The Covid‐19 pandemic has highlighted many of the difficult ethical issues that health care professionals confront in caring for patients and families. The decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. Our focus is on the implications for nurses, who are the largest global health care workforce but whose perspectives are not always fully considered. This essay discusses three overarching ethical issues that create a myriad of concerns and will likely affect nurses globally (...) in unique ways: the safety of nurses, patients, colleagues, and families; the allocation of scarce resources; and the changing nature of nurses’ relationships with patients and families. We urge policy‐makers to ensure that nurses’ voices and perspectives are integrated into both local and global decision‐making so as to minimize the structural injustices many nurses have faced to date. Finally, we urge nurses to seek sources of support throughout this pandemic. (shrink)

Ascribing mental qualities like beliefs, intentions and wants to a machine is sometimes correct if done conservatively and is sometimes necessary to express what is known about its state. We propose some new definitional tools for this: definitions relative to an approximate theory and second order structural definitions.

Moral distress has received much attention in the international nursing literature in recent years. In this article, we describe the evolution of the concept of moral distress among nursing theorists from its initial delineation by the philosopher Jameton to its subsequent deployment as an umbrella concept describing the impact of moral constraints on health professionals and the patients for whom they care. The article raises worries about the way in which the concept of moral distress has been portrayed in some (...) nursing research and expresses concern about the fact that research, so far, has been largely confined to determining the prevalence of experiences of moral distress among nurses. We conclude by proposing a reconsideration, possible reconstruction and multidisciplinary approach to understanding the experiences of all health professionals who have to make difficult moral judgements and decisions in complex situations. (shrink)

This collection of articles and associated discussion papers focuses on a problem that has attracted increasing attention from linguists and psychologists throughout the world during the past several years. Reduced to essentials, the problem is that of discovering the character of the mental capacities that make it possible for human beings to attain knowledge of their language on the basis of fragmentary and haphazard early linguistic experience. A fundamental assumption running through all of these contributions is that people possess strong (...) innate predispositions that are critical for success in this task. (shrink)

In the last three decades, considerable theoretical and empirical research has been undertaken on the topic of moral distress among health professionals. Understood as a psychological and emotional response to the experience of moral wrongdoing, there is evidence to suggest that—if unaddressed—it contributes to staff demoralization, desensitization and burnout and, ultimately, to lower standards of patient safety and quality of care. However, more recently, the concept of moral distress has been subjected to important criticisms. Specifically, some authors argue that the (...) standard account of moral distress elucidated by Jameton :542–551, 1984) does not refer to a discrete phenomenon and/or that it is not sufficiently broad and that this makes measuring its prevalence among health professionals, and other groups of workers, difficult if not impossible. In this paper, we defend the standard account of moral distress. We understand it as a concept that draws attention to the social, political and contextual determinants of moral agency and brings the emotional landscape of the moral realm to the fore. Given the increasing pressure on health professionals worldwide to meet efficiency, financial and corporate targets and reported adverse effects of these for the quality and safety of patient care, we believe that further empirical research that deploys the standard account moral distress is timely and important. (shrink)

These notes discuss formalizing contexts as first class objects. The basic relationships are: ist(c,p) meaning that the proposition p is true in the context c, and value(c,p) designating the value of the term e in the context c Besides these, there are lifting formulas that relate the propositions and terms in subcontexts to possibly more general propositions and terms in the outer context. Subcontextx are often specialised with regard to time, place and terminology. Introducing contexts as formal objects will permit (...) axiomatizations in limited contexts to be expanded to transcend the original limitations. This seems necessary to provide AI programs using logic with certain capabilities that human fact representation and human reasoning possess. Fully implementing transcendence seems to require further extensions to mathematical logic, ie. beyond the nonmonotonic inference methods first invented in AI and now studied as a new domain of logic. (shrink)

This article is inspired by recent psychological studies confirming that a child is not born a blank slate but has important innate capabilities. An important part of the ``learning'' required to deal with the three dimensional world of objects, processes, and other beings was done by evolution. Each child need not do this learning itself.

