This article aims: (1) to introduce the wider philosophy of Aristotle to nurses and healthcare practitioners; (2) to show that Aristotle's philosophical system is an interdependent whole; and (3) to defend its plausibility and usefulness despite its ancient and alien origins.Aristotle's system can be set out as a hierarchy, with metaphysics at the top and methodology running throughout. Beneath metaphysics are the sciences, with theoretical, practical and productive (or craft) sciences in hierarchical order. This hierarchy does not imply that, say, (...) metaphysics is superior to biology or nursing, but rather that metaphysics can be understood without reference to the other two but, as we shall see, not vice versa.Two themes run through Aristotelian philosophy. The first is Aristotle's method of inquiry, central to which is that our starting point is not pure empirical data, but rather current puzzles; complementing this method is a realist philosophy. The second theme is teleology, the understanding of action in the world in terms of ends, as when we say a plant grows roots to reach water and nutrients.Implications for nursing. Good health is the good functioning of the material aspect of humans; flourishing is good functioning of humans per se. The goals of nursing, which are based on health, are subsumed by the overall human goal of flourishing, and this helps us to understand and set boundaries to health care. Two examples illustrate this. The first is that mental illness is strongly within the purview of nursing and health care whereas bad decisions, such as smoking, are only marginally so. The second is ethics, where it is argued that the attempt to describe ethical decision‐making as in addition to and separate from the decisions made within nursing and health care itself cannot be sustained. (shrink)

The purpose of this article is to set out an Aristotelian account of individual autonomy. Individual autonomy is the capacity of the individual to make and act upon judgments for which he is held morally accountable. This sense of autonomy may be contrasted to a number of other senses. Of these, the most important are political or legal autonomy and Kantian principled autonomy. Political or legal autonomy concerns the environment in which an individual operates. It exists where individuals are able (...) to operate reasonably freely.1 For the most part we will not consider this sense except insofar as it is necessary to explain the importance placed on respecting individual autonomy. Kantian principled autonomy has been described recently by Onora O‟Neill in a series of writings.2 On this account, autonomy is seen as a characteristic of the principle behind action rather than of action per se and is not a characteristic of agents at all. (shrink)

In this paper, we consider three arguments for the irrelevance of the doctrine of double effect in end-of-life decision making. The third argument is our own and, to that extent, we seek to defend it. The first argument is that end-of-life decisions do not in fact shorten lives and that therefore there is no need for the doctrine in justification of these decisions. We reject this argument; some end-of-life decisions clearly shorten lives. The second is that the doctrine of double (...) effect is not recognized in UK law ; therefore, clinicians cannot use it as the basis for justification of their decisions. Against this we suggest that while the doctrine might have dubious legal grounds, it could be of relevance in some ways, e.g. in marking the boundary between acceptable and unacceptable practice in relation to the clinician's duty to relieve pain and suffering. The third is that the doctrine is irrelevant because it requires there to be a bad effect that needs justification. This is not the case in end-of-life care for patients diagnosed as dying. Here, bringing about a satisfactory dying process for a patient is a good effect, not a bad one. What matters is that patients die without pain and suffering. This marks a crucial departure from the double-effect doctrine; if the patient's death is not a bad effect then the doctrine is clearly irrelevant. A diagnosis of dying allows clinicians to focus on good dying and not to worry about whether their intervention affects the time of death. For a patient diagnosed as dying, time of death is rarely important. In our conclusion we suggest that acceptance of our argument might be problematic for opponents of physician-assisted death. We suggest one way in which these opponents might argue for a distinction between such practice and palliative care; this relies on the double-effect doctrine's distinction between foresight and intention. (shrink)

Virtue ethics is often proposed as a third way in health‐care ethics, that while consequentialism and deontology focus on action guidelines, virtue focuses on character; all three aim to help agents discern morally right action although virtue seems to have least to contribute to political issues, such as austerity. I claim: This is a bad way to characterize virtue ethics. The 20th century renaissance of virtue ethics was first proposed as a response to the difficulty of making sense of ‘moral (...) rightness’ outside a religious context. For Aristotle the right action is that which is practically best; that means best for the agent in order to live a flourishing life. There are no moral considerations besides this. Properly characterized, virtue ethics can contribute to discussion of austerity. A criticism of virtue ethics is that fixed characteristics seem a bad idea in ever‐changing environments; perhaps we should be generous in prosperity, selfish in austerity. Furthermore, empirical evidence suggests that people indeed do change with their environment. However, I argue that virtues concern fixed values not fixed behaviour; the values underlying virtue allow for different behaviour in different circumstances: in austerity, virtues still give the agent the best chance of flourishing. Two questions arise. In austere environments might not injustice help an individual flourish by, say, obtaining material goods? No, because unjust acts undermine the type of society the agent needs for flourishing. What good is virtue to those lacking the other means to flourish? The notion of degrees of flourishing shows that most people would benefit somewhat from virtue. However, in extreme circumstances virtue might harm rather than benefit the agent: such circumstances are to be avoided; virtue ethics thus has a political agenda to enable flourishing. This requires justice, a fortiori when in austerity. (shrink)

This article claims that health promotion is best practised in the light of an Aristotelian conception of the good life for humans and of the place of health within it.

