Advance care directives for health care have been promoted as a way to improve end-of-life decision making. These documents allow a patient to state, in advance of incapacity, the types of medical treatments they would like to receive, to name a surrogate to make those decisions, or to do both. Although studies have shown that both physicians and patients generally have positive attitudes about the use of these documents, relatively few individuals have actually completed one.What underlies this discrepancy between attitudes (...) and behavior with regard to advance care directives? One obvious explanation is lack of access. Emanuel et al. estimated that approximately 90 percent of the population desire an advance care directive, and they pointed to access as the major barrier. Yet interventions that increase accessibility have typically failed to yield more than a 20 percent completion rate. Thus, it appears that access is not the sole determinant of advance care directive completion. (shrink)

A major shift has taken place since the 1960s concerning disclosure to patients that they have a diagnosis of cancer and that their disease is considered terminal. Full disclosure is now considered the patient's right in the United States. However, there remain many countries in which nondisclosure is still the norm. When patients from those countries are diagnosed with cancer in America, differences in attitudes and expectations can cause conflict and misunderstanding.

This edited collection examines the means to create, maintain, and enhance positive educational experiences at colleges and universities in the United States and abroad with personal accounts, case studies, models, programs, and other frameworks written by practitioners in higher education.

The under-reporting of sexual abuse reduces the chances of winning the battle against sexual abuse of women and children in Zimbabwe. It leaves girl children powerless and vulnerable, despite the country’s determination to put an end to injustice and gender discrimination in line with the Sustainable Development Goals (SDGs), in particular, SDG 5, which focuses on gender and equality, and SDG 16, which is concerned with justice and peace. The aim of this study was to explore the barriers to reporting (...) sexual abuse in Ruwa. Informed by the human rights-based approach, the study adopted a quantitative research design. Survey data were solicited from 51 randomly selected female respondents. Results revealed that 69% of the respondents were abused, yet only 2% of the total respondents reported the abuse to authorities, while 67% did not report incidences of abuse. About 98% of respondents believed that most sexual abuse cases in Ruwa went unreported. Results also showed that barriers to reporting sexual abuses comprised cultural and economic factors, most of which were characterised by shame, embarrassment, and fear, as well as the desire to protect male breadwinners. The results are consistent with existing literature generalisations on sexual abuse, particularly in terms of the prevalence of sexual abuse and under-reporting. It is also argued that culture is the determinant factor for most of the barriers to reporting sexual abuse, as well as the effects of reporting.Based on the results and in view of promoting and protecting human rights associated with sexuality, the study recommends that local authorities and social institutions implement awareness programmes and campaigns on reporting sexual abuse in the community.Contribution: This study is the first of its kind in Ruwa. Its significance is embedded in how it reflects on the role played by culture, religion and societal views on matters of sexual abuse. (shrink)

Six articles discuss the benefits and disadvantages of postmodern philosophy as a foundation for social work and human service practice. Simultaneously co-published as Social Thought, v.18, no.3 1998. Annotation copyrighted by Book News, Inc., Portland, OR.

This chapter corrects for Susan Sontag's undeserved neglect by contemporary ethical philosophers by bringing awareness to some of the unique metaethical insights born of her reflections on photographic representations of evil. I argue that Sontag's thought provides fertile ground for thinking about: (1) moral perception and its relation to moral knowledge; and (2) the epistemic and moral value of our emotional responses to the misery and suffering of others. I show that, contrary to standard moral perception theory (e.g. Blum 1994), (...) Sontag holds that we can have general moral perceptual knowledge. I then explore Sontag's idea that certain emotional responses, like sympathy and compassion, can sometimes be impertinent, in virtue of their having false or illusory content. I explain why this is so, and show the epistemic and motivational problems it poses for moral sentimentalism. (shrink)

