Abstract:Vulnerability is an important criterion to assess the ethical justification of the inclusion of participants in research trials. Currently, vulnerability is often understood as an attribute inherent to a participant by nature of a diagnosed condition. Accordingly, a common ethical concern relates to the participant’s decisionmaking capacity and ability to provide free and informed consent. We propose an expanded view of vulnerability that moves beyond a focus on consent and the intrinsic attributes of participants. We offer specific suggestions for how (...) relational aspects and the dynamic features of vulnerability could be more fully captured in current discussions and research practices. (shrink)

In this article we report relevant data that shed light on the topic of hope and patients’ expectations in the use of DBS, for standard, approved, and established indications, based on a broader qualitative study on the ethical and social challenges that healthcare providers face in the field of DBS.

Are fragile majorities capable of opening themselves to deep-rooted and new ethnic and cultural pluralism? What role does education play in this process? Based on ten years of comparative research, Fragile Majorities and Education is a nuanced study of ethnic dominance, linguistic integration of immigrants, and diversity in education. Ethnic relations are often depicted in an oversimplified framework where a clear dominant majority exercises power over various minorities. In many societies worldwide, however, this model does not hold true. In some (...) countries, two or more groups possess relatively equal power to control the state and impose their definitions of the nation, as is the case with Flemish speakers and French speakers in Belgium, and with Catholics and Protestants in Northern Ireland. In other instances, such as in Quebec or Catalonia, clearly identifiable majorities are nonetheless minorities at a larger nation-state level, which creates a situation of ambiguous ethnic dominance. Marie McAndrew analyzes and clarifies these complex situations through the lens of education as a means for both maintaining and transforming ethnic boundaries and identities. Deeply insightful and meticulously researched, Fragile Majorities and Education is a groundbreaking contribution to the field of ethnic studies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:EugenicsMary Carrington Coutts (bio) and Pat Milmoe McCarrick (bio)The word eugenics (from the Greek eugenes or well-born) was coined in 1883 by Francis Galton, an Englishman and cousin of Charles Darwin, who applied Darwinian science to develop theories about heredity and good or noble birth (I, Kevles 1985, p. x).The entry under "eugenics" in the Encyclopedia of Bioethics notes that the term has had different meanings in different eras: (...) "a science that investigates methods to ameliorate the genetic composition of the human race; a program to foster such betterment; a social movement; and in its perverted form, a pseudo-scientific retreat for bigots and racists" (V, Ludmerer 1978, p. 457). Kevles, who places a stronger emphasis than Ludmerer on the degeneration of eugenics, says that by 1935 it "had become 'hopelessly perverted' into a pseudoscientific facade for 'advocates of race and class prejudice, defenders of vested interests of church and state, Fascists, Hitlerites, and reactionaries generally'" (I, Kevles 1985, p. 164).Phrases such as "survival of the fittest" and "struggle for existence" came into use at the end of the nineteenth century when eugenics societies were created throughout the world to popularize genetic science. "Negative eugenics" utilized marriage restriction, sterilization, or custodial commitment of those thought to have unwanted characteristics. "Positive eugenics" tried to encourage the population perceived as "superior" to have more offspring (V, Ludmerer 1978, p. 459).In the United States, after World War I, new information, such as the importance of environmental influences and the more complex concept of multi-gene effects in inheritance, diminished the scientific justification for eugenics, but this knowledge did not decrease the pressure for legislation, judicial action, or immigration controls. The U.S. Immigration Restriction Act of 1924 favored immigration from northern Europe and greatly restricted the entry of persons from other areas referred to as "biologically inferior." Between 1907 and 1937, 32 [End Page 163] states required sterilization of various citizens viewed as undesirable: the mentally ill or handicapped; those convicted of sexual, drug, or alcohol crimes; and others viewed as "degenerate" (V, Larson 1991).In Germany, interest in eugenics flourished after the turn of the century when Dr. Alfred Ploetz founded the Archives of Race-Theory and Social Biology in 1904 and the German Society of Racial Hygiene in 1905. The German term Rassenhygiene or race hygiene encompassed more than the word "eugenics;" it included all attempts to improve hereditary qualities as well as measures directed at population increase (III, Weiss 1987). By the 1920s, various German textbooks incorporated ideas of heredity and racial hygiene, and German professors were participating in the international eugenics movement. The Kaiser Wilhelm Institute of Anthropology, Human Heredity, and Eugenics was founded in 1927; by 1933 a sterilization law, the Law for the Prevention of Congenitally Ill Progeny, which originally was entitled "Eugenics in the Service of Public Welfare," indicated compulsory sterilization "for the prevention of progeny with hereditary defects" in cases of "congenital mental defects, schizophrenia, manic-depressive psychosis, hereditary epilepsy... and severe alcoholism." (III, Müller-Hill 1988, p. 10).The co-mingling of science, politics, and Weltanschauung (ideological or religious world view) caused the darkest period for eugenics when Nazi Germans embarked on their "final solution" to the Jewish "problem", or the Holocaust. The Nazi racial-hygiene program began with involuntary sterilizations and ended with genocide. Beginning with the 1933 Law for the Prevention of Congenitally Ill Progeny, 350,000 schizophrenic and other mentally ill persons were involuntarily sterilized, and marriage or sexual contact between Jews and other Germans was banned. Several hundred black children and 30,000 German Gypsies were sterilized. By 1945, when the allies liberated those remaining in Nazi concentration camps, six million Jews, 750,000 Gypsies, and 70,000 German psychiatric patients had been killed by the Nazis (III, Müller-Hill 1992, p. 47). As a result of the German experience, eugenic thought dropped to its nadir, and to the present day, the term "eugenics" invokes a sense of horror in some people.Great Britain, the United States, and Germany were the countries most involved with eugenic science in the first half of this century, but interest was present in Europe and other... (shrink)

