One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

A medical narrative from a woman in her 90s describes her childhood bout with diphtheria in Kansas City, Missouri, apparently immediately after vaccination, her confinement in the “pest hospital,” and her treatment with what she understood as a blood transfusion from a donor who was found through a radio appeal. In this essay, we trace the narrative back to the institutions, medical practices, and historical context, examining both the underlying history of medical practice and scientific understanding that is reflected in (...) her experience and also the contexts of that history, including racial and religious attitudes. (shrink)

Writing in 1999, legal ethics scholar Brad Wendel noted that “[v]ery little empirical work has been done on the moral decision making of lawyers.” Indeed, since the mid-1990s, few empirical studies have attempted to explore how attorneys deliberate about ethical dilemmas they encounter in their practice. Moreover, while past research has explored some of the ethical issues confronting lawyers practicing in certain specific areas of practice, no published data exists probing the moral mind of health care lawyers. As signaled by (...) the creation of a regular column “devoted to ethical issues arising in the practice of health law” in the Journal of Law, Medicine & Ethics, the time to address the empirical gap in the professional ethics literature is now. Accordingly, this article presents data collected from 120 health care lawyers. Presenting this population with a number of hypothetical scenarios relating to how they would respond when confronting an ethical dilemma without an obvious solution or when facing a situation in which their personal values were in tension with their professional obligations, this article represents a first step toward better understanding how lawyers who practice in health care settings understand and resolve the moral discomfort they encounter in their professional lives. (shrink)

The empirical literature exploring lawyers and their moral decision making is limited despite the “crisis” of unethical and unprofessional behavior in the bar that has been well documented for over a decade. In particular we are unaware of any empirical studies that investigate the moral landscape of the health lawyer’s practice. In an effort to address this gap in the literature, an interdisciplinary team of researchers at Vanderbilt University designed an empirical study to gather preliminary evidence regarding the moral reasoning (...) of health care attorneys. The primary research question was how health lawyers respond when they encounter ethical or moral dilemmas in their practice for which the law fails to offer a bright-line solution. In exploring this question, we sought to understand better what motivations or influences guide action when health lawyers confront ethical quandaries, and whether there are specific differences, e.g., gender, experience, or religiosity, that are associated with specific responses to situations testing ethical or moral boundaries. (shrink)

Feminism was born in controversy and it continues to flourish in controversy. The distinguished contributors to this volume provide an array of perspectives on issues including: universal values, justice and care, a feminist philosophy of science, and the relationship of biology to social theory.

