Increased technological and pharmacological interventions in patient care when patient outcomes are uncertain have been linked to the escalation in moral and ethical dilemmas experienced by health care providers in acute care settings. Health care research has shown that facilities that are able to attract and retain nursing staff in a competitive environment and provide high quality care have the capacity for nurses to process and resolve moral and ethical dilemmas. This article reports on the findings of a systematic review (...) of the empirical literature (1980 — February 2007) on the effects of unresolved moral distress and poor ethical climate on nurse turnover. Articles were sought to answer the review question: Does unresolved moral distress and a poor organizational ethical climate increase nurse turnover? Nine articles met the criteria of the review process. Although the prevailing sentiment was that poor ethical climate and moral distress caused staff turnover, definitive answers to the review question remain elusive because there are limited data that confidently support this statement. (shrink)

This paper focuses on examining the dynamic nature of community supported agriculture (CSA) and the real-world experiences which mark its contours, often making it distinct from the early idealized CSA “model.” Specifically, our study examines the narratives of the farmers of Devon Acres CSA over its duration, in tandem with a survey of recent shareholders in order to understand and explain its evolution. The framework we develop here shows that this CSA is largely characterized by instrumental and functional beliefs and (...) practices, with some elements in the collaborative mode. A key contribution of this research is the development of a framework which helps to highlight the relative fluidity and patchwork quality of CSA participant positions over time. At Devon Acres, the real-world factors and issues influencing CSA evolution are seen to be products of both the local and larger contexts, evident in such areas as shifts in farmer learning and adaptation, differences between beliefs and practices in member volunteer efforts, and changes in farm and resource conditions. With respect to CSA more broadly, we argue that the reality of dominant food system context and site-specific influences on CSA development compels us to rework our attachment to early idealized “model” traits. Expansion in CSA numbers, evidence of adaptation and situated learning, and retention of the local and organic as core traits, speak to the pragmatic yet transformative potential of CSA contribution to food system change. (shrink)

I. EXECUTIVE SUMMARY The MRCT Center Post-trial Responsibilities: Continued Access to an Investigational Medicine Framework outlines a case-based, principled, stakeholder approach to evaluate and guide ethical responsibilities to provide continued access to an investigational medicine at the conclusion of a patient’s participation in a clinical trial. The Post-trial Responsibilities (PTR) Framework includes this Guidance Document as well as the accompanying Toolkit. A 41-member international multi-stakeholder Workgroup convened by the Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard University (...) (MRCT Center) developed this Guidance and Toolkit. Project Motivation A number of international organizations have discussed the responsibilities stakeholders have to provide continued access to investigational medicines. The World Medical Association, for example, addressed post-trial access to medicines in Paragraph 34 of the Declaration of Helsinki (WMA, 2013): “In advance of a clinical trial, sponsors, researchers and host country governments should make provisions for post-trial access for all participants who still need an intervention identified as beneficial in the trial. This information must also be disclosed to participants during the informed consent process.” This paragraph and other international guidance documents converge on several consensus points: • Post-trial access (hereafter referred to as “continued access” in this Framework [for terminology clarification – see definitions]) is the responsibility of sponsors, researchers, and host country governments; • The plan for continued access should be determined before the trial begins, and before any individual gives their informed consent; • The protocol should delineate continued access plans; and • The plan should be transparent to potential participants and explained during the informed consent process. -/- However, there is no guidance on how to fulfill these responsibilities (i.e., linking specific responsibilities with specific stakeholders, conditions, and duration). To fill this gap, the MRCT Center convened a working group in September of 2014 to develop a framework to guide stakeholders with identified responsibilities. This resultant Framework sets forth applicable principles, approaches, recommendations and ethical rationales for PTR regarding continued access to investigational medicines for research participants. (shrink)

BackgroundNeuroethics describes several interdisciplinary topics exploring the application and implications of engaging neuroscience in societal contexts. To explore this topic, we present Part 3 of a four-part bibliography of neuroethics’ literature focusing on the “ethics of neuroscience.”MethodsTo complete a systematic survey of the neuroethics literature, 19 databases and 4 individual open-access journals were employed. Searches were conducted using the indexing language of the U.S. National Library of Medicine. A Python code was used to eliminate duplications in the final bibliography.ResultsThis bibliography (...) consists of 1137 papers, 56 books, and 134 book chapters published from 2002 through 2014, covering ethical issues in neuroimaging, neurogenetics, neurobiomarkers, neuro-psychopharmacology, brain stimulation, neural stem cells, neural tissue transplants, pediatric-specific issues, dual-use, and general neuroscience research issues. These works contain explanations of recent research regarding neurotechnology, while exploring ethical issues in future discoveries and use. (shrink)

