How should nursing knowledge advance? This exploration contextualizes its evolution past and present. In addressing how it evolved in the past, a probable historical evolution of its development draws on the perspectives of Frank & Gills's World System Theory, Kuhn's treatise on Scientific Revolutions, and Foucault's notions of Discontinuities in scientific knowledge development. By describing plausible scenarios of how nursing knowledge evolved, I create a case for why nursing knowledge developers should adopt a post‐structural stance in prioritizing their research (...) agenda(s). Further, by adopting a post‐structural stance, I create a case on how nurses can advance their disciplinary knowledge using an engaging post‐colonial strategy. Given an interrupted history caused by influence(s) constraining nursing's knowledge development by power structures external, and internal, to nursing, knowledge development can evolve in the future by drawing on post‐structural interpretation, and post‐colonial strategy. The post‐structural writings of Deleuze & Guattari's understanding of ‘Nomadology’ as a subtle means to resist being constrained by existing knowledge development structures, might be a useful stance to understanding the urgency of why nursing knowledge should advance addressing the structural influences on its development. Furthermore, Bhabha's post‐colonial elucidation of ‘Hybridity’ as an equally discreet means to change the culture of those constraining structures is an appropriate strategy to enact how nursing knowledge developers can engage with existing power structures, and simultaneously influence that engagement. Taken together, ‘post‐structural stance’ and ‘post‐colonial strategy’ can refocus nursing scholarship to learn from its past, in order to develop relevant disciplinary knowledge in its future. (shrink)

First published in 1998. Routledge is an imprint of Taylor & Francis, an informa company.

The essence of religion was once widely thought to be a unique form of experience that could not be explained in neurological, psychological, or sociological terms. In recent decades scholars have questioned the privileging of the idea of religious experience in the study of religion, an approach that effectively isolated the study of religion from the social and natural sciences. Religious Experience Reconsidered lays out a framework for research into religious phenomena that reclaims experience as a central concept while bridging (...) the divide between religious studies and the sciences. Ann Taves shifts the focus from "religious experience," conceived as a fixed and stable thing, to an examination of the processes by which people attribute meaning to their experiences. She proposes a new approach that unites the study of religion with fields as diverse as neuroscience, anthropology, sociology, and psychology to better understand how these processes are incorporated into the broader cultural formations we think of as religious or spiritual. Taves addresses a series of key questions: how can we set up studies without obscuring contestations over meaning and value? What is the relationship between experience and consciousness? How can research into consciousness help us access and interpret the experiences of others? Why do people individually or collectively explain their experiences in religious terms? How can we set up studies that allow us to compare experiences across times and cultures? Religious Experience Reconsidered demonstrates how methods from the sciences can be combined with those from the humanities to advance a naturalistic understanding of the experiences that people deem religious. (shrink)

Du Bois regarded social reform as a legitimate object for the scientist. He gave a place to non-epistemic values in scientific reasoning and, to counter the effects of scientific racism, he constructed his approach around the belief that scientists must adopt an assumption or scientific hypothesis that African Americans are human. His engagement in scientific research was a way to reform the society in which he lived, which in turn, led him to defend the faithfulness to fact as his conception (...) of scientific objectivity. This essay examines his sophisticated theory of facts, account of the difference between the natural and human sciences, and unique pragmatist theory of truth. (shrink)

Dispositional compatibilists argue that a proper understanding of our abilities vindicates both compatibilism and the principle of Alternate Possibilities (the claim that the ability to do otherwise is required for freedom and moral responsibility). In this paper, I argue that this is mistaken. Both analyses of dispositions and abilities should distinguish between local and global dispositions or abilities. Once this distinction is in place, we see that neither thesis is established by an analysis of abilities.

