Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs’ perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants’ moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work environment. We used quantitative instruments and (...) explored participants’ perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses. (shrink)

Dual-track assessment directs research ethics committees to assess the risks of research interventions based on the unclear distinction between therapeutic and non-therapeutic interventions. The net risks test, in contrast, relies on the clinically familiar method of assessing the risks and benefits of interventions in comparison to the available alternatives and also focuses attention of the RECs on the central challenge of protecting research participants.Research guidelines around the world recognise that clinical research is ethical only when the risks to participants are (...) reasonable.1 Appropriate implementation of this requirement is vital to protecting research participants and allowing research to proceed when it poses acceptable risks. Unfortunately, as the US National Bioethics Advisory Commission notes: “current regulations do not further elaborate how risks and potential benefits are to be assessed, and little additional guidance is available to IRBs.”1The NBAC, as well as numerous commentators, recommend that research ethics committees , ethics review committees and institutional review boards should adopt what may be called dual-track risk assessment.2–5 Yet, dual-track assessment unnecessarily divides research interventions into two different categories before assessing their risks and relies on the unclear distinction between therapeutic and non-therapeutic interventions. As a result, dual-track assessment provides RECs with confusing guidance and has the potential to block valuable research that poses acceptable risks. This paper describes one alternative, the net risks test, and argues that this approach offers a better method for assessing research risks, one that puts RECs in a position to protect participants without blocking appropriate research studies.BACKGROUNDClinical research exposes participants to interventions and procedures to gather systematic data that may be used to improve overall health and well-being. To ensure that research is ethical, RECs must ensure that the risks and burdens to participants are not excessive and that …. (shrink)

The disagreement over whether Aristotle recognized rights in some form unavoidably involves disagreement over what rights are, and the theory of rights itself is still highly contested. There is no consensus concerning how " right'? is to be defined, how rights are to be theoretically grounded, or how rights theory is to be applied in particular circumstances. This is not, however, a good reason to dismiss the issue of whether there are rights in Aristotle: for Aristotle, like modern rights theorists, (...) is concerned about the moral and legal status of the individual within the community, and he expresses this in terms of claims of justice. The issue is worthy of study not only because it can lead to a deeper understanding of Aristotle's conceptions of justice and the common good, but also because it may shed valuable light on the theoretical foundations of human rights, since he offers a theory of political justice which is based on a metaphysical theory of human nature. (shrink)

We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between “legally dead” and “legally blind” (...) demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about brain death, but it has practical implications as well. Once brain death is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike. (shrink)

The idea that there could be spatially extended mereological simples has recently been defended by a number of metaphysicians (Markosian 1998, 2004; Simons 2004; Parsons (2000) also takes the idea seriously). Peter Simons (2004) goes further, arguing not only that spatially extended mereological simples (henceforth just extended simples) are possible, but that it is more plausible that our world is composed of such simples, than that it is composed of either point-sized simples, or of atomless gunk. The difficulty for these (...) views lies in explaining why it is that the various sub-volumes of space occupied by such simples, are not occupied by proper parts of those simples. Intuitively at least, many of us find compelling the idea that spatially extended objects have proper parts at every sub-volume of the region they occupy. It seems that the defender of extended simples must reject a seemingly plausible claim, what Simons calls the geometric correspondence principle (GCP): that any (spatially) extended object has parts that correspond to the parts of the region that it occupies (Simons 2004: 371). We disagree. We think that GCP is a plausible principle. We also think it is plausible that our world is composed of extended simples. We reconcile these two notions by two means. On the one hand we pay closer attention to the physics of our world. On the other hand, we consider what happens when our concept of something—in this case space—contains elements not all of which are realized in anything, but instead key components are realized in different features of the world. (shrink)

Controversies about the diagnosis and meaning of brain death have existed as long as the concept itself. Here we review the historical development of brain death, and then evaluate the various attempts to justify the claim that patients who are diagnosed as brain dead can be considered dead for all legal and social purposes, and especially with regard to procuring their vital organs for transplantation. While we agree with most commentators that death should be defined as the loss of integration (...) of the functioning of the organism as a whole, we conclude that patients diagnosed as brain dead have not, in fact, lost this integrated functioning. We close with reflections on the implications of this conclusion generally and particularly with regard to organ transplantation, and briefly make reference to alternative approaches to justifying the procurement of transplantable organs that do not depend upon a flawed approach to the diagnosis of death. (shrink)

The principles for universal reading models proposed by Frost correspond to developmental theories, in which neurocognitive constraints and cultural experiences shape development. We question his contention that Hebrew word identification is fundamentally about roots, excluding verbal and nominal word-pattern morphemes; and we propose that readers use all information available in stimuli, adjusting for volume and usefulness.

