Background: Moral distress is an important and well-studied phenomenon among nurses and other healthcare providers, yet the conceptualization of parental moral distress remains unclear. Objective: The objective of this dimensional analysis was to describe the nature of family moral distress in serious pediatric illness. Design and methods: A dimensional analysis of articles retrieved from a librarian-assisted systematic review of Scopus, CINAHL, and PsychInfo was conducted, focusing on how children, parents, other family members, and healthcare providers describe parental moral distress, both (...) explicitly through writings on parental moral experience and implicitly through writings on parental involvement in distressing aspects of the child’s serious illness. Ethical considerations: To promote child and family best interest and minimize harm, a nuanced understanding of the moral, existential, emotional, and spiritual impact of serious pediatric illness is needed. The cases used in this dimensional analysis come from the first author’s IRB approved study at the Children’s Hospital of Philadelphia and subsequent published studies; or have been adapted from the literature and the authors’ clinical experiences. Findings: Three dimensions emerged from the literature surrounding parent moral distress: an intrapersonal dimension, an interpersonal dimension, and a spiritual/existential dimension. The overarching theme is that parents experience relational solace and distress because of the impact of their child’s illness on relationships with themselves, their children, family, healthcare providers, their surrounding communities, and society. Discussion: Elucidating this concept can help nurses and other professionals understand, mitigate, or eliminate antecedents to parental moral distress. We discuss how this model can facilitate future empirical and conceptual bioethics research, as well as inform the manner in which healthcare providers engage, collaborate with, and care for families during serious pediatric illness. Conclusion: Parent moral distress is an important and complex phenomenon that requires further theoretical and empirical investigation. We provide an integrated definition and dimensional schematic model that may serve as a starting point for future research and dialogue. (shrink)

Recent estimates indicate that over 40,000 children die annually in the United States and a majority have life-limiting conditions. Children at end of life require extensive healthcare resources, including multiple hospital readmissions and emergency room visits. Yet, many children still suffer from symptoms at end of life—including fatigue, pain, dyspnea, and anxiety—with less than 10% of these children utilizing hospice care services. A critical barrier to pediatric hospice use was the original federal regulations associated with the hospice care that required (...) a diagnosis of 6 months to live and the discontinuation of all curative treatments. The Concurrent Care Provision of the United States’ Affordable Care Act eliminated the need to forgo curative therapies in order to enroll in hospice for children in Medicaid or Children’s Health Insurance Program. Concurrent care for children can help mitigate the tension families experience in choosing between essential forms of care, as well as contribute to improved end-of-life outcomes for the child and possibly bereavement outcomes for the family. Understanding concurrent care for children from a social justice perspective has important advocacy and research implications for hospice and palliative care clinicians providing care for children and their families. We apply Powers and Faden’s theory of social justice “as the moral foundation of public health and health policy” to the provision of concurrent care to children near end of life and families in the United States. The goals of applying this theory are to explore additional insights and perspectives into concurrent care policy may provide and to assess the usefulness of this theory when applied to end-of-life health policy. We argue that concurrent care policy is socially just since it has potential to promote well-being in vulnerable children and families and can limit the inequity children at end-of-life experience in access to high-quality hospice care. (shrink)

Background:Collaboration between physicians and nurses is key to improving patient care. We know very little about collaboration and interdisciplinary practice in African healthcare settings.Research question/aim:The purpose of this study was to explore the ethical challenges of interdisciplinary collaboration in clinical practice and education in Botswana Participants and research context: This qualitative descriptive study was conducted with 39 participants (20 physicians and 19 nurses) who participated in semi-structured interviews at public hospitals purposely selected to represent the three levels of hospitals in (...) Botswana (referral, district, and primary).Ethical considerations:Following Institutional Review Board Approval at the University of Pennsylvania and the Ministry of Health in Botswana, participants’ written informed consent was obtained.Findings:Respondents’ ages ranged from 23 to 60 years, and their duration of work experience ranged from 0.5 to 32 years. Major qualitative themes that emerged from the data centered on the nature of the work environment, values regarding nurse–doctor collaboration, the nature of such collaboration, resources available for supporting collaboration and the smooth flow of work, and participants’ views about how their work experiences could be improved.Discussion:Participants expressed concerns that their work environment compromised their ability to provide high-quality and safe care to their patients. The physician staffing structure was described as consisting of a few specialists at the top, a vacuum in the middle that should be occupied by senior doctors, and junior doctors at the bottom—and not a sufficient number of nursing staff.Conclusion:Collaboration between physicians and nurses is critical to optimizing patients’ health outcomes. This is true not only in the United States but also in developing countries, such as Botswana, where health care professionals reported that their ethical challenges arose from resource shortages, differing professional attitudes, and a stressful work environment. (shrink)