In AI, consciousness of self consists in a program having certain kinds of facts about its own mental processes and state of mind. We discuss what consciousness of its own mental structures a robot will need in order to operate in the common sense world and accomplish the tasks humans will give it. It's quite a lot. Many features of human consciousness will be wanted, some will not, and some abilities not possessed by humans have already been found feasible and (...) useful in limited contexts. We give preliminary fragments of a logical language a robot can use to represent information about its own state of mind. A robot will often have to conclude that it cannot decide a question on the basis of the information in memory and therefore must seek information externally. Gödel's idea of relative consistency is used to formalize non-knowledge. Programs with the kind of consciousness discussed in this article do not yet exist, although programs with some components of it exist. Thinking about consciousness with a view to designing it provides a new approach to some of the problems of consciousness studied by philosophers. One advantage is that it focusses on the aspects of consciousness important for intelligent behavior. (shrink)

Background: Written reflections on practice are frequently requirements of nursing curricula. They are widely accepted as necessary for improving critical thinking and problem-solving skills. Faculty, are expected to review reflections and provide feedback that helps professional development and facilitates good practice. It is less clear what the actions of nurse educators should be when ethical infractions are revealed in the narratives. Objectives: We had two aims: 1) To combine insights from a literature review of empirical and theoretical research related to (...) responding to ethical issues revealed in student reflections with our experiences reviewing the reflections of undergraduate nursing and midwifery students, and 2) to construct and analyze a hybrid case from these insights in order to develop guidelines for nurse educators. Research Design: A literature review was conducted using CINAHL, MEDLINE, PsycINFO, SocINDEX and ERIC databases and pertinent key words. A hybrid case was constructed of commonly encountered ethical issues using insights from the literature review and the authors’ experiences. The case was analyzed by combining Beauchamp and Childress’ principlist approach with Campbell and McCarthy’s ethical decision-making tool (Table 1). Participants and Research Context: No human participants Findings: A gap in the literature exists related to addressing ethical issues revealed in student practice reflections. However, a combination of insights from the literature and the authors’ experiences facilitated the development of a hybrid case. Subsequent case analysis facilitated the development of a series of guidelines that can be utilized to address a range of issues commonly emerging in the reflections of nursing students during practice experiences. Discussion: A number of recommendations and guidelines are provided to enable the safeguarding of students and staff and support them in practicing ethically. Conclusion: Structured ethical analysis of a constructed hybrid reflection of commonly revealed ethical issues was useful in developing guidelines for educators. (shrink)

OBJECTIVES: To investigate the need for hospital clinical ethics committees by studying the frequency with which ethical dilemmas arose, the perceived adequacy of the process of their resolution, and the teaching and training of staff in medical ethics. DESIGN: Interviews with individuals and three multidisciplinary teams; questionnaire to randomly selected individuals. SETTING: Two major London children's hospitals. RESULTS: Ethical dilemmas arose frequently but were resolved in a relatively unstructured fashion. Ethical concerns included: the validity of consent for investigations and treatment; (...) lack of children's involvement in consent; initiation of heroic or futile treatments; resource allocation. Staff expressed the need for a forum which would provide consultation on ethical issues, develop guidelines for good ethical practice, undertake teaching and training, and provide ethical reflection outside the acute clinical setting. CONCLUSION: Multidisciplinary, accountable and audited clinical ethics committees with predominantly advisory, practice development and educational roles could provide a valuable contribution to UK clinical practice and perhaps in other countries that have not developed hospital clinical ethics committees. (shrink)

To prevent and reduce the transmission of the coronavirus to vulnerable populations, the World Health Organization recommended the restriction of visitors to nursing homes. It was recognised that such restrictions could have profound impact on residents and their families. Nonetheless, these measures were strictly imposed over a prolonged period in many countries; impeding families from remaining involved in their relatives’ care and diluting the meaningful connections for residents with society. It is timely to explore the impact of public health measures (...) on people living in nursing homes from an ethical perspective. In order to foreground the ethical dimensions of the implications of visitor restrictions in nursing homes, we compiled an ethical case that reflects some recent experiences of nursing homes residents and their families, in the Irish Republic. We describe a series of events encountered by a woman and her family during the first wave of the pandemic in 2020 and we deploy an ethical decision-making tool to guide and structure our analysis. Our case analysis draws attention to ethical principles that are relevant to explicating the ethical duties and obligations that arise in relation to the interests, well-being, and safety of residents and their families, as well as nursing home staff and the wider community during a pandemic. These include the right of autonomy, trust, minimising harm, and proportionality. We conclude that a number of different strategies should be adopted by nursing homes and relevant regulatory bodies. This includes honest, regular communication between the nursing home staff, the resident and their family. Central to communications is the resident’s wishes, their current clinical status and the all-important wider public health obligations. National strategies include mass vaccination, the timely provision of guidance documents and interventions from regulatory bodies that are patient-centred, adaptable, and cost effective. (shrink)

