BackgroundMost end-of-life decisions are made by family members. Current ethical guidelines for family decision making are based on a hierarchical model that emphasizes the patient’s wishes over his or her best interests. Evidence suggests that the model poorly reflects the strategies and priorities of many families.MethodsResearchers observed and recorded 26 decision-making meetings between hospital staff and family members. Semi-structured follow-up interviews were conducted. Transcriptions were analyzed using qualitative techniques.ResultsFor both staff and families, consideration of a patient’s best interests generally took (...) priority over the patient’s wishes. Staff generally introduced discussion of the patient’s wishes for rhetorical purposes, such as persuasion. Competing moral frameworks, which de-emphasized the salience of patients’ autonomy and “right to choose,” played a role in family decision making.ConclusionsThe priority given to the patients’ wishes in the hierarchical model does not reflect the priorities of staff and families in making decisions about end-of-life care. (shrink)

This book contains important technical innovations, including comparative measures for the testable content, depth, and unity of scientific theories. Originally published in 1984. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich (...) scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

This case is about a study of burn patients that included a request to the IRB for a waiver of consent for perianal specimen collection–a request which ultimately was not approved by a reviewing IR...

Difficult Atheism shows how contemporary French philosophy is rethinking the legacy of the death of God in ways that take the debate beyond the narrow confines of atheism into the much broader domain of post-theological thinking. Christopher Watkin argues that Alain Badiou, Jean-Luc Nancy and Quentin Meillassoux each elaborate a distinctive approach to the post-theological, but that each approach still struggles to do justice to the death of God.

Arguments from perceptual variation challenge the view that colors are objective properties of objects, properties that objects have independent of how they are perceived. This paper attempts, first, to diagnose one central reason why arguments from perceptual variation seem especially challenging for objectivists about color. Second, we offer a response to this challenge, claiming that once we focus on determinate colors rather than the determinables they determine, a response to arguments from perceptual variation becomes apparent. Third, our nominal opponents are (...) relationalist (like Cohen in The red and the real: an essay on color ontology, Oxford University Press, Oxford, 2009) and we will argue that the main argument for rejecting objectivism commits the relationalist to a position that is more radical than the one he would wish to endorse. Fourth, we suggest that insight into which properties could be relational may be found by looking to our best scientific theories. (shrink)

This chapter contains sections titled: Metaphysical Approaches Metaphysical Problems References.

This essay series attempts to stimulate the debate about the moral challenges that internationalisation confronts us with, both in the Netherlands and abroad, and in particular for Artist-in-Residencies (AIRs). The publication is a reflection on how the crisis is reconsidering our international ambitions, starting from a post-COVID society. Internationalisation is an inevitable reality, inherent to the art landscape. The current time calls for a critical reflection on major issues such as climate inequality, plurality and the Western-dominant canon. 0With contributions and (...) critical insights by Jeanne van Heeswijk, Jack Segbars, Erik Hagoort, Pascal Gielen, Cecilia Bengtsson, Merlijn Twaalfhoven, Hicham Khalidi, reinaart vanhoe and Suzanne van der Beek. Thanks to Jan van Eyck Academie, Mondriaan Fonds, Prins Bernhard Cultuurfonds en het Amsterdams Fonds voor de Kunst for their support. (shrink)

What does 'autonomy' mean today? Is the Enlightenment understanding of autonomy still relevant for contemporary challenges? How have the limits and possibilities of autonomy been transformed by recent developments in artificial intelligence and big data, political pressures, intersecting oppressions and the climate emergency? The challenges to autonomy today reach across society with unprecedented complexity, and in this book leading scholars from philosophy, economics, linguistics, literature and politics examine the role of autonomy in key areas of contemporary life, forcefully defending a (...) range of different views about the nature and extent of resistance to autonomy today. These essays are essential reading for anyone who wants to understand the predicament and prospects of one of modernity's foundational concepts and one of our most widely cherished values. (shrink)

The case (Dawson et al. 2024) raises tensions between the ethical demands of respect for patient autonomy, patients’ clinical needs, and research to improve clinical care. Given burn patients’ urge...

