Diagnostic self-testing devices are being developed for many illnesses, chronic diseases and infections. These will be used in hospitals, at point-of-care facilities and at home. Designed to allow earlier detection of diseases, self-testing diagnostic devices may improve disease prevention, slow the progression of disease and facilitate better treatment outcomes. These devices have the potential to benefit both the individual and society by enabling individuals to take a more proactive role in the maintenance of their health and by helping society improve (...) health and reduce health costs. However, the full implications of future home-based diagnostic technology for individuals and society remain unclear due to their novelty. We argue that the development of diagnostic tools, especially for home use, will heighten a number of ethical challenges. This paper will explore some of the ethical implications of home-based self-testing diagnostic devices for the autonomous and relational dimensions of the person. This will be facilitated by examining the impact of diagnostic devices for individual autonomy, for the delivery of accurate diagnosis and for the personal significance of the information for the user. The latter will be examined using Charles Taylor's view of personhood and his emphasis on human agency and interpretation. While the ethical issues are not necessarily new, the development of home-based self-testing diagnostic devices will make issues regarding autonomy, accuracy of information and personal significance more and more demanding. This will be the case particularly when an individual's autonomous choices come into conflict with the person's relational responsibilities. (shrink)

This paper aims to critique the phenomenon of advanced patient autonomy and choice in healthcare within the specific context of self-testing devices. A growing number of self-testing medical devices are currently available for home use. The premise underpinning many of these devices is that they assist individuals to be more autonomous in the assessment and management of their health. Increased patient autonomy is assumed to be a good thing. We take issue with this assumption and argue that self-testing provides a (...) specific example how increased patient autonomy and choice within healthcare might not best serve the patient population. We propose that current interpretations of autonomy in healthcare are based on negative accounts of liberty to the detriment of a more relational understanding. We also propose that Kantian philosophy is often applied to the healthcare arena in an inappropriate manner. We draw on the philosophical literature and examples from the self-testing process to support these claims. We conclude by offering an alternative account of autonomy based on the interrelated concepts of relationality, care and responsibility. (shrink)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care (...) left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

Many of the activities of clinical practice happen to, with or upon vulnerable human beings. For this reason numerous nursing authors draw attention to or claim a significant moral domain in clinical practice. A number of nursing authors also discuss the emotional involvement and/or emotional labour which is often experienced in clinical practice. In this article I explore the importance of emotion for moral perception and moral agency. I suggest that an aspect of being a good nurse is having an (...) emotional sensitivity to other human beings (patients), because this emotional sensitivity allows the nurse to perceive more accurately the context and perspective of the patient. It is thus important to the moral agency of the nurse and to morally sensitive clinical practice. As such education of the emotions should be a feature of the moral education of the nurse. A useful conception of the role of educated emotion in the moral life can be discovered in Aristotelian ethics. (shrink)

This article presents the results of an exploratory study that investigated the role that religiosity plays in determining consumer attitudes/beliefs in various situations regarding questionable consumer practices. Two dimensions of religiosity – intrinsic and extrinsic religiousness – were studied. Results indicated that an intrinsic religiousness was a significant determinant of consumer ethical beliefs, but extrinsic religiousness was not related to those beliefs.

This article presents the results of a study that investigated the roles that one's money ethic, religiosity and attitude toward business play in determining consumer attitudes/beliefs in various situations regarding questionable consumer practices. Two dimensions of religiosity - intrinsic and extrinsic religiousness - were studied. A global scale of money ethic was examined, as was a global measure of attitude toward business. Results indicate that both types of religiosity as well as one's money ethic and attitude toward business were significant (...) determinants of at least some types of consumer ethical beliefs. (shrink)

This article presents the results of a study that investigated the roles that religiosity and ones money ethic play in determining consumer attitudes/beliefs in various situations regarding questionable consumer practices. One dimension of religiosity – intrinsic religiousness – was studied. Four separate dimensions of a money ethic scale were initially examined, but only one was used in the final analyses. Results indicated that both intrinsic religiousness and one’s money ethic were significant determinants of most types of consumer ethical beliefs.

This article presents the results of a study that investigated the role that religiosity plays in determining consumer attitudes/beliefs regarding various questionable consumer practices. Additionally, other personal factors were examined including idealism, relativism, consumer alienation and selected demographics such as income and age. All of these constructs were examined as antecedents of consumer ethical beliefs. The results of a post hoc analysis indicated that religiosity was a significant determinate of both idealism and relativism, and since idealism and relativism determine consumer (...) ethical beliefs, religiosity is a significant indirect determinate of consumer ethical beliefs. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

This paper offers an account of a fallacy we will call bothsiderism, which is to mistake disagreement on an issue for evidence that either a compromise on, suspension of judgment regarding, or continued discussion of the issue is in order. Our view is that this is a fallacy of a unique and heretofore untheorized type, a fallacy of meta-argumentation. The paper develops as follows. After a brief introduction, we examine a recent bothsiderist case in American politics. We use this as (...) a pivot point to survey the theoretical literature on the fallacy. The most prominent theory is that bothsiderism is a case of dialogue-shifting. This view fails, we maintain, to explain how bothsiderism might be persuasive. We argue, rather, bothsiderism is a kind of meta-argumentative fallacy. (shrink)

