Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)

Court D. Lewis, author of Repentance and the Right to Forgiveness, presents a rights-based theory of ethics grounded in eirenéism, a needs-based theory of rights (inspired by Nicholas Wolterstorff) that seeks peaceful flourishing for all moral agents. This approach creates a moral relationship between victims and wrongdoers such that wrongdoers owe victims compensatory obligations. However, one further result is that wrongdoers may be owed forgiveness by victims. This leads to the “repugnant implication” that victims may be wrongdoers who do not (...) forgive. Author Lewis addresses the “repugnant implication” by showing that victims are obligated to work toward forgiveness, if not forgiveness itself. Critic Gregory L. Bock argues that victims are not the only ones who can forgive, that the personal dimensions of forgiveness are overlooked, and that the force of the “repugnancy implication” may be questioned. Instead of rights-based eirenéism, Bock supports a virtue ethics framework. Instead of rights-based eirenéism, Bock encourages virtue ethics. Critic David Boersema raises questions about the binding nature of relationships, the dependency of flourishing upon forgiveness, and the nature of needs or rights. Boersema also questions the wisdom of a rights-based approach to forgiveness. Critic Jennifer Kling asks whether a rights-based approach is necessary to ground obligations to meet the needs of others: why not an ethics of care? If a rights-based approach is taken, perhaps a wrongdoer is obligated to not make forgiveness a life good. By disengaging this obligation, we avoid constraining a victim’s work toward forgiveness, especially when the wrongdoing is oppressive. Author Lewis responds to these objections. (shrink)

We have all heard a refrain much like this one over the last decade, increasingly so, as the cost of genetic sequencing has been drastically reduced with improvements in associated techniques and technologies. Already, discoveries are being made in laboratories that can help doctors determine from which drug a particular patient will receive the most efficacious treatment. The working presumption is that, eventually, individuals’ genetic sequence information will be included in each of their personal medical records.

In this introduction to a special section on the philosophy of Bat-Ami Bar On, guest editor Court Lewis introduces Jennifer Kling’s article on equitable resettlement of refugees, Wim Laven’s article on meaningful political citizenship, and his own work on the analysis of the violent threat of citizen culture-warriors.

The growth and sustainability of the nursing profession depends on the ability to recruit and retain the upcoming generation of professionals. Understanding the career choice experiences and professional expectations of Millennial nurses (born 1980 or after) is a critical component of recruitment and retention strategies. This study utilized Polkinghorne's interpretive, narrative approach to understand how Millennial nurses explain, account for and make sense of their choice of nursing as a career. The positioning of nursing as a virtuous choice was both (...) temporally and contextually influenced. The decision to enter the profession was initially emplotted around a traditional understanding of nursing as a virtuous profession: altruistic, noble, caring and compassionate. The centricity of virtues depicts one‐dimensional understanding of the nursing profession that alone could prove dissatisfying to a generation of professionals who have many career choices available to them. The narratives reveal how participants' perceptions and expectations remain influenced by a stereotypical understanding of nursing, an image that remains prevalent in society and which holds implications for the future recruitment, socialization and retention strategies for upcoming and future generations of nurses. (shrink)

Volume 20, Issue 7, July 2020, Page 1-5.

Kathryn Paxton George's recent publication, Animal, Vegetable, or Woman?, is the culmination of more than a decade's work and encompasses standard and original arguments against the feminist-vegetarian connection. This paper demonstrates that George's key arguments are deeply flawed, antithetical to basic feminist commitments, and beg the question against fundamental aspects of the debate. Those who do not accept the feminist-vegetarian connection should rethink their position or offer a non-question-begging defense of it.

