Clinical ethics consultation service remains undeveloped in developing countries. It is recognised that its introduction poses challenges. Malaysia, a multicultural society with diverse religions, values and perceptions further complicate the introduction of formal clinical ethics consultation service. Clinicians attending a national congress workshop completed a Strengths–Weaknesses–Opportunities–Threats analysis. The aim was to gain insight into clinician’s expectations and promote initiatives leading to the introduction of clinical ethics consultation service. Clinicians agree that clinical ethics consultation service can improve quality of care, reduce (...) healthcare costs and advocate for patients and providers. The analysis highlighted constraints in sufficient critical mass of relevant expertise and restricted opportunities for training. The opportunities lie in education, curriculum development and availability of dedicated proponents. Cultural barriers, limited resources, lack of awareness, differenc... (shrink)

The laws of classical logic are taken to be logical truths, which in turn are taken to hold objectively. However, we might question our faith in these truths: why are they true? One general approach, proposed by Putnam [8] and more recently Dickson [3] or Maddy [5], is to adopt empiricism about logic. On this view, logical truths are true because they are true of the world alone – this gives logical truths an air of objectivity. Putnam and Dickson both (...) take logical truths to be true in virtue of the world’s structure, given by our best empirical theory, quantum mechanics. This assumes a determinate logical structure of the world given by quantum mechanics. Here, I argue that this assumption is false, and that the world’s logical structure, and hence the related ‘true’ logic, is underdetermined. This leads to what I call empirical conventionalism. (shrink)

Background:Moral distress, moral sensitivity, and moral courage among healthcare professionals have been explored considerably in recent years. However, there is a paucity of studies exploring these topics among baccalaureate nursing students.Aim/objective:The purpose of this study was to explore the relationship between and among moral distress, moral sensitivity, and moral courage of undergraduate baccalaureate nursing students.Research design:The research employed a descriptive-correlational design to explore the relationships between and among moral distress, moral sensitivity, and moral courage of undergraduate nursing students.Participants and research (...) context:A total of 293 baccalaureate Filipino nursing students who have been exposed to various clinical areas participated in the study.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Results indicate that a majority of the nursing students in the clinical areas encounter morally distressing situations that compromise quality patient care. However, despite the fact that they want to do what is in the best interest of their patients, their perception of being the inexperienced among the healthcare team drives the majority of them to ignore morally distressing situations to avoid conflict and confrontation. Another interesting finding is that 79.20% of the respondents hardly consider quitting the nursing profession even if they frequently encounter morally distressing situations. Analysis also shows associations between moral distress intensity and frequency ( r = 0.13, p < 0.05) and moral distress intensity and moral sensitivity ( r = 0.25, p < 0.05). The dimensions of moral courage are also related to both moral distress and moral sensitivity.Conclusion:Results of the study imply that moral distress is a reality among all healthcare professionals including nursing students and requires more consideration by nurse educators. (shrink)

Social desirability bias (SDB) is one of the main concerns in self-reported studies that measures explicit attitudes such as ethics research. Although SDB was introduced since the early 1950s, little effort has been made to understand the necessity of including an SDB scale in studies of sensitive topics such as ethics. The purpose of this paper was to (1) identify whether current ethics-related studies considered SDB when conducting their research and (2) ascertain whether SDB was a significant variable in such (...) studies. This investigation takes the form of a systematic review of articles published within the last 20 years in well-known business ethics journals (2000–2019). We found that (a) only 13.67% of ethics research measured SDB; (b) although the majority of the reviewed articles were from the West, researchers in Asia have also made significant progress in recent years in measuring SDB in their studies; (c) SDB was used mainly as a control variable and as such researchers preferred scales with fewer items; and (d) SDB was unavoidable even when using online surveys. Based on our findings, we attempt to provide an overview of SDB in ethics research and encourage ethics researchers who adopt self-reported surveys to include an SDB measurement in their studies to control SDB. (shrink)

We show that an individual using a choice function is sequentially rational and the decisions he makes are independent of the order of implementation of the rationales if and only if he is rational with the union of the rationales as a base binary relation. When he makes his decisions following a choice correspondence, the sufficiency part of this claim still holds, the necessity part of it does not.

