Background:A growing number of frameworks for the practice of clinical ethics are described in the literature. Among these, hermeneutical frameworks have helped highlight the interpretive and contextual nature of clinical ethics practice.Objectives:The aim of this article is to further advance this body of work by drawing on the ideas of Charles Taylor, a leading hermeneutical philosopher.Design/Findings:A Hermeneutical Rapprochement Framework is presented for clinical ethics practice, based on Taylor’s hermeneutical “retrieval” and “rapprochement.” This builds on existing hermeneutical approaches for the practice (...) of clinical ethics by articulating a framework with interpretive and reconciliatory scope that extends beyond the presenting “local” context. A Hermeneutical Rapprochement Framework considers broader socio-historical horizons and imaginaries grounded on Taylor’s expansive work in epistemological, ontological, political, and moral philosophy.Discussion:The framework is discussed in terms of how it can be operationalized for clinical practice as well as normative development. Implications for the educational preparation of clinical ethicists are also discussed. Although this work is directly relevant for clinical ethicists, it can also help inform the ethical practice of all clinicians. (shrink)

This analysis presents an epistemological and moral examination of suffering. It addresses the specific questions: (1) What is suffering? (2) Can one's suffering be assessed by another? and (3) What is the moral significance of suffering? The epistemological analysis is orientated by Peter Hacker's framework for the investigation of emotions, demonstrating that suffering is an emotion. This leads to a discussion of whether suffering is a phenomenon that can be evaluated objectively by another person who is not experiencing the suffering, (...) questioning the validity of some decisional models for limiting life-sustaining therapies with the aim of preventing suffering. This analysis highlights that understandings of suffering are value laden. It is conventionally implied that suffering is `bad' and that it should be eliminated. Suffering is commonly regarded as a moral wrong that needs to be made right by health care. This article concludes with a recommendation for a paradigm shift in how suffering can be better understood, through the practice of empathic attunement. (shrink)

In this article I argue for an interpretive approach to bioethics with critically ill children. I begin by highlighting the dominant Anglo-American bioethical framework that defines standards for ethical care in critically ill children and then outline a critique of this framework. Drawing predominantly on the ideas of Charles Taylor, Michael Walzer and Richard Zaner, I call for a reconception of bioethics and propose an interpretive ‘thick’ framework that is centred on culture and context. Finally, I illustrate this interpretive approach (...) through a comparative study of two cases in pediatric intensive care: the narratives of Marc and Larry. These case studies reveal that ethical dilemmas in pediatric critical care can be traced to relational tensions over respect, trust and power rooted in the disparity of moral horizons among the persons involved. (shrink)

We characterize the sets of all Π2 and all equation image theorems of IΠ−1 in terms of restricted exponentiation, and use these characterizations to prove that both sets are not deductively equivalent. We also discuss how these results generalize to n > 0. As an application, we prove that a conservation theorem of Beklemishev stating that IΠ−n + 1 is conservative over IΣ−n with respect to equation image sentences cannot be extended to Πn + 2 sentences. © 2011 WILEY-VCH Verlag (...) GmbH & Co. KGaA, Weinheim. (shrink)

This article reviews empirical evidence and ethical norms in cross-linguistic nursing. Empirical evidence highlights that linguistic barriers between nurses and patients can perpetuate discrimination and compromise nursing care. There are significant organizational and relational challenges involved in ensuring adequate use of interpreters by nurses. Some evidence suggests that linguistic barriers are particularly problematic for nurses when compared with physicians. A comparative analysis of nursing ethical norms for cross-linguistic nursing was conducted using the codes of ethics of the American Nurses Association, (...) the Canadian Nurses Association, and the International Council of Nurses. Five principal ethical norms for cross-linguistic nursing were identified: (1) respect for the patient as a unique person; (2) respect for the patient’s right to self-determination; (3) respect for patient privacy and confidentiality; (4) responsibility for one’s own competence, judgment, and action; and (5) responsibility to promote action better to meet the needs of patients, families, and groups. (shrink)

Nursing scholars have called for nursing approaches with children that ensure the promotion of their childhood, contesting dominant adult-based approaches that are adapted for practice with children. Although the nursing literature includes many important advances in the promotion of child-centered approaches, there are still significant gaps in fully recognizing the complexities of childhood within nursing. Within this paper, I (a) outline some key advances in nursing approaches with children, sometimes referred to as “Children's Nursing” (shifting away from “Pediatric Nursing” conceptions (...) that may be focused more on diseases than childhood); (b) highlight key gaps in current conceptions of Children's Nursing, namely the inadequate integration of work from the interdisciplinary field of Childhood Studies which challenges dominant age-based developmental models which discount children's voices and experiences as “immature”; and (c) propose a Childhood Ethics-based framework that bridges advances in Children's Nursing with those within Childhood Studies, which I refer to as the VOICE Children's Nursing Framework. The latter is rooted in the recognition of (a) children as active agents with capacities and interests in participating in discussions and decisions that affect them, and (b) best interests as the foundational basis for determining the nursing care required by a child which should be defined in an individualized manner, informed by a child's expressed aspirations and concerns. This Framework integrates biological, relational, and ethical dimensions of children's wellbeing and draws on hermeneutic approaches for eliciting and interpreting children's agential expressions, which involves continuous part/whole shifting to meticulously discern what is meaningful within a situation. The Framework is operationalized for clinical practice through the use of orienting questions, which is demonstrated through discussion of a clinical exemplar. The paper closes with proposed future directions for Children's Nursing development in practice, education, and research. (shrink)

