An enquiry into plant consciousness requires, on the one hand, taking into account recent experiments in plant biology and, on the other hand, refining the theoretical framework of behaviour and the various degrees of cognition. The main goal of this contribution is to advance such a framework by comparing classical animal and human cognition approaches with the theories of minimal cognition. This leads us to interpret more carefully the various plant activities and to highlight the limits of classical theories of (...) zoocentric cognition. In particular, the article shows that the notions of cognition and consciousness are often abusively confused, and with that of behaviour. Once this ambiguity is removed, it is possible to better distinguish several meanings of consciousness and to evaluate their relevance to plant activities. (shrink)

Increasingly sophisticated and expensive medical technologies, chronic illness and aging, and a population that insists upon the best health care and coverage, together demand that priorities be set in the public funding of health care. This article describes Spanish initiatives in dealing with such problems and analyses the ethical implications of health care legislation and rationing.

Ethical problems are continuing to expand in health care due to conflicts of technology and value. This study investigated what kind of ethical problems nurses face in clinical situations and what process they use in deciding on actions to take. Ethical theories in justice and caring were explored. Qualitative research was used and ethnographic analysis was conducted with six staff nurses from three clinical areas. An analysis of the data yielded an overarching theme of ‘Suffering and ethical caring: incompatible (...) entities’. Six domains were identified: informant definitions, preceding conditions, actions taken, intervening variables, risks and recommendations. Future research is needed in the field of client and family suffering and pain. (shrink)

Though antiretroviral therapy is the standard of care for people living with HIV, its treatment limitations, burdens, stigma and costs lead to continued interest in HIV cure research. Early-phase cure trials, particularly those that include analytic treatment interruption, involve uncertain and potentially high risk, with minimal chance of clinical benefit. Some question whether such trials should be offered, given the risk/benefit imbalance, and whether those who choose to participate are acting rationally. We address these questions through a longitudinal decision-making (...) study nested in a Thai acute HIV research cohort. In-depth interviews revealed central themes about decisions to join. Participants felt they possessed an important identity as members of the acute cohort, viewing their bodies as uniquely suited to both testing and potentially benefiting from HIV cure approaches. While acknowledging risks of ATI, most perceived they were given an opportunity to interrupt treatment, to test their own bodies and increase normalcy in a safe, highly monitored circumstance. They were motivated by potential benefits to themselves, the investigators and larger acute cohort, and others with HIV. They believed their own trial experiences and being able to give back to the community were sufficient to offset participation risks. These decisions were driven by the specific circumstances experienced by our participants. Judging risk/benefit ratios without appreciating these lived experiences can lead to false determinations of irrational decision- making. While this does not minimise vital oversight considerations about risk reduction and protection from harm, it argues for inclusion of a more participant-centered approach. (shrink)

Objective: The objectives of this study are to understand the current functions, structure and operation of hospital ethics committees (HECs) in Shanghai and to facilitate their improvement. Methods: (1) A questionnaire survey, (2) interviews with secretaries and (3) on-site document reviews of HECs in Shanghai were used in the study, which surveyed 33 hospitals. Results: In Shanghai, 57.56% of the surveyed hospitals established HECs from 1998 to 2005. Most HECs used bioethical review of research involving human subjects as well as (...) bioethical review or consultation regarding medical care services and administrative decision- making. Of the surveyed HECs, 14.3% did not provide any formal bioethical training to the HECs’ members and many HECs had no standard operating procedures. Some HECs had no clear definition of what was “conflict of interest” that should be considered by the HECs, while 44.4% of the HECs did not perform continuing review. Discussion: After the issues of related national regulations, more and more hospitals established HECs in Shanghai, but the functions of HECs need to be further developed and formal training on bioethics should be provided to HEC members. To assure the independence and good performance of HECs, the conflict of interest procedure, the standard operating procedures and bioethical review should be improved. Conclusion: HECs in Shanghai had developed in the preceding 10 years and they played great roles in protecting the rights and welfare of human subjects and patients; some areas need improvement. (shrink)

Background and rationale Clinicians often encounter a variety of ethical challenges in their routine clinical practice, and it varies across healthcare and cultural settings of their practice. Despite of this, there are no clear-cut available guidelines concerning the right course of action in a given ethically challenging situation. A validated instrument that could capture the health care providers’ viewpoints in this regard is lacking from Indian settings. Thus, the current study aimed at developing an instrument to assess (...) the HCP’s perspective regarding different ethically challenging situations encountered in the Indian settings. Methods The questionnaire was developed by involving 15 medical experts. A mixed-method approach, Delphi-technique, and online survey were used for item generation and validation. Results The questionnaire comprised of 11 items representing four factors: health-resource constraints, medical responsibility of the HCP, obtaining patients/family members’ consent for the treatment, and treatment beyond the standard protocol. The gender and clinical disciplines of the participants were related to their level of endorsement for various domains of the ECCS-Q. Conclusions Ethical challenges in the clinical practice fall in different clusters. The clinicians’ course of action in such situations have many socio-demographic and professional determinants. Future studies are warranted to investigate these phenomena. (shrink)

