Traditionally, physicians and parents made decisions about children’s health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children — of diverse levels of cognitive development — are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning (...) children’s ‘best interest’. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families. (shrink)

Answering important public health questions often requires collection of sensitive information about individuals. For example, our understanding of how HIV is transmitted and how to prevent it only came about with people's willingness to share information about their sexual and drug-using behaviors. Given the scientific need for sensitive, personal information, researchers have a corresponding ethical and legal obligation to maintain the confidentiality of data they collect and typically promise in consent forms to restrict access to it and not to publish (...) identifying data.The interests of others, however, can threaten researchers' promises of confidentiality when legal demands are made to access research data. In some cases, the subject of the litigation is tightly connected to the research questions, and litigants' interest in the data is not surprising. Researchers conducting studies on tobacco or occupational or other chemical exposures, for example, are relatively frequent targets of subpoenas. (shrink)

For this second edition, the editors have returned to Austin's original lecture notes, amending the printed text where it seemed necessary.

This book is the one to put into the hands of those who have been over-impressed by Austin 's critics....[Warnock's] brilliant editing puts everybody who is concerned with philosophical problems in his debt.

Deep convolutional networks exceed humans in sensitivity to local image properties, but unlike biological vision systems, do not discover and encode abstract relations that capture important properties of objects and events in the world. Coupling network architectures with additional machinery for encoding abstract relations will make deep networks better models of human abilities and more versatile and capable artificial devices.

First published in 1962, contains the William James Lectures delivered at Harvard University in 1955. It sets out Austin's conclusions in the field to which he directed his main efforts for at least the last ten years of his life. Starting from an exhaustive examination of his already well- known distinction of performative utterances from statements, Austin here finally abandons that distinction, replacing it by a more general theory of 'illocutionary forces' of utterances which has important bearings on (...) a wide variety of philosophical problems. (shrink)

Meaning in life has become an important topic in empirical research in the psychology of religion. Although it has been studied and found applicable in many different contexts, research on meaning in life and sources of meaning in African countries is scarce. This study qualitatively investigates understandings and experiences of meaning in life and sources of meaning among urban and village dwellers with different educational backgrounds in Zambia. Seven focus group interviews (total N = 52) were conducted and analysed, drawing (...) on Schnell’s model of meaning in life and sources of meaning. The results indicate that the concept of meaning in life is relevant to both urban and village dwellers in Zambia. Meaning experiences and sources of meaning are associated with certain life domains: relationships; religion; education and work; leisure activities; and health and survival. Each life domain includes several fundamental sources of meaning, which can be related to Schnell’s four dimensions of sources of meaning: self-transcendence, self-actualisation, order and well-being and relatedness. The results are discussed in light of extant studies on meaning and cultural characteristics in Africa. (shrink)

Beliefs and desires are linked with one another by an obvious kind of duality. Everyone assumes that a person's beliefs may be, to some extent, ascertained by seeing how he acts: for we suppose that he will do the things which he believes will fulfil his wishes, and avoid doing what he thinks will frustrate them. Similarly, his desires may, to some extent, be ascertained by seeing how he acts; for if we know what he thinks about the results of (...) his actions, we suppose that the expected results are desired or not disliked and those believed unlikely are disliked or undesired. We have three variables, conduct, desire, and belief; and we suppose that there is some equation by which the first in conjunction with one of the others implies a determinate value of the third. In principle, it should be equally possible to deduce conduct from belief and desire. But that seems of less metaphysical interest, because we think of actions as open to observation in a straightforward way, whereas we are more dubious about beliefs and desires. (shrink)

Nowadays the word “ conscience ” has an old-fashioned, obsolete air. I shall try to guess at the reasons, and then I shall consider whether they are good reasons.

