Background:Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic.Objective:To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency.Research design:A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses caring for Covid-19 patients in (...) the acute care units within large academic medical systems in Maryland and New York City during April to June 2020.Ethical considerations:We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore.Results:We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies.Discussion/Conclusion:Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences. (shrink)

The sensorimotor theory of perceptual experience claims that perception is constituted by bodily interaction with the environment, drawing on practical knowledge of the systematic ways that sensory inputs are disposed to change as a result of movement. Despite the theory’s associations with enactivism, it is sometimes claimed that the appeal to ‘knowledge’ means that the theory is committed to giving an essential theoretical role to internal representation, and therefore to a form of orthodox cognitive science. This paper defends the role (...) ascribed to knowledge by the theory, but argues that this knowledge can and should be identified with bodily skill rather than representation. Making the further argument that the notion of ‘representation hunger’ can be replaced with ‘prima facie representation hunger’, it concludes that although the theory could optionally be developed scientifically in part by reference to internal representation, it makes a strong and natural fit with anti-representationalist embodied or enactive cognitive science. (shrink)

The purpose of this paper is to re-examine the nature of “meaning” and “meaningfulness” in the context of instrumental music education. By doing so, I propose to expand the ways in which instrumental music educators conceive their mission and the ways in which we may instill meaning in people’s lives. Traditionally, pursuits of philosophical deliberation have claimed that meaningfulness comes from either personal happiness (e.g., Jeremy Bentham and John Stuart Mill) or an impersonal sense of duty (e.g., St. Augustine, St. (...) Thomas Aquinas, and Immanuel Kant). However, philosopher Susan Wolf (2010) criticizes these positions in favor of a broader perspective, one that arises from understanding that there is a third sort of value, namely “meaningfulness.” Rightly understanding meaningfulness may help us engage more fully with a greater sense and understanding of the full potentials of eudaimonia: a life of significance and value for oneself and one’s community. Therefore, this paper links meaningfulness to a 4-E (embodied, embedded, enacted, and extended) account of “sense-making” in/for instrumental music education. In doing so, I discuss the aims of public-school music education; aims that engage teachers and students in meaningfulness—a meaningfulness that is ethical, embodied, enacted, and extended—in, with, and through musics and, more directly, “instrumental” music making. (shrink)

BackgroundBiobanks have recently been established in several low- and middle-income countries in the Arab region of the Middle East. We aimed to explore the views of biobank managers regarding the challenges, ethical issues, and governance arrangements of their biobanks.MethodsIn-depth semi-structured qualitative interviews were conducted with a purposive sample of eight biobank managers from Egypt, Jordan, and Sudan. Interviews were performed either face-to-face, by phone, or via Zoom and lasted approximately 45–75 min. After verbal consent, interviews were recorded and then transcribed. (...) The authors performed a thematic analysis of the transcripts independently and then integrated the themes via a consensus process.ResultsBiobank managers discussed the main challenges in establishing their biobanks. These included the staff’s lack of experience and training, limited funds, deficit awareness of biobanks, obtaining funding from different sources. Only four reported they were active in distributing biospecimens and health data to researchers. Six biobanks used a broad consent model, one used tiered consent, and another allowed participants to opt-out of being recontacted. Five managers avoided partnerships with pharmaceutical companies due to concerns with unfavorable reactions from the community. Five managers did not have clear policies for returning research results to the donors. Five expressed challenges with sample and data sharing with international collaborators; all five used material transfer agreements. The biobank managers revealed variable governance arrangements and activities with community involving awareness and educational efforts rather than active engagement. Several expressed the importance of transparency with the operations of their biobanks and gaining the trust of their stakeholders.ConclusionManagers of biobanks in LMICs in the Arab Middle East encounter financial, operational, and social challenges toward their sustainability efforts. Discussions with key stakeholders are warranted to manage ethical issues involving informed consent, privacy, data sharing, and the return of results. We recommend that biobank managers in the Arab Middle East form collaborative networks within the region and internationally, develop trusting governance relationships with their stakeholders, and pursue engagement activities with their communities to enhance trust. (shrink)