As the burden of misconduct in medical research is increasingly recognised, questions have been raised about how best to address this problem. Whilst there are existing mechanisms for the investigation and management of misconduct in medical literature, they are inadequate to deal with the magnitude of the problem. Journal editors and publishers play an essential role in protecting the veracity of the medical literature. Whilst ethical guidance for journal editors and publishers is important, it is not as readily enforceable as (...) legal obligations might be. This article questions the legal obligations that might exist for journal editors and publishing companies with respect to ensuring the veracity of the published literature. Ultimately, there is no enforceable legal obligation in Australia, the United Kingdom, or the United States. In light of this, more robust mechanisms are needed to deliver greater confidence and transparency in the investigative process, the management of concerns or findings of misconduct and the need to cleanse the literature. We show that the law disincentivises journals and publishers from ensuring truth in their publications. There are harmful consequences for medical care and public confidence in the medical profession and health care system when the foundations of medical science are questionable. (shrink)

The image of “the good nurse” is mainly studied from the perspective of nurses, which often does not match the image held by patients. Therefore, a descriptive study was conducted to examine oncology patients’ perceptions of “the good nurse” and the influence of patient- and context-related variables. A cross-sectional, comparative, descriptive design was used. The sample comprised 557 oncology patients at one of six Flemish hospitals, where they were treated in an oncology day-care unit, oncology hospital ward, or palliative (...) care unit. Data were collected using the Flemish Care-Q instrument. Factor analysis summarised the most important characteristics of “the good nurse”. We reassessed the reliability and construct validity of the Flemish Care-Q and examined the influence of patient- and context-related variables on patient perceptions. Using factor analysis, we grouped the different items of the Flemish Care-Q according to three characteristics: “the good nurse” (I) has a supportive and communicative attitude towards patient and family, (II) is competent and employs a professional attitude, and (III) demonstrates personal involvement towards patient and family. Median factor scores of Factors I, II, and III, respectively, were 8.00, 9.00, and 8.00 (varying from 1, not important, to 10, very important). In order of importance, Factors II, I, and III were identified as valuable characteristics of “the good nurse”. Gender, care setting, and province were influential variables. As perceived by oncology patients, “the good nurse” has a broad range of qualities, of which competence and professionalism are the most valuable. (shrink)

This systematic review identified and evaluated instruments measuring patients' perceptions of patient‐centred nursing care. Of 2629 studies reviewed, 12 were eligible for inclusion. Four instruments were reported: The Individualized Care Scale, the Client‐Centred Care Questionnaire, the Oncology patients' Perceptions of the Quality of Nursing Care Scale and the Smoliner scale. These instruments cover themes addressing patient participation and the clinician–patient relationship. Instruments were shown to have satisfactory psychometric properties, although not all were adequately assessed. More research (...) is needed regarding test–retest reliability, convergent and discriminant validity, validity with known groups and structural validity using confirmatory factor analysis. (shrink)

Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with (...) five-point Likert scales were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78–87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience. (shrink)

Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with (...) five-point Likert scales were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78–87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience. (shrink)

The aim of this study is to describe how hermeneutic photography and one application of hermeneutic photography in particular, namely the photo-instrument, can be used as a health care intervention that fosters meaning (re-)construction of mental illness experiences. Studies into the ways how patients construct meaning in illness narratives indicate that aesthetic expressions of experiences may play an important role in meaning making and sharing. The study is part of a larger research project devoted to understanding the photostories (...) that result from groups of psychiatric patients using the photo-instrument. Within a focused ethnography approach we employed a qualitative design of a single case study. Text analysis of photostories was combined with observational data. Data were analyzed using hermeneutic theory. Participant observations were used for triangulation and complementarity. The interaction and collaboration between health care professionals and patients in the context of a photo group emerged as core concept that underlies the photo-instrument. The interaction triggered a reframing of meaning in the patient’s illness narrative that offered new perspectives on positive identity growth. The role of visualizing meaning in images was found to lend a dynamic power to the process and triggered a dialectic between real life circumstances and imagination played out in the context of situated action. The findings suggest that a positive reframing of meaning in illness narratives is facilitated by the photo-instrument. (shrink)

Twenty-five years ago, robotics guru Joseph Engelberger had a mission to motivate research teams all over the world to design the ‘Elderly Care Giver’, a multitasking personal robot assistant for everyday care needs in old age. In this article, we discuss how this vision of omnipotent care robots has influenced the design strategies of care robotics, the development of R&D initiatives and ethics research on use of care robots. Despite the expectations of robots revolutionizing (...) class='Hi'>care of older people, the role of robots in human care has remained marginal. The value of world trade in service robots, including care robots, is rather small. We argue that the implementation of robots in care is not primarily due to negative user attitudes or ethical problems, but to problems in R&D and manufacturing. The care robots currently available on the market are capable of simple, repetitive tasks or colloquial interaction. Thus far, also research on care robots is mostly conducted using imaginary scenarios or small-scale tests built up for research purposes. To develop useful and affordable robot solutions that are ethically, socially and ecologically sustainable, we suggest that robot initiatives should be evaluated within the framework of care ecosystems. This implies that attention has to be paid to the social, emotional and practical contexts in which care is given and received. Also, the political, economic and ecological realities of organizing care and producing technological commodities have to be acknowledged. It is time to openly discuss the drivers behind care robot initiatives to outline the bigger picture of organizing care under conditions of limited resources. (shrink)