A unique and controversial study of Nietzsche's philosophy in relation to Kantian methodologies.

In 1979, neuroscientists Libet, Wright, Feinstein and Pearl introduced the “delay-and-antedating” hypothesis/paradox based on the results of an on-going series of experiments dating back to 1964 that measured the neural adequacy [brain wave activity] of “conscious sensory experience”. What is fascinating about the results of this experiment is the implication, especially when considered in the light of Merleau-Ponty’s notions of “intentionality” and the “pre-reflective life of human motility”, that the body, and hence not solely the mind, is a thinking thing. (...) The experiments and conclusions of Libet et al. have attracted considerable academic attention and have been used in the development of psychological theories on automotivism and the adaptive unconscious. Moreover, they have engendered a series of important considerations in respect of the question of free will. This paper outlines the connections between the findings of Libet et al. and Merleau-Ponty’s ontology as presented in the Phenomenology of Perception. It is not our intention to argue that the former amounts to new wine in old bottles, but rather to show counterfactually that Merleau-Ponty’s ontology provides a theoretical framework which explains the experimental data obtained by Libet et al., and provides further speculative confirmation of the work stemming from neuro-physical research and emerging theories on the adaptive unconscious. (shrink)

Philosophers ask just whose expression, if anyone’s, we hear in lyric poetry. Walton provides a novel possibility: it’s the reader who “uses” the poem (just as a speech giver uses a speech) who makes the language expressive. But worries arise once we consider poems in particular social or political settings, those which require a strong self-other distinction, or those with expressions that should not be disassociated from the subjects whose experience they draw from. One way to meet this challenge is (...) to consider the poem expressive of a plural subject, which frees us from looking for a particular individual whose voice we hear in the work, whether she be fictional or actual. Some lyrics give voice to a group whose experience is attended to in the work. This may be done through a posited fictional speaker, but the ontology of the speaker is shown to be less important. Attending to a group whose concerns are voiced allows us to explain how poems can manage to address our-worldly concerns even when lacking actual persons whose expressions we encounter in the poems. (shrink)

A supplemental text for an Issues in Early Childhood Education or Introduction to Early Childhood Education course in Early Childhood Education departments or in Child and Family Studies departments. Covers five leading theorists whose perspectives are studied and applied widely in early childhood education. The book distills each theorist's work and explains how it relates to early care and education. Brief, inexpensive; a perfect complement to foundational courses.

_This practical and forward-focused book presents a framework that uses social infrastructure to produce effective and inclusive professional development options in education._ Although technology has increased our capacity for social networking both in the digital space and face-to-face, Kira J. Baker-Doyle contends that most professional development opportunities for educators are still fundamentally asocial. She calls for the adoption of humanizing network practices to create meaningful continuing education experiences that leverage the collective knowledge, expertise, and social capital of educators to (...) spark educational change. Baker-Doyle shows how the critical network literacy (CNL) framework overlays critical theory, multiliteracies theory, and social network theory in a way that encourages critical reflection and collaboration among participants. She draws from sources including empirical studies of teacher educators and teacher activists, meta-analytical studies of social network research in education, and professional experience with collective organizing efforts, to detail the many benefits of cultivating CNL in educational spaces. Baker-Doyle provides evidence of how the framework’s practices and protocols can increase transparency, improve representation, and incorporate affirming and restorative discourse. Her work demonstrates how CNL helps create environments that honor teachers’ social identities, their social networks, and the broader social context in which they work. This thought-provoking book is filled with exercises that reinforce social competencies, questions that prompt dialogue and understanding, and real-world examples that underscore the framework's relevance to key educational practices. The generous guidance offered in _Critical Network Literacy_ can be used as a launching point to promote innovation and leadership in teaching. (shrink)

Annotation Scholars of medieval scholastic philosophy as well as those who study semiotics will appreciate this side-by-side translation, with introduction, by Doyle (Saint Louis U.) of a late 16th-early 17th century Jesuit text. The text (its name is taken from the U. of Coimbra, in Portugal, where the authors taught) contains commentaries on Aristotle, as part of a course in philosophy, particularly logic. Annotation c. Book News, Inc., Portland, OR (booknews.com).

