BackgroundConcerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking.AimTo analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors.DesignThe data presented in this paper were collected as part of a wider research study of end-of-life care in an acute (...) hospital setting. Data collection comprised ethnographic non-participant observation on two acute hospital wards and individual interviews with patients, relatives and healthcare professionals caring for patients thought to be approaching the end of life. Data were analysed using a constructivist grounded theory approach.ResultsDiscussions and decision making about resuscitation present many challenges for those involved on acute medical wards. The data highlight the potential for multiple interpretations of legal precedents, creating misunderstandings that may impact patient care in less positive ways.ConclusionsThis paper provides unique insights into how doctors respond to the changing medico-legal culture and the subsequent effects on patient care. It demonstrates how the juridification of medical practice can occur. It highlights the potential benefit of a structure to support clinicians, patients and relatives in discussing and navigating decisions around care at the end of life in line with the patient’s wishes and preferences. Recommendations for future research are made and legal ramifications are discussed. (shrink)

Problematic substance use (PSU) among nurses has wide‐ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature and (...) that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use. (shrink)

This paper argues that close personal relationships play an important role in our judgments about what is fair. I start with an explanation of leading theories of fairness, highlighting the potential for further work on the grounds of fairness. Next, I offer an account of close personal relationships as having the ability to generate legitimate and reasonable expectations of one or other party to a judgment about fairness, or both. I show how and when close personal relationships can ground fairness.

While vaccination rates in the United States are high — generally over 90 percent — rates of exemptions have been going up, and preventable diseases coming back. Aside from their human cost and the financial cost of treatment imposed on those who become ill, outbreaks impose financial costs on an already burdened public health system, diverting resources from other areas. This article examines the financial costs of non-vaccination, showing how high they can be and what they include. It makes a (...) case for requiring those who do not vaccinate to cover the costs of outbreak caused by their choice. Such recouping is justified because the choice not to vaccinate can easily be seen as negligent. But even if it is not, that choice involves imposing costs on others, and there are good reasons to require the actors to internalize those costs. The article proposes alternative statutory and regulatory schemes to cover the costs imposed on the public purse, focusing on no-fault mechanisms. We consider both ex ante mechanisms like a tax or a fee that will go into a no-fault fund to cover the costs and ex post mechanisms like a statutory authorization for recoupment of those costs by health officials. (shrink)

Nurses’ experiences in, and the overall effectiveness of, widely used alternative‐to‐discipline programs to manage nurses’ substance‐use problems have not been adequately scrutinized. We uncovered the conflicted official and experiential ways of knowing one such alternative‐to‐discipline program in a Canadian province. We explicated this conflict through an institutional ethnography analysis. Ethnographic data from interviews with 12 nurses who were enrolled in an alternative‐to‐discipline treatment program and three program administrators, as well as institutional texts, were analyzed to explore how institutional practices and (...) power relations co‐ordinated and managed nurses’ experiences. Analysis revealed the acritical acceptance of a standardized program not based on current norms of practice. Potential and actual conflicts of interest, power imbalances, and prevailing corporate interests were rife. Nurses were not afforded the same rights to quality ethical health care as other citizens. ‘Expert’ physicians’ knowledge was privileged while nurses’ knowledge was subordinated. Conclusions were that regulatory bodies cannot rely on the taken‐for‐granted standardized treatment model in widespread use. Individualized treatment alternatives reflecting current, scientific evidence must be offered to nurses, and nurses’ knowledge, expertise, and experiences need to be included in decision‐making processes in these programs. (shrink)

This article focuses on three recent discussions on determinism in the philosophy of science. First, determinism and predictability will be discussed. Then, second, the paper turns to the topic of determinism, indeterminism, observational equivalence and randomness. Finally, third, there will be a discussion about deterministic probabilities. The paper will end with a conclusion.

It is a genuine pleasure to engage with the insightful and generous comments of my colleagues. I have learned a lot from them, and I hope to continue our conversations in the future. The range of c...

