Background:Moral courage is defined as courage to act according to one’s own ethical values and principles even at the risk of negative consequences for the individual. In a complex nursing practice, ethical considerations are integral. Moral courage is needed throughout nurses’ career.Aim:To analyse graduating nursing students’ moral courage and the factors associated with it in six European countries.Research design:A cross-sectional design, using a structured questionnaire, as part of a larger international ProCompNurse study. In the questionnaire, moral courage was assessed (...) with a single question (visual analogue scale 0–100), the questionnaire also covered several background variables.Participants and research context:The sample comprised graduating nursing students (n = 1796) from all participating countries. To get a comprehensive view about graduating nursing students’ moral courage, the views of nurse managers (n = 538) and patients (n = 1327) from the same units in which the graduating nursing students practised were also explored, with parallel questionnaires.Ethical considerations:Ethical approvals and research permissions were obtained according to national standards in every country and all participants gave their informed consent.Results:The mean of graduating nursing students’ self-assessed moral courage was 77.8 (standard deviation 17.0; on a 0–100 scale), with statistically significant differences between countries. Higher moral courage was associated with many factors, especially the level of professional competence. The managers assessed the graduating nursing students’ moral courage lower (66.5; standard deviation 18.4) and the patients slightly higher (80.6; standard deviation 19.4) than the graduating nursing students themselves.Discussion and conclusions:In all countries, the graduating nursing students’ moral courage was assessed as rather high, with differences between countries and populations. These differences and associations between moral courage and ethics education require further research. (shrink)

Ethics is a foundational competency in healthcare inherent in everyday nursing practice. Therefore, the promotion of qualified nurses’ and nursing students’ moral competence is essential to ensure ethically high-quality and sustainable healthcare. The aim of this integrative literature review is to identify the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence. The review has been registered in PROSPERO (CRD42023386947) and reported according to the PRISMA guideline. Focusing on qualified nurses’ and nursing students’ moral competence, a (...) literature search was undertaken in January 2023 in six scientific databases: CINAHL, Cochrane Library, PsycINFO, PubMed Medline, Scopus and Web of Science. Empirical studies written in English without time limitation were eligible for inclusion. A total of 29 full texts were retrieved and included out of 5233 citations. Quality appraisal was employed using Joanna Briggs Institute checklists and the Mixed Method Appraisal Tool. Data were analysed using inductive content analysis. Research about the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence is limited and mainly explored using descriptive research designs. The contributing factors were identified as comprising two main categories: (1) human factors, consisting of four categories: individual, social, managerial and professional factors, and ten sub-categories; and (2) structural factors, consisting of four categories: educational, environmental, organisational and societal factors, and eight sub-categories. This review provides knowledge about the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence for the use of researchers, nurse educators, managers, organisations and policymakers. More research about the contributing factors is needed using complex intervention, implementation and multiple methods designs to ensure ethically sustainable healthcare. (shrink)

Research ethics committees (RECs) evaluate whether the risk-benefit ratio of a study is acceptable. Decentralized clinical trials (DCTs) are a novel approach for conducting clinical trials that potentially bring important benefits for research, including several collateral benefits. The position of collateral benefits in risk-benefit assessments is currently unclear. DCTs raise therefore questions about how these benefits should be assessed. This paper aims to reconsider the different types of research benefits, and their position in risk-benefit assessments. We first propose a categorization (...) of research benefits, based on the types of benefits that can be distinguished from the literature and ethical guidelines. Secondly, we will reconsider the position of collateral benefits. We argue that these benefits are not fundamentally different from other benefits of research and can therefore be included in risk-benefit assessments of DCTs. (shrink)

Bullying often results in negative coping in victims, including an increased consumption of alcohol. Recently, however, an increase in alcohol use has also been reported among perpetrators of bullying. The factors triggering this pattern are still unclear. We investigated the role of empathy in the interaction between bullying and alcohol use in an adolescent sample (IMAGEN) at age 13.97 (±0.53) years (baseline (BL), N = 2165, 50.9% female) and age 16.51 (±0.61) years (follow-up 1 (FU1), N = 1185, 54.9% female). (...) General empathic distress served as a significant moderator of alcohol use in perpetrators (F9, 493 = 17.978, p < 0.01), which was specific for males and FU1. Male perpetrators, who are generally less sensitive to distress, might thus be more vulnerable to alcohol abuse. (shrink)

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory (...) determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

Research question and aimClinical Ethics Committees (CECs) aim to support healthcare professionals (HPs) and healthcare organizations to deal with the ethical issues of clinical practice. In 2020,...

