Background:Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives, setting, and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether research nurses experience unique ethical challenges distinct from those experienced (...) by nurses in traditional patient-care settings.Research objectives:The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice.Research design:The study utilized a qualitative descriptive design with individual interviews.Participants and research context:Participating nurses self-identified as having experienced ethical challenges during screening. The majority were Caucasian, female, and worked in outpatient settings. Approximately 50% had > 10 years of research experience.Ethical considerations:The human subjects review board approved the study. Written informed consent was obtained.Findings:Predominant themes were revealed: the inability to provide a probable good, or/do no harm, and dual obligations. The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship.Discussion:Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science.Conclusion:Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

Die Entscheidung für oder gegen lebensverlängernde Behandlungsmaßnahmen geht inzwischen der Hälfte aller Todesfälle in Europa voraus. Sie wird im klinischen Alltag häufig als ethische Herausforderung wahrgenommen, zudem sind unter Klinikern juristische Unsicherheiten und Fragen der korrekten Vorgehensweise verbreitet. Die hier vorgestellte Münchner Leitlinie zu Entscheidungen am Lebensende soll rechtliche Unsicherheit reduzieren, Klinikumsmitarbeiter für die ethische Dimension von Therapieentscheidungen am Lebensende sensibilisieren und ethisch begründete Entscheidungen fördern. Aus organisationsethischer Perspektive soll mit der Leitlinie eine Reflexion und Meinungsbildung zu einem ethisch relevanten (...) Themenbereich erfolgen und ein Beitrag zur Qualitätssicherung der Patientenversorgung und damit auch zur Patientenzufriedenheit geleistet werden. Die Prozesse der Leitlinienentwicklung, -aktualisierung und -implementierung werden vorgestellt. Die wesentlichen inhaltlichen Elemente der Leitlinie mit Darstellung der Rechtslage, der Definition zentraler Begriffe und Klärung medizinischer Entscheidungskriterien werden an Hand eines Entscheidungsalgorithmus dargestellt. Inhalt und Prozess der Leitlinienentwicklung werden auf die folgenden organisationsethischen Qualitätskriterien hin überprüft: deliberativer Prozess, inhaltliche Transparenz, repräsentative Zusammensetzung der Arbeitsgruppe, Implementierung und Evaluation der Leitlinie. Institutionen, die diese Leitlinie übernehmen wollen, sollten diese von einem autorisierten Gremium überprüfen lassen und auf die spezifischen Bedürfnisse ihrer Institution adaptieren. Hierfür ist eine vorgeschaltete Bedarfserhebung hilfreich. In dem Gremium sollten all diejenigen vertreten sein, die in der Folge mit der Leitlinie arbeiten werden. (shrink)

Die Entscheidung für oder gegen lebensverlängernde Behandlungsmaßnahmen geht inzwischen der Hälfte aller Todesfälle in Europa voraus. Sie wird im klinischen Alltag häufig als ethische Herausforderung wahrgenommen, zudem sind unter Klinikern juristische Unsicherheiten und Fragen der korrekten Vorgehensweise verbreitet. Die hier vorgestellte Münchner Leitlinie zu Entscheidungen am Lebensende soll rechtliche Unsicherheit reduzieren, Klinikumsmitarbeiter für die ethische Dimension von Therapieentscheidungen am Lebensende sensibilisieren und ethisch begründete Entscheidungen fördern. Aus organisationsethischer Perspektive soll mit der Leitlinie eine Reflexion und Meinungsbildung zu einem ethisch relevanten (...) Themenbereich erfolgen und ein Beitrag zur Qualitätssicherung der Patientenversorgung und damit auch zur Patientenzufriedenheit geleistet werden. Die Prozesse der Leitlinienentwicklung, -aktualisierung und -implementierung werden vorgestellt. Die wesentlichen inhaltlichen Elemente der Leitlinie mit Darstellung der Rechtslage, der Definition zentraler Begriffe und Klärung medizinischer Entscheidungskriterien werden an Hand eines Entscheidungsalgorithmus dargestellt. Inhalt und Prozess der Leitlinienentwicklung werden auf die folgenden organisationsethischen Qualitätskriterien hin überprüft: deliberativer Prozess, inhaltliche Transparenz, repräsentative Zusammensetzung der Arbeitsgruppe, Implementierung und Evaluation der Leitlinie. Institutionen, die diese Leitlinie übernehmen wollen, sollten diese von einem autorisierten Gremium überprüfen lassen und auf die spezifischen Bedürfnisse ihrer Institution adaptieren. Hierfür ist eine vorgeschaltete Bedarfserhebung hilfreich. In dem Gremium sollten all diejenigen vertreten sein, die in der Folge mit der Leitlinie arbeiten werden. (shrink)

Sur une suggestion de David Halperin, John Winkler, professeur à Yale puis à Stanford, rassembla, l’année de sa mort (1990), des études datées de 1981/1989, pour la plupart inédites. Leur convergence autorisait un livre sur l’éthique sexuelle grecque dans une approche sémiotique et anthropologique des pratiques sociales, se démarquant de l’histoire intellectuelle, comme de celles des idées et des mentalités, et du New Historicism des années 1980. À partir d’« observations informelles du compo...

