The ethical challenges of caring for the chronically ill are of increasing concern to nurses as they attempt to create humanitarian environments for long-term care. This article suggests two ethical perspectives to guide the agenda of the nursing profession to achieve social change in the care of the chronically ill and aging. First, a reemphasis on the public duties of the professions is recommended which extends beyond serving the interests of the nursing profession to recognizing the need to serve the (...) common good. Second, the limitations of the autonomy paradigm are explored and the foundation for the development of a new moral paradigm is analyzed in terms of its' potential usefulness in addressing ethical problems of chronic illness. Several initiatives that nursing must undertake to facilitate the emergence of this paradigm are proposed. (shrink)

There is a growing consensus in Britain on the importance of character, and on the belief that the virtues that contribute to good character are part of the solution to many of the challenges facing modern society. Parents, teachers and schools understand the need to teach basic moral virtues to pupils, such as honesty, self-control, fairness, and respect, while fostering behaviour associated with such virtues today. However, until recently, the materials required to help deliver this ambition have been missing in (...) Britain. The Knightly Virtues Programme, devised by the Jubilee Centre for Character and Virtues, aims to help solve this challenge. The programme, designed for 9 to 11 year olds, draws on selected classic stories to help teach moral character in schools. This approach has proved to be popular with children and teachers, with more than 5,000 pupils from one hundred schools having participated in the programme so far. Fifty-five of these schools and 3,272 pupils were directly involved in different stages of the research. Based at the University of Birmingham, the Jubilee Centre houses leading academics dedicated to researching the various ways in which good character, which underpins the building blocks of society, can be developed. Recent research from the Centre has shown that the qualities that make up character can be learnt and taught, and suggests that we need a new emphasis on their importance in schools and in professional education. This report from the Centre into the use of classic literature within schools sets out the ways in which the Knightly Virtues Programme is able to develop the virtue literacy of school pupils, and the extent to which an understanding and awareness of good moral character can make positive changes to behaviour. The impact of the programme has been tested using several rigorous research methods, detailed in this report alongside their findings, which provide substantial empirical evidence for the effectiveness of using stories to develop virtue literacy. (shrink)

The aim of the My Character project was to develop a better understanding of how interventions designed to develop character might enhance moral formation and futuremindedness in young people. Futuremindedness can be defined as an individual’s capacity to set goals and make plans to achieve them. Establishing goals requires considerable moral reflection, and the achievement of worthwhile aims requires character traits such as courage and the capacity to delay gratification. The research team developed two new educational interventions – a website (...) and a hard-copy journal – with the specific aim of developing future-mindedness. After development, the website and journal were piloted over a one-year period by over 1,000 11–14 year olds in six schools across England. Various research methods, including group interviews and case studies, were implemented to assess impact. In addition, a pilot RCT was conducted to assess the feasibility of using experimental methods to measure character. The main findings from the research are that: - Students benefit from opportunities in school to think about future-mindedness; this can be successfully taught through character education. - Harnessing new technology, such as the Internet, offers exciting opportunities for character education. - It is beneficial to investigate the impact of new character education resources in order to bring greater clarity about ‘what works’. The most useful approach is a mixed methods one that allows for triangulation of evidence. - It is possible to run RCTs and other experimental research in schools to assess developmental projects of this kind, but applying the method in schools and creating suitable outcome measures present challenges for researchers. - A positive indicator of the success is that five out of the six pilot schools have embedded My Character into their curriculum. In addition, many new schools, both in Britain and internationally, have started to use the website and / or journal. This report describes the research, analyses the impact of My Character and concludes with recommendations for policy makers, practitioners and researchers embarking on similar projects. These recommendations include: i) advocating that schools create space in the curriculum to teach future-mindedness through character education; ii) enhancing traditional character education teaching methods with opportunities brought by Internet technologies; iii) evaluating character education interventions using triangulated evidence drawn from a mixture of research methods. (shrink)