We propose Rhythmic Relating for autism: a system of supports for friends, therapists, parents, and educators; a system which aims to augment bidirectional communication and complement existing therapeutic approaches. We begin by summarizing the developmental significance of social timing and the social-motor-synchrony challenges observed in early autism. Meta-analyses conclude the early primacy of such challenges, yet cite the lack of focused therapies. We identify core relational parameters in support of social-motor-synchrony and systematize these using the communicative musicality constructs: pulse; quality; (...) and narrative. Rhythmic Relating aims to augment the clarity, contiguity, and pulse-beat of spontaneous behavior by recruiting rhythmic supports and relatable vitality; facilitating the predictive flow and just-ahead-in-time planning needed for good-enough social timing. From here, we describe possibilities for playful therapeutic interaction, small-step co-regulation, and layered sensorimotor integration. Lastly, we include several clinical case examples demonstrating the use of Rhythmic Relating within four different therapeutic approaches. These clinical case examples are introduced here and several more are included in the Supplementary Material. A suite of pilot intervention studies is proposed to assess the efficacy of combining Rhythmic Relating with different therapeutic approaches in playful work with individuals with autism. Further experimental hypotheses are outlined, designed to clarify the significance of certain key features of the Rhythmic Relating approach. (shrink)

Background:Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions.Objectives:An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions.Review Methods:This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies.Results:Synthesis of the scientific literature revealed (...) inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions.Conclusion:Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended. (shrink)

The importance of ethical consumerism to many companies worldwide has increased dramatically in recent years. Ethical consumerism encompasses the importance of non-traditional and social components of a company's products and business process to strategic success - such as environmental protectionism, child labor practices and so on. The present paper utilizes a random utility theoretic experimental design to provide estimates of the relative value selected consumers place on the social features of products.

Nearly all studies of consumers’ willingness to engage in ethical or socially responsible purchasing behavior is based on unconstrained survey response methods. In the present article we ask the question of how well does asking consumers the extent to which they care about a specific social or ethical issue relate to how they would behave in a more constrained environment where there is no socially acceptable response. The results of a comparison between traditional survey questions of “intention to purchase” and (...) estimates of individuals willingness-to-pay for social attributes in products reveal that simple survey questions are too “noisy” to provide operationally meaningful information and overstate intentions to a considerable extent. (shrink)