Epistemic Evaluation aims to explore and apply a particular methodology in epistemology. The methodology is to consider the point or purpose of our epistemic evaluations, and to pursue epistemological theory in light of such matters. Call this purposeful epistemology. The idea is that considerations about the point and purpose of epistemic evaluation might fruitfully constrain epistemological theory and yield insights for epistemological reflection. Several contributions to this volume explicitly address this general methodology, or some version of it. Others focus on (...) advancing some application of the methodology rather than on theorizing about it. The papers go on to explore the idea that purposes allow one to understand the conceptual demands on knowing, examine how purposeful epistemology might shed light on the debate between internalist and externalist epistemologies, and further develop the idea of purposeful epistemology. (shrink)

This paper is a beginning—an initial attempt to think of the function and character of epistemic norms as a kind of social norm. We draw on social scientific thinking about social norms and the social games to which they respond. Assume that people individually follow epistemic norms for the sake of acquiring a stock of true beliefs. When they live in groups and share information with each other, they will in turn produce a shared store of true beliefs, an epistemic (...) public good. True beliefs, produced individually or in groups, constitute an epistemic good—one commonly stockpiled and distributed within a community. Epistemic norms can then be understood as a kind of socially developed and transmitted normative sensibility having to do with the production of this individual and public good. Epistemic norms should serve to regulate this practice—coordinating the practice of individuals so as to afford the benefits of life in an interdependent epistemic community—and to manage the risks of being epistemically dependent on others within such a community. Here, we provide some attempts to characterize the central aspects of "the epistemic game"—the epistemic choice situation confronted by communities of epistemic agents. (shrink)

This chapter examines how epistemic norms could be social norms, with a reliance on work on the philosophy and social science of social norms from Bicchieri (on the one hand) and Brennan, Eriksson, Goodin and Southwood (on the other hand). We explain how the social ontology of social norms can help explain the rationality of epistemic cooperation, and how one might begin to model epistemic games.

This book examines cultural recognition and the struggle for identity in America's schools. In particular, the contributing authors focus on the recognition and misrecognition as antagonistic cultural forces that work to shape, and at times distort identity.

Though antiretroviral therapy is the standard of care for people living with HIV, its treatment limitations, burdens, stigma and costs lead to continued interest in HIV cure research. Early-phase cure trials, particularly those that include analytic treatment interruption, involve uncertain and potentially high risk, with minimal chance of clinical benefit. Some question whether such trials should be offered, given the risk/benefit imbalance, and whether those who choose to participate are acting rationally. We address these questions through a longitudinal decision-making study (...) nested in a Thai acute HIV research cohort. In-depth interviews revealed central themes about decisions to join. Participants felt they possessed an important identity as members of the acute cohort, viewing their bodies as uniquely suited to both testing and potentially benefiting from HIV cure approaches. While acknowledging risks of ATI, most perceived they were given an opportunity to interrupt treatment, to test their own bodies and increase normalcy in a safe, highly monitored circumstance. They were motivated by potential benefits to themselves, the investigators and larger acute cohort, and others with HIV. They believed their own trial experiences and being able to give back to the community were sufficient to offset participation risks. These decisions were driven by the specific circumstances experienced by our participants. Judging risk/benefit ratios without appreciating these lived experiences can lead to false determinations of irrational decision- making. While this does not minimise vital oversight considerations about risk reduction and protection from harm, it argues for inclusion of a more participant-centered approach. (shrink)

Familiar accounts have it that one explains thoughts or actions by showing them to be rational. It is common to find that the standards of rationality presupposed in these accounts are drawn from what would be thought to be aprioristic sources. I advance an argument to show this must be mistaken. But, recent work in epistemology and on rationality takes a less aprioristic approach to such standards. Does the new (psychological or cognitive scientific) realism in accounts of rationality itself significantly (...) improve the prospects for unproblematic forms of rationalizing explanation? Do earlier misgivings about rationalizing explanation ring hollow when the rationality to be attributed is "naturalized"? Answer: while explanation in terms of naturalized rationality would be free of one fatal flaw possessed by explanation in terms of rationality understood in the traditional fashion, it would yet have parallel flaws. (shrink)

