AimsThis study evaluates a protocol for early, routine ethics consultation for patients on extracorporeal membrane oxygenation to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.MethodsWe conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019. Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of (...) treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.ResultsLimited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.ConclusionData from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages. (shrink)

Previous research has identified user concerns about biometric authentication technology, but most of this research has been conducted in European contexts. There is a lack of research that has investigated attitudes towards biometric technology in other cultures. To address this issue, data from India, South Africa and the United Kingdom were collected and compared. Cross-cultural attitudinal differences were seen, with Indian respondents viewing biometrics most positively while respondents from the United Kingdom were the least likely to have a positive opinion (...) about biometrics. Multiple barriers to the acceptance of biometric technology were identified with data security and health and safety fears having the greatest overall impact on respondents’ attitudes towards biometrics. The results of this investigation are discussed with reference to Hofstede’s cultural dimensions and theories of technology acceptance. It is argued that contextual issues specific to each country provide a better explanation of the results than existing theories based on Hofstede’s model. We conclude that cultural differences have an impact on the way biometric systems will be used and argue that these factors should be taken into account during the design and implementation of biometric systems. (shrink)

The minimally conscious state presents unique ethical, legal, and decision-making challenges because of the combination of diminished awareness, phenomenal experience, and diminished or absent comm...

The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile's (Practice‐based education: Perspectives and strategies, Rotterdam: Sense, 2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the healthcare assistant. In the British context, delegation and supervision are thought of as skills which are learnt (...) “on the job.” We suggest that learning “on‐the‐job” is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011 to 2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and healthcare assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the “invisible learning” which occurs as newly qualified nurses learn to delegate and supervise. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:736 Feminist Studies 44, no. 3. © 2018 by Feminist Studies, Inc. Carol Giardina MOW to NOW: Black Feminism Resets the Chronology of the Founding of Modern Feminism The first meeting of feminist protest in the 1960s was called to order by Dorothy Height, the president of the 800,000-member National Council of Negro Women (NCNW), in Washington, DC, on August 29, 1963. It was the day after the historic (...) March on Washington for Jobs and Freedom (MOW).1 “We could hardly believe that after all we were doing in the Civil Rights Movement,” Height recalls, “the women came to feel that they were getting a kind of runaround” as they sought and were denied fair representation in the march because of their sex.2 “I was determined,” she said in her 2003 memoir, “to bring wise women together to learn and gather strength from the experience.”3 As “women talked freely of their concern about women’s participation,” Height observed, “we began to realize that if we did not... demand our rights, we were not going to get them. The women became much more aware and much more aggressive in facing up to sexism in our dealings with 1. Dorothy Height, Open Wide the Freedom Gates: A Memoir (New York: Public Affairs, 2003), 146. 2. Dorothy Height, “We Wanted the Voice of a Woman to Be Heard,” in Sisters in the Struggle: African American Women in the Civil Rights-Black Power Movement, ed. Bettye Collier-Thomas and V. P. Franklin (New York: New York University Press, 2001), 88. 3. Height, Open Wide, 146. Carol Giardina 737 the male leadership in the movement.”4 “That moment,” Height recalled, “was vital to awakening the women’s movement.”5 Black women’s fight for representation in the MOW appears narrowly framed in scholarly literature as a specific and isolated reaction to the sexism of male MOW planners. I argue, however, that the campaign of feminist protest meetings surrounding the MOW—and the political lessons that emerged—was a starting point in the chronology of the rebirth years of feminist upheaval in the 1960s. Why? Because the lessons of that campaign provided the crucial conceptual model of an “NAACP for women” that would be consciously and purposely adopted by the newly forming National Organization for Women (NOW). Together with Height, Anna Arnold Hedgeman, the only woman on the MOW planning committee, and longtime co-conspirator Pauli Murray, who spearheaded the MOW protests, were critical actors in NOW’s formation and brought the model to NOW’s more well-known white organizers. This model, and the Black women who developed it, opened the trajectory that led to NOW’s establishment in 1966, the first feminist organization of the decade. Black scholar activist Bernice Johnson Reagon called the Civil Rights Movement the “borning” struggle of its time.6 By the early 1960s, the impact of this phase of civil rights mobilization was felt nationwide from lunch counters in small towns to Congress and the Supreme Court. Since at least the 1955–1956 Montgomery Bus Boycott, many thousands of African American women had been protesting, organizing, staging sit-ins and jail-ins, writing treatises, and giving speeches for Black civil rights. Although some white women did participate in the Civil Rights Movement, there were far fewer of them than African American women. Because of African American women’s collective confrontation with white supremacy, more of them were positioned to grasp the systemic nature of male supremacy and the need to fight it collectively. They understood sexism sooner than most white women because they 4. Height, “We Wanted the Voice,” 88–89. 5. Height, Open Wide, 145. 6. Mary King, Casey Hayden, Jean Wheeler Smith, Joyce Ladner, Prathia Hall, Kathie Sarachild, Michael Thelwell, and Bernice Johnson Reagon, “SNCC Women and the Stirrings of Feminism,” in A Circle of Trust: Remembering SNCC, ed. Cheryl Lynn Greenberg (New Brunswick, NJ: Rutgers University Press, 1998), 150. 738 Carol Giardina had already learned the operations of power and exploitation. They were best prepared to challenge female oppression, as were the white women who participated in the Civil Rights Movement. After all, if the established order could be pushed back when it... (shrink)

