Terri Traudt, Joan Liaschenko, and Cynthia Peden-McAlpine’s study contributes to a much-needed reorientation in thinking about and working with the challenges of moral distress. In providing a vital example of nurses able to navigate morally distressing situations in positive and constructive ways, and offering an analysis of the component elements of these nurses’ success, the study helps identify promising directions we might take in addressing the epidemic of moral distress. It also invites important questions, concerning the challenges faced by (...) clinicians who do not who work in healthy “moral communities,” who lack the ethical competencies, and who don’t have the presumptive authority and recognition enjoyed by the seasoned clinicians studied here. We explore some of these questions, and suggest ways we might build on the insights of Traudt and colleagues’ study. (shrink)

Despite over three decades of research into the sources and costs of what has become an “epidemic” of moral distress among healthcare professionals, spanning many clinical disciplines and roles, there has been little significant progress in effectively addressing moral distress. We believe the persistent sense of frustration, helplessness, and despair still dominating the clinical moral distress narrative signals a need for re-orientation in the way moral distress is understood and worked with. Most fundamentally, moral distress reveals moral investment and energy. (...) It is the troubled call of conscience, an expression of fidelity to moral commitments seen as imperiled or compromised.It is crucial that we find ways to empower clinicians in heeding this call—to support clinicians’ moral agency and voice, foster their moral resilience, and facilitate their ability to contribute to needed reform within the organizations and systems in which they work. These objectives must inform creative expansion in the design of strategies for addressing moral distress in the day-to-day of clinical practice. We include suggestions about promising directions such strategies might take in the hope of spurring further innovation within clinical environments. (shrink)

Discussion of the ethics of forgoing medically provided nutrition and hydration tends to focus on adults rather than infants and children. Many appellate court decisions address the legal propriety of forgoing medically provided nutritional support of adults, but only a few have ruled on pediatric cases that pose the same issue.The cessation of nutritional support is implemented most commonly for patients in a permanent vegetative state ). An estimated 4,000 to 10,000 American children are in the permanent vegetative state, compared (...) to 10,000 to 25,000 adults. Yet the dearth of literature, case reports, and court decisions suggests that physicians and families of pediatric patients stop medically provided nutrition or seek court orders much less frequently. (shrink)

Undisputedly, the United States’ health care system is in the midst of unprecedented complexity and transformation. In 2014 alone there were well over thirty‐five million admissions to hospitals in the nation, indicating that there was an extraordinary number of very sick and frail people requiring highly skilled clinicians to manage and coordinate their complex care across multiple care settings. Medical advances give us the ability to send patients home more efficiently than ever before and simultaneously create ethical questions about the (...) balance of benefits and burdens associated with these advances. Every day on every shift, nurses at the bedside feel an intense array of ethical issues. At the same time, administrators, policy‐makers, and regulators struggle to balance commitments to patients, families, staff members, and governing boards. Ethical responsibilities and the fiduciary, regulatory, and community service goals of health care institutions are not mutually exclusive; they must go hand in hand. If they do not, our health care system will continue to lose valued professionals to moral distress, risk breaking the public's trust, and potentially undermine patient care. At this critical juncture in health care, we must look to new models, tools, and skills to confront contemporary ethical issues that impact clinical practice. The antidote to the current reality is to create a new health care paradigm grounded in compassion and sustained by a culture of ethical practice. (shrink)

This narrative symposium illuminates the problem of clinician moral distress. NIB editorial staff and narrative symposium editors, Cynda Rushton, PhD, RN, FAAN and Renee Boss, MD, MHS, developed a call for stories, which was sent to several list serves and posted on Narrative Inquiry in Bioethics’ website. The request for personal stories from inter–professional healthcare providers asked them to: identify specific clinical situations that give rise to moral distress; discuss the sources of this distress; reflect on how they experienced (...) moral distress—physically, psychologically, socially, or spiritually; assess how they managed their situations; and offer suggestions for avoiding future problems of a similar nature. Twelve stories are found in the print version of the journal and an additional eight supplemental stories are published online only through Project MUSE. The clinicians describe a wide range of experiences with patients, other clinicians, and their own professional and personal identities. Embedded in each of the narratives are deeply felt emotions that accompany their experiences of moral distress. Katherine Brown-Saltzman (a nurse), Alisa Carse (a philosopher), Zhanna Bagdasarov and Shane Connelly (industrial–organizational psychologists), and Nancy Berlinger (a bioethicist) provided commentaries. (shrink)

