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)

This essay series attempts to stimulate the debate about the moral challenges that internationalisation confronts us with, both in the Netherlands and abroad, and in particular for Artist-in-Residencies (AIRs). The publication is a reflection on how the crisis is reconsidering our international ambitions, starting from a post-COVID society. Internationalisation is an inevitable reality, inherent to the art landscape. The current time calls for a critical reflection on major issues such as climate inequality, plurality and the Western-dominant canon. 0With contributions and (...) critical insights by Jeanne van Heeswijk, Jack Segbars, Erik Hagoort, Pascal Gielen, Cecilia Bengtsson, Merlijn Twaalfhoven, Hicham Khalidi, reinaart vanhoe and Suzanne van der Beek. Thanks to Jan van Eyck Academie, Mondriaan Fonds, Prins Bernhard Cultuurfonds en het Amsterdams Fonds voor de Kunst for their support. (shrink)

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)

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)

Hornsby defiende una interpretación muy particular de la distinción personal-subpersonal tal como fue propuesta por Dennett y de la doctrina filosófica en la que está enraizada esta distinción. Según Hornsby de la aceptación de la distinción y la doctrina se sigue una defensa de la autonomía explicativa del nivel personal. Esta defensa nos compromete con un nivel personal genuino de explicación y la idea de que los hechos subpersonales no explican hechos personales. Hornsby sostiene, además, que mientras que en Dennett (...) se defiende la autonomía del nivel explicativo personal, en Dennett post-1969 al modificarse la doctrina de base cambia la manera de entender la distinción y con ello se reniega de ambos compromisos, de lo cual se sigue un abandono de la tesis de la autonomía del nivel explicativo personal. La tesis que vamos a sostener en este trabajo es que si bien la distinción de Dennett nos compromete con , no nos compromete con . Dado que una defensa de la autonomía explicativa del nivel personal, tal como Hornsby la entiende, abarca ambos compromisos, se sigue que no hay tal defensa. En consecuencia, si bien hay algunas cuestiones que en Dennett no se plantean de manera tan explícita y clara como en Dennett post-1969, no hay un cambio sustancial en su concepción de la distinción.According to Hornsby , Dennett's personal-subpersonal distinction has as one of its consequences a defense of the autonomy of personal level explanation, and this defense is based on two commitments: the personal level is a genuine level of explanation, and subpersonal facts do not explain personal facts. Moreover, Hornsby argues that Dennett post-1969 rejects both commitments, and that he consequently abandons the autonomy thesis. In this paper we shall argue that, although Dennett's distinction is committed to , it is not committed to . Given that a defense of the autonomy, as Hornsby understands it, presupposes both commitments, it follows that there is no such defense. We hold that there is no substantial change in Dennett's conception of the distinction, although some of these issues are not as clear and explicit in Dennett 1969 as in Dennett post-1969. (shrink)

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)

This case is about a study of burn patients that included a request to the IRB for a waiver of consent for perianal specimen collection–a request which ultimately was not approved by a reviewing IR...

There is little information about the content of ethics consultations in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance (...) in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is need.. (shrink)

Dans les stations de tourisme de montagne, les intersaisons correspondent à des creux d’activité durant lesquels les offres d’emploi alternatives sont peu nombreuses. Les saisonniers se trouvent donc confrontés à une période de chômage cyclique. Cette situation « intermédiaire », réunissant une forme d’incertitude de la relation d’emploi ainsi qu’une relative prévisibilité des périodes de recrutement n’est pas sans susciter certaines controverses. Dans ce contexte, comment sont vécues les phases de chômage saisonnier dans ces territoires? Ces séquences temporelles correspondent-elles à (...) un « temps mort » ou à un temps pluriel? Comment se négocie le temps pour soi dans le cadre d’embauches à contre-rythmes des temps sociaux dominants? Dans le cadre de cette forme d’emploi intermittente, le temps de chômage peut-il être conçu comme un temps de construction de la carrière professionnelle? Cet article s’intéresse aux formes d’adaptation aux rythmes d’emploi et de chômage des saisonniers en montagne et montre comment ces périodes hors-emploi participent de l’intériorisation de rythmicités spécifiques. (shrink)

