Professional identity and competent ethical behaviors of nursing students are commonly developed through curricular inclusion of professional nursing values education. Despite the enactment of this approach, nursing students continue to express difficulty in managing ethical conflicts encountered in their practice. This descriptive correlational study explores the relationships between professional nursing values, self-esteem, and ethical decision making among senior baccalaureate nursing students. A convenience sample of 47 senior nursing students from the United States were surveyed for their level of internalized professional (...) nursing values (Revised Professional Nursing Values Scale), level of self-esteem (Rosenberg’s Self-Esteem Scale), and perceived level of confidence in ethical decision making. A significant positive relationship (p < 0.05) was found between nursing students’ professional nursing values and levels of self-esteem. The results of this study can be useful to nursing educators whose efforts are focused on promoting professional identity development and competent ethical behaviors of future nurses. (shrink)

This clinical case report illustrates the potential dilemmas that can arise from knowledge gained through genetic analysis. These conflicts require careful ethical analysis of presumed duties to protect patient privacy and maintain confidentiality, the duty to warn a second party of a health risk, and the duty of veracity. While the questions raised by genetic testing of one individual for disease that reveals potentially important information about relatives, such as risk for Huntington chorea or breast cancer, have been discussed, the (...) continuing expansion in our capacity for sophisticated genetic analysis continues to present new and challenging situations. The resolution of this case and others like it requires close collaboration among the treatment team, geneticists, and clinical ethicists. (shrink)

Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, (...) we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice. (shrink)

Pilgrimage, Politics, and Pestilence: The Haj from the Indian Subcontinent 1860–1920. By Saurabh Mishra. New Delhi: Oxford University Press, 2011. Pp. ix +177. $55.

In the United States, there is no consensus about who should make decisions in acute but non-emergent situations for incapacitated patients who lack surrogates. For more than a decade, our academic medical center has utilized community volunteers from the hospital ethics committee to engage in shared decision-making with the medical providers for these patients. In order to add a different point of view and minimize conflict of interest, the volunteers are non-clinicians who are not employed by the hospital. Using case (...) examples and interviews with the community members, this paper describes how the protocol has translated into practice over the years since its inception. Members reported comfort with the role as well as satisfaction with the thoroughness of their discussions with the medical team. They acknowledged feelings of moral uncertainty, but expressed confidence in the process. Questions raised by the experience are discussed. Overall, the protocol has provided oversight, transparency, and protection from conflict of interest to the decision-making process for this vulnerable patient population. (shrink)

Numerous ethical issues are raised in cancer treatment and research. Informed consent is challenging due to complex treatment modalities and prognostic uncertainty. Busy oncology clinics limit the ability of oncologists to spend time reinforcing patient understanding and facilitating end-of-life planning. Despite these issues and the ethics consultations they generate, clinical ethicists receive little if any focused education about cancer and its treatment. As the field of clinical ethics develops standards for training, we argue that a basic knowledge of cancer should (...) be included and offer an example of what cancer ethics training components might look like. We further suggest some specific steps to increase collaboration between clinical ethicists and oncology providers in the outpatient setting to facilitate informed consent and proactively identify ethical issues. (shrink)

setting, are warranted. This article details a descriptive study in which patients were interviewed, during hospital stays, about their beliefs and understanding of advanced directions, as well as the processes used in completing them. The study was undertaken in a community hospital located in a rural area in the Midwest. Findings show that many patients were able to clearly articulate what an AD means in terms of making their choices known. However, misconceptions were found in patients' understanding of ADs and (...) only 46% reported discussing their ADs with a physician. Strategies for effective implementation of education programs related to ADs are detailed here. © 1999 Lippincott Williams & Wilkins, Inc.... (shrink)

We examined differences in the knowledge and beliefs that exist among nurse researchers in the USA (n = 119) regarding informed consent and the use of data from patients’ medical records. Using a mail survey, two domains of ethical knowledge and beliefs were assessed: the legal right to privacy and the moral right to privacy. More than half of the participants were very confident in their knowledge of institutional review board procedures, research ethics, informed consent, the legal right to privacy, (...) and the moral right to privacy. In contrast, most rated themselves as uncertain about US federal research regulations and there was wide variation in knowledge about current federal guidelines. Those who were more confident in their knowledge of or had more practical experience with research ethics, were no more likely to answer correctly a question about current federal guidelines regulating the use of patient data from medical records than those who reported less confidence or experience. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