The prospect of using genome technologies to modify the human germline has raised profound moral disagreement but also emphasizes the need for wide-ranging discussion and a well-informed policy response. The Hinxton Group brought together scientists, ethicists, policymakers, and journal editors for an international, interdisciplinary meeting on this subject. This consensus statement formulated by the group calls for support of genome editing research and the development of a scientific roadmap for safety and efficacy; recognizes the ethical challenges involved in clinical reproductive (...) applications of genome editing but, importantly, rejects the idea that human reproductive germline modification is necessarily morally unacceptable; and highlights the importance of meaningful engagement in discussions of genome editing and the development of regulation and oversight mechanisms to govern future uses of such technologies. (shrink)

Jung's explanation of the religious tendency of the psyche addresses many sides of the contemporary debate on religion and the role that it has in individual and social life. This book discusses the emergence of a new mythic consciousness and details ways in which this consciousness supersedes traditional concepts of religion to provide a spirituality of more universal inclusion. _On Behalf of the Mystical Fool_ examines Jung's critique of traditional western religion, demonstrating the negative consequences of religious and political (...) collective unconsciousness, and their consequent social irresponsibility in today's culture. The book concludes by suggesting that a new religiosity and spirituality is currently emerging in the West based on the individual’s access to the sense of ultimacy residual in the psyche, and seeking expression in a myth of a much wider compass. This book will be of interest to scholars and students at all levels who are engaged in the expanding field of Jungian studies. It will also be key reading for anyone interested in the theoretical and therapeutic connections between the psyche and religious experience. (shrink)

A common understanding of the political function of human rights is as a trigger for international intervention, with states typically understood to be duty bound by these rights claims. The unique character of the human right to health raises some complications for these conventional views. In this paper, I will argue that because of the unique character of the human right to health, intervention on its behalf can be justified not only in response to outright violation, but also due (...) to unmet needs of populations. As a secondary goal of this paper, I will attempt to respond to some of the worries about cultural imperialism in human rights and cross-cultural humanitarian interventions, specifically in the context of global health justice. (shrink)

This paper provides an analysis of the phrase ‘acting on behalf of another.’ To do this, acting on behalf is first distinguished from ‘acting for the sake of another,’ the latter being a matter of other-directed motivation, the former of what we call ‘normative other-directedness’—i.e., acting on the claims and duties of the other. Second, we provide a distinction between two kinds of acting on behalf of another: representation as other-directedness plus normative replacement, and normative support as (...) other-directedness without normative replacement. Third, the paper offers conditions of appropriateness for both types of acting on behalf. (shrink)

In this essay I discuss two limitations that emerge when considering Tsoukas analysis of the Academy of Management’s initial response to the travel ban issued by President Trump in 2017. First, I suggest that any initial official response on the part of AOM would have required its leaders to “speak on behalf of” all AOM members and thus would have created a number of problems. We therefore need to take better account of others’ perspectives whenever speaking for others. For (...) this reason I emphasize that moral imagination does not constitute a solely individual cognitive act but must be thought of as a deliberative process. Second, while Tsoukas’ analysis suggests that the leadership of AOM should have made an exception to the rule on taking public stands, I show that such exceptions need to be justified communicatively, especially when dealing with moral questions. My analysis outlines the formal and informal communication processes necessary to facilitate such justification and explores ways in which AOM’s current approach to deliberation can be improved. (shrink)

ABSTRACT Because of the existence of severely defective humans it is commonly held that whatever consideration is due to all humans is also due to many other animals, and that therefore speciesism, or the readiness to prefer the interest of humans to those of other animals, is unjustified. After criticism of this reasoning a ‘naturalised’ speciesism, acknowledging, for example, the affinities between species, is articulated and defended. A key to this defence is the separation of the task of specifying morally (...) significant differences between humans and other animals from the task of justifying the extension of consideration to defective humans. The conclusion is that more traditional vices than speciesism are chiefly to blame for the shabby treatment of animals by humans. (shrink)

ABSTRACTThough responses to Stout's book, Democracy and Tradition, have touched on his discussion of rights, none has comprehensively examined his position on the subject. Having endorsed several objections Stout raises against some influential views on democracy and rights, this article proceeds to criticize Stout's description and theoretical account of the natural and human rights traditions. The central argument is that Stout cannot successfully both affirm the traditions and adhere to his account.

