Istarted my nursing career as a pediatric nurse working with children and their families at the Children's Hospital National Medical Center in Washington, DC. My first position was a staff nurse on a busy surgical floor called 4 Blue. To some degree, and as I reflect on that time, one is never truly prepared as a newly minted nurse or physician for the realities of becoming a clinician. So it was for me. I initially worked a rotational schedule of two (...) weeks of days and two weeks of nights where textbook pediatric cases became everyday experiences. Caring for the most complex of childhood illnesses included patients with osteosarcoma, Wilms tumor, neuroblastoma, short gut syndrome, biliary... (shrink)

Who carries the burden of proof in analytic philosophical debates, and how can this burden be satisfied? As it turns out, the answer to this joint question yields a fundamental challenge to the very conduct of metaphysics in analytic philosophy. Empirical research presented in this book indicates that the vastly predominant goal pursued in analytic philosophical dialogues lies not in discovering truths or generating knowledge, but merely in prevailing over one’s opponents. Given this goal, the book examines how most effectively (...) to allocate and discharge the burden of proof. It focuses on premises that must prudently be avoided because a burden of proof on them could never be satisfied, and in particular discusses unsupportable bridge premises across inference barriers, like Hume’s barrier between ‘is’ and ‘ought’, or the barrier between the content of our talk or thought, and the world beyond such content. Employing this content/world barrier for a critical assessment of mainstream analytic philosophical methods, this book argues that we must prudently avoid invoking intuitions or other content of thought or talk in support of claims about the world beyond content, that is, metaphysically significant claims. Yet as content-located evidence is practically indispensable to metaphysical debates throughout analytic philosophy, from ethics to the philosophy of mathematics, this book reaches the startling conclusion that all such metaphysical debates must, prudently, be terminated. (shrink)

The effects of psycholinguistic variables on reading development are critical to the evaluation of theories about the reading system. Although we know that the development of reading depends on both individual differences (endogenous) and item-level effects (exogenous), developmental research has focused mostly on average-level performance, ignoring individual differences. We investigated how the development of word recognition in Chinese children in both Chinese and English is affected by (a) item-level, exogenous effects (word frequency, radical consistency, and curricular grade level); (b) subject-level, (...) endogenous individual differences (orthographic awareness and phonological awareness); and (c) their interactive effect. We tested native Chinese (Putonghua)-speaking children (n = 763) in grades 1 to 6 with both Chinese character and English word identification (lexical) decision tasks. Our findings show that (a) there were effects of both word frequency and age of acquisition in both Chinese and English, but these item-level effects generally weakened with increasing age; (b) individual differences in phonological and orthographic awareness each contributed to successful performance; and (c) in Chinese, item-level effects were weaker for more proficient readers. We contend that our findings can be explained by theoretical models that incorporate cumulative learning as the basis for development of item-level effects in the reading system. (shrink)

In his critique of egoism as a doctrine of ends, G. E. Moore famously challenges the idea that something can be someone. Donald Regan has recently revived and developed the Moorean challenge, making explicit its implications for the very idea of individual welfare. If the Moorean is right, there is no distinct, normative property good for, and so no plausible objectivism about ethics could be welfarist. In this essay, I undertake to address the Moorean challenge, clarifying our theoretical alternatives so (...) that we may better decide what to admit into our moral ontology and better assess what may be at stake in whether objectivists treat good or good for (or neither) as fundamental. I compare the Moorean and welfarist pictures of value, providing an account of the form and function of good for. According to this account expresses a distinct relational value that has its source in the value of persons. Good for value is thus a form of extrinsic value that provides agent-neutral reasons for action, and it plays a pervasive normative role in regulating child rearing, guiding individual life choices, and shaping social policy formation. (shrink)

Connie Wang ABSTRACT: Accounts of deep disagreements can generally be categorized as optimistic or pessimistic. Pessimistic interpretations insist that the depth of deep disagreements precludes the possibility of rational resolution altogether, while optimistic variations maintain the contrary. Despite both approaches’ respective positions, they nevertheless often, either explicitly or implicitly, agree on the underlying assumption that...

