Background:Nurses exposed to community health nursing commonly encounter situations that can be morally distressing. However, most research on moral distress has focused on acute care settings and very little research has explored moral distress in a community health nursing setting especially among nursing students.Aim:To explore the moral distress experiences encountered by undergraduate baccalaureate nursing students in community health nursing.Research design:A descriptive qualitative design was employed to explore the community health nursing experiences of the nursing students that led them to have (...) moral distress.Participants and research context:The study included 14 senior nursing students who had their course in Community Health Nursing in their sophomore year and stayed in the partner communities in their junior year for 6 and 3 weeks during their senior year.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Nursing students are vulnerable and likely to experience moral distress when faced with ethical dilemmas. They encounter numerous situations which make them question their own values and ideals and those of that around them. Findings of the study surfaced three central themes which included moral distress emanating from the unprofessional behavior of some healthcare workers, the resulting sense of powerlessness, and the differing values and mindsets of the people they serve in the community.Conclusion:This study provides educators a glimpse of the morally distressing situations that often occurs in the community setting. It suggests the importance of raising awareness and understanding of these situations to assist nursing students to prepare themselves to the “real world,” where the ideals they have will be constantly challenged and tested. (shrink)

In this ground-breaking work, Deborah Cowen makes the first book-length critical intervention into the field of business logistics. Tracing the social, spatial and political transformations wrought by the ‘logistics revolution’, Cowen argues that logistical systems have blurred the boundaries between production and circulation, civilian and military life, and geopolitics and geo-economics, constructing an architecture of the supply chain animated by both the art of war and the science of business. This review considers the political stakes of Cowen’s argument that logistics (...) has reconfigured capitalist social relations of production, especially in relation to the securitisation of spatial mobility and the restructuring of the labour process. In particular, Cowen’s wager that logistical supply-chains are characterised by their vulnerability – and that attendant possibilities for building solidarity emerge out of movements that disrupt such flows – is interrogated in order to question whether such interruptions effectively produce challenges to value-in-motion, or actually become integral to processes of value production. (shrink)

This article describes challenges of conducting an HIV prevention program involving 40 male and female participants ages 12–18 in Hammanskraal, South Africa, aimed at increasing awareness and knowledge of laws protecting children’s sexual health rights and access to services through a culturally based “study circle” format. Challenges highlighted by the project included Institutional Review Board approval of youth consent procedures, cooperation and coordination with local policymakers, the need to modify presentation materials to youths’ comprehension levels, availability of youth-based sexual health (...) service providers, and cultural ambiguity over parental involvement in youth health care decisions and laws pertaining to sexual relationships among minors. (shrink)

Engaging communities in community-based health research is increasingly being adopted in low- and middle-income countries. The use of community advisory boards is one method of practicing community involvement in health research. To date, few studies provide in-depth accounts of the strategies that CAB members use to practice community engagement. We assessed the perspectives, experiences and practices of the first local CAB in Eswatini, which was implemented as part of the MaxART Early Access to ART for All study. Trained Swazi research (...) assistants conducted two focus group discussions and 13 semi-structured interviews with CAB members who had been part of the MaxART study for at least 2.5 years. Interviews explored CAB composition and recruitment, the activities of CAB members, the mechanisms used to engage with communities and the challenges they faced in their role. The MaxART CAB played an active role in the implementation of the Early Access to Art for All study, and activities mainly focused on: promoting ethical conduct, in particular privacy, consent and confidentiality; communication and education, communicating about the study and educating the community on the benefits of HIV testing and early access to HIV treatment; and liaising between the community and the research team. Strategies for interacting with communities were varied and included attending general community meetings, visiting health facilities and visiting public places such as cattle dipping tanks, buses, bars and churches. Differences in the approach to community engagement between CAB members living in the study areas and those residing outside were identified. The experiences of the first CAB in Eswatini demonstrate that community engagement using CABs is a valuable mechanism for engaging communities in implementation studies. Considerations that could impact CAB functioning include clearly defining the scope of the CAB, addressing issues of CAB independence, the CAB budget, providing emotional support for CAB members, and providing continuous training and capacity building. These issues should be addressed during the early stages of CAB formation in order to optimize functioning. (shrink)