This qualitative study explores the experiences and challenges SPED teachers face amidst the new normal of education. Employing Heidegerian Phenomenology and Interpretative Phenomenology analysis, findings suggest that the SPED teachers can’t enjoy their life outside work because of a lack of support from the government, physically and financially; thus, they experience burnout. Also, the salary they earn is not even enough to raise a family, and the fact that they almost shoulder the learning resources in the class makes it worse. (...) Moreover, the participants need practical training to adapt to the needs of their students amidst the challenges of the new learning modality. (shrink)

How would feminist concerns fare in the debate between Confucian role ethics and virtue ethics? Ann Pang-White sketches the contours of a non-dichotomous, role-based virtue ethics that is illuminated by a Confucian feminist account as one possible answer to this query. By reimagining the virtues of chastity and filiality that are indispensable to Confucian contexts, Pang-White seeks to develop a reading that can be useful in defending feminist values and replacing outdated understandings of gender roles in societies informed by Confucian (...) thought today. In continuing the conversation with her, Stephen Angle asks whether a modernized, relational, role-based virtue ethics can really suffice to respond to feminist concerns. Sarah Mattice proposes that Pang-White center intersectional perspectives on feminism for the latter’s project, while Lily Zhang invites her to analyze how certain ethical conflicts that arise within the framework of Confucian ethics between roles and virtues can be resolved from Pang-White’s perspective. Pang-White’s reply to the panel reiterates different aspects of her relational role-based virtue ethical reading of Confucian feminism to argue that a better appreciation of the situatedness and imperfections of morality is needed to understand the imperfections that come in with it. _ _. (shrink)

Background:Moving into the last phase of life comprises a developmental transition with specific needs and risks. Facilitating transitions is an important component of the work of nurses. When curative interventions are no longer helpful, nurses enact key roles in caring for patients and families.Aim:The aim of this study was to examine the experiences of registered nurses in acute care settings as they worked with patients and families to facilitate transition to comfort-focused care.Research design:Sampling, data collection, and data analysis were guided (...) by constructivist grounded theory, chosen because of its strength in identifying and explicating social processes.Participants and context:A purposeful sample of 26 registered nurses working in acute care hospitals in one community in the northeastern United States participated in this study through semi-structured interviews.Ethical considerations:The study received approval from the university’s Institutional Review Board for the Protection of Human Subjects. Participants provided informed consent.Findings:Nurses facilitated transition to comfort-focused care by enacting their moral commitments to patients and families. They focused on building relationships, honoring patient self-determination, and maintaining respect for personhood. In this context, they discerned a need for transition, opened a discussion, and used diverse strategies to facilitate achieving consensus on the part of patients, family members, and care providers. Regardless of how the process unfolded, nurses offered support throughout.Discussion:Achievement of consensus by all stakeholders is critical in the transition to comfort-focused care. This study deepens our understanding of how nurses as moral agents utilize specific strategies to assist progress toward consensus. It also offers an example of recognizing the moral agency of nurses through listening to their voices.Conclusion:Increased understanding of effective nursing strategies for facilitating transition to comfort-focused care is essential for developing needed evidence for excellent care and strengthening end-of-life nursing education. (shrink)

Examines how violence has been conceptually and rhetorically put to use in continental social theory.

_This illuminating account of contemporary American Buddhism shows the remarkable ways the tradition has changed over the past generation_ The past couple of decades have witnessed Buddhist communities both continuing the modernization of Buddhism and questioning some of its limitations. In this fascinating portrait of a rapidly changing religious landscape, Ann Gleig illuminates the aspirations and struggles of younger North American Buddhists during a period she identifies as a distinct stage in the assimilation of Buddhism to the West. She observes (...) both the emergence of new innovative forms of deinstitutionalized Buddhism that blur the boundaries between the religious and secular, and a revalorization of traditional elements of Buddhism, such as ethics and community, that were discarded in the modernization process. Based on extensive ethnographic and textual research, the book ranges from mindfulness debates in the Vipassana network to the sex scandals in American Zen, while exploring issues around racial diversity and social justice, the impact of new technologies, and generational differences between baby boomer, Gen X, and millennial teachers. (shrink)