Discussion of the ethics of forgoing medically provided nutrition and hydration tends to focus on adults rather than infants and children. Many appellate court decisions address the legal propriety of forgoing medically provided nutritional support of adults, but only a few have ruled on pediatric cases that pose the same issue.The cessation of nutritional support is implemented most commonly for patients in apermanent vegetative state(often referred to aspersistent vegetative state(hereinafter “PVS”)). An estimated 4,000 to 10,000 American children are in the (...) permanent vegetative state, compared to 10,000 to 25,000 adults. Yet the dearth of literature, case reports, and court decisions suggests that physicians and families of pediatric patients stop medically provided nutrition or seek court orders much less frequently. (shrink)

Analytic philosophy has become the dominant philosophical tradition in the English-speaking world. This book illuminates that tradition through a historical examination of a crucial period in its formation: the rejection of Idealism by Bertrand Russell and G.E. Moore at the beginning of the twentieth century, and the subsequent development of Russell's thought in the period before the First World War.

Critics have argued that Rawls's account of self-respect is equivocal. I show, first, that Rawls in fact relies upon an unambiguous notion of self-respect, though he sometimes is unclear as to whether this notion has merely instrumental or also intrinsic value. I show second that Rawls’s main objective in arguing that justice as fairness supports citizens’ self-respect is not, as many have thought, to show that his principles support citizens’ self-respect generally, but to show that his principles counter the effects (...) of the market on lower class citizens’ sense of worth. This discussion establishes that Rawls, in the end, sees self-respect primarily as an intrinsic good. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Navigating Intersex Healthcare: My OdysseyCynthiaI was born in 1965 with what the medical community called “ambiguous genitalia.” My initial announcement as a boy was called into question upon closer assessment of my atypical anatomy by medical specialists at a children’s hospital in Chicago. That team of medical experts included a pediatric urologist and a pediatric endocrinologist, as well as a prominent pediatric surgeon, who was at that time presiding (...) president of the relatively newly established American Pediatric Surgeons Association. I have wondered over the years whether, or to what extent, that status and position had any important impact on the unfolding of my medical case.Just over 100 days after my birth, I was surgically and socially reassigned female, and renamed Cynthia. My mother and physician father, ages 25 and 30, respectively, with two young sons at home, did the best they could to move ahead in life as a young family. Part of our family story is that my unusual birth contributed to my parents’ decision to move away from Chicago, where both of my parents had been raised and wanted to settle, and where my father had many professional opportunities. We relocated to Southern California to make a “fresh start” where no one would know the dark secret too terrible to be shared with any beyond a small circle of close friends and family. It would never be talked about openly.With the exception of the rare and dreaded occasions of medical appointments with my primary care physician, or maybe an endocrinologist to renew hormone prescriptions, my parents chose [End Page E3] to have me travel from our home in San Diego to a clinician in Los Angeles, away from my father’s medical colleagues. This decision was puzzling to me at the time, and maybe more so now. These trips were a source of considerable stress and anxiety, as I had no idea of what to expect; my mother told me only that treatment would “help me get my period started.” I was instructed to tell my friends and teachers that I was taking off school on a weekday to go on a “shopping trip” with my mother. As far as I know, these trips were never discussed at home with my older brothers. I heard years later that my parents disclosed some information about me with my brothers when my parents travelled outside the country. They felt that my brothers should know what had happened to me in the event of a catastrophic accident that might prevent my parents from telling me themselves. I suppose they believed that I wasn’t ready at the time to be told my own life and medical history. I can’t say for sure.I don’t want to judge my parents too harshly for how they handled my medical care. I know that it was an extremely stressful and uncertain time for them, and peer support, which I know now is so vitally important for both parents and young affected individuals like myself, was not made available to us. I never thought to ask about such help, or even consider the idea that anyone else would be in a similar situation like mine. I don’t think I would have been even remotely comfortable or willing to discuss it openly at that point.In my early twenties, I had to face another milestone in my journey and in my interactions with the medical community. I had yet to have the vaginoplasty I was told I “needed.” There was no discussion as to whether or not I wanted it or not. It just had to be done, and I was aware of the limitations I had at this vulnerable time in my life when my peer group was sexually active and I was not. My awareness of the obstacle posed by my difference made me avoid the topic of dating; it was difficult even to think about the possibility of a romantic relationship. I put it out of my mind, but I knew that it was a significant concern for my parents. My physician father did most of the prodding to get me to acknowledge the reality... (shrink)

