Advocacy has been positioned as an ideal within the practice of nursing, with national guidelines and professional standards obliging nurses to respect patients' autonomous choices and to act as their advocates. However, the meaning of advocacy and autonomy is not well defined or understood, leading to uncertainty regarding what is required, expected and feasible for nurses in clinical practice. In this article, a feminist ethics perspective is used to examine how moral responsibilities are enacted in the perinatal nurse—patient relationship and (...) to explore the interaction between the various threads that influence, and are in turn affected by, this relationship. This perspective allows for consideration of contextual and relational factors that impact on the way perinatal nursing care is given and received, and provides a framework for exploring the ways in which patient autonomy, advocacy and choice are experienced by childbearing women and their nurses during labour and birth. (shrink)

The authors of this book engage in essay form in a lively debate over the fundamental characteristics of legal and moral rights. They examine whether rights fundamentally protect individuals' interests or whether they instead fundamentally enable individuals to make choices. In the course of this debate the authors address many questions through which they clarify, though not finally resolve, a number of controversial present-day political debates, including those over abortion, euthanasia, and animal rights.

Bishop is a professor of nursing; Scudder is a professor of philosophy.

From a post-structuralist position, it is problematic and seemingly impossible to refer to God as the Trinity. This article describes possibilities for thinking about the Trinity (religion and God) within a post-structuralist context. As an example of such thinking, the 2015 culture-critique film, The Brand New Testament, will be analysed. It is a creative retelling of the Christian story and of the Trinity in a secular and post-metaphysical vein. This ‘Brand New Testament’ reveals God as ‘one’ – as the encompassing (...) love, hope and life which we may experience in this life. The life-giving characteristics of this ‘god’ are surprisingly close to the biblical understanding of the Trinity. In the ‘Brand New Testament’, however, the Trinity is portrayed radically differently than in the Christian tradition. The personae of father, son and spirit are deconstructed in the film, in that a daughter and a mother also form part of the godhead. This deconstruction of the Trinity, which should not be confused with blasphemy, opens up a possible post-structuralist imagining of God. It playfully reveals a powerless god who shares some fundamental characteristics with the Trinity – such as love, joy and life. It allows for the ‘oneness of god’ to include more, and less, than the ‘Holy Trinity’. (shrink)

Alan Gewirth has propounded a moral theory which commits him to the view that prescriptions can appropriately be addressed to people who have neither any moral reasons nor any prudential reasons to follow the prescriptions. We highlight the strangeness of Gewirth's position and then show that it undermines his attempt to come up with a supreme moral principle.

Wynn's model for the evolution of spatial cognition is well supported by fossil evidence from brain endocasts, and from neurological studies of the cerebellum and the posterior parietal region of the cerebral cortex. Wynn's intriguing hypothesis that the spatial skill reflected in artifacts is an index of navigational ability, could be further explored by an analysis of lithic transport patterns.

In our multicultural, globalised and increasingly postmodern world, people live within competing and contradicting philosophies, and the question of ethics becomes extremely pertinent. It is within this context that this article sheds light on ethics by comparing ubuntu, as part of the African philosophical tradition, and transimmanence, as part of the Western deconstructionist philosophical tradition. As divergent as these traditions may be, ethics are a key feature in both and a crucial point of overlap. Notions of identity, personhood, the community (...) and sense (meaning), for example, play a pivotal role in ubuntu and transimmanence. A reading of these two contrasting philosophical traditions (ubuntu and transimmanence), each through the lens of the other, helps one to develop a better understanding of each of these traditions with regard to their respective ethics and eventually to develop a better understanding of ethics per se. (shrink)

Sally Gadow influenced our work when we first began exploring the meaning of nursing philosophically. In this article, we discuss two major themes of Gadow's work that have influenced us: existential advocacy and treating the body objectively without reducing the patient to the moral status of an object. Our treatment of these issues is appreciative but not uncritical. We argue that existential advocacy makes an important contribution to the meaning of nursing but that it cannot be its essential meaning. We (...) contend that Gadow, by making self‐direction the essence of care, tends to diminish the intersubjective nature of care. Then we show how Gadow recovers the intersubjective nature of care by disclosing how nurses and patients both become subjects in personal relationships, even when tending to the body objectively. We show how hermeneutic phenomenology, which we favour, can contribute to Gadow's existential phenomenology by using examples from nursing practice to disclose the meaning of nursing. Gadow's major contribution to our work has been in the ways her work has evoked creative thought from us concerning the meaning of nursing. (shrink)