This collection of essays on themes in the work of John Locke , George Berkeley , and David Hume , provides a deepened understanding of major issues raised in the Empiricist tradition. In exploring their shared belief in the experiential nature of mental constructs, The Empiricists illuminates the different methodologies of these great Enlightenment philosophers and introduces students to important metaphysical and epistemological issues including the theory of ideas, personal identity, and skepticism. It will be especially useful in courses devoted (...) to the history of modern philosophy. (shrink)

Boris Hessen’s ‘The Social and Economic Roots of Newton’s Principia’ (see https://doi.org./10.1163/1569206X-00002041) is considered a pioneering work in the historiography of the natural sciences. For some, it marks the founding moment of the ‘externalist’ approach to this field of study. Previously, Hessen published another paper on Newton entitled ‘Preface to Articles by A. Einstein and J.J. Thomson’, which, some maintain, bears a stronger resemblance to works in the ‘internalist’ camp of the historiography of the natural sciences. For decades, scholars have (...) puzzled over why Hessen chose to argue for, seemingly, diametrically opposed positions. In this paper, however, I argue that Hessen does not advance two different historiographical methods, but a single, dialectical-materialist approach that accounts for the ‘unity in opposition’ of the external and internal dimensions of natural-scientific theory. I draw from Hessen’s two papers on Newton, his previously untranslated writings, as well as selections from the secondary literature. (shrink)

The aim of the article is to use J.-P. Sartre’s reflections to show the influence of memory and imagination on the formation of an individual’s life history. The first part of the work consist of philosophical analyses. The imaginations are analyzed here compared to the perceptions and memories. The second part is devoted to autobiography, inseparably connected with the first-person perspective. The philosopher's different creative and intellectual activities and the wide range of material his works contain allow us to expose (...) the discussed issues in a diverse and complementary way. (shrink)

When John Winkler died in 1990, he was working on a book that aimed at a wide-ranging reinterpretation of Greek tragedy as a pedagogical exercise aimed primarily at the city’s young men (“ephebes,”...

Near the end of his Euboean Discourse, Dio attacks prostitution because it encourages men to seek sexual pleasure from other sources as well, including youths from noble households. While some scholars find no evidence in this diatribe for Dio's revulsion against male-male sexual relations per se, others conclude that it does indeed reflect Dio's contempt for all sexual relations between men. This study considers afresh Dio's treatments of sexual relations between men in his Discourses, and concludes that Dio may endorse (...) both male-male and male-female sexual relations when the agent initiating sexual contact pursues philia and eunoia. On the other hand, Dio expresses his disgust when the agent uses sexual relations self-indulgently for pleasure. The content and form of his arguments illustrate his familiarity with both Stoic doctrine and the forms of popular moralizing discourse. The paper first examines Dio's remarks in the third Discourse on Kingship, where he praises sexual relations in a measured way, indicating his familiarity with Stoic teachings on eros. Second, it considers Dio's remarks in the Euboean Discourse and supports John Winkler's argument that Dio objects to prostitution because it is rooted in self-indulgent pleasure-seeking. Dio's rhetorical approach reflects his awareness of popular teachings against self-indulgence typical of Cynic-Stoic diatribe. Third, the essay argues that Dio's remarks in the First Tarsian oration condemn adult male sexual passivity, not all aspects of sexual relations between males. Fourth, brief remarks in his Borystheniticus are not to be taken as evidence for Dio's hostility to sexual relations between men, though they possibly indicate his discomfort with how he imagines non-Greeks engage in sex. (shrink)