If a quest for universal ethical standards in journalism is to be productive, we should first be able to articulate an overarching set of universal ethical standards that can apply across cultures, across ethical schools of thought, across professions. In this article I offer 4 likely universal standards that have relevance to journalism, suggesting universal journalism standards can also be identified. Although these and other standards will not be panaceas for the ethical dilemmas journalists often face, they provide needed anchors (...) for decision making. (shrink)

Population-based genomics studies have proven successful in identifying genetic variants associated with diseases. High-quality biospecimens linked with informative health data from diverse segments of the population have made such research possible. However, the success of biobank research depends on the willingness of the public to participate in this type of research. We aimed to explore the factors associated with the willingness of the public to participate in biobank research from four low- and middle-income countries in the Arab region (Egypt, Jordan, (...) Morocco, and Sudan). We used a previously validated questionnaire to assess several constructs that included the public’s perceptions, attitudes, and willingness to participate in biobank research. We recruited 967 participants. More than half did not have prior awareness of biobanks. Participants’ willingness to donate biospecimens and health data was less than 10%. Our results also showed that participants harbored concerns with trust, privacy, and with data-sharing involving international researchers. Predictors of willingness to participate in biobank research included no previous involvement in research and positive attitudes toward biobanks. Finally, our study showed several differences between the four countries regarding several of the investigated constructs. We conclude there should be additional efforts to raise public awareness and enhance perceptions of the public in biobanking research to enhance trust. We further recommend qualitative research to explore the underlying factors that contribute to the public’s concerns with international data sharing that would enhance global health. (shrink)

Let me begin with some of the background worries that motivate the paper. First, for years I have been working on the relation of the Timaeus to the Republic guided by this triple analogy: as the demiurge is to the cosmos, so the philosopher-ruler is to the polis, so reason is to the soul or individual. The key claim is Tim. 29e: the demiurge is good and so wants to make everything it makes like it itself is, i.e., good, as (...) good as possible. I take the demiurge to be reason idealized, so I infer reason wants to make everything it makes as good as possible. This sets the stage: how is reason related to the good? (shrink)

The Dialectic of Essence offers a systematic new account of Plato's metaphysics. Allan Silverman argues that the best way to make sense of the metaphysics as a whole is to examine carefully what Plato says about ousia (essence) from the Meno through the middle period dialogues, the Phaedo and the Republic, and into several late dialogues including the Parmenides, the Sophist, the Philebus, and the Timaeus. This book focuses on three fundamental facets of the metaphysics: the theory of Forms; (...) the nature of particulars; and Plato's understanding of the nature of metaphysical inquiry. Silverman seeks to show how Plato conceives of "Being" as a unique way in which an essence is related to a Form. Conversely, partaking ("having") is the way in which a material particular is related to its properties: Particulars, thus, in an important sense lack essence. Additionally, the author closely analyzes Plato's idea that the relation between Forms and particulars is mediated by form-copies. Even when some late dialogues provide a richer account of particulars, Silverman maintains that particulars are still denied essence. Indeed, with the Timaeus's introduction of the receptacle, there are no particulars of the traditional variety. This book cogently demonstrates that when we understand that Plato's concern with essence lies at the root of his metaphysics, we are better equipped to find our way through the labyrinth of his dialogues and to better appreciate how they form a coherent theory. (shrink)

This title, first published in 1991, opens with an account by Gadamer of his own life and work and their relation to the achievements of hermeneutics. Building upon the key theme of dialogue, Gadamer and Hermeneutics provides a series of essays, either linked Gadamer to other major contemporary philosophers or focusing on a given Gadamerian theme. This book will be of interest to students of literary theory.

I argue that we should rethink the nature and scope of Spinoza’s “one and the same” relation. Contrary to the standard reading, the nature of this relation is not identity but a union, and its scope includes all idea-object pairs, even God and the idea of God. A crucial reason we should adopt this dual picture is that the idea of God must be one and the same as something found when Nature is conceived under each of the other attributes. (...) If “one and the same” is interpreted as a relation of identity, this requirement cannot be met. However, maintaining that God and the idea of God are one and the same not only fulfills this requirement, but also is independently motivated. I also briefly consider how the thesis that God and the idea of God are one and the same affords us with positive insights concerning the nature of this relation. (shrink)