... The purpose of this paper is to try to clarify the extent to which consumers “value” ethical product features when making purchases by utilizing a distinctive methodology – structured choice experiments ( Louviere et al., 2000) – that What Will Consumers Pay ... Jordan J. Louviere ... \n.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 35.1 (2002) 1-21 [Access article in PDF] Turning Kant Against the Priority of Autonomy: Communication Ethics and the Duty to Community Pat J. Gehrke Communication ethics scholars afford Immanuel Kant significantly less attention than one might expect. This may be because, as Robert Dostal notes, Kant argues that rhetoric merits no respect whatsoever (223). This rejection of rhetoric, Dostal writes, is grounded in the significant emphasis (...) given to Kant's concept of autonomy (232). The focus on autonomy and, hence, rhetoricians' relative neglect of Kant's ethical theory are both connected to the separation of Kant's Critique of Pure Reason (hereinafter CPuR) from his subsequent ethical and moral philosophy. Kenneth Burke writes that Kant's first critique has no ethical implications, "no 'wills,' 'oughts,' 'shoulds,' or 'thou shalt nots'... nothing but an inevitable is, a description of conditions as they necessarily are for human experience" (191; emphasis in original). Such readings lose much of the richness and complexity of Kant's thought and tend instead to produce simple moral duties, such as Mike Markel's assertion that technical communicators must be truthful.Perhaps the most critical element of Kant's work lost in our focus on autonomy is his articulation of a ground for a duty to community. While Kant makes clear the importance of community for his metaphysics in the first critique (CPuR), the importance of community in Kant's moral philosophy often is overlooked. Some scholars claim that an ethical duty to community is either rejected by Kant's emphasis on the autonomy of will or simply ignored. This article combines a reading of Kant's metaphysics of experience with his moral philosophy to articulate a communication ethic grounded in community. This argument is made in three parts: first, the community of objects in experience—the Third Analogy of Experience—is an organizing principle of and a necessary condition for the possibility of all experience; second, this metaphysical principle of community is relevant [End Page 1] to community as developed in Kant's ethical writings; and finally, Kant's own work undermines the primacy of autonomy and better supports a communication ethic grounded in a duty to community.Scholars interested in Jurgen Habermas's theory of communicative action have special reason to take note of Kant's work. Kant is not only a figure that Habermas sees reflected in his own work, 1 but a constant point of contrast. Craig Calhoun writes that much of Habermas's own philosophy emerges by rejecting Kant's epistemology and elements of his metaphysics while still giving credence to Kantian moral philosophy (2). However, like most communication scholars and philosophers, Habermas believes that autonomy governs Kantian ethics: "Formalistic ethics (Kant) binds the criterion of generality of norms to the further criterion of autonomy, that is, independence from contingent motives" (Habermas, Legitimation 89). Since autonomy excludes or represses the contingent, if our readings of Kant give primacy to autonomy we leave little room for any notion of community as manifest in experience. In no small part, it is the criticism of Kant for privileging autonomy that has given Habermasians their break from Kantian ethics. However, if we turn to the first critique to guide our reading of the moral philosophy, there is another way to understand the role of autonomy and community in Kant's thought. By linking Kant's metaphysics with his moral philosophy, this article turns Kant away from the primacy of autonomy and uses Kant's own works to argue that autonomy is but one half of an antinomy that is organized under the principle of community. Thus, this article recuperates the possibility of deploying Kantian metaphysics and moral philosophy together as grounds for a communication ethic that privileges community and recovers the value of rhetoric.For rhetorical scholars, the resistance to the priority of autonomy may be related to the frequent expression of community through appeal to commonality, sameness, or identification. Today, feminist, race, postmodern, and poststructural communication scholars are questioning the value of commonality as a ground for ethics (e... (shrink)

Much of the scholarship on Kant’s theory of concept formation has focused on the question of whether his theory suffers from circularity, i. e., whether it presupposes the very concepts whose origin it should explain. In this article, I defend Kant against a well-known objection raised by Hannah Ginsborg. Ginsborg, I argue, overlooks the relatively narrow aim of Kant’s theory of concept formation. Kant explicitly frames it as an account of a concept’s inherent generality, or form. However, Ginsborg’s objection is (...) not about a concept’s form; it concerns the concept’s content. Moreover, Kant addresses the issue that she raises in his theory of definitions, which explains how a concept’s content can be revised and perfected. Kant considered all empirical concepts to be incomplete and imprecise. For this reason, he denied that they can be properly defined. Kant also did not regard the content of empirical concepts as fixed or permanent. Indeed, he expected that we would continually expand and revise their content on the basis of experience. I argue that these facts, along with the narrow scope of Kant’s theory of concept formation, effectively defuse Ginsborg’s objection. (shrink)

Using touch as a medium for exploring the ways in which it is constructed by nurses, the body is here characterized by a plethora of competing and co‐existing terms: disobedient, obedient, mirroring, stigmatized, sinful, post‐mortem, sanitized, angelic, desexualized, dangerous, dominant, dominating, deceitful, submissive, disciplined, postmodern and communicative. We have tried to be provocative by juxtaposing contradictory messages and evoking conflicting emotions, and we hope that the reader will not assume that we believe everything we write, or that everything may be (...) taken only at face value. There are as many messages and meanings in the paper as each reader thinks there are. (shrink)

