Background and Objectives Primary care providers (PCPs) report decreased job satisfaction and high levels of burnout, yet little is known about their experience of moral distress. The aim of this study was to gain insight into the experiences of PCPs regarding moral distress including causative factors and proposed mitigation strategies. Methods This qualitative pilot study used semi-structured interviews to identify causes of moral distress in PCPs in an academic family medicine department. Interviews were analyzed using conventional content analysis. Results Of (...) 35 eligible participants, 12 completed the study (34% participation rate). Most were white, female, and had practiced for less than 10 years. Four PCPs had considered leaving their position due to moral distress. Participants identified five causes of moral distress: policies and procedures that conflict with patient needs, the unpredictable nature of primary care, need to “bend the rules,” lack of accountability, and lack of support staff. Six internal conflicts made resolving morally distressing situations difficult: perceived powerlessness, sense of responsibility, socialization to follow orders, emotional toll of the job, competing obligations, and fear of mistakes. Conclusions These findings matched themes in the current literature and identified an unbending infrastructure. This, coupled with the chaotic nature of primary care, resulted in frequent moral distress. Participants offered solutions to reduce and mitigate moral distress (also similar with current literature) and suggested moral distress and burnout are closely linked. (shrink)

Kolbe and de Melo-Martin’s (2023) arguments draw attention to what is most useful about moral distress—identifying its causes is at least as important as measuring its severity. Jameton’s original...

Originally published in 1900, this book presents a discussion of the relationship between ethics and education. The text is divided into four main parts: 'Congenital Endowment: its Nature and Treatment'; 'Educative Influences'; 'Sound Judgment'; and 'Self-Development and Self-Control'. This book will be of value to anyone with an interest in philosophy and the history of education.

Drawing from our interdisciplinary qualitative study of LGBTI conservative Christians and their allies, we name an especially toxic form of shame—what we call sacramental shame—that affects the lives of LGBTI and other conservative Christians. Sacramental shame results from conservative Christianity's allegiance to the doctrine of gender complementarity, which elevates heteronormativity to the level of the sacred and renders those who violate it as not persons, but monsters. In dispensing shame as a sacrament, nonaffirming Christians require constant displays of shame as (...) proof that LGBTI church members love God and belong in the community. Part of what makes this shame so harmful is that parents and pastors often dispense it with sincere expressions of care and affection, compounding the sense that one's capacity to give and receive love is damaged. We foreground LGBTI Christian movements to overcome sacramental shame by cultivating nonhubristic pride, and conclude by discussing briefly their new understandings of love and justice that could have far‐reaching benefits. (shrink)

Concerns regarding corporate ethics have grown steadily throughout the past decade. In order to remain competitive, many organizational leaders are faced with the challenge of creating an ethical environment within their organization. A model is presented showing the process and elements necessary for the institutionalization of organizational ethics. The transformational leadership style lends itself well to the creation of an ethical environment and is suggested as a means to facilitate the institutionalization of corporate ethics. Finally, the benefits of using transformational (...) leadership are demonstrated through the components of a psychological contract, organizational commitment, and ethical culture to institutionalize organizational ethics. (shrink)

According to Roger Scruton, it is not possible for photographs to be representational art. Most responses to Scruton’s scepticism are versions of the claim that Scruton disregards the extent to which intentionality features in photography; but these cannot force him to give up his notion of the ideal photograph. My approach is to argue that Scruton has misconstrued the role of causation in his discussion of photography. I claim that although Scruton insists that the ideal photograph is defined by its (...) ‘merely causal’ provenance, in fact he fails to take the causal provenance of photographs seriously enough. To replace Scruton’s notion of the ideal photograph, I offer a substantive account of the causal provenance of photographs, centred on the distinctive role of ‘the photographic event’. I conclude that, with a proper understanding of the photographic process, we have good reason to re-open the question of photography as a representational art. (shrink)