Vaccination is one of history's most successful public health interventions. Since 2000, vaccination campaigns against measles, which is highly contagious but preventable through the measles‐mumps‐rubella (MMR) vaccine, have reduced both the global incidence of the disease and measles deaths by 80 percent. However, progress toward measles elimination has slid backward in several previously well‐protected global regions. With more communities below or at risk of falling below the 95 percent immunization rates required for herd immunity—due more and more to vaccine skepticism (...) and declination rather than lack of access—many U.S. states and countries must reappraise their vaccination policies and programs. (shrink)

Karlfriedrich Herb shows that the new theory of representation in Leviathan implies a rejection of direct democracy, which was still referred to, and active as a political model, in The Elements of Law and De cive. Since the social contract gives full authority to the sovereign, there is no longer any reason to consider democracy as the original form of all governments. Democracy thus plays no part in the definition of the citizen’s liberty, and consequently the liberty of the (...) subject is not at all a matter of participation in political life. To the contrary, this civil liberty is directly proportional to the independence left to the citizen by the legislator. The famous maxim defining liberty as the silence of the law is therefore to be considered anew in the perspective of the theory of representative sovereignty. The authority of the sovereign has nothing to do, in Hobbes’s thought, with the authoritas of the ancient Romans, since actual peace is its only source of legitimacy. It is not possible, therefore, to include Leviathan in a history of Republicanism. (shrink)

The aim of this long essay is to explain why the philosopher-ruler of Plato's Republic descends “with regret” or having been “compelled” from his contemplation of the Forms to rule the state. It offers a new, optimistic interpretation of his goal in so descending, namely to try to make everyone into a philosopher. After a brief introductory section, I turn to the argument of the Republic to show both that the philosopher's understanding of the Good causes him to try to (...) maximize the amount of good in the cosmos, and that, since every rational person is capable, in virtue of his rational soul, of becoming a philosopher, this amounts to adopting the aforementioned goal. In the third section, I argue that the source of his regret cannot be that he sacrifices his own happiness in descending. Here the vehicle is a consideration of the “Plotinian” reading of the Republic, whose conclusion is that once he has achieved knowledge of the Forms, the philosopher can neither increase his happiness by further study, nor lose his happiness. Hence, if he is true to his goal, he has to try to improve the lot of others. In the next section, I argue that the Timaeus' account of the Demiurge's construction of the cosmos helps us to understand both the nature of the ruler's attempts to make everyone a philosopher and why he also understands that he will inevitably fail. Here the key idea is to link the Timaeus' account of Necessity or the Wandering Cause with the circumstances facing the philosopher in ruling the state. In the conclusion, I sketch how this account of the philosopher's reason for descending suggests that the best or ideal city in the Republic is not the tripartite kallipolis, but is rather a version of the City of Pigs. Footnotesa Parts of this paper have been presented to audiences at Princeton, UCLA, the Australian Association of Philosophy, Monash University, Kansas, and Berkeley. I am indebted to those in the audiences on all those occasions. Special thanks are owed to Chris Bobonich, David Keyt, Fred Miller, and the other contributors to this volume. (shrink)

Until about thirty years ago, the extent of disclosure about and consent-seeking for medical interventions was influenced by a beneficence model of professional behaviour. Informed consent shifted attention to a duty to respect the autonomy of patients. The new requirement arrived on the American scene in two separate contexts: for daily practice in 1957, and for clinical study in 1966. A confusing double standard has been established. 'Daily consent' is reviewed, if at all, only in retrospect. Doctors are merely exhorted (...) to obtain informed consent; they often minimise uncertainties about 'best' treatment and they feel duty-bound to provide patients with an unequivocal recommendation for action. 'Study consent' in a clinical trial is reviewed prospectively, and doctors are compelled by regulation to point out that there is insufficient evidence to make a rational choice between two compared treatments. It has been impossible to devise informed consent practices that satisfy, in full, the competing moral imperatives of respect for autonomy, concern for beneficence with emphasis on the value of health, and a vigil for justice. A way must be found to experiment with various discretionary approaches that would strike a realistic balance among competing interests. (shrink)

(2008). In Praise of Top-Down Decision Making in Managerial Hierarchies. World Futures: Vol. 64, Postformal Thought and Hierarchical Complexity, pp. 513-523.