The manuscript diary of Jane Attwater, an earnestly religious woman from a village near Salisbury in England, offers valuable insight into how women's so-called “private” writings were crucial in preserving familial and community history and in contributing to the production of religious culture. Written regularly between the ages of twelve and eighty-one, Attwater's diary is the most extensive diary written by a nonconformist woman in the eighteenth and nineteenth centuries. The text itself is an extraordinary record of her own religious (...) and family life. At the same time, the materiality of the diary reveals a complex interweaving of faith, family, and memory. The diary contains four generations of Attwater women's diary entries, carefully interleaved to produce diary-conversations; there is evidence of ongoing revisions and excisions throughout; and it was studiously and self-consciously curated for future readership. Attwater wrote both as an aid to her own memory, faithfully placing on paper reminders of God's help, and to preserve the memory of her family and religious community, creating what Pierre Nora calls “lieux de mémoire” – sites for anchoring a group's memory. (shrink)

Externalism in the philosophy of mind has been thought by many to pose a serious threat to the claim that subjects are in general authoritative with regard to certain of their own intentional states.¹ In a series of papers, Tyler Burge (1985_a_, 1985_b_, 1988, 1996) has argued that the distinctive entitlement or right that subjects have to self- knowledge in certain cases is compatible with externalism, since that entitlement is environmentally neutral, neutral with respect to the issue of the individuation (...) dependence of subjects' intentional states on factors beyond their bodies. His reason is that whereas externalism—the view that certain intentional states of persons are individuation-dependent on objects and/or phenomena external to their bodies—is a metaphysical thesis, authoritative self-knowledge is an epistemological matter. This being so, there is no reason to suppose that the two need conflict with one another. (shrink)

The introduction discusses the shared themes of German Idealism and phenomenology—principally, the critique of naturalism or a reductive scientific account of reality, the nature of consciousness and subjectivity, the implications of that account for epistemology and ethics, and the significance of intersubjectivity. The introduction also outlines the ways in which twentieth-century phenomenologists reacted against some key assumptions and philosophical methods of the German Idealists. It briefly mentions the key figures in each movement and their central concepts. Finally, it sets out (...) the structure of the volume and gives brief summaries of each chapter. (shrink)

Both Kant and Levinas contrast morality with a vision of the lives of animals, governed by self-interested instincts. Despite this shared Hobbesian-Darwinian account of the struggle for existence, there are significant differences: Kant positions reason as the path to transcending instinct and inclination, through respect for the moral law, but as a survivor of the Shoah, Levinas claims that reason is continuous with self-interested motivations, and the ethical should instead be understood as a form of anarchy that traumatizes the self-possessed, (...) autonomous subject. Central to both accounts is a commitment to ethics as the transcendence of animality, and we should question whether that shared association between animality and self-interested violence is warranted. (shrink)

...Through this eleven-session Bible study, you will learn to turn from worldly satisfactions to a life of contentment, from selfishness to humility, and from unbelief to rich fellowship with God.--back cover.