Engaging communities in community-based health research is increasingly being adopted in low- and middle-income countries. The use of community advisory boards is one method of practicing community involvement in health research. To date, few studies provide in-depth accounts of the strategies that CAB members use to practice community engagement. We assessed the perspectives, experiences and practices of the first local CAB in Eswatini, which was implemented as part of the MaxART Early Access to ART for All study. Trained Swazi research (...) assistants conducted two focus group discussions and 13 semi-structured interviews with CAB members who had been part of the MaxART study for at least 2.5 years. Interviews explored CAB composition and recruitment, the activities of CAB members, the mechanisms used to engage with communities and the challenges they faced in their role. The MaxART CAB played an active role in the implementation of the Early Access to Art for All study, and activities mainly focused on: promoting ethical conduct, in particular privacy, consent and confidentiality; communication and education, communicating about the study and educating the community on the benefits of HIV testing and early access to HIV treatment; and liaising between the community and the research team. Strategies for interacting with communities were varied and included attending general community meetings, visiting health facilities and visiting public places such as cattle dipping tanks, buses, bars and churches. Differences in the approach to community engagement between CAB members living in the study areas and those residing outside were identified. The experiences of the first CAB in Eswatini demonstrate that community engagement using CABs is a valuable mechanism for engaging communities in implementation studies. Considerations that could impact CAB functioning include clearly defining the scope of the CAB, addressing issues of CAB independence, the CAB budget, providing emotional support for CAB members, and providing continuous training and capacity building. These issues should be addressed during the early stages of CAB formation in order to optimize functioning. (shrink)

The laws of classical logic are taken to be logical truths, which in turn are taken to hold objectively. However, we might question our faith in these truths: why are they true? One general approach, proposed by Putnam [8] and more recently Dickson [3] or Maddy [5], is to adopt empiricism about logic. On this view, logical truths are true because they are true of the world alone – this gives logical truths an air of objectivity. Putnam and Dickson both (...) take logical truths to be true in virtue of the world’s structure, given by our best empirical theory, quantum mechanics. This assumes a determinate logical structure of the world given by quantum mechanics. Here, I argue that this assumption is false, and that the world’s logical structure, and hence the related ‘true’ logic, is underdetermined. This leads to what I call empirical conventionalism. (shrink)

Background:Moral distress, moral sensitivity, and moral courage among healthcare professionals have been explored considerably in recent years. However, there is a paucity of studies exploring these topics among baccalaureate nursing students.Aim/objective:The purpose of this study was to explore the relationship between and among moral distress, moral sensitivity, and moral courage of undergraduate baccalaureate nursing students.Research design:The research employed a descriptive-correlational design to explore the relationships between and among moral distress, moral sensitivity, and moral courage of undergraduate nursing students.Participants and research (...) context:A total of 293 baccalaureate Filipino nursing students who have been exposed to various clinical areas participated in the study.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Results indicate that a majority of the nursing students in the clinical areas encounter morally distressing situations that compromise quality patient care. However, despite the fact that they want to do what is in the best interest of their patients, their perception of being the inexperienced among the healthcare team drives the majority of them to ignore morally distressing situations to avoid conflict and confrontation. Another interesting finding is that 79.20% of the respondents hardly consider quitting the nursing profession even if they frequently encounter morally distressing situations. Analysis also shows associations between moral distress intensity and frequency ( r = 0.13, p < 0.05) and moral distress intensity and moral sensitivity ( r = 0.25, p < 0.05). The dimensions of moral courage are also related to both moral distress and moral sensitivity.Conclusion:Results of the study imply that moral distress is a reality among all healthcare professionals including nursing students and requires more consideration by nurse educators. (shrink)