Hermeneutics, also referred to as interpretive phenomenology, has led to important contributions to nursing research. The philosophy of Charles Taylor has been a major source in the development of contemporary hermeneutics, through his ontological and epistemological articulations of the human sciences. The aim of this paper is to demonstrate that Taylor's ideas can further enrich hermeneutic inquiry in nursing research, particularly for investigations of ethical concerns. The paper begins with an outline of Taylor's hermeneutical framework, followed by a review of (...) his key ideas relevant for ethics research. The paper ends with a discussion of my empirical research with critically ill children in Canada and France in relation to Taylor's ideas, chiefly Social Imaginaries. I argue that Taylor's hermeneutics provides a substantive moral framework as well as a methodology for examining ethical concerns. (shrink)

Accepted standards of parental decisional autonomy and child best interests do not address adequately the complex moral problems involved in the care of critically ill children. A growing body of moral discourse is calling for the recognition of `tragedy' in selected human problems. A tragic dilemma is an irresolvable dilemma with forced terrible alternatives, where even the virtuous agent inescapably emerges with `dirty hands'. The shift in moral framework described here recognizes that the form of conduct called for by tragic (...) dilemmas is the practice of phronesis. The phronetic agent has acquired a capacity to discern good agency in tragic circumstances. This discernment is practiced through the artful creation of moral narratives: stories that convey that which is morally meaningful in a particular situation; that is, stories that are `meaning making'. The phronetic agent addresses tragic dilemmas involving children as a narrator of contextualized temporal embodied human (counter)stories. (shrink)

Within his earliest contributions to the human sciences, Charles Taylor challenged dominant behavioral views by advancing a hermeneutical conception of human agency. For Taylor, persons continually...

This paper investigates the status of the fragments of Peano Arithmetic obtained by restricting induction, collection and least number axiom schemes to formulas which are Δ1\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\Delta_1}$$\end{document} provably in an arithmetic theory T. In particular, we determine the provably total computable functions of this kind of theories. As an application, we obtain a reduction of the problem whether IΔ0+¬exp\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${I\Delta_0 + \neg \mathit{exp}}$$\end{document} implies BΣ1\documentclass[12pt]{minimal} (...) \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${B\Sigma_1}$$\end{document} to a purely recursion-theoretic question. (shrink)

The modern West has vigorously sought to overcome death, or at the very least minimize the suffering that it entails. Whereas the former has been predominantly pursued through modern scientific medicine, the minimization of the adversity of death and dying has been sought through ‘death technologies’. This technologization of death is analyzed in light of Martin Heidegger’s phenomenological philosophy. The analysis begins with an outline of the fundamental tenets of Heidegger’s ‘philosophy of Being’. In turn, his philosophical framework is utilized (...) to highlight the manner in which the technologization of dying serves to conceal the central existential questions about being and finitude that dying gives rise to. The paper concludes with a discussion of how Heidegger’s work can inspire a more authentic stance toward dying. Leo Tolstoy’s The Death of Ivan Ilych is referred to in order to illustrate Heidegger’s construal of this existential struggle toward dying. (shrink)

BackgroundFollowing the SARS pandemic, jurisdictions around the world began developing ethical resource allocation frameworks for future pandemics—one such framework was developed by Thompson and colleagues. While this framework offers a solid backbone upon which decision-makers can rest assured that their work is driven by rigorous ethical processes and principles, it fails to take into account the nuanced experiences and interests of children and youth (i.e., young people) in a pandemic context. The current COVID-19 pandemic offers an opportunity to re-examine this (...) framework from young people’s perspectives, informed by advances in childhood ethics and children’s rights.Main bodyIn this paper, we revisit the Thompson et al. framework and propose adaptations to the ethical processes and values outlined therein. This work is informed by expertise in clinical ethics and literature related to impacts of COVID-19 and other pandemics on the health and well-being of children around the world, though with particular attention to Canada. During the processes of drafting this work, stakeholders were consulted—aligned with the approach used by Thompson and colleagues—to validate the interpretations provided. We also propose a new principle, namely practicability, to indicate the complex balance between what is possible and what is convenient that is required in ethically sound decisions in the context of services affecting young people. We outline and discuss the strengths and limitations of our work and indicate next steps for scholars in the areas of childhood studies and child health.ConclusionEfforts to ensure frameworks are truly child-inclusive should be the status-quo, so pandemic impacts and policy implications can be considered in advance of emergency preparedness contexts. (shrink)

