Abstract Occupational stress in nursing has attracted considerable attention as a focus for research and as a consequence multiple objects of nurses' stress, or 'stressors', have been identified. This paper puts into question the dominant conceptual and methodological approach to occupational stress in nursing research by both foregrounding the notion of anxiety and juxtaposing it with the notion of 'stress'. It is argued that the notion of 'stress' and the domination of the questionnaire have produced a narrow reading of the (...) topic. Some of the literature on occupational stress/anxiety in nursing is reviewed and our analysis illustrates how the identified objects of stress have a tendency to multiply contingent on the number of studies undertaken. Thus definitive objects of nurses' stress remain elusive. We argue that a return to the notion of 'anxiety' and methodological approaches other than empirical ones can bring both depth and breadth to the consideration of occupational distress in nursing. Further, we argue that the object of 'anxiety' is unconscious, thus unknown, and given this, a more informative approach is to map nurses' response to anxiety, the discursive formations arising out of anxiety, rather than attempt to define those objects of anxiety. (shrink)

The nurses’ relationship to knowledge has been theorised in a variety of different ways, not the least being in relation to medical dominance. In this study, the authors report on one of the findings of a case study into nurses’ anxiety informed by psychoanalytic theory. They argue that the nurse’s subjection to the knowledge of the other health professional, inclusive of the doctor, can be a transference arising in the context of anxiety for the nurse. Grasped by anxiety, the nurse (...) finds their own knowledge insufficient and in this moment can operate a transference to their non‐nursing colleague, who obligingly, responds. This transference is not present in the change‐of‐shift handover report though, when the other’s knowledge is suspect, even open to derision. Thus, this reference to the knowledge of the other is not consistently present in nursing and can be seen to be just one way that nurses organise themselves in relation to anxiety. Therefore, those wanting to break down the medical dominance of the nursing profession might consider other ways nurses might organise themselves in relation to anxiety, so that the political dominance of the other is not reinforced via transference to that other. (shrink)

This paper reports on the findings of a study that considered how anxiety might function to organise nurses’ practice. With reference to psychoanalytic theory this paper analyses field notes taken during a series of nursing change‐of‐shift handovers. The handover practices analysed met all the criteria for a ritual, as understood in psychoanalytic theory, and functioned to alleviate anxiety in the short term while symbolically expressing a forbidden and unknown knowledge. We argue that the handover ritual contained certain prohibitions, yet allowed (...) some expression of the prohibited knowledge in a disguised way. The prohibition concerned how the patient affected the nurse, that is, moved the nurse to love and hate the patient. We argue that this prohibition is expressed, in disguise, via the displacement of affection for the patient onto other nurses and through negative stereotyping of some patients. We also argue that these prohibitions of the handover mirror broader prohibitions within nursing, and thus the rituals of the handover become an expression of how professional prohibitions are enacted in practice. We conclude that the important implicit function of the handover ritual is to keep anxiety at bay, thereby enabling the nurse to commence practice rather than being immobilised by the effect of potentially overwhelming anxiety. (shrink)

_Illegal Leisure _offers a unique insight into the role drug use now plays in British youth culture. The authors present the results of a five year longitudinal study into young people and drug taking. They argue that drugs are no longer used as a form of rebellious behaviour, but have been subsumed into wider, acceptable leisure activities. The new generation of drug user can no longer be seen as mad or bad or from subcultural worlds - they are ordinary and (...) everywhere. Illustrated throughout with interview material, _Illegal Leisure _shows how drug consumption has become normalised, and provides a well-informed analysis of the current debate. (shrink)

The Second Sex offers a philosophy of bodies that hinges on the crucial concepts of ambiguity and singularity. I revisit two widely influential essays on the status of “the body” in The Second Sex, those of Moira Gatens and Catriona Mackenzie. However, both of these readings mistakenly present Beauvoir as accepting lived experiences of politically overdetermined immanence, rather than exploring them as stifled modes of transcendence. Several years later, Moira Gatens took a very helpful “second look” at the status of (...) bodies and biology in Beauvoir. I contrast this with Judith Butler's reading of The Second Sex as a project engaged in the denaturalization of gender. My chapter charts a middle way between Gatens’ second essay and Butler's reading: I argue that The Second Sex does “denaturalize” gender, but it does so precisely to bring attention to the powers and plurality of bodies. Singularity as multiplicitous lived bodily variance, according to Beauvoir, will “always exist” regardless of the static and idealizing categories of some approaches to biology. (shrink)