Regarding Equality offers an innovative and controversial analysis of the relationship between equality and pluralism. Tackling an issue central to modern political thought, Freeberg highlights the struggle to characterize citizens as equals while respecting their moral, religious, and cultural diversity. The work ably contrasts and critiques the prevailing models for balancing equality with pluralism from thinkers Amartya Sen, Martha Nussbaum, John Rawls, Amy Gutmann, Dennis Thompson, Michael Oakeshott, and Drucilla Cornell. From these liberal, democratic, and conservative approaches to equality (...) and pluralism, Freeberg builds a theory of responsive regard: reciprocal civility between citizens that forms a chastened conception of what we share as free and equal persons. This work will greatly add to political theorists' and philosophers' arsenals of concepts for egalitarian and democratic theory. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Wuthering Heights: The Romantic AscentMartha NussbaumI“If I were in heaven, Nelly,” she said, “I should be extremely miserable.”“I dreamt, once, that I was there.... [H]eaven did not seem to be my home; and I broke my heart with weeping to come back to earth; and the angels were so angry that they flung me out, into the middle of the heath on the top of Wuthering Heights, where I (...) woke sobbing for joy.” 1Cathy’s soul cannot live in the Christian heaven. For her soul, she explains, is the same as Heathcliff’s soul, and the heavenly soul of Linton is as different from theirs “as a moonbeam from lightning, or frost from fire” (p. 95). Much later, as she lies on her deathbed, now the wife of Edgar Linton, thinking the Linton thought that what she wants is an escape into “that glorious world” of paradise and peace, Heathcliff watches her with burning eyes. At last she calls to him:In her eagerness she rose and supported herself on the arm of the chair. At that earnest appeal he turned to her, looking absolutely desperate. His eyes, wide and wet, at last flashed fiercely on her; his breast heaved convulsively. An instant they held asunder, and then how they met I hardly saw, but Catherine made a spring, and he caught her, and they were locked in an embrace from which I thought my mistress would never be released alive: in fact, to my eyes, she seemed directly insensible. He flung himself into the nearest seat, and on my approaching hurriedly to ascertain if she had fainted, he gnashed at me, and foamed like a mad dog, and gathered her to him with greedy jealousy. I did not feel as if I were in the company of a creature of my own species: it appeared that he would not understand, though I spoke to him; so I stood off, and held my tongue, in great perplexity.(pp. 188–89) [End Page 362]Brontë’s description alludes to the imagery of the Christian ascent tradition. As in Augustine and Dante, love is a flame that animates the eyes, a lightning bolt that pierces the fog of our obtuse daily condition; as in that tradition, love’s energy causes the lover to leap away from the petty egoism of the daily into an ecstatic and mutually loving embrace. But we know we are far from the world of the Christian ascent, even its erotic Augustinian form. Cathy’s spring is not an upward, but a horizontal movement—not toward heaven, but toward her beloved moors and winds, severed from which she would find heaven miserable; not toward God but toward Heathcliff, the lover of her soul. Nor is there redemption into heaven in this work; there is, if anything, a redemption from a world dominated by the imagination of heaven, into a world that the pious Ellen Dean can recognize only as an animal world, a world inhabited by creatures of a different species, who probably do not understand language, so thoroughly are they identified with the energy of the body. A few hours after Cathy’s death Heathcliff, as Ellen Dean tells us, in a sudden “paroxysm of ungovernable passion,” dashes his head against the knotted trunk of a tree, splashing the bark with blood, “and, lifting up his eyes, howled, not like a man, but like a savage beast being goaded to death with knives and spears” (p. 197). It is in his world alone, it would seem, that flame is truly found. As Cathy said to Edgar Linton, “Your cold blood cannot be worked into a fever: your veins are full of ice-water; but mine are boiling, and the sight of such chillness makes them dance.”Brontë’s novel situates itself within a long tradition of writing about love and its ascent or purification. This tradition, inaugurated by Socrates’ description of the ladder of love in Plato’s Symposium, is continued by later Platonists, and radically reformulated by Christian thinkers, who stress, against Plato, the soul’s receptivity and vulnerability to the inscrutable operations of grace. In both the Platonic and... (shrink)

Nurses have moral obligations incurred by membership in the profession to participate knowingly in health policy advocacy. Many barriers have historically hindered nurses from realizing their potential to advance health policy. The contemporary political context sets additional challenges to policy work due to polarization and conflict. Nursing education can help nurses recognize their role in advancing health through political advocacy in a manner that is consistent with disciplinary knowledge and ethical responsibilities. In this paper, the authors describe an exemplar of (...) Elizabeth Barrett's “Power as Knowing Participation in Change” theory as a disciplinary lens within a doctoral nursing health policy course. Barrett (radically) emphasizes “power as freedom” instead of “power as control.” This approach is congruent with nursing disciplinary values and enhances awareness of personal freedom and building collaborative relationships in the policy process. The theory was used in concert with other traditional policy content and frameworks from nursing and other disciplines. We discuss the role of nursing ethics viewed as professional responsibility for policy action, an overview of Barrett's theory, and the design of the course. Four student reflections on how the course influenced their thinking about policy advocacy are included. While not specific to policymaking, Barrett's theory provides a disciplinary grounding to increase students' awareness of freedom and choices in political advocacy participation. Our experience suggests that Barrett's work can be fruitful for enhancing nurses' awareness of choices to participate in change across settings. (shrink)

Perry Anderson, Edward Palmer Thompson, David Harvey, Moishe Postone, Derek Sayer, Simon Clarke, Robert Brenner, Ellen Meiksins Wood et David McNally : neuf penseurs importants dont l'influence grandissante marque un renouveau de l'apport de l'oeuvre de Marx et de ses successeurs au champ des sciences sociales. Chaque chapitre décrit le parcours intellectuel de l'une de ces figures et analyse sa contribution à une pensée en mouvement, offrant ainsi pour la première fois au public francophone un tour d'horizon des (...) différentes formes du marxisme anglo-saxon contemporain. Hétérogène, ce courant de pensée résolument antidogmatique est traversé de tendances communes telles la critique du réductionnisme économique et une sensibilité accrue aux processus historiques des rapports de domination. Historiens, sociologues, politologues, géographes ou philosophes, les auteurs ici réunis ont chacun à leur manière contribué au vaste chantier théorique de la pensée marxiste et du matérialisme historique, qui continue de s'étendre, un siècle et demi après sa fondation. (shrink)

