While various definitions of moral distress have been proposed, some agreement exists that it results from illegitimate constraints in clinical practice affecting healthcare professionals’ moral agency. If we are to reduce moral distress, instruments measuring it should provide relevant information about such illegitimate constraints. Unfortunately, existing instruments fail to do so. We discuss here several shortcomings of major instruments in use: their inability to determine whether reports of moral distress involve an accurate assessment of the requisite clinical and logistical facts (...) in play, whether the distress in question is aptly characterized as moral, and whether the moral distress reported is an appropriate target of elimination. Such failures seriously limit the ability of empirical work on moral distress to foster appropriate change. (shrink)

Pictures of sides of beef, hanging from overhead rails in refrigerated warehouses and meat-processing plants, often leave a feeling of unease. These pictures provoke the notion that human beings have no right to inflict suffering and death on other sentient beings for the sole purpose of providing food. However, the ethical analysis conducted in this study shows that meat production, if animal welfare and deaths per calorie created are considered, is less of a pressing problem compared to the production of (...) milk. While meat can be provided with minimal suffering to animals, the consumption of milk is always associated with considerable suffering during the dairy cow’s life-span and the lives of their offspring. Moreover, more bovine deaths per unit of calorific value created are associated with milk production compared to meat production. The vegan movement, which is currently growing, wishes to minimise farm animal suffering as much as possible. However, if a vegan diet is not possible, consumers should make an informed decision about the products they consume. Replacement of the calories obtained from meat with those from milk and dairy products is not rational if animal welfare is considered. (shrink)

Naloxone, which reverses the effects of opioids, was synthesized in 1960, though the hunt for opioid antagonists began a half-century earlier. The history of this quest reveals how cultural and medical attitudes toward opioids have been marked by a polarization of discourse that belies a keen ambivalence. From 1915 to 1960, researchers were stymied in seeking a “pure” antidote to opioids, discovering instead numerous opioid molecules of mixed or paradoxical properties. At the same time, the quest for a dominant explanatory (...) and therapeutic model for addiction was likewise unsettled. After naloxone’s discovery, new dichotomizing language arose in the “War on Drugs,” in increasingly divergent views between addiction medicine and palliative care, and in public debates about layperson naloxone access. Naloxone, one of the emblematic drugs of our time, highlights the ambivalence latent in public and biomedical discussions of opioids as agents of risk and relief. (shrink)

This book offers a comprehensive virtue ethics that breaks from the tradition of eudaimonistic virtue ethics. In developing a pluralistic view, it shows how different ’modes of moral response’ such as love, respect, appreciation, and creativity are all central to the virtuous response and thereby to ethics. It offers virtue ethical accounts of the good life, objectivity, rightness, demandingness, and moral epistemology.

Indigenous communities have always cultivated social studies learning that is interactive, dynamic, and integrated with traditional knowledges. To confront the assimilative and deculturalizing education that accompanied European settlement of the Americas, Montana has adopted Indian Education for All (IEFA). This case study evaluates the Digital Storywork Partnership (DSP), which strives to advance the goals of IEFA within and beyond the social studies classroom through community-centered research and filmmaking. Results demonstrate the potential for DSP projects to advance culturally revitalizing education, community (...) connectedness, and identity-development. The DSP offers a model for social studies education that is not only culturally affirming and revitalizing for Indigenous communities, but also holds potential for use in all communities. We conclude with recommendations for educators, scholars, and community members engaged in similar efforts. (shrink)

This book should be essential reading for anyone interested in the new reproductive technologies, biomedical ethics, and women's health.

This book argues that the question posed by virtue theories, namely, “what kind of person should I be?” provides a more promising approach to moral questions than do either deontological or consequentialist moral theories where the concern is with what actions are morally required or permissible. It does so both by arguing that there are firmer theoretical foundations for virtue theories, and by persuasively suggesting the superiority of virtue theories over deontological and consquentialist theories on the question of explaining morally (...) bad behavior. Virtue theories can give a richer account by appealing to the kinds of dispositions that make certain bad choices appear attractive. This richer account also exposes a further advantage of virtue theories: they provide the best kinds of motivations for agents to become better persons. (shrink)

In this paper we shall introduce two types of contextual-hierarchical approaches to the strengthened liar problem. These approaches, which we call the ‘standard’ and the ‘alternative’ ch-reconstructions of the strengthened liar problem, differ in their philosophical view regarding the nature of truth and the relation between the truth predicates T r n and T r n+1 of different hierarchy-levels. The basic idea of the standard ch-reconstruction is that the T r n+1-schema should hold for all sentences of \. In contrast, (...) the alternative ch-reconstruction, for which we shall argue in section four, is motivated by the idea that T r n and T r n+1 are coherent in the sense that the same sentences of \ should be true according to T r n and T r n+1. We show that instances of the standard ch-reconstruction can be obtained by iterating Kripke’s strong Kleene jump operator. Furthermore, we will demonstrate how instances of the alternative ch-reconstruction can be obtained by a slight modification of the iterated axiom system KF and of the iterated strong Kleene jump operator. (shrink)

