This is the first book to take nursing ethics beyond stock 'moral concepts' to a critical examination of the fundamental assumptions underlying the very nature of nursing. It takes as its point of departure the difficulties nurses experience practising within the confines of a bioethical model of health and illness and a hierarchical, technocratic health care system. The contributors go on to deal openly and honestly with controversial issues faced by nurses, such as euthanasia and HIV.

This is the first book to take nursing ethics beyond stock 'moral concepts' to a critical examination of the fundamental assumptions underlying the very nature of nursing. It takes as its point of departure the difficulties nurses experience practising within the confines of a bioethical model of health and illness and a hierarchical, technocratic health care system. The contributors go on to deal openly and honestly with controversial issues faced by nurses, such as euthanasia and HIV.

A team of renowned philosophers and a new generation of thinkers come together to offer the first book-length examination of the relationship between philosophical anthropology and animal studies.

This article takes issue with procedural reductionism, which is the inclination to reduce all matters of judgement and responsibility to the following of some procedure or rule. Two scenarios provide content for a discussion of professional discretion in the context of accountability. The author shows that in professional life there will always be situations that stand beyond the rules of procedures and require the unique judgement of the professional at the time. While this judgement may be determined by the facts (...) available in a situation of uncertainty, it cannot be reduced to the facts (including facts about rules and procedures). The moral judgement will still have an essential indeterminancy about it. (shrink)

Western civilization has probably reached an impasse, expressed as a crisis on all fronts: economic, technological, environmental and political. This is experienced on the cultural level as a moral crisis or an ethical deficit. Somehow, the means we have always assumed as being adequate to the task of achieving human welfare, health and peace, are failing us. Have we lost sight of the primacy of human ends? Governments still push for economic growth and technological advances, but many are now asking: (...) economic growth for what, technology for what? Health care and nursing are caught up in the same inversion of human priorities. Professionals, such as nurses and midwives, need to take on social responsibilities and a collective civic voice, and play their part in a moral regeneration of society. This involves carrying civic rights and duties into the workplace. (shrink)

In this article I attempt to transcend the mainstream conception of health care ethics, including nursing ethics, by bringing into the foreground a tension between a sense of life and an industrial-bureaucratic style of health care, with its emphasis on the systematic and procedural work culture necessary for mass production. I use the concept of ‘a sense of life’ to draw attention to the wisdom, sensitivity and responsibility that is necessary for the authentic care of others to be given a (...) chance in the development of modern health care. I emphasize the mindfulness that the professional requires for genuine care, and how the systematic organization of modern health care, on the whole, ignores, obstructs and even suppresses such mindfulness. (shrink)

The authors believe there is a need for novel ways of enhancing professional judgment and discretion in the contemporary healthcare environment. The objective is to provide a framework to guide a discursive analysis of an ongoing clinical scenario by a small group of healthcare professionals to achieve consensual understanding in the decision-making necessary to resolve specific healthcare inadequacies and promote organisational learning. REPVAD is an acronym for the framework’s five decision-making dimensions of reasoning, evidence, procedures, values, attitudes and defences. The (...) design is set out in terms of well-defined definitions of the dimensions, a rationale for using REPVAD, and explications of dimensions one at a time. Furthermore, the REPVAD process of application to a scenario is set out, and a didactic scenario is given to show how REPVAD works together with a sample case. A discussion is fleshed out in four real life student cases, and a conclusion indicates strengths and weaknesses and the possibility of further development and transferability. In terms of findings, the model has been tried, tested and refined over a number of years in the development of advanced practitioners at university healthcare faculties in two European countries. Consent was obtained from the four participating students. (shrink)

The paper attempts to account for the confusion over the validity of the concept of schizophrenia in terms of two closely related aspects of conceptual indeterminacy. Firstly, it is identified on the basis of a breakdown in intelligibility, but what constitutes such a breakdown is indeterminate. Secondly, the concept sits between the categories of natural disease or illness on the one hand, and character trait or moral failing or gift on the other. This entails an indeterminacy in attempting to define (...) the role that physiological explanation could have. Light may be thrown on the concept by exploring a distinction between a life story in which the schizophrenic condition emerges as the conclusion of the story and a causal process in which the condition is the end result or final consequence. (shrink)

This article takes issue with procedural reductionism, which is the inclination to reduce all matters of judgement and responsibility to the following of some procedure or rule. Two scenarios provide content for a discussion of professional discretion in the context of accountability. The author shows that in professional life there will always be situations that stand beyond the rules of procedures and require the unique judgement of the professional at the time. While this judgement may be determined by the facts (...) available in a situation of uncertainty, it cannot be reduced to the facts (including facts about rules and procedures). The moral judgement will still have an essential indeterminancy about it. (shrink)