The ethics literature has identified moral motivation as a factor in ethical decision-making. Furthermore, moral identity has been identified as a source of moral motivation. In the current study, we examine religiosity as an antecedent to moral identity and examine the mediating role of self-control in this relationship. We find that intrinsic and extrinsic dimensions of religiosity have different direct and indirect effects on the internalization and symbolization dimensions of moral identity. Specifically, intrinsic religiosity plays a role in counterbalancing the (...) negative impact of extrinsic religiosity on the internalization of moral identity. Further, intrinsic religiosity also counterbalances the negative and indirect impact of extrinsic religiosity on symbolization of moral identity via self-control. Lastly, self-control does not play a mediating role in the impact of religiosity on the internalization dimension of moral identity. We conclude that this study presents important findings that advance our understanding of the antecedents of moral identity, and that these results may have implications for the understanding of ethical decision-making. (shrink)

This study examined the effect of various antecedent variables on marketers’ perceptions of the role of ethics and socialresponsibility in the overall success of the firm. Variables examined included Hofstede’s cultural dimensions (i.e., power distance, uncertainty avoidance, individualism, masculinity, and Confucian dynamism), as well as corporate ethical values and enforcement ofan ethics code. Additionally, individual variables such as ethical idealism and relativism were included. Results indicated that most ofthese variables impacted marketers’ perceptions of the importance of ethics and social responsibility, (...) although to varying degrees. (shrink)

This paper situates the moral domain of practice within the context of a particular description of nursing practice – one that sees human interaction at the heart of that practice. Such a description fits not only with professional rhetoric but also with literature from patients and recent empirical work exploring the nature of nursing practice.Martha Levine in her 1977 description of ethics, within the context of nursing practice, indicated that what was important from an ethical perspective was how we interact (...) with each other, with patients and colleagues, on a daily basis. What enables such interaction to display moral sensitivity, insight into patient need, and a focus on the good for the patient? Of relevance when answering this question is the empirical evidence indicating that professional socialization, as a nurse or a doctor, may dull the individual’s moral sense. If this is the case, cognizance needs to be taken of such evidence when identifying theoretical approaches from mainstream ethics that may provide insight and value for nurse education. It is suggested that such insight and value can be gained from a consideration of the work of Aristotle, Murdoch, and Vetlesen. (shrink)

This paper revisits a 2003 publication in Nursing Philosophy: The need for accurate perception and informed judgement in determining the appropriate use of the nursing resource: hearing the patient's voice. The author suggests that the basic ideas and focus of this 16‐year‐old paper are still topical and relevant in considerations of nursing care. However, it is also suggested that greater attention to the importance of the nurse–patient relationship in considerations of resource allocation, and potential rationing of nursing care, would have (...) strengthened the original paper. (shrink)

This article presents the results of a study that investigated the roles that one’s money ethic, religiosity and attitude toward business play in determining consumer attitudes/beliefs in various situations regarding questionable consumer practices. Two dimensions of religiosity – intrinsic and extrinsic religiousness – were studied. A global scale of money ethic was examined, as was a global measure of attitude toward business. Results indicate that both types of religiosity as well as one’s money ethic and attitude toward business were significant (...) determinants of at least some types of consumer ethical beliefs. (shrink)

John Dewey points out in A Common Faith (1934) that what stands in the way of religious belief for many is the apparent commitment of Western religious traditions to supernatural phenomena and questionable historical claims. We are to accept claims that in any other context we would find laughable. Are we to believe that water can be turned into wine without the benefit of the fermentation process? Are we to swallow the claim that there is such a phenomenon as the (...) spontaneous conception of a child without the intervention of the traditional technique? Were we to confront these claims in any but a religious context, we would dismiss them as the workings of an overactive imagination or simple cover for an overactive sex life. But for the devout believer, there is no doubt even with a paucity of evidence. At the same time, the rise of science has forcibly suggested the idea that the natural world is self-contained and, if explainable, that explanation will come from within. There seems to be no room for the traditional God and, much as one might wish otherwise, nothing for him to do. Perhaps... (shrink)

Compromise as a notion is frequently met in discussion and debate regarding many everyday decisions, including health care. It therefore seems that it may be of interest and value to try to give this some careful consideration. In the following pages, an attempt is made to discuss what one might mean when one uses this concept. Consideration is then given to some possible uses of compromise in health care. Having suggested that in certain situations compromise is a morally valuable process, (...) the author also considers some of the possible limits of compromise. (shrink)

The Heythrop Journal, Volume 63, Issue 4, Page 807-816, July 2022.