We discuss first order theories in which individual concepts are admitted as mathematical objects along with the things that reify them. This allows very straightforward formalizations of knowledge, belief, wanting, and necessity in ordinary first order logic without modal operators. Applications are given in philosophy and in artificial intelligence. We do not treat general concepts, and we do not present any full axiomatizations but rather show how various facts can be expressed.

This article briefly outlines some of the key problems with the way in which the moral realm has traditionally been understood and analysed. I propose two alternative views of what is morally interesting and applicable to nursing practice and I indicate that instability has its upsides. I begin with a moral tale – a 'Good Samaritan' story – which raises fairly usual questions about the nature of morality but also the more philosophically fundamental question about the relationship between subjectivity and (...) moral agency. I then consider this relationship from the perspectives of two twentieth century philosophers: Emmanuel Levinas and Michel Foucault. Levinas' basic point is that the experience of ethical subjectivity is made possible through others: the demand to respond to the existence of others is the basic social structure that precedes individual freedom. If Levinas posits intersubjectivity as a fundamental or primitive feature of the moral realm, Foucault poses an even more basic question: how have moral subjects and relations of obligation been constituted? The aim of ethical inquiry, for Foucault, is to describe the network of discourses, institutions, relations, and practices through which certain kinds of subjects are constituted and constitute themselves, e.g. as a kind of person who can act morally. Finally, I consider some recent research in philosophy of nursing which illustrates how Levinasian and/or Foucauldian perspectives can deepen understanding of nurses' moral practices, specifically, the work of Norwegian public health nurses, Canadian pediatric nurses, and Irish midwives. I suggest that in spite of the instability of morality in general and the particular ethical challenges that face nurses, there are grounds for hope and possible strategies for living in unstable times. (shrink)

This paper makes the case for a pluralist, contextualist view of nursing ethics. In defending this view, I briefly outline two current perspectives of nursing ethics – the Traditional View and the Theory View. I argue that the Traditional View, which casts nursing ethics as a subcategory of healthcare ethics, is problematic because it (1) fails to sufficiently acknowledge the unique nature of nursing practice; and (2) applies standard ethical frameworks such as principlism to moral problems which tend to alienate (...) or undermine nursing ethical concerns. Alternatively, the Theory View, which aims to build an independent and comprehensive theory of nursing ethics, is also found wanting because it (1) fails to sufficiently acknowledge the heterogeneous nature of nursing practices; (2) overemphasizes the differences and undervalues the similarities between nurses and other health professionals; and (3) assumes that one ethical framework can be meaningfully applied across diverse moral problems and contexts.My alternative, is to argue that nursing ethics inquiry should take a pluralist and critical stance towards available ethical frameworks and the negotiation of the ethical realm. On this view, the search for moral consensus or a unique ethical framework for nursing is replaced by the task of working strategically with multiple frameworks in order to expand the moral agency of nurses and empower them to positively engage with moral uncertainty as an inevitable feature of living a moral life. I conclude by indicating some of the implications that this has for the teaching of nursing ethics. (shrink)

Why the narrative self? -- Contemporary interest in narrative theory -- Is the self real or illusory? -- Dennett's brand of naturalism -- The heterophenomenological method (HM) -- Consciousness and the self -- The naturalist narrative self -- Puzzle cases -- The HM and the narrative self -- The limitations of Dennett's account -- The limits of language -- Epistemological fragility -- Ontological fragility -- Naturalism and phenomenology -- Confronting naturalism -- Phenomenology and hermeneutics -- The detour of interpretation -- (...) Reflexivity -- The problem of personal identity -- The number of selves, identity relations and truth -- The capable self and its narrative identity -- Narrative identity and aristotelian muthos -- Narrative recounting of human lives -- LPSE-identity and literary puzzle cases -- Certainty, knowledge and attestation -- Narrative attestation -- Fact and fiction -- Narrative attestation -- The limitations of Ricoeur's account -- Selective appeals to literary and psychoanalytic discourses -- Focus on the self-examining self -- The ontological status of the narrative self -- The epistemological status of the narrative self -- The practical self -- Why the narrative self? (shrink)