It is widely accepted that Judith Butler’s work represents a fundamental departure from that of Luce Irigaray. However, in a 2001 essay, Butler suggests that Irigaray’s work plays a formative role in her own, and that the problematization of the biological and cultural distinction that Irigaray’s notion of sexual difference accomplishes must be rethought and multiplied rather than simply rejected. In this essay, I place the notion of precarity in the work of Butler alongside that of sexual difference in (...) Irigaray, to show how together they seek to address violence to certain bodies through an approach that is at once ecological and political. I show that Butler’s concept of precarity has deep, largely unappreciated, roots in the work of Irigaray. Butler explores precarity as bodily multiplicity in ways that pluralize Irigaray’s own ethics and politics of difference. Butler is, in other words, rewriting sexual difference as precarity. (shrink)

Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with the genomics (...) revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health. (shrink)

Schopenhauer is famously abusive toward his philosophical contemporary and rival, Friedrich William Joseph von Schelling. This chapter examines the motivations for Schopenhauer’s immoderate attitude and the substance behind the insults. It looks carefully at both the nature of the insults and substantive critical objections Schopenhauer had to Schelling’s philosophy, both to Schelling’s metaphysical description of the thing-in-itself and Schelling’s epistemic mechanism of intellectual intuition. It concludes that Schopenhauer’s substantive criticism is reasonable and that Schopenhauer does in fact avoid Schelling’s errors: (...) still, the vehemence of the abuse is best perhaps explained by the proximity of their philosophies, not the distance. Indeed, both are developing metaphysics of will with full and conflicted awareness of the Kantian epistemic strictures against metaphysics. In view of this, Schopenhauer is particularly concerned to mark his own project as legitimate by highlighting the manner in which he avoids Schelling’s errors. (shrink)

Julian Savulescu argues for two principles of reproductive ethics: reproductive autonomy and procreative beneficence, where the principle of procreative beneficence is conceptualised in terms of a duty to have the child, of the possible children that could be had, who will have the best opportunity of the best life. Were it to be accepted, this principle would have significant implications for the ethics of reproductive choice and, in particular, for the use of prenatal testing and other reproductive technologies for the (...) avoidance of disability, and for enhancement. In this paper, it is argued that this principle should be rejected, and it is concluded that while potential parents do have important obligations in relation to the foreseeable lives of their future children, these obligations are not best captured in terms of a duty to have the child with the best opportunity of the best life. (shrink)

Clinical geneticists are increasingly confronted with ethical tensions between their responsibilities to individual patients and to other family members. This paper considers the ethical implications of a “familial” conception of the clinical genetics role. It argues that dogmatic adherence to either the familial or to the individualistic conception of clinical genetics has the potential to lead to significant harms and to fail to take important obligations seriously.Geneticists are likely to continue to be required to make moral judgments in the resolution (...) of such tensions and may find it useful to have access to ethics training and support. (shrink)

The practice of medicine frequently involves the unconsented restriction of liberty. The reasons for unilateral liberty restrictions are typically that being confined, strapped down, or sedated are necessary to prevent the person from harming themselves or others. In this paper, we target the ethics of chemical restraints, which are medications that are used to intentionally restrict the mental states associated with the unwanted behaviors, and are typically not specifically indicated for the condition for which the patient is being treated. Specifically, (...) we aim to identify the conditions under which chemical restraints are ethically permissible. It is wrong to assume that what is morally true of physical restraints is also true of chemical restraints. Our aim is thus to identify the conditions under which chemical restraints are permissible while distinguishing these conditions from those of the application of physical restraints. (shrink)

