Registered nurses (RNs) employed in an urban medical center in the USA identified moral distress as a practice concern. This study describes RNs' moral distress and the frequency of morally distressing events. Data were collected using the Moral Distress Scale and an open-ended questionnaire. The instruments were distributed to direct-care-providing RNs; 100 responses were returned. Morally distressing events included: working with staffing levels perceived as `unsafe', following families' wishes for patient care even though the nurse disagreed with the plan, and (...) continuing life support for patients owing to family wishes despite patients' poor prognoses. One high frequency distressing event was carrying out orders for unnecessary tests and treatments. Qualitative data analysis revealed that the nurses sought support and information from nurse managers, chaplaincy services and colleagues. The RNs requested further information on biomedical ethics, suggested ethics rounds, and requested a non-punitive environment surrounding the initiation of ethics committee consultations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Knowing the EastPatti M. MarxsenKnowing the East. By Paul Claudel. Translated by James Lawler. Princeton, NJ: Princeton University Press, 2004. 136 pp.Fifty years after his death, Paul Claudel (1868–1955) is remembered for many things. Not only was he a major twentieth-century poet and playwright, he was an astute observer of Dutch, Spanish, and Japanese art. Not only was he the brother of sculptor Camille Claudel, he was a (...) diplomat who lived for nearly twenty years in Asia, including a stint as the French ambassador to Japan (1921–1927). When he was elected as a member of the Académie Française in 1946 at nearly 80 years of age he quipped, "For an academic, that is puberty." He died at 87, having lived large in two centuries and on three continents.Following an adolescence marked with indifference toward religion, Claudel experienced a profound conversion to Catholicism during a Christmas night service at Notre Dame Cathedral in Paris at the age of 18. With Christianity at the center of his universe and under the influence of Symbolist poets Rimbaud and Mallarmé, he developed a response to the world that was at once poetic and spiritual. Through his poetry, plays, and essays, he insisted on a fundamental unity between matter and spirit, a harmonious and vast universe into which the human mind could enter. And, at least for him, the point of entry was the portal of the Church. He struggled at times, but never lost sight of his faith. For all this, he is often credited with the revival of French Catholicism in the wake of WWI. After all, if Paul Claudel could take religion seriously and find meaning in it, pourquoi pas the rest of us?The facts of his extraordinary biography form a peculiar background to the recent translation by James Lawler of Claudel's collection of prose poems titled Knowing [End Page 229] the East. First published in 1946 as Connaissance de l'est, these sixty-one texts were written between 1895 and 1905 during Claudel's first visits to China and Japan as a young vice-consul stationed in Shanghai. He was twenty-six and still finding his poetic voice. And though his stance in the world is decidedly Christian, the content of this intriguing work reveals an inner dialogue with Buddhist ideas of interconnection, harmony, the ongoing quest for a higher life condition, and the overwhelming impact of nature in the lives of mere humans.In "Pagoda," Claudel describes a seven-story Chinese pagoda as it "amplifies and multiplies the roof, exaggerates the horned corners that rise with an elegant surge, and turns their curves upward to the sky." This form that "does away with walls" and concentrates on the uplifting roof creates a space where "Buddha, Prince of Peace, dwells inside with all the gods." In this architecture he reads a structuring of physical and spiritual space, a kind of never ending upward movement divided into "the seven mystical heavens." The culminating effect is the heavenly achievement of the unknowable. And so, after going as far as he can go into the world of the spirit, he ends this prose poem with an abrupt return to temporal reality. "I have no more to say of the Pagoda. I do not know its name."Elsewhere, in "The Wanderer," he turns his sense of awe toward nature. "Every tree has its personality, every small beast its role, every voice its part in the symphony," he writes. "As one understands music, so I understand nature, like a detailed narrative of proper names; as my walk and the day advance, so does the elaboration of the doctrine." The "doctrine," it seems, is the idea of dependent origination, the interrelation of all life that springs from a single source. In the last line, he states, "I understand the world's harmony. When will I grasp its melody?"In "The Temple of Consciousness" Claudel climbs "the black rock's vertical wall, and only at this late afternoon hour do I know myself to be on the right track." Below, he observes golden rice fields. Ahead there is an "old stairway overlaid with hoary moss... (shrink)

In order to receive controlled pain medications for chronic non-oncologic pain, patients often must sign a “narcotic contract” or “opioid treatment agreement” in which they promise not to give pills to others, use illegal drugs, or seek controlled medications from health care providers. In addition, they must agree to use the medication as prescribed and to come to the clinic for drug testing and pill counts. Patients acknowledge that if they violate the opioid treatment agreement, they may no longer receive (...) controlled medications. OTAs have been widely implemented since they were recommended by multiple national bodies to decrease misuse and diversion of narcotic medications. But critics argue that OTAs are ethically suspect, if not unethical, and should be used with extreme care if at all. We agree that OTAs pose real dangers and must be implemented carefully. But we also believe that the most serious criticisms stem from a mistaken understanding of OTAs’ purpose and ethical basis. (shrink)