Although activated spinal cord glia contribute importantly to neuropathic pain, how nerve injury activates glia remains controversial. It has recently been proposed, on the basis of genetic approaches, that toll-like receptor 4 may be a key receptor for initiating microglial activation following L5 spinal nerve injury. The present studies extend this idea pharmacologically by showing that TLR4 is key for maintaining neuropathic pain following sciatic nerve chronic constriction injury. Established neuropathic pain was reversed by intrathecally delivered TLR4 receptor antagonists derived (...) from lipopolysaccharide. Additionally, -naltrexone, -naloxone, and -naloxone, which we show here to be TLR4 antagonists in vitro on both stably transfected HEK293-TLR4 and microglial cell lines, suppressed neuropathic pain with complete reversal upon chronic infusion. Immunohistochemical analyses of spinal cords following chronic infusion revealed suppression of CCI-induced microglial activation by -naloxone and -naloxone, paralleling reversal of neuropathic pain. Together, these CCI data support the conclusion that neuron-to-glia signaling through TLR4 is important not only for initiating neuropathic pain, as suggested previously, but also for maintaining established neuropathic pain. Furthermore, these studies suggest that the novel TLR4 antagonists -naloxone and -naloxone can each fully reverse established neuropathic pain upon multi-day administration. This finding with -naloxone is of potential clinical relevance. This is because -naloxone is an antagonist that is inactive at the -opioid selective receptors on neurons that produce analgesia. Thus, these data suggest that -opioid antagonists such as -naloxone may be useful clinically to suppress glial activation, yet -opioid agonists suppress pain. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

When I read, rather belatedly, Professor Davison's article on Theognis 257–66 in C.R. ix , 1–5, I found myself remembering somewhat uncomfortably that I have an article awaiting publication in Mnemosyne in which I present a new interpretation of Theognis 1209–16 as a griphos. Against Carriere, Davison remarks that it would be easier to accept 261–6 as a griphos ‘if there were any serious evidence for the prevalence of in the Theognidean corpus’ ; this is an eminently sane attitude and (...) leaves the question open for later consideration. But lower on the same page E. Harrison's dictum that ‘sweeping emendations’ are ‘the last infirmity of exegesis’ has given birth to a pronouncement that ‘recourse to riddles’ is one of two ‘penultimate infirmities of academic minds’. This is really too much. I have not yet acquired a fixation on this subject, but I am sufficiently impenitent to maintain that the griphos appears at least twice in the corpus, at 1209–16 and 261–6. I have no opinion on 257–60, which seems at any rate to be in its proper place. (shrink)

ABSTRACT:Promoting dignity is at the heart of the human capability approach to development. We introduce the concept of stakeholder capability enhancement, beginning with a discussion of the capability approach to development proposed by Sen (1985) and further advanced by Nussbaum (1990) to incorporate notions of dignity. Thereafter follows a review of the literature on value creation stakeholder management and convergent stakeholder theory (Freeman, 1984; Freeman, Harrison, Wicks, Palmer, & DeColle, 2010; Harrison & Wicks, 2013; Jones & Wicks, 1999), (...) as the foundation for our concept of stakeholder capability enhancement. The remainder of this article develops a model that integrates stakeholder management with the human capability approach to detail the cooperative advantage that accrues to business and its stakeholders, as well as the gains in social wellbeing and dignity, when stakeholder capability enhancement becomes a common enterprise strategy. The model also explores the risks and boundary conditions firms face when seeking to profit from stakeholder capability tradeoffs. In explaining the model, we explore normative responsibilities and consequences with regard to human capabilities and dignity. We conclude with implications for future research. (shrink)