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of (...) first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection. (shrink)

Taking the formal analogies between black holes and classical thermodynamics seriously seems to first require that classical thermodynamics applies in relativistic regimes. Yet, by scrutinizing how classical temperature is extended into special relativity, I argue that the concept falls apart. I examine four consilient procedures for establishing the classical temperature: the Carnot process, the thermometer, kinetic theory, and black-body radiation. I argue that their relativistic counterparts demonstrate no such consilience in defining the relativistic temperature. As such, classical temperature doesn’t appear (...) to survive a relativistic extension. I suggest two interpretations for this situation: eliminativism akin to simultaneity, or pluralism akin to rotation. (shrink)

Achieving an ambitious goal frequently requires succeeding in a sequence of intermediate tasks, some being critical for the final outcome, and others not. However, individuals are not always able to provide a level of effort sufficient to guarantee success in all such intermediate tasks. The ability to manage effort throughout the sequence of tasks is, therefore, critical when resources are limited. In this paper, we propose a criterion of importance that is person- and context-specific, as it is based on how (...) an individual should optimally allocate a limited stock of exhaustible efforts over tasks. We test this importance criterion in a laboratory experiment that reproduces the main features of a tennis match. We show that our importance criterion is able to predict the individuals’ performance and it outperforms the Morris-importance criterion that defines the importance of a point in terms of its impact on the probability of achieving the final outcome. (shrink)

Strong non-maximalism holds that some truths require no ontological ground of any sort. Strong non-maximalism allows one to accept that some propositions are true without being forced to endorse any corresponding ontological commitments. We show that there is a version of truthmaker theory available—anti-aboutness truthmaking—that enjoys the dialectical benefits of the strong non-maximalist’s position. According to anti-aboutness truthmaking, all truths require grounds, but a proposition need not be grounded in the very thing(s) that the proposition is about. We argue that (...) if strong non-maximalism can be defended, then so can anti-aboutness truthmaking on the very same basis; one can enjoy the benefits of strong non-maximalism without giving up on the idea that truth is always grounded in being. (shrink)

We give a characterization of majority voting rules with quorums in the framework of May (Econometrica 20:680–684, 1952)’s seminal article. According to these voting rules, an alternative is socially chosen if and only if it obtains the relative majority of votes and the total number of voters not abstaining reaches the quorum.

Background:Nurses exposed to community health nursing commonly encounter situations that can be morally distressing. However, most research on moral distress has focused on acute care settings and very little research has explored moral distress in a community health nursing setting especially among nursing students.Aim:To explore the moral distress experiences encountered by undergraduate baccalaureate nursing students in community health nursing.Research design:A descriptive qualitative design was employed to explore the community health nursing experiences of the nursing students that led them to have (...) moral distress.Participants and research context:The study included 14 senior nursing students who had their course in Community Health Nursing in their sophomore year and stayed in the partner communities in their junior year for 6 and 3 weeks during their senior year.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Nursing students are vulnerable and likely to experience moral distress when faced with ethical dilemmas. They encounter numerous situations which make them question their own values and ideals and those of that around them. Findings of the study surfaced three central themes which included moral distress emanating from the unprofessional behavior of some healthcare workers, the resulting sense of powerlessness, and the differing values and mindsets of the people they serve in the community.Conclusion:This study provides educators a glimpse of the morally distressing situations that often occurs in the community setting. It suggests the importance of raising awareness and understanding of these situations to assist nursing students to prepare themselves to the “real world,” where the ideals they have will be constantly challenged and tested. (shrink)

