Moral distress has been well reviewed in the literature with established deleterious side effects for all healthcare professionals, including nurses, physicians, and others. Yet, little is known about the quality and effectiveness of interventions directed to address moral distress. The aim of this integrative review is to analyze published intervention studies to determine their efficacy and applicability across hospital settings. Of the initial 1373 articles discovered in October 2020, 18 were appraised as relevant, with 1 study added by hand search (...) and 2 after a repeated search was completed in January and then in May of 2021, for a total of 22 reviewed articles. This review revealed data mostly from nurses, with some studies making efforts to include other healthcare professions who have experienced moral distress. Education-based interventions showed the most success, though many reported limited power and few revealed statistically lowered moral distress post intervention. This may point to the difficulty in adequately addressing moral distress in real time without adequate support systems. Ultimately, these studies suggest potential frameworks which, when bolstered by organization-wide support, may aid in moral distress interventions making a measurable impact. (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)

Background: Moral distress has been identified as a significant issue in nursing practice for many decades. However, most studies have involved American nurses or Western medicine settings. Cultural differences between Western and non-Western countries might influence the experience of moral distress. Therefore, the literature regarding moral distress experiences among non-Western nurses is in need of review. Aim: The aim of this integrative review was to identify, describe, and synthesize previous primary studies on moral distress experienced by non-Western nurses. Review method: (...) Whittemore and Knafl’s integrative review methodology was used to structure and conduct the review of the literature. Research context and data sources: Key relevant health databases included the Ovid MEDLINE, CINAHL, Web of Science, and Google Scholar databases. Two relevant journals, Nursing Ethics and Bioethics, were manually searched. Ethical consideration: We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. Findings: A total of 17 primary studies published between 1999 and 2019 were appraised. There was an inconsistency with regard to moral distress levels and its relationship with demographic variables. The most commonly cited clinical causes of moral distress were providing futile care for end-of-life patients. Unit/team constraints (poor collaboration and communication, working with incompetent colleagues, witnessing practice errors, and professional hierarchy) and organizational constraints (limited resources, excessive administrative work, conflict within hospital policy, and perceived lack of support by administrators) were identified as moral distress’s stimulators. Negative impacts on nurses’ physical, psychological, and spiritual well-being were also reported. Conclusion: Further research is needed to investigate moral distress among other healthcare professions which may further build understanding. More importantly, interventions to address moral distress need to be developed and tested. (shrink)

Moral distress, is, at its core, an organizational problem. It is experienced on a personal level, but its causes originate within the system itself. In this commentary, we argue that moral distress is not inherently good, that effective interventions must address the external sources of moral distress, and that while there is a place for resilience in the healthcare professions, it cannot be an effective antidote to moral distress.

Background: Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed. Objective: To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation. Methods: A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff when moral distress was present. (...) The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale. Results: Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment. Conclusions: Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness. (shrink)

In their article “A Broader Understanding of Moral Distress,” Campbell, Ulrich, and Grady (2016) correctly assert that moral distress is well established in the nursing literature and is gaining at...

Background and Objectives Primary care providers (PCPs) report decreased job satisfaction and high levels of burnout, yet little is known about their experience of moral distress. The aim of this study was to gain insight into the experiences of PCPs regarding moral distress including causative factors and proposed mitigation strategies. Methods This qualitative pilot study used semi-structured interviews to identify causes of moral distress in PCPs in an academic family medicine department. Interviews were analyzed using conventional content analysis. Results Of (...) 35 eligible participants, 12 completed the study (34% participation rate). Most were white, female, and had practiced for less than 10 years. Four PCPs had considered leaving their position due to moral distress. Participants identified five causes of moral distress: policies and procedures that conflict with patient needs, the unpredictable nature of primary care, need to “bend the rules,” lack of accountability, and lack of support staff. Six internal conflicts made resolving morally distressing situations difficult: perceived powerlessness, sense of responsibility, socialization to follow orders, emotional toll of the job, competing obligations, and fear of mistakes. Conclusions These findings matched themes in the current literature and identified an unbending infrastructure. This, coupled with the chaotic nature of primary care, resulted in frequent moral distress. Participants offered solutions to reduce and mitigate moral distress (also similar with current literature) and suggested moral distress and burnout are closely linked. (shrink)