El realismo intencional acérrimo quiere dos cosas que, según intentaré mostrar, son difíciles de lograr conjuntamente: estados con contenido semánticamente interpretable y que tengan rol causal en la producción de la conducta. Si bien no hay dificultades para obtener, el problema es con. La estrategia del RIA consiste en postular la existencia de leyes intencionales causales. El problema es que esas leyes son de un estatus dudoso, al punto que muchos consideran que no son posibles y ni siquiera necesarias. Según (...) el RIA, si no se puede obtener conjuntamente y se desprenderían dos consecuencias indeseables: si los estados intencionales no tienen rol causal qua intencionales significaría que no se es realista acerca de las creencias y deseos; y que no sean posibles las leyes intencionales implicaría que no se puede tener una psicología científica. En la primera parte del trabajo me ocuparé de exponer las tesis del RIA y mostraré que no puede cumplir conjuntamente con las exigencias y. En la segunda parte me ocuparé de defender la idea de que del hecho de que no se pueda conciliar y no se sigue un eliminativismo acerca de los estados intencionales ni la imposibilidad de que la psicología sea una ciencia. The Hairy Intentional Realism aims for two things that I shall try to show are difficult to jointly obtain: states with an interpretable semantic content, and with causal role in the production of behavior. There is no difficulty in obtaining, the problem is with. HIR's strategy consists in the postulation of causal intentional laws. The problem is that these laws have a doubtful status to the point that many consider them not possible and not even necessary. According to HIR, if and cannot be jointly obtained, two unwanted consequences emerge: if intentional states do not have a causal role qua intentional, that would mean ceasing to be realistic about them; and if intentional laws are not possible that would imply that we could not have a scientific psychology. In the first part of this paper I shall exhibit HIR's main theses and I shall show that it cannot accomplish the two demands. Second, I shall defend the idea that because of the fact that and cannot be reconciled, neither an eliminativism about intentional states, nor the impossibility that psychology is a science can follow. (shrink)

Genomic sequencing is becoming more common both in clinical practice and as a routine aspect of much research. Over the last 15 years there has been ongoing discussion about the implications of gen...

Eyal et al have recently argued that researchers should consider conducting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human challenge studies to hasten vaccine development. We have conducted (J. L.) and overseen (L. D.) human challenge studies and agree that they can be useful in developing anti-infective agents. We also agree that adults can autonomously choose to undergo risks with no prospect of direct benefit to themselves. However, we disagree that SARS-CoV-2 challenge studies are ethically appropriate at this time, for (...) 3 reasons: (1) current scientific knowledge of SARS-CoV-2 infection is insufficient to manage risks; (2) autonomous decision making, while necessary, does not override concerns about risk; and (3) undertaking challenge studies now would imperil confidence in the research enterprise, potentially undermining the global response to the coronavirus disease 2019 (COVID-19) pandemic. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

This paper examines how three Dutch political parties employ the Internet as a tool to enhance ‘digital democracy’. The potential of digital democracy is considered to be strongest in the sphere of collective action outside the domain of political institutions. In this article, however, attention is given to how institutionalized channels might be supportive of digital democracy. Three components of the democratic process – information provision, deliberation, and political decision-making – are examined in the content and user assessments of the (...) web sites of the Socialist Party, the Christian Democratic Party and the Green Party. Minor differences were found in the party web sites regarding information provision; substantial differences were found regarding the degree and nature of political deliberation available on the sites. Indicators of the third component, political decision-making, were least evident on all three web sites. User assessments of the sites and opportunities for political deliberation followed, more or less, the general public images of the related political parties. (shrink)