Pierre Bourdieu was one of the most important thinkers of the twentieth century. He argued for, and practiced, rigorous and reflexive scholarship, interrogating the inequities and injustices of modern societies. Through a lifetime's explication of the ways in which schooling both produces and reproduces the status quo, Bourdieu offered a powerful critique and method of analysis of the history of schooling, and of contemporary educational polices and trends. Though frequently used in educational research, Bourdieu's work has had much less take (...) up in Educational Leadership, Management and Administration. Educational Leadership and Pierre Bourdieuargues that ELMA scholars have much to gain by engaging more thoroughly with his work. The book explains each of the key terms in Bourdieu's thinking tool kit, showing how the tripartite concepts of field, habitus and capitals offer a way through which to understand the interaction of structure and agency, and the limits on the freedom of an individual - in this case an educational leader - to act. Educational Leadership and Pierre Bourdieuoffers an analysis of dominant trends in ELMA research, examining the kinds of questions asked, projects undertaken and methods used. It provides alternative questions and methods based on a Bourdieusian approach, further readings and a range of exemplars of the application of these tools. The book will be of interest to those whose primary focus is the utility of Bourdieu's social theory. (shrink)

Any panpsychism building complex consciousness out of basic atoms of consciousness needs a theory of ‘mental chemistry’ explaining how this building works. This paper argues that split-brain patients show actual mental chemistry or at least give reasons for thinking it possible. The paper next develops constraints on theories of mental chemistry. It then puts forward models satisfying these constraints. The paper understands mental chemistry as a transformation consistent with conservation of consciousness rather than an aggregation perhaps followed by the creation (...) of something in addition. The paper suggests that this kind of mental chemistry alone yields a workable panpsychism. (shrink)

This study uses best–worst scaling experiments to examine differences across six countries in the attitudes of consumers towards social and ethical issues that included both product related issues (such as recycled packaging) and general social factors (such as human rights). The experiments were conducted using over 600 respondents from Germany, Spain, Turkey, USA, India, and Korea. The results show that there is indeed some variation in the attitudes towards social and ethical issues across these six countries. However, what is more (...) telling are the similarities seen and the extent to which individual variation dominates observable demographics and country-based variables. (shrink)

On the importance of sociological and political thoughts to develop India.

This study uses best–worst scaling experiments to examine differences across six countries in the attitudes of consumers towards social and ethical issues that included both product related issues (such as recycled packaging) and general social factors (such as human rights). The experiments were conducted using over 600 respondents from Germany, Spain, Turkey, USA, India, and Korea. The results show that there is indeed some variation in the attitudes towards social and ethical issues across these six countries. However, what is more (...) telling are the similarities seen and the extent to which individual variation dominates observable demographics and country-based variables. (shrink)

The most plausible type of panpsychism explains high-level consciousness as a compound of basic conscious properties instantiated by basic bottom-level physical objects. Arguments for panpsychism stand little chance in the absence of an account that makes sense of basic bottom-level experience; and explains how basic bottom-level experiences yield high-level experiences. This paper tackles the first task. It develops a method for investigating basic bottom-level experience: it identifies constraints, motivated by scientific and philosophical considerations, that force a unique account. Then it (...) applies this method, using quarks as stand-ins for basic but conscious physical objects. It concludes that quark-consciousness is maximally simple ; multiple ; and internal. (shrink)

Robert Veatch and others have questioned whether there are internal moral rules of medicine. This paper examines the legal regulatory model for governing professions as the autonomous exercise of professional skills and asks whether there is a theoretical basis for this model. Taking John Rawls’s distinction between the justification of a practice and justification of the rules internal to the practice, this paper argues that the autonomous exercise of professional skills is justified so long as it benefits society. In opposition (...) to Christopher Boorse, it is argued that medicine is pathocentric and that physicians exercise skills in treating pathologies. The autonomous treatmentof pathologies is justified because non-interference with physicians will lead to greater treatment of pathologies and so benefit society. Finally, the analysis of medicine as the autonomous exercise of skills in treating pathologies yields the rule that physicians not be forced to cause pathologies. (shrink)

Because psychiatry deals specifically with ‘mental’ suffering, its efforts are always centrally involved with the meaningful world of human reality. As such, it sits at the interface of a number of discourses: genetics and neuroscience, psychology and sociology, anthropology, philosophy, and the humanities. Each of these provides frameworks, concepts, and examples that seek to assist our attempts to understand mental distress and how it might be helped. However, these discourses work with different assumptions, methodologies, values, and priorities. Some are in (...) dispute with one another. At various times in the history of psychiatry, a particular form of understanding has become dominant and worked to marginalize .. (shrink)

But still I think some account has to be given of the application of CM to tides and cannon balls etc. etc. It seems to me that Einstein's and Bohr's analysis was essentially correct: we make the connection, and thus apply the mathematical statements of CM to macroscopic features of the world about us, by constructing, within the mathematical framework,. macroscopic conglomerates of the elementary particles and fields that should have the general appearance of tides and billiard, looked at from (...) a distance, and that would respond to the probings of mathematical models of measuring devices, whose "pointers" we can see from afar, in the ways that waves and billiard balls do. I think a look at how CM has been used and applied since the time of Newton and Galileo shows that the mathematical theory is linked into our experiences of the world in this nonproblematic way, and that this correspondence at this nonproblematic level is part of classical mechanics in the broad sense in which it is understood by people who use it. (shrink)