To date no one has identified or described the population of incapacitated patients being treated in an inpatient setting who lack proxy decision-makers. Nor, despite repeated calls for protocols to be developed for decision-making, has any institution reported on the utilization of such a protocol. In 2005, our urban tertiary care hospital instituted a protocol utilizing community members of the ethics committee to meet with the medical providers and engage in shared decision-making for patients without proxies. We conducted a retrospective (...) chart review and in this paper describe nearly 200 patients who were identified and treated according to the protocol over a 12 year period. After an aggressive search, family members were located for a surprising number of patients, leaving 80 patients who needed decisions to be made utilizing the PWP committee. We review the decisions required, the results of the shared decision-making meetings, and the patient outcomes. Our experience has shown that a protocol involving community volunteers to make decisions for PWPs in a timely manner is feasible and ethically defensible. The protocol has been accepted by physicians and utilized with increasing frequency. Because it was possible to gather at least minimal information on most patients, a standard of “informed best interest” was used to make decisions. PWP committee recommendations varied, but in all cases agreement was reached with the attending physicians. (shrink)

Returning genomic research results to family members raises complex questions. Genomic research on life-limiting conditions such as cancer, and research involving storage and reanalysis of data and specimens long into the future, makes these questions pressing. This author group, funded by an NIH grant, published consensus recommendations presenting a framework. This follow-up paper offers concrete guidance and tools for implementation. The group collected and analyzed relevant documents and guidance, including tools from the Clinical Sequencing Exploratory Research Consortium. The authors then (...) negotiated a consensus toolkit of processes and documents. That toolkit offers sample consent and notification documents plus decision flow-charts to address return of results to family of living and deceased participants, in adult and pediatric research. Core concerns are eliciting participant preferences on sharing results with family and on choice of a representative to make decisions about sharing after participant death. (shrink)

Standardizing consultation processes is increasingly important as clinical ethics consultation becomes more utilized in and vital to medical practice. Solid organ transplant represents a relatively nascent field replete with complex ethical issues that, while explored, have not been systematically classified. In this paper, we offer a proposed taxonomy that divides issues of resource allocation from viable solutions to the issue of organ shortage in transplant and then further distinguishes between policy and bedside level issues. We then identify all transplant related (...) ethics consults performed at the Cleveland Clinic between 2008 and 2013 in order to identify how consultants conceptually framed their consultations by the domains they ascribe to the case. We code the CC domains to those in the Core Competencies for Healthcare Consultation Ethics in order to initiate a broader conversation regarding best practices in these highly complex cases. A discussion of the ethical issues underlying living donor and recipient related consults ensues. Finally, we suggest that the ethical domains prescribed in the Core Competencies provide a strong starting ground for a common intra-disciplinary language in the realm of formal CEC. (shrink)

This paper responds to the contributions by Alexander Bird, Nathan Wildman, David Yates, Jennifer McKitrick, Giacomo Giannini & Matthew Tugby, and Jennifer Wang. I react to their comments on my 2015 book Potentiality: From Dispositions to Modality, and in doing so expands on some of the arguments and ideas of the book.

Substructural fuzzy logics are substructural logics that are complete with respect to algebras whose lattice reduct is the real unit interval [0.1]. In this paper, we introduce Uninorm logic UL as Multiplicative additive intuitionistic linear logic MAILL extended with the prelinearity axiom ((A → B) ∧ t) ∨ ((B → A) ∧ t). Axiomatic extensions of UL include known fuzzy logics such as Monoidal t-norm logic MTL and Gödel logic G, and new weakening-free logics. Algebraic semantics for these logics are (...) provided by subvarieties of (representable) pointed bounded commutative residuated lattices. Gentzen systems admitting cut-elimination are given in the framework of hypersequents. Completeness with respect to algebras with lattice reduct [0, 1] is established for UL and several extensions using a two-part strategy. First, completeness is proved for the logic extended with Takeuti and Titani's density rule. A syntactic elimination of the rule is then given using a hypersequent calculus. As an algebraic corollary, it follows that certain varieties of residuated lattices are generated by their members with lattice reduct [0, 1]. (shrink)

Offers a comprehensive view of St Augustine's political ideas.

