Energy has an ambivalent status in social theory, variously figuring as a driver or an outcome of social and institutional change, or as something that is woven into the fabric of society itself. In this article the authors consider the underlying models on which different approaches depend. One common strategy is to view energy as a resource base, the management and organization of which depends on various intersecting systems: political, economic and technological. This is not the only route to take. (...) The authors develop an alternative approach, viewing energy supply and energy demand as part of the ongoing reproduction of bundles and complexes of social practice. In articulating and comparing these two positions they show how social-theoretical commitments influence the ways in which problems like those of reducing carbon emissions are framed and addressed. Whereas theories of practice highlight basic questions about what energy is for, these issues are routinely and perhaps necessarily obscured by those who see energy as an abstract resource that structures or that is structured by a range of interlocking social systems. (shrink)

Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centred outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated (...) patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centred TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centred TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centred outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarised, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilisation of multivariate prediction models to inform individually-tailored interventions targeting a range of health conditions. (shrink)

During the past two decades, several reports have documented substantial support from clinicians, policy-makers, and the general public for the use of advance directives, yet studies continue to find that only a minority of individuals have completed these legal documents. Advance directives are written instructions, such as living wills or durable powers of attorney for health care, which describe an individual's medical treatment wishes in the event that individual becomes incapacitated in the future. The completion and use of advance directives (...) is one of several components of the broader activity of advance care planning, that is, the overall planning and communication of personal wishes concerning future medical care.In December 1991, the federal Patient Self-Determination Act became effective. Promoted as a federal initiative to enhance an individual's control over medical treatment decision making and, therefore, patient autonomy and self-determination, PSDA placed several new requirements on health care organizations receiving Medicare or Medicaid payments. (shrink)

Adopting the perspective of another person is an important aspect of social cognition and has been shown to depend on multisensory signals from one’s own body. Recent work suggests that interoceptive signals not only contribute to own-body perception and self-consciousness, but also to empathy. Here we investigated if social cognition – in particular adopting the perspective of another person – can be altered by a systematic manipulation of interoceptive cues and further, if this effect depends on empathic ability. The own-body (...) transformation task – wherein participants are instructed to imagine taking the perspective and position of a virtual body presented on a computer screen – offers an effective way to measure reaction time differences linked to the mental effort of taking an other’s perspective. Here, we adapted the OBT with the flashing of a silhouette surrounding the virtual body, either synchronously or asynchronously with the timing of participants’ heartbeats. We evaluated the impact of this cardio-visual synchrony on reaction times and accuracy rates in the OBT. Empathy was assessed with the empathy quotient questionnaire. Based on previous work using the cardio-visual paradigm, we predicted that synchronous cardio-visual stimulation would increase self-identification with the virtual body and facilitate participants’ ability to adopt the virtual body’s perspective, thereby enhancing performance on the task, particularly in participants with higher empathy scores. We report that participants with high empathy showed significantly better performance during the OBT task during synchronous versus asynchronous cardio-visual stimulation. Moreover, we found a significant positive correlation between empathic ability and the synchrony effect. We conclude that synchronous cardio-visual stimulation between the participant’s body and a virtual body during an OBT task makes it easier to adopt the virtual body’s perspective, presumably based on multisensory integration processes. However, this effect depended on empathic ability, suggesting that empathy, interoception and social perspective taking are inherently linked. (shrink)

Orations of the Fatimid Caliphs: Festival Sermons of the Ismaili Imams. Ed. and tr. Paul E. Walker. Ismaili Texts and Translations Series, vol. 10. London: I. B. Tauris, with the Institute of Ismaili Studies, 2009. Pp. xvii + 162 + 58. £29.50, $51.29.

Background: Explicating nurses’ moral identities is important given the powerful influence moral identity has on the capacity to exercise moral agency. Research objectives: The purpose of this study was to explore how nurses narrate their moral identity through their understanding of their work. An additional purpose was to understand how these moral identities are held in the social space that nurses occupy. Research design: The Registered Nurse Journal, a bimonthly publication of the Registered Nurses’ Association of Ontario, Canada, features a (...) regular column entitled, ‘In the End … What Nursing Means to Me …’ These short narratives generally include a story of an important moment in the careers of the authors that defined their identities as nurses. All 29 narratives published before June 2015 were analysed using a critical narrative approach, informed by the work of Margaret Urban Walker and Hilde Lindemann, to identify a typology of moral identity. Ethical considerations: Ethics approval was not required because the narratives are publicly available. Findings: Two narrative types were identified that represent the moral identities of nurses as expressed through their work: (1) making a difference in the lives of individuals and communities and (2) holding the identities of vulnerable individuals. Discussion: Nurses’ moral identities became evident when they could see improvement in the health of patients or communities or when they could maintain the identity of their patients despite the disruptive forces of illness and hospitalization. In reciprocal fashion, the responses of their patients, including expressions of gratitude, served to hold the moral identities of these nurses. Conclusion: Ultimately, the sustainability of nurses’ moral identities may be dependent on the recognition of their own needs for professional satisfaction and care in ways that go beyond the kind of acknowledgement that patients can offer. (shrink)