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

The aim of this study was to explore the obligations of nurses and physicians in providing end-of-life care. Nineteen nurses and 11 physicians from a single newborn intensive care unit participated. Using content analysis, an overarching obligation of creating the best possible experience for infants and parents was identified, within which two categories of obligations (decision making and the end of life itself) emerged. Obligations in decision making included talking to parents and timing withdrawal. End-of-life obligations included providing options, preparing (...) parents, being with, advocating, creating peace and normalcy, and providing comfort. Nurses and physicians perceived obligations in both categories, although nurse obligations centered on the end of life while physician obligations focused on decision making. The findings demonstrate that, although the ultimate goal is shared by both disciplines, the paths to achieving that goal are often different. This has important implications for collaboration, communication, and improving the end of life. (shrink)

Kolbe and de Melo-Martin’s (2023) arguments draw attention to what is most useful about moral distress—identifying its causes is at least as important as measuring its severity. Jameton’s original...

Moral distress is a phenomenon increasingly recognized in healthcare that occurs when a clinician is unable to act in a manner consistent with his or her moral requirements due to external constraints. We contend that some experiences of moral distress are self-inflicted due to one’s under-assertion of professional authority, and these are potentially avoidable. In this article we outline causes of self-inflicted moral distress and offer recommendations for mitigation.

Background:Moral distress is recognized as a problem affecting healthcare professionals globally. Unaddressed moral distress may lead to withdrawal from the moral dimensions of patient care, burnout, or leaving the profession. Despite the importance, studies related to moral distress are scant in Thailand.Objective:This study aims to describe the experience of moral distress and related factors among Thai nurses.Design:A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the Measure of Moral Distress for Healthcare Professionals (...) and interview guide. The analysis was conducted separately and then integrated.Participants:Participants were Thai nurses from two large tertiary care institutions in a Southern province of Thailand.Ethical considerations:This study was approved by our organization's Institutional Review Board for Health Sciences Research, and by the Institutional Review Boards of the two local institutions in Thailand. Permission from the publisher was received to translate and utilize the Measure of Moral Distress (MMD-HP) under the license number: 4676990097151.Results:A total of 462 participants completed the survey questions. The top 7 causes of moral distress were related to system-level root causes and end-of-life care situations. Hierarchical multiple regression showed that work units, considering leaving position, and number of moral distress episodes in the past year were significant predictors of moral distress. Twenty interviews demonstrated three main themes of distressing causes: (1) powerlessness (at patients/family-, team-, and organizational-levels), (2) end-of-life issues, and (3) poor team function (poor communication and collaboration, incompetent healthcare providers, and inappropriate behavior of colleagues). The integration of data from both components indicated that the qualitative interviews enrich the quantitative findings, especially as related to the top 7 causes of moral distress.Discussion:Although the experience of moral distress among Thai nurses is similar to studies conducted elsewhere, the patient’s and family’s religious perspective that ties into the concept of moral distress needs to be explored.Conclusions:Although the root causes of moral distress are similar among different cultures, the experience of Thai nurses may vary according to culture and context. (shrink)

It is predicted that the rapid acquisition of new genetic knowledge and related applications during the next decade will have significant implications for virtually all members of society. Currently, most people get exposed to information about genes and genetics only through stories publicized in the media. We sought to understand how individuals in the general population used and understood the concepts of ???genetics??? and ???genes.??? During in-depth one-on-one telephone interviews with adults in the United States, we asked questions exploring their (...) basic understanding of these terms, as well as their belief as to the location of genes in the human body. A wide range of responses was received. Despite conversational familiarity with genetic terminology, many noted frustration or were hesitant when trying to answer these questions. In addition, some responses reflected a lack of understanding about basic genetic science that may have significant implications for broader public education measures in genetic literacy, genetic counseling, public health practices, and even routine health care. (shrink)

