In the context of health care system complexity, nurses need responsive leadership and organizational support to maintain intrinsic motivation, moral sensitivity and a caring stance in the delivery of patient care. The current complexity of nurses’ work environment promotes decreases in work motivation and moral satisfaction, thus creating motivational and ethical dissonance in practice. These and other work-related factors increase emotional stress and burnout for nurses, prompting both new and seasoned nurse professionals to leave their current position, or even the (...) profession. This article presents a theoretical conceptual model for professional nurses to review and make sense of the ethical reasoning skills needed to maintain a caring stance in relation to the competing values that must coexist among nurses, health care administrators, patients and families in the context of the complex health care work environments in which nurses are expected to practice. A model, Nurses’ Ethical Reasoning Skills, is presented as a framework for nurses’ thinking through and problem solving ethical issues in clinical practice in the context of complexity in health care. (shrink)

This article offers a qualified defence of the view that there is a moral difference between telling lies to one's patients, and deceiving them without lying. However, I take issue with certain arguments offered by Jennifer Jackson in support of the same conclusion. In particular, I challenge her claim that to deny that there is such a moral difference makes sense only within a utilitarian framework, and I cast doubt on the aptness of some of her examples of non-lying deception. (...) But I argue that lies have a greater tendency to damage trust than does non-lying deception, and suggest that since many doctors do believe there is a moral boundary between the two types of deception, encouraging them to violate that boundary may have adverse general effects on their moral sensibilities. (shrink)

I SHALL develop, in this article, certain distinctions suggested by recent contributions to the philosophical discussion of punishment, which help to clarify the issues involved. Having separated out what I consider the four central philosophical questions, I shall suggest an approach to them, which, while mainly utilitarian, takes due account, I believe, of the retributivist case where it is strongest, and meets the main retributivist objections.

Contemporary moral philosophy rightly gives an important place not only to theories of right action, but to the nature and value of our interpersonal moral attitudes, including such reactions as resentment, admiration and forgiveness. Whilst these concerns have always been of interest to theologians and psychologists, their philosophical importance partly derives from wider concerns about the nature of persons. The recent resurgence, for instance, of retributivist theories of punishment, which are finding favour among many philosophical writers, largely bases itself on (...) the idea that a range of ‘participant reactive attitudes’ is both socially indispensable and morally legitimate. In this web of interpersonal responses is forgiveness, which cannot properly be examined without discussion of other responses such as indignation, anger and even hatred. (shrink)

The neural basis of progress monitoring has received relatively little attention compared to other sub-processes that are involved in goal directed behavior such as motor control and response inhibition. Studies of error-monitoring have identified the dorsal anterior cingulate cortex (dACC) as a structure that is sensitive to conflict detection, and triggers corrective action. However, monitoring goal progress involves monitoring correct as well as erroneous events over a period of time. In the present research, 20 healthy participants underwent fMRI while playing (...) a game that involved monitoring progress towards either a numerical or a visuo-spatial target. The findings confirmed the role of the dACC in detecting situations in which the current state may conflict with the desired state, but also revealed activations in the frontal and parietal regions, pointing to the involvement of processes such as attention and working memory in monitoring progress over time. In addition, activation of the cuneus was associated with monitoring progress towards a specific target presented in the visual modality. This is the first time that activation in this region has been linked to higher-order processing of goal-relevant information, rather than low-level anticipation of visual stimuli. Taken together, these findings identify the neural substrates involved in monitoring progress over time, and how these extend beyond activations observed in conflict and error monitoring. (shrink)

