Ethical climate (EC) has been broadly described as how well institutions respond to ethical issues. Developing a tool to study and evaluate EC that aims to achieve sustained improvements requires a contemporary framework with identified relevant drivers. An extensive literature review was performed, reviewing existing EC definitions, tools and areas where EC has been studied; ethical challenges and relevance of EC in contemporary paediatric intensive care (PIC); and relevant ethical theories. We surmised that existing EC definitions and tools designed to (...) measure it fail to capture nuances of the PIC environment, and sought to address existing gaps by developing an EC framework for PIC founded on ethical theory. In this article, we propose a Paediatric Intensive Care Ethical Climate (PICEC) conceptual framework and four measurable domains to be captured by an assessment tool. We define PICEC as the collective felt experience of interdisciplinary team members arising from those factors that enable or constrain their ability to navigate ethical aspects of their work. PICEC both results from and is influenced by how well ethical issues are understood, identified, explored, reflected on, responded to and addressed in the workplace. PICEC encompasses four, core inter-related domains representing drivers of EC including: (1) organisational culture and leadership; (2) interdisciplinary team relationships and dynamics; (3) integrated child and family-centred care; and (4) ethics literacy. Future directions involve developing a PICEC measurement tool, with implications for benchmarking as well as guidance for, and evaluation of, targeted interventions to foster a healthy EC. (shrink)

Pharmaceutical industry funding has transformed much grassroots community activism on health into corporate-sponsored advocacy. This critical commentary outlines recent evidence about industry funding of patient advocacy groups, offers a commentary on the history of grassroots activism appearing in this issue of the journal, and calls for greater scrutiny of the impacts and ethics of such sponsorship.

The historical continuity of spinal catastrophism, traced across multiform encounters between philosophy, psychology, biology, and geology. Drawing on cryptic intimations in the work of J. G. Ballard, Georges Bataille, William Burroughs, Andre Leroi-Gourhan, Elaine Morgan, and Friedrich Nietzsche, in the late twentieth century Daniel Barker formulated the axioms of spinal catastrophism: If human morphology, upright posture, and the possibility of language are the ramified accidents of natural history, then psychic ailments are ultimately afflictions of the spine, which itself is a (...) scale model of biogenetic trauma, a portable map of the catastrophic events that shaped that atrocity exhibition of evolutionary traumata, the sick orthograde talking mammal. Tracing its provenance through the biological notions of phylogeny and "organic memory" that fueled early psychoanalysis, back into idealism, nature philosophy, and romanticism, and across multiform encounters between philosophy, psychology, biology, and geology, Thomas Moynihan reveals the historical continuity of spinal catastrophism. From psychoanalysis and myth to geology and neuroanatomy, from bioanalysis to chronopathy, from spinal colonies of proto-minds to the retroparasitism of the CNS, from "railway spine" to Elizabeth Taylor's lost gill-slits, this extravagantly comprehensive philosophical adventure uses the spinal cord as a guiding thread to rediscover forgotten pathways in modern thought. Moynihan demonstrates that, far from being an fanciful notion rendered obsolete by advances in biology, spinal catastrophism dramatizes fundamental philosophical problematics of time, identity, continuity, and the transcendental that remain central to any attempt to reconcile human experience with natural history. (shrink)

Mimesis as Make-Believe is important reading for everyone interested in the workings of representational art.

This chapter defends the property dualism argument. The term “semantic premise” mentioned is used to refers to an assumption identified by Brian Loar that antiphysicalist arguments, such as the property dualism argument, tacitly assume that a statement of property identity that links conceptually independent concepts is true only if at least one concept picks out the property it refers to by connoting a contingent property of that property. It is argued that, the property that does the work in explaining the (...) possibility of a posteriori identities need not be a first-order property of the referent in question. On his view, the property dualism argument requires only a weaker semantic premise, which allows that the property in question be a higher order property. A refined version of the property dualism argument is formulated, which uses the weaker premise, and defends the argument against various objections. (shrink)

In Working Virtue: Virtue Ethics and Contemporary Moral Problems, leading figures in the fields of virtue ethics and ethics come together to present the first ...