Despite the promise of new gene editing technologies (GETs) (e.g., CRISPR) in accelerating sustainable agri-food production, the social acceptability of these technologies remains unclear. Prior literature has primarily addressed the regulatory and economic issues impacting GETs ongoing acceptability, while little work has examined socio-cultural impacts despite evolving food policies and product commercialisation demanding input from various actors in the food system. Our systematic review across four databases addresses this gap by synthesising recent research on food system actors’ perspectives to identify (...) the key socio-cultural factors influencing GET acceptability. This review extends prior literature by including views from a more diverse range of actors (e.g., farmers and NGOs) and provides a better understanding of their perceived social benefits and concerns. We find food system actors perceive positive and negative impacts of using GETs in agriculture. These perspectives are often entangled in broader debates regarding sustainability and food systems issues (e.g., social justice). We discuss practical recommendations for policymakers, agri-food industry managers, and scientists to better align gene edited foods (GEFs) with food system actors’ values. GEF policy, development, and commercialisation must reflect social values such as collective wellbeing and transparency to improve actors’ acceptability. More research is required among marginalised food actors such as Indigenous and smallholder farmers. (shrink)

In What Philosophers Know, Gary Gutting provides an epistemology of philosophical reflection. This paper focuses on the roles that various intuitive inputs are said to play in philosophical thought. Gutting argues that philosophers are defeasibly entitled to believe some of these, prior to the outcome of the philosophical reflection, and that they then rightly serve as significant (again defeasible) anchors on reflection. This paper develops a view of epistemic entitlement and applies it to argue that many prephilosophical convictions of the (...) kind Gutting discusses would be just the sort of belief for which entitlement would plausibly be defeated from the start. They then could not properly play the role in philosophical reflection that Gutting envisions for them. (shrink)

Background Design thinking is a tool for generating and exploring ideas from multiple stakeholders. We used DT principles to introduce students to the ethical implications of organ transplantation. Students applied DT principles to propose solutions to maximise social justice in liver transplant allocation. Methods A 150 min interactive workshop was integrated into the longitudinal ethics curriculum. Following a group didactic on challenges of organ donation in the USA supplemented by patient stories, teams of students considered alternative solutions to optimise fairness (...) of organ distribution and ethical implications of changing the current model. Facilitators led students through DT steps of empathy, defining the team’s point of view, ideating on potential solutions, prototyping a specific idea and testing the idea through oral presentation, with questions and answers by peers and faculty. The curriculum was evaluated with presurveys and postsurveys including quantitative and open-ended items. Results 100 first year medical students participated. Before the session, 75.3% of students had no practical experience with DT. Following participation, students reported an increased understanding of the current liver transplant allocation system and an increased appreciation of shortcomings of the current organ allocation system. After the session, 73.8% of students felt that DT could be used to approach complex health system problems. Discussion Students participating in a DT workshop displayed improved knowledge and attitudes toward organ transplantation and DT. In this pilot study, DT showed promise as a student-led approach emphasising collaboration and creativity in ethics curricula in medical education. (shrink)

Foreword -- Preface -- Acknowledgments -- Introduction to corporate social responsibility and ethics -- Business ethics and the meetings and events industry -- Strategies for sustainable meetings -- Social responsibility and culture -- Meetings, events, and environmental science -- Shared value and strategic corporate responsibility -- Communication, marketing, and public relations -- Sustainable supply chains for meetings and events -- Sustainability measurement and evaluation -- Sustainability reporting for meetings and events -- Risk management and legal considerations -- Backcasting and scenario (...) planning for a sustainable meetings and events industry -- Glossary -- Index. (shrink)

This study explores building code negotiation between straw bale advocates’ ecology-oriented values and health and safety values that underlie building codes in general by focusing on how values and ethics are articulated and embodied in practice and discourse in the two states where straw bale building standards were first initiated. The local, contingent nature of interactions, grounded in particular practices, material culture, and written and visual texts in which values were embedded, coupled with organizational factors contributed to strategies for a (...) prescriptive code in Arizona and for a performance code in New Mexico. Examination of situated practice in standards development for unconventional materials that may not fit well with practices based on conventional technologies sheds light on how norms associated with the ethics of safe building are enmeshed in existing practice where they can be taken for granted as ethical absolutes and illustrates the kinds of insights available through paying attention to ethics in practice. (shrink)

This issue of Science in Context presents a sampling of current work by art historians examining modern artists' engagement with science as well as the relationship of photography to both science and art. The essays' topics span the mid-to-later nineteenth century to the 1960s and, thus, in a series of case studies provide an introduction to aspects of artistic modernism. Indeed, it is impossible to understand fully many of the radical innovations of modern art without some knowledge of an artist's (...) cultural context, and developments in science have often played a critical role in defining that milieu. Collected together, these essays also represent methodological models of historical work on art and science that serve as useful examples in this developing field. (shrink)

Under the impressive editorship of Warren Samuels et al, this book addresses the state of the history of economic thought today. An important contribution to the study of the history of economics, this eagerly-awaited book will develop an unsurprisingly large following.