Walker Percy was both a medical doctor and a serious Catholic—a scientist and a religious believer. He thought, however, that science had become hegemonic in the twentieth century and that it was incapable of answering the most fundamental needs of human beings. He thus leveled a critique of the scientific method and its shortcomings in failing to address the individual person over against the group. In response to these shortcomings Percy postulates a religious understanding of human life, one in (...) which man's life is understood as a pilgrimage or a search. The person who searches may not find the “object” of his search during his earthly life, but it is likely that he will come to a better understanding of himself by means of it. (shrink)

For deliberations on the ethical and meta-ethical implications of Alfred North Whitehead's process philosophy, here are abstracts and papers from the Ethics Section of the 6th International Whitehead Conference held at the University of Salzburg in Salzburg, Austria in July 2006. In accordance with the conference schedule, there are three subsections. The subsection on "Metaphysics of Morals and Moral Theory" includes contributions from Franklin I. Gamwell (Does Morality Presuppose God?), John W. Lango (abstract only), Duane Voskuil ("Ethics' Dipolar Necessities and (...) Theistic Implications), and Theodore Walker Jr. ("Neoclassical Cosmology and Matthew 22:36-40). The subsection on "Evaluating Moral Practices" includes contributions from Frederick Ferrè (abstract only), Seung Gap Lee (Hope for the Earth: A Process Eschatological Eco-ethics for South Korea), Mary Elizabeth Mullino Moore (Compassion, Creativity, and Form: The Ethics of Institutions), and George W. Shields (Ruse, Altruism, and Process Philosophy). The subsection on "Ethics and Aesthetic Values" includes contributions from Stephen T. Franklin (abstract only), Brian G. Henning (Is There an Ethics of Creativity?), Mihàly Tòth (Art of Life and the Ethics of Life Forming), and Guorong Yang (Problems and Perspectives in the Emerging of Global Society). (shrink)

Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating their values (...) and responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life. (shrink)

This essay explores small “ordinary” experiences of moral harm as problems of social injustice. Starting with two stories, we first argue against a dominant framework of personal responsibility that assigns responsibility to particular blameworthy agents. Instead we sketch an account of why structural responsibility for social harm must be considered, drawing on the work of Iris Marion Young and Pierre Bourdieu. Finally, drawing on Margaret Walker’s notion of moral repair and Christopher Marshall’s interpretation of the parable of the Good (...) Samaritan, we sketch an account of Christian moral responsibility grounded in restorative justice that seeks to address daily experiences of moral harm through the moral repair work of neighbor-love. (shrink)

Medical futility is often defined as providing inappropriate treatments that will not improve disease prognosis, alleviate physiological symptoms, or prolong survival. This understanding of medical futility is problematic because it rests on the final outcomes of procedures that are narrow and medically defined. In this article, Walker's `expressivecollaborative' model of morality is used to examine how certain critical care interventions that are considered futile actually have broader social functions surrounding death and dying. By examining cardiopulmonary resuscitation and life-sustaining intensive (...) care measures as moral practices, we show how so-called futile interventions offer ritualistic benefit to patients, families, and health care providers, helping to facilitate the process of dying. This work offers a new perspective on the ethical debate concerning medical futility and provides a means to explore how the social value of treatments may be as important in determining futility as medical scientific criteria. (shrink)

It may be the case that the most challenging moral problem of the twenty‐first century will be the relationship between the individual moral agent and the practices and institutions in which the moral agent is embedded. In this paper, we continue the efforts that one of us, Joan Liaschenko, first called for in 1993, that of using feminist ethics as a lens for viewing the relationship between individual nurses as moral agents and the highly complex institutions in which they do (...) the work of nursing. Feminist ethics, with its emphasis on the inextricable relationship between ethics and politics, provides a useful lens to understand the work of nurses in context. Using Margaret Urban Walker's and Hilde Lindemann's concepts of identity, relationships, values, and moral agency, we argue that health care institutions can be moral communities and profoundly affect the work and identity and, therefore, the moral agency of all who work within those structures, including nurses. Nurses are not only shaped by these organizations but also have the power to shape them. Because moral agency is intimately connected to one's identity, moral identity work is essential for nurses to exercise their moral agency and to foster moral community in health care organizations. We first provide a brief history of nursing's morally problematic relationship with institutions and examine the impact institutional master narratives and corporatism exert today on nurses’ moral identities and agency. We close by emphasizing the significance of ongoing dialogue in creating and sustaining moral communities, repairing moral identities, and strengthening moral agency. (shrink)

