Bioethics has made remarkable progress as a scholarly and applied field. A mere fledgling in the 1960s, it is now firmly established in hospitals, medical schools, and government agencies and boasts a number of professional associations and a handsome collection of journals.

Ethical sensitivity was introduced to caring science to describe the first component of decision making in professional practice; that is, recognizing and interpreting the ethical dimension of a care situation. It has since been conceptualized in various ways by scholars of professional disciplines. While all have agreed that ethical sensitivity is vital to practice, there has been no consensus regarding its definition, its characteristics, the conditions needed for it to occur, or the outcomes to professionals and society. The purpose of (...) this article is to explore the meaning of the concept of ethical sensitivity based on a review of the professional literature of selected disciplines. Qualitative content analysis of the many descriptors found within the literature was conducted to enhance understanding of the concept and identify its essential characteristics. Ethical sensitivity is considered to be an emerging concept with potential utility in research and practice. (shrink)

Participant safety and data integrity, critical in trials of new investigational drugs, are achieved through honest participant report and precision in the conduct of procedures. HIV prevention post-trial access studies in middle-income countries potentially offer participants many benefits including access to proven efficacious but unlicensed technologies, ancillary care that often exceeds local standards-of-care, financial reimbursement for participation and possibly unintended benefits if participants choose to share or sell investigational drugs. This case study examines the possibility that this combination of benefits (...) may constitute an undue inducement for some participants in middle-income countries, where economic challenges are prevalent. A case study is presented of a single participant in a cohort of 382 participants who used concealment, fabrication and deception to ensure eligibility for a post-trial access study of an unlicensed HIV prevention technology at potential risk to her health and that of her fetus. A root cause analysis revealed her desire to access HIV prevention during an unplanned pregnancy with a partner whose faithfulness was in question. Researchers should consider implementation of systems to efficiently identify similar cases without inconveniencing the majority of participants Trial registration number NCT01691768. (shrink)

The commitment of transplant physicians to protect the physical and psychological health of potential donors is fundamental to the process of living donor organ transplantation. It is appropriate that strict regulations to govern an individual’s decision to donate have been developed. Some may argue that adherence to such regulations creates a doctor-patient relationship that is rooted in paternalism, which is in drastic contrast with a doctor-patient relationship that is rooted in patients’ autonomy, characteristic of most other operative interventions.In this article (...) we analyze the similarities between cosmetic plastic surgery and living donor surgery as examples of surgeries governed by different ethical principles. It is interesting that, while the prevailing ethical approach in living donor surgery is based on paternalism, the ethical principle guiding cosmetic surgery is respect for patients’ autonomy. The purpose of this article is not to criticize either practice, but to suggest that, given the similarities between the two procedures, both operative interventions should be guided by the same ethical principle: a respect for patients’ autonomy. We further suggest that if living organ donation valued donors’ autonomy as much as cosmetic plastic surgery does, we might witness a wider acceptance of and increase in living organ donation. (shrink)

BackgroundAs part of the research project “End-of-life Communication in Nursing Homes. Patient Preferences and Participation”, we have studied how Advance Care Planning is carried out in eight Norwegian nursing homes. The concept of ACP is a process for improving patient autonomy and communication in the context of progressive illness, anticipated deterioration and end-of-life care. While an individualistic autonomy based attitude is at the fore in most studies on ACP, there is a lack of empirical studies on how family members’ participation (...) and involvement in ACP- conversations may promote nursing home patients’ participation in decisions on future treatment and end-of-life care. Based on empirical data and family ethics perspectives, the purpose of this study is to add insights to the complexity of ACP-conversations and illuminate how a family ethics perspective may improve the quality of the ACP and promote nursing home patients’ participation in advance care planning.MethodsParticipant observations of ACP-conversations in eight nursing homes. The observations were followed by interviews with patients and relatives together on how they experienced being part of the conversation, and expressing their views on future medical treatment, hospitalization and end-of-life issues.ResultsWe found that the way nursing home patients and relatives are connected and related to each other, constitutes an intertwined unit. Further, we found that relatives’ involvement and participation in ACP- conversations is significant to uncover, and give the nursing home staff insight into, what is important in the nursing home patient’s life at the time. The third analytical theme is patients’ and relatives’ shared experiences of the dying and death of others. Drawing on past experiences can be a way of introducing or talking about death.ConclusionsAn individual autonomy approach in advance care planning should be complemented with a family ethics approach. To be open to family ethics when planning for the patient’s future in the nursing home is to be open to diversity and nuances and to the significance of the patient’s former life and experiences. (shrink)