In this article Troels Norager discusses the subject of sacrifice in the context of Kierkegaard's Works of Love and Fear and Trembling. The first section argues that contrary to contemporary attempts to turn Kierkegaard into a phenomenologist of love, Kierkegaard should be regarded as a radical Christian thinker who (partly for biographical reasons) deliberately emphasized the necessity of being willing to sacrifice one's most precious love object. The second part deals with Abraham's dilemma in Genesis 22 and argues, critically surveying (...) the intriguing interpretation proposed by Ingolf Dalferth, that no credible solution to this deeply troubling story is to be found. In the final section the author ponders the contemporary significance of Abraham's sacrifice and briefly points to insights from eminent political philosophers like Rawls and Habermas. This leads to the conclusion that theology should finally be taking leave of Abraham by rejecting Abraham as the 'Father of faith' and as a paradigm to be emulated. Instead, theologians and philosophers of religion are called upon to embrace our post-secular modernity without surrendering to the demands of authoritarian religion. (shrink)

This paper brings together the concepts of social norms and innovation diffusion to assess two community development projects with gender targets. The projects failed to meet their objectives although they embodied leading global ?good practices? for community-based participatory approaches. In order to succeed, the projects needed to reach and empower poor women; however, they were located in contexts with significant gender inequalities and weak governance in one case, and with political conflict in the other. In such contexts, participatory projects with (...) gender objectives likely require more strategic and longer term interventions than current community development models are allowing. (shrink)

In February 2010, the American Psychiatric Association (APA) launched their DSM-5 website with details about the development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The APA invited “the general public” to review the draft diagnostic criteria and provide written comments and suggestions. This revision marks the first time the APA has solicited public review of their diagnostic manual. This article analyzes reported speech on the DSM-5 draft diagnostic criteria for the classification Posttraumatic Stress (...) Disorder. It demonstrates how textual standardization facilitates the cultural portability of the DSM-5 diagnostic criteria such that a community of speakers beyond the borders of the APA come to be seen as exemplary speakers, writers, and revisers of the professional style. Furthermore, analysis shows how co-authoring practices recontextualize the “voice” and persona of putative patient reported speech on Criterion D2. As a consequence of textual standardization, spoken discourse becomes recontextualized as the product of scientific inquiry and the organization of psychiatric knowledge. (shrink)

This article experiments with multimedia storytelling to re-vision difference outside biomedical and humanistic frames by generating new understandings of living dis/artfully with illness. We present and analyze seven short videos created by women and trans people living with illness as part of an arts-based research project that aimed to speak back to hegemonic concepts of disability that create barriers to healthcare.1 We call for a welcoming in of disability studies’ disruptive and re-imaginative orientations to bodily difference to unsettle medicine’s humanistic (...) accounts. In turn, we advance medical post-humanistic approaches that call on disability studies to re-embody its theories and approaches. (shrink)

In recent years, the concepts of charity and development aid have changed significantly. Present concepts combine direct money transfer with co-production, knowledge sharing and the development of products and services designed for the need of developing and transition economies. The concept of micro-financing is a financial service which has proven to allow for entrepreneurs in the respective countries to start up their businesses. A relatively new financial product for these countries is micro-insurance. This article deals with the question whether consumers (...) in the Netherlands are willing to donate micro-insurances and which factors influence this willingness to contribute to the non-profit micro-insurance approach of an insurance company. The data were collected with questionnaires among a sample of the Dutch population. The data have been processed in a one-way between-groups ANOVA, a paired sample t test and an ordinal regression analysis. The results show that approximately half of the Dutch consumers are willing to pay an additional amount on their insurance premium for the donation of micro-insurances. The amount of the insurance premium did, however, not affect the willingness to donate. If consumers could choose the beneficiary less people are willing to donate, yet those people are willing to donate more money. In conclusion, there is readiness among consumers to contribute to micro-insurance via an insurance company that assists in setting up micro-insurance projects. This indicates a possible role for companies to act as an intermediary between philanthropic acts and consumers. (shrink)

Today there are over 1,500 public-use airports in the United States. Each of these airports provides a service to the surrounding community, whether in the form of a general aviation or commercial air service facility. An airport is dependent on many facets of the local government infrastructure for support services. Also, the airports have ties to neighboring or resident military installations. A military installation has similar missions and objectives to an airport, a situation that enables a working relationship that is (...) complementary to each party. For example, airports and military installations alike must provide such services as emergency response, fire protection, airspace control, environmental protection, and a safe infrastructure for aircraft operations. While many aspects of the relationships are intangible and subjective, others are easily measured. (shrink)

