Background:Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives, setting, and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether research nurses experience unique ethical challenges distinct from those experienced (...) by nurses in traditional patient-care settings.Research objectives:The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice.Research design:The study utilized a qualitative descriptive design with individual interviews.Participants and research context:Participating nurses self-identified as having experienced ethical challenges during screening. The majority were Caucasian, female, and worked in outpatient settings. Approximately 50% had > 10 years of research experience.Ethical considerations:The human subjects review board approved the study. Written informed consent was obtained.Findings:Predominant themes were revealed: the inability to provide a probable good, or/do no harm, and dual obligations. The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship.Discussion:Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science.Conclusion:Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

Die Entscheidung für oder gegen lebensverlängernde Behandlungsmaßnahmen geht inzwischen der Hälfte aller Todesfälle in Europa voraus. Sie wird im klinischen Alltag häufig als ethische Herausforderung wahrgenommen, zudem sind unter Klinikern juristische Unsicherheiten und Fragen der korrekten Vorgehensweise verbreitet. Die hier vorgestellte Münchner Leitlinie zu Entscheidungen am Lebensende soll rechtliche Unsicherheit reduzieren, Klinikumsmitarbeiter für die ethische Dimension von Therapieentscheidungen am Lebensende sensibilisieren und ethisch begründete Entscheidungen fördern. Aus organisationsethischer Perspektive soll mit der Leitlinie eine Reflexion und Meinungsbildung zu einem ethisch relevanten (...) Themenbereich erfolgen und ein Beitrag zur Qualitätssicherung der Patientenversorgung und damit auch zur Patientenzufriedenheit geleistet werden. Die Prozesse der Leitlinienentwicklung, -aktualisierung und -implementierung werden vorgestellt. Die wesentlichen inhaltlichen Elemente der Leitlinie mit Darstellung der Rechtslage, der Definition zentraler Begriffe und Klärung medizinischer Entscheidungskriterien werden an Hand eines Entscheidungsalgorithmus dargestellt. Inhalt und Prozess der Leitlinienentwicklung werden auf die folgenden organisationsethischen Qualitätskriterien hin überprüft: deliberativer Prozess, inhaltliche Transparenz, repräsentative Zusammensetzung der Arbeitsgruppe, Implementierung und Evaluation der Leitlinie. Institutionen, die diese Leitlinie übernehmen wollen, sollten diese von einem autorisierten Gremium überprüfen lassen und auf die spezifischen Bedürfnisse ihrer Institution adaptieren. Hierfür ist eine vorgeschaltete Bedarfserhebung hilfreich. In dem Gremium sollten all diejenigen vertreten sein, die in der Folge mit der Leitlinie arbeiten werden. (shrink)

Die Entscheidung für oder gegen lebensverlängernde Behandlungsmaßnahmen geht inzwischen der Hälfte aller Todesfälle in Europa voraus. Sie wird im klinischen Alltag häufig als ethische Herausforderung wahrgenommen, zudem sind unter Klinikern juristische Unsicherheiten und Fragen der korrekten Vorgehensweise verbreitet. Die hier vorgestellte Münchner Leitlinie zu Entscheidungen am Lebensende soll rechtliche Unsicherheit reduzieren, Klinikumsmitarbeiter für die ethische Dimension von Therapieentscheidungen am Lebensende sensibilisieren und ethisch begründete Entscheidungen fördern. Aus organisationsethischer Perspektive soll mit der Leitlinie eine Reflexion und Meinungsbildung zu einem ethisch relevanten (...) Themenbereich erfolgen und ein Beitrag zur Qualitätssicherung der Patientenversorgung und damit auch zur Patientenzufriedenheit geleistet werden. Die Prozesse der Leitlinienentwicklung, -aktualisierung und -implementierung werden vorgestellt. Die wesentlichen inhaltlichen Elemente der Leitlinie mit Darstellung der Rechtslage, der Definition zentraler Begriffe und Klärung medizinischer Entscheidungskriterien werden an Hand eines Entscheidungsalgorithmus dargestellt. Inhalt und Prozess der Leitlinienentwicklung werden auf die folgenden organisationsethischen Qualitätskriterien hin überprüft: deliberativer Prozess, inhaltliche Transparenz, repräsentative Zusammensetzung der Arbeitsgruppe, Implementierung und Evaluation der Leitlinie. Institutionen, die diese Leitlinie übernehmen wollen, sollten diese von einem autorisierten Gremium überprüfen lassen und auf die spezifischen Bedürfnisse ihrer Institution adaptieren. Hierfür ist eine vorgeschaltete Bedarfserhebung hilfreich. In dem Gremium sollten all diejenigen vertreten sein, die in der Folge mit der Leitlinie arbeiten werden. (shrink)