This book closely examines our commonly held beliefs about human suffering, and offers unique insights into God's role in why we suffer. Dr. Perri critically examines what it means to be human from a Judeo-Christian perspective, and extrapolates from the work of Carl Gustav Jung showing a deeply complex development of human transcendence in human suffering. On an interpersonal level, Dr. Perri elaborates on the work of Martin Buber and Emanuel Levinas and shows how our suffering can be shared and (...) lessened by our unconditionality and presence for the other. Scriptural passages are quoted from both the Hebrew and New Testament texts, and are used to depict the suffering of humankind as seen in the face of Job. It was this face, according to Perri, that Jesus saw in the faces of those He came to redeem, and that ultimately brought Him to the crucifix of redemption. Dr. Perri challenges Sartre's position that our existence precedes our essence, and draws on the work of Abraham Joshua Heschel and Christian theology in this regard. He further elaborates a neurodevelopmental paradigm that creates essence as the basis of our freedom to choose. This book can be read and studied by both professionals in the helping and healing professions, and lay persons seeking to better understand our suffering, and how to better help those who suffer. Dr. Perri offers specific ways in how to be present for those who suffer, how to read and receive the hidden language of human suffering, and how to use silence as a communication skill. (shrink)

A revolutionary new theory and call to action on animal rights, ethics, and law from the renowned philosopher Martha C. Nussbaum.

The aim of this study was to explore how Belgian nurses view issues related to the development, dissemination and implementation of a code of ethics for nurses. Fifty nurses took part in eight focus groups. The participants stated that, on the whole, a code of ethics for nurses would be useful. They stressed that a code should be a practical and useful instrument developed by nurses for nurses, and that it should be formulated and presented in a practical way, just (...) as educational courses dealing specifically with codes of ethics require a practical approach to be effective. They emphasized that the development of a code should be an ongoing process, enabling nurses to provide input as they reflect on the ethical issues dealt with in the code and apply the code in their practice. Finally, they stressed the need for support at institutional level for the effective implementation of a code. (shrink)

Much of the discussion surrounding the ethics of abortion has centered around the notion of personhood. This is because many philosophers hold that the morality of abortion is contingent on whether the fetus is a person - though, of course, some famous philosophers have rejected this thesis (e.g. Judith Thomson and Don Marquis). In this article, I construct a novel argument for the immorality of abortion based on the notion of impairment. This argument does not assume that the fetus is (...) a person - indeed, I concede (for the sake of argument) that the fetus is not a person - and hence the morality of abortion is not contingent on whether the fetus is a person. I finish by answering a plethora of objections to my argument, concluding that none of them are successful. (shrink)

The founder of modern linguistics, Ferdinand de Saussure inaugurated semiology, structuralism, and deconstruction and made possible the work of Jacques Derrida, Roland Barthes, Michel Foucault, and Jacques Lacan, thus enabling the development of French feminism, gender studies, New Historicism, and postcolonialism. Based on Saussure's lectures, _Course in General Linguistics_ traces the rise and fall of the historical linguistics in which Saussure was trained, the synchronic or structural linguistics with which he replaced it, and the new look of diachronic linguistics that (...) followed this change. Most important, Saussure presents the principles of a new linguistic science that includes the invention of semiology, or the theory of the "signifier," the "signified," and the "sign" that they combine to produce. This is the first critical edition of _Course in General Linguistics_ to appear in English and restores Wade Baskin's original translation of 1959, in which the terms "signifier" and "signified" are introduced into English in this precise way. Baskin renders Saussure clearly and accessibly, allowing readers to experience his shift of the theory of reference from mimesis to performance and his expansion of poetics to include all media, including the life sciences and environmentalism. An introduction situates Saussure within the history of ideas and describes the history of scholarship that made _Course in General Linguistics_ legendary. New endnotes enlarge Saussure's contexts to include literary criticism, cultural studies, and philosophy. (shrink)

It is often assumed that if the fetus is a person, then abortion should be illegal. Thomson1 laid the groundwork to challenge this assumption, and Boonin2 has recently argued that it is false: he argues that abortion should be legal even if the fetus is a person. In this article, I explain both Thomson’s and Boonin’s reason for thinking that abortion should be legal even if the fetus is a person. After this, I show that Thomson’s and Boonin’s argument for (...) legalised abortion fail; they have not given us good reason for thinking abortion should be legal.1 Finally, I argue that—if we play Boonin’s game—abortion should be illegal. When discussing the ethics and politics of abortion, whether the fetus is a person is usually central.3 4.2 However, Thomson1 long ago challenged this view. She argued that abortion is permissible even if the fetus is a person. To do so, she asks us to consider a case in which you are non-consensually taken to a hospital and hooked up to a famous violinist. The violinist, if he is to survive, needs to filter his blood through your body. After 9 months, he will be fine and you can unplug yourself and go on your way. If you unplug yourself prior to this, however, he will die. Is it permissible to unplug yourself? Thomson thinks the answer is ‘yes’. And this, she thinks, shows that abortion is permissible even if the fetus is a person. While the majority of her article focuses on the ethics of abortion, it is clear that she also aims to show that abortion should be legal if the fetus is a person; she would no doubt reject the view that the state is right to coerce you into …. (shrink)

