Adults who are incapacitated and alone, having no surrogates, may be known as “unbefriended.” Decision-making for these particularly vulnerable patients is a common and vexing concern for healthcare providers and hospital ethics committees. When all other avenues for resolving the need for surrogate decision-making fail, patients who are incapacitated and alone may be referred for “public guardianship” or guardianship of last resort. While an appropriate mechanism in theory, these programs are often under-staffed and under-funded, laying the consequences of inadequacies on (...) the healthcare system and the patient him or herself. We describe a qualitative study of professionals spanning clinical, court, and agency settings about the mechanisms for resolving surrogate consent for these patients and problems therein within the state of Massachusetts. Interviews found that all participants encountered adults who are incapacitated and without surrogates. Four approaches for addressing surrogate needs were: work to restore capacity; find previously unknown surrogates; work with agencies to obtain surrogates; and access the guardianship system. The use of guardianship was associated with procedural challenges and ethical concerns including delays in care, short term gains for long term costs, inabilities to meet a patient’s values and preferences, conflicts of interest, and ethical discomfort among interviewees. Findings are discussed in the context of resources to restore capacity, identify previously unknown surrogates, and establish improved surrogate mechanisms for this vulnerable population. (shrink)

Adults who are incapacitated and alone, having no surrogates, may be known as “unbefriended.” Decision-making for these particularly vulnerable patients is a common and vexing concern for healthcare providers and hospital ethics committees. When all other avenues for resolving the need for surrogate decision-making fail, patients who are incapacitated and alone may be referred for “public guardianship” or guardianship of last resort. While an appropriate mechanism in theory, these programs are often under-staffed and under-funded, laying the consequences of inadequacies on (...) the healthcare system and the patient him or herself. We describe a qualitative study of professionals spanning clinical, court, and agency settings about the mechanisms for resolving surrogate consent for these patients and problems therein within the state of Massachusetts. Interviews found that all participants encountered adults who are incapacitated and without surrogates. Four approaches for addressing surrogate needs were: work to restore capacity; find previously unknown surrogates; work with agencies to obtain surrogates; and access the guardianship system. The use of guardianship was associated with procedural challenges and ethical concerns including delays in care, short term gains for long term costs, inabilities to meet a patient’s values and preferences, conflicts of interest, and ethical discomfort among interviewees. Findings are discussed in the context of resources to restore capacity, identify previously unknown surrogates, and establish improved surrogate mechanisms for this vulnerable population. (shrink)

The role of a corporation is often debated as a mutually exclusive choice between economic responsibility to shareholders and social responsibility to society. An evolving viewpoint embraces an integrated approach focused on long-term value creation for shareholders which benefits other stakeholders. Maximizing long-term shareholder value as a corporate objective can be compatible with stakeholder theory when an enlightened shareholder maximization strategy is embraced. Firms implementing an enlightened shareholder maximization strategy are expected to make decisions and use resources which (...) achieve long-term value-creating outcomes. However, critics of enlightened shareholder maximization as a corporate goal contend this strategy conflicts with maximizing shareholder value. This study explores whether firms which embrace a balanced enlightened shareholder maximization strategy indeed create long-term value which does not sacrifice shareholder wealth. (shrink)

Setting the terms of praise‐ and blameworthiness has long dominated philosophers’ discussions of responsibility. Analytic philosophy has most often looked to reason and the abstract relations between individual rational judgements and actions to advance the discourse on moral responsibility. Those whose capacity for reasoned judgement is impaired are deeply problematic. Is it proper to morally appraise ‘the mentally ill’? The philosopher T.M. Scanlon discusses moral responsibility as a precondition of moral appraisal and contends that it is not appropriate to (...) appraise a person as (morally) praise‐ or blameworthy if that person cannot be held responsible for the action(s) for which he is being praised or blamed. What are the conditions, then, under which one can properly be said to be responsible for one's actions? Can one hold ‘the mentally ill’ responsible for their actions? If not, can it in any way be reasonable to expect them to ‘take responsibility’ for their actions and/or characters? The expectation that ‘the mentally ill’ will attempt to control, i.e. take responsibility for their behaviour despite the fact of their mental illness is a pervasive feature of psychiatric approaches to the care and treatment of ‘the mentally ill’. It would seem that such treatment approaches are coherent only to the degree ‘the mentally ill’ can be considered responsible moral agents. This paper explores these issues with regard to that form of mental illness categorized as the personality disorders. It describes the morally and clinically relevant features of personality disorder, explains how they do not fit traditional analytic paradigms of ‘mental illness’ and elaborates the argument that persons with this category of mental illness are fully moral persons who are rightly subject to praise and blame. (shrink)