At 47e–53c of the Timaeus Plato presents his most detailed metaphysical analysis of particulars. We are told about the construction of the physical universe, the ways we can and cannot talk about the phenomena produced, and about the two causes – Necessity and Intelligence – which govern the processes and results of production. It seems to me that we are told too much and too little: too much, because we have two accounts of the generation of phenomenal particulars – one, (...) the ‘formal account’, which makes use of the receptacle, Forms and form-copies, and a second, the ‘geometrical account’, which appeals to geometrical shapes, the Demiurge and, apparently, matter; too little, because there is insufficient guidance as to how to relate the two accounts. (shrink)

In the late 1970s, while working in my laboratory at the American Health Foundation, I received a phone call from Henry Spira. Not one for small talk, he did not even bother introducing himself beyond his name. He immediately began questioning me about my studies using the protozoan Tetrahymenathermophila, which I hoped would serve as an alternative to the Draize ocular irritation test. While flattered that someone cared about my work, I was soon lost in confusion and skepticism about the (...) true purpose of his call. Who was Henry Spira? Why did he want to visit my animal facility and why did he want to bring a physician colleague with him? Not only was I naive about the budding opposition to the Draize test, I was equally naive that it was Spira, an ardent animal protectionist, who was leading the fight. This seminal interaction began a friendship that spanned nearly twenty years; a friendship that indelibly changed my perception of nonhuman animals and how I relate to them. (shrink)

In philosophy of religion, there are few more frequently visited topics than the problem of evil, which has attracted considerable interest since the time of Epicurus. It is well known that the problem of evil involves responding to the apparent tension between 1) belief in the existence of a good, all powerful, all knowing God and 2) the existence of evil—such as personal suffering embodied in the experience of cancer. While a great deal has been written concerning abstract philosophical theories (...) that academics use to explain the existence of evil, much less has been written about how religious lay people make sense of evil and suffering. What explanations, meanings, and perceptions do they hold concerning the religious significance of evil? What can theologians and philosophers learn from these lay experiences? Our interdisciplinary team designed an experiment to identify the religious significance that personal suffering held for a group of religious cancer sufferers. We interviewed twenty-nine self-identified evangelical Christians who had received a cancer diagnosis at some point in their lives for our experiment. Since all interviewees identified as Christians, it was expected that they would assent to belief in a theistic God. It was also expected that each interviewee would assent the existence of evil and see their cancer experience as a dramatic and personal instance of an evil event. The explicit existential threat of cancer guarantees that the individual has much at stake in the experience. Furthermore, the pain and suffering that typically accompanies either the cancer itself or cancer treatments make it a compelling example of evil experienced in a very personal way. Finally, even when successfully treated, the ongoing threat of potentially fatal recurrence looms over the sufferer for years to come. We asked 17 questions related to the religious significance of their cancer experience in each interview and coded these interviews looking for five distinct types of explanations for/meaning of evil: trusting God in mystery, free will, moral development, spiritual growth, and growth in human relationships/community. These categories were meant to correspond loosely to five philosophical responses to the existence of evil.Our interviews included several important results. First, 79% of interviewees had at least one answer that fit into the ‘trust God in mystery’ category of responses with 48% using this category of responses as their most frequently cited theme. This result could be interpreted as a kind of generic theodical response: God has a good, but unknown reason for allowing evil/suffering. Alternatively, another possible interpretation is that at least some of these interviewees intuited something similar to skeptical theism, since it claims that if one understands the type of God proposed by theism and possesses an accurate view of human cognitive capacities, it is apparent that there is no real tension to be resolved between theism and the existence of evil. Some of our interviewees seemed to believe not only that the answer to why evil exists is mysterious, but that they simply could not have the necessary perspective to judge what kinds of purposes God might have for allowing this painful episode in their lives.While it was unsurprising that religious sufferers would find it important to trust God in ambiguous difficult circumstances, more surprisingly, we found that 52% of our respondents did not judge that their cancer experience was at all in tension with their religious beliefs. Whereas a broad range of philosophers and theologians acknowledge that there is at least an apparent conflict between the existence of a good, all-powerful God and the existence of evil, most of our interviewees did not even perceive an apparent tension between theistic beliefs and their painful cancer experiences that would be in need of additional reconciliation.There are at least two ways this result might be interpreted. First, our interviewees might hold additional beliefs that make the existence of evil easier for them to accept. After all, these interviewees were not ‘bare theists’ who held only to the existence of God, but presumably held a broad range of religious beliefs which may already serve to reconcile the existence of evil: that growing closer to God is more important than earthly life itself, that in evil in this life allows us a greater appreciation of a blessed eternity, or simply that ‘God works for our good in mysterious ways.’ Thus, a fully developed Christian worldview may already accommodate the existence of evil in a way not fully appreciated by philosophers.Another possible interpretation is that at least some of our interviewees were not adequately reflective to perceive the tension between their religious beliefs and their experience of suffering. There is at least some reason to doubt this explanation as an overarching interpretation of this result since our interviewees were generally well educated with the median participant holding at least a Bachelor’s degree, and most were ongoing participants in a cancer support group ensuring long-term ongoing engagement with their cancer experience.A final significant finding is that a high portion of our interviewees, 83% reported specific examples of beneficial personal growth—moral, spiritual, or relational— that resulted from their cancer experience. When asked about their cancer experience’s broad effect upon their lives in these areas they volunteered at least one example of a benefit they received in these areas. Depending on one’s accompanying value theory and whether such benefits might have been otherwise achieved, they might provide a morally sufficient reason for the existence of suffering. Our interviewees frequently described experiencing the kind of benefits at the heart of John Hick’s soul making theodicy and Eleonore Stump’s ‘spiritual growth’ theodicy, providing at least some corroborating evidence for such views. Experiences common to our interviewees were similar to what such theodicies would predict. (shrink)