The main claim of this paper is that the method outlined and used in Aristotle’s Ethics is an appropriate and credible one to use in bioethics. Here “appropriate” means that the method is capable of establishing claims and developing concepts in bioethics and “credible” that the method has some plausibility, it is not open to obvious and immediate objection. It begins by suggesting why this claim matters and then gives a brief outline of Aristotle’s method. The main argument is made (...) in three stages. First, it is argued that Aristotelian method is credible because it compares favourably with alternatives. In this section it is shown that Aristotelian method is not vulnerable to criticisms that are made both of methods that give a primary place to moral theory (such as utilitarianism) and those that eschew moral theory (such as casuistry and social science approaches). As such, it compares favourably with these other approaches that are vulnerable to at least some of these criticisms. Second, the appropriateness of Aristotelian method is indicated through outlining how it would deal with a particular case. Finally, it is argued that the success of Aristotle’s philosophy is suggestive of both the credibility and appropriateness of his method. (shrink)

This paper reports a literature review on the topic of ethical issues in in-depth interviews. The review returned three types of article: general discussion, issues in particular studies, and studies of interview-based research ethics. Whilst many of the issues discussed in these articles are generic to research ethics, such as confidentiality, they often had particular manifestations in this type of research. For example, privacy was a significant problem as interviews sometimes probe unexpected areas. For similar reasons, it is difficult to (...) give full information of the nature of a particular interview at the outset, hence informed consent is problematic. Where a pair is interviewed (such as carer and cared-for) there are major difficulties in maintaining confidentiality and protecting privacy. The potential for interviews to harm participants emotionally is noted in some papers, although this is often set against potential therapeutic benefit. As well as these generic issues, there are some ethical issues fairly specific to in-depth interviews. The problem of dual role is noted in many papers. It can take many forms: an interviewer might be nurse and researcher, scientist and counsellor, or reporter and evangelist. There are other specific issues such as taking sides in an interview, and protecting vulnerable groups. Little specific study of the ethics of in-depth interviews has taken place. However, that which has shows some important findings. For example, one study shows participants are not averse to discussing painful issues provided they feel the study is worthwhile. Some papers make recommendations for researchers. One such is that they should consider using a model of continuous (or process) consent rather than viewing consent as occurring once, at signature, prior to the interview. However, there is a need for further study of this area, both philosophical and empirical. (shrink)

Science seems to develop by inducing new knowledge from observation. However, it is hard to find a rational justification for induction. Popper offers one attempt to resolve this problem. Nursing theorists have tended to ignore or reject Popper, often on the false belief that he is a logical positivist (and hence hostile to qualitative research). Logical positivism claims that meaningful sentences containing any empirical content should ultimately be reducible to simple, observation statements. Popper refutes positivism by showing that there are (...) no such simple statements. He is not a positivist. For Popper, the scientist begins with problems and puts forward trial solutions. These are subjected to rigorous testing aimed at falsifying them. A new theoretical position is then reached in which the scientist knows either that the trial solutions are false or that they have not yet been falsified. Science is characterized by the fact that it tests its ideas through attempted falsification. Nonscience tests its ideas through attempted refutation. Nursing theory is a mixture of science and non-science. Popper’s method requires rigorous testing of theory in both realms. As such, some nursing theory should be discarded. Popper’s view faces at least two important criticisms. One is that a scientist can always reject an apparent falsification by instead altering some auxiliary hypothesis (e.g. denying the accuracy of the falsifying observation). Popper can deal with this argument by saying that defence of a theory in this way will eventually break down if the theory is false. The second criticism is that Popper’s method does ultimately draw upon induction. This criticism is true, but his method can be usefully adapted. An adapted from of Popper’s philosophy of science provides a good basis for nursing theory. (shrink)