Background: While there have been studies exploring moral habitability and its impact on the work environments of nurses in Western countries, little is known about the moral habitability of the work environments of nurses and midwives in resource-constrained settings. Research objective: The purpose of this research was to examine the moral habitability of the work environment of nurses and midwives in Ghana and its influence on their moral agency using the philosophical works of Margaret Urban Walker. Research design and (...) participants: A critical moral ethnography was conducted through the analysis of interviews with 30 nurses and midwives, along with observation, and documentary materials. Ethical considerations: After receiving ethics approval, signed informed consent was obtained from participants before data collection. Results: Five themes were identified: (1) holding onto the values, identities, and responsibilities of being a midwife/nurse; (2) scarcity of resources as limiting capacity to meet caring responsibilities; (3) gender and socio-economic inequities shaping the moral-social context of practice; (4) working with incoherent moral understandings and damaged identities in the context of inter- and intra-professional relationships; and (5) surviving through adversity with renewed commitment and courage. Discussion: The nurses and midwives were found to work in an environment that was morally uninhabitable and dominated by the scarcity of resources, overwhelming and incoherent moral responsibilities, oppressive conditions, and workplace violence. These situations constrained their moral agency and provoked suffering and distress. The nurses and midwives negotiated their practice and navigated through morally uninhabitable work environment by holding onto their moral values and commitments to childbearing women. Conclusion: Creating morally habitable workplaces through the provision of adequate resources and instituting interprofessional practice guidelines and workplace violence prevention policies may promote safe and ethical nursing and midwifery practice. (shrink)

Background: Nurses are expected to provide comprehensive, holistic and ethically accepted care according to their code of ethics and practice. However, in Malawi, this is not always the case. This article analyses moral competence concept using the Walker and Avant's strategy of concept analysis. Objective: The aim of this article is to analyse moral competence concept in relation to nursing practice and determine defining attributes, antecedents and consequences of moral competence in nursing practice. Method: Analysis of moral competence concept (...) was done using Walker and Avant's strategy of concept analysis. Results: Deductive analysis was used to find the defining attributes of moral competence, which were kindness, compassion, caring, critical thinking, ethical decision making ability, problem solving, responsibility, discipline, accountability, communication, solidarity, honesty, and respect for human values, dignity and rights. The identified antecedents were personal, cultural and religious values; nursing ethics training, environment and guidance. The consequences of moral competence are team work spirit, effective communication, improved performance and positive attitudes in providing nursing care. Conclusion: Moral competence can therefore be used as a tool to improve care in nursing practice to meet patients' problems and needs and consequently increase public's satisfaction in Malawi. (shrink)

First published in 1998. Routledge is an imprint of Taylor & Francis, an informa company.

Although debates continue, studies of cognition in infancy suggest that knowledge begins to emerge early in life and constitutes part of humans' innate endowment. Early-developing knowledge appears to be both domain-specific and task-specific, it appears to capture fundamental constraints on ecologically important classes of entities in the child's environment, and it appears to remain central to the commonsense knowledge systems of adults.

Name der Zeitschrift: Semiotica Jahrgang: 2015 Heft: 205 Seiten: 191-205.

While the search for scientific measures, models and explanations of consciousness is currently a growing area of research, this thesis identifies a series of methodological problems with the field that suggest that ‘consciousness’ is not in fact a viable scientific concept. This eliminativist stance is supported by assessing the current theories and methods of consciousness science on their own grounds, and by applying frameworks and criteria for ‘good’ scientific practice from philosophy of science. A central problem consists in the way (...) that qualitative difference and dissociation paradigms are misused in order to identify measures of consciousness. Another problem concerns the wide range of experimental protocols used to operationalise consciousness and the implications this has on the findings of integrative approaches across behavioural and neurophysiological research. Following from this the way that mechanisms of consciousness have been inadequately demarcated, and how this affects whether ‘consciousness’ refers to any scientific kinds, is discussed. A final problem is the significant mismatch that exists between the common intuitions and phenomenological claims about the content of consciousness that motivate much current consciousness science, and the properties of neural processes that underlie sensory and cognitive phenomena.It is argued that the failure of these methods to be appropriately applied to the concept of consciousness, both in particular cases, and in the way that these methods fail to fulfil their crucial heuristic role in the practise of science, suggests that the concept of ‘consciousness’ should be eliminated from scientific discourse. Aside from the purely negative claim found in eliminativist accounts, the strong empirical grounding of this eliminativist claim also allows positive characterisations to be made about the products of the current science of consciousness, to (re-)identify real target phenomena and valid research questions for the mind sciences, and to suggest how the intuitions that ground the confused research program on consciousness result from real features of our cognitive architecture. (shrink)