Xunzi's philosophy provides a rich resource for understanding how ethical relationships between humans and nature can be articulated in terms of harmony. In this paper, I build on his ideas to develop the concept of reciprocal harmony, which requires us to reciprocate those who make our lives liveable. In the context of the environment, I argue that reciprocal harmony generates moral obligations towards nature, in return for the existential debt that humanity owes towards heaven and earth. This can be used (...) as a normative basis for an environmental ethic that enables humanity and nature to flourish together. (shrink)

The observed Taiwanese neonatal professionals' more conservative attitudes than their worldwide colleagues towards end-of-life (EOL) decision making may stem from cultural attitudes toward death in children and concerns about medicolegal liability. Healthcare practice is rooted in local culture and laws; however that should be adjusted to patients' best interests. Improving Taiwanese neonatal professionals' knowledge and competence in EOL care may minimize ethical dilemmas, allow appropriate EOL care decision making, avoid infants' suffering, and ease parents' bereavement grief.

Investigating instances where lexical selection fails can lead to deeper insights into the cognitive machinery and architecture supporting successful word retrieval and speech production. In this paper, we used a multiplex lexical network approach that combines semantic and phonological similarities among words to model the structure of the mental lexicon. Network measures at different levels of analysis (degree, network distance, and closeness centrality) were used to investigate the influence of network structure on picture naming accuracy and errors by people with (...) Anomic, Broca's, Conduction, and Wernicke's aphasia. Our results reveal that word retrieval is influenced by the multiplex lexical network structure in at least two ways—(a) the accuracy of production and error type on incorrect productions were influenced by the degree and closeness centrality of the target word, and (b) error type also varied in terms of network distance between the target word and produced error word. Taken together, the analyses demonstrate that network science techniques, particularly the use of the multiplex lexical network to simultaneously represent semantic and phonological relationships among words, reveal how the structure of the mental lexicon influences language processes beyond traditionally examined psycholinguistic variables. We propose a framework for how the multiplex lexical network approach allows for understanding the influence of mental lexicon structure on word retrieval processes, with an eye toward a better understanding of the nature of clinical impairments, like aphasia. (shrink)

We give some characterizations for both the untrapped set and the top cycle choice functions. We link these characterizations with the well-known characterization of the maximal elements choice function. Our characterizations strongly rely on the notion of “two-tier domination”.

An agent is rational by dominance then states of mind (DSM) if he makes his decisions by, first, preselecting the alternatives that are not dominated by any other alternative in the choice set, and second, by choosing the preselected alternative corresponding to his state of mind. This state of mind is dependent on the previous choices he made. An agent is rational by states of mind then dominance (SMD) if he makes his decisions by, first, preselecting the alternatives corresponding to (...) his state of mind and second, choosing the alternative that is not dominated. We give axiomatizations for SMD-rational or DSM-rational choice functions. (shrink)

Objective: Mindfulness-based intervention has been proposed to alleviate loneliness and improve social connectedness. Several randomized controlled trials have been conducted to evaluate the effectiveness of MBI. This study aimed to critically evaluate and determine the effectiveness and safety of MBI in alleviating the feeling of loneliness.Methods: We searched Medline, Embase, PsycInfo, Cochrane CENTRAL, and AMED for publications from inception to May 2020. We included RCTs with human subjects who were enrolled in MBI with loneliness as an outcome. The quality of (...) evidence was assessed using Cochrane's Risk of Bias tool and Grading of Recommendations Assessment, Development, and Evaluation. A random-effects model was used for meta-analysis.Results: Out of 92 articles identified, eight studies involving 815 participants were included in this study. Most trials conducted a minimum of 8 weeks of MBI. Most of the trials used UCLA-Loneliness Scale. A pooled analysis combining three trials and compared with wait-list showed significant improvement in loneliness score reduction using the UCLA-R scale with MD of −6.33 [95% confidence interval : −9.39, −3.26]. Subgroup analysis with only two Cognitively-Based Compassion Training trials also showed similar MD of −6.05. The overall quality of evidence was low.Conclusions: Mindfulness intervention with an average length of 8-week duration significantly improved the population's loneliness level with no mental health issue. However, this evidence had a low GRADE level. (shrink)

