Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender (...) diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used a qualitative description approach. Participants were recruited using purposive sampling between October 2020 to May 2021 from pediatric critical care units in a (...) western Canadian province. We conducted individual semi-structured interviews via Zoom. A total of 10 registered nurses participated in the study. Four main themes were identified: (1) “I’m sorry, there’s nothing else”: increasing supports for patients and families; (2) “someone will commit suicide”: improving supports for nurses: (3) “Everyone needs to be heard”: improving patient care communication; and (4) “I didn’t see it coming”: providing education to mitigate moral distress. Most participants stated they wanted an intervention to improve communication among the healthcare team and noted changes to unit practices that could decrease moral distress. This is the first study that asks nurses what is needed to minimize their moral distress. Although there are multiple strategies in place to help nurses with difficult aspects of their work, additional strategies are needed to help nurses experiencing moral distress. Moving the research focus from identifying moral distress towards developing effective interventions is needed. Identifying what nurses need is critical to develop effective moral distress interventions. (shrink)

This study is unique in that it presents the first empirically developed framework for use as a tool for measuring historical empathy. The Historical Empathy Measurement Tool (HEMT) was developed using a design-based research method with three iterative macrocycles of design, experiment, and retrospective analysis. The study involved question responses from 276 students in grade 8 studying WWI trench warfare. The research resulted in a framework of seven levels. (0) Non-response, (1) Facts, (2) Assumptions and Deficits, (3) General Comparison of (...) the Past and Present, (4) Emotional Comparison of the Past and Present, (5) Understanding Motives, Behaviors, Thoughts, & Emotions in the Past, and (6) Acknowledgement of Differences from those in the Past. The inter-rater reliability at the end of macrocycle three was 95%. (shrink)

Background:Moral distress is a significant concern for nurses as it can lead to burnout and intentions to leave the profession. Pediatric nurses encounter stressful and ethically challenging situations when they care for suspected victims of child maltreatment. Data on pediatric nurses’ moral distress are limited, as most research in this field has been done in adult inpatient and intensive care units.Aim:The purpose of this study was to describe pediatric nurses’ moral distress and evaluate the impact of caring for suspected victims (...) of child maltreatment on nurses’ moral distress, burnout, and intention to leave. Design and method: This descriptive cross-sectional correlational study was conducted in a mid-Atlantic, urban area Magnet pediatric level I trauma center that cares for over 1800 cases of suspected child maltreatment annually. An anonymous electronic survey was sent to all the nurses working at the hospital.Ethical considerations:Institutional Review Board approval was received from the first author’s university and the hospital where the study was conducted.Findings:Overall, nurses ( N = 146) reported low levels of moral distress with a mean score of 59.54 (SD = 49.22) and a range of 0–300 on the Moral Distress Scale Neonatal–Pediatric version. Although the frequency of caring for suspected child maltreatment victims did not affect nurses’ moral distress, caring for victims with fatal maltreatment contributed to nurses’ intention to leave, χ2(1) = 5.35, p = 0.02.Conclusion:The results of this study add to the understanding of moral distress in pediatric nursing. Caring for victims with fatal maltreatment impacts pediatric nurses’ intention to leave. (shrink)

Fertility preservation has become more common for various populations, including oncology patients, transgender individuals, and women who are concerned about age-related infertility. Little attention has been paid to fertility preservation for patients with differences/disorders of sex development (DSD). Our goal in this article is to address specific ethical considerations that are unique to this patient population. To this end, we present a hypothetical DSD case. We then explore ethical considerations related to patient’s age, risk of cancer, concern about genetic transmission (...) of a DSD condition to children, co-occurring gender dysphoria, and access to experimental fertility preservation procedures. Given the limitations of current technologies, we recommend offering fertility preservation to individuals living with DSD using an informed decision-making approach that instills realistic expectations and minimizes the potential for false hope. Finally, we conclude with practical recommendations for this case based on the ethical considerations. (shrink)