It is 2048 BE; the Anonyma Network, represented by a young philosopher known affectionately as Annie, offers this fiftieth anniversary edition of Mary Daly's revolutionary work of Radical Elemental Feminism, Quintessence ... Realizing the Archaic Future. Mary Daly has, for the past thirty years, been at the forefront of radical feminist thinking. Here she exposes and examines the abuses women face at the end of the twentieth century - for example, the dangerous rhetoric of the Promise Keepers; the (...) systematic rape of women in war zones like Bosnia; and the invasive manipulation of women's bodies and all of nature in genetic engineering, fertility experiments, and cloning. But she also offers a "Far-Out Vision and Hope for Wonderlusting Women" who are beginning to discover Quintessence: Spirit that fills the universe and gives it life and vitality. (shrink)

The phrase "natural kind term" has come into the linguistic and philosophical literature in connection with well-known work of Kripke (1972) and Putnam (1970, 1975a). I use that phrase here in the sense it has acquired from those and subseqnent works on related topics. This is not the transparent sense of the phrase. That is, if I am right in what follows there are words for kinds of things existing in nature which are not natural kind terms in the current (...) sense - e.g. planet, woman, and weed. I use the term "nondescriptional", following Salmon (1981), to mean "lacking a Fregean sense", where a Fregean sense is taken to be a property or group of properties semantically associated with an expression which determines its denotation. I hope that the term "nondescriptional" will be clarified in subsequent discussion, but perhaps a few words about it and its opposite, "descriptional", would be useful here. These terms (as Salmon notes (p.15, n. 11)) should be taken as technical terms. The idea is that descriptional words, of which bachelor is the overwhelmingly favorite example, express a semantic content, or sense, which is what mediates their denotation. Entities fall in their denotation in virtue of possessing the property or properties expressed as their sense. (It is not necessary, however, that this sense be as easily paraphrasable with descriptive synonyms as it is typically held to be in the case of bachelor, or even that it be paraphrasable at all.) In the case of nondescriptional words there is no Fregean sense to mediate the link between word and object. Hence such terms are described by what Salmon, following Kaplan, calls "the theory of direct reference". What it is that does associate such terms with their denotations is another question which will be touched on briefly at the end. I have several aims in this paper. The first is to defend a conservative position on nondescriptionality. I will argue that relatively few natural language words have this property. My other aims are primarily clarificatory. Among the issues I would like to clarify are those connected with the determination of this property and flae explanation of why it exists, its relationship with other properties such as rigid designation and essentiality, and its significance for lexical semantics. The organization of the paper is as follows. The first section identifies the position taken here on the question of which expressions are nondescriptional and provides a general defense of it. The second section is a critical examination of criteria associated with nondescriptionality. In the third section provide further defense for the conservative position, and in the fourth section we turn to related issues in lexical semantics. (shrink)

Haeusermann et al. (Citation2023) draw three overall conclusions from their study on closed loop neuromodulation and self-perception in clinical treatment of refractory epilepsy. The first is that closed-loop neuromodulation devices did not substantially change epileptic patient’s personalities or self-perception postoperatively. The second is that some patients and caregivers attributed observed changes in personality and self-perception to the epilepsy itself and not to the DBS treatments. The third is that the devices provided participants with novel ways to make sense of their (...) illness. These findings further demonstrate a misalignment between some neuroethicists’ concerns about putative postoperative changes to personality, and the empirical evidence for such changes. Haeusermann et al. nonetheless concede that “neurotechnology directed at persisting rather than episodic clinical phenomena could have greater implications for personality or self-perception, either because they operate more continuously or are directed at clinical phenomena that are more stably integrated into patients’ self-concepts” (41). We acknowledge that the hypothesis that participants did not report changes because they were only episodically and not continually stimulated offers an interesting line for future investigation. Nonetheless, we would like to propose that potential postoperative personality changes might be correlated with the pathophysiology itself, rather than the stimulation effects of the technology. Generally, we advance the view that unintended effects solely induced by the technology cannot be excluded per se. Regardless, this comment aims to highlight that ethicists’ starting premise should be that patients suffering from diverse pathophysiology, or patients who are treated with stimulation in different brain regions and with differing parameters, would likely not react in the same way to treatment. (shrink)