A letter to the editor from Howard Brody, David Buchanan, and Franklin G. Miller in response to the recent article by Erik Malmqvist Understanding Exploitation," March-April 2011).

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

Advances in life-saving technologies in the past few decades have challenged our traditional understandings of death. Traditionally, death was understood to occur when a person stops breathing, their heart stops beating and they are cold to the touch. Today, physicians determine death by relying on a diagnosis of ‘total brain failure’ or by waiting a short while after circulation stops. Evidence has emerged, however, that the conceptual bases for these approaches to determining death are fundamentally flawed and depart substantially from (...) the established biological conception of death. We argue that the current approach to determining death consists of two different types of unacknowledged legal fictions. These legal fictions were developed for practices that are largely ethically legitimate but need to be reconciled with the law. The considerable debate over the determination of death in the medical and scientific literature has not informed the public that vital organs are being procured from still-living donors and it seems unlikely that this information can remain hidden for long. Given the instability of the status quo and the difficulty of making the substantial legal changes required by complete transparency, we argue for a second-best policy solution: acknowledging the legal fictions involved in determining death to move in the direction of greater transparency. This may someday result in more substantial legal change to directly confront the challenges raised by life-sustaining and life-preserving technologies without the need for fictions. (shrink)

: This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in (...) moral problem solving are discussed. (shrink)

An overview of the concept of Strong Emergence, and a summary of the papers within the special issue.

Initial responses to questionnaires used to assess participants' understanding of informed consent for malaria vaccine trials conducted in the United States and Mali were tallied. Total scores were analyzed by age, sex, literacy (if known), and location. Ninety-two percent (92%) of answers by United States participants and 85% of answers by Malian participants were correct. Questions more likely to be answered incorrectly in Mali related to risk, and to the type of vaccine. For adult participants, independent predictors of higher scores (...) were younger age and female sex in the United States, and male sex in Mali. Scores in the United States were higher than in Mali (P = 0.005). Despite this difference participants at both sites were well informed overall. Although interpretation must be qualified because questionnaires were not intended as research tools and were not standardized among sites, these results do not support concerns about systematic low understanding among research participants in developing versus developed countries. (shrink)

As computer-based information systems start to have a great impact on people, organizations, and society as a whole, there is much debate about information technology in relation to social control and privacy, security and reliability, and ethics and professional responsibilities. However, more often than not, these debates reveal some fundamental disagreements, sometimes about first principles. In this article the authors suggest that a fruitful and interesting way to conceptualize some of these moral and ethical issues associated with the use of (...) information technology is to apply the principles of Aristotle's ethics to this topic. They argue that framing the moral and ethical choices associated with information technology in Aristotelian terms draws attention to the fact that there are fundamental dilemmas to be addressed. These dilemmas are discussed in relation to the four areas suggested by Dejoie, Fowler, and Paradice (1991): (a) privacy, (b) information accuracy, (c) access to information, and (d) intellectual property rights. The dilemmas associated with all four areas are illustrated with references to recent legal developments in Australia and New Zealand. (shrink)

A summary of the papers within the Philosophica special issue on Strong Emergence.