In this discussion note, I defend Gaunilo's famous parody of Anselm's Ontological Argument for God's existence against a well-known objection due to Alvin Plantinga.

A bi-level account of trust is developed and defended, one with relevance in ethics as well as epistemology. The proposed account of trust—on which trusting is modelled within a virtue-theoretic framework as a performance-type with an aim—distinguishes between two distinct levels of trust, apt and convictive, that take us beyond previous assessments of its nature, value, and relationship to risk assessment. While Sosa, in particular, has shown how a performance normativity model may be fruitfully applied to belief, my objective is (...) to apply this kind of model in a novel and principled way to trust. I conclude by outlining some of the key advantages of the performance-theoretic bi-level account of trust defended over more traditional univocal proposals. (shrink)

Being alive throughout all history need not save you from dying, even if history extends infinitely into the past and future. Infinitely-long lives can fall short of genuine immortality and suffer all an ordinary mortal’s diminution in experience. Adapting David Lewis on time travel, Roy Sorensen imagines quasi-immortal ‘spore gods’, whose finite personal lives are distributed across infinite external time. While criticising the ‘Eleatic’ terms in which Sorensen presents spore gods, this paper argues his essential claims are correct: ‘spore god’ (...) worlds are logically and metaphysically possible. Indeed, going beyond Sorensen, spore gods are even nomologically accessible within General Relativity. (shrink)

responses to Sloep and Van der Steen, Biol. Philos. 1987 (2)33.

A growing number of decision theorists have, in recent years, defended the view that rationality is permissive under risk: Different rational agents may be more or less risk-averse or risk-inclined. This can result in them making different choices under risk even if they value outcomes in exactly the same way. One pressing question that arises once we grant such permissiveness is what attitude to risk we should implement when choosing on behalf of other people. Are we permitted to implement (...) any of the rationally permissible risk attitudes, is there some specific risk attitude that is required when choosing for others, or are we required to defer to the risk attitudes of the people on whose behalf we are choosing? This article elaborates on this question, explains its wider practical and theoretical significance, provides an overview of existing answers, and explores how to go about providing a more systematic account of how to choose on behalf of others in risky contexts. (shrink)

A bi-level account of trust is developed and defended, one with relevance in ethics as well as epistemology. The proposed account of trust—on which trusting is modelled within a virtue-theoretic framework as a performance-type with an aim—distinguishes between two distinct levels of trust, apt and convictive, that take us beyond previous assessments of its nature, value, and relationship to risk assessment. While Ernest Sosa (2009; 2015; 2017), in particular, has shown how a performance normativity model may be fruitfully applied to (...) belief, my objective is to apply this kind of model in a novel and principled way to trust. I conclude by outlining some of the key advantages of the performance-theoretic bi-level account of trust defended over more traditional univocal proposals. (shrink)

Everyone agrees that we can’t change the past. But what about the future? Though the thought that we can change the future is familiar from popular discourse, it enjoys virtually no support from philosophers, contemporary or otherwise. In this paper, I argue that the thesis that the future is mutable has far more going for it than anyone has yet realized. The view, I hope to show, gains support from the nature of prevention, can provide a new way of responding (...) to arguments for fatalism, can account for the utility of total knowledge of the future, and can help in providing an account of the semantics of the English progressive. On the view developed, the future is mutable in the following sense: perhaps, once, it was true that you would never come to read a paper defending the mutability of the future. And then the future changed. And now you will. (shrink)

In clarifying and defending Molinism, Thomas Flint argues against a position he terms Maverick Molinism. This version of Molinism maintains that, though counterfactuals of freedom have their truth-value logically prior to God’s acts of will, God could have so acted that these counterfactuals would have had a different truth value from that which they actually have. Flint believes this position is flawed, and presents an argument for rejecting it. I argue that Flint’s argument against Maverick Molinism is flawed, and suggest (...) that the Maverick has a position with advantages over more traditional versions of Molinism. (shrink)

Through a critique of Karl Rahner and an exegesis of John of Damascus, the article argues that there is no difference in essential logic between Greek and Latin Trinitarianism. In particular, both traditions establish an epistemic gap between the doctrine of the immanent Trinity and the doctrine of the economic Trinity, which (contrary to prevailing theological opinion) is well-placed, but does not imply that the inner self of the Trivine God remains hidden and unknown in the economy of salvation.