Ulrich Beck's best selling Risk Society established risk on the sociological agenda. It brought together a wide range of issues centering on environmental, health and personal risk, provided a rallying ground for researchers and activists in a variety of social movements and acted as a reference point for state and local policies in risk management. The Risk Society and Beyond charts the progress of Beck's ideas and traces their evolution. It demonstrates why the issues raised by Beck reverberate widely throughout (...) social theory and covers the new risks that Beck did not foresee, associated with the emergence of new technologies, genetic and cybernetic. The book is unique because it offers both an introduction to the main arguments in Risk Society and develops a range of critical discussions of aspects of this and other works of Beck. (shrink)

According to the Nomological Argument, observed regularities in nature are best explained by an appeal to a supernatural being. A successful explanation must avoid two perils. Some explanations provide too little structure, predicting a universe without regularities. Others provide too much structure, thereby precluding an explanation of certain types of lawlike regularities featured in modern scientific theories. We argue that an explanation based in the creative, intentional action of a supernatural being avoids these two perils whereas leading competitors do not. (...) Although our argument falls short of a full defense, it does suggest that the Nomological Argument is worthy of philosophical attention. (shrink)

Szabó follows Heim in viewing familiarity, rather than uniqueness, as the essence of the definite article, but attempts to derive both familiarity and uniqueness implications pragmatically, assigning a single semantic interpretation to both the definite and indefinite articles. I argue that if there is no semantic distinction between the articles, then there is no way to derive these differences between them pragmatically.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:For the Sake of Argument: Practical Reasoning, Character, and the Ethics of BeliefRobert MetcalfFor the Sake of Argument: Practical Reasoning, Character, and the Ethics of Belief. Eugene Garver. Chicago: University of Chicago Press, 2004. pp. 264. $55.00, hardcover; $22.50, paperback.Professor Garver's book, For the Sake of Argument: Practical Reasoning, Character, and the Ethics of Belief, is a provocative and illuminating study of practical reasoning, and one that develops (...) many of the ideas found in his magisterial study, Aristotle's Rhetoric: An Art of Character (Chicago: University of Chicago Press, 1994). The previous book concluded by arguing that Aristotle's Rhetoric is philosophically more interesting today than it was in Aristotle's time, in part because for us there is no polis to which the argumentative facility of rhetoric would be subordinate (1994, 233ff.). This idea is echoed in the present book when Garver writes: "The more we take disagreement to be a permanent part of the situation of practical reasoning, and not something soon to be overcome by appropriate theory or universal enlightenment, the more rhetorical facility becomes a central part [End Page 95] of practical reason" (2004, 175). It is, indeed, a fascinating feature of For the Sake of Argument that it defends the autonomy and integrity of practical reason through Aristotle's insights on the various connections between argument, persuasion, and ethos (153), and illustrates these through examples such as the South African Truth and Reconciliation Commission, the landmark Brown v. Board of Education, and subsequent Supreme Court decisions.The book is divided into eight chapters, and, as Garver explains, these represent four pairs of essays in which a more concrete or "applied" chapter is followed by a chapter that draws generalizations from the examples of the prior chapter. Among the themes most prominent in the book are the connection between reason and character, on which Garver writes, "Practical reason has its own integrity when who we are and how we think are intimately connected" (2); the compatibility, within practical reason, of truth and one's own interest; the "ampliative" nature of practical reason, such that the implications of one's beliefs can lead to discoveries unanticipated at the beginning; the connection between the ethos of a leader and the ethos of a community; and the underappreciated power of epideictic rhetoric "to affirm values and articulate new vocabularies" (178). In addressing such broad themes, Garver's attention to concrete examples, like Brown v. Board of Education, is thoroughly instructive. The Brown decision, he argues, is "an epideictic declaration that equality and antidiscrimination are fundamental American Constitutional values" (73). Brown clearly demonstrates the ampliative nature of practical reason in that the conclusion it reaches is stronger than the premises from which it begins (i.e., the Fourteenth Amendment); moreover, it generates what Garver calls an "ethical surplus" that allows for unanticipated implications that are stronger still, such as the later Court decision striking down antimiscegenation laws (71–73). This "increase" in strength in proceeding from premises to conclusion is "impossible under a purely deductive conception of rationality," Garver writes (73), yet it is well explained by his Aristotle-inspired account of practical reasoning.Surely some readers will recoil from Garver's more provocative claims, such as that "we decide... to be convinced and choose to find a line of reasoning compelling" (119), offered within a discussion of the responsibility we bear in ethical argumentation. However, the issue that is more problematic, to my mind, concerns Garver's treatment of Plato. This may seem odd, given that Plato only appears as a foil in the book—but the problem is that it is merely a caricature of Plato that Garver allows to act as [End Page 96] a foil. Garver argues against "the Platonic program which will save reason by removing it from human contamination" (3) and "the Platonic hope of replacing ethical reasoning by the certainties of science" (5). He sides with Aristotle's idea that we can aim at effectiveness and at rightness together (48, 200) over against the allegedly Platonic idea that we must choose between truth and our own interest, reason and emotion, and so forth, or else... (shrink)