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Testimony of Sense: Empiricism and the Essay from Hume to Hazlitt by Tim MilnesMargaret WatkinsTim Milnes. The Testimony of Sense: Empiricism and the Essay from Hume to Hazlitt. Oxford: Oxford University Press, 2019. Pp. viii + 278. Hardback. ISBN: 9780198812739. $91.00.In his brief autobiography, “My Own Life,” Hume reports that “almost all [his] life has been spent in literary pursuits and occupations” (E-MOL: xxxi). This is one (...) of at least ten places in this brief work in which he associates himself with “letters” or “literature”—as compared to at most four associations with philosophy. The moral to be inferred is not that Hume considered himself not to be a philosopher. Rather, he conceived of philosophy as a kind of literature. The Treatise was itself a “literary attempt.” Indeed, opposition between the “literary” and “philosophical” aspects of a text would have been foreign to Hume and his contemporaries—a notion for a later age, despite his occasional loose distinction between the relevant genres, as in his list of writings “historical, philosophical, or literary” in “My Own Life” (E-MOL: xxxvi).Yet despite Hume’s own understanding of the continuity between philosophy and literature, broadly conceived, it is still common for contemporary philosophers to ignore literary questions in their examination of Hume’s work, or to presume that one can easily distinguish the “philosophical” parts from the “literary” ones. Tim Milnes’s The Testimony of Sense is therefore a welcome addition to the Hume literature (pun intended). With a particular focus on the essay—a genre of great importance to Hume—Milnes contributes to the small set of engagements with Hume from the disciplinary perspective of English literature. With training in both philosophy and literature, as well as established expertise on Romanticism and its own essays, Milnes is well-qualified for the task. The Testimony of Sense includes sustained engagement with Hume’s contemporaries and successors, but for the purposes of this review, I engage the book primarily as a Hume scholar for Hume scholars.Milnes’s story plays out in three acts. The first establishes the need for public trust created by a skeptical crisis, itself a product of Hume’s criticism of the epistemic program of thinkers in the Cartesian and Lockean traditions. The second explains how the essays of the long eighteenth century constitute a response to that need in various ways. The third reveals in detail how the Romantic essayists, particularly William Hazlitt and Charles Lamb, both respond to and deviate from the “neoclassical” essayists, typified by Hume and Samuel Johnson.The first chapter, “Self and Intersubjectivity,” lays the groundwork by articulating how Hume, Adam Smith, Thomas Reid, and Dugald Stewart identify the need for what we now call intersubjectivity. Milnes describes the common thread as a kind of “natural transcendentalism.” In what sense are these thinkers properly understood as [End Page 175] transcendentalists? The central idea seems to be that all posit things other than reason as “conditions of meaningful thought” (72). For Hume, it is the social, linguistic experience of a community of virtuous judges. The intricate relations between self and other essential to such a community get “internalized within the specular drama of the impartial spectator” (72) in Smith’s writing, which itself takes part in the drama through his “halting, qualified syntax” that mimics “everyday speech” (44). Reid posits a “prescience” of trust, which grounds our reliance on both human testimony and the uniformity of nature, itself undergirded by the design of a benevolent God. Stewart, who posits axiomatic truths that help constitute the “stamina of intellect,” goes furthest, actually calling these truths transcendental (55). This chapter also puts these eighteenth-century thinkers in conversation with twentieth-century theorists, including Habermas, Davidson, and Rorty.Chapter 2, “The Subject of Trust,” deepens the analysis by situating these “natural transcendentalisms” in the broader enlightenment context. In contrast to Descartes, Bacon, and Locke, who were suspicious of our reliance on the opinions of others, the eighteenth-century thinkers understand trust as prior to reason in various ways—though not prior to solidarity. The particulars in each case depend on their responses to skepticism and their accounts of the relation between... (shrink)

Does it make sense to refer to bird song - a complex vocalization, full of repetitive and transformative patterns that are carefully calculated to woo a mate - as art? What about a pack of wolves howling in unison or the cacophony made by an entire rain forest? Redefining music as "the art of possibly animate things," Musical Vitalities charts a new path for music studies that blends musicological methods with perspectives drawn from the life sciences. In opposition to humanist (...) approaches that insist on a separation between culture and nature--approaches that appear increasingly untenable in an era defined by human-generated climate change--Musical Vitalities treats music as one example of the cultural practices and biotic arts of the animal kingdom rather than as a phenomenon categorically distinct from nonhuman forms of sonic expression. The book challenges the human exceptionalism that has allowed musicologists to overlook music's structural resemblances to the songs of nonhuman species, the intricacies of music's physiological impact on listeners, and the many analogues between music's formal processes and those of the dynamic natural world. Through close readings of Austro-German music and aesthetic writings that suggest wide-ranging analogies between music and nature, Musical Vitalities seeks to both rekindle the critical potential of nineteenth-century music and rejoin the humans at the center of the humanities with the nonhumans whose evolutionary endowments and planetary fates they share. (shrink)