The purpose of this essay is to explore, and clarify, some key features in Aquinas’ account of the virtue of temperance, with an eye to answering some common objections raised against a positive evaluation of temperance. In particular, I consider three features of Aquinas’ understanding of temperance: First, the role of the rational mean in temperance; second, the role of rightly ordered passions in temperance; and third, the ‘despotic’ control of reason over the passions in temperance. Along the way I (...) consider three common objections to Aquinas’ account of temperance: the objection that temperance can be misused for evil, the objection that temperance devalues effort, and the objection that temperance devalues strong passions and thereby implicitly devalues the goodness of sexuality. In responding to these objections on behalf of Aquinas, I take the opportunity to clarify and slightly extend Aquinas’ account of temperance. (shrink)

Conventional wisdom holds that the von Neumann entropy corresponds to thermodynamic entropy, but Hemmo and Shenker (2006) have recently argued against this view by attacking von Neumann's (1955) argument. I argue that Hemmo and Shenker's arguments fail due to several misunderstandings: about statistical-mechanical and thermodynamic domains of applicability, about the nature of mixed states, and about the role of approximations in physics. As a result, their arguments fail in all cases: in the single-particle case, the finite particles case, and the (...) infinite particles case. (shrink)

Various aspects of semantic features drive early vocabulary development, but less is known about how the global and local structure of the overall semantic feature space influences language acquisition. A feature network of English words was constructed from a large database of adult feature production norms such that edges in the network represented feature distances between words (i.e., Manhattan distances of probability distributions of features elicited for each pair of words). A word's global feature distinctiveness is measured with respect to (...) all other words in the network and a word's local feature distinctiveness is measured relative to words in sub‐networks derived from clustering analyses. This paper investigates how feature distinctiveness of individual words at local and global scales of the network influences language acquisition. Regression analyses indicate that global feature distinctiveness was associated with earlier age of acquisition ratings, and was a stronger predictor of age of acquisition than local feature distinctiveness. These results suggest that the global structure of the semantic feature network could play an important role in language acquisition, whereby globally distinctive concepts help to structure vocabulary development over the lifespan. (shrink)

In Everettian quantum mechanics, justifications for the Born rule appeal to self-locating uncertainty or decision theory. Such justifications have focused exclusively on a pure-state Everettian multiverse, represented by a wave function. Recent works in quantum foundations suggest that it is viable to consider a mixed-state Everettian multiverse, represented by a (mixed-state) density matrix. Here, we develop the conceptual foundations for decoherence and branching in a mixed-state multiverse, and extend the standard Everettian justifications for the Born rule to this setting. This (...) extended framework provides a unification of 'classical' and 'quantum' probabilities, and additional theoretical benefits, for the Everettian picture. (shrink)

In this ground-breaking work, Deborah Cowen makes the first book-length critical intervention into the field of business logistics. Tracing the social, spatial and political transformations wrought by the ‘logistics revolution’, Cowen argues that logistical systems have blurred the boundaries between production and circulation, civilian and military life, and geopolitics and geo-economics, constructing an architecture of the supply chain animated by both the art of war and the science of business. This review considers the political stakes of Cowen’s argument that logistics (...) has reconfigured capitalist social relations of production, especially in relation to the securitisation of spatial mobility and the restructuring of the labour process. In particular, Cowen’s wager that logistical supply-chains are characterised by their vulnerability – and that attendant possibilities for building solidarity emerge out of movements that disrupt such flows – is interrogated in order to question whether such interruptions effectively produce challenges to value-in-motion, or actually become integral to processes of value production. (shrink)