This title sees the re-emergence of the seminal 1970s magazine Curtains edited by Paul Buck. With its early promotion of French writers such as Georges Bataille, Maurice Blanchot, Jacques Derrida, Jean-Pierre Faye and Edmond Jabès, Curtains’ re-appearance in 2016 arrives after an exhibition at Focal Point Gallery in 2012 that was recreated from an earlier 1992 work at Cabinet Gallery around the concept of ‘disappearing’. The invited contributions come from thirteen artists with whom the editor has engaged over the years. (...) In addition, Buck has returned to pull threads from the earlier editions of his magazine to explore ideas with writers encountered in the intervening years, making all appear in a consolidated grouping as a final gesture, one that refuses to disappear. Contributions include those by: Kathy Acker, Anne-Marie Albiach, Mireille Andres, Stephen Barber, David Barton, Diane Bataille, Georges Bataille, Mathieu Bénézet, Jean-Pierre Bobillot, Joë Bousquet, Michael Camus, Danielle Collobert, David Coxhead, John Cussans, Tatjana Doll, Jerry Estrin, Ulli Freer, Margarita Gluzsberg, Paul Green, Anouchka Grose, Pierre Guyotat, Susan Hiller, Andrew Hunt, Franz Kamin, Chris Kraus, Liane Lang, Roger Laporte, Francesca Lisette, Lucy McKenzie, Bernard Noël, Hestia Peppe, Holly Pester, Perle Petit, Richard Prince, Pascal Quignard, Clunie Reid, Mitsou Ronat, Claude Royet-Journoud, Eugène Savitzkaya, Will Shutes, Sophie Sleigh-Johnson, Miroslav Tichy, Colette Thomas, Simon Thompson, Sophie von Hellermann, and Gabrielle Wittkop. (shrink)

While the origin and development of the just war tradition until the early modern period blended concerns, ideas, and practices from the moral, legal, political, and military spheres, from the mid-seventeenth century until the mid-twentieth it largely disappeared as a conscious source of moral reflection about war and its restraint. Beginning in the 1960s, however, American theologian Paul Ramsey initiated a recovery of just war thinking in a series of writings applying the principles of discrimination and proportionality, ideas he traced (...) both to Augustinian theology and to natural law, to the debate over nuclear weapons and later to the Vietnam War. Ramsey's work directly engaged both theological and policy debate over military force, initiating lines of reflection that have since developed further and become increasingly institutionalized. This brief essay examines the nature of Ramsey's just war thought and its influence over the last 40 years. (shrink)

Recently the relevance of the philosophy of Martin Heidegger has been critiqued in nursing literature. However, this critique is based primarily upon an appropriation of Heidegger that does not reflect an understanding of meaning as grounded in temporality. Therefore, this paper aims to (1) explicate Heidegger's grounding of meaning, (2) briefly contrast Heidegger's and Husserl's notions of the origin of meaning, (3) describe how Heidegger was first introduced to nursing, and (4) illustrate through examples from a research study how the (...) philosophy of Heidegger might inform the phenomenological researcher. (shrink)

Following Aristotle (who himself was following Parmenides), philosophers have appealed to the distributional reflexes of expressions in determining their semantic status, and ultimately, the nature of the extra-linguistic world. This methodology has been practiced throughout the history of philosophy; it was clarified and made popular by the likes of Zeno Vendler and J.L. Austin, and is realized today in the toolbox of linguistically minded philosophers. Studying the syntax of natural language was fueled by the belief that there is a conceptually (...) tight connection between the syntax of our language and its semantics, and the belief that there is a similarly tight connection between the semantics of our language and metaphysical facts about the world. We are less confident than our colleagues about the relation syntax has to semantics and metaphysics. In particular, we do not believe that the current status of theoretical syntax (or semantics or metaphysics) provides much support for either of the above two beliefs. We will illustrate our view with a case study regarding the status of complex demonstratives. We will show that a recent and particularly subtle syntactically based argument for the semantic/metaphysical status of complex demonstratives does not in fact show what semantic category complex demonstratives are.. (shrink)

