We explore the various ethical challenges that arise during the practical implementation of an emergency resource allocation protocol. We argue that to implement an allocation plan in a crisis, a hospital system must complete five tasks: (1) formulate a set of general principles for allocation, (2) apply those principles to the disease at hand to create a concrete protocol, (3) collect the data required to apply the protocol, (4) construct a system to implement triage decisions with those data, and (5) (...) create a system for managing the consequences of implementing the protocol, including the effects on those who must carry out the plan, the medical staff, and the general public. Here we illustrate the complexities of each task and provide tentative solutions, by describing the experiences of the Coronavirus Ethics Response Group, an interdisciplinary team formed to address the ethical issues in pandemic resource planning at the University of Rochester Medical Center. While the plan was never put into operation, the process of preparing for emergency implementation exposed ethical issues that require attention. (shrink)

This highly acclaimed, prize-winning biography of one of the foremost political philosophers of the twentieth century is here reissued in a trade paperback edition for a new generation of readers. In a new preface the author offers an account of writings by and about Arendt that have appeared since the book's 1982 publication, providing a reassessment of her subject's life and achievement. Praise for the earlier edition: “Both a personal and an intellectual biography... It represents biography at its best.”—Peter Berger, (...) front page, The New York Times Book Review “A story of surprising drama.... At last, we can see Arendt whole.”—Jim Miller, Newsweek “Indispensable to anyone interested in the life, the thought, or... the example of Hannah Arendt.”—Mark Feeney, Boston Globe “An adventure story that moves from pre-Nazi Germany to fame in the United States, and... a study of the influences that shaped a sharp political awareness.”—Richmond (Va.) Times-Dispatch Cover drawing by David Schorr. (shrink)

Phenomenology is one of the most popular qualitative research methodologies used in nursing research. Although interpretive phenomenology is often a logical choice to address the concerns of nursing, the vast number of methods of phenomenology means choosing an appropriate method can be daunting, especially for novice researchers. It is critical that nurse researchers select a phenomenological method that fits the research problem and the skill and world view of the researcher; doing so will result in a research experience that resonates (...) with and excites the researcher. The interpretive phenomenological methodologies of Benner, Munhall, and Conroy each offer unique methods of phenomenological inquiry. However, to date, we are not aware of any literature that explores and compares the methodological approaches of these nurses. In this paper, the origins and influence of phenomenology as both a philosophy and methodology on nurse researchers will be explored, followed by a critical analysis and comparison of these three nurses. By highlighting the distinctive differences and attributes of each method, this paper provides an analysis and comparison of the approaches of these prominent nurses. In doing so, we aim to aid the researcher in their methodological selection, thereby resulting in a successful and rewarding research endeavor. (shrink)

Nursing knowledge development and application are influenced by numerous factors within the context of science and practice. The prevailing culture of science along with an evolving context of increasingly technological environments and rationalization within health care impacts both the generation of nursing knowledge and the practice of nursing. The effects of the culture of science and the context of nursing practice may negatively impact the structure and application of nursing knowledge, how nurses practice, and how nurses understand the patients and (...) families for whom they care. Specifically, the nature of critical care and its highly technical environment make critical care nursing especially vulnerable to these potentially negative influences. The influences of the culture of science and the increasingly technical practice context may result in an overreliance on the natural sciences to guide critical care nursing actions and an associated marginalization of the caring relationship in critical care nursing practice. Within this environment, nursing philosophy may not be foundational to nursing actions; rather, the dominant culture of science and the rationalization of health care may be informing nursing practice. As such, the ideology and goals of nursing may not be central to the practice of critical care nursing. The purpose of this paper is to explore the influence of the culture of science on the development of nursing knowledge and theory. Further, we aim to describe the value of using conceptual frameworks, such as Roy's Adaptation Model, as a nursing philosophy to influence the development of person‐centred nursing knowledge and theory to inform critical care nursing practice as it related to the care of patients and families. In doing so, nursing philosophy is situated as foundational for nursing actions. (shrink)