Provides evidence that human consciousness can never be reproduced and exposes the perils of artificial intelligence. Explains how consciousness transcends the brain and body through quantum theory and accounts of consciousness in the clinically dead. Shares scientific evidence of how the image on the Shroud of Turin was produced and connects these findings to evidence concerning near-death experiences. Reveals how consciousness cannot be reproduced by a machine and how attempts to do so threaten what makes us human.

We propose in this paper to focus upon the de-ontological self concept discoverable in Eastern and Western philosophical traditions. In a larger study, we intend to contrast this “no self” paradigm with major pro-ontological formulations of the self concept. These pro-ontological definitions can be divided into three basic types, namely the absolute-universal self, the transcendental-constituting self, and the natural-organic self.

Philosophy and Desire , the seventh book in the well-known Continental Philosophy series, examines questions of desire--desire for another person, desire for happiness, desire for knowledge, desire for a better world, desire for the impossible, desire in text, desire in language and desire for desire itself. The theme of desire is explored through readings of contemporary figures such as Merleau-Ponty, Bataille, Sartre, de Beauvoir, Levinas, Irigaray, Barthes, Derrida, and Derrida. A hot, timely topic in philosophy today Expands the contemporary debates.

Open peer commentary on the article “Sensorimotor Direct Realism: How We Enact Our World” by Michael Beaton. Upshot: In light of the construal of sensorimotor theory offered by the target article, this commentary examines the role the theory should admit for internal representation.

O’Regan and Noë’s sensorimotor approach rejects the old-fashioned view that perceptual experience in humans depends solely on the activation of internal representations. Reflecting a wealth of empirical work, for example active vision, the approach suggests that perceiving is, instead, a matter of bodily exploration of the outside environment. To this end, the approach says the perceiver must deploy knowledge of sensorimotor contingencies, the ways sense input changes with movement by the perceiver or object perceived. Clark has observed that the approach (...) faces a challenge accounting for the experience of temporal duration, since event-like properties cannot be characterised by reference to the sensory consequences of possible movements. This paper argues that the account can best be shored up by emphasising, more than Noë does, the dependence of perceptual experience, in general, on temporally extended, organismic interaction with the outside environment. The paper argues, moreover, that an ‘extensionalist’ account of temporal experience could help make sense of object experience, which is itself, plausibly, an experience of temporal duration. (shrink)

The Prudence of Love focuses upon the intersection of philosophical, theological, and psychological issues related to love. Eric Silverman defends an account of love derived from the views of Thomas Aquinas and argues that love provides numerous psychological and relational benefits that increase the lover's happiness. Furthermore, he argues that love is beneficial according to all major contemporary accounts of happiness.

John Alderson, Principled Policing: Protecting the Public with Integrity Winchester, U.K.: Waterside Press, 1998, 185 pp.