Moral distress is a concept used to date in clinical literature to describe the experience of staff in circumstances in which they are prevented from delivering the kind of bedside care they believe is expected of them, professionally and ethically. Our research objective was to determine if this concept has relevance in terms of key health care managerial functions, such as priority setting and resource allocation. We conducted interviews and focus groups with mid- and senior-level managers in two British Columbia (...) (Canada) health authorities. Transcripts were analyzed qualitatively using constant comparison to identify key themes related to moral distress. Both mid- and senior-level managers appear to experience moral distress, with both similarities and differences in how their experiences manifest. Several examples of this concept were identified including the obligation to communicate or ‘sell’ organizational decisions or policies with which a manager personally may disagree and situations where scarce resources compel managers to place staff in situations where they meet with predictable and potentially avoidable risks. Given that moral distress appears to be a relevant issue for at least some health care managers, further research is warranted into its exact nature, prevalence, and possible organizational and personal responses. (shrink)

This volume argues for a new image of science that understands both natural and social phenomena to be the product of mechanisms, casting the work of science as an effort to understand those mechanisms. Glennan offers an account of the nature of mechanisms and of the models used to represent them in physical, life, and social sciences.

Stuart Kauffman here presents a brilliant new paradigm for evolutionary biology, one that extends the basic concepts of Darwinian evolution to accommodate recent findings and perspectives from the fields of biology, physics, chemistry and mathematics. The book drives to the heart of the exciting debate on the origins of life and maintenance of order in complex biological systems. It focuses on the concept of self-organization: the spontaneous emergence of order widely observed throughout nature. Kauffman here argues that self-organization plays (...) an important role in the emergence of life itself and may play as fundamental a role in shaping life's subsequent evolution as does the Darwinian process of natural selection. Yet until now no systematic effort has been made to incorporate the concept of self-organization into evolutionary theory. The construction requirements which permit complex systems to adapt remain poorly understood, as is the extent to which selection itself can yield systems able to adapt more successfully. This book explores these themes. It shows how complex systems, contrary to expectations, can spontaneously exhibit stunning degrees of order, and how this order, in turn, is essential for understanding the emergence and development of life on Earth. Topics include the new biotechnology of applied molecular evolution, with its important implications for developing new drugs and vaccines; the balance between order and chaos observed in many naturally occurring systems; new insights concerning the predictive power of statistical mechanics in biology; and other major issues. Indeed, the approaches investigated here may prove to be the new center around which biologicalscience itself will evolve. The work is written for all those interested in the cutting edge of research in the life sciences. (shrink)

Philosophers of science typically associate the causal-mechanical view of scientific explanation with the work of Railton and Salmon. In this paper I shall argue that the defects of this view arise from an inadequate analysis of the concept of mechanism. I contrast Salmon's account of mechanisms in terms of the causal nexus with my own account of mechanisms, in which mechanisms are viewed as complex systems. After describing these two concepts of mechanism, I show how the complex-systems approach avoids certain (...) objections to Salmon's account of causal-mechanical explanation. I conclude by discussing how mechanistic explanations can provide understanding by unification. (shrink)

The Realm of Reason develops a new, general theory of what it is for a thinker to be entitled to form a given belief. The theory locates entitlement in the nexus of relations between truth, content, and understanding. Peacocke formulates three principles of rationalism that articulate this conception. The principles imply that all entitlement has a component that is justificationally independent of experience. The resulting position is thus a form of rationalism, generalized to all kinds of content.To show how these (...) principles are realized in specific domains, Peacocke applies the theory in detail to several classical problems of philosophy, including the nature of perceptual entitlement, induction, and the status of moral thought. These discussions involve an elaboration of the structure of entitlement in ways that have applications in many other areas of philosophy. He also relates the theory to classical and recent rationalist thought, and to current issues in the theory of meaning, reference and explanation. In the course of these discussions, he proposes a general theory of the a priori.The focus of the work lies in the intersection of epistemology, metaphysics, and the theory of meaning, and will be of interest both to students and researchers in these areas, and to anyone concerned with the idea of rationality. (shrink)

In this work, Mill reflects on the struggle between liberty and authority and defends the view that “the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.” He questions the justification for the limits of freedom of conscience and religion, freedom of speech, freedom of action, and the nature of liberalism itself. This new Broadview Edition demonstrates the ways in which Mill’s intellectual landscape differed (...) markedly from our own, while also drawing attention to the reasons why the work remains relevant and essential reading in the present day. Appendices include antecedents to Mill’s work, critical discussions by his contemporaries, and related writings by Mill. Please note: Broadview offers two separate editions of On Liberty. The Kahn edition is particularly relevant to readers who are interested in how the work is situated in the history of political philosophy, whereas the Alexander edition is recommended to those most interested in the work’s Victorian literary and social contexts. (shrink)