In all western countries health care budgets are under considerable constraint and therefore a reflection process has started on how to gain the most health benefit for the population within limited resource boundaries. The field of ethics of resource allocation has evolved only recently in order to bring some objectivity and rationality in the discussion. In this article it is argued that priority setting is the prerequisite of ethical resource allocation and that for purposes of operationalization, instruments such as (...) need assessment and health technology assessment (HTA) are essential worktools for making more rational decisions. Thresholds (deduced from the need assessment and HTA) are - within this context - guiding but not binding principles. -/- Discussion of theoretical concepts of not only priority setting, need assessment and HTA complemented by practical examples for showing the challenges and the need, but also the chances of a more explicit and transparent policy of resource allocation in health care. Results: Priority setting in health care is based on the values of equity, justice and solidarity. Health packages decisions are determined from medical need (the severity of the condition) and/or the appropriateness of medical interventions (their cost-effectiveness). With growing awareness that originally effective and cost-effective services and programmes are eventually provided inappropriately, the focus is shifting towards the organisational aspects of provision and application. Therefore, need assessment is based on the distinction of health care needs from demand, supply, or actual care. Additionally HTA provides the evidence on health care interventions in a way that it becomes obvious who benefits from an intervention and who definitely does not benefit, but eventually is harmed. -/- Health services research on effective and cost-effective interventions and research/monitoring of performance that the effective and cost-effective services are provided appropriately are of increasing importance for guiding the decision-making process on priority setting and need assessment. Effective healthcare for all is sustainable, if we start to put expenditures in perspective and focus health policies and research strategies on managing expectations through patient information and a more realistic notion of medical advancements and, on the other hand, on encouraging need-based and cost-effective innovations. (shrink)

The care of patients should be professional, human and humane. This is an ethical issue. The words human (inhimillinen) and humane (ihmisläheinen) have different meanings in the Finnish language. At Kuopio University Hospital (1200 beds), in Finland, it was decided to provide patients with professional and humane caring. Ethical values differ for different groups of people. Therefore humane caring was assessed by questioning both hospital patients (n = 160) and staff (n = 196). The data were subjected to content (...) analysis. The result was that the values obtained for both patients and staff were similar. Five descriptive categories of humane caring emerged. To discover what kind of caring was provided for patients, the categories were operationalized into 66 criteria and a questionnaire was drawn up on the basis of these criteria. The data for evaluation of the quality of caring were collected from patients (n = 1708). The data were analysed using cross-tabulations and the chi-squared test; sum variables were calculated for the five standards. The results suggest that special attention should be paid to vulnerable patient groups (e.g. the elderly and the young). One means of ethical management is to support our staff to care more humanely by discussing with them the results of this study, setting standards and criteria for humane caring and what this means in practice. It is hoped our caring will therefore be more humane. (shrink)

This article presents an ethics support instrument for healthcare professionals called CURA. It is designed with a focus on and together with nurses and nurse assistants in palliative care. First, we shortly go into the background and the development study of the instrument. Next, we describe the four steps CURA prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and (4) Act. In order to demonstrate how CURA can structure a moral reflection among caregivers, we discuss (...) how a case was discussed with CURA at a psychogeriatric ward of an elderly care home. Furthermore, we go into some considerations regarding the use of the instrument in clinical practice. Finally, we focus on the need for further research on the effectiveness and implementation of CURA. (shrink)

BackgroundExisting clinical ethics support (CES) instruments are considered useful. However, users report obstacles in using them in daily practice. Including end users and other stakeholders in developing CES instruments might help to overcome these limitations. This study describes the development process of a new ethics support instrument called CURA, a low-threshold four-step instrument focused on nurses and nurse assistants working in palliative care. MethodWe used a participatory development design. We worked together with stakeholders in a Community of (...) Practice throughout the study. Potential end users (nurses and nurse assistants in palliative care) used CURA in several pilots and provided us with feedback which we used to improve CURA.ResultsWe distinguished three phases in the development process. Phase one, Identifying Needs, focused on identifying stakeholder and end user needs and preferences, learning from existing CES instruments, their development and evaluation, and identify gaps. Phase two, Development, focused on designing, developing, refining and tailoring the instrument on the basis of iterative co-creation. Phase three, Dissemination, focused on implementation and dissemination. The instrument, CURA, is a four-step low-threshold instrument that fosters ethical reflection.ConclusionsParticipatory development is a valuable approach for developing clinical ethics support instruments. Collaborating with end users and other stakeholders in our development study has helped to meet the needs and preferences of end users, to come up with strategies to refine the instrument in order to enhance its feasibility, and to overcome reported limitations of existing clinical ethics instruments. (shrink)