The influence of J. L. Austin on contemporary philosophy was substantial during his lifetime, and has grown greatly since his death, at the height of his powers, in 1960. Philosophical Papers, first published in 1961, was the first of three volumes of Austin's work to be edited by J. O. Urmson and G. J. Warnock. Together with Sense and Sensibilia and How to do things with Words, it has extended Austin's influence far beyond the circle who knew (...) him or read the handful of papers he published in journals. (shrink)

The subject of this paper, Excuses, is one not to be treated, but only to be introduced, within such limits. It is, or might be, the name of a whole branch, even a ramiculated branch, of philosophy, or at least of one fashion of philosophy. I shall try, therefore, first to state what the subject is, why it is worth studying, and how it may be studied, all this at a regrettably lofty level: and then I shall illustrate, in more (...) congenial but desultory detail, some of the methods to be used, together with their limitations, and some of the unexpected results to be expected and lessons to be learned. Much, of course, of the amusement, and of the instruction, comes in drawing the coverts of the microglot, in hounding down the minutiae, and to this I can do no more here than incite you. But I owe it to the subject to say, that it has long afforded me what philosophy is so often thought, and made, barren of -- the fun of discovery, the pleasures of co-operation, and the satisfaction of reaching agreement. (shrink)

Increasingly, clinical research is evaluated on the quality of its statistical analysis. Traditionally, statistical analyses in clinical research have been carried out from a ‘frequentist’ perspective. The presence of an alternative paradigm – the Bayesian paradigm – has been relatively unknown in clinical research until recently. There is currently a growing interest in the use of Bayesian statistics in health care research. This is due both to a growing realization of the limitations of frequentist methods and to the ability of (...) Bayesian methods explicitly to incorporate prior expert knowledge and belief into the analyses. This is in contrast to frequentist methods, where prior experience and beliefs tend to be incorporated into the analyses in an ad hoc fashion. This paper outlines the frequentist and Bayesian paradigms. Acute myocardial infarction mortality data are then analysed from both a Bayesian and a frequentist perspective. In some analyses, the two methods are seen to produce comparable results; in others, they produce different results. It is noted that in this example, there are clinically relevant questions that are more easily addressed from a Bayesian perspective. Finally, areas in clinical research where Bayesian ideas are increasingly common are highlighted. (shrink)

There are perpetual debates about the extent of freedom in politics. Are we free to choose? Are we overdetermined by our material conditions? Some hybrid between the two? In this text, Austin Hayden Smidt analyzes an oft-overlooked text by Jean-Paul Sartre in order to ground a logical framework for exploring this problem.

The book uses Zen Buddhism as the opening wedge for an extraordinarily wide-ranging exploration of consciousness.

Experiences of moral distress encountered in psychiatric practice were explored in a hermeneutic phenomenological study. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychiatrists describe struggling ‘to do the right thing’ for individual patients within a societal system that places unrealistic demands on psychiatric expertise. Certainty on the part of the psychiatrist is an expectation when judgments of dangerousness and/or the need for coercive treatments are made. This assumption, however, ignores the uncertainty and (...) complexity of reality. Society entrusts psychiatrists to care for and treat those among its most vulnerable members: persons deemed to have a severely diminished capacity for autonomy due to a mental disorder. Simultaneously, psychiatrists are held accountable by society for the protection of the public. Moral distress arose for psychiatrists in their efforts to fulfill both roles. They described an ‘outsider/insider’ status and the ways in which they attempted to cope with moral distress. (shrink)

A summary of the existing literature related to moral distress (MD) and the paediatric intensive care unit (PICU) reveals a high-tech, high-pressure environment in which effective teamwork can be compromised by MD arising from different situations related to: consent for treatment, futile care, end-of-life decision making, formal decision-making structures, training and experience by discipline, individual values and attitudes, and power and authority issues. Attempts to resolve MD in PICUs have included the use of administrative tools such as shift worksheets, the (...) implementation of continuing education, and encouragement to report. The literature does not yet show these approaches to be effective in the resolution of MD. The need to acknowledge MD among PICU teams is discussed and an argument made that, to facilitate understanding among team members, practice stories need to be shared. (shrink)

A recent development in biology has been the growing acceptance that holobionts, entities comprised of symbiotic microbes and their host organisms, are widespread in nature. There is agreement that holobionts are evolved outcomes, but disagreement on how to characterize the operation of natural selection on them. The aim of this paper is to articulate the contours of the disagreement. I explain how two distinct foundational accounts of the process of natural selection give rise to competing views about evolutionary individuality.