The general theme of this article is the actual practice of how definitions are justified and formulated in mathematics. The theoretical insights of this article are based on a case study of topological definitions of chaos. After introducing this case study, I identify the three kinds of justification which are important for topological definitions of chaos: natural-world-justification, condition-justification and redundancy-justification. To my knowledge, the latter two have not been identified before. I argue that these three kinds of justification are widespread (...) in mathematics. After that, I first discuss the state of the art in the literature about the justification of definitions in the light of actual mathematical practice. I then go on to criticize Lakatos’s account of proof-generated definitions—the main account in the literature on this issue—as being limited and also misguided: as for topological definitions of chaos, in nearly all mathematical fields various kinds of justification are found and are also reasonable. (shrink)

Transient receptor potential vanilloid 4 (TRPV4), a member of the TRP superfamily, is a broadly expressed, cell surface‐localized cation channel that is activated by a variety of environmental stimuli. Importantly, TRPV4 has been increasingly implicated in the regulation of cellular morphology. Here we propose that TRPV4 and the cytoskeletal remodeling small GTPase RhoA together constitute an environmentally sensitive signaling complex that contributes to pathological cell cytoskeletal alterations during neurological injury and disease. Supporting this hypothesis is our recent work demonstrating direct (...) physical and bidirectional functional interactions of TRPV4 with RhoA, which can lead to activation of RhoA and reorganization of the actin cytoskeleton. Furthermore, a confluence of evidence implicates TRPV4 and/or RhoA in pathological responses triggered by a range of acute neurological insults ranging from stroke to traumatic injury. While initiated by a variety of insults, TRPV4–RhoA signaling may represent a common pathway that disrupts axonal regeneration and blood–brain barrier integrity. These insights also suggest that TRPV4 inhibition may represent a safe, feasible, and precise therapeutic strategy for limiting pathological TRPV4–RhoA activation in a range of neurological diseases. (shrink)

Marcus Arvan’s Rightness as Fairness is a highly ambitious book. In fewer than 230 pages, Arvan hopes to demonstrate that we ought to evaluate moral theories in a similar manner to the sciences, that existing moral theories fall short on that evaluation, that moral normativity reduces to instrumental rationality, and that a new theory of rightness as fairness meets the scientific evaluative standards better than any of the alternatives. I’m afraid I was unconvinced that we should abandon our preferred moral (...) theories in favor of rightness as fairness. (shrink)

Stem cells may have a special importance in the neoplastic behavior of certain lineages as well as in the normal development of these tissues. The role of oncogenes, and their normal cellular analogues, in stem cell behavior is therefore of special interest. This review describes recent results on the effects of virally‐mediated src‐gene transfer into hemopoietic stem cells in the physiological and developmental properties of these cells.

Marcus Arvan’s Rightness as Fairness is a highly ambitious book. In fewer than 230 pages, hopes to demonstrate that we ought to evaluate moral theories in a similar manner to sciences, that existing moral theories fall short on that evaluation, that moral normativity reduces to instrumental rationality, and that a new theory of ‘rightness as fairness’ meets the scientific evaluative standards better than any of the alternatives.

Betrachtet man den Gebrauch der Worte ‘Moral’ und ‘Vernunft’ etwas genauer, so stellt man fest, dass nicht klar ist, was sie bezeichnen bzw. wie Moral und Vernunft zusammenhängen. In dem Buch ‘Rationalität in der Angewandten Ethik’, in dem sich verschiedene Autoren die Aufgabe gestellt haben, diese Umstände in das Licht der Betrachtung zu rücken, finden wir Fragen darüber, wie “Moral”, “Angewandte Ethik” und “Vernunft” (auch in der Anwendung) zu verstehen und zu vereinen sind.

The punchy central claim of Torbjörn Tännsjö's book is that act-utilitarianism best explains our considered intuitions about the moral status of different kinds of killing. An interesting aspect of this book is Tännsjö's revisionary methodology, which he names 'Applied Ethics (Turned Upside Down)'. So, why does Tännsjö choose applied ethics (turned upside down) to argue for act-utilitarianism's role in explaining our considered intuitions about killing and what, exactly, is his innovative method of moral investigation?

The current research investigated the role of gratitude in economic decisions about offers that vary in fairness yet benefit both parties if accepted. Participants completed a trait/dispositional gratitude measure and then were randomly assigned to recall either an event that made them feel grateful or the events of a typical day. After the gratitude induction task, participants played the ultimatum game, deciding whether to accept or reject fair offers and unfair offers from different proposers. Results showed that trait gratitude was (...) positively correlated with respondents’ acceptance of unfair offers. However, experimentally induced momentary gratitude did not influence acceptance of unfair offers. The trait or disposition to be grateful involves the enduring capacity across different types of situations and benefactors to see the good that is present, even when that benefit is small. Accordingly, dispositional gratitude – but not momentarily induced gratitude – was associated with a greater propensity to accept even the small benefits within unfair offers which otherwise pose barriers to making the effective economic decision of accepting offers regardless of their relative size. (shrink)