Bayes’ rule shows how one might rationally change one’s beliefs in the light of evidence. It is the foundation of a statistical method called Bayesianism. In health care research, Bayesianism has its advocates but the dominant statistical method is frequentism. There are at least two important philosophical differences between these methods. First, Bayesianism takes a subjectivist view of probability (i.e. that probability scores are statements of subjective belief, not objective fact) whilst frequentism takes an objectivist view. Second, Bayesianism is explicitly (...) inductive (i.e. it shows how we may induce views about the world based on partial data from it) whereas frequentism is at least compatible with non-inductive views of scientific method, particularly the critical realism of Popper. Popper and others detail significant problems with induction. Frequentism’s apparent ability to avoid these, plus its ability to give a seemingly more scientific and objective take on probability, lies behind its philosophical appeal to health care researchers. However, there are also significant problems with frequentism, particularly its inability to assign probability scores to single events. Popper thus proposed an alternative objectivist view of probability, called propensity theory, which he allies to a theory of corroboration; but this too has significant problems, in particular, it may not successfully avoid induction. If this is so then Bayesianism might be philosophically the strongest of the statistical approaches. The article sets out a number of its philosophical and methodological attractions. Finally, it outlines a way in which critical realism and Bayesianism might work together. (shrink)

In his recent work, ‘Sport, Aesthetic Experience, and Art as the Ideal Embodied Metaphor’, Tim L. Elcombe explores links between sport and art from a pragmatically informed conception of aesthetic experience. However, Elcombe's work does not highlight the role of the imagination in the interpretation of the aesthetic something Michael Polanyi claims to be the ‘cornerstone of aesthetic theory’. With the backdrop of an increased interest in the aesthetics, phenomenology, and epistemology of sport, this discussion essay seeks to defend the (...) usefulness and value of definitional demarcation debates between sport and art, to use Polanyi’s distinctions among technical, scientific and artistic problems to support the claim that sport is not art, and to offer an account of how sport contributes in its own way to human flourishing and why it is no less valuable experientially than art. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diagnostic Criteria, Psychological Tests, and Ratings Scales: Extending the HistoryPeter Zachar, PhD (bio)Le moigne narrates a history of the development of psychiatric ratings scales as hybrids between psychological tests and diagnostic categories. In his telling, psychological tests seek to quantify population-based traits on which every person has a position and which tend to be conceptualized as being stable. Personality traits are often conceptualized as dispositions. Diagnostic categories represent not (...) trait-like properties of populations but episodic states consisting of clusters of symptoms experienced by individuals with disorders. Ratings, scales, he notes, are hybrids between the two. They are used to quantify psychiatric symptom clusters so that change over time can be measured. Le Moigne argues that these distinctions were initially suggested during the development of measures that could assess outcomes in psychopharmacological treatment studies.With respect to depression, Le Moigne writes that in the 1970s and 1980s something akin to depressive personality was reconceptualized as a temperament. A key move, somewhat reflective of Kraepelin’s notion of a depressive temperament, was to view a dysthymic temperament as both a predisposing factor and an attenuated form of depression. Thus, an episodic state commandeered the predisposing–dispositional role that was assigned to stable personality traits.This conceptual shift allowed test-like ratings scales to be seen as useful for quantifying not just stable traits, but salient features of episodic states that are potentially subject to change in response to interventions. To put it another way, in the development of a psychological test, one goal is to have high test-retest reliability (i.e., stability of measurement). With rating scales used to measure change, one wants the scores to not be as stable; ideally the scores on the later assessments will be lower. According to Le Moigne, when dysthymia was subsequently placed on axis I of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III (as a syndrome) and segregated from personality disorders which were placed on axis II, personality traits were evicted from the conceptualization of depressive disorders.One perennial feature of psychiatry and psychology is that even if an older idea is superseded [End Page 253] in the view of some thinkers, it can still attract adherents. Indeed, interest in understanding a relationship between personality and attenuated states did not fully disappear. For example, based on research in genetics, the schizophrenia spectrum concept included not only schizophrenia, but also milder conditions such that were conceptualized as personality disorders; that is, schizotypal personality disorder and paranoid personality disorder (Kety, Rosenthal, Wender, & Schulsinger, 1971).During the development of the DSM-IV, some people wanted to add depressive personality disorder to the manual (Phillips, Hirschfeld, Shea, & Gunderson, 1995). It seems to have become a territorial dispute between mood disorder specialists and personality disorder specialists The mood disorders specialists challenged the personality disorder specialists to differentiate depressive personality disorder from early onset, chronic dysthymia. They were able to do so by using criteria such as critical, blaming, and derogatory toward self. After the mood disorders work group proposed incorporating some of those criteria into a revised criteria set for dysthymia, the two sets overlapped. The result was the old criteria for dysthymia were printed in DSM-IV and criteria for depressive personality disorder and the revised criteria for dysthymia were both placed in the appendix.In the DSM-5, Axis II was eliminated and personality disorders were placed alongside all the syndromic symptom clusters at the same level. Even so, interest in attenuated presentations as personality-related lingered still. During the development of the DSM-5 there was some thought to using diagnostic spectra as a meta-structure for organizing the manual (Andrews et al., 2009). One idea was to move some personality disorders into a best fitting spectrum, akin to attenuated forms. This did occur with schizotypal personality disorder which is both in the DSM-5 chapter on schizophrenia and in the chapter on personality disorder. In the schizophrenia chapter it is positioned as the earliest emerging disorder on the spectrum. There was also some interest in grouping avoidant personality disorder with the anxiety disorders, but the evidence supporting such a change was not available.These issues may... (shrink)