How should we talk to children about war? The basic story we tell them is that the world is split into good guys and bad guys, and that sometimes we have to kill the bad guys for the sake of justice. These stories of heroic killing teach children to train their attention on violence, and to interpret that violence as just or good. I show how this basic story – which also motivates much of our philosophical thinking about the morality (...) of war and killing, mostly notably just war theory – makes it difficult for us to consider and evaluate pacific alternatives. If we are to give children the space to develop their imagination, so that they can more genuinely engage with the possibilities of nonviolence and peace, then we must learn to tell a different story. (shrink)

Although moral distress is now a well-recognized phenomenon among all of the healthcare professions, few evidence-based strategies have been published to address it. In morally distressing situations, the “presenting problem” may be a particular patient situation, but most often signals a deeper unit- or system-centered issue. This article describes one institution’s ongoing effort to address moral distress in its providers. We discuss the development and evaluation of the Moral Distress Consultation Service, an interprofessional, unit/system-oriented approach to addressing and ameliorating moral (...) distress. (shrink)

This article proposes to reconceive moral education on the model of spiritual practice. Such an education would be defined not by its content—that is, explicit instruction about moral rules or particular virtues—but rather by the form of its constituent activities. Drawing on the works of both Plato and Foucault, the article addresses questions about the epistemic complexity of virtue raised in Mark E. Jonas and Yoshiaka Nakzawa’s A Platonic Theory of Moral Education. It then goes on to suggest that the (...) form of spiritual practice is uniquely suited to the cultivation of virtue understood on their Platonic model. (shrink)

The causal theory of properties is standardly combined with a realist's ontology of universals or tropes. In this paper, I consider an uncharted alternative – a nominalist causal theory of properties. I discuss advantages and disadvantages of the resulting theory of properties, and explore the Rylean understanding of causal powers that emerges.

Philosophical discussion about the reality of sensory perceptions has been hijacked by two tendencies. First, talk about perception has been largely centered on vision. Second, the realism question is traditionally approached by attaching objects or material structures to matching contents of sensory perceptions. These tendencies have resulted in an argumentative impasse between realists and anti-realists, discussing the reliability of means by which the supposed causal information transfer from object to perceiver takes place. Concerning the nature of sensory experiences and their (...) capacity to provide access to reality, this article challenges the standard categories through which most arguments in this debate have been framed to date. Drawing on the underexplored case of olfaction, I first show how the details of the perception process determine the modalities of sensory experiences. I specifically examine the role of measurement and analyze its influence on the characterization of perceptions in olfaction. My aim is to argue for an understanding of perception through a process view, rather than one pertaining to objects and properties of objects. (shrink)

Do sensory measurements deserve the label of “measurement”? We argue that they do. They fit with an epistemological view of measurement held in current philosophy of science, and they face the same kinds of epistemological challenges as physical measurements do: the problem of coordination and the problem of standardization. These problems are addressed through the process of “epistemic iteration,” for all measurements. We also argue for distinguishing the problem of standardization from the problem of coordination. To exemplify our claims, we (...) draw on olfactory performance tests, especially studies linking olfactory decline to neurodegenerative disorders. (shrink)

Does the sense of smell involve the perception of odor objects? General discussion of perceptual objecthood centers on three criteria: stimulus representation; perceptual constancy; and figure-ground segregation. These criteria, derived from theories of vision, have been applied to olfaction in recent philosophical debates about psychology. An inherent problem with such framing of olfactory objecthood is that philosophers explicitly ignore the constitutive factors of the sensory systems that underpin the implementation of these criteria. The biological basis of odor coding is fundamentally (...) different from the coding principles of the visual system. This article analyzes the three measures of perceptual objecthood against the biological background of the olfactory system. It contrasts the coding principles in olfaction with the visual system to show why these criteria of objecthood fail to be instantiated in odor perception. The argument demonstrates that olfaction affords perceptual categorization without the need to form odor objects. (shrink)

The feminist philosopher and social scientist shows how "gendering" has affected the social and natural sciences as she reconciles the long-standing dichotomy between the quantitative and qualitative methods and demonstrates the tandem use of both experimental and intuitive approaches.

