Jeffery Aubin,Dianne Cole,Julio Cesar Dias Chaves,Jonathan von Kodar,Anne-France Morand,Timothy Pettipiece,Paul-Hubert Poirier,Martin Voyer,Eric Crégheur.

Jeffery Aubin ,Marie Chantal ,Dianne Cole ,Julio Chaves ,Cathelyne Duchesne ,Christel Freu ,Steve Johnston ,Brice Jones ,Amaury Levillayer ,Stéphanie Machabée ,Paul-Hubert Poirier ,Philippe Therrien ,Jonathan von Kodar ,Martin Voyer ,Jennifer Wees ,Eric Crégheur.

Conserving the vitality of suffering: addressing family constraints to illness conversationsWhen persons are confronted with life‐threatening or chronic illness, there is always a possibility that family members other than the person experiencing the illness also suffer as they attempt to manage their own distress. This paper describes exemplars from a hermeneutic study that explored therapeutic conversations between nurses and families who were living with a member experiencing ischaemic heart disease. These conversations uncovered the complexity of both individual and family suffering (...) following acute cardiac illness events, and called attention to nursing practices that addressed some of the ways that family members were constrained from having conversations about the illness. When spaces were created for these conversations to occur, possibilities for making sense of illness and suffering were revealed as vital. These understandings support the efforts of family members to sustain and conserve family relationships in the face of illness and suffering, and inform both the professional and personal lives of nurses. (shrink)

Self-protection can have psychological and behavioral implications. We contrast them with the implications of a self-enhancement strategy. Both self-enhancement and self-protection have costs and benefits as survival strategies, and we identify some of the emotional, cognitive, and behavioral tradeoffs associated with the differential preferences for each strategy. New analyses on a large existing data set confirm the target article's hypothesis that women are more attuned than men to potential negative consequences of innovations.

Some difficulties arise when considering the 1930 encyclical letter of Pope Pius XI, Casti connubii, and the 1997 Vademecum for Confessors in light of the consistent teaching of the magisterium on the intrinsic evil of every contraceptive act. One difficulty is how to reconcile certain teachings of these two documents, which clearly allow for some sort of cooperation with a spouse who voluntarily renders the marital act infecund, with the absolute prohibition against formally acting in a contraceptive manner. The author (...) provides a care­ful reading of the documents that takes into account related magisterial and curial decisions, and shows that the documents reveal a consistent teaching. The teaching permits a certain limited cooperation with a spouse who renders the marital act infecund in a so-called natural way (e.g., natural onanism, or withdrawal) but excludes active material cooperation in sexual acts with a spouse who employs a condom or its equivalent. This teaching has relevance to recent debates about the prophylactic use of condoms among spouses. National Catholic Bioethics Quarterly 11.2 (Summer 2011): 301–328. (shrink)

The complexity of registered nurses’ work in the intensive care unit places them at risk of experiencing critical incident stress. Gadamer's philosophical hermeneutics (1960/2013) was used to expand the meanings of work‐related critical incident stress for registered nurses working with adults in the intensive care unit. Nine intensive care unit registered nurses participated in unstructured interviews. The interpretations emphasized that morally distressing experiences may lead to critical incident stress. Critical incident stress was influenced by the perception of judgment from co‐workers (...) and the organizational culture. Nurses in this study attempted to cope with critical incident stress by functioning in ‘autopilot’, temporarily altering their ability to critically think and to conceal emotions. Participants emphasized the importance of timely crisis interventions tailored to support their needs. This study highlighted that critical incident stress was transformative in how intensive care unit nurses practiced, potentially altering their professional self‐identity. Work‐related critical incident stress has implications for nurses, the discipline, and the health care system. (shrink)

The Tuskegee Syphilis Study is often cited as a major reason for low research participation rates among racial/ethnic minorities. We use data from a random-digit-dial telephone survey of 510 African Americans and 253 Latinos drawn from low income Los Angeles neighborhoods to investigate associations between knowledge of the study and endorsement of HIV/aids conspiracy theories. Results indicate African Americans were significantly more likely than Latinos to endorse HIV/aids conspiracy theories and were more aware of the study. Nevertheless, few Americans and (...) Latinos had ever heard of Syphilis Study suggesting that awareness is not a major factor in low participation rates. (shrink)