This article makes the following three programmatic points. First, an understanding of divine transcendence, prominent in Christian theology's apophatic strain, developed in tandem, both historically and logically, with ideas about creation that eventuated in a creation ex nihilo viewpoint. Such an account of divine transcendence, second, fosters an account of creation that typically mixes both natural and personalistic images and categories. The loss of such an account of transcendence since the early modern period, I suggest thirdly and in conclusion, is (...) therefore responsible in great part for the dualistic, mutually exclusive alternation between a deistic, interventionist God and pantheism so common in modern Christian thought. (shrink)

De senere år har pleie- og omsorgstjenesten i mange norske kommuner startet med ulike former for etikkarbeid, oftest initiert av KS’ prosjekt “Samarbeid om etisk kompetanseheving”. Hensikten med vår studie var å evaluere innsatsen i de kommunene som deltok i prosjektet fra starten av, med vekt på hvilke tiltak som var iverksatt, hvilke virksomheter dette omfattet, og om tiltakene har fortsatt utover prosjektperioden. Studien har et kvalitativt design. Materialet er hovedsakelig basert på telefonintervjuer med kontaktpersoner for etikksatsingen i 34 kommuner. (...) Det transkriberte materialet er analysert ved kvalitativ innholdsanalyse. Med unntak av fem kommuner som aldri kom i gang med etikkarbeidet, hadde de fleste startet etikkrefleksjon innenfor flere tjenester, oftest i sykehjem og hjemmetjenester. Noen kommuner hadde imidlertid ikke klart å videreføre etikkarbeidet utover en prosjektperiode. Det var stor variasjon både i etikkarbeidets forankring i kommunen, omfang, hyppighet og metoder. Et gjennomgående funn er vektlegging av behovet for etikkkompetanse og oppfølging av dem som skal lede etikkarbeidet. Flertallet av kommunene som fortsatt gjennomfører etikkrefleksjon, tar utgangspunkt i egen praksis, men et mindretall anvender strukturerte metoder. Dersom etikkarbeidet i kommunen skal være levedyktig over tid, bør arbeidet forankres på flere nivåer i organisasjonen, og de som skal lede dette arbeidet, bør få styrket sin kompetanse i etikk og etikkrefleksjon.Nøkkelord: etikk, evaluering, kommunehelsetjenestenEnglish summary: Building ethical competence in Norwegian municipalities: What has been done and what has been sustainable?“Cooperation for building ethics competence” is a national project aimed to stimulate moral reflection and build competence in ethics in community health services in Norway. This article is based on an evaluation of the activities implemented by the first 34 participating municipalities, exploring which measures were implemented, which services and employees were involved, and if the measures are sustainable. The study has a qualitative design, and the data mainly consists of telephone interviews with “key” persons in 34 municipalities. With the exception of five municipalities that never really started ethics work, the majority had implemented ethical reflection in several areas, most often in nursing homes and home care services. There was great variation with regard to the implementation. Many had tried a variety of reflection models, and only a minority of the municipalities were using a structured method of ethical reflection. A consistent finding is the need for more competence; many of those who run ethical reflection are reported to need more competence both in ethics and methods for systematic reflection. There were also great variations in how well the ethics projects were anchored within the municipality. To make ethical interventions sustainable, this study indicates the importance of strong anchoring within the municipality, the need for ethical competence, as well as good methods for structuring ethical reflection. (shrink)

It is only fair to hold someone accountable for outcomes over which they have sufficient control. The evidence-based approach to education (“evidence-based education,” or EBE) promises to give educators sufficient control over their students’ outcomes by providing access to interventions that are effective according to scientific research. I argue that EBE fails to secure sufficient control because the research on which it relies doesn't establish that interventions are generally effective. If they are to be fair, accountability practices must reflect the (...) limited control educators have, even when using evidence-based interventions that have improved outcomes in other settings. I glean relevant insights by considering accountability for medical practitioners within the context of evidence-based medicine (EBM). (shrink)