For decades scholars thought they knew Hume's position on the existence of causes and objects he was a sceptic. However, this received view has been thrown into question by the `new readings of Hume as a sceptical realist. For philosophers, students of philosophy and others interested in theories of causation and their history, The New Hume Debate is the first book to fully document the most influential contemporary readings of Hume's work. Throughout, the volume brings the debate beyond textual issues (...) in Hume to contemporary philosophical issues concerning causation and knowledge of the external world and issues in the history of philosophy, offering the reader a model for scholarly debate. This revised paperback edition includes three new chapters by Janet Broughton, Peter Kail and Peter Millican. Contributors: Kenneth A. Richman, Barry Stroud, Galen Strawson, Kenneth P. Winkler, John P. Wright, Simon Blackburn, Edward Craig, Martin Bell, Daniel Flage, Anne Jaap Jacobson, Rupert Read, Janet Broughton, Peter Millican, Peter Kail. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What Emotional Responding Is to Blame It Might Not Be to ResponsibilityR. J. R. Blair (bio)Keywordsblame, responsibility, emotional responses, psychopathyIn this interesting paper, Levy argues that by failing the moral/conventional distinction task (Blair 1995), individuals with psychopathy show a fundamental inability to categorize moral harms and as such their moral responsibility for their actions is reduced. He argues that, although we might still wish to incarcerate such individuals to (...) prevent them inflicting further harm on others, we should be less enthusiastic to blame them for their actions.In many respects, I agree with much of Levy's treatise. I certainly do not regard ascriptions of blame as useful in my own work with this population. I believe that our goal should be to fully understand the nature of their emotional deficit to be able to treat it similarly to other researchers who work to treat other emotional disorders. To me, Levy's argument appears sound.However, I offer three considerations and raise questions within these considerations that might further the debate. First, not all rules involve care-based emotional responses to victims. As Levy notes, this is the origin of the moral/conventional distinction. The problem here is that we do consider someone responsible if they break a conventional transgression. The student talking in class is generally considered blameworthy for this action as long as they knew that the rule of not talking during the lesson applied to that classroom. Yet, there is no victim and no care-based emotional response. Here, the only thing necessary to ascribe blame and responsibility is that the individual knew that a rule exists. Given this holds for conventional transgressions, why must we necessarily make a special case, with respect to responsibility, for moral transgressions?I believe that Levy is fully aware of this concern. He specifically makes reference to moral responsibility and writes that:the kind and degree of wrongness, and therefore blame, which attaches to infringements of the rules [against double parking or line-jumping] is very different, and usually much less significant, than the kind and degree attaching to moral wrongs. For psychopaths, all offences are merely conventional, and therefore—from their point of view—none of them are all that serious.(2007, p. 132)But the danger here is that issues of blame and responsibility may become highly relativistic and hinge on the strength of the emotional reaction. This is a problem because, although we might judge someone as more blameworthy if he intentionally [End Page 149] runs over five people rather than one, do we really consider that there is a distinction in moral responsibility between these two cases? If not, might not responsibility relate to factual knowledge of the existence of the rule against the transgression rather than the emotional response to the transgression?Second, there is considerable debate regarding whether psychopathy represents a taxon or a continuum (e.g., Vasey et al. 2005; Edens et al. 2006). Assuming it does represent a continuum, then we have an additional concern. How little of an emotional response to the transgression reduces one's moral responsibility and blame? Is it only the very reduced (although usually not absent) levels of emotional response that are shown by individuals with psychopathy? Or should we consider moral responsibility and blame proportional to the level of the emotional response? If this latter option is adopted, then what should we do about individuals who show heightened emotional responses, for example, patients with specific anxiety disorders (Rauch, Shin, and Wright 2003)? There are already some data that inhibited children (a developmental precursor to some anxiety disorders; Kagan and Snidman 1999) show heightened conscience development (Asendorpf and Nunner-Winkler 1992). If such children commit moral transgressions, should we regard them as more morally responsible and more blameworthy than regular folks?Third, the issue of intention received little attention in this paper. I have been considered to show a similar lack of attention to intention in the past (Nichols 2002) and, moreover, in some respects the issue was of limited concern given Levy's main goals. However, I mention it because so much of whether we consider someone responsible for their actions and... (shrink)

Tomemos el camino iniciado por Ricœur, quien, de la mano de Aristóteles, reconoce en el Mythos, en la trama, la estructura lingüística más conveniente para decir aquello en lo que consiste “devenir un sí mismo”. ¿Caben relatos que digan más pertinentemente qué es un sí mismo? La aparición, cada vez más insistente, de otros modos de narrar ―extraños y peculiares por su falta de estructura y por su condición de narraciones decepcionantes― cuestionan que la trama sea el modo narrativo que (...) más le pertenece a la identidad personal. Tal sería el caso de P. Handke, J. Winkler, H. Müller, T. Bernhard, C. Lispector, E. Jelinek, D. Kis o W.G Sebald. Entonces cabría la posibilidad de relatarnos no ya para sostenernos, para apacentarnos con viento ―en palabras de Sánchez Ferlosio― sino para decir más verdaderamente lo que somos: ruido y furia. «Es significativo que la relación que aquí se aprecia entre nuestra lectora y la literatura sea tan radicalmente filosófica. La lectora ha escrito un texto en el que destellan los aspectos más nodales del pensar contemporáneo, que en su realidad no deja de ser clásico. No se trata de que haya escudriñado asuntos filosóficos en los textos literarios, es que lo que resulta filosófico es su propia lectura, su mirada, su consideración, porque trata a los textos como la literatura se trata a sí misma». (shrink)