Controversial view agnosticism is the thesis that we are rationally obligated to withhold judgment about a large portion of our beliefs in controversial subject areas, such as philosophy, religion, morality and politics. Given that one’s social identity is in no small part a function of one’s positive commitments in controversial areas, CVA has unsurprisingly been regarded as objectionably ‘spineless.’ That said, CVA seems like an unavoidable consequence of a prominent view in the epistemology of disagreement—conformism—according to which the rational response (...) to discovering that someone you identify as an epistemic peer or expert about p disagrees with you vis-à-vis p is to withhold judgment. This paper proposes a novel way to maintain the core conciliatory insight without devolving into an agnosticism that is objectionably spineless. The approach offered takes as a starting point the observation that–for reasons that will be made clear—the contemporary debate has bypassed the issue of the reasonableness of maintaining, rather than giving up, representational states weaker than belief in controversial areas. The new position developed and defended here explores this overlooked space; what results is a kind of controversial view. (shrink)

Thirty years ago, Buchanan and Brock distinguished between guidance principles and interference principles in the setting of surrogate decision making on behalf of children and incompetent adult patients. They suggested that the best interest standard could serve as a guidance principle, but was insufficient as an interference principle. In this issue of The Journal of Clinical Ethics, Ross argues that the best interest standard can serve as neither a guidance nor interference principle for decision making on behalf of (...) children, but that her model of constrained parental autonomy can serve as both. I will argue that Buchanan and Brock were correct that a single model or standard cannot serve as both a guidance and interference principle in pediatrics and that the best interest standard is a sufficient guidance principle. The harm principle fulfills the conditions necessary for an interference principle, at least insofar as deciding when state intervention to interfere with parental decision making is justified. (shrink)

This is a reply to W. Paul Franks’ critique (‘Why a Believer Could Believe that God Answers Prayers’) of my recent paper in Sophia (2007). I argue that Franks’ Plantinga-inspired criticism fails because it turns on the dubious assumption that the efficacy of prayer could provide evidence for the existence of God.

In this comment I express my puzzlement about Burrell’s employment of “the distinction,” and request further clarification. I also discuss at some length his views concerning free will. I explain the libertarian view as I understand it and point out why his criticisms of it do not succeed. I sketch out his own view of created freedom, and raise certain questions concerning that view.

The consequence argument for the incompatibility of free action and determinism has long been under attack, but two important objections have only recently emerged: Warfield’s modal fallacy objection and Campbell’s no past objection. In this paper, I explain the significance of these objections and defend the consequence argument against them. First, I present a novel formulation of the argument that withstands their force. Next, I argue for the one controversial claim on which this formulation relies: the trans-temporality thesis. This thesis (...) implies that an agent acts freely only if there is one time at which she is able to perform an action and a distinct time at which she actually performs it. I then point out that determinism, too, is a thesis about trans-temporal relations. I conclude that it is precisely because my formulation of the consequence argument emphasizes trans-temporality that it prevails against the modal fallacy and no past objections. (shrink)

Brian Garrett claims, in defence of Gaunilo’s Perfect Island and contra Plantinga, that ‘Properly understood, the great-making qualities of an island are maximal’. This article demonstrates that they are not, thus ‘the greatest conceivable island’ remains an incoherent concept and Gaunilo’s parody fails.

Suppose we are able to transplant Jones's pain centres into Smith's brain. Half way through the operation we test the pain centres by stimulating them electrically in vitro. Would there be pain? Roland Puccetti argues that there would not be. Because pains must have owners and the only available candidate for that role — the excised tissue — is logically unfit to play it. He concludes that the firing of such centres in a normally functioning brain cannot be pain either (...) and that, therefore, materialism is false.So far as I can see, Puccetti's “refutation” is a series of nonsequiturs from start to finish, and that is what I mainly want to show. It will not follow, of course, that materialism is true. Indeed, I think the view which Puccetti attacks under that name is too naive to be taken seriously by anyone. (shrink)

In this book, Mugerauer emphasizes the interplay between European continental philosophy and North American environments and architecture.

An utterance of a sentence involving an incomplete (definite) description, ‘the F’, where the context—even taking the speaker’s intentions into account—does not determine a unique F, would be unintelligible. But an utterance (in the same context) of the corresponding Russellian paraphrase would not be unintelligible. So I urged in ‘A Strawsonian objection to Russell’s theory of descriptions’ (ANALYSIS 53, 1993, pp. 209-12). I compared an utterance of (1) The table is covered with books. with an utterance of (1)’s Russellian paraphrase..