This historical study aims to explain how the transition from student nurse service to fully qualified “graduate nurse” service in the United States in the 20th century affected assumptions about fundamental patient care in hospital wards and provide historical context for current apprenticeship programs. Through analysis of documents from 1920 when student nurse service, a nurse apprentice model, was the norm to 1960 when the nurse apprentice model was waning in favor of registered nurse service, this study found that the (...) replacement of student nurses with registered nurses led to weakened standardization of fundamental bedside care and the introduction of large numbers of unlicensed nursing assistants. While student nurses could perform all the functions of fully qualified graduate nurses, nursing assistants could not, resulting in a separation of fundamental nursing care from the professional nurse role and changes in assumptions and attitudes toward fundamental care. These changes had a negative effect on fundamental nursing care. New apprenticeship programs provide opportunities for improvement. (shrink)

This historical study aims to refine understanding of the nature of nursing work. The study focuses on the 1880 crisis at Guy's Hospital in London to examine the nature and meaning of nursing work, particularly the concept of nursing work as many ‘little things.’ In this paper, an examination of Margaret Lonsdale's writing offers an original contribution to our understanding of the ways in which nursing work differs from medical practice. In this way, we use the late-nineteenth-century controversy at Guy's (...) Hospital as a prism through which to examine the contested nature of nursing work. Lonsdale's ideas are corroborated by examination of writings by nurse leaders Florence Nightingale and Eva Luckes. Luckes, in particular, elaborated what was meant by nursing as the performance of a thousand little things, which are specific to nursing work. While physicians had been performing much of what was considered to be nursing work, nurses developed some of these and other interventions into a unique body of work characterized by meticulous attention to significant details. Some implications regarding current nursing practice are discussed. (shrink)

: Kathryn Paxton George's recent publication, Animal, Vegetable, or Woman? (2000), is the culmination of more than a decade's work and encompasses standard and original arguments against the feminist-vegetarian connection. This paper demonstrates that George's key arguments are deeply flawed, antithetical to basic feminist commitments, and beg the question against fundamental aspects of the debate. Those who do not accept the feminist-vegetarian connection should rethink their position or offer a non-question-begging defense of it.

Two related themes have dominated discussions about the Left in advanced industrial democracies in recent years. The first is that an increasingly integrated world economy is creating a fundamentally new situation for leaders and publics, imposing burdens and constraining choices. You can either opt out of the system and languish, or put on what New York Times columnist Thomas Friedman has called neoliberalism's “Golden Straightjacket”—at which point “two things tend to happen: your economy grows and your politics shrinks.” The second (...) is that traditional social democracy has played itself out as a political ideology, creating a vacuum that can and should be filled by some new progressive movement with greater contemporary relevance. For example, Ralf Dahrendorf has argued that “socialism is dead, and … none of its variants can be revived,” while Anthony Giddens has written that reformist socialism has become “defensive” and perhaps even “moribund.”. (shrink)

One-ing is as close a description of "What It May Be All About" that you may ever read.The awesome task that is your destiny is connecting Heaven and Earth and ...

WISDOM OF THE WILD offers a deeper appreciation of life, relationships, and experiences through the exploration of nature's spiritual offerings. This collection of life lessons focuses on aspects of the natural world and their philosophical connection to our own lives, providing insights to daily living and a deeper connection to our spiritual selves. Each entry features a phenomenon found in nature, demonstrating how readers may connect the world to their human experiences. With activities, rituals, and affirmations, this book of natural (...) wonders aligns readers' inner and outer worlds to cultivate peace, balance, and harmony. (shrink)

For centuries, the British royal family has been the subject of books, articles, broadcast media, and digital communication. The addition of social media platforms has further increased the attention of the royals. Each of the family’s official social media sites have large numbers of followers around the world. The present study uses Goffman’s Presentation of Self to qualitatively examine how the current British royal family portrays itself visually via its official Instagram account. An analysis of two years of posts on (...) the social platform provides a glimpse of how the family works to maintain its image through a highly popular social media platform. Results indicated the presence of three main themes: Queen as the Head of the Monarchy, Honoring the Past, and The Working Royalty. This study offers a means of understanding the importance of visuals in conveying the royal family. (shrink)