The topic of Hannah Arendt's Jewish identity can be approached from many directions. This chapter considers Arendt in the context of the vision of world history articulated by her teacher and mentor Karl Jaspers, in which her people, the Jews of Palestine, were considered as one of the “Axial Age” peoples. It argues that it is Arendt's Jewish identity—not just the identity she asserted in defending herself as a Jew when attacked as one, but more deeply her connection to the (...) Axial Age prophetic tradition—that made her the cosmopolitan she was, while Jaspers's cosmopolitanism was more learned than inherited and reinforced by group experience. (shrink)

Three basic assumptions distinguish Thucvdides' historical perspective from the perspective of the debate speeches in his history: he did not assume that events are continuous or repeatable, that human nature in unchangeable, and that the ultimate causes of human affairs are within human ken. In Thucydides' history, statesmen and citizens are judged by their capacities to do as Thucydides himself tried to do -judge novelty and greatness clearly. Lastingly effective good judgment unifies people because it stems from and appeals to (...) respect for the imponderables of human affairs, the unpredictability of the future and the fragility of human nature. Those who can appreciate novelties know that the future will not be lacking in them, as those who can appreciate greatness know that its causes are ultimately beyond analysis. Like Thucydides himself, such people are storytellers rather than moralists. (shrink)

BackgroundMoral distress (MD) is an emotional and psychological response to morally challenging dilemmas. Moral distress is experienced frequently by nurses in the intensive care unit (ICU) and can result in emotional anguish, work dissatisfaction, poor patient outcomes, and high levels of nurse turnover. Opportunities to discuss ethically challenging situations may lessen MD and its associated sequela.ObjectiveThe purpose of this project was to develop, implement, and evaluate the impact of nursing ethics huddles on participants’ MD, clinical ethics knowledge, work satisfaction, and (...) patient care among ICU nurses.Sample and SettingThe sample, 32 nurses from three ICU settings in an 800-bed tertiary academic medical center, participated in six nursing ethics huddles over a two-month period.MethodsAlvita K. Nathaniel’s Theory of Moral Reckoning guided development of the nursing ethics huddle process.1 The Moral Distress Thermometer was administered at three data points: baseline level of MD, and pre- and post-huddle to determine changes in the subjects’ level of MD.2 Focused content analysis was used to analyze qualitative responses from questionnaires about the subjects’ perception of the effect of the huddles on work satisfaction and patient care. Knowledge attainment was evaluated via open-ended short-answer questions.ResultsOverall, use of nurse-ethicist-led nursing ethics huddles was associated with improved quality of work life, patient care, and clinical ethics knowledge. The change in pre- and post-nursing ethics huddles MD scores was statistically significant (p < 0.0001). (shrink)

Psychoanalytica Elisabeth Young-Bruehl gaat nader in op de bewering van Jonathan Sacks in diens openingslezing dat het Verbond van Noach gold voor alle mensen, niet slechts een groep uitverkorenen, en dat het daarmee ruim baan gaf tolerantie en vrijheid van godsdienst. Young-Bruehl is eerder van het tegendeel overtuigd: het Verbond legt wetten op die al wie ze niet gehoorzaamt, uitsluiten. De monotheïstische godsdiensten blijven daarmee bij uitstek intrinsiek autoritair en sadomasochistisch van aard.

Elisabeth Young-Bruehl illuminates the psychological and intellectual demands writing biography makes on the biographer and explores the complex and frequently conflicted relationship between feminism and psychoanalysis. She considers what remains valuable in Sigmund Freud's work, and what areas - theory of character, for instance - must be rethought to be useful for current psychoanalytic work, for feminist studies, and for social theory. Psychoanalytic theory used for biography, she argues, can yield insights for psychoanalysis itself, particularly in the understanding of creativity.