Sur une suggestion de David Halperin, John Winkler, professeur à Yale puis à Stanford, rassembla, l’année de sa mort (1990), des études datées de 1981/1989, pour la plupart inédites. Leur convergence autorisait un livre sur l’éthique sexuelle grecque dans une approche sémiotique et anthropologique des pratiques sociales, se démarquant de l’histoire intellectuelle, comme de celles des idées et des mentalités, et du New Historicism des années 1980. À partir d’« observations informelles du compo...

This collection of essays on themes in the work of John Locke , George Berkeley , and David Hume , provides a deepened understanding of major issues raised in the Empiricist tradition. In exploring their shared belief in the experiential nature of mental constructs, The Empiricists illuminates the different methodologies of these great Enlightenment philosophers and introduces students to important metaphysical and epistemological issues including the theory of ideas, personal identity, and skepticism. It will be especially useful in courses devoted (...) to the history of modern philosophy. (shrink)

Boris Hessen’s ‘The Social and Economic Roots of Newton’s Principia’ (see https://doi.org./10.1163/1569206X-00002041) is considered a pioneering work in the historiography of the natural sciences. For some, it marks the founding moment of the ‘externalist’ approach to this field of study. Previously, Hessen published another paper on Newton entitled ‘Preface to Articles by A. Einstein and J.J. Thomson’, which, some maintain, bears a stronger resemblance to works in the ‘internalist’ camp of the historiography of the natural sciences. For decades, scholars have (...) puzzled over why Hessen chose to argue for, seemingly, diametrically opposed positions. In this paper, however, I argue that Hessen does not advance two different historiographical methods, but a single, dialectical-materialist approach that accounts for the ‘unity in opposition’ of the external and internal dimensions of natural-scientific theory. I draw from Hessen’s two papers on Newton, his previously untranslated writings, as well as selections from the secondary literature. (shrink)

The aim of the article is to use J.-P. Sartre’s reflections to show the influence of memory and imagination on the formation of an individual’s life history. The first part of the work consist of philosophical analyses. The imaginations are analyzed here compared to the perceptions and memories. The second part is devoted to autobiography, inseparably connected with the first-person perspective. The philosopher's different creative and intellectual activities and the wide range of material his works contain allow us to expose (...) the discussed issues in a diverse and complementary way. (shrink)

When John Winkler died in 1990, he was working on a book that aimed at a wide-ranging reinterpretation of Greek tragedy as a pedagogical exercise aimed primarily at the city’s young men (“ephebes,”...