This article explores the relationship between music and ecofeminist theology and investigates how music and sound can advance the development of ecofeminist thought. On a physical level, the act of breathing connects humankind with the earth’s atmosphere and the element of air produces music and sound. On a theological level, traditional church teachings about the power and danger of music have reflected similar warnings about women and nature. Ecofeminist theologian Sally McFague made a persuasive case for metaphorical theology that supported (...) the arts being included in theological development. Religious Studies scholar Heidi Epstein engaged McFague’s metaphorical theology to develop a feminist theology of music and featured female composers including Hildegard of Bingen. I propose that metaphorical theology and music can also connect through the development of sonic metaphors. Sonic metaphors are created with pitch, rhythm, and sound. While most metaphors rely on the eyes to process written text and visual art, sonic metaphors are processed through the ears and offer different pathways for cognition. Sonic metaphors have been underutilized in theology and they offer potential for exploring theological concepts that can be challenging to comprehend through textual or visual means. These metaphors are particularly applicable for developing ecofeminist theology because sound and music can connect our bodies with nature in illuminating ways. I include examples from my own musical background, and I offer suggestions for non-musicians and ecofeminist theologians who want to incorporate sonic metaphors into their own creative theological reflection. (shrink)

Epstein et al. fail to show that L2 learners have full access to UG because they do not explain the relationship between UG and functional categories (FCs). Nor do they provide an explanation of why learners with (supposed) full knowledge of FCs fail to use them in a native-like way.

We live in a world of crowds and corporations, artworks and artifacts, legislatures and languages, money and markets. These are all social objects — they are made, at least in part, by people and by communities. But what exactly are these things? How are they made, and what is the role of people in making them? In The Ant Trap, Brian Epstein rewrites our understanding of the nature of the social world and the foundations of the social sciences. (...) class='Hi'>Epstein explains and challenges the three prevailing traditions about how the social world is made. One tradition takes the social world to be built out of people, much as traffic is built out of cars. A second tradition also takes people to be the building blocks of the social world, but focuses on thoughts and attitudes we have toward one another. And a third tradition takes the social world to be a collective projection onto the physical world. Epstein shows that these share critical flaws. Most fundamentally, all three traditions overestimate the role of people in building the social world: they are overly anthropocentric. Epstein starts from scratch, bringing the resources of contemporary metaphysics to bear. In the place of traditional theories, he introduces a model based on a new distinction between the grounds and the anchors of social facts. Epstein illustrates the model with a study of the nature of law, and shows how to interpret the prevailing traditions about the social world. Then he turns to social groups, and to what it means for a group to take an action or have an intention. Contrary to the overwhelming consensus, these often depend on more than the actions and intentions of group members. (shrink)

Social ontology is the study of the nature and properties of the social world. It is concerned with analyzing the various entities in the world that arise from social interaction. -/- A prominent topic in social ontology is the analysis of social groups. Do social groups exist at all? If so, what sorts of entities are they, and how are they created? Is a social group distinct from the collection of people who are its members, and if so, how is (...) it different? What sorts of properties do social groups have? Can they have beliefs or intentions? Can they perform actions? And if so, what does it take for a group to believe, intend, or act? -/- Other entities investigated in social ontology include money, corporations, institutions, property, social classes, races, genders, artifacts, artworks, language, and law. It is difficult to delineate a precise scope for the field (see section 2.1). In general, though, the entities explored in social ontology largely overlap with those that social scientists work on. A good deal of the work in social ontology takes place within the social sciences (see sections 5.1–5.8). -/- Social ontology also addresses more basic questions about the nature of the social world. One set of questions pertains to the constituents, or building blocks, of social things in general. For instance, some theories argue that social entities are built out of the psychological states of individual people, while others argue that they are built out of actions, and yet others that they are built out of practices. Still other theories deny that a distinction can even be made between the social and the non-social. -/- A different set of questions pertains to how social categories are constructed or set up. Are social categories and kinds produced by our attitudes? By our language? Are they produced by causal patterns? And is there just one way social categories are set up, or are there many varieties of social construction? -/- The term ‘social ontology’ has only come into wide currency in recent years, but the nature of the social has been a topic of inquiry since ancient Greece. As a whole, the field can be understood as a branch of metaphysics, the general inquiry into the nature of entities. (shrink)