McCoy and colleagues (2023) offer a reflective framework for data ethics and governance with several historical bioethics principles as a foundation. Their framework is one among a plethora of othe...

Corporate and commercial values are inducing some healthcare organizations to prescribe a customer service model that reframes the provision of nursing care. In this paper it is argued that such a model is incommensurable with nursing conceived as a moral practice and ultimately places nurses at risk. Based upon understanding from ongoing research on compassion fatigue, it is proposed that compassion fatigue as currently experienced by nurses may not arise predominantly from too great a demand for compassion, but rather from (...) barriers to enacting compassionate care. These barriers are often systemic. The paradigm shift in which healthcare environments are viewed as marketplaces rather than moral communities has the potential to radically affect the evolution of nursing as a discipline. (shrink)

Using a Solomon four-group design, we investigate the effect of a case-based critical thinking intervention on students’ critical thinking skills. We randomly assign 31 sessions of business classes to four groups and collect data from three sources: in-class performance, university records, and Internet surveys. Our 2 × 2 ANOVA results showed no significant between-subjects differences. Contrary to our expectations, students improve their critical thinking skills, with or without the intervention. Female and Caucasian students improve their critical thinking skills, but males (...) and non-Caucasian do not. Positive performance goals and negative mastery goals enhance and decrease improvements of their CTA scores, respectively. ACT and age are related to pre- and post-test. Gender is related to pre-test. GPA is related to post-test. Results shed light on the Pygmalion effect, the Galatea effect, ability, motivation, and opportunity as signals for human capital, and business ethics. (shrink)

Among mycologists, questions persist about what entities should be treated as the fundamental units of fungal populations. This article articulates a coherent view about populations of heterokaryotic fungi and the individuals that comprise them. Using Godfrey-Smith’s minimal concept of a Darwinian population, I argue that entities at two levels of the biological hierarchy satisfy the minimal concept in heterokaryotic fungi: mycelia and nuclei. I provide a preliminary answer to the question of how to understand the relation between these two populations. (...) This article contributes to discussions about the nature of biological individuality, organismality, and evolutionary transitions. (shrink)

Eukaryogenesis is widely viewed as an improbable evolutionary transition uniquely affecting the evolution of life on this planet. However, scientific and popular rhetoric extolling this event as a singularity lacks rigorous evidential and statistical support. Here, we question several of the usual claims about the specialness of eukaryogenesis, focusing on both eukaryogenesis as a process and its outcome, the eukaryotic cell. We argue in favor of four ideas. First, the criteria by which we judge eukaryogenesis to have required a genuinely (...) unlikely series of events 2 billion years in the making are being eroded by discoveries that fill in the gaps of the prokaryote:eukaryote “discontinuity.” Second, eukaryogenesis confronts evolutionary theory in ways not different from other evolutionary transitions in individuality; parallel systems can be found at several hierarchical levels. Third, identifying which of several complex cellular features confer on eukaryotes a putative richer evolutionary potential remains an area of speculation: various keys to success have been proposed and rejected over the five-decade history of research in this area. Fourth, and perhaps most importantly, it is difficult and may be impossible to eliminate eukaryocentric bias from the measures by which eukaryotes as a whole are judged to have achieved greater success than prokaryotes as a whole. Overall, we question whether premises of existing theories about the uniqueness of eukaryogenesis and the greater evolutionary potential of eukaryotes have been objectively formulated and whether, despite widespread acceptance that eukaryogenesis was “special,” any such notion has more than rhetorical value. (shrink)

Side effects are ubiquitous in medicine and they often play a role in treatment decisions for patients and clinicians alike. Philosophers and health researchers often use side effects to illustrate issues with contemporary medical research and practice. However, technical definitions of ‘side effect’ differ among health authorities. Thus, determining the side effects of an intervention can differ depending on whose definition we assume. Here I review some of the common definitions of side effect and highlight their issues. In response, I (...) offer an account of side effects as jointly (i) unintended and (ii) effects due to the causal capacities or invariances of an intervention. I discuss (i) by examining the intentions or reasons behind therapeutic interventions, and I discuss (ii) by appealing to a manipulationist model of causation. The analysis here highlights that side effects are conceptually distinct from related outcomes like adverse events, adverse drug reactions, and placebo effects. The analysis also allows for reflection on the utility of ‘side effect’ as a technical term in medical research and practice. (shrink)