Dispositionalism about modality is the view that metaphysical modality is a matter of the dispositions possessed by actual objects. In a recent paper, David Yates has raised an important worry about the formal adequacy of dispositionalism. This paper responds to Yates’s worry by developing a reply that Yates discusses briefly but dismisses as ad hoc: an appeal to a ’plenitude of powers’ including such powers as the necessarily always manifested power for 2+2\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} (...) \begin{document}$$2+2$$\end{document} to be 4. I argue that the reply is not ad hoc at all, by defending the metaphysics of dispositions that should underly it. I then argue, first, that a proper understanding of dispositions’ degrees provides us with an argument for such necessarily always manifested dispositions; second, that all the natural attempts to block that argument can be resisted without being ad hoc; and third, that pragmatic considerations explain our intuitive resistance to the ascription of necessarily always manifested dispositions. Dispositionalism can be formally adequate after all. (shrink)

We defend Joseph Melia's thesis that the role of mathematics in scientific theory is to ‘index’ quantities, and that even if mathematics is indispensable to scientific explanations of concrete phenomena, it does not explain any of those phenomena. This thesis is defended against objections by Mark Colyvan and Alan Baker.

Current UK legislation is impacting upon the feasibility and cost-effectiveness of medical record-based research aimed at benefiting the NHS and the public heath. Whereas previous commentators have focused on the Data Protection Act 1998, the Health and Social Care Act 2001 is the key legislation for public health researchers wishing to access medical records without written consent. The Act requires researchers to apply to the Patient Information Advisory Group for permission to access medical records without written permission. We present a (...) case study of the work required to obtain the necessary permissions from PIAG in order to conduct a large scale public health research project. In our experience it took eight months to receive permission to access basic identifying information on individuals registered at general practices, and a decision on whether we could access clinical information in medical records without consent took 18 months. Such delays pose near insurmountable difficulties to grant funded research, and in our case £560 000 of public and charitable money was spent on research staff while a large part of their work was prohibited until the third year of a three year grant. We conclude by arguing that many of the current problems could be avoided by returning PIAG’s responsibilities to research ethics committees, and by allowing “opt-out” consent for many public health research projects. (shrink)

In this seminal study, Barbara Galli explores Rosenzweig's statement that his notes to Halevi's poems exemplify a practical application of the philosophic ...

There are growing discontinuities between the research practices of data science and established tools of research ethics regulation. Some of the core commitments of existing research ethics regulations, such as the distinction between research and practice, cannot be cleanly exported from biomedical research to data science research. Such discontinuities have led some data science practitioners and researchers to move toward rejecting ethics regulations outright. These shifts occur at the same time as a proposal for major revisions to the Common Rule—the (...) primary regulation governing human-subjects research in the USA—is under consideration for the first time in decades. We contextualize these revisions in long-running complaints about regulation of social science research and argue data science should be understood as continuous with social sciences in this regard. The proposed regulations are more flexible and scalable to the methods of non-biomedical research, yet problematically largely exclude data science methods from human-subjects regulation, particularly uses of public datasets. The ethical frameworks for Big Data research are highly contested and in flux, and the potential harms of data science research are unpredictable. We examine several contentious cases of research harms in data science, including the 2014 Facebook emotional contagion study and the 2016 use of geographical data techniques to identify the pseudonymous artist Banksy. To address disputes about application of human-subjects research ethics in data science, critical data studies should offer a historically nuanced theory of “data subjectivity” responsive to the epistemic methods, harms and benefits of data science and commerce. (shrink)