The academic community in the West tends to be suspicious of Russian philosophy, often relegating it to another category, such as “ideology” or “social thought.” But what is philosophy? There is no simple universal definition, and many thinkers consider it impossible to formulate one. The most credible attempt is nominalistic: philosophy is the practice in which Plato and Aristotle were involved. As Alfred North Whitehead wrote, “The safest general characterization of the European philosophical tradition is that it consists of a (...) series of footnotes to Plato.”If so, then Russian thought needs to be understood as an important part of the Western philosophical heritage, given that it offers perhaps the most elaborate set of footnotes to Plato's most mature and comprehensive dialogues: the Republic and the Laws. The status of ideas in Russian philosophy mirrors Plato's vision of them as ontological and political entities, “laws,” or ideal principles—as distinct from mere epistemic units or tools of cognition. The Platonic tendency to integrate and implement religious, philosophical, and political teachings culminated in twentieth-century Russia. In the Soviet state, perhaps more than anywhere else in history, philosophy became a supreme legal and political institution, acquiring the power of a suprapersonal, universal reason. Hence thought itself, in the moment of its triumph, became a prisoner in the social structures that Soviet ideocracy erected on a philosophical foundation. In discussing Russian philosophy, we inevitably consider the practical application of Platonic conceptions by the Soviet ideocracy to a state in which philosophy was called upon to rule.According to Sergei Averintsev, the emphasis on Platonism in the Russian intellectual tradition is nothing to be proud of; it should rather be lamented and repented. Despite the obvious Platonic preferences of Russian thinkers (from Ivan Kireyevsky to Aleksei Losev), Averintsev asks whether even now we might be able to reorient the tradition toward Aristotle instead—toward a more secular, tolerant, and analytic philosophy of human nature. “If Plato is the first utopian,” Averintsev writes, “Aristotle is the first thinker to look the spirit of utopia right in the eye and overcome it.... Aristotle's technique of thought is more neutral toward religion than is Plato's ecstasy.” Characteristically, the name index to the Palgrave Handbook of Russian Thought contains almost twice as many mentions of Plato as of Aristotle.Each national tradition has its own “strange attractor,” as they say now in complexity theory. English empiricism, French rationalism, German Idealism, American pragmatism... However stereotypical these generalizations are, they help to clarify the nations’ distinctive contributions to philosophy. Where does Russia stand in this row? I think that Caryl Emerson is correct to pinpoint, among the most distinctive features of the Russian intellectual tradition, the striving for “wholeness” (tselostnost’). Many Russian thinkers seem to evade definitive and particular “isms,” preferring to find ways of complementing (and thus diluting) those that are on offer. Faced with the claims for rationalism, for example, the Russian response tends to be that true rationality is or should be coupled with fullness of feeling. The characteristic Russian “ism” is at best “holism,” at worst “totalitarianism,” and is usually directed against Western thought. Kireyevsky declares: There [in the West] is a bifurcation [razdvoenie] of the spirit, a bifurcation of thoughts, a bifurcation of the sciences, a bifurcation of the state, a bifurcation of estates, a bifurcation of society, a bifurcation of family rights and duties, a bifurcation of morality and the heart.... In Russia, on the contrary, there is a predominant tendency toward the wholeness of the inner and the outer, of public and moral being.Vladimir Solovyov held that the goal of all knowledge was to comprehend “total unity” and to overcome all kinds of unilateralism, which he referred to as “abstract elements” (otvlechennye nachala). These one-sided elements included Realism, rationalism, empiricism, and positivism, all of which had been advanced by Western philosophical movements.Reading the Handbook, I was struck by how steadily, from one thinker to another, the concept of “unity” is reiterated in various synonyms and contexts: “all-unity,” “wholeness,” “totality,” “integrity,” “edinstvo,” “tsel'nost,’” “tselostnost,” “sobornost,” and so forth. Russian thinkers endeavor not to create something original and special but to unify everything that has already been done and known. Consider opponents, like the Slavophiles and Westernizers; take Petr Chaadaev and Vissarion Belinsky, Kireyevsky and Alexander Herzen, Dostoevsky and Solovyov—all are united by this “super-idea,” proclaiming its embodiment to be the all-embracing vocation of the Russian people. At the same time, they sharply reject all “private principles” and “trashy certainty” (Belinsky's driannaia opredelennost’)—anything that restricts and divides individuals or nations. All these forms of privacy and particularity must be overcome on the way to a universal whole that is even greater in scale than Western Catholicism. According to this logic of totality, we would be better off left with nothing than to be content with the particular and the limited. The first original Russian thinker, Chaadaev (1794–1856), makes the salto mortale of declaring Russia a country that has given nothing to the world, then proclaiming that Russia's destiny is to rise above the rest of the world and resolve all its contradictions. From nothing to