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of (...) first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection. (shrink)

Strong non-maximalism holds that some truths require no ontological ground of any sort. Strong non-maximalism allows one to accept that some propositions are true without being forced to endorse any corresponding ontological commitments. We show that there is a version of truthmaker theory available—anti-aboutness truthmaking—that enjoys the dialectical benefits of the strong non-maximalist’s position. According to anti-aboutness truthmaking, all truths require grounds, but a proposition need not be grounded in the very thing(s) that the proposition is about. We argue that (...) if strong non-maximalism can be defended, then so can anti-aboutness truthmaking on the very same basis; one can enjoy the benefits of strong non-maximalism without giving up on the idea that truth is always grounded in being. (shrink)

Taking the formal analogies between black holes and classical thermodynamics seriously seems to first require that classical thermodynamics applies in relativistic regimes. Yet, by scrutinizing how classical temperature is extended into special relativity, I argue that the concept falls apart. I examine four consilient procedures for establishing the classical temperature: the Carnot process, the thermometer, kinetic theory, and black-body radiation. I argue that their relativistic counterparts demonstrate no such consilience in defining the relativistic temperature. As such, classical temperature doesn’t appear (...) to survive a relativistic extension. I suggest two interpretations for this situation: eliminativism akin to simultaneity, or pluralism akin to rotation. (shrink)

Xunzi's philosophy provides a rich resource for understanding how ethical relationships between humans and nature can be articulated in terms of harmony. In this paper, I build on his ideas to develop the concept of reciprocal harmony, which requires us to reciprocate those who make our lives liveable. In the context of the environment, I argue that reciprocal harmony generates moral obligations towards nature, in return for the existential debt that humanity owes towards heaven and earth. This can be used (...) as a normative basis for an environmental ethic that enables humanity and nature to flourish together. (shrink)

The purpose of this essay is to explore, and clarify, some key features in Aquinas’ account of the virtue of temperance, with an eye to answering some common objections raised against a positive evaluation of temperance. In particular, I consider three features of Aquinas’ understanding of temperance: First, the role of the rational mean in temperance; second, the role of rightly ordered passions in temperance; and third, the ‘despotic’ control of reason over the passions in temperance. Along the way I (...) consider three common objections to Aquinas’ account of temperance: the objection that temperance can be misused for evil, the objection that temperance devalues effort, and the objection that temperance devalues strong passions and thereby implicitly devalues the goodness of sexuality. In responding to these objections on behalf of Aquinas, I take the opportunity to clarify and slightly extend Aquinas’ account of temperance. (shrink)

Conventional wisdom holds that the von Neumann entropy corresponds to thermodynamic entropy, but Hemmo and Shenker (2006) have recently argued against this view by attacking von Neumann's (1955) argument. I argue that Hemmo and Shenker's arguments fail due to several misunderstandings: about statistical-mechanical and thermodynamic domains of applicability, about the nature of mixed states, and about the role of approximations in physics. As a result, their arguments fail in all cases: in the single-particle case, the finite particles case, and the (...) infinite particles case. (shrink)

This study looked for evidence of biases in the allocation and disengagement of attention in dysphoric individuals. Participants studied images for a recognition memory test while their eye fixations were tracked and recorded. Four image types were presented (depression-related, anxiety-related, positive, neutral) in each of two study conditions. For the simultaneous study condition, four images (one of each type) were presented simultaneously for 10 seconds, and the number of fixations and the total fixation time to each image was measured, similar (...) to the procedure used by Eizenman et al. (2003) and Kellough, Beevers, Ellis, and Wells (2008). For the sequential study condition, four images (one of each type) were presented consecutively, each for 4 seconds; to measure disengagement of attention an endogenous cuing procedure was used (Posner, 1980). Dysphoric individuals spent significantly less time attending to positive images than non-dysphoric individuals, but there were no group differences in attention to depression-related images. There was also no evidence of a dysphoria-related bias in initial shifts of attention. With respect to the disengagement of attention, dysphoric individuals were slower to disengage their attention from depression-related images. The recognition memory data showed that dysphoric individuals had poorer memory for emotional images, but there was no evidence of a conventional mood-congruent memory bias. Differences in the attentional and memory biases observed in depressed and dysphoric individuals are discussed. (shrink)