Emergency nurses apply specialist knowledge to the practice of emergency care. This paper discusses the ways in which three emergency nurses understand the nature of their care from their own frames of reference and experiences and presents some of the data collected in a larger study. Various discourses, which compete to inform emergency nurses' understandings of practice, are linked with the notion of nurses as subjects; that is, each discourse may inform, shape and constitute the practice of the nurse and, (...) in turn, the ways in which the patient comes to be known and understood. I will examine the ways in which emergency nurses come to experience or position themselves vis‐à‐vis extant forms of knowledge of emergency care and the extent to which they articulate new or distinctive formulations of emergency care. This paper illuminates the commonalities that constitute the discourses of emergency nursing care, and also analyse nurses' language which demonstrates that within each discourse variations, contradictions and resistances exist. Emergency nursing care occurs in a context of a biomedical discourse that dominates, or tends to dominate, the work of the emergency setting and so to determine acceptable or possible practices. Nevertheless, nurses contest in various ways the ‘truths' that they understand to underpin their practice. Challenges to biomedical discourses are revealed, to some extent, by drawing attention to specific situations and particular struggles encountered in emergency nurses' everyday practice. (shrink)

Methodologies of poststructuralist theory and critical social theory may be appropriated for nursing research and practice. Researchers using either methodology employ an analysis of power to explore experiences in various fields, and raise issues diat are highly relevant to nursing. However, the two methodologies differ and, often, die respective dieories are sharply opposed. In diis paper, die differences bodi from widiin and between each approach are explored, showing dieir tensions and limits. I contend that a reflexive approach to discourse analysis (...) provides insight into some of die methodological challenges diat arise in die context of bodi dieories. It is argued diat die differences between poststructuralism and critical social dieory seem likely to be mellowed by encounters diat treat each other with respect. To some extent, such encounters may tend to converge die two positions. (shrink)

There is little information about the content of ethics consultations in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance (...) in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is need.. (shrink)

Dans les stations de tourisme de montagne, les intersaisons correspondent à des creux d’activité durant lesquels les offres d’emploi alternatives sont peu nombreuses. Les saisonniers se trouvent donc confrontés à une période de chômage cyclique. Cette situation « intermédiaire », réunissant une forme d’incertitude de la relation d’emploi ainsi qu’une relative prévisibilité des périodes de recrutement n’est pas sans susciter certaines controverses. Dans ce contexte, comment sont vécues les phases de chômage saisonnier dans ces territoires? Ces séquences temporelles correspondent-elles à (...) un « temps mort » ou à un temps pluriel? Comment se négocie le temps pour soi dans le cadre d’embauches à contre-rythmes des temps sociaux dominants? Dans le cadre de cette forme d’emploi intermittente, le temps de chômage peut-il être conçu comme un temps de construction de la carrière professionnelle? Cet article s’intéresse aux formes d’adaptation aux rythmes d’emploi et de chômage des saisonniers en montagne et montre comment ces périodes hors-emploi participent de l’intériorisation de rythmicités spécifiques. (shrink)

This paper examines how three Dutch political parties employ the Internet as a tool to enhance ‘digital democracy’. The potential of digital democracy is considered to be strongest in the sphere of collective action outside the domain of political institutions. In this article, however, attention is given to how institutionalized channels might be supportive of digital democracy. Three components of the democratic process – information provision, deliberation, and political decision-making – are examined in the content and user assessments of the (...) web sites of the Socialist Party, the Christian Democratic Party and the Green Party. Minor differences were found in the party web sites regarding information provision; substantial differences were found regarding the degree and nature of political deliberation available on the sites. Indicators of the third component, political decision-making, were least evident on all three web sites. User assessments of the sites and opportunities for political deliberation followed, more or less, the general public images of the related political parties. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

Eyal et al have recently argued that researchers should consider conducting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human challenge studies to hasten vaccine development. We have conducted (J. L.) and overseen (L. D.) human challenge studies and agree that they can be useful in developing anti-infective agents. We also agree that adults can autonomously choose to undergo risks with no prospect of direct benefit to themselves. However, we disagree that SARS-CoV-2 challenge studies are ethically appropriate at this time, for (...) 3 reasons: (1) current scientific knowledge of SARS-CoV-2 infection is insufficient to manage risks; (2) autonomous decision making, while necessary, does not override concerns about risk; and (3) undertaking challenge studies now would imperil confidence in the research enterprise, potentially undermining the global response to the coronavirus disease 2019 (COVID-19) pandemic. (shrink)

Genomic sequencing is becoming more common both in clinical practice and as a routine aspect of much research. Over the last 15 years there has been ongoing discussion about the implications of gen...