RésuméÉtant donné un ensemble de données D, les tenants de l'unicité épistémique soutiennent qu'une seule réponse doxastique est rationnelle, tandis que les tenants du permissivisme épistémique soutiennent que plusieurs réponses doxastiques peuvent être rationnelles. Comme certains auteurs l'ont signalé, l'un des attraits de la position permissiviste est qu'elle nous permet de comprendre le désaccord philosophique comme un désaccord dans lequel aucune des parties ne commet de faute rationnelle, et donc de respecter le statut épistémique de chacune d'elles. Je soutiens au (...) contraire que la position permissiviste ne parvient pas à offrir un tel avantage dans de nombreux désaccords philosophiques. (shrink)

This article will examine the phase of Nishida’s thought in which he turns to the historical world and present the benefits of this turn to his overall philosophical project. In “The Philosophy of History in the ‘Later’ Nishida,” Woo-Sung Huh claims that Nishida Kitaro’s attempt to integrate history into his earlier writings on self-consciousness is a “wrong turn.” I will demonstrate how Huh’s criticism of Nishida’s writings on history stems from Huh’s own ontological assumption that consciousness and the historical world (...) occupy distinct realms. Leveling this criticism against Nishida causes the reader to miss Nishida’s greatest insight, namely that there is no such distinction; there is only one reality of consciousness and materiality. Nishida’s emphasis on the historical world makes his earlier claim that consciousness is inseparable from things more robust. I will argue that by expanding his earlier focus on consciousness to include the formative power of created physical objects and human bodies on consciousness, Nishida’s philosophy is actually strengthened. (shrink)

Drawing on her memories of growing up in a racially segregated South, the author argues not so much for the removal and erasure of Confederate memorials as for mutilating them or retaining a version of their presence glossed with an explanation for their rejection. Connecting the southern anti-Semitism and anti-Black racism of her youth, she explains the parallels and differences between German efforts to come to terms with the Holocaust and American efforts, southern and northern, to move beyond and make (...) reparation for both slavery and continuing twentieth- and twenty-first-century racism. (shrink)

"An examination of the writings on virtues and ethics of eighteenth-century Puritan Jonathan Edwards"--Provided by publisher.

While many books on ethics contain a chapter discussing prisoners’ rights and the ethical dimensions of research involving incarcerated persons, Vulnerability and Incarceration is the first monograph devoted to the subject. Victor interrogates the concept of vulnerability to examine prisoners’ right to medical research from a novel point of view.

E-games are a dramatically expanding dimension of contemporary exploitations of computing and computer network technologies - one that, thus far, has evoked much more heat among parents and politicians than light in the form of serious scholarly and philosophical analysis. We argue that e-games deserve such analysis in part because of their intrinsic philosophical interest as they raise primary philosophical questions of ontology, epistemology, human nature, the character of "gameplay," - and most especially, of ethics. We further suggest that such (...) analyses - exemplified by the articles collected here - may also contribute to resolving the larger social and political debates evoked by e-games. (shrink)

Background Ethical and scientific principles require that clinical trials address an important question and have the resources needed to complete the study. However, there are no clear standards for review that would ensure that these principles are upheld.Methods We conducted semi-structured interviews with a convenience sample of nineteen experts in clinical trial design, conduct, and/or oversight to elucidate current practice and identify areas of need with respect to ensuring the scientific value and feasibility of clinical trials prior to initiation and (...) while ongoing. We used a priori and grounded theory to analyze the data and constant comparative method to induce higher order themes.Results Interviewees perceived determination of scientific value as the responsibility of the investigator and, secondarily, other parties who review or oversee research. Interviewees reported that ongoing trials are rarely reevaluated due to emerging evidence from external sources, evaluation is complex, and there would be value in the development of standards for monitoring and evaluating evidence systematically. Investigators, IRBs, and/or data monitoring committees (DMCs) could undertake these responsibilities. Feasibility assessments are performed but are typically inadequate; potential solutions are unclear.Conclusions There are three domains where current approaches are suboptimal and in which further guidance is needed. First, who has the responsibility for conducting scientific review, whether it be the investigator, IRB, and/or DMC is often unclear. Second, the standards for scientific review (e.g., appropriate search terms, data sources, and analytic plan) should be defined. Third, guidance is needed on the evaluation of ongoing studies in light of potentially new and evolving evidence, with particular reference to evidence from outside the trial itself. (shrink)

_Explores the philosophical contributions and contemporary relevance of early German Romanticism._.