Near the end of his Euboean Discourse, Dio attacks prostitution because it encourages men to seek sexual pleasure from other sources as well, including youths from noble households. While some scholars find no evidence in this diatribe for Dio's revulsion against male-male sexual relations per se, others conclude that it does indeed reflect Dio's contempt for all sexual relations between men. This study considers afresh Dio's treatments of sexual relations between men in his Discourses, and concludes that Dio may endorse (...) both male-male and male-female sexual relations when the agent initiating sexual contact pursues philia and eunoia. On the other hand, Dio expresses his disgust when the agent uses sexual relations self-indulgently for pleasure. The content and form of his arguments illustrate his familiarity with both Stoic doctrine and the forms of popular moralizing discourse. The paper first examines Dio's remarks in the third Discourse on Kingship, where he praises sexual relations in a measured way, indicating his familiarity with Stoic teachings on eros. Second, it considers Dio's remarks in the Euboean Discourse and supports John Winkler's argument that Dio objects to prostitution because it is rooted in self-indulgent pleasure-seeking. Dio's rhetorical approach reflects his awareness of popular teachings against self-indulgence typical of Cynic-Stoic diatribe. Third, the essay argues that Dio's remarks in the First Tarsian oration condemn adult male sexual passivity, not all aspects of sexual relations between males. Fourth, brief remarks in his Borystheniticus are not to be taken as evidence for Dio's hostility to sexual relations between men, though they possibly indicate his discomfort with how he imagines non-Greeks engage in sex. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What Emotional Responding Is to Blame It Might Not Be to ResponsibilityR. J. R. Blair (bio)Keywordsblame, responsibility, emotional responses, psychopathyIn this interesting paper, Levy argues that by failing the moral/conventional distinction task (Blair 1995), individuals with psychopathy show a fundamental inability to categorize moral harms and as such their moral responsibility for their actions is reduced. He argues that, although we might still wish to incarcerate such individuals to (...) prevent them inflicting further harm on others, we should be less enthusiastic to blame them for their actions.In many respects, I agree with much of Levy's treatise. I certainly do not regard ascriptions of blame as useful in my own work with this population. I believe that our goal should be to fully understand the nature of their emotional deficit to be able to treat it similarly to other researchers who work to treat other emotional disorders. To me, Levy's argument appears sound.However, I offer three considerations and raise questions within these considerations that might further the debate. First, not all rules involve care-based emotional responses to victims. As Levy notes, this is the origin of the moral/conventional distinction. The problem here is that we do consider someone responsible if they break a conventional transgression. The student talking in class is generally considered blameworthy for this action as long as they knew that the rule of not talking during the lesson applied to that classroom. Yet, there is no victim and no care-based emotional response. Here, the only thing necessary to ascribe blame and responsibility is that the individual knew that a rule exists. Given this holds for conventional transgressions, why must we necessarily make a special case, with respect to responsibility, for moral transgressions?I believe that Levy is fully aware of this concern. He specifically makes reference to moral responsibility and writes that:the kind and degree of wrongness, and therefore blame, which attaches to infringements of the rules [against double parking or line-jumping] is very different, and usually much less significant, than the kind and degree attaching to moral wrongs. For psychopaths, all offences are merely conventional, and therefore—from their point of view—none of them are all that serious.(2007, p. 132)But the danger here is that issues of blame and responsibility may become highly relativistic and hinge on the strength of the emotional reaction. This is a problem because, although we might judge someone as more blameworthy if he intentionally [End Page 149] runs over five people rather than one, do we really consider that there is a distinction in moral responsibility between these two cases? If not, might not responsibility relate to factual knowledge of the existence of the rule against the transgression rather than the emotional response to the transgression?Second, there is considerable debate regarding whether psychopathy represents a taxon or a continuum (e.g., Vasey et al. 2005; Edens et al. 2006). Assuming it does represent a continuum, then we have an additional concern. How little of an emotional response to the transgression reduces one's moral responsibility and blame? Is it only the very reduced (although usually not absent) levels of emotional response that are shown by individuals with psychopathy? Or should we consider moral responsibility and blame proportional to the level of the emotional response? If this latter option is adopted, then what should we do about individuals who show heightened emotional responses, for example, patients with specific anxiety disorders (Rauch, Shin, and Wright 2003)? There are already some data that inhibited children (a developmental precursor to some anxiety disorders; Kagan and Snidman 1999) show heightened conscience development (Asendorpf and Nunner-Winkler 1992). If such children commit moral transgressions, should we regard them as more morally responsible and more blameworthy than regular folks?Third, the issue of intention received little attention in this paper. I have been considered to show a similar lack of attention to intention in the past (Nichols 2002) and, moreover, in some respects the issue was of limited concern given Levy's main goals. However, I mention it because so much of whether we consider someone responsible for their actions and... (shrink)