This paper examines economic arguments employers sometimes use to justify restricting or excluding from employment those workers who are Iikely to incur high costs in health care insurance. We argue that, although profit-making is a legitimate goal for businesses, hiring practices based on non-job-related criteria violate principles of self determination, autonomy, discrimination, justice, and privacy. We conclude that hiring practices based on Iiability-driven ethics are not morally justified, but that as long as health care insurance and employment are Iinked, businesses (...) will continue to have an incentive to use liability-driven arguments. (shrink)

Can war be justified? Pacifists answer that it cannot; they oppose war and advocate for nonviolent alternatives to war. But defenders of just war theory argue that in some circumstances, when the effectiveness of nonviolence is limited, wars can be justified. -/- In this book, two philosophers debate this question, drawing on contemporary scholarship and new developments in thinking about pacifism and just war theory. Andrew Fiala defends the pacifist position, while Jennifer Kling defends just war traditions. Fiala argues (...) that pacifism follows from the awful reality of war and the nonviolent goal of building a more just and peaceful world. Kling argues that war is sometimes justified when it is a last-ditch, necessary effort to defend people and their communities from utter destruction and death. Pulling from global traditions and histories, their debate will captivate anyone who has wondered or worried about the morality of political violence and military force. Topics discussed include ethical questions of self-defense and other-defense, the great analogy between individuals and states, evolving technologies and methods of warfighting, moral injury and post-traumatic stress disorder, broader political and communal issues, and the problem of regional security in a globalizing world. The authors consider cultural and religious issues as well as the fundamental question of moral obligation in a world saturated in military conflict. The book was written in the aftermath of the war on terrorism and includes reflection on lessons learned from the past decades of war, as well as hopes for the future in light of emerging threats in Europe and elsewhere. -/- The book is organized in a user-friendly fashion. Each author presents a self-contained argument, which is followed by a series of responses, replies, and counter-arguments. Throughout, the authors model civil discourse by emphasizing points of agreement and remaining areas of disagreement. The book includes reader-friendly summaries, a glossary of key concepts, and suggestions for further study. All of this will help students and scholars follow the authors’ dialogue so they may develop their own answer to the question of whether war can be justified. (shrink)

ABSTRACT The Swedish case bears out Lewin's contention, in Self-Interest and Public Interest in Western Politics, that public spiritedness is much more important than is suggested by public-choice theories positing the universal dominance of self-interestedness. However, in Sweden we find that public spiritedness on the part of the public—as evidenced, for example, in sociotropic voting—was cultivated by political institutions, policies, and rhetoric that transformed a divided, conflictual society into one in which the “public interest” was both coherent and desirable. In (...) turn, this cultivation was the result of decisions by politicians that were, in the most simplistic sense, self-interested, because they secured the politicians’ election and re-election. But the goal of election and re-election was to create a just society. In short, the politicians, too, were public spirited. (shrink)

The Swedish case bears out Lewin's contention, in Self-Interest and Public Interest in Western Politics, that public spiritedness is much more important than is suggested by public-choice theories positing the universal dominance of self-interestedness. However, in Sweden we find that public spiritedness on the part of the public—as evidenced, for example, in sociotropic voting—was cultivated by political institutions, policies, and rhetoric that transformed a divided, conflictual society into one in which the “public interest” was both coherent and desirable. In turn, (...) this cultivation was the result of decisions by politicians that were, in the most simplistic sense, self-interested, because they secured the politicians’ election and re-election. But the goal of election and re-election was to create a just society. In short, the politicians, too, were public spirited. (shrink)

Contemporary arguments about private paramilitary organizations often focus on the threat of physical violence that they pose to the state: if such organizations garner enough physical power, then they can overtake the state via violent coup. Inspired by the legalist scholar Han Feizi’s position, we contend that such organizations also represent a sociopolitical, existential threat to the state. Specifically, their tendency for ideological expansion and subsequent gathering of political influence undermines state institutions, even without the use of overt physical force. (...) Consequently, the sociopolitical enterprise of having a unified, stable state is incompatible with the existence of, and public political support for, private paramilitary organizations, regardless of their actual or potential physical power. This argument succeeds regardless of the moral status of such paramilitary groups. Such groups, when they match the essential components of the description Han Feizi provides, are practically and politically antithetical to the integrity of the state. (shrink)

Current law does not adequately protect patients' privacy or their medical records. Proposals to computerize these records could further erode confidentiality unless new federal laws are enacted.