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues. Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix. Setting: University medical center. Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center. Interventions: Presented with four hypothetical cases involving urgent decision making near the end of (...) life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases. Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r 2 < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study. Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies. (shrink)

Developing caring competences is considered to be one of the most important aims of undergraduate nursing education and the role of clinical placement is recognised as special in this regard. Students' reflection on caring, their experience and obstacles in being caring is recommended as a key strategy in the process of teaching and studying the nursing discipline. Therefore, the aim of this study was to describe the concept of caring, its manifestations and possible obstacles while caring, as perceived by first‐year (...) nursing students before and after their first clinical placement. Qualitative content analysis of 15 Polish students' narratives written before and after their clinical experience in the form of text‐diaries was undertaken. The findings revealed that students entered their nursing education with a deep humanistic vision of caring both on theoretical and practical levels and the first clinical placement has enriched this vision. Expressive caring was more appreciated by students than the instrumental one and their concept of caring was coherent with the caring behaviours as described in their narratives. Several internal and external obstacles for caring have been reported by students, indicating a specific tension between their ideal of caring and their practical experience of caring in the clinical reality. (shrink)

The Endangered Species Act of 1973 is one of America’s most powerful statutes, not only in American domestic environmental law, but in American domestic law in general. The first part of the ESA gives us the ‘Findings, Purposes, and Policy’ that underlie the Act. In this prefratory language, it is explicit that the ESA is referring to instrumental aesthetic, ecological, educational, historical, recreational, and scientific values. But J. Baird Callicott and Andrew Wetzler argued that the ESA is also implicitly committed (...) to endangered species having intrinsic value. I argue that the best explanation of the seeming tacit intrinsic value in the ESA is not that such value really is implicit in the ESA; rather, the best explanation is that the ESA is committed to instrumental value with a certain feature that has not been carefully considered in the environmental ethics/philosophy literature before, that of incalculable instrumental value, in this case held by endangered species. (shrink)

Scientific instruments are not neutral artefacts; the perception of their value is greatly determined not only by the objects themselves and the function they perform, but also by the context of their use. In the 16th and 17th centuries, scientific instruments – not only nautical ones – acquired a prominent place in European societies that greatly transcended the specific narrow professional circles that used them. This has already been noted as being an important feature in the development of science in (...) early modern Europe. But exactly how did this happen? Following other recent studies, I argue in this paper that in order to understand this phenomenon one has to look carefully at artisanal practices of the period. (shrink)

[Michael Smith] The requirements of instrumental rationality are often thought to be normative conditions on choice or intention, but this is a mistake. Instrumental rationality is best understood as a requirement of coherence on an agent's non-instrumental desires and means-end beliefs. Since only a subset of an agent's means-end beliefs concern possible actions, the connection with intention is thus more oblique. This requirement of coherence can be satisfied either locally or more globally, it may be only one among a number (...) of such requirements on an agent's total set of desires and beliefs, and it has no special connection with reasoning. An appreciation of these facts leads to a better understanding of both the nature and the significance of instrumental rationality. /// [Edward Harcourt] I argue that the incoherence Smith claims to identify in agents who desire that q, believe that p is a necessary means to q, but fail to desire that p is illusory, since it rests on the false assumption that every property I know to be possessed by an object of my desire is an object of my desire. Though the failure of Smith's account of the irrationality of this pattern of attitudes leaves it open that the pattern is indeed irrational, I argue that there are instances of it that are not irrational where the desires are desires for what the agent knows to be impossible for him. This conclusion casts doubt on the overall strategy-that of making a Humean theory of action explanation do duty as a theory of instrumental rationality-which implies that the norms of instrumental rationality apply to desires simply as such. I then try to criticise the strategy in such a way as to leave the Humean theory of action explanation unaffected. (shrink)

Early modern experimental philosophers often appear to commit to and utilise corpuscular and mechanical hypotheses. This is somewhat mysterious, for such hypotheses frequently appear to be simply assumed, which is odd for a research program which emphasises the careful experimental accumulation of facts. Isaac Newton was one such experimental philosopher, and his optical work is considered a clear example of the experimental method. Focusing on his optical investigations, Walsh identifies three roles for hypotheses. First, Newton introduces a hypothesis to explicate (...) his abstract theory. The purpose here is primarily to improve understanding or uptake of the theory. Second, he uses a hypothesis as a platform from which to generate some crucial experiments to decide between competing accounts. The purpose here is to suggest experiments in order to bring a dispute to empirical resolution. Third, he uses a hypothesis to suggest an underlying physical cause, which he then operationalises and represents abstractly in his formal theory. The second and third roles are related in that they are both cases of scaffolding: hypotheses provide a temporary platform from which further experimental work and/or theorising can be carried out. In short, the entities and processes included in Newton’s optical hypothesis are not simply assumed hypothetical posits. Rather, they play instrumental roles in Newton’s experimental philosophy. (shrink)