For decades scholars thought they knew Hume's position on the existence of causes and objects he was a sceptic. However, this received view has been thrown into question by the `new readings of Hume as a sceptical realist. For philosophers, students of philosophy and others interested in theories of causation and their history, The New Hume Debate is the first book to fully document the most influential contemporary readings of Hume's work. Throughout, the volume brings the debate beyond textual issues (...) in Hume to contemporary philosophical issues concerning causation and knowledge of the external world and issues in the history of philosophy, offering the reader a model for scholarly debate. This revised paperback edition includes three new chapters by Janet Broughton, Peter Kail and Peter Millican. Contributors: Kenneth A. Richman, Barry Stroud, Galen Strawson, Kenneth P. Winkler, John P. Wright, Simon Blackburn, Edward Craig, Martin Bell, Daniel Flage, Anne Jaap Jacobson, Rupert Read, Janet Broughton, Peter Millican, Peter Kail. (shrink)

Tomemos el camino iniciado por Ricœur, quien, de la mano de Aristóteles, reconoce en el Mythos, en la trama, la estructura lingüística más conveniente para decir aquello en lo que consiste “devenir un sí mismo”. ¿Caben relatos que digan más pertinentemente qué es un sí mismo? La aparición, cada vez más insistente, de otros modos de narrar ―extraños y peculiares por su falta de estructura y por su condición de narraciones decepcionantes― cuestionan que la trama sea el modo narrativo que (...) más le pertenece a la identidad personal. Tal sería el caso de P. Handke, J. Winkler, H. Müller, T. Bernhard, C. Lispector, E. Jelinek, D. Kis o W.G Sebald. Entonces cabría la posibilidad de relatarnos no ya para sostenernos, para apacentarnos con viento ―en palabras de Sánchez Ferlosio― sino para decir más verdaderamente lo que somos: ruido y furia. «Es significativo que la relación que aquí se aprecia entre nuestra lectora y la literatura sea tan radicalmente filosófica. La lectora ha escrito un texto en el que destellan los aspectos más nodales del pensar contemporáneo, que en su realidad no deja de ser clásico. No se trata de que haya escudriñado asuntos filosóficos en los textos literarios, es que lo que resulta filosófico es su propia lectura, su mirada, su consideración, porque trata a los textos como la literatura se trata a sí misma». (shrink)

David Hume wrote that Berkeley's arguments `admit of no answer but produce no conviction'. This book aims at the kind of understanding of Berkeley's philosophy that comes from seeing how we ourselves might be brought to embrace it. Berkeley held that matter does not exist, and that the sensations we take to be caused by an indifferent and independent world are instead caused directly by God. Nature becomes a text, with no existence apart from the spirits who transmit and receive (...) it. Kenneth P. Winkler presents these conclusions as natural consequences of Berkeley's reflections on such topics as representation, abstraction, necessary truth, and cause and effect. In the closing chapters Proefssor Winkler offers new interpretations of Berkeley's view on unperceived objects, corpuscularian science, and our knowledge of God and other minds. (shrink)

Logic is essential to correct reasoning and also has important theoretical applications in philosophy, computer science, linguistics, and mathematics. This book provides an exceptionally clear introduction to classical logic, with a unique approach that emphasizes both the hows and whys of logic. Here Nicholas Smith thoroughly covers the formal tools and techniques of logic while also imparting a deeper understanding of their underlying rationales and broader philosophical significance. In addition, this is the only introduction to logic available today that presents (...) all the major forms of proof--trees, natural deduction in all its major variants, axiomatic proofs, and sequent calculus. The book also features numerous exercises, with solutions available on an accompanying website. -/- Logic is the ideal textbook for undergraduates and graduate students seeking a comprehensive and accessible introduction to the subject. -/- Provides an essential introduction to classical logic Emphasizes the how and why of logic Covers both formal and philosophical issues Presents all the major forms of proof--from trees to sequent calculus Features numerous exercises, with solutions available online The ideal textbook for undergraduates and graduate students . (shrink)

BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. ResultsThree (...) hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. (shrink)

In this comparative analysis of twelve focus groups conducted in Austria, France, and the Netherlands, we investigate how lay people come to terms with two biomedical technologies. Using the term ‘‘technopolitical culture,’’ we aim to show that the ways in which technosciences are interwoven with a specific society frame how citizens build their individual and collective positions toward them. We investigate how the focus group participants conceptualized organ transplantation and genetic testing, their perceptions of individual agency in relation to the (...) two technologies and to more collective forms of acting and governing, and also their understanding of the two technologies’ relationship to broader societal value systems. Against the background of the sustained political effort to build common European values, we suggest that more fine-grained attention toward the culturally embedded differences in coming to terms with biomedical technologies is needed. (shrink)