I consider a grand, yet neglected proposal put forward by Shoemaker—a functionalist theory of all properties. I argue that two possible ways of developing this proposal meet with substantial objections. However, if we are prepared to endorse an ontology of tropes, one of these functionalist analyses can be developed into an original and informative theory of properties.

Correspondence in Nature Human Behaviour.

“Humanism” is a term that has designated a remarkably disparate set of ideologies. Nonetheless, strains of religious, secular, existential, and Marxist humanism have tended to circumscribe the category of the human with reference to the themes of reason, autonomy, judgment, and freedom. This essay examines the emergence of a new humanistic discourse in feminist theory, one that instead finds its provocation in the unwilled passivity and vulnerability of the human body, and in the vulnerability of the human body to suffering (...) and violence. Grounded in a descriptive ontology that privileges figures such as exposure, dispossession, vulnerability, and “precariousness,” this new humanism is a corporeal humanism. This essay probes both the promise and the limitations of this emergent humanism with particular reference to recent work by feminist philosophers Judith Butler and Adriana Cavarero. (shrink)

Influential libertarians from diverse backgrounds and professions who have worked toward a freer society across the globe share their personal and intellectual journeys, including what their lives and thoughts were before they embraced libertarianism; which people, texts, or events most inspired them; what experiences, challenges, tribulations, and achievements they have had as participants or leaders in this movement, and how this philosophy has affected their private and professional lives. The volume’s 80 contributors span the political-philosophical spectrum of libertarianism, including anarcho-capitalists, (...) monarchists, constitutionalists, classical liberals, and thick libertarians. Their essays express different perspectives on many issues even while articulating such core principles as an appreciation for individual liberty, private property rights, the rule of law, and free enterprise. Together, they represent myriad individual journeys toward libertarianism, however defined. By bringing together a range of contemporary voices from outside the dominant left-right paradigm, this book aims to contribute to the viewpoint diversity that is crucially needed in today’s public discourse. These autobiographies not only offer compelling insights into their individual authors and the state of the world today, but may also inspire the next generation to make our society a freer one. (shrink)

This chapter contains sections titled: What are Genuine Moral Dilemmas? Applications.

A User's Guide to Melancholy takes Robert Burton's encyclopaedic masterpiece The Anatomy of Melancholy (first published in 1621) as a guide to one of the most perplexing, elusive, attractive, and afflicting diseases of the Renaissance. Burton's Anatomy is perhaps the largest, strangest, and most unwieldy self-help book ever written. Engaging with the rich cultural and literary framework of melancholy, this book traces its causes, symptoms, and cures through Burton's writing. Each chapter starts with a case study of melancholy - from (...) the man who was afraid to urinate in case he drowned his town to the girl who purged a live eel - as a way into exploring the many facets of this mental affliction. A User's Guide to Melancholy presents in an accessible and illustrated format the colourful variety of Renaissance melancholy, and contributes to contemporary discussions about wellbeing by revealing the earlier history of mental health conditions. (shrink)