John Urry was an extraordinary, generous and compelling force. As is evident in the hundreds of tributes and testimonials to his memory gathered already, his work influenced so many people through his talks at conferences, his published words in the pages of journals and his many books, and in conversations across viva examination tables, PhD juries and supervisory meetings. This essay remembers John’s contribution to the study of mobility and spatial theory more generally.

This article presents the first author's experiences as an Australian doctoral student undertaking a PhD by publication in the arena of the social sciences. She published nine articles in refereed journals and a peer-reviewed book chapter during the course of her PhD. We situate this experience in the context of current discussion about doctoral publication practices, in order to inform both postgraduate students and academics in general. The article discusses recent thinking about PhD by publication and identifies the factors that (...) students should consider prior to adopting this approach, in terms of university requirements, supervisors' attitudes, the research subject matter, intellectual property, capacity and working style, and issues of co-authorship. It then outlines our perceptions of the advantages and disadvantages of undertaking a PhD by publication. We suggest that, in general, the advantages outweigh the disadvantages. We conclude by reflecting on how the first author's experiences relate to current discussions about fostering publications by doctoral students. (shrink)

This article considers the relationship between business ethics and philosophy, specifically in relation to the field and persons working in it. The starting point is a grammatical one: business ethics by the rules of grammar belongs to ethics. In terms of academic disciplines, it belongs to applied ethics, which belongs to ethics, which belongs to practical philosophy, which belongs to philosophy. However, in the field of business ethics today one will seldom meet colleagues from philosophy; instead, they will come from (...) business, applying business studies perspectives, approaches, and increasingly quantitative methods. This article provides empirical evidence that today the three top journals with “business ethics” in their titles are mostly run by business scholars with PhDs in business. The article compares the three journals today with their inaugural issues and finds that at their inception all three were run by a majority of philosophers. The article discusses six possible explanations for this shift and provides suggestions for how to bring business ethics back to philosophers. (shrink)

The British National Lottery has now been running for almost three years and it arouses social and ethical misgivings in several quarters, whether in its contribution to the British gambling scene or in the size and distribution of its prizes or in its contributions to the good causes which it was introduced to benefit. Bringing wide experience and an expert eye to analyse and comment on the lottery, Dr Moore, DSc PhD FIA, is Emeritus Professor of Decision Sciences at London (...) Business School, Sussex Place, Regent’s Park, London NW1 4SA. (shrink)

After meeting in Zurich, Nikos Kazantzakis and Elli Lambridi undertook a number of Nietzsche pilgrimages in Switzerland together in 1918, beginning with a trip to Silvaplana. At the time, Kazantzakis had written a thesis on Nietzsche and had translated The Birth of Tragedy and Thus Spoke Zarathustra into Greek, while Elli Lambridi was enrolled in a PhD in philosophy at the University of Zurich writing on Aristotle. They continually debated the nature of the philosopher-type in relation to Nietzsche and Dionysianism, (...) and this philosophical engagement is the central topic of this paper. Lambridi envisaged a Dionysian philosopher fully engaged in an ethical and natural life within a community of others and also envisaged a derived politics of affirmative communal responsibility. Kazantzakis considered that the philosopher should take a much more Apolline, spiritually focused and solitary path, continually ascending toward heroic self-redemption. As well as examining their recorded exchanges, this paper also addresses the fictional resumption of their relationship in The New People, a novel which Lambridi wrote some time after Kazantzakis’ death. In the novel, they resume their discussion of the philosopher-type in 2118, in an eternal recurrence event. In the end, the male character, Petros, learns that the grounding event of a Dionysian Nietzscheanism is an instinctive promise of responsibility for the future of others. (shrink)

The British National Lottery has now been running for almost three years and it arouses social and ethical misgivings in several quarters, whether in its contribution to the British gambling scene or in the size and distribution of its prizes or in its contributions to the good causes which it was introduced to benefit. Bringing wide experience and an expert eye to analyse and comment on the lottery, Dr Moore, DSc PhD FIA, is Emeritus Professor of Decision Sciences at London (...) Business School, Sussex Place, Regent’s Park, London NW1 4SA. (shrink)