As a founding father of Existentialism, Karl Jaspers has been seen as a twentieth-century successor to Nietzsche and Kierkegaard; as an exponent of reason, he has been seen as an heir of Kant. But studies tracing influences upon his thought or placing him in the context of Existentialism have not dealt with Jaspers's concern with the political realm and how we think in it and about it. In this study Elisabeth Young-Bruehl explicates Jaspers's practical philosophizing, his search for ways in (...) which we can orient ourselves toward our world and its political questions. (shrink)

Mind and the Body Politic is a collection of Elisabeth Young-Bruehl's essays and lectures on political theory, psychoanalysis, feminism, and the theory of biography.

Recently ethical implications of human resource management have intensified the focus on care perspectives in management and organization studies. Appeals have also been made for the concept of organizational care to be grounded in philosophies of care rather than business theories. Care perspectives see individuals, especially women, as primarily relational and view work as a means by which people can increase in self-esteem, self-develop and be fulfilled. The ethic of care has received attention in feminist ethics and is often socially (...) construed as a feminine ethic. Although well developed in the caring professions there remains no model or definition of the care ethic in management literature with little care research undertaken. This paper develops the concept of the care ethic using Heidegger’s philosophy, namely, care is fundamental to human being. To show Heideggerian care, an individual notices, pays attention to another and responds in ways to empower and enable. In a study which aimed to analyze women’s lived experience of career, we applied the philosophically grounded methodology hermeneutic phenomenology. Findings revealed the power of Heideggerian care, Sorge, as a key factor in creating meaning. From this, we propose that care has potential as a theoretical and philosophically based construct with strong practical implications. It provides a way of understanding the care ethic, lies at the heart of our being, and is essential to meaning in our grelationships and undertakings. Crucially, it can provide reprieve from the existential angst that trademarks our being. (shrink)

Cette biographie de référence éclaire d'un jour nouveau tout un pan de la vie intellectuelle du XXe siècle, celui de ces universitaires juifs allemands obligés de fuir le IIIe Reich et qui, d'étape en étape, finirent par trouver refuge aux Etats-Unis. Le livre associe la présentation des grandes étapes de la pensée et de l'œuvre de Hannah Arendt aux événements historiques qui la sollicitent et au tableau des amitiés et des cercles successifs. Si la liaison qu'elle eut brièvement au début (...) des années 30 avec Heidegger est désormais bien connue, d'autres aspects de son existence, pourtant du plus haut intérêt, le sont moins : son rapprochement avec le sionisme sous l'égide de Kurt Blumenfeld avant et pendant la guerre, son mariage avec Günther Stern, puis avec Heinrich Blücher, sa longue amitié aux Etats-Unis avec la romancière Mary McCarthy ou avec le poète W.H. Auden. Polémiste redoutable et critique cinglante, constante dans ses fidélités, et en premier lieu dans sa relation avec cette grande conscience allemande que fut Karl Jaspers, Arendt a traversé tous les débats du siècle, sans jamais céder ni sur son indépendance d'esprit ni sur sa lucidité : face au totalitarisme, dont elle forge le concept, mais aussi face au racisme et aux mouvements pour les droits civils aux Etats-Unis, face à la création de l'Etat d'Israël et au devenir du sionisme, face à l'engagement américain dans la guerre du Vietnam, face à la révolte de la jeunesse des années 60. Ne s'abandonnant jamais à la tentation aristocratique du retrait, elle accomplit une œuvre de pensée sans avoir besoin de décrier le monde, mais en prônant l'amour de la réalité, donnant ainsi l'image rare d'une vie de penseur à la hauteur de ses accomplissements spéculatifs. Indisponible depuis une dizaine d'années, cet ouvrage a été mis à jour et enrichi d'une nouvelle préface de l'auteur. (shrink)

The concept of the Golden Mean, which has been accepted as a behavioral guideline of human beings for thousands of years, is briefly reviewed. Several empirical studies in the field of organizational behavior are summarized as evidence that the concept has practical management applications. Based on the Golden Mean concept and its management empirical evidence, the authors propose a model of “Reasoned Responses” and its practical application to the decision-making process.