Emotional hardcore and other music genres featuring screamed vocals are puzzling for the appreciator. The typical fan attaches appreciative value to musical screams of emotional pain all the while acknowledging it would be inappropriate to hold similar attitudes towards their sonically similar everyday counterpart: actual human screaming. Call this the screamed vocals problem. To solve the problem, I argue we must attend to the anti-sublimating aims that get expressed in the emotional hardcore vocalist’s choice to scream the lyrics. Screamed vocals (...) help us see the value in rejecting (a) restrictive social norms of emotional expressiveness and (b) restrictive artistic norms about how one ought to express or represent pain in art, namely that if one is going to do so they must ensure the pain has been ‘beautified’. In developing this second point I argue that emotional hardcore is well-suited (though not individually so) for putting pressure on longstanding views in the history of aesthetics about the formal relationship between art and human pain. (shrink)

Traditional measurement of multisensory facilitation in tasks such as speeded motor reaction tasks (MRT) consistently show age-related improvement during early childhood. However, the extent to which motor function increases with age and hence contribute to multisensory motor reaction times in young children has seldom been examined. Thus, we aimed to investigate the contribution of motor development to measures of multisensory (auditory, visual, and audiovisual) and visuomotor processing tasks in three young school age groups of children (n = 69) aged (5−6, (...) n = 21; 7−8, n = 25.; 9−10 n = 18 years). We also aimed to determine whether age-related sensory threshold times for purely visual inspection time (IT) tasks improved significantly with age. Bayesian results showed decisive evidence for age-group differences in multisensory MRT and visuo-motor processing tasks, though the evidence showed that threshold time for visual identification IT performance was only slower in the youngest age group children (5−6) compared to older groups. Bayesian correlations between performance on the multisensory MRT and visuo-motor processing tasks indicated moderate to decisive evidence in favor of the alternative hypothesis (BF10 = 4.71 to 91.346), though not with the threshold IT (BF10 < 1.35). This suggests that visual sensory system development in children older than 6 years makes a less significant contribution to the measure of multisensory facilitation, compared to motor development. In addition to this main finding, multisensory facilitation of MRT within race-model predictions was only found in the oldest group of children (9−10), supporting previous suggestions that multisensory integration is likely to continue into late childhood/early adolescence at least. (shrink)

This chapter offers a general outline of Schopenhauer’s peculiarly named concept of the 'acquired character’ and explains its basic function in his ethical thought. For Schopenhauer, a person of acquired character is someone who knows the ways of acting (Handlungsweise) that are most expressive of their individuality and who allows that self-knowledge to structure their practical and emotional life. In keeping with certain elements of his psychological determinism, acquired character is not the acquisition of a ‘new’ character; rather, it is (...) the acquisition of self-knowledge of one’s essentially fixed empirical character. It is part of the argument of this chapter that by introducing the acquired character into his reflections on human action and agency Schopenhauer weaves a certain view of individual flourishing (eudaimonia) into his ethics. There are two central ingredients of Schopenhauer’s conception of eudaimonia, and both are linked to the acquired character. The first is self-knowledge; the second is a sense of personal autonomy that follows in the wake of the first. The chapter ends with a brief attempt to connect Schopenhauer’s concept of acquired character to contemporary debates in ethics concerning autonomy, practical identity, and what some call the ‘normative significance of self’. (shrink)

This dissertation develops a reading of Arthur Schopenhauer’s theory of agency and autonomy that centers on the notion of the acquired character. I argue for a non-homuncular functionalist reading of Schopenhauerian self-government. On my reading, to be self-governing in Schopenhauer’s sense is just for a certain organizational structure to obtain between one’s individual character and one’s motivation. This structure is put in place through the hard-fought achievement of acquiring genuine self-knowledge of one’s characteristic patterns of acting, evaluative commitments, and, most (...) importantly, one’s volitional necessities. This is the achievement of what he calls the 'acquired character'. My reading also stresses the importance of the phenomena of self-expression and sublimation for Schopenhauer's view of autonomy. I also explore the overlap between Schopenhauer's views and contemporary non-homuncular models of agency, particularly Harry Frankfurt’s hierarchical model of agency, on the one hand, and Michael E. Bratman’s planning theory of autonomous self-governance, on the other. Whereas others have been skeptical of the very idea of Schopenhauerian autonomy, I argue that these reservations rest on a failure to recognize the non-homuncular option. An exploration of contemporary philosophical work on agency helps make this point stick. In the final chapter, I propose that we can see Nietzsche's famous prescription that we ‘give style' to our character as carrying forward certain elements of Schopenhauer's view of autonomy, particularly its aesthetic dimensions. This accomplishes two things. First, it shows that Schopenhauer's influence on Nietzsche goes deeper into the latter's ethical thought than many tend to think. Second, it points towards an elaboration of the view of Schopenhauerian autonomy that I establish earlier on. With the aesthetic dimensions of agency in view, acquired character can be seen as a process through which an agent develops an individual style of acting; it is a process through which one comes to fully act within themselves by embodying their character, just as the best stage and screen actors do. (shrink)