This study examines discrimination in the overseas recruitment print ads of Multinational National Corporations (MNCs) in a lax regulatory environment, Singapore. Institutionalization theory suggests that in a weakly regulated environment, MNC affiliates would tend to adopt the less stringent requirements. With the lack of a strong legal framework in the host country, the home country's legal and cultural imperatives would be more salient, suggesting differences in discrimination as a function of home country imperatives. Some 1122 recruitment print ads of U.S., (...) U.K., and Japanese affiliates of MNCs were examined. While discrimination was found in the print ads of all organizations, U.S. affiliates were least discriminatory, followed by Japan and U.K. affiliates. When Singapore firms were included, they were found to be least discriminatory. However, Singapore firms became more discriminatory when the request for a recent photograph was considered in the discrimination index. Implications of the findings are discussed and suggestions for future research advanced. (shrink)

Prior studies have provided explanations for the presence, use and dissemination of codes of corporate ethics or codes of corporate conduct of business corporations. Most such explanations are functional in nature, and are descriptive as they are derived from the codes and their associated documents. We search for more underlying explanations using two complementary theories: first, social contract theories explaining the exogenous and endogenous reasons of organizational behavior, and then institutional theory explaining why organizations take similar measures in response to (...) institutional pressures. Based on our explanations, we contend that the codes and their use and dissemination are arising from underlying social and institutional pressures for firms to continuously validate their existence in the face of increasing changes and recurrent uncertainties. (shrink)

Programs in quantum gravity often claim that time emerges from fundamentally timeless physics. In the semiclassical time program time arises only after approximations are taken. Here we ask what justifies taking these approximations and show that time seems to sneak in when answering this question. This raises the worry that the approach is either unjustified or circular in deriving time from no–time.

L S Penrose’s Limit Theorem – which is implicit in Penrose [7, p. 72] and for which he gave no rigorous proof – says that, in simple weighted voting games, if the number of voters increases indefinitely and the relative quota is pegged, then – under certain conditions – the ratio between the voting powers of any two voters converges to the ratio between their weights. Lindner and Machover [4] prove some special cases of Penrose’s Limit Theorem. They give a (...) simple counter-example showing that the theorem does not hold in general even under the conditions assumed by Penrose; but they conjecture, in effect, that under rather general conditions it holds ‘almost always’ – that is with probability 1 – for large classes of weighted voting games, for various values of the quota, and with respect to several measures of voting power. We use simulation to test this conjecture. It is corroborated with respect to the Penrose–Banzhaf index for a quota of 50% but not for other values; with respect to the Shapley–Shubik index the conjecture is corroborated for all values of the quota. (shrink)

Several ethicists have defended the use of responsibility-based criteria in healthcare rationing. Yet in this article we outline two challenges to the implementation of responsibility-based healthcare rationing policies. These two challenges are, namely, that responsibility for past behavior can diminish as an agent changes, and that blame can come apart from responsibility. These challenges suggest that it is more difficult to hold someone responsible for health related actions than proponents of responsibility-sensitive healthcare policies suggest. We close by discussing public health (...) policies that could function as an alternative to contentious, responsibility-sensitive rationing policies. (shrink)

This book is born out of two contradictions: first, it explores the making of meaning in a musical form that was made to lose its meaning at the turn of the nineteenth century; secondly, it is a history of a music that claims to have no history - absolute music. The book therefore writes against that notion of absolute music which tends to be the paradigm for most musicological and analytical studies. It is concerned not so much with what music (...) is, but with why and how meaning is constructed in instrumental music and what structures of knowledge need to be in place for such meaning to exist. From the thought of Vincenzo Galilei to that of Theodore Adorno, Daniel Chua suggests that instrumental music has always been a critical and negative force in modernity, even with its nineteenth-century apotheosis as 'absolute music'. (shrink)