ABSTRACTHIV/AIDS harms the viability and competitiveness of African businesses. As a consequence, companies increasingly subscribe to the view that taking a proactive role to combat HIV/AIDS is not simply a question of compassion and good corporate citizenship. Rather, these firms see assertive action against HIV as critical to their long‐term profitability, and some have concluded that it is cost effective even in the short term. The article discusses how South African companies are taking action against HIV in ways that (...) set new benchmarks, enhance the effectiveness of international AIDS advocacy efforts, and spur businesses across Africa and beyond to strengthen their corporate responses to HIV/AIDS. (shrink)

Tinkering with technologies and other human-made artifacts is a longstanding practice. Freedom to tinker has largely existed without formal legal recognition. Tinkering has typically taken place in an unregulated zone within which people were at liberty to act unobstructed by others so long as they did not harm others. The main reason why it now seems desirable to articulate some legal principles about freedom to tinker and why it needs to be preserved is because freedom to tinker is being (...) challenged by some legal developments. This Article explains that user-innovators have traditionally had considerable freedom to tinker under trade secrecy, patent, and trademark laws. Although copyright law permits a modest degree of tinkering with existing products, it restricts freedom to tinker more than other IP laws. Copyright law and sometimes contract law place substantial constraints on user rights to tinker with and modify computer programs and other digital works. These constraints are of particular concern to tinkerers because computer programs are embedded in such a wide range of technologies these days. This Article offers suggestions about how and why the law should protect a zone of freedom to tinker for socially beneficial purposes. (shrink)

This paper discusses the tenability of John Greco's solution to the problems of the nature and value of knowledge in his book, Achieving knowledge (2010). Divided into two parts, the discussion (1) specifies how both problems have developed until the current period and (2) determines whether Greco, with his virtue reliabilism, supplies an adequate solution to both problems. I take the view that regardless of Greco's adoption of a contextualist semantics, his epistemic theory remains inadequate so long as it (...) is unable to specify the extent to which a person's abilities can be appropriately involved in the attainment of knowledge or any success from ability. (shrink)

In spite of the seemingly omnipresent corruption and Mafia activity plaguing modern Russia it is nevertheless possible, and desirable, to conduct business ethically there, as the author testifies. Pamela Woolley has recently completed a full time MBA at London Business School, prior to which her career was in international telecommunications. She has long been interested in Russia and worked in Moscow during the summer between her two years of study. The experience has prompted her to seek a more (...) permanent position in the region and was the impetus behind writing this article. She also wishes to thank Dr Jan Dauman of InterMatrix Group for his interest and contribution to the information gathered in the preparation of this article. (shrink)

In spite of the seemingly omnipresent corruption and Mafia activity plaguing modern Russia it is nevertheless possible, and desirable, to conduct business ethically there, as the author testifies. Pamela Woolley has recently completed a full time MBA at London Business School, prior to which her career was in international telecommunications. She has long been interested in Russia and worked in Moscow during the summer between her two years of study. The experience has prompted her to seek a more (...) permanent position in the region and was the impetus behind writing this article. She also wishes to thank Dr Jan Dauman of InterMatrix Group for his interest and contribution to the information gathered in the preparation of this article. (shrink)

Spirituality and spiritual care have long been kept separate from patient care in mental health, primarily because it has been associated with psycho-pathology. Nursing has provided limited spiritual care competency training for staff in mental health due to fears that psychoses may be activated or exacerbated if religion and spirituality are addressed. However, spirituality is broader than simply religion, including more existential issues such as providing non-judgmental presence, attentive listening, respect, and kindness. Unfortunately, healthcare personnel working in mental health (...) institutions are not well prepared to address spiritual concerns or resources of their patients. Therefore, a mixed-method pilot study was conducted using a self-assessment survey tool to examine spiritual care competencies of mental health staff in Norway and to understand the perspectives of mental health staff in the Scandinavian context. Five questions and comments related to survey items provided rich qualitative data. While only a small pilot with 24 participants, this study revealed a need for spiritual care educational materials targeted specifically for those who work in mental health, materials that address the approach of improving attitudes, enhancing skills, and increasing knowledge related to spirituality and spiritual care of patients. (shrink)