Written by leading researchers in educational and social psychology, learning science, and neuroscience, this edited volume is suitable for a wide-academic readership. It gives definitions of key terms related to motivation and learning alongside developed explanations of significant findings in the field. It also presents cohesive descriptions concerning how motivation relates to learning, and produces a novel and insightful combination of issues and findings from studies of motivation and/or learning across the authors' collective range of scientific fields. The authors provide (...) a variety of perspectives on motivational constructs and their measurement, which can be used by multiple and distinct scientific communities, both basic and applied. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Respire, Con-spireMarielle Macé (bio)Translated by Alexis Ann StanleyA rather suffocating atmosphere is becoming our customary environment, ecologically, politically, and socially. It is time to affirm "a universal right to breathe"–what Achille Mbembe called the essential demand for justice that escalated during the age of the Anthropocene and is now crudely reemerging in the current pandemic's attack on the respiratory system.But the right to breathe is not "merely" the right (...) to live, to breathe in unpolluted spaces, or to share clean air; it is also the right to a breathable life, a life worth caring for. It is the right to love life, life with and among one another: the right to fraternize in and through breath, the right to detoxify our relationships and breathe with others. To respire with: to con-spire.Because in order to breathe, one needs air, but one especially needs other living beings, a world and landscapes with which to breathe, in which to breathe, and which can breathe through us. To breathe is not only to maintain one's own breath or nourish one's own organic system as if it lived an unconnected life; it is to acquiesce to the world, to the fact that there is a world—this one, precisely—and to participate in it. A person who breathes, in fact, partakes both in and of the world. Moreover, they make a gift to it, contributing to the way of the world in its entirety by a breath that tightly holds the ties binding each of our bodies to the current state of the living._______The lack of air, the feeling of a stifling age, even the fear of overwhelming suffocation—such is our current "natural" condition, the primary characteristic not only of our virtually toxic living environment, but also of our smothering, asphyxiating political condition wrought with violence and discrimination. Such also is the state of our social condition—the way we (rather poorly) create community—or rather, of our distinct social conditions. For there is a very inequitable distribution of the right to air or to breathe determined by which lives "count" and which do not.The Anthropocene is perhaps the age of a new respiratory 'condition.' Toxic fumes, pestilential odors, extensive carbon consumption, agro-chemical [End Page 177] discharge, microparticles, deforestation and soil asphyxiation, radioactive clouds with phantom trajectories and invisible powers of penetration… the history of industrial modernity is that of "the continuous and large-scale alteration of life's atmospheric conditions" (Zimmer 25). Recently, wildfires affecting America and Europe have been adding their horrifying fumes to century-old pollution. Even clouds ("the clouds up there, the marvelous clouds" of Baudelaire) are being targeted: China recently announced the country's intention to accelerate its cloud seeding program1 (in 2008, over one thousand shells loaded with silver iodide were dispersed in order to clear the skies of Beijing and prevent rain from ruining the opening ceremony of the Olympic games. This technique is also used more and more frequently to generate rainfall and avoid agricultural droughts. This type of 'sky colonization' or climate militarization is a profanation of language as much as of nature: to "sow the clouds" (or "grow meat")—even language tells us something is wrong…)It took a great amount of time and much denial before widespread bodily infection and industrial pollution's public health effects could be recognized. Industrialists may object (at times with doctors), but in the most working-class regions, bodies know: "lungs and our sense of smell protest in their own way against any conclusive evidence which would exonerate factories" (Zimmer 23).The history of pollution is, in fact, also a question of exploitation as well as a social history: that of the unequal distribution of air and the inequitable exposure (depending on one's living milieux) to what is oppressive, stifling—in a word, unbreathable. Unsanitary housing, proximity to mines or factories, and lack of access to healthcare are always factors; respiratory diseases are the most prevalent of occupational illnesses2; and the staggering surge in childhood lead poisoning in the very heart of our capitals—the weakest of bodies have... (shrink)

This is a ground-breaking study of the way educated people were trained to think in Renaissance Europe. As Ann Moss demonstrates, the commonplace-book of quotations which every schoolboy of the period was taught to use opens a window on to the manner in which attitudes were structured, a moral consensus was established, and styles of writing evolved. Printed Commonplace-Books and the Structuring of Renaissance Thought is much more than an account of humanist classroom practice: it is a major work of (...) cultural history. (shrink)