From the operation of the universe to DNA, the brain and the economy, natural and social frequently describe their activity as being concerned with discovering mechanisms. Despite this fact, for much of the twentieth century philosophical discussions of the nature of mechanisms remained outside philosophy of science. The Routledge Handbook of Mechanisms and Mechanical Philosophy is an outstanding reference source to the key topics, problems and debates in this exciting subject and is the first collection of its kind. Comprising over (...) thirty chapters by a team of international contributors the _Handbook_ is divided into four parts: Historical Perspectives on Mechanisms The Nature of Mechanisms Mechanisms and the Philosophy of Science Disciplinary Perspectives. Within these sections central topics and problems are examined, including the rise of mechanical philosophy in the seventeenth century; mechanisms as parts and wholes and their interactive powers; mechanisms and laws and regularities; how mechanisms are discovered and explained; dynamical systems theory; and disciplinary perspectives from physics, chemistry, biology, biomedicine, ecology, neuroscience and the social and political sciences. Essential reading for students and researchers in philosophy of science and philosophy the _Handbook _will also be of interest to those in related fields, such as metaphysics, philosophy of psychology and history of science. (shrink)

A fascinating exploration of the very essence of life itself sheds new light on the order and evolution in complex life systems and defines and explains autonomous agents and work within the contexts of thermodynamics and information theory, setting the stage for a dramatic technological revolution. 50,000 first printing.

At Home in the Universe presents and extends the intellectual core ofKauffman's earlier book The Origins of Order (OUP 1993) for any intelligentgeneral reader can understand and appreciate. The reader is very effectivelyinvited into Kauffman's vision and thought processes, in one of the moreexhilarating and important books of popular science.

Machine generated contents note: -- Chapter 1. A Short View of Ignorance -- Chapter 2. Finding Out -- Chapter 3. Limits, Uncertainty, Impossibility, and Other Minor Problems -- Chapter 4. Unpredicting -- Chapter 5. The Quality of Ignorance -- Chapter 6. Ignorance in Action: Case Histories -- Chapter 7. Ignorance beyond the Lab.

Since the Harvard Committees bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committees proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a large body of (...) literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead. (shrink)

In their searching contributions to this Symposium, Gideon Rosen, Timothy Williamson and Crispin Wright identify a set of issues crucial for assessing the principle-based treatment of modality I presented in Chapter Four of Being Known. I thank them for such focused and thoughtful discussions. This response is organized as a series of questions and proposed answers that aim to address the issues they raise. I hope their contributions will be as helpful to the reader as they have been to me (...) in understanding what is, and what is not, involved in the principle-based conception. My response will not consist only in defense and elaboration. On some issues, I will argue that the position formulated in Being Known needs supplementation. On others, especially those concerned with actualism and possibilia, it needs revision and a new positive theory. (shrink)

Explores the possiblity and process of evolution beyond the standard and established scientific principles.

"The pursuit of science by professional scientists every day bears less and less resemblance to the perception of science by the general public. It is not the rule-based, methodical system for accumulating facts that dominates the public view. Rather it is the idiosyncratic, often bumbling search for understanding in mostly uncharted places. It is full of wrong turns, cul-de-sacs, mistaken identities, false findings, errors of fact and judgment-and the occasional remarkable success. The widespread but distorted view of science as infallible (...) originates in an education system that teaches nothing but facts using very large, very frightening textbooks, and is spread by media that report on discoveries but almost never on process. It is further reinforced by politicians who pay for it and want to use it to determine policy and therefore want it right and, worst of all, sometimes by scientists who learn early on that talking too much about failures and not enough about successes can harm their careers. Failure, then, is a book that seeks to make science more appealing by exposing its faults. In this sequel to Ignorance, Stuart Firestein shows us that scientific enterprise is riddled with failures, and that this is not only necessary but good. Failure reveals how science got its start, when humans began to use a process-trial and error-as a kind of recipe that includes a hefty dose of failure. It gives the non-scientifically trained public an insider's view of how science is actually done, with the aim of making it accessible, comprehensible, and entertaining."--Publisher description. (shrink)

Mechanism is undoubtedly a causal concept, in the sense that ordinary definitions and philosophical analyses explicate the concept in terms of other causal concepts such as production and interaction. Given this fact, many philosophers have supposed that analyses of the concept of mechanism, while they might appeal to philosophical theories about the nature of causation, could do little to inform such theories. On the other hand, methods of causal inference and explanation appeal to mechanisms. Discovering a mechanism is the gold (...) standard for establishing and explaining causal connections. This fact suggests that it might be possible to provide an analysis of causation that appeals to mechanisms. (shrink)

My aim in this paper is to make a case for the singularist view from the perspective of a mechanical theory of causation, and to explain what, from this perspective, causal generalizations mean, and what role they play within the mechanical theory.