What are the processes, from conception to adulthood, that enable a single cell to grow into a sentient adult? Neuroconstructivism is a pioneering 2 volume work that sets out a whole new framework for considering the complex topic of development, integrating data from cognitive studies, computational work, and neuroimaging.

One hundred and three participants solved conflict and non-conflict versions of four reasoning tasks using a two-response procedure: a base rate task, a causal reasoning task, a denominator neglect task, and a categorical syllogisms task. Participants were asked to give their first, intuitive answer, to make a Feeling of Rightness judgment, and then were given as much time as needed to rethink their answer. They also completed a standardized measure of IQ and the actively open-minded thinking questionnaire. The FORs of (...) both high- and low-capacity reasoners were responsive to conflict, such that FORs were lower for conflict relative to non-conflict problems. Consistent with the quantity hypothesis, high-capacity reasoners made a greater distinction between conflict and non-conflict items on measures of Type 2 thinking, namely, rethinking time and probability of changing answers. In contrast to the quality hypothesis, however, this rethinking time did not advantage the ability of the high-capacity group to produce normative answers, except for the base rate task. Indeed, we observed that the correlation between capacity and the probability of normative answers emerged at the initial response, rather than after rethinking. (shrink)

In this paper we develop a general theory of algorithmic fairness. Drawing on Johnson King and Babic’s work on moral encroachment, on Gary Becker’s work on labor market discrimination, and on Strawson’s idea of resentment and indignation as responses to violations of the demand for goodwill toward oneself and others, we locate attitudes to fairness in an agent’s utility function. In particular, we first argue that fairness is a matter of a decision-maker’s relative concern for the plight of people (...) from different groups, rather than of the outcomes produced for different groups. We then show how an agent’s preferences, including in particular their attitudes to error, give rise to their decision thresholds. Tying these points together, we argue that the agent’s relative degrees of concern for different groups manifest in a difference in decision thresholds applied to these groups. (shrink)

ABSTRACT:Despite widespread attention to corruption and organizational change in the literature, to our knowledge, no research has attempted to understand the linkages between these two powerful organizational phenomena. Accordingly, we draw on major theories in ethics, sociology, and management to develop a theoretical framework for understanding how organizational change can sometimes generate corruption. We extend anomie theory and ethical climate theory to articulate the deinstitutionalization of the normative control system and argue that, through this deinstitutionalization, organizations have the potential to (...) become incubators for corruption. We qualify this process by proposing conditions more ripe for anomie and under which this deinstitutionalization is more likely to occur, propounding moderating relationships that influence organizational reconfiguration. Examples of turbulence in the contemporary business environment that can trigger change highlight our discussion. We conclude with managerial implications, offering means by which the deleterious effects of corruption may be arrested or controlled. (shrink)

SummaryThe Gainj of highland Papua New Guinea do not use contraception but have a total fertility rate of only 4·3 live births per woman, one of the lowest ever recorded in a natural fertility setting. From an analysis of cross-sectional demographic and endocrinological data, the causes of low reproductive output have been identified in women of this population as: late menarche and marriage, a long interval between marriage and first birth, a high probability of widowhood at later reproductive ages, low (...) effective fecundability and prolonged lactational amenorrhoea. These are combined with near-universal marriage, a low prevalence of primary sterility and a pattern of onset of secondary sterility similar to that found in other populations. Of all the factors limiting fertility, by far the most important are those involved in birth spacing, especially lactational amenorrhoea. (shrink)

Volume 20, Issue 4, May 2020, Page 106-108.

While tens of thousands of people across the United States serve on hospital and other healthcare ethics committees , almost no carefully prepared educational material exists for HEC members. Ethics by Committee is a one volume collection of chapters developed exclusively for this educational purpose. Experts in bioethics, clinical consultation, health law, and social psychology from across the country contribute chapters on ethics consultation, education, and policy development.