Using information collected from a convenience sample of graduate and undergraduate students affiliated with a Midwestern university in the United States, this study determined the extent to which gender (defined as sex differences) is related to consumers' moral philosophies and ethical intentions. Multivariate and univariate results indicated that women were more inclined than men to utilize both consequence-based and rulebased moral philosophies in questionable consumption situations. In addition, women placed more importance on an overall moral philosophy than did men, and (...) women had higher intentions to behave ethically. The marketing and practical implications of these findings are discussed, and the limitations of the research are presented along with several suggestions for future inquiry, which could advance current understanding of consumer ethics. (shrink)

Using information collected from a convenience sample of graduate and undergraduate students affiliated with a Midwestern university in the United States, this study determined the extent to which gender is related to consumers’ moral philosophies and ethical intentions. Multivariate and univariate results indicated that women were more inclined than men to utilize both consequence-based and rule-based moral philosophies in questionable consumption situations. In addition, women placed more importance on an overall moral philosophy than did men, and women had higher intentions (...) to behave ethically. The marketing and practical implications of these findings are discussed, and the limitations of the research are presented along with several suggestions for future inquiry, which could advance current understanding of consumer ethics. (shrink)

We review three possible theoretical mechanisms for the placebo effect: conditioning, expectancy and endogenous opiates and consider the implications of the first two for clinical research and practice in the area of pain management. Methodological issues in the use of placebos as controls are discussed and include subtractive versus additive expectancy effects, no treatment controls, active placebo controls, the balanced placebo design, between- versus within-group designs, triple blind methodology and the double expectancy design. Therapeutically, the possibility of shaping negative placebo (...) responses through placebo sag, overservicing and the use of placebos on their own are explored. Suggestions for using conditioned placebos strategically in conjunction with nonplacebos are made and ways of maximizing the placebo component of nonplacebo treatments are examined. Finally, the importance of investigating the placebo effect in its own right is advocated in order to better understand the long-neglected psychological aspects of the therapeutic transaction. (shrink)

Dialogical egalitarianism is the thesis that any proposition asserted in dialogue, if questioned, must be supported or else retracted. Dialogical foundationalism is the thesis that some propositions are privileged over this burden of proof, standing in no need of support unless and until support for their negation is provided. I first discuss existing arguments for either thesis, dismissing each one of them. Absent a successful principled argument, I then examine which thesis it is pragmatically more advantageous to adopt in analytic (...) philosophical dialogue. This requires identifying the goal of such dialogue, to the attainment of which the thesis would be so advantageous. To identify this goal, I draw on Douglas Walton’s typology of dialogues for an analysis of the types of dialogue of 110 representatively selected journal articles in current analytic philosophy. 95% of articles are found to instantiate persuasion dialogue. In light of the thus prevalent goal of persuading one’s opponent, I argue that the adoption of dialogical egalitarianism in analytic philosophical dialogue is pragmatically inescapable. (shrink)

In a digital era that neglects handwriting, the current study is significant because it examines the mechanisms underlying this process. We recruited 9- to 10-year-old Chinese children, who were at an important period of handwriting development, and adult college students, for both behavioral and electroencephalogram experiments. We designed four learning conditions: handwriting Chinese, viewing Chinese, drawing shapes followed by Chinese recognition, and drawing shapes followed by English recognition. Both behavioral and EEG results showed that HC facilitated visual word recognition compared (...) to VC, and behavioral results showed that HC facilitated visual word recognition compared to drawing shapes. HC and VC resulted in a lateralization of the N170 in adults, but not in children. Taken together, the results of the study suggest benefits of handwriting on the neural processing and behavioral performance in response to Chinese characters. The study results argue for maintaining handwriting practices to promote the perception of visual word forms in the digital age. (shrink)

Of the many ideas for which Ronald Dworkin is justly famous, perhaps the most striking is his idea that the US Constitution is to be read morally. This essay seeks to honor Dworkin’s idea by sketching the beginnings of an alternative approach to reading constitutions morally. It begins by distinguishing between the idea that constitutions of a certain sort are to be read morally and Dworkin’s way of reading a constitution morally. I review some of the well-known difficulties for his (...) approach in order to make clear how an alternative would need to do better. Finally, I sketch a moral learning approach to reading constitutions morally. I argue that concern for constitutional legitimacy, respect for the overriding authority of morality, and humility about our own limitations support an approach to interpreting a constitution that allows for moral learning to be reflected in the law. (shrink)