_Philosophy Through Science Fiction_ offers a fun, challenging, and accessible way in to the issues of philosophy through the genre of science fiction. Tackling problems such as the possibility of time travel, or what makes someone the same person over time, the authors take a four-pronged approach to each issue, providing · a clear and concise introduction to each subject · a science fiction story that exemplifies a feature of the philosophical discussion · historical and contemporary philosophical texts that investigate (...) the issue with rigor, and · glossary, plot profiles of pertinent science fiction stories and films, and questions for further reflection. _Philosophy Through Science Fiction_ includes stories from contemporary science fiction writers including Greg Egan and Mike Resnick, as well as from classic authors like Philip K. Dick and Robert Heinlein. Philosophy readings include historical pieces by René Descartes and David Hume, and contemporary pieces by John Searle and Mary Midgley. (shrink)

Der folgende Artikel ist im Jahr 2003 unter dem Titel „Clinical Pragmatism: A Method of Moral Problem Solving“ in dem Sammelband „Pragmatic bioethics“ erschienen, welcher sich mit der Bedeutung der pragmatistischen Philosophie für die Praxis befasst. In dem vom Internisten und Bioethiker Joseph J. Fins, dem Thoraxchirurgen Matthew D. Bacchetta und dem Philosophen und Medizinethiker Franklin G. Miller verfassten Beitrag wird der pragmatistische Ansatz in der klinischen Ethik anhand eines Fallbeispiels gleichzeitig beschrieben, begründet und demonstriert. Obgleich die Denkrichtung der (...) pragmatistischen Philosophie sowohl wissenschaftstheoretisch wie praktisch hoch bedeutsam ist – ohne diese ist weder die heutige sozialwissenschaftliche Forschung noch die angewandte, insbesondere die klinische Ethik denkbar –, werden pragmatistische Ansätze im deutschsprachigen Raum bis heute eher rudimentär rezipiert. (shrink)

One standard criticism of the doctrine of continuous creation is that it entails the occasionalist position that God alone is a true cause and that the events we commonly identify as causes are merely the occasions upon which God brings about effects. I begin by clearly stating Malebranche's argument from continuous creation to occasionalism. Next, I examine two strategies for resisting Malebranche's argument ??? strong and weak concurrentism ??? and argue that weak concurrentism is the more promising strategy. Finally, I (...) argue that weak concurrentism requires a necessitarian approach to secondary causation. (shrink)

Support vector machines are being used increasingly in affective science as a data-driven classification method and feature reduction technique. Whereas traditional statistical methods typically compare group averages on selected variables, SVMs use a predictive algorithm to learn multivariate patterns that optimally discriminate between groups. In this review, we provide a framework for understanding the methods of SVM-based analyses and summarize the findings of seminal studies that use SVMs for classification or data reduction in the behavioral and neural study of emotion (...) and affective disorders. We conclude by discussing promising directions and potential applications of SVMs in future research in affective science. (shrink)

The traditional view of divine conservation holds that it is simply a continuation of the initial act of creation. In this essay, I defend the continuous-creation tradition against William Lane Craig's criticism that continuous creation fundamentally misconstrues the intuitive distinction between creation and conservation. According to Craig, creation is the unique causal activity of bringing new patient entities into existence, while conservation involves acting upon already existing patient entities to cause their continued existence. I defend continuous creation by challenging Craig's (...) intuitive distinction and by showing that the alternative account of creation and conservation he bases upon it is fraught with serious internal difficulties. (shrink)

Assesses the presuppositions underlying Aristotle's political theory. The principle of teleology holds that human beings strive to fulfil certain natural ends such as rationality and social cooperation; the principle of perfectionism holds that the good for human beings consists in the attainment of these ends; the principle of community holds that individuals can attain the good only if they are subject to the authority of the community, including the state ; and the principle of rulership holds that the community can (...) function successfully only if order is imposed on it by rational agents. This chapter considers the extent to which these principles may be defended against powerful objections that have been raised by modern philosophers and scientists. Finally, it is pointed out that the modern theory of rights, which assumes a version of extreme individualism, faces serious difficulties, so that Aristotle's theory of rights, based on a moderately individualistic theory of justice, is an alternative still worthy of serious consideration. (shrink)

Justice is central to Aristotle's political theory because he holds that all constitutions are a form of justice. In so far as it is just in the universal sense, the constitution aims at the happiness of the political community; in so far as it is just in the particular sense of distributive justice, the constitution assigns rights to offices, property, or honours to the citizens in accordance with their worth. Aristotle also claims that political justice is partly natural and partly (...) legal, but adds that ‘one constitution only is everywhere according to nature the best’, thus implying that the polis is in a natural condition when it has the best constitution and laws. Aristotle recognizes that justice may exist outside the polis, but he regards political justice as the highest form of justice. (shrink)