Until now, it has mostly been assumed that the kind of health the human right to health is concerned with is clearly understood and universal. Here, I question this assumption and offer an explicitly political and pluralistic account of health that is designed to help guide international and cross-cultural interventions on behalf of health. In order to be a useful mechanism of accountability, the human right to health needs an enforceable minimum standard of health by which to judge situations and (...) to determine if a violation of rights has occurred, but due to its international nature, it also needs to admit a large degree of cultural flexibility. With the account of health that I provide, I hope to clarify what makes up that minimum standard in a way that avoids unjustified parochial bias, while not being so permissive as to undermine the political force of a universal human right. (shrink)

The unique mix of modern Western and traditional Confucian values in Singapore presents young people with contradictory views on duties to aging parents. It remains to be seen whether the changing demands of modern life will result in new generations giving up Confucian family ethics or whether the Confucian dynamic will find a way to adapt to the new pressures. It is the opinion of this author that the Confucian family structure has mixed potential for the growing crisis of elder (...) care. Alone, both Confucian traditions and typical Western institutional approaches toward elder care fall short of what is necessary for intergenerational social justice, yet a hybrid of the two has great potential for the growing aging crisis. To demonstrate this, I first give a brief account of the history of filial piety in Confucianism as well as the social environment from which it originated. Then I turn my attention to the present issues of an aging population and elder care that face much of the developed world in the twenty-first century. Finally, I show how adherence to Confucian filial traditions can both help to address many of these issues and how it can potentially leave unjust gaps in elder care. Ultimately, I conclude that the crisis of elder care may be best dealt with through a hybrid of Confucian values and Western approaches. (shrink)

In this qualitative study I researched how five fifth-grade teachers’ beliefs in student capabilities influenced their curricular decision-making in daily activities with the History Alive! textbook. Students in the classrooms had reading levels 4–5 grades above and below grade level and included students with mild high-incidence disabilities. For four teachers, their strong beliefs determined what they did on a daily basis and matched the stated goals of the History Alive! textbook. For one teacher, the relationship was less clear. Three areas (...) of beliefs emerged from observations and interviews, including: 1) beliefs about students’ capabilities in reading, 2) beliefs about students’ individual differences in learning, and 3) beliefs about students’ responsibility. Findings include when teachers believed and could articulate strong beliefs about the capability of students to read, write, and participate in collaborative activities, they designed classroom activities and assessments so that all students could learn from and participate in social studies activities. When teachers’ beliefs about student capabilities aligned with Teachers’ Curriculum Institute's principles for inclusive classrooms, classroom practices reflected those beliefs and textbooks supported their practices. (shrink)

As environments and their inhabitants undergo a multitude of abrupt changes due to climate, in the aesthetic field there has been a hardening of a few representational figures that stand in for those contested political ecologies. Biodiversity loss and habitat change can be seen to be forcing an acceleration of archival practices that mobilize various images of the ‘play of the world’, including the making of star species to represent planetary loss, and the consolidation of other species into archives implicitly (...) organized around the category of their destruction. The first section of this article looks at Jacques Rancière’s concept of political aesthetics in order to extend an argument about the importance of aesthetics in multispecies living beyond a concentration on practices per se and into a more excessive engagement articulated by Georges Bataille. I argue that aesthetics must be considered as part of the practice of politics and a space that configures the realm of what is possible in that politics. This is to suggest aesthetics as a form of ethics or an ‘aesthetics of existence’, as Foucault put it. The conclusion considers how a biopolitical aesthetic comes into being through such archival practices, and asks what aesthetic shifts would make the ‘play of the world’ more present in its absences. (shrink)

Working retrospectively in an uncertain field of knowledge, physicians are engaged in an interpretive practice that is guided by couterweighted, competing, sometimes paradoxical maxims. When you hear hoofbeats, don't think zebras, is the chief of these, the epitome of medicine's practical wisdom, its hermeneutic rule. The accumulated and contradictory wisdom distilled in clinical maxims arises necessarily from the case-based nature of medical practice and the narrative rationality that good practice requires. That these maxims all have their opposites enforces in students (...) and physicians a practical skepticism that encourages them to question their expectations, interrupt patterns, and adjust to new developments as a case unfolds. Yet medicine resolutely ignores both the maxims and the tension between the practical reasoning they represent and the claim that medicine is a science. Indeed, resolute epistemological naivete is part of medicine's accommodation to uncertainty; counterweighted, competing, apparently paradoxical (but always situational) rules enable physicians simultaneously to express and to ignore the practical reason that characterizes their practice. (shrink)