Nurses have a long tradition of storytelling. Nurses in the New Zealand government’s Backblocks Nursing Service, established in 1909 for settlers in remote rural areas, related narratives of personal experience in articles, conference papers and letters to their chief nurse that were published in the country’s nursing journal. Analysis of the 16 stories published between 1910 and 1915 revealed 14 had a common storyline and structure. Structural elements included a call, arduous journey, arrival and reconnaissance, trial (difficult case or (...) circumstance), resolution and homily. Using a literary folkloristics approach, this article argues that repetition of the story by nurses in different regions traditionalised it as a professional folktale, ‘The nurse’s odyssey’. It enabled nurses to debrief from difficult cases and write‐into‐being this new role and practice. Striking differences in the practice setting ensured the story’s reportability, while clinical details connected writer and readers through a common professional aesthetic context and strengthened the story’s credibility. For the chief nurse who was also a journal editor, publishing the stories allowed her to potentially attract nurses to the service while alerting them to its harsh realities, and show policy‐makers the profession’s value in meeting new health service needs. (shrink)

I here press an often overlooked question: Why does the fairness of a sanction require an adequate opportunity to avoid it? By pressing this question, I believe I have come to better understand something that has long puzzled me, namely, what philosophers (and others) might have in mind when they talk about “true moral responsibility,” or the “condemnatory force” of moral blame, or perhaps even “basic desert.” In presenting this understanding of “condemnation” or of “basic desert,” I am presenting (...) an idea that I do not, myself, endorse—one to which I am, myself, opposed. I present and defend it, hoping that, if what I say accurately captures what people have in mind, it will also show how condemnation or desert, in this sense, can be left behind. (shrink)

This volume, along with Volume V, completes the edition of the long English Wycliffite sermon cycle and two related tracts; the first three volumes, published in 1983, 1987 and 1990, contained the texts of the 294 sermons, together with variants and some introductory material. This volume contains a review of the evidence concerning the date, authorship and audience of the sermons, followed by a survey of the main polemical issues repeatedly under discussion in the sermons and by a commentary (...) on the text, which is continued in Volume V. The material here, along with the introductions to the three text volumes, will enable scholars to assess the background and importance of this extensive body of vernacular preaching. In particular, the discussion traces the large debt of the sermons to a wide range of Wyclif's own Latin works, and shows their relationship to other works of the Wycliffite movement. (shrink)

This volume completes the edition of the long English Wycliffite sermon cycle and two related tracts; This final volume contains a detailed commentary on the text, essential for the study of the earlier text volumes. The material here, along with the introductions to the three text volumes and the survey of the main polemical issues repeatedly under discussion in the sermons in Volume IV, will enable scholars to assess the background and importance of this extensive body of vernacular preaching, (...) tracing the sermons, debt to a wide range of Wyclif's own Latin works, and reveals their relationship to other works of the Wycliffite movement. (shrink)

This series was inaugurated last year, the year which marked the 350th anniversary of Rene Descartes' first published writing, the Discourse on Method and Essays. Like that writing, this important series, admirably edited by Willis Doney, is both the first of its kind, and a survey of all parts of Cartesian philosophy. It likewise promises to be tremendously beneficial to its readers: by making available valuable books and articles long out of print by a variety of interpreters and on (...) virtually every Cartesian writing, it invites us to reevaluate the state of Cartesian studies altogether. (shrink)

The Arabic translation of the De Gen. Anim., made at the beginning of the ninth century by Yahyā ibn al-Bitrīq from a Syriac version, contains seven long omissions, noted by Drossaart Lulofs in his edition. Six of these represent approximately 110 letters or a multiple thereof in the Greek: 728b33–729a2 , 761a9–25 , 762a6–8 , 762b34–763a2 , 768a18–20 and 781a7–12 . The seventh omission is too long to be useful, as the scope for accidental errors is too great.