Emotion dysregulation (ED) is a vulnerability factor for affective disorders that may originate from deficits in cognitive control (CC). Although measures of ED are often designed to assess trait-like tendencies, the extent to which such measures capture a time-varying (TV) or state-like construct versus a time-invariant (TI) or trait-like personality characteristic is unclear. The link between the TV and TI components of ED and CC is also unclear. In a 6-wave, 5-month longitudinal study, community participants (n = 1281) completed the (...) Difficulties in Emotion Regulation Scale (DERS-16), a commonly used measure of ED and measures of CC. A latent variable (trait-state-occasion) model showed that the proportion of TI factor variance (.80) was greater than the TV factor variance (.19). Although TV factor stability was significant, the coefficients were small in magnitude. Furthermore, regression weights for the ED TI factor (average β = −.62) were significant and larger than those for the TV factor (average β = −.10) in predicting latent CC at each of the six-time points. These findings suggest that ED, as assessed by the DERS-16, is largely TI and this TI component is more strongly linked to CC than the TV component. (shrink)

This book taps the best American thinkers to answer the essential American question: How do we sustain our experiment in government of, by, and for the people? Authored by an extraordinary and politically diverse roster of public officials, scholars, and educators, these chapters describe our nation's civic education problem, assess its causes, offer an agenda for reform, and explain the high stakes at risk if we fail.

Decisions related to births in the “gray zone” of periviability are particularly challenging. Despite published management guidelines, clinicians and families struggle to negotiate care management plans. Stakeholders must reconcile conflicting values in the context of evolving circumstances with a high degree of uncertainty within a short time period. Even skilled clinicians may struggle to guide the patient in making value–laden decisions without imposing their own values. Exploring the experiences of one pregnant woman and her caregivers, this case study highlights how (...) bias may undermine caregivers’ ability to meet their obligation to enhance patient autonomy and the moral distress they may experience when a patient’s values do not align with their own. Management strategies to mitigate the potential impact of bias and related moral distress are identified. The authors then describe one management strategy used in this case, facilitated ethics consultation, which is focused on thoughtful consideration of the patient’s perspective. (shrink)

One specific instantiation of the storm-and-stress view of adolescence is the idea that “normal” adolescence involves high-risk substance use behaviors. However, although uptake of some substance use behaviors is more common during adolescence than other life stages, it is clear that not all adolescents engage in risky substance use—and among those who do, there is much variation in emotional, behavioral, and contextual precursors of this behavior. One such set of predictors forms the internalizing pathway to substance use disorder, whereby internalizing (...) symptoms in childhood such as negative affect and anxiety set off a chain of consequences culminating in high-risk substance use in late adolescence. However, findings linking internalizing symptoms to substance use are mixed, and it is clear that this link varies across adolescents and contexts. One heretofore unanswered question is whether and how geographic location, specifically whether the adolescent lives in an urban or rural location, moderates this link. The current report is a secondary analysis of data from the Longitudinal Study of Australian Children, in which we examined the link between internalizing symptoms in childhood and initiation of substance use through age 19. Using a multiple event process survival mixture model, we identified three trajectories of substance use initiation in adolescence: one characterized by near-complete abstinence until late adolescence, another by earlier initiation of alcohol, nicotine, and cannabis, and another by early initiation of these substances and later initiation of more hazardous drugs such as cocaine and methamphetamine. Although childhood externalizing symptoms increased the risk of being in the second or third class, internalizing symptoms decreased risk when rural and non-rural adolescents were considered together. Few effects of rurality were found, but the negative relationship between internalizing at age 10 and high-risk substance use was only observed among non-rural adolescents. This finding, which was inconsistent with our initial predictions that rurality might confer higher risk for substance use, instead suggests a potentially protective effect of internalizing symptoms for engagement in risky substance use which may differ based on an adolescent’s geographical context. (shrink)

_BMC Medical Ethics_ is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies. _BMC __Medical Ethics _is part of the _BMC_ series which publishes subject-specific journals focused on the needs of individual research communities across all areas of biology and medicine. We do not make editorial decisions on the basis of the interest of a study or (...) its likely impact. Studies must be scientifically valid; for research articles this includes a scientifically sound research question, the use of suitable methods and analysis, and following community-agreed standards relevant to the research field. Specific criteria for other article types can be found in the submission guidelines. _BMC series - open, inclusive and trusted_. (shrink)

In honoring Carroll Izard’s contributions to emotion research, we discuss infant facial activity and emotion expression. We consider the debated issue of whether infants are biologically prepared to express specific emotions. We offer a perspective that potentially integrates differing viewpoints on infant facial expression of emotion. Specifically, we suggest that evolution has prepared infants with innate action readiness patterns, which are crucial for early infant–caregiver social interaction, and in the course of social interaction specific facial configurations acquire functional significance, becoming (...) associated with specific emotions. Research has not confirmed the presence of innate neurophysiological action patterns that map onto discrete emotions but evidence indicates that the possibility has not been ruled out. (shrink)