A commentary on the arguments whereby Hume endeavored to delimit the role of reason in morality. Harrison’s procedure is largely one of logical analysis: he identifies individual arguments, examines inferences, asks whether there are reasons to believe premises. Throughout, he displays a balanced, appreciative approach, and when obliged to draw attention to Hume’s mistakes, he does so only reluctantly. Over half of the book is taken up in a careful examination of the text which, in terms of clarity and (...) penetration, goes beyond previous studies of Hume’s ethics. Additionally, Harrison offers chapters on Hume’s general epistemology and on the classical is/ought passage. In the latter he declares that Hume quite obviously thought that the derivation of an ought from an is was impossible, and then goes on, in what he labels an independent treatment of the problem, to offer a subtle exploration on the contours of our usage of the language of evaluation and obligation. But perhaps the most valuable contribution of the book is the closing section in which Harrison endeavors to arrive at a depiction of Hume’s alternative to rationalism. He puts forward five distinct interpretations of Hume’s positive moral philosophy, each of which has textual support as well as its own advocates. Harrison finds no grounds for affirming that any one of these interpretations defeats the others. Concluding with the judgment that Hume was confused in expounding his own position, the author notes that "Hume himself would not have approved of a reverence which substituted a superficial acceptance for a thorough grasp and realistic appraisal of his opinions." Despite the opposition which his work may provoke from those who defend some single interpretation of Hume’s moral philosophy, Harrison’s study may be expected to become a standard reference work on Hume’s ethics.—J.T.K. (shrink)

ADDRESS ETHICS WITHOUT PROPOSITIONS. By WINSTON H. F. BARNES 1 SYMPOSIUM : ARE ALL PHILOSOPHICAL QUESTIONS, QUESTIONS OF LANGUAGE I. By STUART HAMPSHIRE 31 II. By AUSTIN DUNAN JONES 49 III. By S. KORNER 63 SYMPOSIUM : THE EMOTIVE THEORY OF ETHICS. f. By RICHARD ROBINSON 79 II. ByH. J. PATON 107 III. ByR.C. CROSS 127 SYMPOSIUM : WHAT CAN LOGIC DO FOR PHILOSOPHY I. By K. K. POPPER 141 II. By WILLIAM KNEALE 155 III. By PROFESSOR A. J. AYER (...) 167 SYMPOSIUM : THINGS AND PERSONS. I. By PROFESSOR D. M. MACKINNON 179 II. By PROFESSOR H. A. HODGES 190 III. BY J. WISDOM 202. (shrink)

Many of the papers in this volume originated in a colloquium at the University of Western Ontario in 1967. These include a paper on the logic of norms by G. H. Von Wright, a paper on the logic of questions by L. Åqvist, a paper on the logic of belief by W. Sellars, and a paper on inductive logic by R. Ackermann. The commentaries by Anderson and Sosa have been revised for the volume and a further commentary to Ackermann's paper (...) by Wesley Salmon has been added. In addition to the colloquium papers a number of further papers are published here for the first time: J. Hintikka on the semantics of propositional attitudes, R. Hilpinen on relativized modalities, C. Harrison on the unanticipated examiner and H. Smokler and M. Rohr on confirmation and translation. The volume is completed by two papers published in Synthese and a well-known paper in modal logic by Lemmon, Meredith, Meredith, Prior, and Thomas published complete with a new postscript by Prior. Although the collection is somewhat haphazard and seems to have no unifying theme, philosophers interested in these topics in philosophical logic will be thankful for the availability of the papers, both old and new.--R. H. K. (shrink)

Originally published in 1926, this book attempts to state 'what has been believed with regard to God's incapacity for suffering'. Mozley charts the development of the doctrine from the Apostolic Fathers through the Reformation to the modern influence of metaphysical philosophy and concludes with six questions intended to prompt further theological discussion on this point. This book will be of value to anyone with an interest in the history of Christian theology.

Virtue theory in philosophical bioethics has influenced clinical ethics with depictions of the virtuous doctor or nurse. Comparatively little has been done with the concept of the virtuous patient, however. Bioethicists should correct the asymmetry in virtue theory between physician virtues and patient virtues in a way that provides a practical theory for the new patient-centered medicine—something clinicians and administrators can take seriously.