This essay provides a subtly new reading of Frantz Fanon's Peau noire, masques blancs through a re-examination of one of its key terms: noirceur, or ‘blackness’. Whi...

Structural injustice broadly refers to objectionable outcomes produced by generally accepted social structures for members of particular social groups. But theorists of structural injustice have said relatively little about why certain outcomes are objectionable, and many theorists suggestively connect structural injustice to a worry about oppression without explaining their precise normative concerns. I provide a normative analysis of structural injustice that addresses this gap and clarifies its connection to oppression. On this view, there are two kinds of structural injustice, each (...) grounded in a distinct moral concern. One is a freedom-based concern for how social structures harmfully constrain members of a social group, depriving them of the means to develop and exercise their capacities. The other is an equality-based concern for how social structures subordinate a social group to others in hierarchies of power, standing, and esteem. By disentangling these concerns, this account shows that our social structures contain multiple kinds of injustice that do not necessarily travel together; some social groups experience unfreedom without being subordinated to others, and indeed their unfreedom is intertwined with their dominant position over subordinated groups. Furthermore, against prevailing philosophical accounts, this analysis shows that there are good reasons to understand oppression primarily as an issue of inequality rather than an issue of unfreedom. (shrink)

This book is part of the growing field of practical approaches to philosophical questions relating to identity, agency and ethics, working across continental and analytical traditions. Kim Atkins explains and justifies the basis of the practical approach through an explication of the structures of human embodiment and an account of how those structures necessitate a narrative model of selfhood, understanding and ethics. She highlights how recent work on agency and autonomy implicitly draws upon conceptions of embodiment and intersubjectivity that underpin (...) the narrative view. (shrink)

The essays collected in this volume address a range of issues that arise when the focus of philosophical reflection on identity is shifted from metaphysical to practical and evaluative concerns. They also explore the usefulness of the notion of narrative for articulating and responding to these issues. The chapters, written by an outstanding roster of international scholars, address a range of complex philosophical issues concerning the relationship between practical and metaphysical identity, the embodied dimensions of the first-personal perspective, the kind (...) of reflexive agency involved in the self-constitution of one’s practical identity, the relationship between practical identity and normativity, and the temporal dimensions of identity and selfhood. In addressing these issues, contributors engage with debates in the literatures on personal identity, phenomenology, moral psychology, action theory, normative ethical theory, and feminist philosophy. (shrink)

This book is part of the growing field of practical approaches to philosophical questions relating to identity, agency and ethics--approaches which work across continental and analytical traditions and which Atkins justifies through an explication of how the structures of human embodiment necessitate a narrative model of selfhood, understanding, and ethics.

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

The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the (...) research team’s understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills. (shrink)

Direction of fit theories usually claim that beliefs are such that they “aim at truth” or “ought to fit” the world and desires are such that they “aim at realization” or the world “ought to fit” them. This essay argues that no theory of direction of fit is correct. The two directions of fit are supposed to be determinations of one and the same determinable two-place relation, differing only in the ordering of favored terms. But there is no such determinable (...) because of ineliminable asymmetries between the way that beliefs “aim at truth” and the way that desires “aim at realization.” This essay traces the ills of direction of fit theory to a misunderstanding of Anscombe and proposes a cure that distinguishes theoretical and practical thought by appeal to a distinction between thought in the form of a state and thought in the form of an event. (shrink)

T he Question of punishment and its justification has been a major preoccupation in recent philosophy of law. The reasons for this growing concern are not difficult to discover. Both philosophers and jurists have become increasingly sceptical of traditional theories of legal punishment. Each of these inherited theories was designed to establish criteria for the recognition and appraisal of punishment as a legal institution. However, alternative theories emphasised different and often conflicting criteria. Some theories emphasised moral desert and retribution, while (...) others appealed to the social utilities of punishment. Failure to reconcile these diverse philosophical viewpoints, through sustained debate over two centuries, has been a major source of intellectual dissatisfaction. (shrink)

Howard S. Cohen and Michael Feldberg, Power and Restraint: The Moral Dimension of Police Work, New York Praeger, 1991; xvii + 166 pp.