everything: such are the philosophical foundations for the totalitarian aspiration of Russian thought, which eventually expressed itself in the revolutionary movements and communist experiments of the twentieth century.As is well known, Russian literature is considered in the West a far more powerful and original expression of philosophical ideas than Russian philosophy as such. Characteristically, then, almost half of the Handbook, its entire second part, is devoted to the dialogue of Russian philosophy with literature and art. As M. N. Forster remarks in the Handbook's concluding essay: “It is natural to wonder why this striking asymmetry between relatively modest achievements in pure philosophy and spectacularly high achievements in literature came about.” To the literary focus of Russian philosophy, we can add a political focus. At least a third of part one of the Handbook is devoted to Russian political and revolutionary philosophy, to Lenin and other Marxists, to Ivan Ilyin, and so on. In this context, both literature and politics assumed philosophical dimensions, often overshadowing philosophy itself.Bertrand Russell lamented that the system of philosophical categories in the West featured mostly nouns (being, consciousness, idea, matter, substance, and so forth), omitting adjectives, verbs, prefixes, and other parts of speech. This criticism should be applied to the category philosophy itself. Why the noun philosophy rather than the adjective philosophical, which can be applied to many areas of activity and creativity, including literature and politics?In Russian intellectual history, the philosophical, rather than philosophy, is the predominant category. The state, ideology, economics, politics and geopolitics, literature, art, warfare, space exploration—all these spheres in Russia and the USSR have been and remain abundantly philosophical, subordinated to certain philosophical tasks, though philosophy as such has never been as developed and sophisticated as in the West. As a discipline, Western philosophy “outsourced” itself to Russian disciples, leaving it to Dostoevsky and Tolstoy, Lenin and Trotsky, to test in literary and political practices a host of Western philosophical ideas, from those of Plato, Rousseau, and Hegel to those of Feuerbach, Marx, and Nietzsche.Likewise, the verb to philosophize is used in ways unusual and awkward in the West. “It is characteristic of the Russian people to philosophize [filosofstvovat'],” as Nikolai Berdyaev observed: “An illiterate Russian peasant likes to pose questions of a philosophical nature—about the meaning of life, about God, about eternal life, about evil and untruth, about how to realize the Kingdom of God.” The philosophical and philosophizing, as attributes and actions of the state and society, overpowered philosophy as a noun—as an academic discipline, if you will. Russian philosophy has had a very modest impact on the West, but the impact of the philosophical has been immense. Nineteenth-century Russian literature influenced Western culture with its philosophical interrogations and existential dilemmas, just as, in the twentieth century, the USSR influenced the West with the philosophical ideas (Marxism, materialism, dialectics, collectivism, socialism, communism) that determined Soviet ideology, politics, and economics.In the USSR of the 1920 and 1930s, for instance, philosophy as an independent academic subject was in a subdued position, as a servant of party ideology. But, meanwhile, the sphere of the philosophical spread to such distant domains as theater (Stanislavsky), physiology (Pavlov), and agriculture (Michurin), with all such activities glorified and sponsored by the state as “philosophically correct”—as faithful to “materialism” and “Realism.” Paradoxically, in the quintessentially philosophical state that was the USSR, the state of philosophy, with the repression of all independent thought and thinkers, was miserable. The fateful and often disastrous originality of Russian philosophy consisted precisely in its dissemination to other areas, in an act of kenosis or self-transcendence that can be viewed both as an aggressive philosophical appropriation of politics, economics, ideology, and literature—and as philosophy's sacrificial devotion to the world beyond its professional boundaries.So there are three features that make Russian thought relevant and dangerous: its Platonic utopian aspiration; its spirit of totality; and its tendency to transcend the boundaries of academic philosophy and to philosophize society, politics, and life in general. Russian philosophy has not been as good at explaining the world as at changing it, sometimes ethically and poetically, sometimes violently and aggressively. Teachers and students of Russian culture should be deeply motivated to draw more attention to the philosophical in Russia and to raise its status in the Western academy. In my view, we would do better service to Russian philosophy if we are frank enough to qualify it as dangerous, sometimes very toxic and addictive, fraught with totalistic tendencies. This philosophy is the voice of the “underground,” both in the Dostoevskian and Leninist senses.At the same time, however, the antidotes concocted in the Russian metaphysical laboratory are of enormous value: the Russian versions of personalism, existentialism, secular and religious liberalism, neorationalism, culturology, conceptualism, and postmodernism. These movements, which counteract totalization, need to be studied precisely because they were cooked up and tested under the same extreme conditions in which the most dangerous intellectual poisons have been produced. (shrink)