This article brings into perspective the need to decolonise the concept of the Trinity (as the specific doctrine and Christian name of God) as a crucial step in decolonising the religious education curriculum. It discusses the concept of decolonisation and its applicability to religious education, specifically Christianity, within higher education (e.g. in Teacher Education Programmes) in the South African context. God as the Trinity has throughout the history of Atlantic slavery and colonialism been employed to legitimise colonial rule and it, (...) therefore, needs to be decolonised. To decolonise the concept of the Trinity is, however, highly problematic, as the historic relation between Christianity and African traditional religions (ATRs) indicates. Decolonising the concept of the Trinity can quickly develop into a tension between a position of either continuity or discontinuity (of ATR with Christianity). Contribution: This article argues for an alternative approach for the decolonisation of the concept of the Trinity, namely to allow for the deconstruction of the concept of the Trinity, and by implication of other concepts – like decolonisation and religion – as well. This approach is proposed to develop more openness and playfulness with regard to religious beliefs in general. I argue that this may provide a hopeful, open and just vision of life which should be part of the decolonised religious education curriculum. (shrink)

It is postulated from different philosophical traditions, and explicitly in recent literature, that there is no further need for doing philosophy of religion – it has become an impossible task. I argue, however, that there remains a philosophical space for this practice and that this space determines greatly how philosophy of religion can be done. The starting point of my argument is the current discussion in the SAJP between De Wet and Giddy and the significance of my article is that (...) it puts this debate within the broader international philosophical context by engaging the work of Trakakis and Desmond to resolve some of the apparently intractable issues raised. Trakakis discusses the divide between the analytic and continental philosophical traditions in which De Wet and Giddy’s work is further contextualized and clarified. Desmond’s work is seminal in its search for a metaxology wherein he advocates a new ‘in between’ position for doing philosophy of religion. I take this view of Desmond further by applying it to the current debate in South Africa and also using it to indicate some possibilities of speaking about the impossible. (shrink)

Although international research is increasing in volume and importance, there remains a dearth of knowledge on similarities and differences in “national human research ethics”, that is, national ethical guidelines, Institutional Review Boards, and research stakeholder’ ethical attitudes and behaviors. We begin to address this situation by reporting upon our experiences in conducting a multinational study into the mental health of children who had a parent/carer in prison. The study was conducted in 4 countries: Germany, Great Britain, Romania, and Sweden. Data (...) on NHREs were gathered via a questionnaire survey, two ethics-related seminars, and ongoing contact between members of the research consortium. There was correspondence but even more so divergence between countries in the availability of NEGs and IRBs and in researcher’ EABs. Differences in NHREs have implications particularly in terms of harmonization but also for ethical philosophy and practice and for research integrity. (shrink)

The present study investigates the association between mental health problems and criminal behavior among adolescents in Sweden. Community crime prevention in a Swedish context is also discussed. Every two years, pupils from schools in Stockholm answer the Stockholm School Survey with questions and statements about their social situation, alcohol and drug use, attitudes, school climate, school grades and criminal behavior. Data collected from pupils who answered the survey in 2014, 2018 and 2020 form the basis of this study. A significant (...) association between mental health problems and criminal behavior was shown, even after controlling for factors suggested in international literature. Mental health problems were shown to be a strong explanation for criminal behavior among adolescents. (shrink)

AimWhite matter changes in individuals at ultra-high risk for psychosis (UHR) may be involved in the transition to psychosis. Sleep-wake disturbances commonly precede the first psychotic episode and predict development of psychosis. We examined associations between white matter microstructure and sleep-wake disturbances in UHR individuals compared to healthy controls (HC), as well as explored the confounding effect of medication, substance use, and level of psychopathology.MethodsSixty-four UHR individuals and 35 HC underwent clinical interviews and diffusion weighted imaging. Group differences on global (...) and callosal mean fractional anisotropy (FA) was tested using general linear modeling. Sleep-wake disturbances were evaluated using the subjective measures disturbed sleep index (DSI) and disturbed awakening index (AWI) from the Karolinska Sleep Questionnaire, supported by objective sleep measures from one-night actigraphy. The primary analyses comprised partial correlation analyses between global FA/callosal FA and sleep-wake measures. Secondary analyses investigated multivariate patterns of covariance between measures of sleep-wake disturbances and FA in 48 white matter regions of interest using partial least square correlations.ResultsUltra-high risk for psychosis individuals displayed lower global FA (F = 14.56, p < 0.001) and lower callosal FA (F = 11.34, p = 0.001) compared to HC. Subjective sleep-wake disturbances were significantly higher among the UHR individuals (DSI: F = 27.59, p < 0.001, AWI: F = 36.42, p < 0.001). Lower callosal FA was correlated with increased wake after sleep onset (r = −0.34, p = 0.011) and increased sleep fragmentation index (r = −0.31, p = 0.019) in UHR individuals. Multivariate analyses identified a pattern of covariance in regional FA which were associated with DSI and AWI in UHR individuals (p = 0.028), but not in HC. Substance use, sleep medication and antipsychotic medication did not significantly confound these associations. The association with objective sleep-wake measures was sustained when controlling for level of depressive and UHR symptoms, but symptom level confounded the covariation between FA and subjective sleep-wake measures in the multivariate analyses.ConclusionCompromised callosal microstructure in UHR individuals was related to objectively observed disruptions in sleep-wake functioning. Lower FA in ventrally located regions was associated with subjectively measured sleep-wake disturbances and was partly explained by psychopathology. These findings call for further investigation of sleep disturbances as a potential treatment target. (shrink)