Supports Ernest Barker's interpretation that Aristotle offers a ‘vindication of the right of private property.’ Although Aristotle emphasizes the common interests of the citizens, he also provides a place for private property in all of his constitutions, including the best constitution. The chapter argues that Aristotle gives a basic account of property ownership that is similar to modern concepts of property rights. He offers justifications of private property, states conditions under which property may be justly acquired, defends private property against (...) Plato's communism, and argues that property is indispensable for the exercise of citizenship. (shrink)

Although past commentators saw Aristotle as recognizing the rights of individuals, recent interpreters have objected that no single Greek word corresponds to the modern word ‘rights’. In reply, it is shown with evidence from Aristotle and other writers that the ancient Greek discourse of law and politics included distinct locutions corresponding to the different senses of ‘rights’ distinguished by the jurist W. N. Hohfeld: to dikaion corresponds to Hohfeld's claim right, exousia to a liberty or privilege, kurios to authority or (...) power, and adeia and ateleia to immunity. A right for Aristotle is essentially a just claim that a person has against other members of the same community, and a natural right is a just claim based in nature. Recent arguments that rights have theoretical implications inimical to Aristotle's principles are also found to be unpersuasive, because they rely on tendentious assumptions that would rule out many modern theories of rights as well. The chapter also indicates how a respect for the rights of others might be justified on the basis of Aristotelian practical wisdom. (shrink)

Aristotle states that ‘there is only one constitution which is everywhere according to nature the best.’ This constitution is unqualifiedly just and ‘according to nature’ because it promotes the common advantage. The interpretation of ‘common advantage’ is problematic: does it consist in the advantage of the citizens considered as distinct individuals or the advantage of the polis considered as a whole? Only on the former, individualistic interpretation would the best constitution be deeply committed to individual rights, and it is argued (...) that a moderate version of individualism is the correct interpretation of Aristotle's best constitution. The chapter goes on to consider difficulties in Aristotle's account of the best constitution, including his views on education and the question of which is better: virtuous kingship or the rule of law. (shrink)

Recognizing that the best or ideal constitution is generally unattainable, Aristotle employs a principle of proximity: although the highest end is best, if it is unattainable, legislation should aim at the result that is closest to the end and thus the best attainable outcome. In politics, this is called the ‘second sailing’, and Aristotle discusses such a constitution under the headings of polity, mixed constitution, and middle constitution. Although this constitution is correct and just, the standard is lowered in the (...) face of necessity. Still, the second‐best constitution serves as a norm for evaluating the various deviant constitutions that are forms of democracy and oligarchy. The second‐best constitution emulates the ideal constitution and it satisfies the maxim of unanimity, which in its strongest form requires that if a constitution is to be preserved, all the citizens should wish that it exist and continue unchanged. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President’s Council on Bioethics*Franklin G. Miller** (bio) and Robert D. Truog (bio)Traditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes (...) in the second half of the twentieth century prompted calls for a new, or at least expanded, definition of death: the development of intensive care medicine, especially the use of mechanical ventilators, and the advent of successful transplantation of vital organs. Patients with profound neurological damage, leaving them incapable of breathing on their own and in an irreversible coma, could be maintained for some period of time with the aid of mechanical ventilation. The situation of these patients posed two ethical questions. Is it appropriate to stop life-sustaining treatment? If so, is it acceptable to retrieve vital organs for transplantation to save the lives of others before stopping treatment?In 1968, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed that death could be determined on the basis of neurological criteria, thus providing a positive answer to these two questions (Ad Hoc Committee 1968). According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation. [End Page 185] Because they are dead, it is appropriate, indeed imperative, to stop mechanical ventilation. And because they are dead, it becomes ethical to procure vital organs for transplantation before stopping what otherwise would be life-sustaining treatment. Remarkably, this innovative neurological determination of death became, with little debate or controversy, the established position in medical ethics and the law throughout the United States.The Harvard Committee articulated the diagnosis of “irreversible coma,” but merely asserted that this condition constituted death. No explanatory rationale was provided. It fell to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research to provide an authoritative rationale in its 1981 report, Defining Death. The second paragraph of the report set the stage as follows: “The question addressed here is not inherently difficult or complicated. Simply, it is whether the law ought to recognize new means for establishing that the death of a human being has occurred” (President’s Commission 1981, p. 3). The Commission claimed that “death is a unitary phenomenon” (p. 7) and that the determination of death by neurological criteria, in terms of the absence of all brain function, is consistent with the traditional conception of death as the cessation of vital functioning of the organism as a whole. The key issue is the integrative functioning of the human organism, which ceases to exist, according to the Commission, when the whole brain, including higher cortical areas and the brain stem, fails to function. Although “brain-dead” patients do not appear to be dead—i.e., the reality of their death is “masked” by the activity of mechanical ventilation—the patient’s body has irreversibly lost all capacity for integrative functioning. In the words of the Commission: “When artificial means of support mask this loss of integration as measured by the old methods [cessation of respiration and heart beat], brain-oriented criteria and tests provide a new window on the same phenomenon” (p. 33). The President’s Commission was instrumental in developing and establishing “The Uniform Definition of Death Act”: “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead” (p. 2).Although the question posed by the President’s Commission was easy to articulate, the answer, over time, has proved complicated and controversial. The coherence and cogency of determining death by neurological criteria has been challenged. Various experts have demonstrated that “brain-dead” patients maintained on mechanical ventilation display a range of vital, integrative, functioning, which conflicts with the judgment that they are dead (Truog and... (shrink)