This article examines the human placenta not only as a scientific, medical and biological entity but as a consumer bio-product. In the emergent placenta economy, the human placenta is exchanged and gains potentiality as food, medicine and cosmetics. Drawing on empirical research from the United States, the United Kingdom, Denmark and Japan, the authors use feminist cultural analysis and consumer theories to discuss how the placenta is exchanged and gains commodity status as a medical supplement, smoothie, pill and anti-ageing lotion. (...) Placenta preparers and new mothers cite medical properties and spirituality as reasons for eating or encapsulating the placenta, reinstating ideas of the liberated good mother. Meanwhile, the cosmetics industry situates the placenta as an extract and hence a commodity, re-naturalizing it as an anti-ageing, rejuvenating and whitening bio-product. The authors conclude that, in the emergent bio-economy, the dichotomy between the inner and the outer body is deconstructed, while the placenta gains clinical and industrial as well as affective value. (shrink)

ABSTRACT When does a state of affairs constitute a harm to someone? Comparative accounts say that being worse off constitutes harm. The temporal version of the comparative account is seldom taken seriously, due to apparently fatal counterexamples. I defend the temporal version against these counterexamples, and show that it is in fact more plausible than the prominent counterfactual version of the account. Non-comparative accounts say that being badly off constitutes harm. However, neither the temporal comparative account nor the non-comparative account (...) can correctly classify all harms. I argue that we should combine them into a hybrid account of harm. The hybrid account is extensionally adequate and presents a unified view on the nature of harm. (shrink)

Background Implementing person-centred care (PCC) in nursing homes is challenging due to a gap between theory and practice. Bridging this gap requires suitable education, which focuses on learning how to attune care to the values and preferences of residents and take moral, relational, and situational aspects into account. Staff’s stories about the care they provide (i.e. caring stories) may deliver valuable insights for learning about these aspects. However, there is limited research on using staff's narratives for moral learning. Objective This (...) study aims to provide insight into the perspectives of nursing staff on using their caring stories to learn about PCC. Research design In this qualitative research, we conducted two rounds of interviews with 17 participants working in nursing homes. We wanted to obtain nursing staff’s perceptions of working with their caring stories and the impact on PCC. Ethical considerations Participation was voluntary, and participants provided written consent. The study protocol is approved by The Institutional Review Board of the Medical Ethical Committee Leiden-Den Haag-Delft. Findings Working with caring stories enables nursing staff to provide PCC and improves job satisfaction. It increases awareness of what matters to residents, fosters information rich in context and meaning, and enhances voice and vocabulary. Through in-depth team reflections, nursing staff discussed the significant moments for residents, which centralizes the discussions on the moral quality of care. Discussion Working with caring stories fosters dialogue on PCC and enhances reflection on ethical situations in daily encounters, contributing to the moral development of nursing staff. Putting nursing staff’s narratives at the centre of learning suits their daily practice and intrinsic motivation. Therefore, the outcomes of this study are an addition to the existing literature about using narratives in long-term care. Conclusion Using nursing staff's narratives contributes to PCC and positively impacts nursing staff. We recommend using staff's caring stories as a vehicle for moral learning in the transition to PCC. (shrink)

Charlotte Witt extracts from this text a coherent and provocative view about sensible substance by focusing on Aristotle's account of form or essence.

The received wisdom in statistical mechanics is that isolated systems, when left to themselves, approach equilibrium. But under what circumstances does an equilibrium state exist and an approach to equilibrium take place? In this paper we address these questions from the vantage point of the long-run fraction of time definition of Boltzmannian equilibrium that we developed in two recent papers. After a short summary of Boltzmannian statistical mechanics and our definition of equilibrium, we state an existence theorem which provides general (...) criteria for the existence of an equilibrium state. We first illustrate how the theorem works with a toy example, which allows us to illustrate the various elements of the theorem in a simple setting. After a look at the ergodic programme, we discuss equilibria in a number of different gas systems: the ideal gas, the dilute gas, the Kac gas, the stadium gas, the mushroom gas and the multi-mushroom gas. In the conclusion we briefly summarise the main points and highlight open questions. (shrink)