A study involving purchasing managers was conducted to test specific Hunt-Vitell theoretical propositions concerning the determinants of managers' teleological evaluations. We extended the Hunt-Vitell model by developing a new integrative construct, namely the desirability of consequences to self versus others. We hypothesized that desirability of consequences affects teleological evaluations in that the more desirable the consequences of a particular action, the more likely managers evaluate that action positively. The results of the present study provided support for this hypothesis. Furthermore, we (...) extended the Hunt-Vitell model by developing a new integrative construct, namely the desirability of consequences of self versus others. We hypothesized that cognitive moral development moderates the relationship between the desirability of consequences of self versus others and teleological evaluation. The results failed to support this hypothesis. We explained the lack of support in terms of the level of aggregation of the data, the possibility of the confounding effect of respondents' sensitivity to ethical issues, and the possibility that deontological evaluations confounded the respondents' teleological judgments. Future research and managerial implications of the findings were also discussed. (shrink)

DUREY A, WYNADEN D, THOMPSON SC, DAVIDSON PM, BESSARAB D and KATZENELLENBOGEN JM. Nursing Inquiry 2012; 19: 144–152 [Epub ahead of print]Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal AustraliansWell‐documented health disparities between Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) and non‐Aboriginal Australians are underpinned by complex historical and social factors. The effects of colonisation including racism continue to impact negatively on Aboriginal health outcomes, despite being under‐recognised and under‐reported. Many Aboriginal people (...) find hospitals unwelcoming and are reluctant to attend for diagnosis and treatment, particularly with few Aboriginal health professionals employed on these facilities. In this paper, scientific literature and reports on Aboriginal health‐care, methodology and cross‐cultural education are reviewed to inform a collaborative model of hospital‐based organisational change. The paper proposes a collaborative model of care to improve health service delivery by building capacity in Aboriginal and non‐Aboriginal personnel by recruiting more Aboriginal health professionals, increasing knowledge and skills to establish good relationships between non‐Aboriginal care providers and Aboriginal patients and their families, delivering quality care that is respectful of culture and improving Aboriginal health outcomes. A key element of model design, implementation and evaluation is critical reflection on barriers and facilitators to providing respectful and culturally safe quality care at systemic, interpersonal and patient/family‐centred levels. Nurses are central to addressing the current state of inequity and are pivotal change agents within the proposed model. (shrink)

There is growing concern that a global economic system fueled predominately by financial incentives may not maximize human flourishing and social welfare externalities. If so, this presents a challenge of how to get economic actors to adopt a more virtuous motivational mindset. Relying on historical, psychological, and philosophical research, we show how such a mindset can be instilled. First, we demonstrate that historically, financial self-interest has never in fact been the only guiding motive behind free markets, but that markets themselves (...) are representations of our individual and collective moral identities. Building on this understanding, we review the research on how economic incentives crowd out virtue-oriented concerns. We then introduce the concept of moral self-awareness (MSA), an evolving mindset informed by reflection on moral identity, namely what one’s actions say about oneself given the impacts on others or society that one’s action may effect. MSA comprises three fundamental aspects of virtue-oriented reasoning: pride, shame, and guilt. Finally, we offer a four-stage model anchored in systems theory, yielding ever more refined motivating strategies for maximizing human flourishing and social welfare externalities. (shrink)

This textbook offers a unique and accessible approach to ethical decision-making for practicing pharmacists and student pharmacists. Unlike other texts, it gives clear guidance based on the fundamental principles of moral philosophy, explaining them in simple language and illustrating them with abundant clinical examples and case studies. The strength of this text is in its emphasis on normative ethics and critical thinking, and that there is truly a best answer in the vast majority of cases, no matter how complex. The (...) authors place high trust in a pharmacist’s moral judgment. This teaches the reader how to think, based on ethical principles, not necessarily what to think. This means navigating between the two extremes of overly theoretical and excessively prescriptive. The cogent framework given in this text uses the language of competing duties, identifying the moral principles at stake that create duties for the pharmacist. This is the balancing act of normative ethics, and of deciding which duties should prevail in a given clinical situation. This work presents a clear-cut pathway for resolving ethical dilemmas encountered by pharmacists, based on foundational principles and critical thinking. Presents a clear-cut pathway for resolving the ethical dilemmas encountered by pharmacists, based on foundational principles and critical thinking. Jon E. Sprague, RPh, PhD, Director of Science and Research for the Ohio Attorney General. (shrink)