Social, legal and health-care changes have created an increasing need for ethical review within end-of-life care. Multiprofessional clinical ethics committees (CECs) are increasingly supporting decision-making in hospitals and hospices. This paper reports findings from an analysis of formal summaries from CEC meetings, of one UK hospice, spanning four years. Using qualitative content analysis, five themes were identified: timeliness of decision-making, holistic care, contextual openness, values diversity and consensual understanding. The elements of an engaged clinical ethics in a hospice context is (...) not generally acknowledged nor its elements articulated. Findings from this study have the potential to explain some of the most challenging ethical problems and to contribute to their resolution. It may also guide future deliberation and raise CEC members' awareness of the recurrent issues and values of their CEC practice. (shrink)

China, India, Brazil and other major Third World nations have long refused to sign the Nuclear Non‐proliferation Treaty. This position might at first sight appear to be without any question morally unjustified and even irrational. Yet their claim that the treaty is ‘discriminatory’ merits the serious attention which it has not received. Only if certain aspects of this claim are accepted by the nuclear weapons signatories does a moral and rational onus to sign become unquestionable.

The assumptions of philosophy need scrutiny as much the assumptions of medicine do. Scrutiny shows that the philosophical method of bioethics is compromised, for it shares certain fundamental assumptions with medicine itself. To show this requires an unorthodox style of philosophy — a literary one. To show the compromised status of bioethics the paper discusses some seminal utilitarian discussions of the definition of death, of whether it is a bad thing, and of when it ought to occur.

Abortion is one of the great moral debates of the epoch. Is there a rational method by which the debate can be resolved? Can bioethics' promise of such a method be fulfilled? Surely, a strictly rational approach can establish solid grounds for our beliefs once and for all. We would then be justified in deeming as unreasonable anyone who does not accept the perfectly rational conclusions. I present two scenarios to show that there can be no such philosophically grounded method (...) and therefore no such facts to which everyone must agree. This does not mean that it is in fact impossible for people to reach agreement. It simply means that there is no incontrovertibly rational means by which they must do so. (shrink)

This article considers the development of nurse-led services as a part of a pilot study and explores the therapeutic nature of the role of the nurse. In particular it suggests a need for reconsideration of the fundamental values of nurse-led care in the context of changing organizational culture. Within the UK there has been pressure from policy makers to extend the role of the specialist nurse and create new nursing roles, shifting the boundaries between professional health groups. The philosophy of (...) nurse-led initiatives has therefore been driven mainly from a service redesign and clinical need standpoint rather than necessarily focusing on enhancing patients’ experience and the changes in organizational culture required to achieve this. While several studies have focused on the safety, comparative cost and comparative patient outcomes in nurse-led care in relation to traditional or doctor-led care, little attention has been given to the changing organizational values underlying the nursing role. Exploring this context is essential if new nursing roles are to provide more than relief for bottlenecks in the system and also meet their potential for providing patient centred and innovative models of care. (shrink)

Finocchiaro offers an interpretation of Antonio Gramscis Prison Notebooks. He is interested in Gramscis thoughts on politics, social science, and religion but tells us that he is not concerned directly with the content of these. Such details are best worked out after we know what he means by religion, science and politics (5). He thinks that Gramscis conceptual framework must be identified first so that one can then proceed to find more order in the Notebooks (5). There follows an extended (...) discussion of what Gramsci says about his method and the method of Croce, Bukharin, and Machiavelli. Unfortunately, the crucial question of the relation of Gramscis thought to that of Marx is not considered in any depth. (shrink)

Originally published in 1967, this book aims to develop an ethical theory which remedies the defects of Utilitarianism while recognising the truths upon which Utilitarians have insisted. Its thesis is offered as a challenge to all schools of moral philosophy which have flourished in the twentieth century. Dr Grice argues that there are two kinds of Judgement of moral obligation. Social Contract theory, in a form which avoids the classical objections, is employed in setting out the ground of basic obligations; (...) and the ultra obligations of individual men are found to be grounded in their own characters. He then demonstrates that the theory offered, unlike Utilitarianism, throws light on judgements of rights and justice. Moral good is seen eventually as the coping stone, not the foundation stone of morality. (shrink)