Disability is primarily a social phenomenon -- a way of being a minority, a way of facing social oppression, but not a way of being inherently or intrinsically worse off. This is how disability is understood in the Disability Rights and Disability Pride movements; but there is a massive disconnect with the way disability is typically viewed within analytic philosophy. The idea that disability is not inherently bad or sub-optimal is one that many philosophers treat with open skepticism, and sometimes (...) even with scorn. The goal of this book is to articulate and defend a version of the view of disability that is common in the Disability Rights movement. To be physically disabled is not to have a defective body, but simply to have a minority body. (shrink)

This book is dedicated to a classic presentation of the theory of computable functions in the context of the foundations of mathematics. Part I motivates the study of computability with discussions and readings about the crisis in the foundations of mathematics in the early 20th century, while presenting the basic ideas of whole number, function, proof, and real number. Part II starts with readings from Turing and Post leading to the formal theory of recursive functions. Part III presents sufficient formal (...) logic to give a full development of Gödel's incompleteness theorems. Part IV considers the significance of the technical work with a discussion of Church's Thesis and readings on the foundations of mathematics. This new edition contains the timeline "Computability and Undecidability" as well as the essay "On mathematics". (shrink)

Instead of treating art as a unique creation that requires reason and refined taste to appreciate, Elizabeth Grosz argues that art-especially architecture, music, and painting-is born from the disruptive forces of sexual selection. She approaches art as a form of erotic expression connecting sensory richness with primal desire, and in doing so, finds that the meaning of art comes from the intensities and sensations it inspires, not just its intention and aesthetic. By regarding our most cultured human accomplishments as (...) the result of the excessive, nonfunctional forces of sexual attraction and seduction, Grosz encourages us to see art as a kind of bodily enhancement or mode of sensation enabling living bodies to experience and transform the universe. Art can be understood as a way for bodies to augment themselves and their capacity for perception and affection-a way to grow and evolve through sensation. Through this framework, which knits together the theories of Charles Darwin, Henri Bergson, Gilles Deleuze, Félix Guattari, and Jakob von Uexküll, we are able to grasp art's deep animal lineage. Grosz argues that art is not tied to the predictable and known but to new futures not contained in the present. Its animal affiliations ensure that art is intensely political and charged with the creation of new worlds and new forms of living. According to Grosz, art is the way in which life experiments with materiality, or nature, in order to bring about change. (shrink)

Social constructionism is often considered a form of anti-realism. But in contemporary feminist philosophy, an increasing number of philosophers defend views that are well-described as both realist and social constructionist. In this paper, I use the work of Sally Haslanger as an example of realist social constructionism. I argue: that Haslanger is best interpreted as defending metaphysical realism about social structures; that this type of metaphysical realism about the social world presents challenges to some popular ways of understanding metaphysical realism.