How far does a researcher’s responsibility extend when an incidental finding is identified? Balancing pertinent ethical principles such as beneficence, respect for persons, and duty to rescue is not always straightforward, particularly in neuroimaging research where empirical data that might help guide decision making are lacking. We conducted a systematic survey of perceptions and preferences of 396 investigators, research participants, and Institutional Review Board members at our institution. Using the partial entrustment model as described by Richardson, we argue that our (...) data supports universal reading by a neuroradiologist of all research MRI scans for incidental findings and providing full disclosure to all participants. (shrink)

This paper examines the current position of copyright for the music industry in the light of innovation and diffusion of technologies which enable audio file sharing amongst web users. We note that there currently appears to be conflicting assessments between the major corporations and the many small firms in Europe with regard to the business potential for online music. In particular, we show that the convergence of technologies together with the emergence of particular practices of ‘net culture’ have posed a (...) number of marketing opportunities and threats for industry incumbents. The role of the Napster program, as well as subsequent innovations in peer‐to‐peer software, is examined together with the responses that have been made by different sections of industry. (shrink)

Extant research suggests that individuals employ traditional moral heuristics to support their observed altruistic behavior; yet findings have largely been limited to inductive extrapolation and rely on relatively few traditional frames in so doing, namely, deontology in organizational behavior and virtue theory in law and economics. Given that these and competing moral frames such as utilitarianism can manifest as identical behavior, we develop a moral framing instrument—the Philosophical Moral-Framing Measure (PMFM)—to expand and distinguish traditional frames associated and disassociated with observed (...) altruistic behavior. The validation of our instrument based on 1015 subjects in 3 separate real stakes scenarios indicates that heuristic forms of deontology, virtue-theory, and utilitarianism are strongly related to such behavior, and that egoism is an inhibitor. It also suggests that deontic and virtue-theoretical frames may be commonly perceived as intertwined and opens the door for new research on self-abnegation, namely, a perceived moral obligation toward suffering and self-denial. These findings hold the potential to inform ongoing conversations regarding organizational citizenship and moral crowding out, namely, how financial incentives can undermine altruistic behavior. (shrink)

There’s a possibly more interesting general question: does technology transform and extend the mind and our mental powers? In a widely discussed 1998 paper titled “The Extended Mind”, Andy Clark and David Chalmers argue that mind and cognition can extend outside the head and can include items and processes in the world. In their thought experiment, Otto has alzheimer’s syndrome but does not lose his ability to function because he records information he learns in a notebook that he always carries. (...) Thus, C&C claim, Otto continues to have beliefs. The notebooks function as his memory. C&C propose a "parity principle": a part of the world is part of a cognitive process if it "functions as a process which, were it done in the head, we would have no hesitation in recognizing [it] as part of the cognitive process .... Cognitive processes ain't (all) in the head!" (in Menary p. 29, original emphasis). (shrink)

This article focuses on the ways that sexual risk behaviors are related to race, class, and gender among low-income, culturally diverse women in South Florida. Data concerning sexual risk and gender are presented in terms of race and class variations. Results indicate that, in general, these women have a high degree of knowledge about acquired immune deficiency syndrome, a quite contemporary awareness of women's gendered subordination, and a lack of trust in heterosexual relationships. Attitudes, beliefs, and knowledge, however, are not (...) translated into sexual behaviors with men partners that would reduce their vulnerability to infection with the human immunodeficiency virus. The data indicate that race is a major factor that places women into an underclass position. Consequently, without socioeconomic resources, gendered behaviors have a direct influence on sexual risk. Multivariate analyses indicate that those women who are sex workers are significantly more likely to negotiate safe sex with clients than with main partners. The research not only challenges mainstream thinking about race, class, and gender but also provides overdue information on the vulnerability of women to HIV infection. (shrink)

Strengths, Opportunities, Aspirations, and Results is a strengths-based framework for strategic thinking, planning, conversations, and leading that focuses on strengths, opportunities, aspirations, and results. The SOAR framework leverages and integrates Appreciative Inquiry to create a transformation process through generative questions and positive framing. While SOAR has been used by practitioners since 2000 as a framework for generating positive organizational change, its use in empirical research has been limited by the absence of reliable and valid measures. We report on the reliability, (...) construct validity, and measurement invariance of the SOAR Scale, a 12-item self-report survey organized into four first-order factors. Data from a sample of 285 U.S. professionals were analyzed in Mplus using confirmatory factor analysis and exploratory structural equation modeling. The Four-Factor first-order exploratory structure equation modeling had the best model fit. Measurement invariance tests found the scalar invariance of the SOAR Scale across gender and education groups. Implications are discussed for using the SOAR Scale to build resilience at the individual, the team, and the organizational levels. (shrink)