Background: A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population. Research aim: To identify challenges in implementing the ‘Let Me Decide’ advance care planning programme in long-term-care. Research design: This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families. Participants and research context: long-term-care residents in two nursing homes and one community hospital. Ethical considerations: The (...) local research ethics committee granted ethical approval. Findings: Following implementation, over 50% of all residents had completed some form of end-of-life care plan. Of the 70 residents who died in the post-implementation period, 14% had no care plan, 10% (with capacity) completed an advance care directive and lacking such capacity, 76% had an end-of-life care plan completed for them by the medical team, following discussions with the resident (if able) and family. The considerable logistical challenge of releasing staff for training triggered development of an e-learning programme to facilitate training. Discussion: The challenges encountered were largely concerned with preserving resident’s autonomy, avoiding harm and suboptimal or crisis decision-making, and ensuring residents were treated fairly through optimisation of finite resources. Conclusions: Although it may be too late for many long-term-care residents to complete their own advance care directive, the ‘ Let Me Decide’ programme includes a feasible and acceptable option for structured end-of-life care planning for residents with variable capacity to complete an advance care directive, involving discussion with the resident (to the extent they were able) and their family. While end-of-life care planning was time-consuming to deliver, nursing staff were willing to overcome this and take ownership of the programme, once the benefits in improved communication and enhanced peace of mind among all parties involved became apparent in practice. (shrink)

Aim: The aim of this review is to examine the ways in which the concept of moral distress has been delineated and deployed in the argument-based nursing ethics literature. It adds to what we already know about moral distress from reviews of the qualitative and quantitative research. Data sources: CINAHL, PubMed, Web of Knowledge, EMBASE, Academic Search Complete, PsycInfo, Philosophers’ Index and Socindex. Review methods: A total of 20 argument-based articles published between January 1984 and December 2013 were analysed. Results: (...) We found that like the empirical literature, most authors in this review draw on Jameton’s original definition and describe moral distress in psychological–emotional–physiological terms. They also agree that moral distress is linked to the presence of some kind of constraint on nurses’ moral agency, and that it is best understood as a two-staged process that can intensify over time. There is also consensus that moral distress has an important normative meaning, although different views concerning the normative meaning of moral distress are expressed. Finally, the authors generally agree that moral distress arises from a number of different sources and that it (mostly) affects negatively on nurses’ personal and professional lives and, ultimately, harms patients. However, despite this consensus, many authors take issue with the way in which moral distress is conceptualized and operationalized. Moreover, while some worry that identifying nurses as a group of health professionals whose voices are ignored or marginalized might disempower nurses and encourage them to avoid their moral responsibilities, others take situations involving moral distress as indicative of more fundamental, structural inequities at the heart of contemporary healthcare provision. Conclusion: We conclude that research on moral distress in nursing is timely and important because it highlights the specifically moral labour of nurses. However, we suggest that significant concerns about the conceptual fuzziness and operationalization of moral distress also flag the need to proceed with caution. (shrink)

The Routledge Handbook of Political Ecology presents a comprehensive and authoritative examination of the rapidly growing field of political ecology. Located at the intersection of geography, anthropology, sociology, and environmental history, political ecology is one of the most vibrant and conceptually diverse fields of inquiry into nature-society relations within the social sciences. The Handbook serves as an essential guide to this rapidly evolving intellectual landscape. With contributions from over 50 leading authors, the Handbook presents a systematic overview of political ecology's (...) origins, practices and core concerns, and aims to advance both ongoing and emerging debates. While there are numerous edited volumes, textbooks, and monographs under the heading 'political ecology,' these have tended to be relatively narrow in scope, either as collections of empirically based (mostly case study) research on a given theme, or broad overviews of the field aimed at undergraduate audiences. The Routledge Handbook of Political Ecology is the first systematic, comprehensive overview of the field. With authors from North and South America, Europe, Australia and elsewhere, the Handbook of Political Ecology provides a state of the art examination of political ecology; addresses ongoing and emerging debates in this rapidly evolving field; and charts new agendas for research, policy, and activism. The Routledge Handbook of Political Ecology introduces political ecology as an interdisciplinary academic field. By presenting a 'state of the art' examination of the field, it will serve as an invaluable resource for students and scholars. It not only critically reviews the key debates in the field, but develops them. (shrink)