Locked-in syndrome (LIS) is a severe neurological condition that typically leaves a patient unable to move, talk and, in many cases, initiate communication. Brain Computer Interfaces (or BCIs) promise to enable individuals with conditions like LIS to re-engage with their physical and social worlds. In this paper we will use extended mind theory to offer a way of seeing the potential of BCIs when attached to, or implanted in, individuals with LIS. In particular, we will contend that functionally integrated BCIs (...) extend the minds of individuals with LIS beyond their bodies, allowing them greater autonomy than they can typically hope for in living with their condition. This raises important philosophical questions about the implications of BCI technology, particularly the potential to change selves, and ethical questions about whether society has a responsibility to aid these individuals in re-engaging with their physical and social worlds. It also raises some important questions about when these interventions should be offered to individuals with LIS and respecting the rights of these individuals to refuse intervention. By aiding willing individuals in re-engaging with their physical and social worlds, BCIs open up avenues of opportunity taken for granted by able individuals and introduce new ways in which these individuals can be harmed. These latter considerations serve to highlight our emergent social responsibilities to those individuals who will be suitable for, and receive, BCIs. (shrink)

In this short text, a distinguished philosopher turns his attention to one of the oldest and most fundamental philosophical problems of all: How it is that we are able to sort and classify different things as being of the same natural class? Professor Armstrong carefully sets out six major theories—ancient, modern, and contemporary—and assesses the strengths and weaknesses of each. Recognizing that there are no final victories or defeats in metaphysics, Armstrong nonetheless defends a traditional account of universals as the (...) most satisfactory theory we have.This study is written for advanced students, but as Armstrong goes considerably beyond his earlier work on this topic, it will interest professional scholars as well. Carefully plotted and clearly written, Universals is both a paradigm of exposition and a case study on the value of careful analysis of fundamental issues in philosophy. (shrink)