Identity construction — the process of creating and building a new future self — is an integral part of a person’s professional career development. However, at present we have little understanding of the psychological mechanisms that underpin this process. Likewise, we have little understanding of the barriers that obstruct it, and which thus may contribute to inequality in career outcomes. Using a social identity lens, and particularly the Social Identity Model of Identity Change (SIMIC), we explore the process of academic (...) identity construction among doctoral students. Through thematic analysis of semi-structured interviews with 22 PhD candidates, we observe that the identity construction process relies on a person’s perception of a navigable pathway between their current self and their future self. Importantly, participants who were able to access multiple identity resources were more likely to perceive a navigable pathway to a future professional self (e.g., as an academic), unless they perceived these identities to be incompatible with those held by leading members of the profession (e.g., their supervisors). This research suggests that the identities that people are able to access as they progress in their careers may play an important role in their ongoing professional identity construction and career success. (shrink)

The thesis that follows proffers a solution to the mind-matter problem, the problem as to how mind and matter relate. The proposed solution herein is a variant of panpsychism – the theory that all (pan) has minds (psyche) – that we name pansentient monism. By defining the suffix 'psyche' of panpsychism, i.e. by analysing what 'mind' is (Chapter 1), we thereby initiate the effacement of the distinction between mind and matter, and thus advance a monism. We thereafter critically examine the (...) prevalent view, antithetical to a pansentient monism, that mind is not identical to matter but emergent therefrom (Chapter 2). This anti-emergentist critique acts also as a fortification of the Genetic Argument for panpsychism: if mind is not emergent (nor distinct) from matter, mind must always have existed with matter. But what is 'matter'? Chapter 3 investigates what we understand by 'matter', or 'the physical', and exposes it as a highly deficient concept and percept that in concreto points to its identity with that denoted by 'mind'. This also acts as a fortification of the Abstraction Argument for panpsychism, employing a new taxonomy of physicalism and a new taxonomy of the varieties of abstraction. Thus do we reach a monism that is a parsimonious psycho-physical identity theory. But here we face what can be called The Identity Problem for Panpsychism: if our panpsychism is a psycho-physical identity theory, how can it respond to the powerful objections that beset the identity theory of the twentieth century? In Chapter 4 it will be argued that, like emergentism, this psycho-neural identity theory presupposed a deficient concept of 'matter', down to which mind was reduced away, let alone identified. But to identify down phenomena to what is actually an abstraction is to commit failure of explanation. When the theory is amended accordingly, we move from a psycho-neural identity theory to a genuine psycho-physical identity theory that as such can overcome the aforementioned identity problem. Furthermore, as Chapter 5 clarifies, our pansentient monism has, in addition to parsimony, the explanatory power to resolve the problem of mental causation that afflicts both the reductive physicalism of psycho-neural identity theory and the non-reductive physicalism of emergentism, by genuinely identifying physical and mental causation. Jaegwon Kim considers the place of consciousness in a physical world and the nature of mental causation to be the two key components of the mind-matter problem. Through the critical analysis of our prosaic understanding of mind and matter in this thesis, which incorporates the thought of both classical and contemporary thinkers through a novel fusion, it is hoped that both components are addressed and redressed. That is to say that I present this pansentient monism as a plausible, parsimonious, explanatory, and thus, I think, powerful position towards this ever-perplexing mind-matter mystery. -/- [This thesis was passed in January 2019 with viva examination from Galen Strawson and Joel Krueger. (shrink)

Viola Cordova was the first Native American woman to receive a PhD in philosophy. Even as she became an expert on canonical works of traditional Western philosophy, she devoted herself to defining a Native American philosophy. Although she passed away before she could complete her life’s work, some of her colleagues have organized her pioneering contributions into this provocative book. In three parts, Cordova sets out a complete Native American philosophy. First she explains her own understanding of the nature of (...) reality itself—the origins of the world, the relation of matter and spirit, the nature of time, and the roles of culture and language in understanding all of these. She then turns to our role as residents of the Earth, arguing that we become human as we deepen our relation to our people and to our places, and as we understand the responsibilities that grow from those relationships. In the final section, she calls for a new reverence in a world where there is no distinction between the sacred and the mundane. Cordova clearly contrasts Native American beliefs with the traditions of the Enlightenment and Christianized Europeans. By doing so, she leads her readers into a deeper understanding of both traditions and encourages us to question any view that claims a singular truth. From these essays—which are lucid, insightful, frequently funny, and occasionally angry—we receive a powerful new vision of how we can live with respect, reciprocity, and joy. (shrink)