Mentoring literature explores the dark side of mentoring as factors such as gender and race and how they affect the overall mentoring experience. The sociocultural context of the nursing and midwifery professions presents unique characteristics warranting a qualitative exploration of negative mentoring experiences. We aimed to characterise the dark side of mentoring based on informal mentoring relationships occurring among nurses and midwives working in hospitals. Utilising semistructured interviews in a qualitative descriptive design and reflexive thematic analysis, we examined the perceptions (...) of 35 nurses and midwives from three public hospitals located in the Western, Northern and North‐western regions of Uganda. Findings emerged in four overarching themes mentoring process deficits, mentoring relational problems, organisational challenges in mentoring and implications of negative mentoring experiences. Our study findings underscore that, while mentoring is frequently beneficial, it can also be interspersed with negative experiences arising from relational dynamics, particular mentoring processes and the overarching hospital environment. Notably, nurses and midwives actively transformed these challenges into opportunities for growth and self‐improvement, while introspectively examining their roles in contributing to these negative experiences. Such a proactive approach highlights their resilience and steadfast commitment to professional development, even in the face of adversity. (shrink)

The success of fecal microbiota transplantation as a treatment for Clostrioides difficile infection has stirred excitement about the potential for microbiota transplantation as a therapy for a wide range of diseases and conditions. In this article, we discuss vaginal microbiota transplantation as “the next frontier” in microbiota transplantation and identify the medical, regulatory, and ethical challenges related to this nascent field. We further discuss what we anticipate will be the first context for testing VMT in clinical trials, prevention of the (...) recurrence of a condition referred to as bacterial vaginosis. We also compare clinical aspects of VMT with FMT and comment on how VMT may be similar to or different from FMT in ways that may affect research design and regulatory decisions. (shrink)

Responding to a major pandemic and planning for allocation of scarce resources under crisis standards of care requires coordination and cooperation across federal, state and local governments in tandem with the larger societal infrastructure. Maryland remains one of the few states with no state-endorsed ASR plan, despite having a plan published in 2017 that was informed by public forums across the state. In this article, we review strengths and weaknesses of Maryland’s response to COVID-19 and the role of the Maryland (...) Healthcare Ethics Committee Network in bridging gaps in the state’s response to prepare health care facilities for potential implementation of ASR plans. Identified “lessons learned” include: Deliberative Democracy Provided a Strong Foundation for Maryland’s ASR Framework; Community Consensus is Informative, Not Normative; Hearing Community Voices Has Inherent Value; Lack of Transparency & Political Leadership Gaps Generate a Fragmented Response; Pandemic Politics Requires Diplomacy & Persistence; Strong Leadership is Needed to Avoid Implementing ASR … And to Plan for ASR; An Effective Pandemic Response Requires Coordination and Information-Sharing Beyond the Acute Care Hospital; and The Ability to Correct Course is Crucial: Reconsidering No-visitor Policies. (shrink)

In this study, we conducted a pseudosign repetition task with 22 children acquiring American Sign Language as a first language from deaf parents. Thirty-nine pseudosigns with varying complexity were developed and organized into eight categories depending on number of hands, number of simultaneous movement types, and number of movement sequences. Pseudosigns also varied in handshape complexity. The children’s performance on the ASL pseudosign task improved with age, displaying relatively accurate production of location and orientation, but much less accurate handshape and (...) movement, a finding in line with real sign productions for both L1 and L2 signers. Handshapes with higher complexity were correlated with lower accuracy in the handshape parameter. We found main effects of sequential and simultaneous movement combinations on overall performance. Items with no movement sequence were produced with higher overall accuracy than those with a movement sequence. Items with two simultaneous movement types or a single movement type were produced with higher overall accuracy than those with three simultaneous movement types. Finally, number of hands did not affect the overall accuracy. Remarkably, movement sequences impose processing constraints on signing children whereas complex hands and two simultaneous movement types do not significantly lower accuracy, indicating a capacity for processing multiple simultaneous components in signs. Spoken languages, in contrast, manifest greater complexity in temporal length. Hearing children’s pseudoword repetition still displays high levels of accuracy on disyllabic words, with complexity effects affecting only longer multisyllabic words. We conclude that the pseudosign repetition task is an informative tool for studies of signing children’s phonological development and that sheds light on potential modality effects for phonological development. (shrink)

This book provides an introduction to postphenomenology, an emerging school of thought in the philosophy of technology and science and technology studies, which addresses the relationships users develop with the devices they use.