A content analysis of 601 commercials was conducted in order to identify the appeals that characterize commercials aimed at children and teenagers. Our findings demonstrated that the use of appeals showed strong age differences and was highly gender-role stereotyped, particularly in commercials aimed at children. The most typical appeals in commercials aimed at male children were action-adventure, sports, and play, whereas commercials aimed at female children emphasized nurturing, physical attractiveness, friendship, and romance. Having the best, competition, and achievement were the (...) dominant appeals in commercials aimed at male teenagers, whereas romance, sexuality, and belonging to a group were emphasized in commercials aimed at female teenagers. (shrink)

In considering the similarities between "momoirs"--popular memoirs written by mothers about motherhood experiences--and evocative autoethnographic mother-writing, I argue that differentiating these two forms of intimate observation and personal narrative requires a rethinking of autoethnographic practice. Specifically, I draw on the work of Gilles Deleuze to advocate for a radical specificity in autoethnographic writing. Thinking the autoethnographic narrative in terms of specificities and differences encourages us to think creatively about personal experiences and cultural relations beyond what is shared and communicable.

In both the academic and societal debates, it is widely assumed that cognitive advertising defenses can reduce children's susceptibility to advertising effects. Empirical evidence supporting this crucial assumption is however missing. It is precisely this gap that the present study aims to fill In a survey of 296 children, we investigate whether children's cognitive defenses reduce the relationship between the amount of television advertising they are exposed to and their desire for advertised product categories. Interaction analysis in regression shows that (...) of all the cognitive defense variables, only understanding advertising's persuasive intent was effective in reducing the impact of advertising exposure on children's advertised product desire. However, this only applies to the older children in the sample. For the younger children, understanding the persuasive intent even increased the impact of advertising. (shrink)

Are democratic states permitted to denationalize citizens, in particular those whom they believe pose dangers to the physical safety of others? In this article, I argue that they are not. The power to denationalize citizens—that is, to revoke citizenship—is one that many states have historically claimed for themselves, but which has largely been in disuse in the last several decades. Recent terrorist events have, however, prompted scholars and political actors to reconsider the role that denationalization can and perhaps should play (...) in democratic states, in particular with respect to its role in protecting national security and in supporting the global fight against terror more generally. In this article, my objective is to show that denationalization laws have no place in democratic states. To understand why, I propose examining the foundations of the right of citizenship, which lie, I shall argue, in the very strong interests that individuals have in security of residence. I use this formulation of the right to respond to two broad clusters of arguments: (1) those that claim that it is justifiable to denationalize citizens who threaten to undermine the safety of citizens in a democratic state or the ability of a democratic state to function as a democratic state, and (2) those that claim that it is justifiable to denationalize dual citizens because they possess citizenship status in a second country that is also able to protect their rights. (shrink)

Calls to expand temporary work programmes come from two directions. First, as global justice advocates observe, every year thousands of poor migrants cross borders in search of better opportunities, often in the form of improved employment opportunities. As a result, international organizations now lobby in favour of expanding ‘guest-work’ opportunities, that is, opportunities for citizens of poorer countries to migrate temporarily to wealthier countries to fill labour shortages. Second, temporary work programmes permit domestic governments to respond to two internal, contradictory (...) political pressures: (1) to fill labour shortages and (2) to do so without increasing rates of permanent migration. Temporary work programmes permit governments to appear ‘tough’ on migration, while responding to employer pressure to locate workers willing to work in low-skilled, poorly remunerated positions. The coincidence of national self-interest and global justice generates a strong case in favour of expanding guest-work. We evaluate the moral benefits and burdens of expanding guest-work opportunities, and conclude that although there are benefits to be gleaned from the perspective of global wealth redistribution, at present, temporary work programmes are generally unjust. We will argue that just temporary work programmes, in time, permit temporary workers to attain citizenship. This spells the end of traditional temporary work programmes, which require that workers return to their home country in time; instead, what is temporary is the employment obligation that must be fulfilled as a requirement to access citizenship. As long as this requirement is met, we endorse guest-work programmes as a tool to respond to global inequality. (shrink)

Elected prosecutors have pledged not to enforce abortion laws, in response to state-level abortion bans. For their pledges to be meaningful, prosecutors must exercise their discretion in cases of individuals who face legal risk, including people who help others self-manage their abortions. With a harm-reduction approach to improving abortion access, prosecutors should aim to reduce abortion helpers’ involvement with the criminal justice system.