[Open access] In this book symposium the author takes up questions from phenomenology, hermeneutics, ethical theory, and intellectual history raised by a group of scholarly interlocutors from a range of backgrounds. In the course of engaging with these issues, he discusses, inter alia, McDowell’s realism, Jonathon Lear’s work on the end of a world, Michael Oakeshott’s view of selfhood, Heidegger’s conception of Jemeinigkeit, Uexküll’s notion of Umwelt, and Gadamer’s hermeneutic conception of truth.

Psychologists have traditionally approached phenomenology by describing perceptual states, typically in the context of vision. The control of actions has often been described as 'automatic', and therefore lacking any specific phenomenology worth studying. This article will begin by reviewing some historical attempts to investigate the phenomenology of action. This review leads to the conclusion that, while movement of the body itself need not produce a vivid conscious experience, the neural process of voluntary action as a whole has distinctive phenomenological consequences. (...) The remainder of the article tries to characterise this phenomenology. First, the planning of actions is often conscious, and can produce a characteristic executive mode of awareness. Second, our awareness of action often arises from the process of matching what we intended to do with what actually happened. Failures of this matching process lead to particularly vivid conscious experience, which we call 'error awareness'. These features of action phenomenology can be directly related to established models of motor control. This allows an important connection between phenomenology and neuroscience of action. Third, whereas perceptual phenomenology is normally seen as caused or driven by the sensory stimulus, a much more fluid model is required for phenomenology of action. Several experimental results suggest that phenomenology of action is partly a post hoc reconstruction, while others suggest that our awareness of action represents an integration of several processes at multiple levels of motor processing. Fourth, and finally, studies of the phenomenology of action, unlike those of perception, show a strong linkage between primary awareness and secondary awareness or self-consciousness: awareness of action is specifically and inextricably awareness of my action. We argue that the concepts of agency and of proprioaction are fundamental to this linkage. For these reasons, action represents a much more promising field than perception for attacking the problematic question of the relation between primary and secondary consciousness. Some promising directions for future research are indicated. (shrink)

The communicative theory of emotions postulates that emotions are communications both within the brain and between individuals. Basic emotions owe their evolutionary origins to social mammals, and they enable human beings to use repertoires of mental resources appropriate to recurring and distinctive kinds of events. These emotions also enable them to cooperate with other individuals, to compete with them, and to disengage from them. The human system of emotions has also grafted onto basic emotions propositional contents about the cause of (...) the emotion, the self, and other matters. Complex emotions always contain such contents, whereas basic emotions can be experienced without them. This article explains the role of basic emotions in social relationships, their effects on reasoning, and their pathology in psychological illness, such as depression and obsessive-compulsive disorder. (shrink)

Psychologists have traditionally approached phenomenology by describing perceptual states, typically in the context of vision. The control of actions has often been described as 'automatic', and therefore lacking any specific phenomenology worth studying. This article will begin by reviewing some historical attempts to investigate the phenomenology of action. This review leads to the conclusion that, while movement of the body itself need not produce a vivid conscious experience, the neural process of voluntary action as a whole has distinctive phenomenological consequences. (...) The remainder of the article tries to characterise this phenomenology. First, the planning of actions is often conscious, and can produce a characteristic executive mode of awareness. Second, our awareness of action often arises from the process of matching what we intended to do with what actually happened. Failures of this matching process lead to particularly vivid conscious experience, which we call 'error awareness'. These features of action phenomenology can be directly related to established models of motor control. This allows an important connection between phenomenology and neuroscience of action. Third, whereas perceptual phenomenology is normally seen as caused or driven by the sensory stimulus, a much more fluid model is required for phenomenology of action. Several experimental results suggest that phenomenology of action is partly a post hoc reconstruction, while others suggest that our awareness of action represents an integration of several processes at multiple levels of motor processing. Fourth, and finally, studies of the phenomenology of action, unlike those of perception, show a strong linkage between primary awareness and secondary awareness or self-consciousness: awareness of action is specifically and inextricably awareness of my action. We argue that the concepts of agency and of proprioaction are fundamental to this linkage. For these reasons, action represents a much more promising field than perception for attacking the problematic question of the relation between primary and secondary consciousness. Some promising directions for future research are indicated. (shrink)