In this article, we contribute to sociological literatures on morality, professional and institutional contexts, and morally stigmatized ‘dirty work’ by emphasizing and exploring how they mutually inform one another in lawyers’ work activities. Drawing on interview data with 58 practitioners in the commercial legal industry in Singapore, we analyze how they experience professional and institutional constraints on the expressions of morality in their work. Our findings illustrate how a dominant managerial and economic focus maintains and reproduces a constrained form of (...) morality, limited to instrumental, utilitarian and commercial ends, and subordinated to lucrative client and firm interests. We discuss our findings in terms of the need to research and reform professions in ways that support more rounded and unconstrained moral reflexivity and autonomy in how work is undertaken and valued. This in turn has implications for how organizations and professions might achieve alternative moral institutional orders, and for legal work to avoid the moral and social taints of dirty work. (shrink)

Photography is valued as a medium for recording and visually reproducing features of the world. I seek to challenge the view that photography is fundamentally a recording process and that every photograph is a record—a view that I claim is based on a ‘single-stage’ misconception of the process. I propose an alternative, ‘multi-stage’ account in which I argue that causal registration of light is not equivalent to recording and reproducing an image. Intervention or non-intervention by photographers is more sophisticated than (...) the traditional view allows. Using the multi-stage account, I describe four models for producing photographic images and pictures. (shrink)

Past research suggests that people process verbal quantifiers differently from numerical ones, but this suggestion has yet to be formally tested. Drawing from traditional correlates of dual-process...

How can we talk meaningfully about the past if it does not exist to be talked about? What gives time its direction? Is time travel possible? This defence of presentism - the view that only the present exists - makes an original contribution to a fast growing and exciting debate.

German philosopher Martin Heidegger stirred educators when in 1951 he claimed teaching is more difficult than learning because teachers must ‘learn to let learn’. However in the main he left the aphorism unexplained as part of a brief four-paragraph, less than two-page set of observations concerning the relationship of teaching to learning; and concluded at the end of those observations that to become a teacher is an ‘exalted matter’. This paper investigates both of Heidegger's claims, interpreting letting learn in the (...) context of Heidegger's larger philosophical project, and suggesting why in light of that project to become a teacher is an exalted concern. The methodology guiding the inquiry is largely hermeneutic, the purpose of the essay to interpret teaching from a Heideggerian perspective: its nature and general method. (shrink)

This paper has already been published in Sociological Research Online, 21/3, August 2016. All rights reserved. © SOCIOLOGICAL RESEARCH ONLINE. It is available from Kent Academic Repository. We thank Dawn Lyon for the permission to republish it here.: This article documents, shows and analyses the everyday rhythms of Billingsgate, London's wholesale fish market. It takes the form of a short film based an audiovisual montage of time-lapse photography and sound recordings, and a - Sociologie – Nouvel article.

Some photographs show determinate features of a scene because the photographed scene had those features. This dependency relation is, rightly, a consensus in philosophy of photography. I seek to refute many long-established theories of photography by arguing that they are incompatible with this commitment. In Section II, I classify accounts of photography as either single-stage or multi-stage. In Section III, I analyze the historical basis for single-stage accounts. In Section IV, I explain why the single-stage view led scientists to postulate (...) “latent” photographic images as a technical phenomenon in early chemical photography. In Section V, I discredit the notion of an invisible latent image in chemical photography and, in Section VI, extend this objection to the legacy of the latent image in digital photography. In Section VII, I appeal to the dependency relation to explain why the notion of a latent image makes the single-stage account untenable. Finally, I use the multi-stage account to advance debate about “new” versus “orthodox” theories of photography. (shrink)

How can we talk meaningfully about the past if it does not exist to be talked about? What gives time its direction? Is time travel possible? This defence of presentism - the view that only the present exists - makes an original contribution to a fast growing and exciting debate.