Recent work by Wan and McLean has shown that all quantum measurements may be reduced to local position measurements. Using an array of particle detectors as the measuring apparatus we show how a model employing superselection rules and unitary evolution leads to a single detector triggering in each act of measurement. We also present an explicit model of particle detection as a unitary ionization process producing a single ion in the detector, subsequent amplification of which to the visible can be (...) described adequately in classical terms. (shrink)

Recent scholarship on technology-induced ‘conceptual disruption’ has spotlighted the notion of a conceptual gap. Conceptual gaps have also been discussed in scholarship on epistemic injustice, yet up until now these bodies of work have remained disconnected. This article shows that ‘gaps’ of interest to both bodies of literature are closely related, and argues that a joint examination of conceptual disruption and epistemic injustice is fruitful for both fields. I argue that hermeneutical marginalization—a skewed division of hermeneutical resources, which serves to (...) diminish the experiences of marginalized folk—does not only transpire because of conceptual gaps, but also because of two other kinds of conceptual disruption: conceptual overlaps and conceptual misalignments. Hence, there are multiple kinds of conceptual disruption that can be usefully studied through the normative lens of epistemic injustice. Technology can play different roles vis-a-vis epistemic injustices, both as a causal trigger of conceptual disruption, but also as a mediator of hermeneutical resources. Its role is normatively significant, in particular because socially disruptive technologies can have different epistemic implications for different groups: they may amplify the epistemic resources of some groups, while diminishing those of others. (shrink)

This new edition of Law and Medical Ethics continues to chart the ever-widening field that the topics cover. The interplay between the health caring professions and the public during the period intervening since the last edition has, perhaps, been mainly dominated by wide-ranging changes in the administration of the National Health Service and of the professions themselves but these have been paralleled by important developments in medical jurisprudence.

Aggregating individuals’ consistent attitudes might produce inconsistent collective attitudes. Some groups therefore need the capacity to form attitudes that are irreducible to those of their members. Such groups, group-agent realists argue, are agents in control of their own attitude formation. In this paper, however, I show how group-agent realism overlooks the important fact that groups consist of strategically interacting agents. Only by eliminating group agency from our social explanations can we see how individuals vote strategically to gain control of their (...) groups and produce collective attitudes we cannot make sense of if we treat groups as agents. (shrink)

This article revisits long-standing questions about consent, membership and emigration in Locke’s thought. Commentators such as A John Simmons have argued that Locke opens political membership to both express consenters and some kind of tacit consenters, and not just to the former, as some have suggested. Simmons’s reading seems to render Locke more sensible in that it does not exclude large numbers of people from membership or burden the few members with all the civic duties, and also in that it (...) allows at least tacit-consenting members the right to relocate, while this right is denied to express-consenting members. Against this reading, the article shows, by resolving seemingly conflicting claims in the text, that people become members only by express consent. It also responds to the criticism that the express-consent-only reading would limit membership to a few and so would render Locke’s account implausible from a practical point of view. The article then addresses the purported restriction Locke imposes on express consenters’ right to emigrate, arguing that the restriction concerns the change of membership and not the right to relocate. (shrink)

The ethical treatment of cancer patientsparticipating in clinical trials requiresthat patients are well-informed about thepotential benefits and risks associated withparticipation. When patients enrolled in phaseI clinical trials report that their chance ofbenefit is very high, this is often taken as evidence of a failure of the informed consent process. We argue, however, that some simple themes from the philosophy of language may make such a conclusion less certain. First, the patient may receive conflicting statements from multiple speakers about the expected (...) outcome of the trial. Patients may be reporting the message they like best. Second, there is a potential problem of multivocality. Expressions of uncertainty of the frequency type can be confused with expressionsof uncertainty of the belief type. Patients may be informed using frequency-type statements and respond using belief-type statements. Third, each speech episode involving the investigator and the patient regarding outcomes may subservemultiple speech acts, some of which may beindirect. For example, a patient reporting ahigh expected benefit may be reporting a beliefabout the future, reassuring family members,and/or attempting to improve his or her outcome by apublic assertion of optimism. These sources oflinguistic confusion should be considered injudging whether the patient's reported expectation isgrounds for a bioethical concern that there hasbeen a failure in the informed consent process. (shrink)