Background Inadequate knowledge among health care providers (HCPs) and parents of affected children limits the understanding and utility of secondary genetic findings (SFs) in under-represented populations in genomics research. SFs arise from deep DNA sequencing done for research or diagnostic purposes and may burden patients and their families despite their potential health importance. This study aims to evaluate the perspective of both groups regarding SFs and their choices in the return of results from genetic testing in the context of orofacial (...) clefts.Methods Using an online survey, we evaluated the experiences of 252 HCPs and 197 parents across participating cleft clinics in Ghana and Nigeria toward the return of SFs across several domains.Results Only 1.6% of the HCPs felt they had an expert understanding of when and how to incorporate genomic medicine into practice, while 50.0% agreed that all SFs should be returned to patients. About 95.4% of parents were willing to receive all the information from genetic testing (including SFs), while the majority cited physicians as their primary information source (64%).Conclusions Overall, parents and providers were aware that genetic testing could help in the clinical management of diseases. However, they cited a lack of knowledge about genomic medicine, uncertain clinical utility, and lack of available learning resources as barriers. The knowledge gained from this study will assist with developing guidelines and policies to guide providers on the return of SFs in sub-Saharan Africa and across the continent. (shrink)

The debate on the influence of markets on virtues has focused on two opposite hypotheses: the doux commerce thesis and the self-destruction thesis. Whereas the doux commerce hypothesis assumes that capitalism polishes human manners, the self-destruction hypothesis holds that capitalism erodes the moral foundation of society. This paper will develop a more balanced position by using the virtue ethics developed by Aristotle, which distinguishes several virtues. The research will focus on the question for which virtues the doux commerce or self-destruction (...) thesis is likely to hold. An extensive literature survey shows that market competition tends to stimulate diligence, crowd out temperance, generosity, and sociability, and stimulate envy. The effect on other virtues – i.e. courage, high-spiritedness, justice, and prudence – is ambiguous. (shrink)

We can contrast rationalising explanations of the form S φs because p with those of the form S φs because S believes that p. According the Common Kind View, the two sorts of explanation are the same. The Disjunctive View denies this. This paper sets out to elucidate the sense in which the Common Kind Theorist asserts, but the Disjunctivist denies, that the two explanations are the same. I suggest that, in the light of the distinction between kinds of explanation (...) and particular explanations, the relevant sameness thesis is ambiguous, thus giving us two distinct versions of the Common Kind View. I then argue that the only direct arguments for Disjunctivism available in the literature fail because they only succeed in undermining one version of the Common Kind View. I finish, however, by providing a fresh argument for the Disjunctive View which aims to undermine both versions of its competitor. (shrink)

Here is a surprisingly neglected question in contemporary epistemology: what is it for an agent to believe that p in response to a normative reason for them to believe that p? On one style of answer, believing for the normative reason that q factors into believing that p in the light of the apparent reason that q, where one can be in that kind of state even if q is false, in conjunction with further independent conditions such as q’s being (...) a normative reason to believe that p. The primary objective of this paper is to demonstrate that that style of answer cannot be right, because we must conceive of believing for a normative reason as constitutively involving a kind of rationality-involving relation that can be instantiated at all only if there is a known fact on the scene, which the agent treats as a normative reason. A secondary objective, achieved along the way, is to demonstrate that in their Prime Time Errol Lord and Kurt Sylvan do not succeed in undermining the factoring picture in general, only a simple-minded version of it. (shrink)

This paper begins with a Davidsonian puzzle in the epistemology of perception and introduces two solutions to that puzzle: the Truth-Maker View (TMV) and the Content Model. The paper goes on to elaborate (TMV), elements of which can be found in the work of Kalderon (2011) and Brewer (2011). The central tenant of (TMV) is the claim that one's reason for one's perceptual belief should, in all cases, be identified with some item one perceives which makes the proposition believed true. (...) I defend an argument against (TMV) which appeals to (a) the claim that the reason for which one believes should always to be identified with the explanans of the rationalising explanation to which one's belief is subject and (b) the claim that the explanantia of rationalising explanations must be identified with truths. I finish by replying to two objections to the argument. (shrink)