Stephen Darwall has recently suggested (following work by Mark Overvold) that theories which identify a person’s good with her own ranking of concerns do not properly delimit the ‘scope’ of welfare, making self-sacrifice conceptually impossible. But whether a theory of welfare makes self-sacrifice impossible depends on what self-sacrifice is. I offer an alternative analysis to Overvold’s, explaining why self-interest and self-sacrifice need not be opposed, and so why the problems of delimiting the scope of welfare and of allowing for self-sacrifice (...) are distinct. If my analysis is correct, desire theories may allow for self-sacrifice however they delimit the scope of welfare. (shrink)

Adaptive immunity provides the unique ability to respond to a nearly infinite range of antigenic determinants. Given the inherent plasticity of the adaptive immune system, a series of tolerance mechanisms exist to reduce reactivity toward self. While this reduces the probability of autoimmunity, it also creates an important gap in adaptive immunity: the ability to recognize microbes that look like self. As a variety of microbes decorate themselves in self‐like carbohydrate antigens and tolerance reduces the ability of adaptive immunity to (...) react with self‐like structures, protection against molecular mimicry likely resides within the innate arm of immunity. In this review, we will explore the potential consequences of microbial molecular mimicry, including factors within innate immunity that appear to specifically target microbes expressing self‐like antigens, and therefore provide protection against molecular mimicry. (shrink)

There has been neglect of systematic conceptual development and empirical investigation within consumer ethics. Scenarios have been a long-standing tool yet their development has been haphazard with little theory guiding their development. This research answers four questions relative to this gap: Do different scenario decision frames encourage different moral reasoning styles? Does the way in which framing effects are measured make a difference in the measurement of the relationship between moral reasoning and judgment by gender? Are true framing effects likely (...) to vary with the situation? and Are true framing effects likely to vary by gender? The conclusions reached were that (1) different scenario frames encourage both types of reasoning, but rule based moral reasoning is dominant regardless of frame, (2) accounting for formal equivalency in the measurement of true framing effects is likely to enhance the interpretation of studies in moral reasoning and judgment, (3) True framing effects are more likely to occur in situations with low to moderate perceived ethicality, and (4) true framing effects are not likely to vary by gender. Explanations as to why these results occurred are discussed. (shrink)

Accounts of deep disagreements can generally be categorized as optimistic or pessimistic. Pessimistic interpretations insist that the depth of deep disagreements precludes the possibility of rational resolution altogether, while optimistic variations maintain the contrary. Despite both approaches’ respective positions, they nevertheless often, either explicitly or implicitly, agree on the underlying assumption that argumentation offers the only possible rational resolution to deep disagreements. This paper challenges that idea by, first, diagnosing this argument-only model of arriving at rational resolutions, second, articulating a (...) competing but undertheorized Hegelian-informed approach, and third, attending briefly to some of the challenges of such an approach. (shrink)

On the traditional view, moral distress arises only in cases where an individual believes she knows the morally right thing to do but fails to perform that action due to various constraints. We seek to motivate a broader understanding of moral distress. We begin by presenting six types of distress that fall outside the bounds of the traditional definition and explaining why they should be recognized as forms of moral distress. We then propose and defend a new and more expansive (...) definition of moral distress and examine how it can enable the development of a taxonomy of moral distress. (shrink)

Dr. Brown, a hospitalist, admits Mark, a patient transferred from a local jail for management of cellulitis. The patient, who was taken into custody two days prior to hospital admission, has a history of intravenous heroin use. Mark explains that he had been prescribed buprenorphine-naloxone maintenance therapy for opioid use disorder for several years prior to being arrested and had not used other opioids during that time. As a policy, the jail where Mark is detained does not prescribe opioid agonists, (...) and his maintenance therapy was stopped upon his arrival there. Dr. Brown discovers that Mark is diaphoretic and appears distressed. Mark's symptoms suggest to Dr. Brown that, in addition to having cellulitis, Mark is actively withdrawing from opioids. Mark tells Dr. Brown that he has felt “horrible” since his buprenorphine-naloxone therapy was stopped and that he now has intense cravings for opioids. He asks Dr. Brown to help alleviate the withdrawal symptoms. Dr. Brown, who is accustomed to treating opioid withdrawal with opioid replacement therapy, wonders if she should initiate ORT for Mark while he is in the hospital. (shrink)