The Arabic translation of the De Gen. Anim., made at the beginning of the ninth century by Yahyā ibn al-Bitrīq from a Syriac version, contains seven long omissions, noted by Drossaart Lulofs in his edition. Six of these represent approximately 110 letters or a multiple thereof in the Greek: 728b33–729a2, 761a9–25, 762a6–8, 762b34–763a2, 768a18–20 and 781a7–12. The seventh omission is too long to be useful, as the scope for accidental errors is too great.

This paper describes a pilot study of a new model for narrative medicine training, “community-based participatory narrative medicine”, which centers on shared narrative work between healthcare trainees and patients. Nine medical students and eight patients participated in one of two, five-week-long pilot workshop series. A case study of participants’ experiences of the workshop series identified three major themes: the reciprocal and collaborative nature of participants’ relationships; the interplay between self-reflection and receiving feedback from others; and the clinical and pedagogical (...) implications of the CBPNM model. Principles and proposed outcomes of the CBPNM model are presented. (shrink)

Roderick T. Long - Aristotle on the Category of Relation - Journal of the History of Philosophy 45:1 Journal of the History of Philosophy 45.1 149-150 Muse Search Journals This Journal Contents Reviewed by Roderick T. Long Auburn University Pamela M. Hood. Aristotle on the Category of Relation. Lanham, MD: University Press of America, 2004. Pp. xi + 154. Paper, $28.00. It is often assumed that Aristotle cannot have an adequate understanding of relations, and in particular that (...) "his substance-accident ontology and his reduction of propositions to the logical structure of subject-predicate form" compel him to treat relations as monadic properties of the relata. But as Hood shows in this book, Aristotle's theory does indeed make room for dyadic predicates—meaning not just that he employs such.. (shrink)

The coronavirus disease 2019 pandemic is altering dynamics in academia, and people juggling remote work and domestic demands – including childcare – have felt impacts on their productivity. Female authors have faced a decrease in paper submission rates since the beginning of the pandemic period. The reasons for this decline in women’s productivity need to be further investigated. Here, we analyzed the influence of gender, parenthood and race on academic productivity during the pandemic period based on a survey answered by (...) 3,345 Brazilian academics from various knowledge areas and research institutions. Productivity was assessed by the ability to submit papers as planned and to meet deadlines during the initial period of social isolation in Brazil. The findings revealed that male academics – especially those without children – are the least affected group, whereas Black women and mothers are the most impacted groups. These impacts are likely a consequence of the well-known unequal division of domestic labor between men and women, which has been exacerbated during the pandemic. Additionally, our results highlight that racism strongly persists in academia, especially against Black women. The pandemic will have long-term effects on the career progression of the most affected groups. The results presented here are crucial for the development of actions and policies that aim to avoid further deepening the gender gap in academia. (shrink)

This collection of original articles, written by leading contemporary European and American philosophers of religion, is presented in celebration of the publication of the fiftieth volume of the International Journal for Philosophy of Religion. Following the Editor's Introduction, John Macquarrie, Adriaan Peperzak, and Hent de Vries take up central themes in continental philosophy of religion. Macquarrie analyzes postmodernism and its influence in philosophy and theology. Peperzak argues for a form of universality different from that of modern philosophy, and de Vries (...) analyzes an intrinsic and structural relationship between religion and the media. The next three essays discuss issues in analytic philosophy of religion. Philip Quinn argues that religious diversity reduces the epistemic status of exclusivism and makes it possible for a religious person to be justified while living within a pluralistic environment. William Wainwright plumbs the work of Jonathan Edwards in order to better understand debates concerning freedom, determinism, and the problem of evil, and William Hasker asks whether theological incompatibilism is less inimical to traditional theism than some have supposed. Representing the Thomist tradition, Fergus Kerr challenges standard readings of Aquinas on the arguments for the existence of God. David Griffin analyzes the contributions of process philosophy to the problem of evil and the relation between science and religion. Illustrating comparative approaches, Keith Ward argues that the Semitic and Indian traditions have developed a similar concept of God that should be revised in view of post-Enlightenment theories of the individual and the historical. Keith Yandell explores themes in the Indian metaphysical tradition and considers what account of persons is most in accord with reincarnation and karma doctrines. Feminist philosophy of religion is represented in Pamela Anderson's article, in which she argues for a gender-sensitive and more inclusive approach to the craving for infinitude. (shrink)

The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of (...) family life, and the intensive utilization of resources—combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay.In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to making clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital. (shrink)