of objectification, I argue that they are better understood as acts of what Ann Cahill calls derivatization. A re-examination of Fricker’s account of the wrong of testimonial injustice as derivatizing rather than objectifying clarifies the wrong of epistemic injustice, reinforces the mutuality of testimonial exchanges where both the speaker and listener are actively engaged and obligated to participate well to succeed, and opens up a discussion of how even when being treated as a source of information, informants can be mistreated. (shrink)

This paper comes out of a panel honoring the work of Anne Donchin (1940-2014), which took place at the 2016 Congress of the International Network on Feminist Approaches to Bioethics (FAB) in Edinburgh. My general aim is to highlight the contributions Anne made to feminist bioethics, and to feminist reproductive ethics in particular. My more specific aim, however, is to have a kind of conversation with Anne, through her work, about whether reproductive justice could demand insurance coverage for in vitro (...) fertilization. I quote liberally from Anne’s work for this purpose, but also to shower the reader with her words, reminding those of us who knew her well what a wonderful colleague she was. (shrink)

Reading, a micro-level and subjective activity, is a mechanism through which gender is constructed and reinforced. Drawing on insights from cultural studies and feminist literary critics, and applying sociological perspectives and methodologies, we explored how 53 women and men read and interpreted two short stories, William Faulkner's “A Rose for Emily” and Jayne Anne Phillip's “Home.” We found that the gender of the readers had relatively few effects on their interpretations, but that indicators of life experience were influential. In general, (...) more substantial life experience as reflected in greater age, being married, and having children was associated with more sympathetic, empathic reactions to the major characters. Ideological positions also influenced readers' interpretations, when those positions were relevant to the themes of the text; these individual values and attitudes were associated with more particularistic patterns of empathy. Rather than dismissing gender as an influence on reading, however, we suggest that gender influences reading and interpretation partially through the pervasive gender-markings of social context. (shrink)

This timely collection of essays is the first to be written on the work of Maurice Blanchot in English. One of the finest writers of our time, Blanchot is a contemporary of Bataille and Levinas; his writing has influenced the likes of Derrida and Foucault. Eminent commentators featured here include: Simon Critchley, Paul Davies, Cristopher Fynsk, Rodolphe Gasche, Leslie Hill, Michael Holland, Jeffery Mehlman, Roger Laporte, Ian Maclachlan, Marie-Claire Ropars-Wuilleumier, Gillian Rose and Ann Smock. The essays consider the political implications (...) of Blanchot's questioning the relationship between philosophy and literature. In addition, the provocative issue of Blanchot's politics during the 1930s is clarified by a letter from Blanchot to one of the contributors, published here for the first time. Maurice Blanchot: The Demand of Writing is a crucial selection for all students of philosophy, literature or French studies. (shrink)

This timely collection of essays is the first to be written on the work of Maurice Blanchot in English. One of the finest writers of our time, Blanchot is a contemporary of Bataille and Levinas; his writing has influenced the likes of Derrida and Foucault. Eminent commentators featured here include: Simon Critchley, Paul Davies, Cristopher Fynsk, Rodolphe Gasche, Leslie Hill, Michael Holland, Jeffery Mehlman, Roger Laporte, Ian Maclachlan, Marie-Claire Ropars-Wuilleumier, Gillian Rose and Ann Smock. The essays consider the political implications (...) of Blanchot's questioning the relationship between philosophy and literature. In addition, the provocative issue of Blanchot's politics during the 1930s is clarified by a letter from Blanchot to one of the contributors, published here for the first time. _Maurice Blanchot: The Demand of Writing_ is a crucial selection for all students of philosophy, literature or French studies. (shrink)

This is the first feminist special issue of The Journal of Aesthetics and Art Criticism. Introduction written by Brand [Weiser] and Korsmeyer with essays by Hilde Hein, Paul Mattick, Jr., Timothy Gould, Joanne B. Waugh, Joseph Margolis, Mary Devereaux, Noel Carroll, Flo Leibowitz, Anita Silvers, Elizabeth Ann Dobie, Renee Cox, and Ellen Handler Spitz. A fuller publication from Indiana University Press followed in 1995 edited by Brand [Weiser] and Korsmeyer entitled, Feminism and Tradition in Aesthetics.

This is the co-authored--with Carolyn Korsmeyer--Introduction to the first published feminist scholarship in The Journal of Aesthetics and Art Criticism (Volume 48, Number 4, Fall 1990). Contributors included Hilde Hein, Paul Mattick, Jr., Timothy Gould, Joanne B. Waugh, Joseph Margolis, Mary Devereaux, Noel Carroll, Flo Leibowitz, Anita Silvers, Elizabeth Ann Dobie, Renee Cox, and Ellen Handler Spitz. All essays were subsequently published in an expanded book version entitled, Feminism and Tradition in Aesthetics by Penn State Press (1995).