On what has become the received view of the principle of charity, it is a fundamental methodological constraint on interpretation that we find peoples’ intentional states patterned in ways that are characterized by norms of rationality. This recommended use of normative principles of rationality to inform intentional description is epistemically unmotivated. To say that the received view lacks epistemic motivation is to say that to interpret as it recommends would be epistemically irresponsible ans, in important respects irrational. On the alternative (...) that I recommend, descriptive psychological generalization are what properly inform interpretation. One can readily understand the epistemic motivations for so interpreting, for they are the familiar reasons for informing description with background descriptive information. No parallel motivations for the received view seems possible. (shrink)

John Henderson focuses on three key Letters visiting three Roman villas, and reveals their meaning as designs for contrasting lives. Seneca brings the philosophical epistle to Latin literature, creating models for moralizing which feature self-criticism, parody, and animated revision of myth. The Stoic moralist wrests writing away from Greek gurus and texts, and recasts it into critical thinking in Latin terms, within a Roman context. The Letters embody critical thinking on metaphor and translation, self-transformation and cultural tradition.

In lieu of an abstract, here is a brief excerpt of the content:The Truth in WritingAmandaAn excerpt from my journal during a dark period in my life reads:I am a survivor of sexual mutilation, of coerced gender roles, and of perpetual lies all in the name of normalization. Sometimes I have a hard time even thinking about the true extent of what all happened. It’s like my mind doesn’t have that type of scope, like when I think about the word (...) “eternity.”I wrote this after combing through old medical records, reading comments like “her introitus has healed nicely and looks normal, but my exam suggests that her vagina is shortened,” and “reduction clitoroplasty... removal of testes.” The records go on to say that my “external genitalia is quite satisfactory,” and “on perineal exam, her neovaginal orifice is quite compliant and easily accepts my second and third digits.”My journal continues:I chose this fake hole when I was a teenager because I didn’t know there was another option. I was told from day one to be a female, to be heteronormative, to act like all the other girls, and the only way I could fully accomplish this is by looking the part. A fake hole would be necessary, I thought, to go along with the rest of the lies. Sometimes I think about how the doctors told me to lie about my surgeries and my scars. Sometimes I wonder what my parents would have told the world if I had died during one of surgeries. Maybe they would have said “we were just trying to make her fuckable.”My strength is growing from the stories and experiences I write and share. My journal started about four years ago, when I was in my early 20s, near the beginning of medical school. My initial purpose in writing the journal was to help sort through my feelings and experiences related to a newly discovered sexuality and a changing gender identity. Medical school was thousands of miles away from my previous life, my family, and my friends. Away from my old social network, I was free to self–discover on my own terms. In the first journal entry, I lay out reasons why I decided to get in contact with a therapist, something I had not done previously. Some of the reasons were fairly standard reasons one seeks out a therapist, such as moving away from home. But the fundamental reasons I sought out a therapist, and why I chose to journal, had to do with exploring feelings after my first sexual encounter with a woman, and then [End Page 98] accepting my intersexuality. My relationship with that therapist did not last, but the journaling did.In the beginning of the journal, I write:I am from a small, religious, white, non–diverse, family oriented suburb of Milwaukee. I was raised to be the picture–perfect daughter in a household that did not talk about feelings, sex, cultural or religious differences, etc. My brother and I also never talked about personal issues (and still don’t), which is quite remarkable since we are twins, and have grown up doing most everything together, from sharing birthday parties, to being locker buddies... [When my mother told me about having Androgen Insensitivity Syndrome (AIS)] knowing this little fact about my body kept me wanting to become as perfectly female in all ways possible.Growing up without being able to talk about having AIS was stifling to say the least. Closing communication implied great shame, and with the shame came even greater repression. My skate-boarding, baseball card collecting, and model car building interests disappeared after learning about my AIS, which I believe was when I was 12 years old, but I cannot remember exactly. Granted, it’s tough to say whether my interests just changed as I grew older, but I do remember having a fear of portraying any masculine tendencies that other girls in my town weren’t displaying (for example, playing soccer was okay, but I had to shave my legs). I also had crafted some pretty good covers for my AIS, including stories about when I first had my (fake) period, or how I acted fearful about a... (shrink)

This book is an introduction to ethical theory, and is intended for people who have had no previous exposure to philosophy. It might be used with profit as a text in a high school philosophy course. In his efforts to be clear to the uninitiated reader, Bond ends each chapter with a summary in point form and some “Questions for Thought.” In some early chapters, he even includes charts and graphs summarizing and collating points in the text. At the end (...) of each part, there are suggestions for further reading, and there is a useful glossary at the end of the book. (shrink)