Curiosita Teaching is the narrative that supports you as you teach creativity and teach creatively. The authors focus on bridging the gap between research, theory, and practical application. Under the umbrella of creativity this engaging resource provides the flexibility and structure to integrate creativity into your curriculum at your comfort level as well as provide for differentiation, multiple intelligences, backward planning, and brain-engaging strategies. The practical, step-by-step approach in The Handbook provides tools, activities, and an organizational plan to develop and (...) implement creativity in your classroom. Sequential lessons provide students with the basic skills and understanding of the creative process. (shrink)

The global space is in need of creative solutions to the challenges posed by those seeking, and deserving of, asylum. In some democratic states, experiments in permitting citizens to have a greater role in selecting refugees for admission are underway; in this article, I consider the conditions that must apply to any citizen‐selection scheme, in order for such a scheme to be morally acceptable. I begin with an account of the way in which citizen‐selection schemes – usually called ‘sponsorship programs’ (...) – operate presently. I then offer a justification for engaging citizens in refugee resettlement in general, as well as in selecting specific refugees for admission in particular, and then identify several conditions that must attend any permissible citizen‐selection scheme. I defend this account from two objections: (1) that states should be the primary, and indeed only, agent that selects refugees for admission and (2) that citizens will inevitably use problematic criteria in selecting refugees for admission, so they should be denied the right to do so. I conclude with some proposals for how a citizen‐selection scheme can be crafted to respond to this latter worry, including an outline of an exception clause that permits citizens to make the case that some refugees ought to be resettled, even if not specially selected by the UNHCR for resettlement priority, including especially family members and friends. (shrink)

This article considers two questions: Do democratic states have the right to deport non-citizens present or residing on their territory? And, if so, what principles should guide deportation in democratic states? The overall objective is to offer an account of what deportation should look like in a liberal democratic state. I begin by situating the practice of deportation in larger discussions of the extent of state discretion in controlling both borders and membership; here, I will argue that potential deportees occupy (...) an awkward middle space, i.e. it is not clear whether they should be treated according to the principles that regulate discretion at the border or discretion in admitting migrants to membership. I then consider more deeply whether deportation can be rendered non-arbitrary, or whether it is bound to remain unjustly applied; where it cannot be rendered non-arbitrary, it must be rejected, or so I shall argue. To be non-arbitrary, the practice of deportation must meet three criteria: a publicity criterion, a justification criterion, and a collective interest criterion. In the final section of the article, I disentangle deportation into its component parts – I distinguish just cause for deportation from just action in deportation – and consider how the criteria that stem from a commitment to non-arbitrariness constrain its application to non-citizen residents. The consequence of requiring deportation to be applied, if at all, in a non-arbitrary way is that there will certainly be cases where liberal democracies find themselves unable to deport those who might otherwise be thought eligible for deportation. Ultimately, I conclude that deportation from liberal democratic states can be fair only in a small number of cases. (shrink)

Examines the facts about the issue being covered, with information about arguments and opinions from around the globe. Special research projects, as well as a great variety of additional resources, invite the reader to engage with the issues that are currently shaping the world.

Algorithmic fairness is a new interdisciplinary field of study focused on how to measure whether a process, or algorithm, may unintentionally produce unfair outcomes, as well as whether or how the potential unfairness of such processes can be mitigated. Statistical discrimination describes a set of informational issues that can induce rational (i.e., Bayesian) decision-making to lead to unfair outcomes even in the absence of discriminatory intent. In this article, we provide overviews of these two related literatures and draw connections between (...) them. The comparison illustrates both the conflict between rationality and fairness and the importance of endogeneity (e.g., “rational expectations” and “self-fulfilling prophecies”) in defining and pursuing fairness. Taken in concert, we argue that the two traditions suggest a value for considering new fairness notions that explicitly account for how the individual characteristics an algorithm intends to measure may change in response to the algorithm. (shrink)

We are not cosmopolitans, if by cosmopolitan we mean that we are willing to prioritize equally the needs of those near and far. Here, I argue that cosmopolitanism has yet to wrestle with the motivational challenges it faces: any good moral theory must be one that well-meaning people will be motivated to adopt. Some cosmopolitans suggest that the principles of cosmopolitanism are themselves sufficient to motivate compliance with them. This argument is flawed, for precisely the reasons that motivate this paper (...) - we are cosmopolitan neither in our attitudes nor in our behaviors towards others. Other cosmopolitans suggest that 'global solidarity' is sufficient to generate a commitment to carrying out duties towards others. These latter efforts implicitly rely on insights best captured by the nationalist thesis, that is, that national communities are the best vehicles, morally speaking, through which individuals can carry out their obligations to others. I consider, and refute, two objections to my argument: first, that it is guilty of a 'time-lag fallacy' and, second, that it ignores an emergent cosmopolitan attitude among global citizens. (shrink)