This study discovers a pattern to Diderot's thinking, a fundamental dualism attributable largely to the attitudes and assumptions of the time and giving a common structure to his ideas and writing. Geoffrey Bremner draws widely on Diderot's works in studying his ideas on perception and action, aesthetics, ethics and politics, as well as his plays and fiction. The subtlety of the textual analysis and the analogies Dr Bremner draws provide a convincing and illuminating argument for his interpretation. He supports (...) this but emphasising the intellectual circumstances in which Diderot wrote and demonstrating his links to other eighteenth- and seventeenth-century writers. His study will therefore make a valuable contribution to the reassessment of the period that is currently underway, as well as to the central, elusive problem presented by Diderot's thought itself. (shrink)

This study discovers a pattern to Diderot's thinking, a fundamental dualism attributable largely to the attitudes and assumptions of the time and giving a common structure to his ideas and writing. Geoffrey Bremner draws widely on Diderot's works in studying his ideas on perception and action, aesthetics, ethics and politics, as well as his plays and fiction. The subtlety of the textual analysis and the analogies Dr Bremner draws provide a convincing and illuminating argument for his interpretation. He supports (...) this but emphasising the intellectual circumstances in which Diderot wrote and demonstrating his links to other eighteenth- and seventeenth-century writers. His study will therefore make a valuable contribution to the reassessment of the period that is currently underway, as well as to the central, elusive problem presented by Diderot's thought itself. (shrink)

One of the ideas elaborated in my recent book is what I called the hermeneutical\nprinciple of the asymmetry between negative and positive evaluation: ’this\nprescribes that the textual evidence needed to justify a negative, unfavourable\nevaluation must be of a high quality, strength, and rigor, whereas for a positive\nevaluation less exacting standards are sufficient’ (Finocchiaro, 1988: 247). There,\nI applied this principle to several cases, relating in one way or another to\nGramsci: some were his critiques of other authors, some were my own critiques\nof (...) his ideas, and some were critiques by others; and the issues involved such\nquestions as the status of Marxism as a religion, as a science, and as politics.\nI believe the principle ought to be applied to book reviews. Now, Geoffrey\nHunt’s recent review of my book in this journal (Hunt, 1990) seems to me to be a\nclear violation of this principle, and therefore an answer to it will not only set the\nrecord straight, but may prove generally instructive. That is, his review devotes a\ngreat deal of space to criticizing my work, and very little to analysing, describing,\nor even summarizing it; and whatever description we find, it is largely inaccurate,\nunfair, and one-sided. In short, what he advances is a negative evaluation of my\nbook not properly and adequately documented and justified. (shrink)

I would first like to congratulate Dr Seale for producing a thought-provoking piece of research that has captured the imagination of the nation's media. 1 I would also like to point out an interesting discordance that I have noted with regard to the findings of this important research, which ought to stimulate further discussion. Although religious doctors were significantly less likely than their non-religious colleagues to provide continuous or deep sedation until death or to provide treatment with at least ….

A Nobel Prize winner, Dr. Szent-Györgyi concerns himself with the underlying forces and conditions that have prevented the realization of the higher possibilities of the American Dream, and, by extension, of all mankind. He addresses himself especially to the youth of the world in his attempt to show how man, the more he progresses technologically, seems the more to regress psychologically and socially, until he resembles his primate ancestors in a state of high schizophrenia. The fundamental question asked by this (...) book is: Why is it that most of the scientific research that is done to elevate human life serves in the end to destroy it? That this phenomenon exists is unarguable. How to alter it is the problem the author tackles. He finds the possibility, indeed the instrument of our survival, in our youth. Dr. Szent-Györgyi calls upon youth the world over to organize and exercise their power to create a new world. He implores them not to waste their energies in petulance and frustration-the world is ripe for the radical changes needed for man's survival, and for youth to fritter away their opportunity would be to compound the tragedy and seal the fate of mankind. Born into the fourth generation of a noted family of scientists in Hungary, Albert Szent-Györgyi decided at an early age to devote his life to biological research. As a medical student he required international recognition for his studies in microscopic anatomy. The First World War, which he spent in the service of the Austro-Hungarian army, caused a break in his career. After the war he left his devastated country to work for ten years in various countries, notably Germany, Holland, England and the United States. He then returned to his native Hungary to help rebuild science there. In 1937, he won the Nobel Prize for his studies on metabolism and for the discovery of ascorbic acid (Vitamin C). He soon found himself in conflict with the growing movement of Nazism, was arrested, escaped, and was hunted for years by the secret service of Hitler. After World War II, disappointed by Soviet colonialism and the terrorist methods of Stalin, he left Hungary and found refuge at the Marine Biological Laboratory of Woods Hole, Massachusetts. (shrink)