Emergency nurses apply specialist knowledge to the practice of emergency care. This paper discusses the ways in which three emergency nurses understand the nature of their care from their own frames of reference and experiences and presents some of the data collected in a larger study. Various discourses, which compete to inform emergency nurses' understandings of practice, are linked with the notion of nurses as subjects; that is, each discourse may inform, shape and constitute the practice of the nurse and, (...) in turn, the ways in which the patient comes to be known and understood. I will examine the ways in which emergency nurses come to experience or position themselves vis‐à‐vis extant forms of knowledge of emergency care and the extent to which they articulate new or distinctive formulations of emergency care. This paper illuminates the commonalities that constitute the discourses of emergency nursing care, and also analyse nurses' language which demonstrates that within each discourse variations, contradictions and resistances exist. Emergency nursing care occurs in a context of a biomedical discourse that dominates, or tends to dominate, the work of the emergency setting and so to determine acceptable or possible practices. Nevertheless, nurses contest in various ways the ‘truths' that they understand to underpin their practice. Challenges to biomedical discourses are revealed, to some extent, by drawing attention to specific situations and particular struggles encountered in emergency nurses' everyday practice. (shrink)

Methodologies of poststructuralist theory and critical social theory may be appropriated for nursing research and practice. Researchers using either methodology employ an analysis of power to explore experiences in various fields, and raise issues diat are highly relevant to nursing. However, the two methodologies differ and, often, die respective dieories are sharply opposed. In diis paper, die differences bodi from widiin and between each approach are explored, showing dieir tensions and limits. I contend that a reflexive approach to discourse analysis (...) provides insight into some of die methodological challenges diat arise in die context of bodi dieories. It is argued diat die differences between poststructuralism and critical social dieory seem likely to be mellowed by encounters diat treat each other with respect. To some extent, such encounters may tend to converge die two positions. (shrink)

Volume 19, Issue 10, October 2019, Page 97-98.

As medicine and science advance, new ethical questions emerge. Over time, deliberation and analysis result in a somewhat settled approach to a problem. Often the settled approach is based on group...

As part of the regulatory review process, both the Food and Drug Administration and Office for Human Research Protections (U.S. Department of Health and Human Services [HHS]...

ZusammenfassungDie Erforschung der Antarktis galt um 1900 als eine der letzten großen Herausforderungen im Zuge der Erschließung der Welt. Viele Nationen beteiligten sich daran, darunter das deutsche Kaiserreich. So fanden im Jahrzehnt vor dem Ersten Weltkrieg auch zwei deutsche Antarktisexpeditionen statt: von 1901 bis 1903 unter der Leitung von Erich von Drygalski und in den Jahren 1911/12 unter der Leitung Wilhelm Filchners. Die Forschung hat das Verhältnis zwischen den Unternehmen der verschiedenen Nationen bislang oftmals mit einem Fokus entweder auf Wettbewerb (...) oder Zusammenarbeit beschrieben. Dieser Aufsatz zeigt, dass internationale Kooperation und Konkurrenz die deutsche Antarktisexploration in spannungsreicher Gleichzeitigkeit prägten. Dabei nutzten die Akteure von Beginn an beide Interaktionsmodi als argumentative Ressourcen und verfolgten bewusst und situativ variabel Handlungsoptionen nach sowohl kompetitiven als auch kooperativen Logiken. Die Akteure bemühten sich darum, keinen der beiden Modi überwiegen zu lassen, sondern ein Gleichgewicht zu wahren, um die sowohl aus Wettbewerb als auch aus Zusammenarbeit entstehenden Vorteile für sich nutzen zu können. Gerade die genauen Kriterien der Konkurrenz wurden dabei zum Teil in der Schwebe gehalten, um sich hier alle Möglichkeiten offen zu halten. Bei der retrospektiven Bewertung ihrer Expeditionen durch die deutsche Öffentlichkeit gelang es ihnen jedoch nicht, die Deutungshoheit über Erfolg und Misserfolg der Unternehmen zu gewinnen: Weder der Verweis auf erfolgreiche Kooperationen, noch auf den Sieg im Wettbewerb um wissenschaftliche Leistungen konnte in der öffentlichen Wahrnehmung im deutschen Kaiserreich die Niederlage beim Erreichen möglichst südlicher Breiten ausgleichen. (shrink)

Volume 20, Issue 10, October 2020, Page 82-83.

Volume 20, Issue 4, May 2020, Page 111-113.