¿Cómo reacciona la ciudadanía en un sistema político polarizado ante una emergencia como la pandemia de la COVID-19?, ¿cómo procesa la ciudadanía las narrativas polarizadas que están en conflicto?, y ¿qué imagen se forman de la gestión política de la amenaza de la pandemia? En EE. UU, hay que retrotraerse a la epidemia de la polio de hace 70 años para encontrar una emergencia sanitaria como la pandemia de la COVID-19. No obstante, hay importantes diferencias; en la década de 1950, (...) el clima político de los EE.UU. era mucho más uniforme y consensuado que el actual, profundamente dividido y polarizado. Este trabajo utiliza datos de un estudio longitudinal realizado durante 35 años en personas jóvenes de la Generación X (ahora ya en la cuarentena) y datos provenientes de encuestas realizadas en Estados Unidos durante tres décadas, con el propósito de examinar los patrones de adquisición de la información en la comprensión de una nueva amenaza. Nuestro análisis de los últimos 35 años de la Generación X muestra que, en las elecciones de 2020, el factor predictivo del voto individual que tuvo más fuerza fue una ideología política polarizada, pero, aquellas personas que contaban con una mejor comprensión del coronavirus fueron más críticas con la gestión de la pandemia de la COVID-19 que realizó la administración de Donald Trump y estuvieron más predispuestas a votar por Joe Biden que a votar por Trump. Un análisis paralelo de una muestra probabilística representativa de personas adultas estadounidenses en 2020 reveló el mismo patrón de influencia del partidismo ideológico, la comprensión del coronavirus y la evaluación de la administración de Trump. Los resultados muestran que el conocimiento y la comprensión pueden proporcionar un efecto moderador crítico en un sistema político polarizado y dividido. (shrink)

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

Ayn Rand's political theory is based on the normative principles that man's life is the standard of value and that concern with his own life is man's primary moral purpose, and the metaphysical facts that reason is his basic tool of survival and that its exercise is volitional and requires the absence of coercion. This chapter first presents Rand's analysis of the nature of government. It then discusses why Rand holds that the proper purpose of government is the securing of (...) individual rights, and why it follows from that that capitalism is the only moral social system. In detailing Rand's defense of capitalism, the chapter also examines why she is an ardent proponent of property rights, and thus why property rights take a central place in her writings on politics. Finally, the chapter describes Rand's defense of intellectual property rights, which she views as core property rights. (shrink)