Courts and legislatures are increasingly being called upon to restrict the autonomy of pregnant women by requiring them to behave in ways that others determine are best for the fetuses they carry. The state should not attempt to transform pregnant women into ideal baby‐making machines. Pregnant women make decisions about their behavior in the context of the rest of their lives, with all the attendant complexities and pressures. Our interest in helping future children by improving prenatal care would best be (...) furthered by helping pregnant women to make informed, less constrained choices, not by punishing women or depriving them of choices altogether. (shrink)

This article introduces and defines the Health in All Policies concept and examines existing state legislation, with a focus on California. The article starts with an overview of HiAP and then analyzes the status of HiAP legislation, specifically addressing variations across states. Finally, the article describes California's HiAP approach and discusses how communities can apply a HiAP framework not only to improve health outcomes and advance health equity, but also to counteract existing laws and policies that contribute to health inequities.

Discourses of interdisciplinary health‐care are becoming more centralised in the context of global healthcare practices, which are increasingly based on multisystem interventions. As with all dominant discourses that are narrated into being, many others have been silenced and decentralised in the process. While questions of the nature and constituents of interdisciplinary practices continue to be debated and rehearsed, this paper focuses on the discourse of interdisciplinary collaboration using psychiatry as an example, with the aim of highlighting competing and alternative discourses. (...) The fundamental premise of this paper is that collaborative relationships form the basis of interdisciplinary practices in psychiatry. Through a critical engagement and a deconstructive reading of the pretext, context and subtexts of interdisciplinarity, we interrogate the concept of interdisciplinary practice within psychiatry. We contend that an important part of understanding and further conceptualising the discourse is through fracturing it. This process is illustrated in the successive stages of our conceptual map of discourse development: establishing, maintaining and developing discourses. An understanding of interdisciplinary practice is not only critical for psychiatry, but also offers important insights into the performance of collaborative failures and indeed successes across nursing and allied health professions. (shrink)

Kathleen Stock’s engaging and careful book demonstrates that ‘extreme intentionalism’ – the view that a fiction’s content is determined by what its author actually intended – has for too long been held back by a set of familiar objections.1 1 It is often thought to have implausible consequences involving disregarding conventional meaning, permitting undetectable fictional content, denying that authorial intentions can be unsuccessful, or giving too much importance to extraneous indications of intention and too little to the work itself. All (...) these objections, Stock argues, are overplayed, all are answerable, and several ultimately favour extreme intentionalism over its rivals. Stock’s defence of extreme intentionalism grounds a view of imaginative resistance, an account of the fiction/non-fiction distinction and of what an individual fiction is, and a characterization of propositional imagining and of the nature of supposition. (shrink)

The traditional doctrine that God is impassible is subject to the objection that it is incompatible with belief that God is loving and compassionate. However, the doctrine that God is passible has grave difficulties as well. I argue that Christian believers should take an analogical approach, by believing that God does something relevantly similar to loving us in a way that involves vulnerability to suffering, and thus conceiving of God as loving us in that way, while simultaneously believing that God (...) is in fact impassible. I conclude with answers to several likely objections. (shrink)

Pervasive, easy-to-use privacy services are keys to enabling users to maintain control of their private data in the online environment. This paper proposes (1) an online privacy lifecycle from the user perspective that drives and categorizes the development of these services, (2) a layered platform design solution for online privacy, (3) the evolution of the PeCAN (Personal Context Agent Networking) architecture to a platform for pervasively providing multiple contexts for user privacy preferences and online informational privacy services, and (4) use (...) of platform network effects for increasing wide-scale user adoption of privacy services. One implication of this paper’s concepts is that platform-mediated networks, which are reportedly the vehicles for most of the revenue earned by 60 of the world’s largest companies, and other platforms that commonly host millions of users, will not have to individually reinvent and manage sophisticated user services for privacy protection since universal privacy platforms can be layered on them in future. (shrink)

A recent paper(1) describing the stage‐specific loss of ubiquitin (UBQ) and ubiquitinated proteins (UBQ‐Ps) during pollen development has raised some interesting questions regarding our understanding of the regulation of protein turnover during cellular differentiation and the specialized development of the pollen grain. The authors, Callis and Bedinger(1), describe experiments in which the profiles of free and protein‐conjugated ubiquitin were examined during pollen development. UBQ and UBQ‐Ps were immunologically detected in extracts of microspores and maturing pollen of maize at six developmental (...) stages. Their results remarkably demonstrate that UBQ and UBQ‐Ps decline to barely detectable levels during the final stages of pollen development. (shrink)

In this essay, I trace the development of Julia Kristeva's theory and practice of “the subject in procession trial” from her semiotic works of the 1960s to her psychoanalytic writings of the 1970s and 1980s. I read Kristeva's exploration of this “subject in procession trial” as contributing to a postmodern feminist ethics.