Activities of daily living are usually defined as skills needed in typical daily self-care. Instrumental activities of daily living are more complex skills beyond basic self-care, and their measurement evaluates how individuals function in their homes, workplaces, and outdoor environments. The skills that pertain to IADLs are exposed to dysfunctions resulting from aging or illness. Reductions in those skills may begin to cause problems with independence but these problems can be solved with the help of others - for (...) example, family members, social workers, and nurses. (shrink)

Summary Care and cure have been described as different kinds of ethical approaches to clinical situations. Female concerns in nursing care have been contrasted with masculine, cure orientated physician's attitudes. Ethics in such different voices may have sociologic determinants, but they do not represent intrinsic distinctions. Medicine has shown a divergent development, on the one hand stressing cure in a deterministic and instrumental way, on the other hand being aware that disease is as much a pathographic as a (...) biographic, care‐requiring existential situation. Disease is a breakdown of the living organism, to be cured by therapeutic efforts, but it is also the distressing failure of the lived body, requiring concern and care. Based on Lévinas’ ethics of encounter, it is suggested that any interpersonal relatedness is based on concern for the other, being grounded on an essentially ethical interaction. The clinical encounter is a paradigm of such ethics‐based relationships, which necessarily builds on awareness of the other qua other, and is concerned with fulfilling the therapeutic mandate. Caring for the other means doing one's best to help her/him, so that care and cure are inextricably interwoven, although care is the more fundamental form of human relatedness. Thus, neither gender nor professional tasks can allow for a caring attitude to develop without curing concerns, just as trying to cure without caring is unthinkable. (shrink)

Many nonhuman animals have the emotional capacities to form caring relationships that matter to them, and for their immediate welfare. Drawing from care ethics, we argue that these relationships also matter as objectively valuable states of affairs. They are part of what is good in this world. However, the value of care is precarious in human-animal interactions. Be it in farming, research, wildlife ‘management’, zoos, or pet-keeping, the prevention, disruption, manipulation, and instrumentalization of care in animals by (...) humans is ubiquitous. We criticize a narrow conception of welfare that, in practice, tends to overlook non-experiential forms of harm that occur when we interfere with caring animals. Additionally, we point out wrongs against caring animals that are not just unaccounted for but denied by even an expansive welfare perspective: The instrumentalization of care and caring animals in systems of use can occur as a harmless wrong that an approach purely focused on welfare may, in fact, condone. We should therefore adopt an ethical perspective that goes beyond welfare in our dealings with caring animals. (shrink)

In this essay I argue that sports at their best qualify as final ends, that is, as ends whose value is such that they ground not only the practices whose ends they are, but everything else we do as human agents. The argument I provide to support my thesis is derived from Harry Frankfurt's provocative work on the importance of the things we care about, more specifically, on his claim that it is by virtue of caring about things and (...) practices, really caring about them ? even loving them ? we are able to regard and treat them as final ends. Sports, I claim, are paradigmatic examples of practices cared about and loved in these deep ways, and as such deserve to be considered, rather than dismissed because of their supposed triviality, as one of those ends around which a life most worth living can be legitimately forged. (shrink)

[Michael Smith] The requirements of instrumental rationality are often thought to be normative conditions on choice or intention, but this is a mistake. Instrumental rationality is best understood as a requirement of coherence on an agent's non-instrumental desires and means-end beliefs. Since only a subset of an agent's means-end beliefs concern possible actions, the connection with intention is thus more oblique. This requirement of coherence can be satisfied either locally or more globally, it may be only one among a number (...) of such requirements on an agent's total set of desires and beliefs, and it has no special connection with reasoning. An appreciation of these facts leads to a better understanding of both the nature and the significance of instrumental rationality. /// [Edward Harcourt] I argue that the incoherence Smith claims to identify in agents who desire that q, believe that p is a necessary means to q, but fail to desire that p is illusory, since it rests on the false assumption that every property I know to be possessed by an object of my desire is an object of my desire. Though the failure of Smith's account of the irrationality of this pattern of attitudes leaves it open that the pattern is indeed irrational, I argue that there are instances of it that are not irrational where the desires are desires for what the agent knows to be impossible for him. This conclusion casts doubt on the overall strategy-that of making a Humean theory of action explanation do duty as a theory of instrumental rationality-which implies that the norms of instrumental rationality apply to desires simply as such. I then try to criticise the strategy in such a way as to leave the Humean theory of action explanation unaffected. (shrink)