In a criminal trial, a judge or jury needs to reason about what happened based on the available evidence, often including statistical evidence. While a probabilistic approach is suitable for analysing the statistical evidence, a judge or jury may be more inclined to use a narrative or argumentative approach when considering the case as a whole. In this paper we propose a combination of two approaches, combining Bayesian networks with scenarios. Whereas a Bayesian network is a popular tool for analysing (...) parts of a case, constructing and understanding a network for an entire case is not straightforward. We propose an explanation method for understanding a Bayesian network in terms of scenarios. This method builds on a previously proposed construction method, which we slightly adapt with the use of scenario schemes for the purpose of explaining. The resulting structure is explained in terms of scenarios, scenario quality and evidential support. A probabilistic interpretation of scenario quality is provided using the concept of scenario schemes. Finally, the method is evaluated by means of a case study. (shrink)

The aim of the article is to illustrate concrete problems in the asymmetrical nurse–patient power relationship. It is an ethical demand that the nurse is faced with the challenges that the power in the relation is administered so that the patient's room for action is expanded and trust maintained. It is an essential message in care philosophy, but in clinical practice, success is not always achievable. A hidden and more or less unconscious restriction of the patient's room for action may (...) result in the excesses of care. Three selected aspects: dependence, trust, and power described by the Danish philosopher K.E. Løgstrup and the Norwegian nursing philosopher Kari Martinsen's care philosophy has inspired this empirically based examination of some current barriers in the asymmetrical nurse–patient relationship. On the basis of qualitative interviews with six patients and six nurses, the research thus provides an identifying and problem‐exploratory examination of some current obstacles in which the handling of trust and power reflects the excesses of care. The findings develop three themes. ‘Being a burden’ acknowledges that the balance of power will always tip to the nurse's advantage. The second theme, ‘Doing only what's absolutely necessary’, shows how a fixation with ‘technicalism’ creates a distance between people that may constrain the patient's room for action. The last theme is concerning the nurse's ability to navigate between closeness and distance is essential in avoiding ‘the excesses of care’, paternalism, and overprotectiveness. A situation in which distance takes the upper hand and care turns into paternalism. A different situation would arise if the nurse's emotions became sentimental or intimate with the result that closeness gets the upper hand. To avoid a harmful exercise of power and the excesses of care, the findings have demonstrated that a relationship‐based caring is a demand for situation‐specific sensitive attention skills. (shrink)

In a criminal trial, evidence is used to draw conclusions about what happened concerning a supposed crime. Traditionally, the three main approaches to modeling reasoning with evidence are argumentative, narrative and probabilistic approaches. Integrating these three approaches could arguably enhance the communication between an expert and a judge or jury. In previous work, techniques were proposed to represent narratives in a Bayesian network and to use narratives as a basis for systematizing the construction of a Bayesian network for a legal (...) case. In this paper, these techniques are combined to form a design method for constructing a Bayesian network based on narratives. This design method is evaluated by means of an extensive case study concerning the notorious Dutch case of the Anjum murders. (shrink)

The issue of shifting scales between the microscopic and the macroscopic dimensions is a recurrent one in the history of science, and in particular the history of microscopy. But it took on new dimensions in the context of early twentieth-century microscophysics, with the progressive realisation that the physical laws governing the macroscopic world were not always adequate for describing the sub-microscopic one. The paper focuses on the researches of Jean Perrin in the 1900s, in particular his use of Brownian motion (...) to produce evidence of the existence of atoms and in favour of the kinetic theory. His results were described by many contemporaries, and subsequently by historians, as the first direct proof of atomic and molecular reality. The paper examines the different strategies developed by Perrin for bridging the macro and sub-microphysical realms and making the latter accessible to the senses; even though neither atoms nor molecules were ever actually seen, and in fact very few visual representations were shown and published in connection with these experiments. This case provides a good example of how visualizing, representing and convincing could be interwoven in the production of evidence about the sub-microphysical realm circa 1900.Keywords: Jean Perrin; Brownian motion; Ultramicroscope; Evidence; Atom; Atomism. (shrink)

To improve the quality and efficiency of research, groups within the scientific community seek to exploit the value of data sharing. Funders, institutions, and specialist organizations are developing and implementing strategies to encourage or mandate data sharing within and across disciplines, with varying degrees of success. Academic journals in ecology and evolution have adopted several types of public data archiving policies requiring authors to make data underlying scholarly manuscripts freely available. The effort to increase data sharing in the sciences is (...) one part of a broader “data revolution” that has prompted discussion about a paradigm shift in scientific research. Yet anecdotes from the community and studies evaluating data availability suggest that these policies have not obtained the desired effects, both in terms of quantity and quality of available datasets. We conducted a qualitative, interview-based study with journal editorial staff and other stakeholders in the academic publishing process to examine how journals enforce data archiving policies. We specifically sought to establish who editors and other stakeholders perceive as responsible for ensuring data completeness and quality in the peer review process. Our analysis revealed little consensus with regard to how data archiving policies should be enforced and who should hold authors accountable for dataset submissions. Themes in interviewee responses included hopefulness that reviewers would take the initiative to review datasets and trust in authors to ensure the completeness and quality of their datasets. We highlight problematic aspects of these thematic responses and offer potential starting points for improvement of the public data archiving process. (shrink)