Spontaneous abortion is rarely addressed in moral evaluations of abortion. Indeed, 'abortion' is virtually always taken to mean only induced abortion. After a brief review of medical aspects of spontaneous abortion, I attempt to articulate the moral implications of spontaneous abortion for the two poles of the abortion debate, the strong pro-abortion and the strong anti-abortion positions. I claim that spontaneous abortion has no moral relevance for strict pro-abortion positions but that the high incidence of spontaneous abortion is not (as (...) some claim) eo ipso any sort of justification for voluntarily induced abortion. Secondly, I show that if the strict anti-abortionist position is to be taken seriously in its insistence that prenatal life has a right to be protected by virtue of its being conceived, then it seems necessary to take measures to prevent spontaneous abortion and its presumptive causes, and this as a matter of moral obligation. (shrink)

Much of the legal and social interest in new neuroimaging techniques stems from the belief that they can deliver on the materialist understanding of the relationship between the brain and the mind. This article looks at predictions about the future both of scientific advances and of social reactions to those predictions. It looks at the likely technical limits on neuroscience-based mindreading, then at the likely limits in how the law might use such technologies. It describes three kinds of technical barriers (...) to detailed and useful mindreading: the likely impossibility of making a complete and accurate model of a human brain in light of its incredible complexity, the problems of interpersonal and intrapersonal plasticity, and the problem of trying to read, now, someone's past mental state. The potential changes to the operation of the law, through the use of mindreading as evidence of pain, deception, or bias, among other things, could be extremely important. (shrink)

There is limited consensus about what constitutes humanly sensitive care, or how it can be sustained in care settings. A new humanised care assessment tool may point to caring practices that are up to the task of meeting persons as humans within busy healthcare environments. This paper describes qualitative development of a tool that is conceptually sensitive to human dimensions of care informed by a life‐world philosophical orientation. Items were generated to reflect eight theoretical dimensions that constitute what makes care (...) feel humanly focused. An action research group process in 2014–2015 with researchers, service users, healthcare professionals in two diverse clinical settings (stroke rehabilitation and dermatology) was used. Feedback on conceptual content, transparency of meaning and readability was then gained from a panel in Sweden and third‐year student nurses in the UK. The tool can be applied to attune staff to human dimensions of care, offering items which point to concrete examples of humanising and dehumanising features of practice in ways that have not yet been fully captured in the caring literature. Based on theoretically led experiential items, with dedicated focus on what makes people feel more, or less than human, it may offer improvement on available assessments of care. (shrink)

This work serves as an introduction to both the theoretical and practical aspects of using computers to improve the delivery of social services. Though many practitioners believe that computerization dehumanizes clients and should be avoided, John Murphy and John Pardeck demonstrate how, through a holistic approach to computer use, this problem, and others like it, can be averted. By providing practitioners the opportunity to sharpen their conceptual skills in computer technology, this book promotes a rational understanding of the possible (...) uses and limitations of computers in social service agencies. Unlike other, technically-oriented works in this field, Murphy and Pardeck's work focuses on the philosophical justification of computer use, along with the conceptual or symbolic nature of computerization. They fully illustrate how to create the organizational conditions necessary for computers to improve social-service delivery, and they do so in a manner that is easily accessible for both general classroom and professional use. Among the topics addressed are the technological world-view, Western philosophy, and knowledge; computer mediated therapy; ethical issues related to computerized service delivery; and construction of a socially responsible technology. This work will be a unique and important resource for courses in computer applications, policy analysis, and social service administration, as well as a useful reference source for human service agencies and practitioners. Public and academic libraries will also find it to be a valuable addition to their collections. (shrink)