Background Patient dignity is sometimes neglected in intensive care unit (ICU) settings, which may potentially cause psychological harm to critically ill patients. However, no instrument has been specifically developed to evaluate the behaviors of dignified care among critical care nurses. Aim This study aimed to develop and evaluate ICU Dignified Care Questionnaire (IDCQ) for measurement of self-assessed dignity-conserving behaviors of critical care nurses during care. Methods The instrument was developed in 3 phases. (...) Phase 1: item generation; phase 2: a two-round Delphi survey and a readability pilot study; phase 3: cross-sectional survey with model estimation. The questionnaire was evaluated by item analysis, exploratory and confirmatory factor analysis, assessment of internal consistency reliability, and test-retest reliability. The investigation was conducted using a convenience sample of 392 critical care nurses from 6 cities in Zhejiang Province, China, of which 30 participated in the test-retest reliability survey 2 weeks later. Ethical considerations The study was approved by ethics committee. All participants provided written informed consent before the survey. The questionnaire survey was anonymous. Results The results showed acceptable reliability and validity of the IDCQ. The 17-item final version questionnaire was divided into 2 dimensions: absolute dignity and relative dignity. These two factors accounted for 62.804% of the total variance, and model fitting results were acceptable. The Cronbach’s alpha coefficient of the questionnaire was 0.94, and the test-retest intraclass correlation coefficient (ICC) was 0.88 after 2 weeks. Conclusions This study developed a brief and reliable instrument (IDCQ) to assess dignified care in ICU nursing. It can help critical care nurses identify their behaviors in maintaining patient dignity and discover their deficiencies. It may also serve as a clinical nursing management tool to help reduce patient disrespect experience in ICU. (shrink)

Despite the centrality of the term within the title, the meaning of ?care? in residential child care remains largely unexplored. Shifting discourses of residential child care have taken it from the private into the public domain. Using a care ethics perspective, we argue that public care needs to move beyond its current instrumental focus to articulate a broader ontological purpose, informed by what is required to promote children's growth and flourishing. This depends upon the establishment (...) of caring relationships enacted within the lifespaces shared by children and those caring for them. We explore some of the central features of caring in the lifespace and conclude that residential child care is best considered to be a practical/moral endeavour rather than the technical/rational one it has become. It requires morally active, reflexive practitioners and containing environments. (shrink)

Background: Nurses encounter complex ethical dilemmas in everyday nursing care. It is important for nurses to have moral courage to act in these situations which threaten patients’ safety or their good care. However, there is lack of research of moral courage. Purpose: This study describes nurses’ experiences of care situations demanding moral courage and their actions in these situations. Method: A qualitative descriptive research design was applied. The data were collected with an open-ended question in the questionnaire (...) used in validation of the Nurses’ Moral Courage Scale. The sample consisted of 286 nurses from four different clinical fields in a major university hospital in Finland, providing a total of 611 answers. Data were analyzed using inductive content analysis. Ethical considerations: The study followed the commonly recognized principles of good scientific practice. The use of data was authorized by the developer of the instrument, the data collector, and the participating hospital. Ethical approval was obtained from the university ethics committee. Findings: Nurses acted morally courageously in most situations but sometimes they failed to do so. Although situations demanding moral courage varied, they could be categorized into seven main domains relating to colleagues, physicians, patients, relatives, nurses themselves, managers, and organizations. Nurses acted in the situations in different ways. The main acts in solving the situations were verbal communication or immediate action, such as interrupting of action. Conclusion: Care situations demanding moral courage focus on good and safe patient care and the patient’s good is at the center of attention. The situations are mostly related to the activities of other healthcare professionals. Findings may be applied in developing ethical nursing care through basic and continuing nursing education. Research is needed on the moral courage of physicians and managers, as well as on patients’ and their relatives’ experiences of care situations demanding moral courage. (shrink)

This new edition of Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals thoroughly updates the highly regarded and groundbreaking first edition, offering the contemporary reader clinical wisdom and ethical guidance for challenging times. As with its predecessor, the second edition features commentaries by leaders in psychiatric ethics, plus two foundational chapters on ethics and professionalism in the field of mental health. These commentaries and introductory chapters provide an overview of essential ethical principles and concepts, the professional (...) obligations of the mental health clinician, common ethical tensions found in practice, ethical aspects of caring for special populations, and ethical issues in professional training and research. The introductory chapters are followed by case-oriented questions and answers on core concepts and topics in clinical care, medical research, and interactions with colleagues and trainees. Topics explored in-depth include authorship, disclosure, and ethical peer review for scientific publications; assisted suicide and euthanasia; professional voyeurism versus patient privacy online and on social media; the appropriate process for reporting an impaired colleague; and problems of burnout, work-life balance, and professional well-being. Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals poses and plumbs critically important ethical dilemmas in a compelling, down-to-earth way for today's practitioners and learners. (shrink)

The Fundamentals of Care Framework is an evidence‐based, theory‐informed framework that conceptualises high‐quality fundamental care. The Framework places the nurse–patient relationship at the centre of care provision and outlines the nurse behaviours required for relationship development. Numerous instruments exist to measure behavioural aspects of the nurse–patient relationship; however, the literature offers little guidance on which instruments are psychometrically sound and best measure the core relationship elements of the Fundamentals of Care Framework. This study evaluated the quality (...) of nurse–patient relationship instruments by (1) assessing their content development and measurement properties (e.g. dimensionality, targeting, reliability, validity) and (2) mapping instrument content to the Framework's core relationship elements: trust, focus, anticipate, know, and evaluate. Twenty‐seven instruments were evaluated. Findings demonstrated that patients and nurses were rarely involved in item development. Most instruments exhibited poor measurement properties, with only one instrument having complete information on all quality indicators. Instrument content focused primarily on nurses getting to know patients and earning their trust, with only 54, 18, and 1 item(s), respectively, measuring ‘focus’, ‘anticipate’ and ‘evaluate’. Hence, there does not appear to be a robust instrument measuring behavioural aspects of nurse–patient relationships, nor one capturing the relationship elements of the Fundamentals of Care Framework. (shrink)