Once a term used primarily by moral philosophers, “moral distress” is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? “Plight” encompasses not (...) only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of “efficiency,” is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals’ moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim. (shrink)

In recent literature in the philosophy of mind and language, one finds a variety of examples that raise serious problems for the traditional analysis of belief as a two-term relation between a believer and a proposition. My main purpose in this essay is to provide a critical test case for any theory of the propositional attitudes, and to demonstrate that this case really does present an unsolved puzzle. Chapter I defines the traditional, propositional analysis of belief, and then introduces a (...) distinction, motivated by the intuitions that underlie Kripke's arguments for direct reference, between purely qualitative and individual propositions. Beliefs typically expressed using proper names, indexicals or demonstratives appear to relate the believer to individual propositions with the entity that may be referred to as subject constituent. Chapter II presents the critical test case . In this and Chapters III-VI it is used to show that the latter sorts of beliefs are not analyzable as dyadically relating the believer to individual propositions. The case constitutes a genuine counterexample to the traditional analysis only if it is possible for a believer to believe an individual proposition with a contingent thing other than herself as a constituent; and the believer in the case is in optimum conditions for believing an individual proposition. In Chapters III, IV, and VI, I criticize views prompted by rejection of , and in Chapter V, I criticize Stalnaker's view, which rejects . Chapter VI also considers the non-traditional, triadic analyses of belief proposed by Kaplan and Richard; they fall prey to the main criticisms of Chapter V. In the Postscript, I give a comparative assessment of approaches to resolving the Two Tubes Puzzle, and I place it in historical context by pointing out the puzzle's similarities to the 'problem of sense data' . Correlatively, I indicate the bearing of Methodological Solipsism on future attempts to solve the puzzle. My conclusion is that although the puzzle remains a puzzle, it gives us reason to supplement, rather than completely abandon, the use of propositions in the analysis of thought; and I say what a supplementing solution must do to remain faithful to the intuitions of Chapter I. (shrink)

The moral distress of psychologists working in psychiatric and mental health care settings was explored in an interdisciplinary, hermeneutic phenomenological study situated at the University of Alberta, Canada. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychologists described specific incidents in which they felt their integrity had been compromised by such factors as institutional and interinstitutional demands, team conflicts, and interdisciplinary disputes. They described dealing with the resulting moral distress by such means as (...) silence, taking a stance, acting secretively, sustaining themselves through work with clients, seeking support from colleagues, and exiting. Recognizing moral distress can lead to a significant shift in the way we perceive moral choices and understand the moral context of practice. (shrink)

Mixed lineage leukemia (MLL) fusion protein (FP)‐induced acute leukemia is highly aggressive and often refractory to therapy. Recent progress in the field has unraveled novel mechanisms and targets to combat this disease. Menin, a nuclear protein, interacts with wild‐type (WT) MLL, MLL‐FPs, and other partners such as the chromatin‐associated protein LEDGF and the transcription factor C‐Myb to promote leukemogenesis. The newly solved co‐crystal structure illustrating the menin–MLL interaction, coupled with the role of menin in recruiting both WT MLL and MLL‐FPs (...) to target genes, highlights menin as a scaffold protein and a central hub controlling this type of leukemia. The menin/WT MLL/MLL‐FP hub may also cooperate with several signaling pathways, including Wnt, GSK3, and bromodomain‐containing Brd4‐related pathways to sustain MLL‐FP‐induced leukemogenesis, revealing new therapeutic targets to improve the treatment of MLL‐FP leukemias. (shrink)

Pragmatic comparative effectiveness randomized controlled trials evaluate the effectiveness of one interventions under real-world clinical conditions. The results of ceRCTs are often directly generalizable to everyday clinical practice, providing information critical to decision-making by patients, clinicians, and healthcare policymakers. The PRECIS-2 framework identifies nine domains that serve to score a trial on a continuum between very explanatory to very pragmatic. According to the framework, pragmatic trials may have one or more of the following features: there are fewer eligibility criteria for (...) participants, in an... (shrink)