ABSTRACT This paper is about the problem of the moral responsibility resting on any person to form rational beliefs about, and moral attitudes towards, the deterrent threat of mutual assured destruction (MAD), which still lies behind the graduated nuclear response strategies now more fashionably discussed by military experts. The problem is to decide what kinds of reasons there are, and how to arrive in the light of them at determinate conclusions about deterrence and unilateral disarmament. Consequential arguments would be powerful, (...) if only they were determinate; but not only do they not point conclusively to one strategy rather than another, there is not even sufficient reason for accepting one rather than another of the competing optimising criteria by which the strategies might be assessed. So the reasons of other kinds against forming a conditional intention to retaliate with a massive second strike could be conclusive, if retaliation itself could do no (consequential) good, and if, as is claimed, the conditional intention could not be simulated. To form such an intention is held to be contrary to core values of a humane, rationalist culture. To assent to a nuclear retaliatory strike would do violence to the moral nature of anyone participating in such a culture, and to form an intention to make (or condone) such a strike would be a corruption of such a nature. So too would condoning the fostering of such an intention in others, as a way of making the retaliatory intention credible. The author accordingly considers this argument against MAD, and for unilateral nuclear disarmament, sufficient, given the inadequacy of the consequential arguments, while acknowledging that this might involve great sacrifice. The paper concludes, however, by considering whether anyone can reject nuclear deterrence who also believes that resistance to Nazism in 1939 was justified, given the then prevailing belief that the war might be massively destructive. The author holds that there is no inconsistency in both supporting resistance to evil, even at risk of total destruction, and in refusing to form or condone a conditional intention to do equivalent but pointless evil in order to make a threat credible. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 189-192 [Access article in PDF] The Responsibility of the Psychopathic Offender:Commentary on Ciocchetti Piers Benn Christopher Ciocchetti has valuable things to say in his article. He takes as his starting point some common ground between his views and my own, especially about the importance of Strawsonian participant reactive attitudes to our understanding of psychopathy. But he proceeds to claim that the distinguishing (...) feature of psychopaths is not their lack of such attitudes but their inability to understand how relationships are affected by their behavior—and indeed their inability, in some sense, to understand interpersonal relationships at all. He also takes me to task for claiming that the participant reactive attitudes (PRAs)—presumably he includes things like resentment, indignation, gratitude, and so on—are essentially communicative. For him, this is too strong a claim, because we can imagine cases when such attitudes are expressed, but without any communicative purpose.On the latter point, I concede that people often do express PRAs even though they know such expression will have no effect on those whose behavior or attitudes gave rise to them. Different things can explain this lack of effect. For example, imagine a normally responsive person who obstinately fails to see that a certain judgment applies to him or her in a particular case. Take a woman who repeatedly expresses frustration and anger toward her husband for failing to do any domestic chores, but without having the slightest effect on him. Eventually her expressions of anger serve more as an emotional release than as an attempt to get him to change. As in Ciocchetti's example of Mary's reaction to her calls not being returned, she gives up in the end, expressing anger but without any hope of getting through to the other person.But there is another possible explanation for her anger: suppose the husband's failure to contribute to the housework does not arise from his inability to respond to moral claims upon him, but because he thinks he is already doing his duty by being the sole wage earner, and is quite intransigent about this. In that case, the woman might still see him, in general, as a proper object of her PRAs. She sees his fault as local rather than general; a failure, or perhaps even an inability, to think properly about this particular issue rather than about moral demands in general. She might regard her angry outbursts as justified, not because they will have any effect on him now, [End Page 189] but because they are a proper participant response to some earlier failure, which he was then able to do something about—maybe he neglected to think properly about fairness when forming his moral outlook.Compare this case, though, with someone who just does not understand the nature of relationships and the obligations they impose. This is the sort of case Ciocchetti has in mind. Anger is, on his account, understandable, not because it is meant to communicate anything, but because it is "an expression with no further aim at all" (2003, p. 178). On this point, I agree that people sometimes do express anger (or other emotions) without trying to induce a response in someone. At the same time, there is a significant difference between times when we do hope to elicit an appropriate participant response like shame, and times when we do not. When we express such attitudes without any hope of a participant response, we miss something that is, if not essential to, at least typical of such expressions. Getting angry with the neighbor's aggressive dog or scrounging cat is understandable, but it is simply not the same kind of thing as getting angry with a normal, rational adult. The typical case, maybe the necessarily typical case, is when we experience or express such emotions toward, or at least concerning, beings capable of PRAs—and, again typically if not always, such beings are capable of understanding when and why the PRAs of others are directed toward them.But the thrust of Ciocchetti's paper lies not... (shrink)