The goal of the present article is to give an answer on the question: Does the first quaestio of the Prima Pars of Aquinas Summa theologiae represents a key for the general insight into the fundamental doctrines, the structure and the method of the most famous work of St. Thomas? Thomists like James Weisheipl answered in the negative to this question. But this paper intents to show by an careful analysis of Sth Ia, q. 1, that this treatise about the (...) necessity, the nature and the method of sacra doctrina is strictly dovetailed with the complete Summa. In a figurative way its possible to speak about this quaestio as a portal of the «cathedral» of the Summa, from which one can survey the complete ensemble of architectonic motifs building this cathedral. (shrink)

Stethoscopes, x-rays and other medical technologies are two-edged swords. They make medical treatment and diagnosis more accurate and effective, but do at the same time reveal our perceptual inadequacy. By transcending our senses, these technologies reveal that we can be seriously diseased without experiencing any symptoms at all. This situation has changed our attitude towards our relations and ourselves. The situation can be analysed using Jürgen Habermas’ conception of systems colonisation of the lifeworld. Medical technologies colonise our life world. They (...) change the way we think and act. They make us all accept that we can become patients almost any minute, even if we feel perfectly healthy. Sense transcending technologies turn us all into proto-patient. (shrink)

"[R]easons for action must have their source in goals, desires, or intentions....[T]he possession of rationality is not sufficient to provide a source for relevant reasons,...certain desires, goals, or intentions are also necessary." ;So says Gilbert Harman. So say many other philosophers, from Aristotle to Hume to Harman and David Gauthier. To these many philosophers, this is a home truth, as obvious as the nose on your face. And yet as many philosophers---from the Stoics to Kant to Nagel and Korsgaard---reject this (...) view, and could not find it more obviously false. Any disagreement of this nature, which forces the disputants to find arguments for claims that seem to them self-evident and undeniable, is likely to generate a long, complicated and nasty war. Fortunately for the world, already subject to more fundamentalist clashes than one cares to count, this particular war stays mostly on paper and inside the walls of the academy, without any literal casualties. ;In this dissertation, I join the ranks of those who oppose Harman and his compatriots. I bring what I believe is a new strategy to the field of engagement. The strategy involves two stages. First, we are to undertake a thorough examination of what our opponents mean when they say that goals, desires, or intentions are the "source" of reasons; no one has ever satisfactorily cashed in this metaphor, and I propose to do so. The second stage follows naturally from the first, for in seeing what our opponents mean, we see a crucial weakness in their position: their troops are mercenary, and can be recruited to our side. The second stage is this recruitment. (shrink)

To achieve its goals of managing andrestricting access to psychiatric care, managedcare organizations rely on an instrument, theoutpatient treatment report, that carriessignificant implications about how they viewpsychiatric patients and psychiatric care. Inaddition to involving ethical transgressionssuch as violation of patient confidentiality,denial of access to care, spurious use ofconcepts like quality of care, and harassmentof practitioners, the managed care approachalso depends on an overly technical,instrumental interpretation of human beings andpsychiatric treatment. It is this grounding ofmanaged (...) care in technical reason that I willexplore in this study. I begin with a reviewof a typical outpatient treatment report andshow how, with its dependence on the DSM-IV,on behavioral symptoms and patient`functioning'', on the biomedical model ofpsychiatric illness, and on gross quantitativemeasures, the report results in a crude,skeletonized view of the human being as acongeries of behavioral symptoms and functions. I then develop the managed care construal ofhuman existence further by showing itsgrounding in technical reason, exploring thelatter in its modern embodiment and deriving itand its opposite, practical reason, fromAristotle''s distinction between technical andpractical reason, techne and phronesis. Inthis analysis of the role of technical reasonin managed care, I point out that managed caredid not have to develop its rationale de novobut could rather lift its arguments, e.g. thebiomedical model, from contemporary psychiatryand simply apply them in a restrictive manner. Finally, I conclude this study by arguing forpsychiatry''s status as a discipline ofpractical knowledge. (shrink)