In Everettian quantum mechanics, justifications for the Born rule appeal to self-locating uncertainty or decision theory. Such justifications have focused exclusively on a pure-state Everettian multiverse, represented by a wave function. Recent works in quantum foundations suggest that it is viable to consider a mixed-state Everettian multiverse, represented by a (mixed-state) density matrix. Here, we develop the conceptual foundations for decoherence and branching in a mixed-state multiverse, and extend the standard Everettian justifications for the Born rule to this setting. This (...) extended framework provides a unification of 'classical' and 'quantum' probabilities, and additional theoretical benefits, for the Everettian picture. (shrink)

Prior studies have provided explanations for the presence, use and dissemination of codes of corporate ethics or codes of corporate conduct of business corporations. Most such explanations are functional in nature, and are descriptive as they are derived from the codes and their associated documents. We search for more underlying explanations using two complementary theories: first, social contract theories explaining the exogenous and endogenous reasons of organizational behavior, and then institutional theory explaining why organizations take similar measures in response to (...) institutional pressures. Based on our explanations, we contend that the codes and their use and dissemination are arising from underlying social and institutional pressures for firms to continuously validate their existence in the face of increasing changes and recurrent uncertainties. (shrink)

Clinical ethics consultation service remains undeveloped in developing countries. It is recognised that its introduction poses challenges. Malaysia, a multicultural society with diverse religions, values and perceptions further complicate the introduction of formal clinical ethics consultation service. Clinicians attending a national congress workshop completed a Strengths–Weaknesses–Opportunities–Threats analysis. The aim was to gain insight into clinician’s expectations and promote initiatives leading to the introduction of clinical ethics consultation service. Clinicians agree that clinical ethics consultation service can improve quality of care, reduce (...) healthcare costs and advocate for patients and providers. The analysis highlighted constraints in sufficient critical mass of relevant expertise and restricted opportunities for training. The opportunities lie in education, curriculum development and availability of dedicated proponents. Cultural barriers, limited resources, lack of awareness, differenc... (shrink)

Programs in quantum gravity often claim that time emerges from fundamentally timeless physics. In the semiclassical time program time arises only after approximations are taken. Here we ask what justifies taking these approximations and show that time seems to sneak in when answering this question. This raises the worry that the approach is either unjustified or circular in deriving time from no–time.

In June 2002, the University of Minnesota hosted a conference to explore the implications of using genetic technologies and genealog.

L S Penrose’s Limit Theorem – which is implicit in Penrose [7, p. 72] and for which he gave no rigorous proof – says that, in simple weighted voting games, if the number of voters increases indefinitely and the relative quota is pegged, then – under certain conditions – the ratio between the voting powers of any two voters converges to the ratio between their weights. Lindner and Machover [4] prove some special cases of Penrose’s Limit Theorem. They give a (...) simple counter-example showing that the theorem does not hold in general even under the conditions assumed by Penrose; but they conjecture, in effect, that under rather general conditions it holds ‘almost always’ – that is with probability 1 – for large classes of weighted voting games, for various values of the quota, and with respect to several measures of voting power. We use simulation to test this conjecture. It is corroborated with respect to the Penrose–Banzhaf index for a quota of 50% but not for other values; with respect to the Shapley–Shubik index the conjecture is corroborated for all values of the quota. (shrink)

