Background: In recent years, the interest in ethical climate has increased in the literature. However, there is limited understanding of the phenomenon within the cancer care context as well as between countries. Aim: To evaluate cancer nurses’ perceptions of hospital ethical climate in Greece and Cyprus. Research design: This was a quantitative descriptive–correlational comparative study with cancer nurses. Data were collected with the Greek version of the Hospital Ethical Climate Survey questionnaire in addition to demographic data. Participants and research context: (...) In total, n = 235 cancer nurses working in cancer care settings in Greece and Cyprus were recruited at two national oncology nursing conferences. Ethical considerations: The study conforms to the principles of the World Medical Association Declaration of Helsinki and the relevant ethical approvals were obtained according to national law. Results: The results showed that in terms of the “Managers” dimension, participants working in Greek hospitals had a higher score compared to the Cyprus participants. The perceptions of nurses working in oncology units in Greece regarding the ethical climate were more positive compared to Cyprus. Nurses with a higher level of education had a lower average ethical climate score across all dimensions. All dimensions exhibit positive and moderate to high correlations between them. Conclusion: It is imperative to evaluate and improve the hospital ethical climate that prevails in each cancer care department. This highlights the fact that nurses working in seemingly similar cultural and organizational contexts might still have different perceptions of the ethical climate. Despite these differences, it is necessary to create the right conditions to address ethical issues. A positive ethical climate requires good relationships between healthcare professionals and the presence of good teamwork in order to ensure better healthcare provision. (shrink)

This article considers the strengths and potential contributions of participatory visual methods for healthcare quality improvement research. It argues that such approaches may enable us to expand our understanding of ‘patient experience’ and of its potential for generating new knowledge for health systems. In particular, they may open up dimensions of people’s engagement with services and treatments which exceed both the declarative nature of responses to questionnaires and the narrative sequencing of self reports gathered through qualitative interviewing. I will suggest (...) that working with such methods may necessitate a more reflexive approach to the constitution of evidence in quality improvement work. To this end, the article will first consider the emerging rationale for the use of visual participatory methods in improvement before outlining the implications of two related approaches—photo-elicitation and PhotoVoice—for the constitution of ‘experience’. It will then move to a participatory model for healthcare improvement work, Experience Based Co-Design. It will argue that EBCD exemplifies both the strengths and the limitations of adequating visual participatory approaches to quality improvement ends. The article will conclude with a critical reflection on a small photographic study, in which the author participated, and which sought to harness service user perspectives for the design of psychiatric facilities, as a way of considering the potential contribution of visual participatory methods for quality improvement. (shrink)

Cognitive psychologists have recently identified alterations in perception and reasoning that contribute to the formation and maintenance of beliefs that happen to be delusional. Clinically significant delusions, however, are often deeply unusual. An account of their formation and maintenance must explain not merely how someone can come to hold false or uncommon beliefs, but also how someone can arrive at beliefs that seem profoundly improbable and even bizarre. This paper uses the philosophical concepts of the Bedrock and the Background to (...) provide an account of that foundational, nonrepresentational, non–rule-governed, dispositional structure of everyday understanding that underpins both our perception and our reasoning. The central claim is that the formation and maintenance of delusions becomes intelligible once they are seen to reflect disturbances to this foundational dispositional structure. Different dimensions of the Background are described along with the delusions that might follow from distortions to these dimensions. We challenge the assumption of much recent cognitive psychological theorizing that delusions can be understood as explanations of unusual experiences or as the product of hasty reasoning. Finally, the implications of the theory for the therapy of the delusional patient are briefly discussed. (shrink)

David Hume is widely recognised as the greatest philosopher to have written in the English language. His Treatise on Human Nature is one of the most important works of moral philosophy ever written. Hume on Morality introduces and assesses * Hume's life and the background of the Treatise * The ideas and text in the Treatise * Hume's continuing importance to philosophy.

Over the past 15 years, medical schools have paid some attention to the importance of developing students' communication skills as part of their medical education. Over the past decade, medical ethics has been added to the curriculum of most U.S. medical schools, at least on paper. More recently, there has been growing discussion of the importance of professionalism in medical education. Yet, the nature and content of these fields and their relationship to one another remains confused and vague, and that (...) lack of clarity, in turn, impairs the effectiveness of medical education. This ambiguity invites serious contention over who should design and teach the curriculum as well as when, where, and how it should be taught. (shrink)

Because the process of moving from moral principles and facts to action-guiding moral conclusions has not been articulated clearly enough to be useful in a practical way, we designed a systematic approach to aid learners and clinicians in their application of ethical principles to the resolution of clinical dilemmas. Our model for clinical moral reasoning is intended to provide a clear and replicable structure that makes the thought process involved in reasoning about clinical cases explicit. In this paper we present (...) the model and demonstrate how it can be used in three clinical cases. (shrink)

Traditional moral theories of rights and principles have dominated medical ethics discussions for decades. Appeals to utilitarian consequences, as well as the principles of respect for autonomy, beneficence, and justice, have provided the standard vocabulary and filled the literature of the field.Recently on the bioethics scene, however, there has been some discussion of virtue, and, particularly within the nursing ethics literature, appeals are being made to the feminist ethics of care. This intimation of a shift in the wind may have (...) to do with postmodern doubt, or it may be attributable to the claim that virtue theory and the ethics of care are more appropriate to private interaction; theories of rights and justice are best applied to the political domain of public policy. (shrink)

Through a number of studies recently published in the psychology literature, T.D. Wilson, D.T. Gilbert, and others have demonstrated that our judgments about what our future mental states will be are contaminated by various distortions. Their studies distinguish a variety of different distortions, but they refer to them all with the generic term “affective forecasting.” The findings of their studies on normal volunteers are remarkably robust and, therefore, demonstrate that we are all vulnerable to the distortions of affective forecasting. a.