‘Twelve Step' recovery programmes such as Alcoholics Anonymous teach that an alcoholic, or other addict, has a disease, and needs to accept that she is ‘powerless' over her addiction before recovery can begin. However, the disease model of addiction has been criticised on the grounds that some addicts recover without external intervention. This critique is questionable, not because such recovery does not occur, but because many genuine diseases are self-limiting. However, the disease model is better criticised on other grounds. Central (...) here is the idea of powerlessness. This article explores various supposed instances of powerlessness, including that induced by extreme fear, provocation and obsessive-compulsive disorder. It is argued that while addiction is a genuine phenomenon, it is strictly inaccurate to describe it as a lack of power. However, there is a deeper sense in which the autonomy of addicts is compromised, although this does not show that addiction is a disease. (shrink)

Inequities in health and health care are one of the greatest challenges facing the international community today. This problem raises serious questions for health care planners, politicians and ethicists alike. The major world religions can play an important role in this discussion. Therefore, interreligious dialogue on this topic between ethicists and health care professionals is of increasing relevance and urgency. This article gives an overview on the positions of Islam and Christianity on equity and the distribution of resources in health (...) care. It has been written in close collaboration and constant dialogue between the two authors coming from the two religions. Although there is no specific concept for the modern term equity in either of the two religions, several areas of agreement have been identified: All human beings share the same values and status, which constitutes the basis for an equitable distribution of rights and benefits. Special provisions need to be made for the most needy and disadvantaged. The obligation to provide equitable health services extends beyond national and religious boundaries. Several areas require intensified research and further dialogue: the relationship between the individual and the community interms of rights and responsibilities, how to operationalize the moral duty to decrease global inequalities in health, and the understanding and interpretation of human rights in regard to social services. (shrink)

This book is a major contribution to the study of the philosophy of action, moral philosophy, and political philosophy. Its central idea is a radically unorthodox theory of rational action. Most contemporary Anglo-American philosophers believe that action is motivated by desire. Professor Benn rejects the doctrine and replaces it with a reformulation of Kant's ethical and political theory, in which rational action can be determined simply by principles, regardless of consequences. The book analyzes the way in which value conflicts (...) can be rationally resolved, the objectivity of value, the concept of moral personality, the principles of non-interference and respect of persons, the ideals of autonomy and community and various aspects of individual rights - focusing on the rights to freedom, welfare, and privacy. (shrink)

S. I. Benn; VI*—Freedom, Autonomy and the Concept of a Person, Proceedings of the Aristotelian Society, Volume 76, Issue 1, 1 June 1976, Pages 109–130, https://.

Arthur Tansley first defined the term ecosystem in his seminal work “Use and Abuse of Vegetational Concepts,” as an improved way of viewing the relationships between plants and their physical environments. However, his definition, while widely influential, privileges the living components over nonliving components of ecosystems, and has thus been unable to fully overcome the biocentrism of early plant ecologists. Moreover, the binary between life and nonlife is untenable, and serves only as a marker of the underlying biocentric values of (...) a researcher. Drawing from Donna Haraway’s argument for situated knowledges, one can critically examine the biocentrism implicit in much of ecology, and reconsider our definition of ecosystem in order to highlight our devaluation of the nonliving, and expand our normative universe. (shrink)

Automated Influence is the use of Artificial Intelligence to collect, integrate, and analyse people’s data in order to deliver targeted interventions that shape their behaviour. We consider three central objections against Automated Influence, focusing on privacy, exploitation, and manipulation, showing in each case how a structural version of that objection has more purchase than its interactional counterpart. By rejecting the interactional focus of “AI Ethics” in favour of a more structural, political philosophy of AI, we show that the real problem (...) with Automated Influence is the crisis of legitimacy that it precipitates. (shrink)

A familiar part of debates about supererogatory actions concerns the role that cost should play. Two camps have emerged: one claiming that extreme cost is a necessary condition for when an action is supererogatory, while the other denies that it should be part of our definition of supererogation. In this paper, I propose an alternative position. I argue that it is comparative cost that is central to the supererogatory and that it is needed to explain a feature that all accounts (...) agree is central to the very notion of supererogation: optionality. Perhaps because of this agreement on its importance, few attempts have been made to clarify and explain the notion of optionality. I argue that giving an account of the optionality of supererogatory requires drawing a line between doing the bare minimum permissible and going beyond the bare minimum and that this line ought to be drawn based on comparative cost of alternative permissible acts. Having outlined my account and motivated it, I discuss and reject two concerns that might be raised: firstly, that it is extreme cost, not comparative cost, that matters and, secondly, that in fact no cost is needed for an act to be supererogatory. (shrink)