1. Chŏngch'i ch'ŏrhak kwa chŏngsin punsŏkhak ŭi mannam -- 2. Han'gugin ŭi chamjae ŭisik kwa chŏngch'i pyŏngni.

Is Anscombean practical knowledge independent of what the agent actually does on an occasion? Failure to understand Anscombe’s answer to this question is a major obstacle to appreciating the subtlety and plausibility of her view. I argue that Anscombe’s answer is negative, and turns on the nature of mistakes in performance, and reveals a distinctive implicit metaphysics of mind and knowledge, structured by related capacities and exercises of capacities. If my interpretation is correct, then practical knowledge shares features with knowledge-how (...) and knowledge-that, but deserves its own epistemic category. (shrink)

The essays collected in this volume address a range of issues that arise when the focus of philosophical reflection on identity is shifted from metaphysical to practical and evaluative concerns. They also explore the usefulness of the notion of narrative for articulating and responding to these issues. The chapters, written by an outstanding roster of international scholars, address a range of complex philosophical issues concerning the relationship between practical and metaphysical identity, the embodied dimensions of the first-personal perspective, the kind (...) of reflexive agency involved in the self-constitution of one’s practical identity, the relationship between practical identity and normativity, and the temporal dimensions of identity and selfhood. In addressing these issues, contributors engage with debates in the literatures on personal identity, phenomenology, moral psychology, action theory, normative ethical theory, and feminist philosophy. (shrink)

This chapter contains sections titled: Zack's Sensitivity Zack's Race Zack's Desire Zack's Violence Music Conclusion Notes.

Decisions about whether or not to become a parent are significant parts of normative human development. Many studies have shown that married different-sex couples are expected to become parents, and that many social pressures enforce this norm. For same-sex couples, however, much less is known about social norms surrounding parenthood within marriage. This study examined injunctive norms and descriptive norms for the pursuit of parenthood as a function of age, gender, and sexual orientation. Participants in an internet survey included 1020 (...) cisgender people from across the United States Findings showed that norms, especially descriptive norms, for the pursuit of parenthood for heterosexual people were much stronger than those for lesbian women and gay men, and that norms for lesbian women were stronger than those for gay men. These differences were more pronounced for older, heterosexual, and male participants. However, lesbian and gay participants, especially gay men, reported that lesbian and gay people ought to become parents to the same extent as heterosexual people. Overall, the results indicated that, regardless of sexual orientation, adults report that lesbian and gay married people ought to become parents, but that they expect only a minority of these couples will pursue parenthood. This research provided a glimpse into how Americans are envisioning family formation among same-sex couples today. (shrink)

All non-nuclear-weapon states are morally and legally obliged by the Nuclear Nonproliferation Treaty (NPT) to refrain from acquiring nuclear weapons. These obligations cannot be overridden for reasons of mere prudence. Only (i) material breaches of the treaty and/or a corresponding; (ii) ‘fundamental change in circumstances’ (rebus sic stantibus) that undermines the integrity of the NPT may override states parties’ legal nonproliferation duties. More than the violations of the NPT by ‘rogue’ states like North Korea or Iran, I argue that the (...) failure of the de jure nuclear-weapon powers since 2001 to uphold their informal and some formal NPT commitments suggests the possibility of material breach and/or institutional subversion. If NPT subversion were to occur, the non-nuclear-weapon states’ collective responsibility to avoid complicity in that subversion leads them to choose between (a) individually seeking nuclear weapons capability for state security; or, more preferably, (b) a publicly announced and collective withdrawal from the NPT that simultaneously refuses to pursue the nuclear weapons option. (shrink)