The aim of this article is to highlight the under-recognized merits of clinical ethics committees (CECs), to help ensure that the development of roles for clinical ethics consultants do not unwittingly compromise the valuable contributions that CECs can continue to provide. I argue that CECs can offer distinctive contributions to the clinical ethics consultation process that can complement and enrich the input provided by a clinical ethics consultant. These distinctions and complementarities should be further examined and developed. This will help (...) to optimize the synergistic contributions that CECs and clinical ethics consultants can make to promote the ethical treatment of patients and their families. (shrink)

In this paper we continue the study of the theories IΔ n+1 (T), initiated in [7]. We focus on the quantifier complexity of these fragments and theirs (non)finite axiomatization. A characterization is obtained for the class of theories such that IΔ n+1 (T) is Π n+2 –axiomatizable. In particular, IΔ n+1 (IΔ n+1 ) gives an axiomatization of Th Π n+2 (IΔ n+1 ) and is not finitely axiomatizable. This fact relates the fragment IΔ n+1 (IΔ n+1 ) to induction (...) rule for Δ n+1 –formulas. Our arguments, involving a construction due to R. Kaye (see [9]), provide proofs of Parsons’ conservativeness theorem (see [16]) and (a weak version) of a result of L.D. Beklemishev on unnested applications of induction rules for Π n+2 and Δ n+1 formulas (see [2]). (shrink)

LetTbe a recursive theory in the language of first order Arithmetic. We prove that ifTextends: (a) the scheme of parameter free Δ1-minimization (plusexp). or (b) the scheme of parameter free Π1-induction, then there are no Σ1-maximal models with respect toT. As a consequence, we obtain a new proof of an unpublished theorem of Jeff Paris stating that Σ1-maximal models with respect toIΔ0+expdo not satisfy the scheme of Σ1-collectionBΣ1.

Translator's summary The translated paper is an extract, published in 1945, of an unpublished thesis, of both historical and technical import, dealing with notions of definability and their relation to invariance under automorphisms. The author develops a metamathematical Galois theory, and discusses and anticipates some aspects of higher-order model theory in an informal but conceptually rich manner.

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as clinical phronesis, i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of virtue ethics, yet one that is informed by the exigencies of moral (...) discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their disengaged form (reflecting the malaise of modern medicine). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the silent world of doctor and patient — provides may deny or refuse any given connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of calculative reasoning only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can save the life of medical ethics — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can prevent the death of medical ethics. (shrink)

Technological developments in the sphere of artificial intelligence (AI) inspire debates about the implications of autonomous weapon systems (AWS), which can select and engage targets without human intervention. While increasingly more systems which could qualify as AWS, such as loitering munitions, are reportedly used in armed conflicts, the global discussion about a system of governance and international legal norms on AWS at the United Nations Convention on Certain Conventional Weapons (UN CCW) has stalled. In this article we argue for the (...) necessity to adopt legal norms on the use and development of AWS. Without a framework for global regulation, state practices in using weapon systems with AI-based and autonomous features will continue to shape the norms of warfare and affect the level and quality of human control in the use of force. By examining the practices of China, Russia, and the United States in their pursuit of AWS-related technologies and participation at the UN CCW debate, we acknowledge that their differing approaches make it challenging for states parties to reach an agreement on regulation, especially in a forum based on consensus. Nevertheless, we argue that global governance on AWS is not impossible. It will depend on the extent to which an actor or group of actors would be ready to take the lead on an alternative process outside of the CCW, inspired by the direction of travel given by previous arms control and weapons ban initiatives. (shrink)

“The Draft UNCITRAL Digest and Beyond” is one of the most useful single volumes available on the CISG. It includes the full text of the draft “UNCITRAL Digest” which catalogues the cases and arbitral awards to date that have interpreted and applied the CISG on an article by article basis. “The Digest and Beyond” includes also commentary by eminent CISG scholars that addresses issues not yet considered in the cases. With more than 1000 decisions applying the CISG in courts and (...) arbitral tribunals around the world, the UNCITRAL Secretariat charged five CISG experts from a variety of regions with the task of creating a digest of CISG case law. “The Digest and Beyond” includes the draft “UNCITRAL Digest”, even before it is released officially by UNCITRAL. It also goes where the authors of the Digest were not allowed to go, given the narrow mandate within which the drafters were asked to work. Its chapters build upon the work of the “UNCITRAL Digest”. The Digest describes the reasoning and results of existing CISG cases; in “The Digest and Beyond”, the Digest authors analyze those cases, and discuss issues that have not yet arisen in the case law. Thus, in many ways, “The Digest and Beyond” provides scholarship that can direct future cases in areas that have not yet been considered by courts and arbitrators as well as in areas in which contradictory court decisions exist. (shrink)