Several ethicists have defended the use of responsibility-based criteria in healthcare rationing. Yet in this article we outline two challenges to the implementation of responsibility-based healthcare rationing policies. These two challenges are, namely, that responsibility for past behavior can diminish as an agent changes, and that blame can come apart from responsibility. These challenges suggest that it is more difficult to hold someone responsible for health related actions than proponents of responsibility-sensitive healthcare policies suggest. We close by discussing public health (...) policies that could function as an alternative to contentious, responsibility-sensitive rationing policies. (shrink)

This book is born out of two contradictions: first, it explores the making of meaning in a musical form that was made to lose its meaning at the turn of the nineteenth century; secondly, it is a history of a music that claims to have no history - absolute music. The book therefore writes against that notion of absolute music which tends to be the paradigm for most musicological and analytical studies. It is concerned not so much with what music (...) is, but with why and how meaning is constructed in instrumental music and what structures of knowledge need to be in place for such meaning to exist. From the thought of Vincenzo Galilei to that of Theodore Adorno, Daniel Chua suggests that instrumental music has always been a critical and negative force in modernity, even with its nineteenth-century apotheosis as 'absolute music'. (shrink)

Good communication between healthcare providers and patients is vital to effective healthcare. In order to understand patients’ complaints, make accurate diagnoses, obtain informed consent and explain treatment regimens, clinicians must communicate well with their patients. This can be challenging when treating patients from unfamiliar cultural backgrounds, such as the Deaf. Not only are they a linguistic and cultural minority, they are also members of the world’s largest and oft-forgotten minority group: the disability community. Under Article 25 of the United Nations (...) Convention on the Rights of Persons with Disabilities, persons with disabilities have rights to the same range, quality and standard of free or affordable healthcare and programmes as provided to other people. Yet communication barriers and healthcare providers’ lack of familiarity with Deaf culture can impair the quality and accessibility of healthcare for the Deaf. This essay analyses the scope of this issue in Singapore: a state party to the CRPD which has a vibrant Deaf community, and yet no legislative or constitutional guarantees of the rights of persons with disabilities. In addition to exploring the communication barriers faced by Deaf patients in Singapore, this essay highlights ways in which healthcare providers and the state can support community-based initiatives to overcome these barriers. (shrink)

[Accepted for publication in Lakatos's Undone Work: The Practical Turn and the Division of Philosophy of Mathematics and Philosophy of Science, special issue of Kriterion: Journal of Philosophy. Edited by S. Nagler, H. Pilin, and D. Sarikaya.] Lakatos’s analysis of progress and degeneration in the Methodology of Scientific Research Programmes is well-known. Less known, however, are his thoughts on degeneration in Proofs and Refutations. I propose and motivate two new criteria for degeneration based on the discussion in Proofs and Refutations (...) – superfluity and authoritarianism. I show how these criteria augment the account in Methodology of Scientific Research Programmes, providing a generalized Lakatosian account of progress and degeneration. I then apply this generalized account to a key transition point in the history of entropy – the transition to an information-theoretic interpretation of entropy – by assessing Jaynes’s 1957 paper on information theory and statistical mechanics. (shrink)

In this article we critically evaluate an argument against state‐sanctioned euthanasia made by David Velleman in his 1992 paper ‘Against the right to die’. In that article, Velleman argues that legalizing euthanasia is morally problematic as it will deprive eligible patients of the opportunity of staying ‘alive by default’. That is to say, those patients who are rendered eligible for euthanasia as a result of legislative reform will face the burden of having to justify their continued existence to their epistemic (...) peers if they are to be perceived as ‘reasonable’. We discuss potential criticisms that could be made of the argument, and consider how a defender of the view might respond. Velleman’s argument is particularly interesting as it is a consequentialist argument against state‐sanctioned euthanasia, challenging the many consequentialist arguments that have been made in favour of legalizing the procedure. We conclude by suggesting that further research on the question of unfair burdens is important to adequately evaluating the potential harms of legalizing euthanasia for patients at the end of life. (shrink)