In this paper Grice's requirements for assertability are imposed on the disjunction of Classical Logic. Defining material implication in terms of negation and disjunction supplemented by assertability conditions, results in the disappearance of the most important paradoxes of material implication. The resulting consequence relation displays a very strong resemblance to Schurz's conclusion-relevant consequence relation.

Narrative has proven itself a continuous as well as adaptable means for environmentally oriented expression. Its role goes beyond the mediation of pre-existing knowledge imported into the realm of storytelling from other domains; rather, influential models of the natural world tend to circulate as storyworlds. This special issue of SubStance proceeds from the premise that narratives are not only a sequence of signs encoding a story but also “invisible, elusive representations that exist only in the mind”. Narrative forms generate and (...) transfer environmental knowledge; moreover, any specifically narrative concerns are important contributing factors to the models of agency, change... (shrink)

The ‘managed care’ idea: implications for health service systems in Australia The growth of corporatism in health‐care in the US, and the consequences arising from US models of health‐care delivery systems provide an enormously valuable point of comparison with health systems of other developed economies, such as Australia. If lessons are to be learnt from the US, then an analysis of the structure and performance of the US health‐care system provides important background for understanding and assessing contemporary policy changes to (...) administrative and organizational designs and techniques for patient care in Australia. (shrink)

This paper contains different approaches to solve the problem how to construct the ultimate position out of one’s interventions in a discussion after possibly one or more position changes. In all approaches it is the aim to come as close as possible to human reasoning. Therefore all logics are adaptive logics. The first logic is an extension of an adaptive translation into S5 of the Rescher-Manor mechanisms. The second one is a dynamic proof theory based on a technique using indices. (...) In the end a satisfactory solution is given by a dynamic proof theory expressing the idea of prioritized compatibility, i.e. compatibility step by step. (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)

The best-known argument in favor of the innatism of certain mental structures is still the 'Poverty of the Stimulus Argument'. The general idea of the POSA is that the knowledge which needs to be acquired to develop a certain cognitive capacity vastly exceeds the information available in the environment, so the organism contributes innate information. A review of the literature on linguistic POSA shows that it is not yet fully clear what kind of argument this is and what it really (...) shows. This paper is intended as a diagnosis of the innateness strategy that makes use of the POSA. I will distinguish three types of POSA and argue, first, that the most appropriate type of POSA, according to certain empirical and theoretical criteria, does not seem to be sufficient for linguistic nativism and, second, that for it to be sufficient, it is usually supplemented with an armchair argument which weakens the empirical nature of the innateness hypothesis. El argumento más conocido en favor del innatismo de ciertas estructuras mentales sigue siendo el 'Argumento de la Pobreza del estímulo'. La idea general del APE es que el conocimiento que se requiere para desarrollar una cierta capacidad cognitiva excede en gran medida la información disponible en el entorno, de manera que el organismo contribuye con información innata. Un examen de la literatura del APE lingüístico muestra que aún no está del todo claro qué clase de argumento es y lo que realmente muestra. Mi objetivo en este trabajo es ofrecer un diagnóstico de la estrategia innatista que utiliza el APE. Así, distingo tres tipos de APE y argumento, en primer lugar, que la versión más apropiada, según ciertos criterios empíricos y teóricos, no parece ser suficiente para el innatismo lingüístico y, en segundo lugar, que para ser suficiente, suele complementarse con un argumento 'de sillón', cuya consecuencia es que convierte al innatismo en una hipótesis empírica debilitada. (shrink)

Volume 20, Issue 10, October 2020, Page 39-41.

In the Philosophy of Cognitive Science, it is a common held view that the modularity hypothesis for cognitive mechanisms and the innateness hypothesis for mental contents are conceptually independent. In this paper I distinguish between substantial and deflationist modularity as well as between substantial and deflationist innatism, and I analyze whether the conceptual independence between substantial modularity and innatism holds. My conclusion will be that if what is taken into account are the essential properties of the substantial modules, i.e. domain (...) specificity and informational encapsulation, then it seems to be such independence. However, if what is taken into account is the function of the substantial modules, then it seems to be a conceptual connection from modularity to substantial innateness. (shrink)