This paper develops a notion of manipulative gaslighting, which is designed to capture something not captured by epistemic gaslighting, namely the intent to undermine women by denying their testimony about harms done to them by men. Manipulative gaslighting, I propose, consists in getting someone to doubt her testimony by challenging its credibility using two tactics: “sidestepping” and “displacing”. I explain how manipulative gaslighting is distinct from reasonable disagreement, with which it is sometimes confused. I also argue for three further claims: (...) that manipulative gaslighting is a method of enacting misogyny, that it is often a collective phenomenon, and, as collective, qualifies as a mode of psychological oppression. (shrink)

ABSTRACT:We focus on the core institution of the capital market and the institutional work of professional service firms that provide ratings on corporate issuers, initially in a bid to maintain this institution, which suffered when those involved relied solely on information from the issuers themselves. Through our analysis we identify a new type of decoupling—complicit decoupling. Complicit decoupling evolves over time, beginning with the creation of a new practice, here corporate ratings as a form of policing work, which emerges to (...) help to maintain a core institution. This practice is then adopted, implemented and later becomes decoupled. Exposure does not undermine the legitimacy of the practice because external actors collude in the ‘window dressing’ and, because it has become normalized, only partial repairs are enacted. It is by nature field-level institutional work, benefiting the majority of the field and inherently involves a violation of promise keeping. We conclude with implications for managers and behavioral ethics researchers. (shrink)

ABSTRACT:We focus on the core institution of the capital market and the institutional work of professional service firms that provide ratings on corporate issuers, initially in a bid to maintain this institution, which suffered when those involved relied solely on information from the issuers themselves. Through our analysis we identify a new type of decoupling—complicit decoupling. Complicit decoupling evolves over time, beginning with the creation of a new practice, here corporate ratings as a form of policing work, which emerges to (...) help to maintain a core institution. This practice is then adopted, implemented and later becomes decoupled. Exposure does not undermine the legitimacy of the practice because external actors collude in the ‘window dressing’ and, because it has become normalized, only partial repairs are enacted. It is by nature field-level institutional work, benefiting the majority of the field and inherently involves a violation of promise keeping. We conclude with implications for managers and behavioral ethics researchers. (shrink)

Quine was one of the foremost philosophers of the Twentieth century. In this outstanding overview of Quine's philosophy, Peter Hylton shows why Quine is so important and how his philosophical naturalism has been so influential within analytic philosophy. Beginning with an overview of Quine's philosophical background in logic and mathematics and the role of Rudolf Carnap's influence on Quine's thought, he goes on to discuss Quine's famous analytic-synthetic distinction and his arguments concerning the nature of the a priori. He (...) also discusses Quine's philosophy of language and epistemology, his celebrated theory of the indeterminacy of translation and his broader views of ontology and modality. This book is essential reading for anyone interested in Quine, twentieth century philosophy and the philosophy of language. (shrink)

Recent research finds that people respond more generously to individual victims described in detail than to equivalent statistical victims described in general terms. We propose that this “identified victim effect” is one manifestation of a more general phenomenon: a positive influence of tangible information on generosity. In three experiments, we find evidence for an “identified intervention effect”; providing tangible details about a charity’s interventions significantly increases donations to that charity. Although previous work described sympathy as the primary mediator between tangible (...) information and giving, current mediational analyses show that the influence of tangible details can operate through donors’ perception that their contribution will have impact. Taken together with past work, the results suggest that tangible information of many types promotes generosity and can do so either via sympathy or via perceived impact. The ability of tangible information to increase impact points to new ways for charities to encourage generosity. (shrink)

Children ranging from 3 to 5 years were introduced to two anthropomorphic robots that provided them with information about unfamiliar animals. Children treated the robots as interlocutors. They supplied information to the robots and retained what the robots told them. Children also treated the robots as informants from whom they could seek information. Consistent with studies of children's early sensitivity to an interlocutor's non-verbal signals, children were especially attentive and receptive to whichever robot displayed the greater non-verbal contingency. Such selective (...) information seeking is consistent with recent findings showing that although young children learn from others, they are selective with respect to the informants that they question or endorse. (shrink)

By exploring diverse and sometimes positive roles for ignorance, A Defense of Ignorance offers a revisionary approach to epistemology that challenges core assumptions about epistemic values. Townley contributes innovative ways of thinking about the practicalities and politics of knowledge and argues for an expanded domain of responsible epistemic conduct. All social scientists, especially those interested in knowledge and in feminist scholarship, stand to benefit from Townley's arguments.