Personal autonomy is often taken to consist in self-government or self-determination. Personal autonomy thus seems to require self-control. However, there is reason to think that autonomy is compatible with the absence of self-control. Akratic action, i.e., action performed against the agent’s better judgement, can be free. And it is also plausible to think that free actions require autonomy. It is only when you determine what you do yourself that you act freely. It follows that akratic actions can be autonomous. At (...) least in some cases, it is the agent herself, and not some alien part of her, who determines her akratic actions. But akratic actions are usually thought to be paradigm cases of self-control failure. Thus, we have reason both to conclude that autonomy requires self-control and that autonomy is compatible with the absence of self-control. My aim is to discuss the main solutions to this paradox. (shrink)

International migration has a female face in the beginning of the twenty-first century; since at least 1990, a total of 49 percent of international migrants have been women (UN 2008).1 Many women relocate in pursuit of goals that they can’t realize in their countries of origin, and many women move on their own to developed countries as caregivers to the very old or the very young, as nurses to attend to the sick in hospitals, and as domestic workers.2 How should (...) we regard their decisions to do so? One way of thinking about such moves is to deplore the fact that women have to move in order to attain certain goals in their lives; it would be more desirable to live in a world that would not make such moves necessary... (shrink)

RésuméJ'ai soutenu dans un article de 1985 que s'il y avait des miracles, cela parlerait contre l'existence du Dieu judéo-chrétien. Dans son livre de 1988 sur le concept de miracle, Robert Larmer propose une critique de mes arguments. J'évalue ici la force de cette critique. Je montre que la redéfinition de «miracle» que propose Larmer est circulaire; que sa distinction est spécieuse entre violer une hi naturelle et la surmonter grâce à la création ou la destruction d'énergie par Dieu; et (...) que sa tentative de montrer que les miracles sont le produit d'un être rationnel, bienfaisant et tout-puissant est inadéquate. (shrink)

To view organismic functioning in terms of integration is a mistake, although the concept has dominated scientific thinking this century. The operative concept for interpreting the organism proposed here is that of ‘articulation’ or decomposition rather than that of composition from segregated parts. It is asserted that holism is the fundamental state of all phenomena, including organisms. The impact of this changed perspective on perceptual theorizing is profound. Rather than viewing it as a process resulting from internal integration of isolated (...) features detected by receptor neurons into a perceptual whole, the new theory suggests that the task of perceptual processing is to break up what initially exists holistically in sense organs into features and eventually perceived objects. Similarly, the goal of perceptual activity is not Sherrington's, that of integrating essentially unrelated organisms with their environmental surround, but rather to generate percepts in which the environment appears as a field of objects and events independent of the perceiver which are available for manipulation. Perception is a process by which organisms use their embeddedness in physical reality as if they were independent of it. There are a number of interesting results of this conceptual reorientation. The binding problem is eliminated because the percept's holistic character is the precondition for neural activity, not its product. The concept of representation can be dispensed with since the fundamental conceptual motivation for its introduction -- the assumed need to produce an internal copy of what was assumed to exist independently outside the organism in order to integrate organismic behaviour with its environmental causes -- is rejected outright. And finally, the issue of perceptual consciousness is addressed: how does the percept acquire its objective status vis-a-vis a perceiver, and what is the basis of the experiential character of perception? (shrink)

The literature on cosmopolitan justice has yet to address what principles to adopt when duties of global justice and duties of social justice are in conflict. In this paper, I address David Miller’s contention that some may fall into the justice gap since we need to prioritize duties of social justice in cases of conflict. I argue that Miller’s analysis depends on three stipulations: the incommensurability of the values underlying duties of social justice and those of global justice; the need (...) to justify duties of justice to their holders; and the need to consider the necessary institutions to realize and implement justice obligations. I argue against the incommensurability clause by showing that both conceptions of justice pursue moral equality as the underlying and commensurate value. Instead, I propose that the currencies of justice we employ in the two contexts of justice are different. Discussing the justifiability clause I agree with the stipulation that we have to justify decisions that affect the realization of justice to those who have to carry the burden of realizing them. This implies, however, that we may have to accept that some prioritize duties of global justice over duties of social justice. If this is the case, it seems as though the state has little recourse to prioritize duties of social justice. Finally, discussing Miller’s institutional clause I ask why the justice relevant institutions can only be those of the state. It is plausible to say that in our current world, institutions of humanitarian aid are effective means to satisfy duties of global justice. (shrink)

As this article is published, Robert Larmer and I have been engaged in a debate that is now eighteen years long, often with gaps of many years between ripostes, about the nature and significance of miracles. The Larmer/overall oeuvre now includes six works, including the two published here. I am grateful to the editors of Dialogue for giving me the opportunity to respond to Larmer’s most recent entry in the debate.

In this reply, I argue that the worries raised by Kurth and this coauthors are not fatal for the perceptual theory of emotions. A first point to keep in mind in discussing the analogy argument in favor of that account is that what counts is the overall balance of similarities and differences, given their respective weight. In any case, I argue that none of the alleged differences between sensory perceptual experiences and emotions are such as to rule out that emotions (...) are a kind of perceptual experience which can confer epistemic justification of our evaluative beliefs. Finally, I suggest that the perceptual theory is in a position to nicely capture what happens when we disagree about evaluative issues. (shrink)