This classic work by one of the most important philosophers and critics of our time charts the genesis and trajectory of the desiring subject from Hegel's formulation in Phenomenology of Spirit to its appropriation by Kojève, Hyppolite, Sartre, Lacan, Deleuze, and Foucault. Judith Butler plots the French reception of Hegel and the successive challenges waged against his metaphysics and view of the subject, all while revealing ambiguities within his position. The result is a sophisticated reconsideration of the post-Hegelian tradition (...) that has predominated in modern French thought, and her study remains a provocative and timely intervention in contemporary debates over the unconscious, the powers of subjection, and the subject. (shrink)

BackgroundCommunity engagement is increasingly promoted as a marker of good, ethical practice in the context of international collaborative research in low-income countries. There is, however, no widely agreed definition of community engagement or of approaches adopted. Justifications given for its use also vary. Community engagement is, for example, variously seen to be of value in: the development of more effective and appropriate consent processes; improved understanding of the aims and forms of research; higher recruitment rates; the identification of important ethical (...) issues; the building of better relationships between the community and researchers; the obtaining of community permission to approach potential research participants; and, the provision of better health care. Despite these diverse and potentially competing claims made for the importance of community engagement, there is very little published evidence on effective models of engagement or their evaluation.MethodsIn this paper, drawing upon interviews with the members of a Community Advisory Board on the Thai-Myanmar border, we describe and critically reflect upon an approach to community engagement which was developed in the context of international collaborative research in the border region.Results and conclusionsDrawing on our analysis, we identify a number of considerations relevant to the development of an approach to evaluating community engagement in this complex research setting. The paper also identifies a range of important ways in which the Community Advisory Board is in practice understood by its members to have morally significant roles and responsibilities beyond those usually associated with the successful and appropriate conduct of research. (shrink)

The development of human genetics raises a wide range of important ethical questions for us all. The interpersonal dimension of genetic information in particular means that genetics also poses important challenges to the idea of patient-centredness and autonomy in medicine. How ought practical ethical decisions about the new genetics be made given that we appear, moreover, no longer to be able to appeal to unquestioned traditions and widely shared communitarian values? This paper argues that any coherent ethical approach to these (...) questions must be able both to uphold the moral status of the individual and at the same time recognise the communitarian, interpersonal dimensions both of the world in which we live and of personal autonomy itself. The paper then goes on to propose an approach to the resolution of the ethical questions raised by the use of the new genetics in reproductive choice through the development of a coherent and principled process of public reason and justification oriented towards the support and development of personal autonomy. (shrink)

We theoretically discuss and empirically show how CEO power based on environmental expertise and formal influence over executives and directors, in the absence and presence of shareholder activism, spurs firms toward greener strategies. Our results support the idea that CEOs with informal power, grounded in expertise, reduce corporate environmental impact and this relationship is amplified when the CEO also enjoys formal power over the board of directors. Additionally, we found that any source of CEO power, whether informal or formal, is (...) a good catalyst for transforming shareholder activism into corporate greening. However, in the absence of such activism, only CEOs’ informal environmental expert power acts as a determinant of firm environmental performance. (shrink)

The internet is becoming increasingly important in health care practice. The number of health-related web sites is rising exponentially as people seek health-related information and services to supplement traditional sources, such as their local doctor, friends, or family. The development of e-medicine poses important ethical challenges, both for health professionals and for those who provide clinical ethics support for them. This paper describes some of these challenges and explores some of the ways in which those who provide clinical ethics support (...) might respond creatively to them. By offering ways of responding to such challenges, both electronically and face-to-face, the providers of clinical ethics support can show themselves to be an indispensable part of good quality health care provision. (shrink)