This book is the first comprehensive report and analysis of the Dutch euthanasia experience over the last three decades. In contrast to most books about euthanasia, which are written by authors from countries where the practice is illegal and therefore practised only secretly, this book analyzes empirical data and real-life clinical behavior. Its essays were written by the leading Dutch scholars and clinicians who shaped euthanasia policy and who have studied, evaluated and helped regulate it. Some of them have themselves (...) practised euthanasia. The book will contribute to the world literature on physician-assisted death by providing a comprehensive examination of how euthanasia has been practised and how it has evolved in one specific national and cultural context. It will greatly advance the understanding of euthanasia among both advocates and opponents of the practice. (shrink)

In this paper, we examine different forms of altruism. We commence by analysing the definition and, after clarifying its conditions for altruism, we argue that it is not in with everyday linguistic usage of the term. We therefore consider a definition, which we likewise refine, and argue that it better reflects ordinary language use. Both behavioural and psychological approaches define altruism descriptively and thus fail to capture an important aspect of altruism, namely its normative component. Altruism, we argue, is a, (...) i.e. one which embodies both positive and normative components. We discuss and compare various formulations of this normative component. (shrink)

Fetal pain has long been a contentious issue, in large part because fetal pain is often cited as a reason to restrict access to termination of pregnancy or abortion. We have divergent views regarding the morality of abortion, but have come together to address the evidence for fetal pain. Most reports on the possibility of fetal pain have focused on developmental neuroscience. Reports often suggest that the cortex and intact thalamocortical tracts are necessary for pain experience. Given that the cortex (...) only becomes functional and the tracts only develop after 24 weeks, many reports rule out fetal pain until the final trimester. Here, more recent evidence calling into question the necessity of the cortex for pain and demonstrating functional thalamic connectivity into the subplate is used to argue that the neuroscience cannot definitively rule out fetal pain before 24 weeks. We consider the possibility that the mere experience of pain, without the capacity for self reflection, is morally significant. We believe that fetal pain does not have to be equivalent to a mature adult human experience to matter morally, and so fetal pain might be considered as part of a humane approach to abortion. (shrink)

A stellar line-up of leading philosophers from around the world offer new treatments of a topic which has long been central to philosophical debate, and in ...

In this highly relevant and important contribution to the debate on the future of the welfare state, Stuart White reconsiders the principles of economic citizenship appropriate to a democratic society, and explores the radical implications of these principles for public policy.

Ethicists and economists commonly assume that if A is all things considered better than B, and B is all things considered better than C, then A is all things considered better than C. Call this principle Transitivity. Although it has great conceptual, intuitive, and empirical appeal, I argue against it. Larry S. Temkin explains how three types of ethical principle, which cannot be dismissed a priori, threaten Transitivity: (a) principles implying that in some cases different factors are relevant to comparing (...) A to C than to comparing A to B or B to C; (b) principles of limited scope; (c) principles implying that morally relevant differences in degree can amount to differences in kind. My counterexamples employ a principle of type (c): pleasures and pains enormously different in intensity differ in kind. Temkin has also endorsed this type of counterexample, using arguments based on earlier drafts of this paper. (shrink)

This is a book about two stories of education. In one story there is a vocabulary of means, efficiency, bureaucracy, inspection and science; in the other, one of autonomy, democracy, emancipation and action research. One is the story of positivist managerialist approaches to education, the other is the story of reflective teaching. This book displaces both of these stories. By applying the techniques of deconstruction, Stuart Parker overturns the assumptions common to both of these positions and, in doing so, (...) jettisons some widely cherished beliefs about education, autonomy and rationality. Moving beyond current debates, this book articulates a new manifesto for education in postmodernity and highlights the implications for educational practices and institutions. (shrink)

In this fascinating read, Kauffman concludes that the development of life on earth is not entirely predictable, because no theory could ever fully account for the limitless variations of evolution. Sure to cause a stir, this book will be discussed for years to come and may even set the tone for the next "great thinker.".

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

The following is a summary of the author’s five-stage model of adult skill acquisition, developed in collaboration with Hubert L. Dreyfus. An earlier version of this article appeared in chapter 1 of Mind Over Machine: The Power of Human Intuition and Expertise in the Era of the Computer (1986, Free Press, New York).