When a reasonable agent deliberates about what to do, she entertains only a limited range of possible courses of action. A theory of practical reasoning must therefore include an account of deliberative attention: an account that both explains the patterns of deliberative attention that reasonable agents typically display and allows us to see why these patterns of deliberative attention are reasonable. I offer such an account, built around two, central claims. A reasonable agent who cares about some end is disposed (...) to exclude courses of action which she believes to be incompatible with that end from the range of possibilities that she will entertain as options in practical deliberation. As I shall put it, an agent’s cares establish deliberative boundaries for her practical thought. The stability of a deliberative boundary varies with the depth of the care that explains it. These two claims motivate the Boundary-Driven Model of the path that a reasonable agent’s deliberative attention will take in temporally extended deliberation. If we locate the model within a maximizing conception of practical rationality, then boundary-driven deliberation, of the sort that the model describes, can be understood and justified instrumentally, as a heuristic device. But if we suppose that there is no single index of value that successful practical choice maximizes, then boundary-driven deliberation is partly constitutive of reasonableness in practical thought. It allows an agent facing plural and incommensurable values to frame her deliberative problems narrowly enough that, in conjunction with deliberative devices which are not part of the model but which are compatible with it, she may be able to reach a non-arbitrary decision – and so give a determinate, verdictive sense to the phrase “the best course of action available to me” in cases in which a determinate meaning for this phrase would otherwise be lacking. (shrink)

Yemeni writer Ahmed Qāsim al-Arīqī, in addition to his profession as a pharmacist, is a writer who has made a name for himself in the country's literary field, especially in the last fifteen years. A prolific writer, al-Arīqī is the author of poetry collections as well as stories and novels that emphasise awareness of the traditional issues of the Yemeni people. He has published "Maḳāmāt al-'Arīḳī" (2006), "Ġalṭṭetu Ḳalem" (2012), "Qurāt al-S̱-S̱elj" (2017), "Ta'riyya" (2018), "Zurbet al-Yumnā" (2018), "Da'wat al-Ḥuḳūl" (2019), (...) "Zuhr al-Ġarām" and "Sīret al-Kūbī" (2022). His novel "Yawma Māta al-Shaytan" (The Day Satan Died) was published electronically by Hindāwī Publishing House in 2022. The novel, which is approximately 120 pages, is written in six chapters. There are eleven passages in the first and fourth chapters, thirteen in the second and sixth chapters, twelve in the third chapter, and eight in the fifth chapter. The novel is about the adventures of a member of the army named Marwan Naji, who was wounded in the war between the Houthi militia and the Yemeni army, and after nine months in a coma, opens his eyes in a perfect world dominated by biological and technological advances. Symbolising the treatment of selfishness and various narcissisms with advanced vaccines through the death of Satan, the author describes Marwan's adventures in his world, which he sometimes describes as the realm of the jinn, in a very simple language, while not failing to criticise reality in its various political, social and religious dimensions. In fact, Marwan's world of imagination and fantasy is the main story of the novel, but not the only one. The author also includes the stories of family members in Marwan's world of turmoil, destruction, massacre, war and victory, giving the reader the opportunity to compare both worlds. While his mother Gusoun, his wife Hamide and his daughter Fatma, who later got engaged in time after being widowed, are the female characters of his real world, Professor Mari and Mariana, one of his seven wives, are the other important characters of his imaginary world. Gusûn is a devoted mother who does not leave the bedside of her comatose son, prays for him day and night and tries to do everything she can for his recovery. Gusûn, who is listened to at home to a certain extent, scolds her grandchildren to prevent the breakup of her son's home because of inheritance, defends that the existing wealth still belongs to her son and reminds them that she will not hesitate to spend money for his recovery. Gusûn's daughter-in-law Hamide also takes care of her husband, who shows no signs of recovery. Hamide, who is not as patient as her mother-in-law, is also a jealous woman. On the other hand, although both of them display false religious tendencies that have no relation with real life, Gusûn is more prone to the superstitious approaches put forward and adopted in the name of religion. Fatma is also a widow who, although she has the will to take care of her children and live her life alone, has been engaged for a long time to her uncle's son Münir, who, like her, took part in anti-regime demonstrations and whose love she believes in. Fatma, who is more conscious than her grandmother and mother, is not alien to the issues that society complains about and often participates in women's movements organised against the government. Professor Mari, one of the two important characters belonging to Marwan's imaginary world, is a psychologist and the chief physician of a large hospital who treats jealousy, anger, lying and selfishness, which are considered dangerous viruses, with vaccines developed by scientists. Professor Mari, who is personally involved in Marwan's treatment, also chairs the committee that records his memory and projects all his memories on a giant screen. Mariana, on the other hand, monitors Marwan's behaviour and thoughts through a biological chip to control the effect of the vaccines given to him, criticises him through the tragic images projected on the screen and provides information that will facilitate his adaptation to his new world. In the article, in which the author's main published works are briefly introduced along with a broad summary of the novel, the social messages that an author, who is not indifferent to the realities of the geography he lives in, tries to give directly and indirectly with a language far from locality, are tried to be determined through the mentioned female characters. It is seen that the desire to become a single nation by making; love, brotherhood, friendship and peace dominant lies behind the author's novelisation of the dream of an ideal world symbolised by the death of Satan. (shrink)

Man (Islam); Islamic philosophy; Islamic ethics.

Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation (...) class='Hi'>instrument. The aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers’ experiences and perceived importance of outcomes of Moral Case Deliberation. (shrink)