Some theorists argue that moral bioenhancement ought to be compulsory. I take this argument one step further, arguing that if moral bioenhancement ought to be compulsory, then its administration ought to be covert rather than overt. This is to say that it is morally preferable for compulsory moral bioenhancement to be administered without the recipients knowing that they are receiving the enhancement. My argument for this is that if moral bioenhancement ought to be compulsory, then its administration is a matter (...) of public health, and for this reason should be governed by public health ethics. I argue that the covert administration of a compulsory moral bioenhancement program better conforms to public health ethics than does an overt compulsory program. In particular, a covert compulsory program promotes values such as liberty, utility, equality, and autonomy better than an overt program does. Thus, a covert compulsory moral bioenhancement program is morally preferable to an overt moral bioenhancement program. (shrink)

Epistemic burdens – the nature and extent of our ignorance (that and how) with respect to various courses of action – serve to determine our incentive structures. Courses of action that seem to bear impossibly heavy epistemic burdens are typically not counted as options in an actor’s menu, while courses of action that seem to bear comparatively heavy epistemic burdens are systematically discounted in an actor’s menu relative to options that appear less epistemically burdensome. That ignorance serves to determine what (...) counts as an option means that epistemic considerations are logically prior to moral, prudential, and economic considerations: in order to have moral, prudential, or economic obligations, one must have options, and epistemic burdens serve to determine our options. One cannot have obligations without doing some epistemic work. We defend this claim on introspective grounds. We also consider how epistemic burdens distort surrogate decision-making. The unique epistemology of surrogate cases makes the priority of the epistemic readily apparent. We then argue that anyone who accepts a principle similar to ought implies can is committed to the logical priority of the epistemic. We also consider and reject several possible counterarguments. -/- . (shrink)

Questioning the dominant view that Deleuze and Merleau-Ponty have little of substance in common, Judith Wambacq draws on unpublished primary sources and current scholarship in English and French to bring them into a compelling dialogue to reveal a shared concern with the transcendental conditions of thought.

There is recent empirical evidence that personal identity is constituted by one’s moral traits. If true, this poses a problem for those who advocate for moral enhancement, or the manipulation of a person’s moral traits through pharmaceutical or other biological means. Specifically, if moral enhancement manipulates a person’s moral traits, and those moral traits constitute personal identity, then it is possible that moral enhancement could alter a person’s identity. I go a step further and argue that under the right conditions, (...) moral enhancement can constitute murder. I then argue that these conditions are not remote. (shrink)

The relationship between evidence-based medicine (EBM) and clinical judgement is the subject of conceptual and practical dispute. For example, EBM and clinical guidelines are seen to increasingly dominate medical decision-making at the expense of other, human elements, and to threaten the art of medicine. Clinical wisdom always remains open to question. We want to know why particular beliefs are held, and the epistemological status of claims based in wisdom or experience. The paper critically appraises a number of claims and distinctions, (...) and attempts to clarify the connections between EBM, clinical experience and judgement, and the objective and evaluative categories of medicine. I conclude that to demystify clinical wisdom is not to devalue it. EBM ought not be conceived as needing to be limited or balanced by clinical wisdom, since if its language is translatable into terms comprehensible and applicable to individuals, it helps constitute clinical wisdom. Failure to appreciate this constitutive relation will help perpetuate medical paternalism and delay the adoption of properly evidence-based practice, which would be both unethical and unwise. (shrink)

This paper provides evidence for a contrastive account of explanation that is motivated by pragmatic theories that recognize the contribution that context makes to the interpretation of a prompt for explanation. This study replicates the primary findings of previous work in explanation-based category learning, extending that work by illustrating the critical role of the context in this type of learning. Participants interacted with items from two categories either by describing the items or explaining their category membership. We manipulated the feature (...) overlap between the categories and examined both the explanations generated and acquired knowledge of the categories. Explanations for membership in a given category were influenced by the unprompted contrast category, indicating an important role for contrastive processing in the generation of explanations. The influence of the contrast category was similarly seen in the transfer performance of the participants. (shrink)

Orr and Siegler have recently defended a restrictive view concerning posthumous sperm retrieval and conception, which would limit insemination to those cases where the deceased man has provided explicit consent for such a procedure. The restrictive view dominates current law and practice. A permissible view, in contrast, would allow insemination and conception in all but those cases where the posthumous procedure has been explicitly refused, or where there is no reasonable evidence that the deceased person desired children. I describe a (...) phenomenology of procreative desires which supports the permissible view, and which is compatible with requirements concerning the interests of the decedent, concepts of medical infertility, and the welfare of the future child. The account illustrates how our current obsession with individual rights and autonomy can be self-defeating and repressive. (shrink)