This paper hinges on the idea that our subjectivities---how individuals come to an understanding about themselves, their relationship to each other and their place in the world---are profoundly affected by the intersubjective quality of recognition we receive from others. Rooted within the Hegelian dialectical perspective, the desire for recognition stems from the view that a major part of our identities are formed through social relations. Misrecognition, in its various forms, promotes fundamental injustices. This is a point that the traditional modernist (...) approach to political philosophy bypasses because of its focus on procedural rather than ethical issues of injustice. (shrink)

In “Expectant Fathers, Abortion, and Embryos,” Dara Purvis evaluates the concepts of intent and gender stereotypes in connection with “expectational fathers” in the related contexts of abortion and assisted reproductive technologies. This comment seeks to build upon Purvis's own analysis to obviate her concern that abortion discourse promotes harmful stereotypes of men as disinterested fathers. To the contrary, for men — no less than for women — a desire to avoid or terminate pregnancy is fully consistent with loving and shared (...) parenthood of existing or future children. The same individuals who choose to become parents at other times in their long reproductive lives will use contraception and have abortions. In fact, most women who have abortions already have children. Policies that empower men and women to avoid unintended pregnancy are the sensible, win-win, front-line approach to avoid disputes over abortion. (shrink)

One fundamental barrier to eliminating health disparities, particularly with regard to the determinants of health, is the persistence of discrimination. Civil rights law is the primary legal mechanism used to address discrimination. Federal civil rights laws have been the subject of wider analyses as a determinant of health as well as a tool to address health disparities. The research on state civil rights laws, while more limited, is growing. This article will highlight a few examples of how some states are (...) using civil rights laws to combat discrimination, particularly in more expansive ways and in the interest of new populations, presenting tools that can target determinants and address the goal of reducing health disparities. (shrink)

In neocolonial contexts of globalization, the epistemological terrain of radical diversity poses significant ethical challenges to transnational feminisms. In view of historical associations between knowledge and discourses of love which were conditioned by imperialist brands of humanism and benevolence under colonialism, this paper argues for a deconstructionist approach to conceptualizing love in relation to knowledge and for an ethics that severs the association with benevolence, instead making alterity the basis for its account.

This Discussion Piece is a response to Mark Windsor's Discussion Piece (2023) 'Photographic Registers are Latent Images', which is a response to my article, (2021) 'Invisible Images and Indeterminacy: Why we need a Multi-stage Account of Photography' JAAC 79(2) 161-174.. -/- I argue that a photosensitive surface does not produce invisible pictorial features when it is exposed to light, and conclude, contra Windsor, that a photographic register is not a latent image. I argue that Windsor does not succeed in defending (...) a single-stage account of photography and I reconfirm that a multi-stage account is correct. (shrink)

A photographic image is said to provide evidence of a photographed scene because it is a causal imprint of reflected light, an indexical trace of real objects and events. Though widely established in the history, theory, and philosophy of photography, this traditional imprinting model must be rejected because it relies on a “single-stage” misconception of the photographic process: the idea that a photographic image comes into existence at the time of exposure. In its place, a “multistage” account properly articulates different (...) production stages, such as registering and rendering, that are relevant to understanding the relation between a photographic image and the photographed scene. By denying that any photographic image is a causal imprint, the multistage approach proposes a more demanding evaluation of photographic evidence. This has implications for documentary film and photojournalism, along with specialized applications such as forensics, surveillance, and face-recognition technology. (shrink)