This article investigates how the turn to affect within the humanities and social sciences re-imagines the relationship between cultural theory and science. We focus on how the writings of two neuroscientists (Antonio Damasio and Joseph LeDoux) and one developmental psychologist (Daniel Stern) are used in order to ground certain claims about affect within cultural theory. We examine the motifs at play in cultural theories of affect, the models of (neuro)biology with which they work, and some fascinating missteps characterizing the taking (...) up of scientific literature. While neuroscience frames the affective as part of a system of regulation that makes both self and social coherence possible, in cultural theory’s narratives, by contrast, affectivity becomes a placeholder for the inherent dynamism and mutability of matter. The article interrogates the consequences of cultural theory’s strange borrowings from neuroscience and developmental psychology in their institution of a model of subjectivity preoccupied with a lived present in excess of the hold of habit and embodied history. (shrink)

a This paper is a revised and shortened version of my chapter, “Justice in Allocations for Terrorism, Biological Warfare, and Public Health” in Public Health Ethics, edited by Michael Boylan, Kluwer; 2004. Portions of this material were presented at the International Bioethics Retreat, Pavia, Italy, June 2003, and at the meetings of the Association for Politics and the Life Sciences, Philadelphia, September 2003.

This paper aims to explore a potential connection between two hypotheses recently put forward in the context of language evolution. One hypothesis argues that some human-specific change in the hominin brain developmental program habilitated the neuronal workspace that enabled “cognitive modernity” to unfold, also resulting in our globularized braincase. The other argues that the cultural niche resulting from our self-domestication favored the emergence of natural languages. In this article we document numerous links between the genetic changes we have claimed may (...) have brought about globularization and neural crest cells, which have been claimed to explain the constellation of distinctive traits found in all domesticated mammals. If these links turn out to be as robust as we think they are, globularization and self-domestication may well be closely related phenomena in the context of human evolution. (shrink)

Professor Rhodes, with Professor Lewis, has collected the evidence for decrees through which the states of the ancient Greek world were governed, and uses the evidence to study the decision-making procedures and the extent to which the citizens were actively involved.

Contemporary research ethics policies started with reflection on the atrocities perpetrated upoconcentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of (...) this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)

This paper challenges the widely held theory that split-brain patients have ‘two-minds’ and can thus be described as being two distinct persons. A distinction is made between the singularity of mind and the coherence of mind. It is stressed that ‘a single mind’ is not something posited to explain coherence among mental contents, but is merely a mark that such coherence holds to a certain degree. However, there is no sharp dividing line regarding what counts as a single mind. It (...) is argued that mental coherence is always a matter of degree, and that our concept of a single mind can accomodate spit-brain phenomena. (shrink)

This paper challenges the widely held theory that split-brain patients have ‘two-minds’ and can thus be described as being two distinct persons. A distinction is made between the singularity of mind and the coherence of mind. It is stressed that ‘a single mind’ is not something posited to explain coherence among mental contents, but is merely a mark that such coherence holds to a certain degree. However, there is no sharp dividing line regarding what counts as a single mind. It (...) is argued that mental coherence is always a matter of degree, and that our concept of a single mind can accomodate spit-brain phenomena. (shrink)

I examine Derek Parfit’s claim that it doesn’t matter whether he survives in the future, if someone survives who is psychologically connected to him by “Relation R.” Thus, were his body to perish and be replaced by an exact duplicate, both physically and psychologically identical to him, this would be just as good as “ordinary” survival. Parfit takes the corollary view that replacement of loved ones by exact duplicates is no loss. In contrast, Peter Unger argues that we place nontransferable (...) value in the lives of individualpersons. I argue that the question of the preferability of Relation R over identity is unanswerable at present, as such hypothetical situations are too far removed from our experience to allow any reliable responses. I contrast cases involving artifacts, where we can make informed judgments concerning whether a given object’s value would be transferred to a duplicate. (shrink)

I examine Derek Parfit's claim that it doesn't matter whether he survives in the future, if someone survives who is psychologically connected to him by “Relation R.” Thus, were his body to perish and be replaced by an exact duplicate, both physically and psychologically identical to him, this would be just as good as “ordinary” survival. Parfit takes the corollary view that replacement of loved ones by exact duplicates is no loss. In contrast, Peter Unger argues that we place nontransferable (...) value in the lives of individual persons. I argue that the question of the preferability of Relation R over identity is unanswerable at present, as such hypothetical situations are too far removed from our experience to allow any reliable responses. I contrast cases involving artifacts, where we can make informed judgments concerning whether a given object's value would be transferred to a duplicate. (shrink)

Name der Zeitschrift: Apeiron Jahrgang: 50 Heft: 4 Seiten: 483-510.