On elective students may not always be clear about safeguarding themselves and others. It is important that placements are safe, and ethically grounded. A concern for medical schools is equipping their students for exposure to and response to uncomfortable and/or unfamiliar requests in locations away from home, where their comfort and safety, or that of the patient, may be compromised. This can require legal, ethical, and/or moral reasoning on the part of the student. The goal of this article is to (...) establish what students actually encounter on elective, to inform better preparing students for safe and ethical medical placements. We discuss the implications of our findings, which are arguably applicable to other areas of graduate training, e.g. first medical roles post-qualification. An anonymised survey exploring clinical and ethical dilemmas on elective was issued across 3 years of returning final year elective medical students. Questions included the prevalence and type of potentially unsafe scenarios encountered, barriers to saying ‘no’ in unsafe situations, perceived differences between resource poor and developed world settings and the degree to which students refused or consented to participation in events outside of the ‘norms’ of their own training experience. Three hundred seventy-nine students participated. 45% were asked to do something “not permissible” at home. 27% were asked to do something they felt “uncomfortable” with, often an invasive clinical task. Half asked to do something not usually permissible were “comfortable”. 48% felt it more acceptable to bypass guidelines in developing settings. 27% refused an offer outside their experience. Of interest are reasons for “going along with” uncomfortable invitations, e.g. “emergency”, self-belief in ‘capability’ and being ‘more qualified’ than host-personnel. This “best pair of hands available” merits scrutiny. Adverse scenarios were not exclusive to developing settings. We discuss preparing students for decision-making in new contexts, and address whether ‘home’ processes are too inflexible to prepare students for ‘real’ medical life? Ethical decision-making and communicating reluctance should be included in elective preparation. (shrink)

Proponents of numerous recent theories of a person's good hold that a plausible account of the good for a person must satisfy existence internalism. Yet little direct defense has been given for this position. I argue that the principal intuition behind internalism supports a stronger version of the thesis than it might appear--one that effects a "double link" to motivation. I then identify and develop the main arguments that have been or might be given in support of internalism about a (...) person's good, showing how these arguments support this stronger version of internalism. (shrink)

During a period in which institutions have been refashioned to meet the demands of a complex social and political economy, the No Child Left Behind Act (NCLB) has helped to alter the public educational system. As scholars and researchers examine the material effects of NCLB, efforts to improve the educational system and its effects must also explore the relationship between policy and racial ideologies including discursive fantasies. This article examines the relationship between NCLB and racial fantasies of Black youth as (...) problematic others in order to help education reform scholarship and advocacy examine the violence of NCLB. (shrink)

In this engagingly written book, Colin McGinn advances a number of related theses, most prominent among them, that moral philosophy is in need of new methodologies in order to get at neglected questions about moral character. The methodology McGinn urges involves drawing upon literature for its deep and intricate portrayals of ethical themes. This would seem a natural approach given McGinn’s substantive views about ethics. He contends that our ethical knowledge is aesthetically mediated ; he speculates that the “innateness” of (...) ethics may be “a by-product of our innate grasp of folk psychology” which comes into play when we interpret literature; and he defends an “aesthetic theory of virtue” according to which virtue coincides with beauty of soul. (shrink)

The purpose of this study was to test a causal model of ethical conflict in practice and autonomy in a sample of 254 nurse practitioners working in the primary care areas of family health, pediatrics, adult health and obstetrics/gynecology in the state of Maryland. A test of the model was conducted using a path analytic approach with LISREL 8.30 hypothesizing individual, organizational and societal/market factors influencing ethical conflict in practice and autonomy. Maximum likelihood estimation was used to estimate the parameters (...) most likely to have generated the data. Forty-five percent of the total variance in ethical conflict was explained by the variables of ethical environment and ethical concern. Ethical concern, idealistic philosophy, ethics education in continuing education, percentage of client population enrolled in managed care, and market penetration explained 15% of the total variance in autonomy. The findings of this study indicate that the causal model of ethical conflict in practice and autonomy is consistent with the data and contributed to a fuller understanding of clinical decision making associated with practicing in a managed care environment. The final model supported a conceptual framework that is inclusive of three domains: individual, organizational and societal/market variables. (shrink)