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

The problem of plant individuality is something which has vexed botanists throughout the ages, with fashion swinging back and forth from treating plants as communities of individuals (Darwin 1800 ; Braun and Stone 1853 ; Münch 1938 ) to treating them as organisms in their own right, and although the latter view has dominated mainstream thought most recently (Harper 1977 ; Cook 1985 ; Ariew and Lewontin 2004 ), a lively debate conducted mostly in Scandinavian journals proves that the issues (...) are far from being resolved (Tuomi and Vuorisalo 1989b ; Fagerström 1992 ; Pan and Price 2001 ). In this paper I settle the matter once and for all, by showing which elements of each side are correct. (shrink)

This chapter develops the idea that the germ-soma split and the suppression of individual fitness differences within the corporate entity are not always essential steps in the evolution of corporate individuals. It illustrates some consequences for multilevel selection theory. It presents evidence that genetic heterogeneity may not always be a barrier to successful functioning as a higher-level individual. This chapter shows that levels-of-selection theorists are wrong to assume that the central problem in transitions is always that of minimizing within-group competition. (...) Evidence of intralevel conflict does not qualify as evidence against the existence of a higher level of selection. (shrink)

In cases in which we must choose between either (i) preventing a woman from remaining unwillingly pregnant or (ii) preventing a fetus from being killed, we should prevent the fetus from being killed. But this suggests that in typical cases abortion is wrong: typical abortions involve preventing a woman from remaining unwillingly pregnant over preventing a fetus from being killed. So abortion is typically wrong—and this holds whether or not fetuses are persons.

In my article "Even if the fetus is not a person, abortion is immoral: The impairment argument" (this journal), I defended what I called “The impairment argument” which purports to show that abortion is immoral. Bruce Blackshaw (2019) has argued that my argument fails on three accounts. In this article, I respond to his criticisms.

This article is a response to Stephen Law's article ‘The evil-god challenge’. In his article, Law argues that if belief in evil-god is unreasonable, then belief in good-god is unreasonable; that the antecedent is true; and hence so is the consequent. In this article, I show that Law's affirmation of the antecedent is predicated on the problem of good (i.e. the problem of whether an all-evil, all-powerful, and all-knowing God would allow there to be as much good in the world (...) as there is), and argue that the problem of good fails. Thus, the antecedent is unmotivated, which renders the consequent unmotivated. Law's challenge for good-god theists is to show that good-god theism is not rendered unreasonable by the problem of evil in the same way that evil-god theism is rendered unreasonable by the problem of good. Insofar as the problem of good does not render belief in evil-god unreasonable, Law's challenge has been answered: since it is not unreasonable to believe in evil-god (at least for the reasons that Law gives) it is not unreasonable to believe in good-god. Finally, I show that – my criticism aside – the evil-god challenge turns out to be more complicated and controversial than it initially appears, for it relies on the (previously unacknowledged) contentious assumption that sceptical theism is false. (shrink)

Microbes are generally thought of as unicellular organisms, but we know that many microbes live as parts of biofilms—complex, surface-attached microbial communities numbering millions of cells. Some authors have recently argued in favour of reconceiving biofilms as biological entities in their own right. In particular, some have claimed that multispecies biofilms are evolutionary individuals : 10126–10132 2015). Against this view, I defend the conservative consensus that selection acts primarily upon microbial cells.

Skeptical theism is a popular response to arguments from evil. Many hold that it undermines a key inference often used by such arguments. However, the case for skeptical theism is often kept at an intuitive level: no one has offered an explicit argument for the truth of skeptical theism. In this article, I aim to remedy this situation: I construct an explicit, rigorous argument for the truth of skeptical theism.