Like many who work on attention, Wu takes William James as an anchor point, concluding, "So, James was right" (274). In fact, this book can be seen as a continuation of James' project -- as with James' "Attention," Wu's book provides an extensive review of current research on attention.[1] In fact, he engages at length with an impressive amount of work in contemporary philosophy and science, mentioning 10 such researchers – Ned Block, John Campbell, Marisa Carrasco, David Chalmers, David Marr, (...) Christopher Mole, Jesse Prinz, Declan Smithies, George Sperling, and Anne Treisman -- more than 30 times each. Readers interested in contemporary research on attention could learn a great deal from these discussions.[2] The book nonetheless falls short of serving as a complete review of research on attention -- a point Wu in fact accepts (9). Two conspicuous absences include historical philosophy and phenomenology, both of which I discuss briefly below. (shrink)

Feminism and Tradition in Aesthetics takes a fresh look at the history of aesthetics and at current debates within the philosophy of art by exploring the ways in which gender informs notions of art and creativity, evaluation and interpretation, and concepts of aesthetic value. Multiple intellectual traditions have formed this field, and the discussions herein range from consideration of eighteenth century legacies of ideas about taste, beauty, and sublimity to debates about the relevance of postmodern analyses for feminist aesthetics. Forward (...) by Arthur C. Danto, 20 authors include Paul Mattick, Jr., Caroline Korsmeyer, Timothy Gould, Christine Battersby, Mary Devereaux, bell hooks, REnee Lorraine, Trinh T. Minh-ha, Elizabeth Ann Dobie, Adrian Piper, Anita Silvers, Susan Feagin, Mary D. Garrard, Ellen Handler Spitz, Noel Carroll, Joanne Waugh, Joseph Margolis, Rita Felski, and Hilde Hein, as well as Peg Brand's essay, "Revising the Aesthetic-Nonaesthetic Distinction: The Aesthetic Value of Activist Art.". (shrink)

Knowing, Naming and Negation: A Sourcebook on Tibetan Sautrantika. Translated, annotated and introduced by Anne Carolyn Klein, with oral commentary by Geshe Belden Drakba, Denma Lochö Rinbochay, and Kensur Yeshay Tupden. Snow Lion, Ithaca, New York 1991. 266 pp. plus Tibetan texts, Pbk £11.96.

The work of Spinoza, Descartes and Leibniz is cited in an attempt to develop, both expositorily and critically, the philosophy of Anne Viscountess Conway. Broadly, it is contended that Conway's metaphysics, epistemology and account of the passions not only bear intriguing comparison with the work of the other well-known rationalists, but supersede them in some ways, particularly insofar as the notions of substance and ontological hierarchy are concerned. Citing the commentary of Loptson and Carolyn Merchant, and alluding to other (...) commentary on the Cambridge Platonists whose work was done in tandem with Conway's, it is contended that Conway's conception of the "monad" preceded and influenced Leibniz's, and that her monistic vitalism was in many respects a superior metaphysics to the Cartesian system. It is concluded that we owe Conway more attention and celebration than she has thus far received. (shrink)

in the steadily growing body of secondary literature on Anne Conway, it has frequently been claimed that Conway anticipated, and maybe even influenced, Leibniz's theory of monads. This trend got going with a 1979 article by Carolyn Merchant, entitled "The Vitalism of Anne Conway: Its Impact on Leibniz's Concept of the Monad."1 It subsequently came to dominate the field; even now, many commentors still just take it for granted that Conway believed in monads. For example, this commitment is considered (...) sufficiently central to her philosophy to earn a mention in the opening paragraph of the preface to Carol Wayne White's book on Conway, listed among just three things that are supposed to mark her out as... (shrink)

The main questions in philosophical research on attention concern its nature and impact. Regarding its nature, one might ask what sort of thing attention is; regarding its impact, one might ask what sort of thing attention does. While these questions have been asked by philosophers for thousands of years, they have had a resurgence in recent years due to advancements in the cognitive and neural sciences. This chapter will cover some historical context as prelude to a discussion of the contemporary (...) debates, ending with issues that are as of yet still on the horizon. Topics covered include the divide between voluntary/involuntary, endogenous/exogenous, and top-down/bottom-up attention; the Posner cueing task; Treisman and the binding problem; Mack and Rock on inattentional blindness; Grassia, Campbell, and Dickie on attention, perception, and knowledge; the debate between Block, Dehaene, and others on consciousness and attention; Wu on attention and action; and future directions for attention research in predictive processing models, neuroethics, technology, and addiction. (shrink)