Measuring outcomes using quantitative analytic methods is the hallmark of scientific research in healthcare. For clinical ethics support services (CESS), tangible outcome metrics are lacking and literature examining CESS quality is limited to evaluation of single cases or the influence on individual healthcare professional’s perceptions or behaviour. This represents an enormous barrier to implementing and evaluating ethics initiatives to improve quality. In this context, Kok _et al_ propose a theoretical framework for how moral case deliberation (MCD) can drive quality at (...) an organisational-level, termed _morisprudence_ 1. By offering mechanistic insights into how MCD can lead to organisational learning and quality improvement (QI), they provide a roadmap for actionable items to measure quality. As conceptualised, _morisprudence_ follows accumulation of organisational practical wisdom from a repertoire of ‘paradigmatic’ MCDs, aiding identification of patterns of morally important features. Here, there are parallels between healthcare professionals’ clinical judgement, where past experience... (shrink)

Life-saving healthcare technology evolves over time, raising new ethical questions. What was once experimental becomes standard care, and what was once unthinkable becomes the next frontier. Ethici...

Current sociological theories appear to have lost their general persuasiveness in part because, unlike the theories of the ‘classical era’, they fail to maintain an integrated stance toward society, and the practical role that sociology plays in society. The authors explore various facets of this failure and possibilities for reconstructing sociological theories as integrated wholes capable of conveying a moral and political immediacy. They discuss the evolution of several concepts (for example, the social, structure, and self) and address the significant (...) disputes (for example, structuralism versus humanism, and individual versus society) that have dominated twentieth-century sociological thought. Their ideas and analyses are directed towards an audience of students and theorists who are coming to terms with the project of sociological theory, and its relationship with moral discourses and political practice. The authors of these essays are sociological theorists from the United States, the United Kingdom and Canada. They are all established, but not ‘establishment’ authors. The book contains no orthodoxies, and no answers. However, the essays do contribute to identifying the range of issues that will constitute the agenda for the next generation of sociological theorists. (shrink)

Two problems are considered here. One relates to who has moral status, and the other relates to who has moral responsibility. The criteria for mattering morally have long been disputed, and many humans and nonhuman animals have been considered “marginal cases,” on the contested edges of moral considerability and concern. The marginalization of humans and other species is frequently the pretext for denying their rights, including the rights to health care, to reproductive freedom, and to bodily autonomy. There is broad (...) agreement across cultural and philosophical traditions about the capacities and responsibilities of moral agents. I propose an inclusive and expansive way of thinking about moral status, situating it not in the characteristics or capacities of individuals, but in the responsibilities and obligations of moral agents. Moral agents, under this view, are not privileged or entitled to special treatment but rather have responsibilities. I approach this by considering some African communitarian conceptions of moral status and moral agency. I propose that moral agency can also be more expansive and include not just individual moral agents but collective entities that have some of the traits of moral agents: power, freedom, and the capacity to recognize and act on the demands of morality and acknowledge and respect the rights of others. Expanding who and what is a moral agent correspondingly extends moral responsibility for respecting rights and fostering the conditions for the health and well-being of humans and animals onto the collective entities who uniquely have the capacity to attend to global-scale health threats such as pandemics and human-caused climate change. (shrink)

Our interpretive resources enable us to make sense of, navigate, and communicate about our shared world. These resources not only carve the world up into categories, but also guide how we, individually and collectively, are oriented towards it. In this thesis, I examine how these resources, and the dispositions they guide, may be harmful. A vital kind of interpretive resources are frames, which equip us with unified perspectives on the world. Perspectives are suites of open-ended interpretive (inquisitive, attentional, inferential, evaluative, (...) and affective) dispositions. Frames thereby guide how we interpret, respond to, and navigate the world. I show that these perspectives are epistemically powerful and indispensable. I argue that flawed perspectives, and the distorting frames that produce them, are deeply pernicious and I examine their relationship to oppression. (shrink)