Traditional memory strategy training interventions improve older adults’ performance on tests of episodic memory, but have limited transfer to episodic memory tasks, let alone to everyday memory. We argue that an alternative approach is needed to assist older adults to compensate for age-related cognitive declines and to maintain functional capacity in their own natural ecologies. We outline a set of principles regarding how interventions can successfully train older adults to increase successful goal pursuit to reduce risks of everyday memory failures. (...) We argue that training individuals to use metacognitive self-regulatory strategies to proactively manage formulation and pursuit of daily goals can compensate for age-related cognitive changes and increase the likelihood of goal attainment. We then describe an intervention approach that instantiates these principles in a multi-modal intervention that is unique in its three-phase approach: individualized assessment of an individual’s current approaches to self-regulation; training memory strategies, self-management skills, and new habits of mind in a group training context; and a behavioral shaping period in which individuals receive coaching and feedback on their efforts to use trained procedures to improve everyday cognition. A recently completed study conducted an initial test of the intervention, with highly encouraging results. We advocate further efforts to replicate, extend, and fine-tune this type of intervention. The ultimate goal is to be able to deliver the intervention in a way that increases its potential reach, including to subpopulations of older adults at risk for everyday cognitive impairments. (shrink)

Is the sense of smell a source of aesthetic perception? Traditional philosophical aesthetics has centered on vision and audition but eliminated smell for its subjective and inherently affective character. This article dismantles the myth that olfaction is an unsophisticated sense. It makes a case for olfactory aesthetics by integrating recent insights in neuroscience with traditional expertise about flavor and fragrance assessment in perfumery and wine tasting. My analysis concerns the importance of observational refinement in aesthetic experience. I argue that the (...) active engagement with stimulus features in perceptual processing shapes the phenomenological content, so much so that the perceptual structure of trained smelling varies significantly from naive smelling. In a second step, I interpret the processes that determine such perceptual refinement in the context of neural decision-making processes, and I end with a positive outlook on how research in neuroscience can be used to benefit philosophical aesthetics. (shrink)

In this article, I propose a new theory of “Buddhist para-charisma” by analyzing the case of an iconoclastic monk in Vietnam. My argument draws from 20 months of ethnographic research conducted in Ho Chi Minh City between 2015 and 2019. During fieldwork, I was introduced to a highly respected monk with the extraordinary capacity to read minds and perceive karmic obstacles in the lives of his lay and monastic followers. This monk was unique for openly consuming meat and alcohol, wearing (...) lay clothing, and using insults while preaching. These behaviors had the deliberate effect of creating an uncomfortable, tense environment among his visitors. Later, the nun who introduced us explained that his harsh language and adversarial demeanor were a rare form of compassion that urged immediate awakening to Buddhist teachings. I compare this case with previously developed theories of Buddhist charisma and moral aesthetics. While past studies analyze Buddhist charisma through the moral aesthetics of physical beauty or affective responses of tranquility, gratitude, and awe, the theory of para-charisma shows how some monks can deliberately use repulsive behavior and negative affects to attract followers and advance spiritual goals. (shrink)

The purpose of this study is to explore and illuminate the phenomenon of busyness as experienced by nurses. The daily work of nursing practice is often characterized by a hectic pace in the execution of tasks. Previous research shows that busyness can potentially lead to a reduction in the quality of nursing. Little has been explored about nurses' own experiences of busyness. This study has a qualitative design. The method chosen is a phenomenological hermeneutical exploration of personal experiences. Results reveal (...) that busyness is experienced as a disparity between perceived necessary tasks and time available to accomplish them. Busyness has an outer dimension of events and a dimension of internal processes. Busyness is experienced as acceptable to some extent, but feels strongly uncomfortable if important tasks remain undone. The intolerable busyness raises negative emotions, steals energy and weakens health. Coping with busyness seems to be a personal and individual struggle, even though health service enterprises are a collective matter. (shrink)

AI has numerous applications and in various fields, including the military domain. The increase in the degree of autonomy in some decision-making systems leads to discussions on the possible future use of lethal autonomous weapons systems (LAWS). A central issue in these discussions is the assignment of moral responsibility for some AI-based outcomes. Several authors claim that the high autonomous capability of such systems leads to a so-called “responsibility gap.” In recent years, there has been a surge in philosophical literature (...) around the concept of responsibility gaps and different solutions have been devised to close or bridge these gaps. In order to move forward in the research around LAWS and the problem of responsibility, it is important to increase our understanding of the different perspectives and discussions in this debate. This paper attempts to do so by disentangling the various arguments and providing a critical overview. After giving a brief outline of the state of the technology of LAWS, I will review the debates over responsibility gaps using three differentiators: those who believe in the existence of responsibility gaps versus those who do not, those who hold that responsibility gaps constitute a new moral problem versus those who argue they do not, and those who claim that solutions can be successful as opposed to those who believe that it is an unsolvable problem. (shrink)