A model of corporate ethics and social responsibility (CESR) was developed and empirically tested among Chinese business undergraduates in Hong Kong and Singapore. As predicted, it was found that CESR beliefs were negatively related to Machiavellianism and two Confucian concepts, guanxi (interpersonal connections) and mianzi (face). CESR beliefs were also lower among Hong Kong than Singaporean youths. The negative effects of guanxi, mianzi, and Machiavellianism were more pronounced for the Hong Kong than Singapore sample. Implications of these findings are discussed (...) and directions for future research suggested. (shrink)

Good communication between healthcare providers and patients is vital to effective healthcare. In order to understand patients’ complaints, make accurate diagnoses, obtain informed consent and explain treatment regimens, clinicians must communicate well with their patients. This can be challenging when treating patients from unfamiliar cultural backgrounds, such as the Deaf. Not only are they a linguistic and cultural minority, they are also members of the world’s largest and oft-forgotten minority group: the disability community. Under Article 25 of the United Nations (...) Convention on the Rights of Persons with Disabilities, persons with disabilities have rights to the same range, quality and standard of free or affordable healthcare and programmes as provided to other people. Yet communication barriers and healthcare providers’ lack of familiarity with Deaf culture can impair the quality and accessibility of healthcare for the Deaf. This essay analyses the scope of this issue in Singapore: a state party to the CRPD which has a vibrant Deaf community, and yet no legislative or constitutional guarantees of the rights of persons with disabilities. In addition to exploring the communication barriers faced by Deaf patients in Singapore, this essay highlights ways in which healthcare providers and the state can support community-based initiatives to overcome these barriers. (shrink)

[Accepted for publication in Lakatos's Undone Work: The Practical Turn and the Division of Philosophy of Mathematics and Philosophy of Science, special issue of Kriterion: Journal of Philosophy. Edited by S. Nagler, H. Pilin, and D. Sarikaya.] Lakatos’s analysis of progress and degeneration in the Methodology of Scientific Research Programmes is well-known. Less known, however, are his thoughts on degeneration in Proofs and Refutations. I propose and motivate two new criteria for degeneration based on the discussion in Proofs and Refutations (...) – superfluity and authoritarianism. I show how these criteria augment the account in Methodology of Scientific Research Programmes, providing a generalized Lakatosian account of progress and degeneration. I then apply this generalized account to a key transition point in the history of entropy – the transition to an information-theoretic interpretation of entropy – by assessing Jaynes’s 1957 paper on information theory and statistical mechanics. (shrink)

Advance care planning is a voluntary process whereby individual preferences, values and beliefs are used to aid a person in planning for end-of-life care. Currently, there is no local instrument to assess an individual’s awareness and attitude towards advance care planning. This study aimed to develop an Advance Care Planning Questionnaire and to determine its validity and reliability among older people in Malaysia. The Advance Care Planning Questionnaire was developed based on literature review. Face and content validity was verified by (...) an expert panel, and piloted among 15 participants. Our study was conducted from October 2013 to February 2014, at an urban primary care clinic in Malaysia. Included were those aged >50 years, who could understand English. A retest was conducted 2 weeks after the first administration. Participants from the pilot study did not encounter any problems in answering the Advance Care Planning Questionnaire. Hence, no further modifications were made. Flesch reading ease was 71. The final version of the Advance Care Planning Questionnaire consists of 66 items: 30 items were measured on a nominal scale, whilst 36 items were measured on a Likert-like scale; of which we were only able to validate 22 items, as the remaining 14 items were descriptive in nature. A total of 245 eligible participants were approached; of which 230 agreed to participate. Factor analysis on the 22 items measured on a Likert-scale revealed four domains: “feelings regarding advance care planning”, “justifications for advance care planning”, “justifications for not having advance care planning: fate and religion”, and “justifications for not having advance care planning: avoid thinking about death”. The Cronbach’s alpha values for items each domain ranged from 0.637–0.915. In test-retest, kappa values ranged from 0.738–0.947. The final Advance Care Planning Questionnaire consisted of 63 items and 4 domains. It was found to be a valid and reliable instrument to assess the awareness and attitude of older people in Malaysia towards advance care planning. (shrink)