This paper makes a case for the centrality of the passion of curiosity to Hobbes’s account of human nature. Hobbes describes curiosity as one of only a few capacities differentiating human beings from animals, and I argue that it is in fact the fundamen- tal cause of humanity’s uniqueness, generating other important difference-makers such as language, science and politics. I qualify Philip Pettit’s (2008) claim that Hobbes believes language to be the essence of human difference, contending that Pettit grants language (...) too central a place in Hobbes’s psychology. Language is, for Hobbes, a tech- nology adopted on account of curiosity. Further, curiosity is necessary not only for linguistic but also for scientific activity. Only after what he calls original knowledge has been gathered are names employed to generate the conditional propositions that con- stitute science. Finally, curiosity can resolve another puzzle of Hobbesian psychology that Pettit leaves unanswered: our tendency towards strife. Hobbes believes that inso- far as human beings have an implacable hunger for knowledge of the future, we are unable to rest content with present gains and must always aspire to secure the best possible outcome for ourselves. (shrink)

As political instruments, human rights can be challenged in two important ways: first, by undermining the claim to universality by appealing to a kind of cultural relativism, and second, by accusing human rights of unjustifiably imposing values that are not genuinely universal (which I dub the problem of parochialism). The human right to health is no exception. If a human right to health is to be a useful instrument in mobilizing action for global health justice, then we need to take (...) seriously the ways that health intersects with culture. Universal applicability is essential to both the legitimacy and efficacy of human rights. But without cultural sensitivity, additional injustices and imperialistic harms may be perpetuated. There are two goals within this paper—(1) to show that cultural imperialism is a moral and practical hazard, both in general and for the human right to health in particular and (2) to articulate a way of thinking about the human right to health that can minimize these hazards and arm it with moral credibility and political weight. (shrink)

Berichte zur Wissenschaftsgeschichte, Volume 45, Issue 3, Page 317-331, September 2022.

This collection of writings offers a glimpse into the minds of three N.A.A.C.P. leaders who occupied the center of black thought and action during some of the most troublesome and pivotal times of the civil rights movement. The volume delineates fifty-seven years of the N.A.A.C.P.'s program under the successive direction of James Weldon Johnson, Walter White, and Roy Wilkins. These writings illustrate the vital roles of these three leaders in building a peoples liberation, underscoring not only their progressive influence throughout (...) their time in power, but also a vision of the future as race relations enter the 21st Century. Much of the material, notably "The Secretary's Reports to the Board," is published here for the first time, offering an invaluable resource for those seeking a deeper knowledge of the history of race in America. (shrink)

Using a densely constructed ethnographic subject, Josephine, the “ugly duckling,” I use Foucault’s complex notion of an Apparatus to examine how Josephine’s decision to have weight-loss surgery is understandable even though it permanently destroys her normally functioning digestive system. I try to illuminate how the decision is deeply embedded in extraordinarily complex neoliberal biopolitical structures and dynamics of fat hatred camouflaged by liberatory discourses that promise “empowerment,” becoming “normal,” and discovery of her “real self.” I argue that in contemporary America, (...) Fat Hatred must be understood as a powerful systemic structure of racialized gendered oppression, that one tactic to normalize weight-loss surgery involves assimilating it to “normal” cosmetic surgery, and that Josephine must be seen, simultaneously, as legitimizing dominant obesity discourses and practices, enacting genuinely liberating personal choices, demonstrating her status as a “good American bio-citizen,” and contributing to the collective physical health and mental health of the nation since “obesity” is soon to be included in the fifth edition of the canonical Diagnostic and Statistical Manual of Mental Disorders as a mental disorder. (shrink)

The paper examines the extent to which philosophical theories about innate sexual dimorphism in the speciés are supported by contemporary biological research. The components of sexual identity are noted and the findings of biological research related to the specific components involved. The paper argues that sexual polymorphism is a more plausible theory, given both the biological findings and the technological advances in the area of sexual determination. The philosophical relevance of this research is then pointed out.