The process of adopting a child is “not for the faint of heart.” This is what we were told the first time we, as a couple, began this process. Part of the challenge lies in fulfilling the licensing requirements for adoption, which, beyond the usual home study, can include mandatory participation in parenting classes. The question naturally arises for many people who are subjected to these requirements whether they are morally justified. We tackle this question in this paper. In our (...) view, while strong reasons exist in favour of licensing adoptive parents, these reasons support the licensing not only of adoptive parents, but of all or some subset of so-called “natural” parents as well. We therefore conclude that the status quo with respect to parental licensing, according to which only adoptive parents need to be licensed, is morally unjustified. (shrink)

John Earman and John Norton have argued that substantivalism leads to a radical form of indeterminism within local spacetime theories. I compare their argument to more traditional arguments typical in the Relationist/Substantivalist dispute and show that they all fail for the same reason. All these arguments ascribe to the substantivalist a particular way of talking about possibility. I argue that the substantivalist is not committed to the modal claims required for the arguments to have any force, and show that this (...) naturally leads to an alteration in the way determinism is characterized for local spacetime theories. (shrink)

A collection of 17 meditative essays and 52 weekly reflections, this book is for readers who are concerned about the daunting future humankind has created and who seek inspiration, wisdom, and spiritual purpose in the face of the collapse of industrial civilization.

Fundamental terms in the field of ecology are ambiguous, with multiple meanings associated with them. While this could lead to confusion, discord, or even tests that violate core assumptions of a given theory or model, this ambiguity could also be a feature that allows for new knowledge creation through the interconnected nature of concepts. We approached this debate from a quantitative perspective, and investigated the cost of ambiguity related to definitions of ecological units in ecology related to the general term (...) “community.” We did a meta-analysis of tests associated with two bodies of literature, Hubbell’s unified neutral theory of biodiversity and biogeography and Diamond’s assembly rules, that rely on a specific ecological unit that assumes that species are existing within a local area and that they have overlapping resource needs. We predicted that if ambiguous terminology is widespread, then researchers will have tested them with many different ecological units, that in addition some of these ecological units will violate the core assumptions of the theory, and finally that the overall level of support for a theory will be stronger if appropriate ecological units were used. We found that indeed multiple different ecological units were used in the literature to test both theories, with 65 percent appropriate ecological units for neutral theory tests, and only 6 percent for assembly rule tests. Finally, there was some evidence that the support for a theory depended on whether appropriate ecological units were used for neutral tests, but there was not enough data for the assembly rule tests. These results thus show that ambiguous terminology in ecology is having measurable effects on research and is not of solely philosophical concern. We advocate that authors be explicit in their writing and outline core assumptions of theories, that researchers apply these consistently in their tests, and that readers be attentive to what is written and cognizant of their potential biases. (shrink)

Much recent research has sought to uncover the neural basis of moral judgment. However, it has remained unclear whether "moral judgments" are sufficiently homogenous to be studied scientifically as a unified category. We tested this assumption by using fMRI to examine the neural correlates of moral judgments within three moral areas: (physical) harm, dishonesty, and (sexual) disgust. We found that the judgment ofmoral wrongness was subserved by distinct neural systems for each of the different moral areas and that these differences (...) were much more robust than differences in wrongness judgments within a moral area. Dishonest, disgusting, and harmful moral transgression recruited networks of brain regions associated with mentalizing, affective processing, and action understanding, respectively. Dorsal medial pFC was the only region activated by all scenarios judged to be morally wrong in comparison with neutral scenarios. However, this region was also activated by dishonest and harmful scenarios judged not to be morally wrong, suggestive of a domain-general role that is neither peculiar to nor predictive of moral decisions. These results suggest that moral judgment is not a wholly unified faculty in the human brain, but rather, instantiated in dissociable neural systems that are engaged differentially depending on the type of transgression being judged. (shrink)

In this adventurous contribution to the project of combining philosophy and biology to understand the mind, Carolyn Price investigates what it means to say that mental states--like thoughts, wishes, and perceptual experiences--are about things in the natural world. Her insight into this deep philosophical problem offers a novel teleological account of intentional content, grounded in and shaped by a carefully constructed theory of functions. Along the way she defends her view from recent objections to teleological theories and indicates how (...) it might be applied to notable problems in the philosophy of mind. (shrink)