Recent research has investigated whether people think of their moral beliefs as objectively true facts about the world, or as subjective preferences. The present research examines variability in the perceived objectivity of different moral beliefs, with respect both to the content of moral beliefs themselves (what they are about), and to the social representation of those moral beliefs (whether other individuals are thought to hold them). It also examines the possible consequences of perceiving a moral belief as objective. With respect (...) to the content of moral beliefs, we find that beliefs about the moral properties of negatively valenced acts are seen as reliably more objective than beliefs about the moral properties of positively valenced acts. With respect to the social representation of moral beliefs, we find that the degree of perceived consensus regarding a moral belief positively influences its perceived objectivity. The present experiments also demonstrate that holding a moral belief to be objective is associated with a more ‘closed’ response in the face of disagreement about it, and with more morally pejorative attributions towards a disagreeing other person. (shrink)

Norms are a pervasive yet mysterious feature of social life. In Explaining Norms, four philosophers and social scientists team up to grapple with some of the many mysteries, offering a comprehensive account of norms: what they are; how and why they emerge, persist and change; and how they work.

Locke is famed for his caution in speculative matters: “Men, extending their enquiries beyond their capacities and letting their thoughts wander into those depths where they can find no sure footing; ‘tis no wonder that they raise questions and multiply disputes”. And he is skeptical about the pretensions of natural philosophy, which he says is “not capable of being made a science”. And yet Locke is confident that “Our reason leads us to the knowledge of this certain and evident truth, (...) that there is an eternal, most powerful and most knowing being; which whether anyone will please to call God it matters not”. His certainty about the existence and attributes of God, I will argue, led him to surprisingly strong convictions about a deep and disputed problem at the intersection of seventeenth century metaphysics and natural philosophy: the absolute reality of space and time. Specifically, he based his absolutist conceptions of space and time on God’s literal omnipresence and eternity. Leibniz probably had Locke in mind when he inveighed in 1716 against “real absolute space, the idol of some modern Englishmen”. And Leibniz was right a decade earlier to voice through his mouthpiece Theophilus the suspicion that, despite Locke’s claim to know nothing about the substance of void space, “there are grounds for thinking you know more about it than you say or believe that you do. Some people have thought that God is the place of objects”. (shrink)

Artificial Intelligence in the form of different machine learning models is applied to Big Data as a way to turn data into valuable knowledge. The rhetoric is that ensuing predictions work well—with a high degree of autonomy and automation. We argue that we need to analyze the process of applying machine learning in depth and highlight at what point human knowledge production takes place in seemingly autonomous work. This article reintroduces classification theory as an important framework for understanding such seemingly (...) invisible knowledge production in the machine learning development and design processes. We suggest a framework for studying such classification closely tied to different steps in the work process and exemplify the framework on two experiments with machine learning applied to Facebook data from one of our labs. By doing so we demonstrate ways in which classification and potential discrimination take place in even seemingly unsupervised and autonomous models. Moving away from concepts of non-supervision and autonomy enable us to understand the underlying classificatory dispositifs in the work process and that this form of analysis constitutes a first step towards governance of artificial intelligence. (shrink)

This groundbreaking book revisits the writings of classic theorists in an effort re-evaluate the importance and influence the psychology of esteem has on the economy. The authors explore ways the economy of esteem may be reshaped to improve overall social outcomes and offer new ways of thinking about how society works and may be made to work.

We argue that Hamiltonian mechanics is more fundamental than Lagrangian mechanics. Our argument provides a non-metaphysical strategy for privileging one formulation of a theory over another: ceteris paribus, a more general formulation is more fundamental. We illustrate this criterion through a novel interpretation of classical mechanics, based on three physical conditions. Two of these conditions suffice for recovering Hamiltonian mechanics. A third condition is necessary for Lagrangian mechanics. Hence, Lagrangian systems are a proper subset of Hamiltonian systems. Finally, we provide (...) a geometric interpretation of the principle of stationary action and rebut arguments for privileging Lagrangian mechanics. (shrink)

Science frequently gives us multiple, compatible ways of solving the same problem or formulating the same theory. These compatible formulations change our understanding of the world, despite providing the same explanations. According to what I call "conceptualism," reformulations change our understanding by clarifying the epistemic structure of theories. I illustrate conceptualism by analyzing a typical example of symmetry-based reformulation in chemical physics. This case study poses a problem for "explanationism," the rival thesis that differences in understanding require ontic explanatory differences. (...) To defend conceptualism, I consider how prominent accounts of explanation might accommodate this case study. I argue that either they do not succeed, or they generate a skeptical challenge. (shrink)