There is an extensive literature on time travel in both philosophy and physics. Part of the great interest of the topic stems from the fact that reasons have been given both for thinking that time travel is physically possible—and for thinking that it is logically impossible! This entry deals primarily with philosophical issues; issues related to the physics of time travel are covered in the separate entries on time travel and modern physics and time machines. We begin with the definitional (...) question: what is time travel? We then turn to the major objection to the possibility of backwards time travel: the Grandfather paradox. Next, issues concerning causation are discussed—and then, issues in the metaphysics of time and change. We end with a discussion of the question why, if backwards time travel will ever occur, we have not been visited by time travellers from the future. (shrink)

One of Tarski’s stated aims was to give an explication of the classical conception of truth—truth as ‘saying it how it is’. Many subsequent commentators have felt that he achieved this aim. Tarski’s core idea of defining truth via satisfaction has now found its way into standard logic textbooks. This paper looks at such textbook definitions of truth in a model for standard first-order languages and argues that they fail from the point of view of explication of the classical notion (...) of truth. The paper furthermore argues that a subtly different definition—also to be found in classic textbooks but much less prevalent than the kind of definition that proceeds via satisfaction—succeeds from this point of view. (shrink)

Every healthcare organisation enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it.Using, as an example, the controversy about patient’s refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency.Policy writing for morally (...) controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO’s obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy. (shrink)

The essays in this book range over the fields of environmental ethics, business ethics, professional ethics, and bio-medical ethics. In each of the essays a significant question in the field of applied ethics is treated in a way that is methodologically revealing and provides some sense of new directions and preoccupations in the field. Among the questions discussed are: How should we conceive of the relations between theoretical ethics and practical ethics? What is the nature of responsible moral reasoning and (...) deliberation? To what extent is rationality ultimately the same in morality and science? Is applied ethics inherently conventional or conservative in its deliberations and results? Can or should specialists in applied ethics claim moral expertise in relation to problems in a given domain? TO what extent is the personal history of persons working in the field opf applied ethics relevant to assessing their work? While the contributors appear to agree on the answers to some of these questions, there is spirited disagreement concerning others. (shrink)

A many-valued (aka multiple- or multi-valued) semantics, in the strict sense, is one which employs more than two truth values; in the loose sense it is one which countenances more than two truth statuses. So if, for example, we say that there are only two truth values—True and False—but allow that as well as possessing the value True and possessing the value False, propositions may also have a third truth status—possessing neither truth value—then we have a many-valued semantics in the (...) loose but not the strict sense. A many-valued logic is one which arises from a many-valued semantics and does not also arise from any two-valued semantics [Malinowski, 1993, 30]. By a ‘logic’ here we mean either a set of tautologies, or a consequence relation. We can best explain these ideas by considering the case of classical propositional logic. The language contains the usual basic symbols (propositional constants p, q, r, . . .; connectives ¬, ∧, ∨, →, ↔; and parentheses) and well-formed formulas are defined in the standard way. With the language thus specified—as a set of well-formed formulas—its semantics is then given in three parts. (i) A model of a logical language consists in a free assignment of semantic values to basic items of the non-logical vocabulary. Here the basic items of the non-logical vocabulary are the propositional constants. The appropriate kind of semantic value for a proposition is a truth value, and so a model of the language consists in a free assignment of truth values to basic propositions. Two truth values are countenanced: 1 (representing truth) and 0 (representing falsity). (ii) Rules are presented which determine a truth value for every proposition of the language, given a model. The most common way of presenting these rules is via truth tables (Figure 1). Another way of stating such rules—which will be useful below—is first to introduce functions on the truth values themselves: a unary function ¬ and four binary functions ∧, ∨, → and ↔ (Figure 2).. (shrink)

Bringing together specialists in various fields, this volume shows that the transformation from the scholastic to more empirical approaches to psychology was a gradual process.