Research integrity climate is an important factor that influences an individual’s behavior. A strong research integrity culture can lead to better research practices and responsible conduct of research. Therefore, investigations on organizational climate can be a valuable tool to identify the strengths and weaknesses of each group and develop targeted initiatives. This study aims to assess the perceptions on integrity climate in three universities in Hungary. A cross-sectional study was conducted with PhD students, postdocs, and professors from three Hungarian universities. (...) The survey included demographic questions, such as gender, age, scientific field, academic rank, and the Survey of Organizational Research Climate. A total of 432 participants completed the survey. Our results show that postdocs and assistant professors perceived integrity climate more negatively than PhD students and full professors in every survey scale. Contrarily, PhD students perceive more positively than the other groups. Disciplinary differences show that researchers in the Biomedical sciences perceive regulatory bodies to be fairer when evaluating their projects than those in the Natural sciences. Natural sciences also perceive more negatively how the department values integrity when compared to Humanities. Humanities perceive more positively Advisor/Advisee Relations than Biomedical Sciences. Our results suggest that institutions should pay more attention to early career researchers, especially insecure and temporary positions like postdocs and assistant professors. They should provide RCR resources, socialize them in RCR, and set more reasonable expectations. Moreover, department leaders should develop initiatives to foster better integrity climates. (shrink)

Background Medical Assistance in Dying in Canada came into effect in 2016 with the passing of Bill C-14. As patient interest and requests for MAID continue to evolve in Canada, it is important to understand the attitudes of future providers and the factors that may influence their participation. Attitudes towards physician hastened death in general and the specific provision of MAID are unknown among Canadian residents. This study examined residents’ attitudes towards PHD and MAID, and identified factors that may influence (...) their decision to participate in PHD and provide MAID. Methods A cross-sectional survey was adapted from prior established surveys on MAID to reflect the Canadian setting. All Canadian family medicine programs were invited to participate. The survey was distributed between December 2016 and April 2017. Analysis of the results included descriptive statistics to characterize the survey participants and multivariable logistic regressions to identify factors that may influence residents’ attitudes towards PHD and MAID. Results Overall, 247 residents from 6 family medicine training programs in Canada participated. While residents were most willing to participate in treatment withdrawal, active participation in PHD and MAID by prescription of a lethal drug and lethal injection were less acceptable. Logistic regressions identified religion as a consistent and significant factor impacting residents’ willingness to participate in PHD and MAID. Residents who were not strictly practicing a religion were more likely to be willing to participate in PHD and MAID. Increased clinical exposure to death and dying crudely correlated with increased willingness to participate in PHD and MAID, but when examined in multivariable models, only a few activities had a statistically significant association. Other significant factors included the residents’ sex and location of training. Conclusions Residents are hesitant to provide MAID themselves, with religious faith being a major factor impacting their decision. (shrink)

This paper is a response to Peter Allmark's thesis that 'there can be no "caring" ethics'. It argues that the current preoccupation in nursing to define an ethics of care is a direct result of breaking nursing tradition. Subsequent attempts to find a moral basis for care, whether from subjective experimental perspectives such as described by Noddings, or from rational and detached approaches derived from Kant, are inevitably flawed. Writers may still implicitly presuppose a concept of care drawn (...) from the Judaeo-Christian tradition but without explicit recourse to its moral basis nursing is left rudderless and potentially without purpose. The very concept of 'care' cut off from its roots becomes a meaningless term without either normative or descriptive content. (shrink)

Preparing to lecture on Aristotle's contribution to Nursing at the International Philosophy of Nursing Conference August 22, 2016, in Quebec City, Quebec, Canada, I came upon the recently published article by my IPONS colleague, Allmark (2016), “Aristotle for Nursing.” Allmark (2016) provides a comprehensive and understandable overview of Aristotle's philosophical system including the substantial nature of being and the four causes of change. Nurses using Aristotle to support practice and theoretical research will benefit from a careful reading of (...) Allmark to enrich their use of the realist understanding of knowledge of nature (epistemology) and the matter–form causal relationships within natural being (ontology and teleology). Allmark carefully displays the distinction between good health and flourishing; a distinction sometimes hard to grasp. Nurses are concerned with the end of health, but cannot achieve for others, the fullness of living which is flourishing.We will limit ourselves to expanding three areas that seem important, first, that nursing is much more than a productive science or craft, second, that Aristotle does provide an important note on the persistence of the soul, and, third, while Aristotle does not address the possibility of a personal creative highest being as Allmark says, his references to the divine are worth considering. (shrink)

This reissue of his collection of early essays, Logico-Linguistic Papers, is published with a brand new introduction by Professor Strawson but, apart from minor ...