In our everyday lives, we confront a host of moral issues. Once we have deliberated and formed judgments about what is right or wrong, good or bad, these judgments tend to have a marked hold on us. Although in the end, we do not always behave as we think we ought, our moral judgments typically motivate us, at least to some degree, to act in accordance with them. When philosophers talk about moral motivation, this is the basic phenomenon they seek (...) to understand. Moral motivation is an instance of a more general phenomenon—what we might call normative motivation—for our other normative judgments also typically have some motivating force. When we make the normative judgment that something is good for us, or that we have a reason to act in a particular way, or that a specific course of action is the rational course, we also tend to be moved. Many philosophers have regarded the motivating force of normative judgments as the key feature that marks them as normative, thereby distinguishing them from the many other judgments we make. In contrast to our normative judgments, our mathematical and empirical judgments, for example, seem to have no intrinsic connection to motivation and action. The belief that an antibiotic will cure a specific infection may move an individual to take the antibiotic, if she also believes that she has the infection, and if she either desires to be cured or judges that she ought to treat the infection for her own good. All on its own, however, an empirical belief like this one appears to carry with it no particular motivational impact; a person can judge that an antibiotic will most effectively cure a specific infection without being moved one way or another. (shrink)

The goal of the current study is to investigate the effects of the distractive textual information on the activation of predictive inference online, and how the readers with high or low working memory capacity differ in their online activation and text memory. To test the two hypothesis of attentional competition and semantic integration, we conducted three experiments to investigate whether a local prediction and a global prediction, both of which could be derived from the description of a critical event, are (...) generated in the mind of the reader, and how this generation process is influenced by contextual and cognitive factors of the reader. The results of Experiment 1 and 2 suggest that the elaboration of the global aspects in the narrative reduces the local prediction, but makes the global prediction more salient to occur. The evidence from Experiment 3 confirms the hypothesis that even automatic processes are constrained by distant contextual factors, in combination with differences in working memory, and examines how referentially local and global predictions are intertwined in text comprehension. Overall, these data support the immediate integration hypothesis across sentence boundaries at different representation levels, as well as interaction assumptions of different processing levels within referentially local and referentially global processing contexts. (shrink)

This essay explores the nature of narrative representations of individual lives and the connection between these narratives and personal good. It poses the challenge of determining how thinking of our lives in story form contributes distinctively to our good in a way not reducible to other value-conferring features of our lives. Because we can meaningfully talk about our lives going well for us at particular moments even if they fail to go well overall or over time, the essay maintains that (...) our good must consist in something more than an accumulation of good discrete moments. Since persons have the capacities to reason, remember, and imagine, our good depends on a larger view of our lives that integrates its particular moments in a narrative. That narrative provides shape and texture to our lives. Storytelling serves to connect the events of our lives to each other, and to explain why the meaning and value of past events or features of our lives can shift as the life, and hence the story of the life, continues to unfold. The essay concludes that narrative enables us to see our lives in ways that support, encourage, or promote our self-concept and self-worth as agents who have controlling authority over our own lives. (shrink)

Book Information Moral Realism: A Defence. Moral Realism:\nA Defence Russ Shafer-Landau , Oxford : Clarendon Press ,\n2003 , x + 322 , {Â}\textsterling35 ( cloth ) By Russ\nShafer-Landau. Clarendon Press. Oxford. Pp. x + 322.\n{Â}\textsterling35 (cloth:).

Background The COVID-19 pandemic continues to disrupt every society as SARs-CoV-2 variants surge among the populations. Health care providers are exhausted, becoming ill themselves, and in some instances have died. Indeed, hospitals are struggling to find staff to care for critically ill patients most in need. Previous work has reported on the unending work-related conditions that hospital staff are laboring under and their subsequent mental and physical health strains. Health care providers need support, but it is not clear where that (...) support is to come from. While much research has reported on the COVID-19-related fears of nurses and physicians, fewer studies have focused on supportive features of the hospital work environment and how it may provide relief to front-line health care providers.Purpose This purpose of this study was to explore an often-overlooked resource within hospital systems across the United States—clinical ethicists—and examine their many roles during COVID-19 and the types of ethical issues they addressed with nurses, physicians, administrators, and others.Methods This was a primary analysis of semi-structured, qualitative interviews with 23 clinical ethicists across the United States. The interviews were conducted from November 2020–April 2021 and were audiotaped, transcribed verbatim, and de-identified; both inductive and deductive analyses were used to identify qualitative themes.Results Five major themes were identified: ethical issues that were increasingly more complex, moral distress that was “endemic,” shifting ethical paradigms from the focus on the individual to the population, fostering a supportive environment, and organizational ethics: variation in the value, roles, and policy input of clinical ethicists.Conclusions Our findings report on the integral and expanded role of clinical ethicists at an unprecedented time in our nation, and how they stepped forward to support front-line clinicians in hospitals across the country. (shrink)

Volume 20, Issue 6, June 2020, Page 68-70.