Abortion restrictions are particularly good for black women—at least in the United States. This claim will likely strike many as outlandish. And numerous commentaries on abortion restrictions have suggested otherwise: many authors have lamented the effects of abortion restrictions on women, and black women in particular—these restrictions are bad for them, these authors say. However, abortion restrictions are clearly good for black women. This is because if someone is prevented from performing a morally wrong action, it’s good for her. For (...) example, it’s good for Sarah if she’s prevented from driving home drunk. However, since abortion is morally wrong, it follows that it’s good for women when they are prevented from getting an abortion. And since black women get abortions at disproportionately high rates, abortion restrictions are good in particular for black women. Indeed, this is an example of a positive effect of intersectionality. (shrink)

There is strong theoretical support for a relationship between various characteristics of religiousness and attitudes towards business ethics. This paper examines three frequently- studied dimensions of religiousness (fundamentalism, conservatism, and intrinsic religiousness) and their ability to predict students' willingness to behave unethically. Because prior research indicated a possible relationship between the religious affiliation of an institution and its members' ethical orientation, we studied students at universities with three different types of religious affiliation: evangelical, Catholic, and none.Results of the study lend (...) support to a negative relationship between the above-mentioned dimensions of religiousness and willingness to behave unethically. In addition, students at the Evangelical university were far less willing to engage in unethical behavior than were students at either the Catholic or the unaffiliated institutions. (shrink)

Shepherd propounds a theory of mind with a fair claim to be better than Hume’s at explaining the sources of commonly held human beliefs about causal necessity due largely to her relational theory of sense perception. In comparison with Hume’s account, it incorporates a more sophisticated treatment of mental representation, especially the role of relational structure and logical form. Most important, perhaps, Shepherd’s theory enforces the division, obscured by Hume, between the evidence of necessity and the metaphysical foundation of necessity.

Although affective facial pictures are widely used in emotion research, standardised affective stimuli sets are rather scarce, and the existing sets have several limitations. We therefore conducted a validation study of 490 pictures of human facial expressions from the Karolinska Directed Emotional Faces database (KDEF). Pictures were evaluated on emotional content and were rated on an intensity and arousal scale. Results indicate that the database contains a valid set of affective facial pictures. Hit rates, intensity, and arousal of the 20 (...) best KDEF pictures for each basic emotion are provided in an appendix. (shrink)

I provide an updated version of The Impairment Argument against abortion and respond to numerous objections that can be (and have been) raised to it.

Mainstream ethical debates concerning responsibility for climate change tend to overemphasise emissions and consumption while ignoring or downplaying the structural drivers of climate change and vulnerability. Failure to examine the political-economic dynamics that have produced climate change and made certain people more susceptible to its harms results in inapposite accounts of responsibility. Recognition of the structural character of the problem suggests duties beyond emissions reduction and redistribution - including, potentially, a responsibility to fundamentally restructure our political and economic institutions.

Introduction to Philosophy, Fourth Edition, is the most comprehensive topically organized collection of classical and contemporary philosophy available. Building on the exceptionally successful tradition of previous editions, this edition for the first time incorporates the insights of a new coeditor, John Martin Fischer, and has been updated and revised to make it more accessible. Ideal for introductory philosophy courses, the text includes sections on the meaning of life, God and evil, knowledge and reality, the philosophy of science, the mind/body problem, (...) freedom of will, consciousness, ethics, and philosophical puzzles and paradoxes. It presents seventy substantial--and in some cases complete--selections from the best and most influential works in philosophy, offering a unique balance between classical and contemporary material. An extensive glossary of philosophical terms is also included. The fourth edition features fifteen new readings, including work by Albert Camus, Roderick M. Chisholm, Daniel Dennett, Harry G. Frankfurt, William Paley, Derek Parfit, John Perry, Richard Taylor, Peter Van Inwagen, Bernard Williams, and Susan Wolf. Part III, Knowledge and Reality, has been restructured and now includes Plato's Thaetetus, selections by Edmund L. Gettier and Robert Nozick, and an essay by Christopher Grau that explores the philosophical concepts presented in the popular film The Matrix. Two new ethics puzzles--"The Trolley Problem" and "Ducking Harm and Sacrificing Others"--are also included. This edition incorporates Study Questions after each reading and is accompanied by an Instructor's CD and a Student Companion Website, both containing helpful resources. (shrink)

Critics of skeptical theism often claim that if it (skeptical theism) is true, then we are in the dark about whether (or for all we know) there is a morally justifying for God to radically deceive us. From here, it is argued that radical skepticism follows: if we are truly in the dark about whether there is a morally justifying reason for God to radically deceive us, then we cannot know anything. In this article, I show that skeptical theism does (...) not entail that we are in the dark about whether (or for all we know) there is a morally justifying reason for God to deceive us. And hence arguments against skeptical theism that make use of this assumption fail. (shrink)