The current work investigated whether differences in phonological overlap between the past- and present-tense forms of regular and irregular verbs can account for the graded neurophysiological effects of verb regularity observed in past-tense priming designs. Event-related potentials were recorded from 16 healthy participants who performed a lexical-decision task in which past-tense primes immediately preceded present-tense targets. To minimize intra-modal phonological priming effects, cross-modal presentation between auditory primes and visual targets was employed, and results were compared to a companion intra-modal auditory (...) study (Justus, T., Larsen, J., de Mornay Davies, P., Swick, D. (2008). Interpreting dissociations between regular and irregular past-tense morphology: evidence from event-related potentials. Cognitive, Affective, Behavioral Neuroscience, 8, 178–194.). For both regular and irregular verbs, faster response times and reduced N400 components were observed for present-tense forms when primed by the corresponding past-tense forms. Although behavioral facilitation was observed with a pseudopast phonological control condition, neither this condition nor an orthographic-phonological control produced significant N400 priming effects. Instead, these two types of priming were associated with a post-lexical anterior negativity (PLAN). Results are discussed with regard to dual- and single-system theories of inflectional morphology, as well as intra- and cross-modal prelexical priming. (shrink)

It has been suggested that damage to anterior regions of the left hemisphere results in a dissociation in the perception and lexical activation of past-tense forms. Specifically, in a lexical-decision task in which past-tense primes immediately precede present-tense targets, such patients demonstrate significant priming for irregular verbs (spoke–speak), but, unlike control participants, fail to do so for regular verbs (looked–look). Here, this behavioral dissociation was first confirmed in a group of eleven patients with damage to the pars opercularis (BA 44) (...) and pars triangularis (BA 45) of the left inferior frontal gyrus (i.e., Broca's area). Two conditions containing word-onset orthographic–phonological overlap (bead–bee, barge–bar) demonstrated that the disrupted regular-verb priming was accompanied by, and covaried with, disrupted ortho-phonological priming, regardless of whether prime stimuli contained the regular inflectional rhyme pattern. Further, the dissociation between impaired regular-verb and preserved irregular-verb priming was shown to be continuous rather than categorical; priming for weak-irregular verbs (spent–spend) was intermediate in size between that of regular verbs and strong verbs. Such continuous dissociations grounded in ortho-phonological relationships between present- and past-tense forms are predicted by single-system, connectionist approaches to inflectional morphology and not predicted by current dual-system, rule-based models. Event-related potential data demonstrated that N400 priming effects were intact for both regular and irregular verbs, suggesting that the absence of significant regular-verb priming in the response time data did not result from a disruption of lexical access, and may have stemmed instead from post-lexical events such as covert articulation, segmentation strategies, and/or cognitive control. (shrink)

BackgroundThis study aimed to determine what, how, and under what circumstances individual-focused interventions improve well-being and decrease burnout for critical care healthcare professionals.MethodThis realist approach, expert opinion interview, was guided by the Realist And Meta-narrative Evidence Synthesis: Evolving Standards II guidelines. Semi-structured interviews with critical care experts were conducted to ascertain current and nuanced information on a set of pre-defined individual interventions summarized from a previous umbrella review. The data were appraised, and relationships between context, mechanisms, and outcomes were extracted, (...) which created theory prepositions that refined the initial program theory.ResultsA total of 21 critical care experts were individually interviewed. By understanding the complex interplay between organizational and personal factors that influenced intervention uptake, it was possible to decipher the most likely implementable intervention for critical care healthcare professionals. The expert recommendation suggested that interventions should be evidence-based, accessible, inclusive, and collaborative, and promote knowledge and skill development. Unique mechanisms were also required to achieve the positive effects of the intervention due to the presence of contextual factors within critical care settings. Mechanisms identified in this study included the facilitation of self-awareness, self-regulation, autonomy, collaboration, acceptance, and inclusion.ConclusionThis validation of a theoretical understanding of intervention that addressed well-being and burnout in critical care healthcare professionals by expert opinion demonstrated essential mechanisms and contextual factors to consider when designing and implementing interventions. Future research would benefit by piloting individual interventions and integrating these new theoretical findings to understand better their effectiveness for future translation into the “real-world” setting. (shrink)

Cette étude préliminaire avait pour objectif de documenter les besoins d’information des familles ayant un enfant avec une déficience du point de vue des parents et des professionnels de la santé impliqués auprès d’eux. Trois groupes de discussion ont été réalisés: deux auprès de parents d’enfant ayant une trisomie 21 ou une déficience motrice cérébrale et un autre auprès de professionnels de la santé impliqués auprès d’eux. Les résultats montrent que l’information recherchée par les parents concerne le problème de santé, (...) les soins et les ressources disponibles. Les parents consultent entre autres sources les professionnels de la santé, d’autres parents, les médias et l’Internet. L’information obtenue par les parents a un impact sur leur adaptation à la situation de santé et sur leur relation avec les professionnels. Enfin, des recommandations sont proposées par les parents et les professionnels en regard des interventions. (shrink)

Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services. Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of this systematic review (...) was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area. (shrink)

ABSTRACT This essay is motivated by the seeming contradiction that Korean unification is sought after by most Koreans yet speculations about the social and cultural changes it might bring are almost absent. This may be because Korean unification denotes a series of differences contrasted to the present—because it is a potent “master symbol” with one foot in utopian speculation and the other in policy studies. In this essay, I outline some of the complexities, starting with an examination of illustrations of (...) unification in textbooks for the tensions and contradictions they introduce. I then turn to fiction and film, sketching not only what some South Koreans hope will happen after unification with the North but, indeed, the limits of their imagination regarding what the future will hold for South Korea. In the end, I concur with Grinker that representations of unification are “utopian,” but I object to the association of “utopia” with a socially engineered straitjacket. On the contrary, the utopias projected here suggest stepping off a precipice into worlds unknown, futures defined by their radical difference from today. The end of the essay locates these more imaginative dimensions of Korean unification in the “hope” of Ernst Bloch. (shrink)

By the 1950s, eugenics had lost its scientific status; it now belonged to the context rather than to the content of science. Interest in the subject was also at low ebb. But that situation would soon change dramatically. Indeed, in an essay-review published in 1993, Philip Pauly commented that a “eugenics industry” had come to rival the “Darwin industry” in importance, although the former seemed less integrated than the latter. Since then, the pace of publication on eugenics, including American eugenics, (...) has only accelerated, while the field has become even more fractured, moving in multiple and even contradictory directions. This essay explores the trajectory of work on the history of American eugenics since interest in the subject revived in the 1960s, noting trends and also fractures. The latter are seen to result partly from the fact that professional historians no longer own the subject, which has attracted the interest of scholars in several other disciplines as well as scientists, political activists, and journalists, and also from the fact that the history of eugenics has almost always been policy-oriented. Historians’ desire to be policy-relevant and at the same time attentive to context, complexity, and contingency has generated tensions at several levels: within individuals, among historians, and between professional historians and others who also engage with the history of eugenics. That these tensions are resolved differently by different authors and even by the same authors at different times helps explain why the fragmentation that Pauly noted is not likely to be overcome anytime soon. (shrink)

Introduction : but is it ethics? -- Alterity : the problem of transcendence -- Singularity : the unrepresentable face -- Responsibility : the infinity of the demand -- Ethics : normativity and norms -- Scarce resources? : Levinas, animals, and the environment -- Failures of recognition and the recognition of failure : Levinas and identity politics.

Text of and reflection on the 1981 encounter between Hans-Georg Gadamer and Jacques Derrida, which featured a dialogue between hermeneutics in Germany and post-structuralism in France. <br.

Diane Blakemore; XI*—Performatives and Parentheticals, Proceedings of the Aristotelian Society, Volume 91, Issue 1, 1 June 1991, Pages 197–214, https://doi.org/.

Explores the political forces underlying shifts in thinking about the respective influence of heredity and environment in shaping human behavior, and the feasibility and morality of eugenics.

To explain how abstract concepts are grounded in sensory-motor experiences, several theories have been proposed. I will discuss two of these proposals, Conceptual Metaphor Theory and Situated Cognition, and argue why they do not fully explain grounding. A central idea in Conceptual Metaphor Theory is that image schemas ground abstract concepts in concrete experiences. Image schemas might themselves be abstractions, however, and therefore do not solve the grounding problem. Moreover, image schemas are too simple to explain the full richness of (...) abstract concepts. Situated cognition might provide such richness. Research in our laboratory, however, has shown that even for concrete concepts, sensory-motor grounding is task dependent. Therefore, it is questionable whether abstract concepts can be significantly grounded in sensory-motor processing. (shrink)

IntroductionThis case study describes the process faculty at a large research university undertook to build a stand-alone online academic integrity course for first-year and transfer students. Because academic integrity is decentralized at the institution, building a more systematic program had to come from the bottom-up (faculty developed) rather than from the top down (institutionally mandated).Case descriptionUsing the learning management system, faculty and e-learning designers collaborated to build the course. Incorporating nuanced scenarios for six different types of misconduct (consistent with the (...) University’s Code of Student Rights, Responsibilities & Conduct), a pre- and post-test, and assessments for each scenario, the course provides experience in recognizing and avoiding academic misconduct.Discussion and evaluationAs a stand-alone course, the faculty who created it maintain control over content and are able to analyze student performance across the institution. In the ten months since its launch, the course has been eagerly adopted by faculty (n = 1853 students have completed the course) and post-test scores indicate students are learning from the course.ConclusionsAfter the successful launch of the student course, the next step, already underway, is the launch of learning modules for faculty and teaching assistants. (shrink)