Conceived as the sequel to Alan Badiou's Being and Event, Logics of Worlds stands as one of the most important texts in contemporary thought. As a complex theory of worlds, the text has, for the most part, been misunderstood. Yet, through William Watkin's diligent and critical close--reading, he guides the reader through the Badiouan text, whilst demonstrating how Logics of Worlds is the essential book for anyone interested in existence, meaning and the potential for radical change.

Gilles Deleuze's ideas are indispensable to understanding how truth and ethics no longer have theological reference points. Watkin's biblical critique enables us to culturally reengage with our Deleuze-influenced society.

The ‘managed care’ idea: implications for health service systems in Australia The growth of corporatism in health‐care in the US, and the consequences arising from US models of health‐care delivery systems provide an enormously valuable point of comparison with health systems of other developed economies, such as Australia. If lessons are to be learnt from the US, then an analysis of the structure and performance of the US health‐care system provides important background for understanding and assessing contemporary policy changes to (...) administrative and organizational designs and techniques for patient care in Australia. (shrink)

This article studies the conceptions of social justice of women active in transnational migrant politics over a period of roughly 20 years in the Netherlands. The novel focus on migrant women reveals that transnational politics is almost completely male-dominated and -directed. Two of the exceptions found in this article include a leftist and a Kurdish women organization supporting the communist cause in the 1980s and the Kurdish struggle in the 1990s in Turkey, respectively. In both organizations gender equality was subordinated (...) to broader ideologies of political parties in their homeland. Leftist activists in the cold war era supported a narrow definition of the "politics of redistribution," while and Kurdish activists, combined classical features of the latter with those of traditional identity politics. (shrink)

Business success depends on the ability to build trust. Trusted brands succeed and sustain. Trusted leaders inspire followers, grow companies, revenues, and futures. But sadly, deceit has infected business and become widespread. Far too many leaders now use their own 'alternative facts', to mislead and mis-inform their customers, colleagues, and communities. The skilfulness and ease with which some leaders now lie has become a Lie-Ability. And when customers stop trusting the products, services, or the stories a leader tells, then the (...) business suffers. If business leaders don't lead a truth renaissance, we are all lost. People no longer trust politicians or the media. And many of the institutions and professions we used to turn to have also lost trust. The only people that can really save us now are business leaders. We need to become truth advocates and activists. We must re-establish a new norm where we tell the truth to ourselves, to our employees, to our shareholders, to our customers and to society at large. This book explores the 7 Deadly Lies that business tells itself, the 7 Dark Arts of Deception that are still used with monotonous regularity to manipulate the narrative. We offer C-suite leaders and senior managers a clear path out of deceit. We offer a solution to the Lie-Ability of some leaders by developing a deeper understanding of truth, how to reclaim it and how to build back trust. (shrink)

The first critical work to attempt the mammoth undertaking of reading Badiou's Being and Event as part of a sequence has often surprising, occasionally controversial results. Looking back on its publication Badiou declared: “I had inscribed my name in the history of philosophy”. Later he was brave enough to admit that this inscription needed correction. The central elements of Badiou's philosophy only make sense when Being and Event is read through the corrective prism of its sequel, Logics of Worlds, published (...) nearly twenty years later. At the same time as presenting the only complete overview of Badiou's philosophical project, this book is also the first to draw out the central component of Badiou's ontology: indifference. Concentrating on its use across the core elements Being and Event-the void, the multiple, the set and the event-Watkin demonstrates that no account of Badiou's ontology is complete unless it accepts that Badiou's philosophy is primarily a presentation of indifferent being. Badiou and Indifferent Being provides a detailed and lively section by section reading of Badiou's foundational work. It is a seminal source text for all Badiou readers. (shrink)

Volume 19, Issue 10, October 2019, Page 97-98.

As medicine and science advance, new ethical questions emerge. Over time, deliberation and analysis result in a somewhat settled approach to a problem. Often the settled approach is based on group...

As part of the regulatory review process, both the Food and Drug Administration and Office for Human Research Protections (U.S. Department of Health and Human Services [HHS]...