Can work-family policies promote greater gender equity in family roles? Using interviews with couples from upstate New York, we examine the role of work-family policies in the decisions dual-earner married couples make about paid work during the transition to parenthood. During the period immediately around a birth, differences in mothers’ and fathers’ access to paid time off from work interacted with their parenting role ideologies to influence gender differences in paid work arrangements. After the initial transition, employed women used and (...) created more flexibility in their work arrangements than their husbands, often reducing their husbands’ need to use available work-family policies. (shrink)

In spite of heralded progress in civil rights, this paper pessimistically maintains that blacks are systematically excluded from directorships on the boards of the major industrial companies in this country. The statistics derived from a 1980 survey, which yielded responses from 143 companies, show that blacks constituted only 1.9 percent of the entire directorate pool, with no black chairmen, no company with more than one black director, and significantly high multiple-board service on the part of a few black directors. There (...) is a strong correlation between size and importance of a company and black directorships, as well as between longer-range company commitments and white male directorships. There is discussion of answers from board members relating to constituency representation, philosophy regarding black recruitment and reasons for the paucity of black representation. After drawing a profile of typical boards, the study shows how the pool of individuals traditionally eligible to serve as directors virtually excludes blacks, confining them to rigid and narrow categories, and concludes that the "white club" remains white because it is insulated by an inflexible system whose inequity has been internalized and whose existence current directors would rather not acknowledge. While admitting the difficulty of discussing and even defining the existence of tokenism, the paper looks at the phenomenon of single-black-member boards, questioning the status, use and professions of some black directors. In the context of a climate that encourages governmental mandating of corporate responsibility, the authors suggest that corporate initiative wisely be generated toward achieving more equitable balances in the highest economic echelons where black impotence, given the present system, can neither be remedied nor tolerated much longer. (shrink)

We have argued that the neurocognitive representation of large-scale, navigable three-dimensional space is anisotropic, having different properties in vertical versus horizontal dimensions. Three broad categories organize the experimental and theoretical issues raised by the commentators: (1) frames of reference, (2) comparative cognition, and (3) the role of experience. These categories contain the core of a research program to show how three-dimensional space is represented and used by humans and other animals.

In this thesis I argue that Adam Smith is committed to moral egalitarianism, which extends to his theory of political economy. While Smith’s work is often used to justify economic inequality in society, I show that his political theory is best understood as a kind of relational egalitarianism. Using Elizabeth Anderson’s Democratic Equality as a model, I examine Smith’s commitment to equality in the space of social relationships. In particular, I argue that Smith’s focus on eliminating inequalities that cause oppression (...) in society in conjunction with his efforts to design a political and economic system that will yield social conditions of freedom for individuals make him a relational egalitarian. (shrink)

This article explores the concept of knowledge as an internal process of inner knowing. In the educational context, we describe our experiences in using art in the classroom to assist our students in accessing this inner knowing. We describe the design and use of such creative expressions. Our findings indicate that students have to integrate both right- and left-brain thinking to access their inner tuition. This slows down linear thinking in order to access the more affective-based learning process. Further, it (...) encourages students to experiment with non-linear methods of learning. We argue that these findings assist students in accessing more choices in their decision making, which in turn will build managers who energize, revitalize and facilitate the growth of humanity through organizational compassion and understanding. (shrink)

This article discusses Neo-Pagan journeys to archaeological or heritage sites (such as ancient temples and stone circles) associated with pre-Christian religions and deities. It argues that within the rationale of a Neo-Pagan worldview, several common binaries dissolve and reveal themselves as continuities at sacred sites: human body and earth body, the past and the present, inner and outer worlds, self and other, human and deity. In the course of Pagans’ bodily performances at sites, inner and outer landscapes co-create and flow (...) into one another: the lived body becomes a fundamental text and starting point for knowledge. Through somatic modes of attention - by attending to and with their bodies in surroundings that frequently include the embodied presence of others - Neo-pagan pilgrims experience themselves not as isolated subjectivities but as sharing an intersubjective milieu with other pilgrims and with the Earth itself. For women in particular, journeys to sacred sites potentially contribute to a radical re-inscription of the female body by exposing women to alternative representations of the feminine and by providing contexts in which the feminine can be re-imagined, re-experienced and performed differently through symbolic activity and ritual. In Butlerian terms, women potentially perform gender differently at sacred sites. (shrink)