Ethics is the emphasis of our first-year Introduction to Clinical Medicine-1 course. Introduction to Clinical Medicine-1 uses problem-based learning to involve groups of seven to nine students and two facilitators in realistic clinical cases. The cases emphasize ethics, but also include human behaviour, basic science, clinical medicine, and prevention learning issues. Three cases use written vignettes, while the other three cases feature standardized patients. Groups meet twice for each case. In session one, students read the case introduction, obtain data from (...) the written case or standardized patient, identify the case's ethical problems, formulate learning issues, discuss ways to resolve the moral conflicts, and assign research responsibilities. In session two, students discuss their assigned learning issues and specify and justify clinical actions to address the case's ethical dilemmas. Following three cases, groups write an essay discussing what they learned and describing how they would approach and resolve the case's learning issues. (shrink)

This breakthrough volume integrates European, British, and American scholarship in advanced areas of philosophy and decision theory. Contributions cover a broad area of economics--from criticism of institutional economics to examination of the role of induction in economic forecasting.

As part of a larger research study, we present model language for disclosing financial interests in clinical research to potential research participants, and we describe the empirical basis and theoretical assumptions used in developing the language. The empirical process for creating appropriate disclosure language resulted in a generic disclosure statement for cases in which no risk to participants’ welfare or the scientific integrity of the research is expected, and nine more specific disclosure statements for cases in which some risk is (...) expected. The disclosure statements are not meant to be canonical, but were instead designed to reflect the typical situations in which disclosure of financial interest might be considered by an institutional review board or conflict of interest committee. Individual institutions could modify key phrases to suit their purposes, and others could use the language in future empirical work on informed consent to better refine the options for disclosing financial interests in clinical research. (shrink)

IN THE beginning Parmenides sought to deny the void. But he found himself trapped by his language and his thought into admitting what he sought to deny. Wisely, he counseled others to avoid the whole region in which the problem arises, lest they too be unwarily ensnared. Plato, being less easily intimidated and grasping for the first time the urgency of the paradox, unearthed each snare in turn until he felt he had found a safe path through the forbidden terrain (...) in a new conception of being and the derivation of its linguistic consequences in the Sophist. Aristotle evidently took Parmenides’ advice; and save for a few groping scholastics, perhaps Leibniz, Brentano, and Meinong, and Frege only in passing, no one else attempted the crossing before Russell made his spectacular dash through the posted ground from the completely new direction of linguistic reference. Again the problem lay dormant for half a century until Strawson constructed a new low road through ordinary language and Quine improved Russell’s high algebraic pass. Refinements of these routes have been forthcoming, especially from Searle and Kripke, until today it might appear that there are two super highways through Parmenides’ forbidden country of nonbeing. In this essay I will first argue that these new linguistic highways are no more than flimsy camouflage hiding but not resolving the old paradoxes. I will then show how Plato’s ontological way out, though more difficult, is the straight and narrow path. (shrink)

Background: The American Medical Association, the British Medical Association and the Canadian Medical Association have guidelines that specifically discourage physicians from self-prescribing or prescribing to family members, but only the BMA addresses informal prescription requests between colleagues. Objective: To examine the practices of paediatric providers regarding self-prescribing, curbsiding colleagues, and prescribing and refusing to prescribe to friends and family. Methods: 1086 paediatricians listed from the American Academy of Paediatrics 2007 web-based directory were surveyed. Results: 44% of eligible survey respondents returned (...) usable surveys. Almost half of respondents had prescribed for themselves. An equal number had informally requested a prescription from a colleague. Three-quarters stated they had been asked to prescribe a prescription drug for a first-degree or second-degree relative, and 51% had been asked by their spouse. Eighty-six per cent stated that they had refused to write a prescription on at least one occasion for a friend or family member. The following reasons “strongly influenced” their decision to refuse a prescription request: outside of provider’s expertise ; patient’s need for his or her own physician ; not medically indicated ; need for a physical examination. Conclusion: These data confirm that most physicians have engaged in self-prescribing or curbside requests for prescriptions. It can be argued that curbsiding is more morally problematic than self-prescribing because it implicates a third party, and should be discouraged regardless of whether the requester is a colleague, family member or friend. (shrink)