Question processing involves parsing, memory retrieval, question categorization, initiation of appropriate answer‐retrieval heuristics, answer formulation, and output. Computational and psychological models have traditionally treated these processes as separate, sequential, independent, and in pursuit of a single answer type at a time. Here this view is challenged and the implications of a theory in which question processes operate simultaneously on multiple question interpretations are explored. A highly interactive model is described in which an expectation‐driven parser generates multiple question candidates, including partially‐specified (...) candidates. Question candidates act as constraints for a matcher which activates memory items. An answer retrieval process examines question candidates and the active portions of memory in an attempt to generate answer candidates. Answer candidates are examined by an output process that derives the final answer. These processes run simultaneously and interact. Three experiments on human question answering are also described which provide evidence that working memory load during question reading is affected by processes related to answer retrieval. (shrink)

The visual world of adults consists of objects at various distances, partly occluding one another, substantial and stable across space and time. The visual world of young infants, in contrast, is often fragmented and unstable, consisting not of coherent objects but rather surfaces that move in unpredictable ways. Evidence from computational modeling and from experiments with human infants highlights three kinds of learning that contribute to infants’ knowledge of the visual world: learning via association, learning via active assembly, and learning (...) via visual-manual exploration. Infants acquire knowledge by observing objects move in and out of sight, forming associations of these different views. In addition, the infant’s own self-produced behavior—oculomotor patterns and manual experience, in particular—is an important means by which infants discover and construct their visual world. (shrink)

Current focus in the health care ethics literature on the character of the practitioner has a reputable pedigree. Rather than offer a staple diet of Aristotelian ethics in the undergraduate curricula, perhaps instead one should follow Murdoch's suggestion and help the practitioner to develop vision and moral imagination, because this has a practical rather than a theoretical aim. The imaginative capacity of the practitioner plays an important part in both the quality of the nurse's role enactment and the moral strategies (...) which the nurse uses. It also plays a central part in the practitioner's ability to communicate with a patient and in the type of person which the practitioner becomes. Can the moral imagination be stimulated and nurtured? Some philosophers and literary critics argue that not only is this possible, but that literature is the means of doing so. If this is the case then a place should be made for literature in already crowded health care curricula. (shrink)

The straw man fallacy consists in inappropriately constructing or selecting weak versions of the opposition’s arguments. We will survey the three forms of straw men recognized in the literature, the straw, weak, and hollow man. We will then make the case that there are examples of inappropriately reconstructing stronger versions of the opposition’s arguments. Such cases we will call iron man fallacies. The difference between appropriate and inappropriate iron manning clarifies the limits of the virtue of open-mindedness.

Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare (...) context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration. (shrink)

To better illuminate aspects of stress that are relevant to the moral domain, we present a definition and theoretical model of “moral stress.” Our definition posits that moral stress is a psychological state born of an individual’s uncertainty about his or her ability to fulfill relevant moral obligations. This definition assumes a self-and-others relational basis for moral stress. Accordingly, our model draws from a theory of the self (identity theory) and a theory of others (stakeholder theory) to suggest that this (...) uncertainty arises as a manager faces competing claims for limited resources from multiple stakeholders and/or across multiple role identities. We further propose that the extent to which the manager is attentive to the moral aspects of the claims (i.e., moral attentiveness) moderates these effects. We identify several consequences of managerial moral stress and discuss theoretical, empirical, and practical implications of our approach. Most importantly, we argue that this work paves an important path for considering stress through the lens of morality. (shrink)

The focus of this article is perceptions of elderly patients and nurses regarding patients’ autonomy in nursing practice. Autonomy is empirically defined as having two components: information received/given as a prerequisite and decision making as the action. The results indicated differences between staff and patient perceptions of patient autonomy for both components in all five countries in which this survey was conducted. There were also differences between countries in the perceptions of patients and nurses regarding the frequency with which patients (...) received information from nursing staff or were offered opportunities to make decisions.This is the second of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented. (shrink)

Modernism is both a contested aesthetic category and a powerful political statement. Modernist music was condemned as degenerate by the Nazis and forcibly replaced by socialist realism under the Soviets. Sympathetic philosophers and critics have interpreted it as a vital intellectual defence against totalitarianism, yet some American critics consider it elitist, undemocratic, and even unnatural. Drawing extensively on the philosophy of Heidegger and Badiou, Quilting Points proposes a new dialectical theory of faithful, reactive, and obscure subjective responses to musical modernism, (...) which embraces all the music of Western modernity. (shrink)

This exploratory study of ethical decision making by individuals in organizations found moral intensity, as defined by Jones (1991), to significantly influence ethical decision making intentions of managers. Moral intensity explained 37% and 53% of the variance in ethical decision making in two decision-making scenarios. In part, the results of this research support our theoretical understanding of ethical/unethical decision-making and serve as a foundation for future research.

A review of the literature on palliative care in the United Kingdom over the last fifteen years suggests that elements such as the development of the modern hospice, on the model developed by Cicely Saunders, have led to major improvements in the lot of the terminally ill.