It has recently been argued that a person’s moral judgments (about both their own and others’ actions) are constrained by the nature and extent of their relevant ignorance and, thus, that such judgments are determined in the first instance by the person’s epistemic circumstances. It has been argued, in other words, that the epistemic is logically prior to other normative (e.g., ethical, prudential, pecuniary) considerations in human decision-making, that these other normative considerations figure in decision-making only after (logically and temporally) (...) relevant ignorance has constrained the decision-maker’s menu of options. If this is right, then a person’s moral judgments in some set of circumstances should vary with their knowledge and ignorance of these circumstances. In this study, we test the hypothesis of the logical priority of the epistemic. We describe two experiments in which subjects’ knowledge and ignorance of relevant consequences were manipulated. In the second experiment, we also compared the effect of ignorance on moral judgments with that of personal force, a factor previously shown to influence moral judgments. We found broad empirical support for the armchair arguments that epistemic considerations are logically prior to normative considerations. (shrink)

As the science and technology of the brain and mind develop, so do the ways in which brains and minds may be surveilled and manipulated. Some cognitive libertarians worry that these developments undermine cognitive liberty, or “freedom of thought.” I argue that protecting an individual’s cognitive liberty undermines others’ ability to use their own cognitive liberty. Given that the threatening devices and processes are not relevantly different from ordinary and frequent intrusions upon one’s brain and mind, strong protections of cognitive (...) liberty may proscribe neurotechnological intrusions, but also ordinary intrusions. Thus, the cognitive libertarian position “hog-ties” others’ use of their own liberties. This problem for the cognitive libertarian is the same problem that ordinary libertarianism faces in protecting individual rights to property and person. But the libertarian strategies for resolving the problem don’t work for the cognitive libertarian. I conclude that the right to mental privacy is weaker than what cognitive libertarians want it to be. (shrink)

Transcranial direct current stimulation (tDCS) is a brain stimulation technique known for its relative safety and minimal invasiveness. tDCS has demonstrated efficacy as a potential treatment for certain neurological disorders, such as Parkinson’s disease, and has been shown to enhance a range of cognitive abilities under certain contexts. As a result, this technique has captured the interest of both the research community and the public at large. However, efforts to gather information about the effects of tDCS on the brain are (...) still in their infancy, leading to concerns about informed consent as it pertains to the possible risks associated with tDCS treatment. The ability to purchase tDCS equipment in the form of commercial, direct-to-consumer devices, generates even more cause for ethical concern, given the unknowns surrounding this technology and its potential broader societal impact. Previous research has touched on the many ethical issues raised by the emergence of this technology, including under what circumstances its use is justifiable and appropriate. In this paper, we survey recent normative and empirical works pertaining to the ethics of tDCS with the goal of summarizing the current state of ethical debate surrounding its use in the contexts of both therapy and cognitive enhancement, with a particular emphasis on the latter. Our analysis of the collected research finds that issues pertaining to user safety are paramount within existing scholarship; that tDCS use in children is an emerging area of concern entailing special considerations; and that regulatory bodies and legal agencies have struggled to implement appropriate, impactful regulation pertaining to tDCS and related technologies in order to balance public welfare against individual autonomy. This analysis will facilitate future efforts to develop bioethical approaches to tDCS by highlighting the ethical dimensions of tDCS prioritized in existing literature and identifying areas where further ethical consideration is needed. (shrink)

Moral bioenhancement is the potential practice of manipulating individuals’ moral behaviors by biological means in order to help resolve pressing moral issues such as climate change and terrorism. This practice has obvious ethical implications, and these implications have been and continue to be discussed in the bioethics literature. What have not been discussed are the epistemological implications of moral bioenhancement. This article details some of these implications of engaging in moral bioenhancement. The argument begins by making the distinction between moral (...) bioenhancement that manipulates the contents of mental states and that which manipulates other, non-representational states. Either way, I argue, the enhanced moral psychology will fail to conform to epistemic norms, and the only way to resolve this failure and allow the moral bioenhancement to be effective in addressing the targeted moral issues is to make the moral bioenhancement covert. (shrink)