Intent and mitigating circumstances play a central role in moral and legal assessments in large-scale industrialized societies. Al- though these features of moral assessment are widely assumed to be universal, to date, they have only been studied in a narrow range of societies. We show that there is substantial cross-cultural variation among eight traditional small-scale societies (ranging from hunter-gatherer to pastoralist to horticulturalist) and two Western societies (one urban, one rural) in the extent to which intent and mitigating circumstances influence (...) moral judgments. Although participants in all societies took such factors into account to some degree, they did so to very different extents, varying in both the types of considerations taken into account and the types of violations to which such considerations were applied. The particular patterns of assessment characteristic of large-scale industrialized societies may thus reflect relatively recently culturally evolved norms rather than inherent features of human moral judgment. (shrink)

-/- Background: Nurses who provide aggressive care often experience the ethical challenge of needing to preserve the hope of seriously ill patients and their families without providing false hope. -/- Research objectives: The purpose of this inquiry was to explore nurses’ moral competence related to fostering hope in patients and their families within the context of aggressive technological care. A secondary purpose was to understand how this competence is shaped by the social–moral space of nurses’ work in order to capture (...) how competencies may reflect an adaptation to a less than ideal work environment. -/- Research design: A critical qualitative approach was used. -/- Participants: Fifteen graduate nursing students from various practice areas participated. -/- Ethical considerations: After receiving ethics approval from the university, signed informed consent was obtained from participants before they were interviewed. -/- Findings: One overarching theme ‘Mediating the tension between providing false hope and destroying hope within biomedicine’ along with three subthemes, including ‘Reimagining hopeful possibilities’, ‘Exercising caution within the social–moral space of nursing’ and ‘Maintaining nurses’ own hope’, was identified, which represents specific aspects of this moral competency. -/- Discussion: This competency represents a complex, nuanced and multi-layered set of skills in which nurses must be well attuned to the needs and emotions of their patients and families, have the foresight to imagine possible future hopes, be able to acknowledge death, have advanced interpersonal skills, maintain their own hope and ideally have the capacity to challenge those around them when the provision of aggressive care is a form of providing false hope. -/- Conclusion: The articulation of moral competencies may support the development of nursing ethics curricula to prepare future nurses in a way that is sensitive to the characteristics of actual practice settings. (shrink)

Corporate social responsibility is a complex discipline that not only demands responsible behavior in production processes but also includes the concepts of communicative transparency and dialogue. Stakeholder dialogue is therefore expected to be an integrated part of the CSR strategy :323–338, 2006). However, only few studies have addressed the practice of CSR stakeholder dialogue and the challenges related hereto. This article adopts a postmodern perspective on CSR stakeholder dialogue. Based on a comprehensive single case study on stakeholder dialogue in a (...) global dairy company, we focus on the complexity of CSR dialogue with multiple stakeholders. Drawing on a critical reflexive methodology :1265–1281, 2007), we develop the research question: How is CSR multi-stakeholder dialogue practiced, experienced, and articulated in an empirical context? The purpose is to understand the underlying assumptions, expectations, and principles guiding CSR multi-stakeholder dialogue in an empirical setting, as we focus on how key stakeholders articulate and anticipate the values of stakeholder dialogue and how the actual stakeholder dialogues are enacted. The findings of the study differ significantly from the ideals of transparent and agenda-free stakeholder dialogue. Rather, the study shows an overall tension between ideal and practice, supporting the progressive importance of the dialogue process in itself as an essential part of the end goal. The implication of this is a growing pressure on creating transparency about the positioning and negotiation of roles throughout the dialogue process. (shrink)

Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor alike. During pregnancy, we tend to note the risks of medical interventions without adequately noting those of failing to intervene, yet when it's time to give birth, interventions are seldom questioned, even when they don't work. Meanwhile, outside the clinic, advice given to pregnant women on how to stay healthy in everyday life can seem capricious and overly cautious. This kind of reasoning reflects fear, (...) not evidence. (shrink)

BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)