Qualitative and quantitative research on the impact of medical and health humanities teaching in baccalaureate education is sparse. This paper reviews recent studies of the impact of medical and health humanities coursework in pre-health professions education and describes a pilot study of baccalaureate students who completed semester-long medical humanities courses in the Division of Medical Humanities & Bioethics at the University of Rochester. The study format was an email survey. All participants were current or former baccalaureate students who had taken (...) one or more courses in literature and narrative in medicine, bioethics, history of medicine, and/or visual arts and healthcare during the past four years. The survey gathered numerical data in several areas: demographic information, career plans, self-reported influence of coursework on educational and career plans, and self-reported influence of coursework on intellectual skills and abilities. It also gathered narrative commentary that elaborated on students’ responses to the numerically-based questions. Notable findings from preliminary analysis of the data include higher scores of self-reported impact of the coursework on specific habits of mind and on preparedness for intended career rather than on gaining admission to future educational programs. Discussion of the results focuses on several potential future directions this type of study might take, including multi-center, longitudinal, and sequential approaches. (shrink)

Organisations that design and deploy artificial intelligence (AI) systems increasingly commit themselves to high-level, ethical principles. However, there still exists a gap between principles and practices in AI ethics. One major obstacle organisations face when attempting to operationalise AI Ethics is the lack of a well-defined material scope. Put differently, the question to which systems and processes AI ethics principles ought to apply remains unanswered. Of course, there exists no universally accepted definition of AI, and different systems pose different ethical (...) challenges. Nevertheless, pragmatic problem-solving demands that things should be sorted so that their grouping will promote successful actions for some specific end. In this article, we review and compare previous attempts to classify AI systems for the purpose of implementing AI governance in practice. We find that attempts to classify AI systems proposed in previous literature use one of three mental models: _the Switch_, i.e., a binary approach according to which systems either are or are not considered AI systems depending on their characteristics; _the Ladder_, i.e., a risk-based approach that classifies systems according to the ethical risks they pose; and _the Matrix_, i.e., a multi-dimensional classification of systems that take various aspects into account, such as context, input data, and decision-model. Each of these models for classifying AI systems comes with its own set of strengths and weaknesses. By conceptualising different ways of classifying AI systems into simple mental models, we hope to provide organisations that design, deploy, or regulate AI systems with the vocabulary needed to demarcate the material scope of their AI governance frameworks. (shrink)

In organ transplantation, there is a lack of ethical discussion about the recipient’s right not to receive a transplant. Using the current situation of living organ transplantation and deceased organ transplantation in Japan as an example, we prospectively discussed to what extent the recipient’s right not to receive a transplant is ethically acceptable. In directed transplantation from a living donor, a recipient may refuse organ donation from a particular donor. It is preferable that a recipient’s request for organ donation from (...) a donor occurs as part of a transparent process. In nondirected transplantation from a deceased donor, refusal of transplantation from a particular type of donor appears potentially justifiable. There are both moral and pragmatic considerations. Certain refusals based solely on belief are morally unacceptable, and refusal to transplant a recipient based on the donor’s age jeopardizes the entire transplant system. When religious beliefs affect mental and physical health, individualized measures are required for transplant rejection. We also deductively developed a prospective argument based on the current status of donor–recipient communication in living organ transplantation in Japan and the 2010 amendment of the law allowing relatives to be given priority in organ transplantation from deceased donors. (shrink)

Even appropriate, ethically sound recommendations can generate angst. In this case, the principal investigator is concerned about the ethics consult recommendation to not inform the participan...

The concept of the Golden Mean, which has been accepted as a behavioral guideline of human beings for thousands of years, is briefly reviewed. Several empirical studies in the field of organizational behavior are summarized as evidence that the concept has practical management applications. Based on the Golden Mean concept and its management empirical evidence, the authors propose a model of Reasoned Responses and its practical application to the decision-making process.