In March 2020, the Government produced a document entitled “Responding to COVID-19: The Ethical Framework for Adult Social Care”. In this article, we summarise the key features of the proposed ethical framework and subject it to critical analysis. We highlight three primary issues. First, the emphasis placed on autonomy as the primary ethical principle. We argue if ever there was a context in which autonomy should dominate the ethical analysis, this is not it. Second, we examine the interface between ethics (...) and law which is largely overlooked in the document. Finally, we explore the surprising lack of attention paid to the concept of responsibility and communal obligations within the framework. (shrink)

My paper challenges an influential distinction between pain and suffering put forward by physician-ethicist, Eric Cassell. I argue that Cassell’s distinction is philosophically untenable because he contrasts suffering with an outdated theory of pain. In particular, Cassell focuses on one type of pain, the interpretation of nociception induced by noxious stimuli such as heat or sharp objects; yet since the late 1970s, pain scientists have rendered both nociception and noxious stimuli unnecessary for pain. I argue that this discrepancy between Cassell’s (...) distinction and pain science produces three philosophical problems for his distinction: first, he frames his distinction too generally, concentrating on only one type of pain to the neglect of others, such as neuropathy; second, it is possible that Cassell’s understanding of pain may include suffering; and third, Cassell gives examples of pain and suffering manifesting independently of each other, but it is possible that these cases may instead exemplify differences between nociceptive and non-nociceptive types of pain. Due to these problems, I conclude that Cassell’s distinction currently lacks a difference. I call for new efforts to articulate the differences, if any, between pain and suffering. (shrink)

With Hegel’s metaphysics attracting renewed attention, it is time to address a long-standing criticism: Scholars from Marx to Popper and Habermas have worried that Hegel’s metaphysics has anti-individualist and authoritarian implications, which are particularly pronounced in his Philosophy of History, since Hegel identifies historical progress with reason imposing itself on individuals. Rather than proposing an alternative non-metaphysical conception of reason, as Pippin or Brandom have done, this article argues that critics are broadly right in their metaphysical reading of Hegel’s central (...) concepts. However, they are mistaken about what Hegel’s approach entails, when one examines the specific types of states discussed by the philosopher in his Philosophy of History. Even on a traditional metaphysical reading, Hegel is not only non-authoritarian; he also makes a powerful argument concerning freedom, whereupon the freest society involves collective oversight and the shaping of social structures so as to ensure that they benefit everybody. (shrink)

Picking up on Marx’s and Hegel’s analyses of human beings as social and individual, the article shows that what is at stake is not merely the possibility of individuality, but also the correct conception of the universal good. Both Marx and Hegel suppose that individuals must be social or political as individuals, which means, at least in Hegel’s case, that particular interests must form part of the universal good. The good and the rational is not something that requires sacrificing one’s (...) interests for the community or denying one’s particular character so as to become an equal rational agent. Very much to the contrary, the rational or the common good is nothing but the harmonious structuring of particular interests. While Section I introduces Marx’s and Hegel’s conceptions of individual and social beings, Sections II and III discuss their respective views of individuality, and Sections IV and V discuss the notion of a universal good containing individual interests. (shrink)

The article examines the construction of “Big Data” in media discourse. Rather than asking what Big Data really is or is not, it deals with the discursive work that goes into making Big Data a socially relevant phenomenon and problem in the first place. It starts from the idea that in modern societies the public understanding of technology is largely driven by a media-based discourse, which is a key arena for circulating collectively shared meanings. This largely ignored dimension invites us (...) to appreciate what matters to journalists and the wider public when discussing the collection and use of data. To this end, our study looks at how Big Data is framed in terms of the governmental use of large datasets as a contentious area of data application. It reconstructs the perspectives surrounding the so-called “Handygate” affair in Germany based on broadcast news and social media conversations. In this incident, state authorities collected and analyzed mobile phone data through a radio cell query during events to commemorate the Dresden bombing in February 2011. We employ a qualitative discourse analysis that allows us to reconstruct the conceptualizations of Big Data as a proper instrument for criminal prosecution or an unjustified infringement of constitutional rights. (shrink)