In this important study D. M. Armstrong offers a comprehensive system of analytical metaphysics that synthesises but also develops his thinking over the last twenty years. Armstrong's analysis, which acknowledges the 'logical atomism' of Russell and Wittgenstein, makes facts the fundamental constituents of the world, examining properties, relations, numbers, classes, possibility and necessity, dispositions, causes and laws. All these, it is argued, find their place and can be understood inside a scheme of states of affairs. This is a comprehensive and (...) rigorously this-worldly account of the most general features of reality, argued from a distinctive philosophical perspective, and it will appeal to a wide readership in analytical philosophy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Community and the “Absolutely Feminine”Sheri I. Hoem (bio)I’ve emphasized the importance of the moment of dissent in the process of constructing knowledge, lying at the heart of the community of thought.—Jean-François Lyotard, The Postmodern ExplainedMaurice Blanchot’s The Unavowable Community places side by side a “community” of writers who confront the very possibility of community as it comes to be inscribed in politico-philosophical and literary modes. His “little book” (...) [56], as he calls it, takes up these modes of discourse separately, in two parts. The first section of his text, “The Negative Community,” constitutes an analytical defense of Bataille’s theoretical concepts of community as they have been interpreted by Jean-Luc Nancy in The Inoperative Community. Blanchot engages the question of community, communion, and communism not simply to contest or continue Nancy’s text, but to restore Bataille to a brotherhood, or “fraternity” [26] of friends and scholars who have come to think in terms of an “unworking” [23] or “negative” community. The second section of Blanchot’s text, “The Community of Lovers,” performs a critical reading of Marguerite Duras’s fictional work The Malady of Death.In The Inoperative Community—the pretext, at least in part, for part one of Blanchot’s little book—Nancy credits Bataille as having “gone farthest into the crucial experience of the modern destiny of community” [16] in that Bataille’s thinking reveals the experience of discerning communism’s failure, followed by a fascination with fascism, and finally a “withdrawal from communitarian enterprises” [16–17] altogether. According to Nancy, at the juncture of the historical and theoretical failings of community, Bataille abandons all forms of community other than “an accursed isolation of lovers and of the artist” [24]. Admitting that he is dealing only with ‘“themes’” rather than with Bataille’s “writing” itself, Nancy nevertheless asserts that Bataille’s thinking on community has always been limited by “the theme of the sovereignty of the subject” [23], even in his community of lovers:Bataille’s lovers are also, at the limit, a subject and an object—where the subject, moreover, is always the man, and the object always the woman, due no doubt to a very classical manipulation of sexual difference in an appropriation of self by self. (However, on another register and in another reading of Bataille’s text, it is not certain that love and jouissance do not pertain essentially to the woman—and to the woman in man. To discuss this it would be necessary to consider Bataille’s writing... something I cannot do here, inasmuch as I am for the moment considering only its “themes.”).[24]Nancy’s reading of Bataille thus clears a space for Nancy’s own investigation into the possibility of community after or beyond the subject, so to speak. Instead of a subject described as an (undivided) individual, Nancy speaks of a “singular being” who is always already othered. Singular beings as such are “constituted by... sharing that makes them [End Page 49] others: other for one another... ‘“communicating’ by not ‘communing’” [25]. For Nancy, it is the very experience of the limits of communication that allows each being to discover a certain singularity in common.Blanchot too reflects on the “theme” of community in Bataille’s works without examining Bataille’s “writing” as such, but he reads Bataille differently. Blanchot demonstrates how Bataille’s thinking gives the effect of “mutation” [4], that Bataille comes to an understanding of self-difference beyond the subject, beyond the limits imposed by Nancy’s reading, beyond the classical construct of subject/object discourse. Blanchot’s “Negative Community” establishes Bataille as one who experienced stages of thought: his thought exhibited its own infidelity.Blanchot turns to certain of Bataille’s terms, particularly “sacrifice,” “ecstasy,” and “inner experience,” to present an alternative to Nancy’s reading. According to Blanchot, the “inner experience” (l’expérience intérieure) is a concept in Bataille that does the opposite of what one might expect. The “inner experience,” Blanchot explains, is amovement of contestation that, coming from the subject, devastates it, but has as a deeper origin the relationship with the other which is community itself... (shrink)

This essay extends Robin DiAngelo’s concept of white fragility in two directions. First, we outline an additional cause of white fragility. The lack of proper terminology available to discuss race-based situations creates a semantic false dichotomy, which often results in an inability to discuss issues of racism in a way that is likely to have positive consequences, either for interpersonal relationships or for social and political change. Second, we argue that white fragility, with its semantic foundations, has serious consequences for (...) racial justice. It perpetuates the mass incarceration of black Americans, and undergirds the knowledge gap and subsequent wealth gap. The result of these racial injustices, which are maintained partially through white fragility, is that black Americans do not live in a democracy; they neither occupy positions of social and political power, nor have the ability to obtain power or directly impact who does obtain power. (shrink)

This article describes how methodologies of EU-funded research within the life sciences and biomedicine have recently become more gender sensitive. This transformation is the result of the Gender Impact Assessments of the EU Fifth Framework Programme, commissioned in 2000-1. The authors assessed the research programme for life sciences, which includes a large health-related component. The new guidelines for research emphasize the need for clear terminology for concepts of sex and gender and for a distinction to be made between the two, (...) for both life sciences and health research. Attention to possible sex differences, even in preclinical research, as well as to effects of gender, will lead to more adequate research data that serve the health of both men and women. The transformation to research becoming more gender-sensitive is further discussed in the context of feminist theory on the body. Being fully aware of the fact that what is happening in bodies is mediated by particular technologies, the authors make an appeal to invest in concepts that take the living and changing body into account. (shrink)