Much of the literature on the relationship between belief and credence has focused on the reduction question: that is, whether either belief or credence reduces to the other. This debate, while important, only scratches the surface of the belief-credence connection. Even on the anti-reductive dualist view, belief and credence could still be very tightly connected. Here, I explore questions about the belief-credence connection that go beyond reduction. This paper is dedicated to what I call the independence question: just how independent (...) are belief and credence? I look at this question from two angles: a descriptive one (as a psychological matter, how much can belief and credence come apart?) and a normative one (for a rational person, how closely connected are belief and credence?) Ultimately, I suggest that the two attitudes are more independent than one might think. (shrink)

If the world itself is metaphysically indeterminate in a specified respect, what follows? In this paper, we develop a theory of metaphysical indeterminacy answering this question.

Women as commercial baby factories, nature as an economic resource, life as one big shopping mall: This is what we get when we use the market as a common ...

Many evidentialists are impermissivists. But there’s no in-principle reason for this. In this paper, I examine and motivate permissivist evidentialism. Not only are permissivism and evidentialism compatible but there are unique benefits that arise for this combination of views. In particular, permissivist evidentialism respects the importance of evidence while capturing its limitations and provides a plausible and attractive explanation of the relationship between the epistemic and non-epistemic. Permissivist evidentialism is thus an attractive option in logical space that hasn’t received enough (...) attention. (shrink)

In this project I am concerned with the extent to which conceptual engineering happens in domains outside of philosophy, and if so, what that might look like. Specifically, I’ll argue that...

This new and important study of semantic change examines how new meanings arise through language use, especially the various ways in which speakers and writers experiment with uses of words and constructions in the flow of strategic interaction with addressees. In the last few decades there has been growing interest in exploring systemicities in semantic change from a number of perspectives including theories of metaphor, pragmatic inferencing, and grammaticalization. Like earlier studies, these have for the most part been based on (...) data taken out of context. This book is the first detailed examination of semantic change from the perspective of historical pragmatics and discourse analysis. Drawing on extensive corpus data from over a thousand years of English and Japanese textual history, Traugott and Dasher show that most changes in meaning originate in and are motivated by the associative flow of speech and conceptual metonymy. (shrink)

A theoretical platform for a much‐needed change in the provision of healthcare based on restoring the autonomy of doctor–patient relationships.

Since the late 1960s, the legal doctrine of consent has occasionally been subject to severe criticism from within the bioethical discourse. The criticism was often based on observations indicating that consents and refusals, which had been considered valid from legal or institutional points of view, had frequently failed to reflect genuinely autonomous decision making, hence genuinely autonomous choices.This has led several critics to conclude that informed consent is a legal fiction. To clarify the concept, a legal fiction is a supposition (...) of fact taken to be true by the courts of law, irrespective of whether it is true or not, and even though it might not be true .1 What these critics probably meant to say was that the law deems any person who has given a legally valid consent to be genuinely task specifically autonomous, regardless of whether this is true or not and even though it might not be true. In other words, informed consent is a legal fiction, since it presupposes—that is, claims to reflect—genuine task specific autonomy, however baselessly.It was precisely this potentially embarrassing conclusion that prompted Faden and Beauchamp to develop a brilliant and remarkably effective argument in defence of the legal doctrine of consent. In their seminal work, AHistory and Theory of Informed Consent, they indeed acknowledged that effective consent often fails to be compatible with autonomous authorisation . Indeed, they recognised that effective consent does not necessarily entail autonomous authorisation. They argued, however, that the former is not a legal fiction, since it does not presuppose the …. (shrink)

Feminist epistemology has often been understood as the study of feminine "ways of knowing." But feminist epistemology is better understood as the branch of naturalized, social epistemology that studies the various influences of norms and conceptions of gender and gendered interests and experiences on the production of knowledge. This understanding avoids dubious claims about feminine cognitive differences and enables feminist research in various disciplines to pose deep internal critiques of mainstream research.