Feminism and Deconstruction incisively examines the contemporary relevance of setting these movements beside one another. Diane Elam has written an intelligent and accessible introduction, which explores how feminism and deconstruction have been linked -- as theories and movements, as philosophies and disciplines. Elam's work allows the reader to rethink the political and contemplate the possibility that there is indeed life after identity politics. Feminism and Deconstruction is essential reading for anyone who needs a no-nonsense but stimulating guide through one (...) of the mazes of contemporary theory. (shrink)

A. NATURAL. HISTORY. OF. THE. SENSES. “This is one of the best books of the year—by any measure you want to apply. It is interesting, informative, very well written. This book can be opened on any page and read with relish.... thoroughly  ...

Diane Blakemore; XI*—Performatives and Parentheticals, Proceedings of the Aristotelian Society, Volume 91, Issue 1, 1 June 1991, Pages 197–214, https://doi.org/.

In philosophy and rhetorical studies, self-knowledge inscribes the absolutely indivisible line that separates “the human” from “the animal.” Autodeixis, the self-reflexive power of the I, is the condition both for language acquisition and for reason; it names an exceptional sort of auto–affection in which a being demonstrates the capacity to step back from itself enough to recognize itself and so to refer to itself as itself. What I propose in this article, however, is that autodeixis involves not a specifically human (...) power to disclose an ontological as such but the extrahuman operations of an allegorical as if. The presumption of self-knowledge is not an innate quality of “the human” but the already relational condition for any living being that must repeat itself to be itself. A kind of preoriginary rhetoricity, I argue, is the very condition for the singularity and functioning of any living being. (shrink)

This chapter contains sections titled: The application of deontological ethics to business The application of economic utilitarianism to business Problems of reconciling deontological and economic perspectives The perspectives' problems of theoretical scope and relevance Conclusion.

Building on the breakthrough text Philosophy and Engineering: An Emerging Agenda, this book offers 30 chapters covering conceptual and substantive developments in the philosophy of engineering, along with a series of critical reflections by engineering practitioners. The volume demonstrates how reflective engineering can contribute to a better understanding of engineering identity and explores how integrating engineering and philosophy could lead to innovation in engineering methods, design and education. The volume is divided into reflections on practice, principles and process, each of (...) which challenges prevalent assumptions and commitments within engineering and philosophy. The volume explores the ontological and epistemological dimensions of engineering and exposes the falsity of the commonly held belief that the field is simply the application of science knowledge to problem solving. Above all, the perspectives collected here demonstrate the value of a constructive dialogue between engineering and philosophy and show how collaboration between the disciplines casts light on longstanding problems from both sides. The chapters in this volume are from a diverse and international body of authors, including philosophers and engineers, and represent a highly select group of papers originally presented in three different conferences. These are the 2008 Workshop on Philosophy and Engineering held at the Royal Academy of Engineering; the 2009 meeting of the Society for Philosophy and Technology at the University of Twente in the Netherlands; and the Forum on Philosophy, Engineering, and Technology, held in Golden, Colorado at the Colorado School of Mines. (shrink)

Applying Foucault’s concepts of disciplinary power and technologies of the self to the ex-periences of social work academics in English universities, this articles reveals their carceral existences, arguing that social work academics and their students exist within a “carceral network” which controls and normalises behaviour by simultaneously trapping them with-in and excluding them from succeeding in academic practices. While social work academics become “docile bodies” as they are shaped and trained by competing norms of neoliberal higher education and professional social (...) practice, their position as insiders and outsiders to both can also enable them to resist certain disciplinary expectations. The findings of the qualitative study discussed in this article support Foucault’s analysis of powerful institu-tions but problematise binary positions of docility or resistance to disciplinary power with-in them. Lived experiences of ‘becoming academic’ in English social work education reveal how normalising judgements and hierarchical observation intersect with neoliberal forms of responsibilisation to create a carcerality rooted in “incompetence”; how “technologies of relationships” are used to mediate individual forms of responsibilisation, and how having to negotiate multiple disciplinary regimes can create opportunities for resistance to each. (shrink)