Although clinical ethics support services are becoming increasingly prevalent in Europe and North America, they remain an uncommon feature of the Irish healthcare system and Irish health professionals lack formal support when faced with ethically challenging cases. We have developed a variant on existing clinical ethics decision-making tools which is designed to build capacity and confidence amongst Irish practitioners and enable them to confront challenging situations in the absence of any dedicated support structure. The tool provided below follows a transparent (...) stepwise procedure which avoids an overcomplicated analysis while remaining sensitive to the complexity of the issues addressed. The novelty of the tool lies in the explicit association it makes between each step in the process and one or more responsibilities based on established norms of ethical decision-making in the public domain. (shrink)

In April 2004 the Irish Government commissioned Judge Maureen Harding Clark to compile a report to ascertain the rate of caesarean hysterectomies at Our Lady of Lourdes Hospital in Drogheda, Republic of Ireland. The report came about as a result of complaints by midwives into questionable practices that were mainly (but not solely) attributed to one particular obstetrician. In this article we examine the findings of this Report through a feminist lens in order to explore what a feminist reading of (...) the Report and the events that led to the inquiry will bring to light. We consider how sex and gender feature in the Lourdes case, draw attention to the deeply gendered asymmetries of power and privilege that existed between the men and women at the centre of this inquiry, and explore the impact such asymmetries had on this particular situation. (shrink)

Logical AI involves representing knowledge of an agent’s world, its goals and the current situation by sentences in logic. The agent decides what to do by inferring that a certain action or course of action is appropriate to achieve the goals. We characterize briefly a large number of concepts that have arisen in research in logical AI. Reaching human-level AI requires programs that deal with the common sense informatic situation. This in turn requires extensions from the way logic has been (...) used in formalizing branches of mathematics and physical science. It also seems to require extensions to the logics themselves, both in the formalism for expressing knowledge and the reasoning used to reach conclusions. A large number of concepts need to be studied to achieve logical AI of human level. This article presents candidates. The references, though numerous, to articles concerning these concepts are still insuf- ficient, and I’ll be grateful for more, especially for papers available on the web. This article is available in several forms via http://www-formal.stanford.edu/jmc/conceptsai.html. (shrink)

We explore contested meanings around care and relationality through the under-explored case of caring after death, throwing the relational significance of ‘bodies’ into sharp relief. While the dominant social imaginary and forms of knowledge production in many affluent western societies take death to signify an absolute loss of the other in the demise of their physical body, important implications follow from recognising that embodied relational experience can continue after death. Drawing on a model of embodied relational care encompassing a ‘me’, (...) a ‘you’ and an ‘us’, we argue that after death ‘me’ and ‘us’ remain (though changed) while crucial dimensions of ‘you’ persist too. In unravelling the binary divide between living and dead bodies, other related dichotomies of mind/body, self/other, internal/external, and nature/social are also called into question, extending debates concerning relationality and openness between living bodies. Through an exploration of autobiographical accounts and empirical research, we argue that embodied relationality expresses how connectedness is lived out after death in material practices and felt experiences. (shrink)

Although living conditions have improved throughout history, protest, at least in the last few decades, seems to have increased to the point of becoming a normal phenomenon in modern societies. Contributors to this volume examine how and why this is the case and argue that although problems such as poverty, hunger, and violations of democratic rights may have been reduced in advanced Western societies, a variety of other problems and opportunities have emerged and multiplied the reasons and possibilities for protest.