Reason and Rationality in Health and Human Services Delivery is the first book to discuss the topic of decisionmaking and services from a multidisciplinary approach. It uses theory and social considerations, not just technology, as a basis for improved services. Health and human service students and professionals will learn how to form rational and reasonable decisions that take their clients'cultural backgrounds into consideration when identifying an illness or appropriating any kind of intervention. With a particular emphasis on theories, models, organizational (...) settings, technologies, and practitioner training methods that lead to culturally sensitive decisions, Reason and Rationality will help you deliver efficient and improved medical and social services to clients from all ethnic backgrounds. Recognizing reason as the centerpiece of most of Western philosophy, this text reveals how our idea of truth, fact, and order are wrongly thought to be universal; yet, Western principles are continually used in the decision-making process for health and social services. Focusing on the policy implications of decisionmaking in medical and social service settings, this text works to incorporate a broad range of factors into the reasoning process, such as cultural traditions and beliefs, that will result in better treatment for patients. Giving you suggestions and strategies for upgrading reasoning and decision-making processes and applying them to every area of service, Reason and Rationality discusses different themes that will help you improve services to patients, such as: the rationale currently used to justify decision-making strategies concerning medical and human services using computer technology to make clinical assessments revising administrative structure, management theories, and organizational strategies so that decision-making processes enhance the overall quality of service delivery how the practitioner/patient relationship is important in choosing the proper treatment soliciting community-based input to assess the public's health and human service needs in order to lessen political involvement in decision-making stages In addition, Reason and Rationality provides information and examples that show why you should consider the "life-world"--the values, beliefs, and commitments of a culture's history-- as the key to understanding the powers of reasoning that specify parameters of health and illness. (shrink)

There are religious and philosophical versions of the thesis that AIDS is a punishment for homosexual behaviour. It is argued here that the religious version is seriously incomplete. Because of this incompleteness and because of the indeterminacies that ordinarily attend religious argumentation, it is concluded that the claim may be set aside as unconvincing. Homosexual behaviour is then judged for its morality against utilitarian, deontological, and natural law theories of ethics. It is argued that such behaviour involves no impediment to (...) important moral goals and is not therefore immoral. Where natural law might be used to condemn homosexual behaviour, it is argued that the theory itself is not well established. Consequently there is a prima facie reason for rejecting the philosophical version of the punishment thesis. This conclusion is further supported by noting the lack of proportion between the purported immorality of homosexuality and a punishment as devastating as AIDS. (shrink)

This paper describes a presentation on ethics for accounting and business students. In 2001 and 2002, major corporate failures such as Enron and Worldcom, combined with questionable accounting practices, made ethics a paramount concern to persons working in business and accounting. While financial statement analysis and regulatory requirements are important technical topics, the issue of ethics provides faculty a unique and very appropriate setting to discuss deeper truths about doing business and living life well. This paper briefly describes the development (...) and assessment of one approach to presenting ethics built around a computerized slide show (PowerPoint). The goal of the presentation is to increase students’ understanding of the essential role of ethics to accounting and business. Following the presentation, students indicated a heightened recognition of the importance of ethics. Educators should do all that they can to encourage students to do the “right” thing, even in difficult circumstances. This encouragement may serve them well in school and later in their careers. (shrink)

This paper examines the roles that self-knowledge and reflection play in Schopenhauer’s view of agency. Focusing in particular on the discussion of the acquired character, his cognitive theory of motivation, and the idea of intellectual freedom, I argue that we find two conceptions of rational agency in Schopenhauer. The ‘minimal’ conception sees rational agency primarily as a kind of reflective motivation, whereas the ‘maximal’ or ‘robust’ conception sees rational agency as involving a kind of reflective self-organization. Furthermore, I argue that (...) rational self-organization and acquired character go hand-in-hand: it is only in virtue of achieving the latter that one achieves the former. Although some worry that the discussion of acquired character does not sit well with Schopenhauer’s broader determinist theory of action, the reading offered here aims to demonstrate that the two are reconcilable. (shrink)