[Elliott Sober] In 'Two Dogmas of Empiricism', Quine attacks the analytic/synthetic distinction and defends a doctrine that I call epistemological holism. Now, almost fifty years after the article's appearance, what are we to make of these ideas? I suggest that the philosophical naturalism that Quine did so much to promote should lead us to reject Quine's brief against the analytic/synthetic distinction; I also argue that Quine misunderstood Carnap's views on analyticity. As for epistemological holism, I claim that this thesis does (...) not follow from the logical point that Duhem and Quine made about the role of auxiliary assumptions in hypothesis testing, and that the thesis should be rejected. \\\ [Peter Hylton] Section I of this essay discusses Quine's views about reference, contrasting them with those of Russell. For the latter, our language and thought succeed in being about the world because of our acquaintance with objects; the relation of reference-roughly, the relation between a name and its bearer-is thus fundamental. For Quine, by contrast, the fundamental relation by which our language comes to be about the world, and to have empirical content, is that between a sentence and stimulations of our sensory surfaces; reference, while important, is a derivative notion. Section II shows how this view of reference as derivative makes possible the notorious Quinean doctrine of ontological relativity. Section III raises the issue of realism. It argues that somewhat different notions of realism are in play for Quine and for Russell-for Russell, objects, and our knowledge of objects, play the fundamental role, while for quine objectivity and truth are fundamental, with ontology being derivative. (shrink)

In 'Two Dogmas of Empiricism', Quine attacks the analytic/synthetic distinction and defends a doctrine that I call epistemological holism. Now, almost fifty years after the article's appearance, what are we to make of these ideas? I suggest that the philosophical naturalism that Quine did so much to promote should lead us to reject Quine's brief against the analytic/synthetic distinction; I also argue that Quine misunderstood Carnap's views on analyticity. As for epistemological holism, I claim that this thesis does not follow (...) from the logical point that Duhem and Quine made about the role of auxiliary assumptions in hypothesis testing, and that the thesis should be rejected. \\\ [Peter Hylton] Section I of this essay discusses Quine's views about reference, contrasting them with those of Russell. For the latter, our language and thought succeed in being about the world because of our acquaintance with objects; the relation of reference-roughly, the relation between a name and its bearer-is thus fundamental. For Quine, by contrast, the fundamental relation by which our language comes to be about the world, and to have empirical content, is that between a sentence and stimulations of our sensory surfaces; reference, while important, is a derivative notion. Section II shows how this view of reference as derivative makes possible the notorious Quinean doctrine of ontological relativity. Section III raises the issue of realism. It argues that somewhat different notions of realism are in play for Quine and for Russell-for Russell, objects, and our knowledge of objects, play the fundamental role, while for quine objectivity and truth are fundamental, with ontology being derivative. (shrink)

We often think of trust as an interpersonal relation, and of the distinction between trust and reliance as a distinction between kinds of interpersonal relations. Indeed this is often the case. I may trust one colleague but not find her reliable; rely on another but find him untrustworthy; both trust and rely on my best friend; neither trust nor rely on my dean. One of us has discussed the nature of such relations and distinctions at length. But trust is not (...) only an interpersonal matter. Human society comprises not only individuals but also institutions, and indeed individuals who occupy crucial institutional roles. We often individually or collectively trust, distrust, rely on, or fail or refuse to rely on such institutions or institutional players qua players. In this essay we explore the structure, scope and value of such institutional trust and distrust, which we call “public trust.” Public trust, we will argue, plays a central role in constituting the public sphere and in structuring societies in which it is worth living. (shrink)