There is a growing body of writing, for instance from the nursing profession, espousing an approach to ethics based on care. I suggest that this approach is hopelessly vague and that the vagueness is due to an inadequate analysis of the concept of care. An analysis of 'care' and related terms suggests that care is morally neutral. Caring is not good in itself, but only when it is for the right things and expressed in the right way. 'Caring' ethics assumes (...) wrongly that caring is good, thus it can tell us neither what constitutes those right things, nor what constitutes the right way. (shrink)

The purpose of this article is to develop a conception of death with dignity and to examine whether it is vulnerable to the sort of criticisms that have been made of other conceptions. In this conception “death” is taken to apply to the process of dying; “dignity” is taken to be something that attaches to people because of their personal qualities. In particular, someone lives with dignity if they live well (in accordance with reason, as Aristotle would see it). It (...) follows that health care professionals cannot confer on patients either dignity or death with dignity. They can, however, attempt to ensure that the patient dies without indignity. Indignities are affronts to human dignity, and include such things as serious pain and the exclusion of patients from involvement in decisions about their lives and deaths. This fairly modest conception of death with dignity avoids the traps of being overly subjective or of viewing the sick and helpless as “undignified”. (shrink)

Objective: To assess whether continuous consent, a process in which information is given to research participants at different stages in a trial, and clinician training in that process were effective when used by clinicians while gaining consent to the Total Body Hypothermia (TOBY) trial. The TOBY trial is a randomised controlled trial (RCT) investigating the use of whole-body cooling for neonates with evidence of perinatal asphyxia. Obtaining valid informed consent for the TOBY trial is difficult, but is a good test (...) of the effectiveness of continuous consent. Methods: Semistructured interviews were conducted with 30 sets of parents who consented to the TOBY trial and with 10 clinicians who sought it by the continuous consent process. Analysis was focused on the validity of parental consent based on the consent components of competence, information, understanding and voluntariness. Results: No marked problems with consent validity at the point of signature were observed in 19 of 27 (70%) couples. Problems were found mainly to lie with the competence and understanding of the parents: mothers, particularly, had problems with competence in the early stages of consent. Problems in understanding were primarily to do with side effects. Problems in both competence and understanding were observed to reduce markedly, particularly for mothers, in the post-signature phase, when further discussion took place. Randomisation was generally understood but unpopular. Information was not always given by clinicians in stages during the short period available before parents gave consent. Most clinicians, however, were able to give follow-up information. Discussion: Consent validity was found to compare favourably with similar trials examined in the Euricon study. Conclusion: Adopting the elements of the continuous consent process and clinician training in RCTs should be considered by researchers, particularly when they have concerns about the quality of consent they are likely to obtain by using a conventional process. (shrink)

My original paper suggested that an ethics of care which failed to specify how, and about what, to care would be devoid of normative and descriptive content. Bradshaw's approach provides such a specification and is, therefore, not devoid of such content. However, as all ethical approaches suggest something about the 'what' and 'how' of care, they are all 'ethics of care' in this broader sense. This reinforces rather than undermines my original conclusion. Furthermore, Bradshaw's 'ethics of care' has philosophical and (...) historical problems which I outline. (shrink)

A complete system of classical Aristotelian logic intended for honors high school and college.

Randomised controlled trials (RCTs) sometimes recruit participants who are desperate to receive the experimental treatment. This paper defends the practice against three arguements that suggest it is unethical first, desperate volunteers are not in equipoise. Second clinicians, entering patients onto trials are disavowing their therapeutic obligation to deliver the best treatment; they are following trial protocols rather than delivering individualised care. Research is not treatment; its ethical justification is different. Consent is crucial. Third, desperate volunteers do not give proper consent: (...) effectively, they are coerced. This paper responds by advocating a notion of equipoise based on expert knowledge and widely shared values. Where such collective, expert equipoise exists there is a prima facie case for an RCT. Next the paper argues that trial entry does not involve clinicians disavowing their therapeutic obligation; individualised care based on insufficient evidence is not in patients best interest. Finally, it argues that where equipoise exists it is acceptable to limit access to experimental agents; desperate volunteers are not coerced because their desperation does not translate into a right to receive what they desire. (shrink)

Clinicians are required to act in the best interest of neonates.However, it is not obvious that entry into a randomised controlled trial (RCT) is in a neonate’s best interest because such trials often involve additional onerous procedures (such as intramuscular injections) in return for which the neonate receives unproven treatment or a placebo.On the other hand, neonatology needs to develop its evidence base, and RCTs are central to this task. The solution posited here is based on two points. First, “best (...) interest” is not equivalent to “the best possible interest” only to “best interest within a certain realm”. The realm of deliberation when asking the title question is the neonate’s health. Deliberating in this realm may involve the exclusion from consideration of some factors that might be thought relevant (such as parental wealth). Furthermore, circumstances may dictate the need to deliberate on other factors that might be thought irrelevant (such as health care resources). Second, deciding on a neonate’s best interest does not involve “putting oneself in its shoes”. Rather, it involves asking in what it has an interest, or stake. These will include some things in which we all, as human beings, have a stake, such as medical progress. Putting these two points together, in the realm of health the answer to whether RCT entry is in a neonate’s best interest is usually very finely balanced. Where this is the case, it is reasonable to invoke a broader notion of best interest and include a broader range of elements in which the neonate has a stake, including medical progress. In this way RCT entry can, usually, be said to be in a neonate’s best interest. (Journal of Medical Ethics 2001;27:110–113) Keywords: Neonates; randomised controlled trials; best interest; ethics. (shrink)