Various thinkers are concerned that the Orthodox view of Ancestral Sin does not avoid the age-old Augustinian concern of Pelagianism. After all, the doctrine of Ancestral Sin maintains that fallen human beings do not necessarily or inevitably commit actual sins. In contemporary literature, this claim could be articulated as a denial of the ‘inevitability thesis.’ A denial of the inevitability thesis, so contemporary thinkers maintain, seems to imply both that human beings can place themselves in right relation to God as (...) well as the Pelagian denial that all require Christ's work to attain this right relation to God. This article demonstrates that the Ancestral Sin, along with a denial of the inevitability thesis, is neither Pelagian nor Semi-Pelagian. I show that the doctrine of Ancestral Sin denies (Semi-) Pelagianism in various ways. I show that, for Ancestral Sin to entail (Semi-) Pelagianism, one must commit to several assumptions, each of which is plausibly deniable and none of which Orthodox thinkers affirm. (shrink)

Despite the lack of evidence for their effectiveness, the use of physical restraints for patients is widespread. The best ethical justification for restraining patients is that it prevents them from harming themselves. We argue that even if the empirical evidence supported their effectiveness in achieving this aim, their use would nevertheless be unethical, so long as well known exceptions to informed consent fail to apply. Specifically, we argue that ethically justifiable restraint use demands certain necessary and sufficient conditions. These conditions (...) are that the physician obtain informed consent for their application, that their application be medically appropriate, and that restraints be the least liberty-restricting way of achieving the intended benefit. It is a further question whether their application is ever medically appropriate, given the dearth of evidence for their effectiveness. (shrink)

In biomedical ethics, there is widespread acceptance of moral realism, the view that moral claims express a proposition and that at least some of these propositions are true. Biomedical ethics is also in the business of attributing moral obligations, such as “S should do X.” The problem, as we argue, is that against the background of moral realism, most of these attributions are erroneous or inaccurate. The typical obligation attribution issued by a biomedical ethicist fails to truly capture the person's (...) actual obligations. We offer a novel argument for rife error in obligation attribution. The argument starts with the idea of an epistemic burden. Epistemic burdens are all of those epistemic obstacles one must surmount in order to achieve some aim. Epistemic burdens shape decision-making such that given two otherwise equal options, a person will choose the option that has the lesser of epistemic burdens. Epistemic burdens determine one's potential obligations and, conversely, their non-obligations. The problem for biomedical ethics is that ethicists have little to no access to others' epistemic burdens. Given this lack of access and the fact that epistemic burdens determine potential obligations, biomedical ethicists often can only attribute accurate obligations out of luck. This suggests that the practice of attributing obligations in biomedical ethics is rife with error. To resolve this widespread error, we argue that this practice should be abolished from the discourse of biomedical ethics. (shrink)

Augustine’s privation theory of evil maintains that something is evil in virtue of a privation, a lack of something which ought to be present in a particular nature. While it is not evil for a human to lack wings, it is indeed evil for a human to lack rationality according to the end of a rational nature. Much of the literature on the privation theory focuses on whether it can successfully defend against counterexamples of positive evils, such as pain. This (...) focus of the discussion is not surprising, given that the privation theory is a theory about the nature of evil. But it is also a theory that protects venerable theological concerns, namely, that God is the good creator of everything, and that everything is good. It is the purpose of this article to further this discussion on both fronts. I argue that the counterexample of pain still defeats the privation theory despite the most recent defense. What is more, I suggest, this is not theologically disastrous. The individual who rejects the privation theory is not obligated to reject the theological theses which motivate it. To show how a rejection of the privation theory is a live option, I offer an alternative view of evil that also maintains these theological theses and encompasses both privative and positive evils. (shrink)