Logical AI develops computer programs that represent what they know about the world primarily by logical formulas and decide what to do primarily by logical reasoning--including nonmonotonic logical reasoning. It is convenient to use logical sentences and terms whose meaning depends on context. The reasons for this are similar to what causes human language to use context dependent meanings. This note gives elements of some of the formalisms to which we have been led. Fuller treatments are in [McC93], [Guh91] and (...) [MB94] and the references cited in the Web page [Buv95]. The first main idea is to make contexts first class objects in the logic and use the formula ist(c,p) to assert that the proposition p is true in the context c. A second idea is to formalize how propositions true in one context transform when they are moved to different but related contexts. An ability to transcend the outermost context is needed to give computer programs the ability to reason about the totality of all they have thought about so far [McC96]. (shrink)

This article is oriented toward the use of modality in artificial intelligence (AI). An agent must reason about what it or other agents know, believe, want, intend or owe. Referentially opaque modalities are needed and must be formalized correctly. Unfortunately, modal logics seem too limited for many important purposes. This article contains examples of uses of modality for which modal logic seems inadequate.I have no proof that modal logic is inadequate, so I hope modal logicians will take the examples as (...) challenges. (shrink)

John Searle begins his ``Consciousness, Explanatory Inversion and Cognitive Science'' with " ``Ten years ago in this journal I published an article criticising what I call Strong AI, the view that for a system to have mental states it is sufficient for the system to implement the right sort of program with right inputs and outputs. Strong AI is rather easy to refute and the basic argument can be summarized in one sentence: {it a system, me for example, could implement (...) a program for understanding Chinese, for example, without understanding any Chinese at all.} This idea, when developed, became known as the Chinese Room Argument.'' " The Chinese Room Argument can be refuted in one sentence. (shrink)

internal events that happen spontaneously from external events (actions). It also treats processes, e.g. a buzzer, that do not settle down. The non-monotonic reasoning is circumscription done situation by situation.

Here's the article which was a 1964 Stanford AI Memo. After the original memo, several people offered different proofs of the theorem including Shmuel Winograd, Marvin Minsky and Dimitri Stefanyuk - none published, to my knowledge. Winograd claimed that his proof was non-creative, because it didn't use an extraneous idea like the colors of the squares. This set off a contest to see who could produce the most non-creative proof. Minsky's idea was to start with the diagonal next to an (...) excluded corner ssquare, note that 2 dominoes had to project from it to the diagonal with three squares, and from there 1 domino to the four square diagonal, etc. Coming from the other end also leaves only six of the eight squares in the long diagonal covered. Minsky's proof gets high points for non-creativity, because it is specific to the 8 by 8 board. (Using the colors it is easy to show that a Minsky style proof will work for any even sized board.). (shrink)

Background The impact of healthcare ethics educational interventions on participants’ ethical development is rarely reported on and assessed; even less attention is paid to educational interventions that focus on end-of-life ethical issues. Aim To evaluate the impact of the Ethical Framework for End-of-Life Care Study Sessions Programme ( EOLCSS) on the moral development of healthcare staff who are delivering end-of-life care. Methods The EOLCSS was delivered to 20 multi-disciplinary health care staff in Ireland in May 2013. Effect on moral reasoning (...) was measured pre and post education using the Defining Issues Test 2 (DIT2). Inferential statistics were used to examine the relationships between change in DIT2 scores and demographic variables. Results Participants experienced moral reasoning development following receipt of EOLCSS. Age and previous ethics education contributed to the observed changes in moral reasoning. Conclusions Receipt of the EOLCSS may contribute to moral reasoning development in practicing healthcare professionals. (shrink)

From the AI point of view, consciousness must be regarded as a collection of interacting processes rather than the unitary object of much philosophical speculation. We ask what kinds of propositions and other entities need to be designed for consciousness to be useful to an animal or a machine. We thereby assert that human consciousness is useful to human functioning and not just and epiphenomenon. Zombies in the sense of Todd Moody's article are merely the victims of Moody's prejudices. To (...) behave like humans, zombies will need what Moody might call pseudo-consciousness, but useful pseudo-consciousness will share all the observable qualities of human consciousness including what the zombie will be able to report. Robots will require a pseudo-consciousness with many of the intellectual qualities of human consciousness but will function successfully with few if any human emotional conscious qualities if that is how we choose to build them. (shrink)