This book explores the concept of school belonging in adolescents from a socio-ecological perspective, acknowledging that young people are uniquely connected to a broad network of groups and systems within a school system. Using a socio-ecological framework, it positions belonging as an essential aspect of psychological functioning for which schools offer unique opportunities to improve. It also offers insights into the factors that influence school belonging at the student level during adolescence in educational settings. Taking a socio-ecological perspective and drawing (...) from innovative research methods, the book encourages researchers interested in school leadership to foster students' sense of belonging by developing their qualities and by changing school systems and processes. (shrink)

This book explores the ethical implications of managing uncertainty in clinical decision-making during the COVID-19 pandemic. It develops an ethics of clinical uncertainty that brings together insights from the clinical and biomedical ethical literatures. The book sets out to recognize the central role uncertainty plays in clinical decision-making and to acknowledge the different levels, kinds, and dimensions of clinical uncertainty. It also aims to aid clinicians and patients in managing clinical uncertainty, and to recognize the ethical duty they have to (...) manage clinical uncertainty. The book addresses four ethical duties related to clinical uncertainty: (1) the duty to advance the welfare of those in clinical medicine, (2) to respect the rights of those in clinical medicine, (3) to promote just access to health care, and (4) to care for one another in clinical medicine. These duties took on select urgency during the COVID-19 pandemic because clinical risk assessments about COVID-19 were limited, we were asked to give informed consent in the context of limited and changing knowledge, the pandemic unearthed myriad problems about the distribution of health care, and the pandemic raised questions about how we care for each other in medicine. An Ethics of Clinical Uncertainty will appeal to scholars, advanced students, and medical professionals working in philosophy of medicine, biomedical ethics, clinical medicine, nursing, public health care, and gerontology. (shrink)

The co-instantiation thesis is pivotal to a significant solution to the problem of causal exclusion. But this thesis has been subject to some powerful objections. In this paper, I argue that these difficulties arise because the thesis lacks the necessary metaphysical framework in which its claims should be interpreted and understood. Once this framework is in place, we see that the co-instantiation thesis can answer its critics. The result is a rehabilitated co-instantiation solution to the troubling problem of causal exclusion. (...) But questions remain concerning the viability of certain of its applications. (shrink)

The notion of virtue in general, and courage in particular, has had a hard time integrating itself into the everyday lexicon of bioethics. Following the lead of enlightenment moral philosophy, which concentrates on the theory of right action as opposed to the ancient Greeks' emphasis on the development of good character, bioethics, with some notable exceptions, has tended to relegate consideration of the virtues to the sidelines of moral argument. Recently, however, there have been calls for the necessity of “moral (...) courage” in the context of clinical ethics. As nurses, physicians, and other health care professionals confront a variety of moral contexts in which the virtue of courage is invoked to "do the right thing," stand up for patients' rights, and uphold the ethical standards of their professions, they are increasingly reminded of their moral duty to exhibit courage in the face of institutional obstacles to the proper care of their patients. For example, a nurse's hesitation to approach a physician to request increased sedation for an agitated patient out of fear of retaliation is represented in one article as a lack of courage.In this paper we offer a critical assessment of such invocations of courage. While we find courage to be an indispensable virtue in some challenging contexts, in other settings we find invocations of courage to be both an unfortunate endorsement of an oppressive status quo that can divert attention from the real problems and an undesirable and potentially destructive strategy within health care institutions whose goal is medically excellent and morally good clinical practice. As we shall argue, a call to virtuousness is not always virtuous. (shrink)

Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective (...) ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings. (shrink)

In this first part, Matthew Lipman offers the reader a glimpse at the thought processes that resulted in Philosophy for Children and, in so doing, ...