The prevailing “segregated model” for understanding clinical research sharply separates it from clinical care and subjects it to extensive regulations and guidelines. This approach is based on the fact that clinical research relies on procedures and methods—research biopsies, blinding, randomization, fixed treatment protocols, placebos—that pose risks and burdens to participants in order to collect data that might benefit all patients. Reliance on these methods raises the potential for exploitation and unfairness, and thus points to the need for independent ethical review (...) and more extensive informed consent. In contrast, it is widely assumed that clinical care does not raise these ethical concerns because it is designed to promote the best interests of individual patients. The segregation of clinical research from clinical care has been largely effective at protecting research participants. At the same time, this approach ignores the fact that several aspects of standard clinical care, such as clinician training and scheduling, also pose some risks and burdens to present patients for the benefit of all patients. We argue that recently proposed learning health care systems offer a way to address this concern, and better protect patients, by developing integrated review and consent procedures. Specifically, current approaches base the need for independent ethical review and more extensive informed consent on whether an activity is categorized as clinical research or clinical care. An ethically sounder approach, which could be incorporated into learning health care systems, would be to base the need for independent ethical review and more extensive informed consent on the extent to which an activity poses risks to present patients for the benefit of all patients. (shrink)

Despite apparent political concern and action—often fuelled by high-profile cases and campaigns—legislative and institutional responses to image-based sexual abuse in the UK have been ad hoc, piecemeal and inconsistent. In practice, victim-survivors are being consistently failed: by the law, by the police and criminal justice system, by traditional and social media, website operators, and by their employers, universities and schools. Drawing on data from the first multi-jurisdictional study of the nature and harms of, and legal/policy responses to, image-based sexual abuse, (...) this article argues for a new joined-up approach that supports victim-survivors of image-based sexual abuse to ‘reclaim control’. It argues for a comprehensive, multi-layered, multi-institutional and multi-agency response, led by a government- and industry-funded online or e-safety organisation, which not only recognises the diversity of victim-survivor experiences and the intersection of image-based sexual abuse with other forms of sexual and gender-based violence and discrimination, but which also enables victim-survivors to reclaim control within and beyond the criminal justice system. (shrink)

Is the market civilizing or destructive? The increased salience of science commercialization is forcing scientists to address this question. Benefiting from the sociology of morality literature’s increased attention to specific kinds of morality and engaging with economic sociology’s moral markets literature, we generate competing hypotheses about scientists’ value-driven attitudes toward patenting. The Civilizing Market thesis suggests scientists who prioritize universalism will tend to support patenting. The Destructive Market thesis, by contrast, suggests universalism will be correlated with opposition to patenting. We (...) analyze survey data from biologists and physicists nested within academic organizations, which are nested within the following regions: France, Hong Kong, India, Italy, Taiwan, Turkey, UK, and the USA. Employing multilevel analysis, we find correlational evidence to support the Destructive Market thesis. Universalism is associated with anti-patenting attitudes, suggesting scientists expect patenting to have deleterious effects on science and society. We end with a discussion of this article’s implications for the moral markets literature, sociology of morality and business ethics. (shrink)

Volume 20, Issue 8, August 2020, Page 46-49.

Commodification is a broad and crosscutting issue that spans debates in ethics (from prostitution to global market practices) and bioethics (from the sale of body parts to genetic enhancement). There has been disagreement, however, over what constitutes commodification, whether it is happening, and whether it is of ethical import. This chapter focuses on one area of the discussion in bioethics – the commodification of human tissue – and addresses these questions – about the characteristics of commodification, its pervasiveness, and ethical (...) significance – in order to clarify and map the commodificatory debate. The chapter does this in three parts. First, it defines commodification as the shift from “persons” to “things” and from “relationships” to services for “contract.” Second, using examples of kidney and gamete sale and commercial surrogacy, it argues that commodification is rife in bioethics. Third, it contends that commodification is an ethical problem for three key reasons: First, because it leads to exploitation; second, because some things should not be for sale; and third, because it damages social goods. The chapter concludes that commodification and commodificatory practices should be resisted. (shrink)

This paper responds to Philipona & O’Regan (2006), which attempts to account for certain color phenomena by appeal to singularities in the space of “accessible information” in the light striking the retina. Three points are discussed. First, it is unclear what the empirical significance/import is of the mathematical analysis of the data regarding the accessible information in the light. Second, the singularity index employed in the study is both mathematically and empirically faulty. Third, the connection drawn between their findings and (...) some data from the World Color Survey is lacking in quantitative analysis in places where it is needed. The difficulties raised prevent Philipona & O’Regan’s conclusions from being accepted. (shrink)

Intellectual humility is a concept in progress—philosophers and psychologists are in the process of defining and coming to understand what intellectual humility is and what place it has in our theories. Most accounts of intellectual humility build from work in virtue epistemology, the study of knowledge as the state that results when agents are epistemically virtuous (or, perhaps, the view that the proper object of study for epistemology is the intellectually virtuous agent). [...].