A child is a developing person with evolving capacities that include autonomy, mental capacity and capacity to assume responsibility. Hence, children are entitled to participatory rights in South Africa as observed in the Children’s Act 38 of 2005. According to section 129 of the Act a child may consent to his or her own medical treatment provided that he or she is over the age of 12 years and is of sufficient maturity and decisional capacity to understand the various implications (...) of the treatment including the risks and benefits thereof. However, the Act does not provide a definition for what qualifies as ‘sufficient maturity’ nor does it stipulate how health professionals ought to assess the decisional capacity of a child. In addition, South Africa is a culturally diverse country. The Western liberal notion of autonomy may not necessarily find equal prominence in the mores of people with a different worldview. Hence we demonstrate a few salient comparisons between legal liberal moral theory and African communitarianism as pertinent to the autonomy of the child. Children are rights-holders by virtue of their humanity. Their dignity as individual human persons affords them the entitlement to human rights as contemplated under the Constitution of the Republic of South Africa. However, contrary to the traditional Western notion of individual autonomous persons African societies hold a communalistic notion of person hence there is less regard for individual autonomy and rights with more emphasis on the communal good and maintaining the continuity of relationships and interdependencies shared within a community. A child considered in this view is not regarded as a full person. This implies that decisions concerning the child, including consent to medical treatment are discussed and determined by the community to which the child belongs. Lastly, in this article, we draw on the notion of capacity for responsibility to produce a pragmatic definition of sufficient maturity. It seems reasonable to suggest a move away from a general legal age of consent for medical treatment toward more individualised, context-specific approaches in determining the maturity of a child patient to consent to medical treatment. Perhaps, decision-making with respect to consent to the medical treatment of a child belonging to a traditional African community where the notion of a person is embedded in communitarianism ought to involve the child’s parents/guardians/caregivers where possible provided that the best interests of the child are awarded priority. (shrink)

This chapter explores the debate between contemporary projectivists or expressivists, and the advocates of sensibility theory. Both positions are best viewed as forms of sentimentalism — the theory that evaluative concepts must be explicated by appeal to the sentiments. It argues that the sophisticated interpretation of such notions as “true” and “objective” that are offered by defenders of these competing views ultimately undermines the significance of their meta-ethical disputes over “cognitivism” and “realism” about value. Their fundamental disagreement lies in moral (...) psychology; it concerns how best to understand the emotions to which sentimentalist theories must appeal. (shrink)

The suffering of war refugees is often regarded as a wrong-less harm. Although war refugees have been made worse off in severe ways, they have not been wronged, because no one intentionally caused their suffering. In military parlance, war refugees are collateral damage. As such, nothing is owed to them as a matter of justice, because their suffering is not the result of intentional wrongdoing; rather, it is the regrettable and unintended result of necessary and proportionate wartime actions. So, while (...) the warring national or extra-national groups might help war refugees, such aid is regarded as humanitarian, not as justice.I challenge the view that war refugees are harmed but not wronged when those harms directly result from necessary and proportionate wartime actions. War refugees are innocent bystanders, and so are an exception to the principle that permits defense by any necessary and proportionate means. Just as an individual may not kill or seriously harm an innocent bystander to save herself, so too national or extra-national groups may not create refugees to win a war. If such groups do create war refugees during the legitimate pursuit of military goals, they have wronged those refugees, and so owe them recompense. (shrink)

This book unearths and outlines the semantic foundations of white fragility and their consequences for racial justice in the United States. It argues that by expanding our racial vocabulary in certain ways, we can make progress toward justice equally enjoyed by all.

In Ralph Waldo Emerson’s groundbreaking essay Nature, he wrote, “The moral law lies at the centre of nature and radiates to the circumference. It is the pith and marrow of every substance, every relation, and every process.”1 This moral quality of nature is embedded in its very core—the stems of plants and the interior of bones—the very places where the transactions that give life take place. And it goes out, like the light of the sun and the stars, to the (...) farthest reaches of the universe. But how did Emerson interpret this book of Nature to which he turned in his religious imagination? While Emerson is often read as a secularizing force in American society, the American liberal religious traditions that .. (shrink)