In a recent paper, Barry Loewer attempts to defend Humeanism about laws of nature from a charge that Humean laws are not adequately explanatory. Central to his defense is a distinction between metaphysical and scientific explanations: even if Humeans cannot offer further metaphysical explanations of particular features of their “mosaic,” that does not preclude them from offering scientific explanations of these features. According to Marc Lange, however, Loewer’s distinction is of no avail. Defending a transitivity principle linking scientific explanantia to (...) their metaphysical grounds, Lange argues that a charge of explanatory inadequacy resurfaces once this intuitive principle is in place. This paper surveys, on behalf of the Humean, three strategies for responding to Lange’s criticism. The ready availability of these strategies suggests that Lange’s argument may not bolster anti-Humean convictions, since the argument rests on premises that those not antecedently sharing these convictions may well reject. The three strategies also correspond to three interesting ways of thinking about relations of grounding linking Humean laws and their instances, all of which are consistent with theses of Humean supervenience, and some of which have been heretofore overlooked. (shrink)

A broad range of intellectual perspectives may be brought to bear on any important social institution. To this general rule, the institution of private property is no exception. The desirability of private property has been endlessly debated across the disciplines: philosophical, historical, economic, and legal. Yet there is very little consensus over its proper social role and limitations. Is it possible to find a unique solution to questions of property and private ownership, good for all resources and for all times? (...) The famous defense of private property that is found in chapter 5 of John Locke'sSecond Treatise of Governmentanswers this question in the affirmative, for Locke writes as though all property was given to mankind in common, and then seeks to find the quickest and most expeditious way to convert all common property into private property. His implicit, but undefended, assumption is that common forms of property are both undesirable and unstable, while private forms of ownership are always just the opposite. Yet his preferred method for moving from a commons to a regime of private property—the unilateral decision to appropriate by each actor—is one that has been frequently condemned as a sop to unbridled egotism, even though it is subject to two constraints: the first against waste, and the second requiring the appropria-tor to leave “enough, and as good” for others. (shrink)

The recently published Report of theAHAG on the Operation of NHS Research Ethics Committees advocates major reforms of the NHS research ethics committees system. The main implications of the proposed changes and their probable effects on the major stakeholders are described.The Ad Hoc Advisory Group on the operation of NHS research ethics committees, set up in November 2004 by Lord Warner on behalf of the Department of Health, submitted its report in June 2005.1 The report advocates major reforms of the (...) research ethics committee system. The primary aim of the report is to streamline the processes around the approval of research projects and to pursue conformity of governance across Europe. Implicit in the report is the contention that failure to achieve this objective would be harmful to everyone with vested interests in improving health and social care. Moreover, it is stated that the reforms will enhance the mechanisms that protect the interests of all parties concerned.1Being mindful of two published critiques of the Warner Report, we suggest that its alleged benefits should not be taken at face value.2,3 In fact, the reformed system will give rise to moral failings akin to those of the existing system, but will differ from the existing system in its effect on the stakeholders. Thus, whereas the outgoing system has given each stakeholder a unique mixture of benefit and harm, the incoming system offers benefit only to sponsors and researchers and nothing but detriment to participants in research and consumers of its products.In the light of this conclusion, we finally suggest that the Warner Report be construed not merely as an ill-considered document, but rather as an ideological reflection of a long-established hegemonic contract fine-tuning itself to contemporary global challenges.To avoid …. (shrink)

Credences are similar to levels of confidence, represented as a value on the [0,1] interval. This chapter sheds light on questions about credence, including its relationship to full belief, with an eye toward the empirical relevance of credence. First, I’ll provide a brief epistemological history of credence and lay out some of the main theories of the nature of credence. Then, I’ll provide an overview of the main views on how credences relate to full beliefs. Finally, I’ll turn to the (...) empirical, and suggest some ways that cognitive science does and could answer questions about credence, such as what credences one has, how credences relate to beliefs, and the extent to which we can control our credences. (shrink)

There is no prepared script for social and cultural life. People work it out as they go along. Creativity and Cultural Improvisation casts fresh, anthropological eyes on the cultural sites of creativity that form part of our social matrix. The book explores the ways creative agency is attributed in the graphic and performing arts and in intellectual property law. It shows how the sources of creativity are embedded in social, political and religious institutions, examines the relation between creativity and the (...) perception and passage of time, and reviews the creativity and improvisational quality of anthropological scholarship itself. Individual essays examine how the concept of creativity has changed in the history of modern social theory, and question its applicability as a term of cross-cultural analysis. The contributors highlight the collaborative and political dimensions of creativity and thus challenge the idea that creativity arises only from individual talent and expression. (shrink)