In lieu of an abstract, here is a brief excerpt of the content:120 A WORD ON BEHALF OF DEMEA Little attention has been given to the a priori argument for God's existence espoused by Demea in Hume's Dialogues concerning Natural Religion. This circumstance is neither surprising nor unjustified. Given Hume's well-known theological sympathies, certainly no one would be tempted to regard Demea as Hume's spokesman. Demea's argument plays so small a role in the Dialogues as to suggest that Hume (...) does not take it at all seriously. He may present it only to establish that he is aware of alternative arguments for God's existence, but thinks them even less successful than the design argument and hence undeserving of extensive critique. Yet, if a philosopher criticizes an argument he deems unworthy of respect, he should still provide sound, not spurious, reasons for rejecting it. This is exactly what D. C. Stove has argued that Hume fails to do in Part IX of the Dialogues, assuming, as is generally done, that the speeches of Cleanthes and Philo present reasoning that Hume would personally endorse. Stove argues that most of the criticisms of Demea's argument are "extremely defective, and that they even include an inconsistency" (Stove, p. 300). This contention has been challenged by Donald Stahl, who has published a succinct point by point rebuttal of Stove's contentions.3 The Stove-Stahl controversy only deals with the reasoning presented in paragraphs 5, 6, 7, and 10 of Part IX because those are the contentions Stove attacks. He has "nothing to say against" the criticisms presented in paragraphs 8 and 9, which he assumes will be generally agreed to be 121 less important than the others (Stove, p. 308). He totally ignores the argument of paragraph 11. However, I am not convinced that the criticisms of these paragraphs are less important and I do have something to say against them. Consequently, instead of intervening directly on either side of the dispute between Professors Stove and Stahl, I shall attend principally to the argumentation of paragraphs 8, 9, and 11. I shall (1) summarize Demea's argument, (2) argue for the significance of the criticisms of paragraphs 8-9, (3) examine those criticisms, and (4) assess the role of Philo's concluding remarks in paragraphs 10-11. 1. Demea's Argument Early on Hume has Demea speak so obviously inconsistently as to make the reader wonder whether this character is supposed to think at all about the implications of the claims he espouses. At the beginning of Part II, he proclaims that God's existence is surely not at issue, since no one of common sense... ever entertained a serious doubt with regard to a truth so certain and self-evident." The nature of God is the only proper object of theological inquiry, and that is "altogether incomprehensible and unknown to us" (D 141)! Given such a radically apophatic position (Hume calls it "mystical"), it is hardly surprising that the sceptical Philo readily concurs, once he specifies that he takes 'God' to mean just "the original cause of this universe (whatever it be)" (D 142). But Demea immediately buttresses his alleged self-evident truth by appealing to the authority of Father Malebranche and the whole tradition of Christian theology, apparently oblivious to the impropriety of 122 supporting an indubitable truth by citing authorities (D 141-142). Further, scarcely more than a page later, after Cleanthes has sketched out the design argument, this same Demea is horrified that Cleanthes gives no abstract arguments or a priori proofs and calls for a "demonstration of the being of a God" (D 143). When, in Part IX, Demea himself undertakes to provide the "simple and sublime argument a priori" (D 188) he expected from Cleanthes, he characterizes the argument as "the common one," which suggests he is more engaged in paraphrasing authority than in thoughtfully arguing. The argument, in fact, as has been generally recognized, closely follows one given by Samuel Clarke in the Boyle Lectures of 1704. 5 Demea begins by assuming that "whatever exists must have a cause or reason of its existence," (D 188) since nothing can cause itself to exist. He then states a dilemma: in tracing the... (shrink)

Janet Staiger _Perverse Spectators: The Practices of Film Reception_ New York and London: New York University Press, 2000 ISBN 0-8147-8139-X 242 pp.

Glenn Pearce, labels the identification of the firing of one's pain centres in the brain with feeling pain ‘a naive view,’ the refutation of which cannot much threaten any serious version of materialism. But in fact at least a dozen proponents of contemporary materialism have already hypothesized the identification of feeling pain with activation of a specific neural mechanism, although they picked the wrong mechanism, namely C-fibres. Just to take a recent example, James Cornman and Keith Lehrer, trying to get (...) around the objection to the identity theory that the language of neural processes and the language of feeling pains belong to different linguistic categories, suggest that the materialist could devise a new term to refer to the same entity across categories: ‘fibain.’They write,He would then claim that there are fibains, that is, entities with those properties usually associated with pains, and also with the properties usually associated with firing C-fibers. He can, then, avoid category mistakes by saying that what are thought to be pains and what are thought to be firing C-fibers are really fibains. (shrink)