Background:Ethical conflict and subsequent nurse moral distress and burnout are common in the intensive care unit (ICU). There is a gap in our understanding of nurses’ perceptions of how organizational resources support them in addressing ethical conflict in the intensive care unit.Research question/objectives/methods:The aim of this qualitative, descriptive study was to explore how nurses experience ethical conflict and use organizational resources to support them as they address ethical conflict in their practice.Participants and research context:Responses to two open-ended questions were collected (...) from critical care nurses working in five intensive care units at a large, academic medical center in the Midwestern region of the United States.Ethical considerations:This study was approved by the Institutional Review Board at the organization where the study took place.Findings:Three main interwoven themes emerged: nurses perceive (1) intensive care unit culture, practices, and organizational priorities contribute to patient suffering; (2) nurses are marginalized during ethical conflict in the intensive care unit; and (3) organizational resources have the potential to reduce nurse moral distress. Nurses identified ethics education, interprofessional dialogue, and greater involvement of nurses as important strategies to improve the management of ethical conflict.Discussion:Ethical conflict related to healthcare system challenges is intrinsic in the daily practice of critical care nurses. Nurses want to be engaged in discussions about their perspectives on ethical conflict and play an active role in addressing ethical conflict in their practice. Organizational resources that support nurses are vital to the resolution of ethical conflict.Conclusion:These findings can inform the development of interventions that aim to proactively and comprehensively address ethical conflict in the intensive care unit to reduce nurse moral distress and improve the delivery of patient and family care. (shrink)

Phenomenology has contributed to healthcare by providing resources for understanding the lived experience of the patient and their situation. But within a burgeoning literature on the characteristic features of illness, there has not yet been an account appropriate to describe congenital illnesses: conditions which are present from birth and cause suffering or medical threat to their bearers. Congenital illness sits uncomfortably with standard accounts in phenomenology of illness, in which concepts such as loss, doubt, alienation and unhomelikeness presuppose prior health. (...) These accounts reflect, in different ways, Maurice Merleau-Ponty’s assumption that the ways of living of the ill contain allusions to fundamental, healthy functions. The originality of congenital illness complicates this assumption and demands its own original phenomenology. In this paper, I sketch my personal experience living with a single-ventricle heart condition. While some of this story may reflect my own idiosyncratic experience, I hope that much of it will resonate with the congenital illness experience. I argue that the phenomenological literature on illness, grounded in the notion of loss, does not describe the congenital illness experience. I show how a number of other patient-centred theories of health and illness which have been influential on phenomenology can and cannot elucidate congenital illness. In particular, I consider Georges Canguilhem’s account of the normal and the pathological; debates in disability; and the notion of illness as biographical disruption. I show that congenital illness results in the preadmission of its patients to a paradoxical logic of medical palliation, one product of which is existential maturity. (shrink)

Phenomenology has a rich tradition of interpreting technology, medicine, and the life sciences. It has not yet had much to say about the medical devices which have always been central to bioethics. In this chapter, I outline what is meant by medical devices, and connect the sense of intention in made-object design with the notion of intentionality in phenomenology. I survey three basic ways of characterising medical devices grounded in the phenomenological literature: Albert Borgmann’s device paradigm, Don Ihde’s human-machine relations, (...) and Merleau-Ponty’s body-subject. Engaging with these approaches could help bring to analyses of medical devices the uniquely whole-of-context view of which phenomenology is capable, and better inform all stakeholders about their phenomenal consequences. (shrink)

This peer commentary opens with setting the context for decisions on the edge of viability through an autoethnographic account (Bochner and Ellis 2016) of the author’s experience of such a situatio...

This article has two aims. First, I offer a philological analysis of a key passage from Kant’s Logic: § 6. § 6 is widely regarded as the locus classicus for Kant’s theory of concept formation. However, I show that the part of this section that is most cited and discussed by scholars should not be attributed to Kant, as it is not corroborated by any of his Reflexionen. Second, I attempt to identify Jäsche’s source for this unsupported passage. Ultimately, I (...) conclude that the unsupported passage in § 6 was based on a set of student notes that was similar to the Wiener and Warschauer logic notebooks. However, I also argue that it would be a mistake to regard this passage as the final or definitive statement of Kant’s views about concept formation. (shrink)