Recent research governance documents say that the body of research evidence must reflect population diversity. The response to this needs to be more sophisticated than simply ensuring minorities are present in samples. For quantitative research looking primarily at treatment effects of drugs and devices four suggestions are made. First, identify where the representation of minorities in samples matters—for example, where ethnicity may cause different treatment effects. Second, where the representation of a particular group matters then subgroup analysis of the results (...) will usually be necessary. Third, ensuring representation and subgroup analysis will have costs; deciding on whether such representation is worthwhile will involve cost benefit analysis. Fourth, the representation of minorities should not be seen as mainly a locality issue. For qualitative research it is argued that the representation of diversity is often important. Given the small samples of many qualitative projects, however, the best way to ensure representation occurs is to allow a proliferation of such research, not to stipulate such representation in samples. (shrink)

Ohne Rücksicht auf disziplinäre Schranken bringt dieses Buch verschiedene nicht-reduktionistische Lerntheorien miteinander ins Gespräch. In einem offenen Diskurs, der die Konzepte zueinander in Beziehung setzt, werden die unterschiedlichen Perspektiven kritisch abgewogen und hinsichtlich ihrer Stärken und Schwächen diskutiert.

Delo se loteva vprašanja aktualnosti pojma subjekta v filozofiji in politiki skozi analizo tistih avtorjev, ki so ga domnevno najbolj radikalno pokopali: pokaže, da vznik radikalno novega in problematika subjekta zavzema osrednje mesto v Deleuzovi filozofiji, kakor tudi v Lyotardovi pozni misli posvečeni praznini, v Foucaultovi obravnavi biopolitike in biooblasti, v delu Negrija in Hardta o Imperiju, ter nazadnje v Badioujevi predelavi temeljnih filozofskih kategorij biti, resnice in subjekta, na osnovi katerih je dandanes znova možna renesansa filozofije. Ta ima po (...) Badiouju štiri razsežnosti, ki se v delu Vznik subjekta nenehno prepletajo: »V osnovi želja filozofije implicira razsežnost upora: ni filozofije brez nezadovoljstva mišljenja v njegovem soočenju s svetom, kakršen je. Pa vendar želja filozofije vključuje tudi logiko: to je, prepričanje v moč argumenta in uma.«. (shrink)

It is argued in this paper that the latest UK government white paper on public health, Choosing Health, is vulnerable to a charge of paternalism. For some years libertarians have levelled this charge at public health policies. The white paper tries to avoid it by constant reference to informed choice and choice related terms. The implication is that the government aims only to inform the public of health issues; how they respond is up to them. It is argued here, however, (...) that underlying the notion of informed choice is a Kantian, ‘‘inner citadel’’ view of autonomy. According to this view, each of us acts autonomously only when we act in accord with reason. On such a view it is possible to justify coercing, cajoling, and conning people on the basis that their current behaviour is not autonomous because it is subject to forces that cause irrational choice, such as addiction. ‘‘Informed choice’’ in this sense is compatible with paternalism. This paternalism can be seen in public health policies such as deceptive advertising and the treatment of ‘‘bad habits’’ as addictions. Libertarians are bound to object to this. In the concluding section, however, it is suggested that public health can, nonetheless, find ethical succour from alternative approaches. (shrink)

“Lay epidemiology” is a term used to describe the processes through which health risks are understood and interpreted by laypeople. It is seen as a barrier to public health when the public disbelieves or fails to act on public health messages. Two elements to lay epidemiology are proposed: empirical beliefs about the nature of illness and values about the place of health and risks to health in a good life. Both elements have to be dealt with by effective public health (...) schemes or programmes, which would attempt to change the public’s empirical beliefs and values. This is of concern, particularly in a context in which the lay voice is increasingly respected. Empirically, the scientific voice of standard epidemiology should be deferred to by the lay voice, provided a clear distinction exists between the measurement of risk, which is empirical, and its weighting, which is based on values. Turning to engagement with values, health is viewed to be an important value and is discussed and reflected on by most people. Public health professionals are therefore entitled and advised to participate in that process. This view is defended against some potential criticisms. (shrink)