Moral distress is a major problem for nurses, other clinicians, and the health system itself. But if properly understood and responded to, it is also a promising guide for healthcare improvement. When individuals experience moral distress or burnout, their reports must be seen as crucial data requiring careful attention to the individuals and to the organization. Distress and burnout will often point to important opportunities for system improvements, which may in turn reduce the experience of distress. For this potential virtuous (...) cycle to happen, individuals must be able to articulate their concerns without fear of retribution, and organizational leaders must be able to listen in an undefensive, improvementoriented manner. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Although leaders in the field of ethics have for many years pointed to the crucial role that organizations play in shaping healthcare ethics, organizational ethics remains a relatively undeveloped area of ethics activity. Clinical ethics committees are an important source of potential expertise, but new skills will be required. Clinical ethics committees seeking to extend their purview to organizational issues will have to respond to three challenges—how to gain sanction and support for addressing controversial and sensitive issues, how to develop (...) an acceptable process, and how to make a difference on the ground. The article presents practical suggestions for how clinical ethics committees meet these challenges. (shrink)

Unchanging God -- Simple God -- Simple God lost -- Eternal creator -- One God, three persons.

The purpose of the present paper is to formulate and resolve a certain puzzle surrounding God's existence and the standard attributes traditionally assigned to God.

In a recent symposium on Descartes' ontological argument, Norman Malcolm has restated a rather ingenious version of St Anse1m's ontological argument. 1 The purpose of the present paper is to assess the merits of this particular version of the ontological argument.

Role of lawyer -- Regulation of lawyers -- Defining and forming the lawyer-client relationship -- Compensating lawyers -- Confidentiality -- Incompatible relations -- Representing organizations -- Duties to the court and others -- Advertising and solicitation -- Judicial conduct.

In this article, I argue that there is no discrepancy between Kant's Doctrine of Right (The Metaphysics of Morals) (1797), which legally permits lies that do not deprive someone of their rights or property, and his On a Supposed Right to Lie from Love of Humanity (1797), which argues that it would be a crime to lie to a murderer about the whereabouts of the innocent person he is pursuing.

One of the contemporary results of Germany’s memorial conundrum is the rise of its “counter-monuments”: brazen, painfully self-conscious memorial spaces conceived to challenge the very premises of their being. On the former site of Hamburg’s greatest synagogue, at Bornplatz, Margrit Kahl has assembled an intricate mosaic tracing the complex lines of the synagogue’s roof construction: a palimpsest for a building and community that no longer exist. Norbert Radermacher bathes a guilty landscape in Berlin’s Neukölln neighborhood with the inscribed light of (...) its past. Alfred Hrdlicka began a monument in Hamburg to counter—and thereby neutralize—an indestructible Nazi monument nearby. In a suburb of Hamburg, Jochen Gerz and Esther Shalev-Gerz have erected a black pillar against fascism and for peace designed to disappear altogether over time. The very heart of Berlin, former site of the gestapo headquarters, remains a great, gaping wound as politicians, artists, and various committees forever debate the most appropriate memorial for this site.4 4. The long-burning debate surrounding projected memorials, to the Gestapo-Gelände in particular, continues to exemplify both the German memorial conundrum and the state’s painstaking attempts to articulate it. For an excellent documentation of the process, see Topographie des Terrors: Gestapo, SS und Reichssicherheitshauptamt auf dem “Prinz-Albrecht-Gelände,” ed. Reinhard Rürup . For a shorter account, see James E. Young, “The Topography of German Memory,” The Journal of Art 1 : 30. James E. Young is assistant professor of English and Judaic studies at the University of Massachusetts, Amherst. He is the author of Writing and Rewriting the Holocaust: Narrative and the Consequences of Interpretation and The Texture of Memory: Holocaust Memorials and Meaning in Europe, Israel, and America , from which this essay is drawn. He is also the curator of “The Art of Memory,” an exhibition at the Jewish Museum of New York. (shrink)

The new discipline of exobiology formed from the intertwining of origin of life research with the search for life or its building blocks on other planets, from 1957-1973. The field was inherently highly interdisciplinary, yet it coalesced very quickly and was responsible in its first twenty years for numerous important contributions to twentieth century life science and planetary sciences such as climatology, the study of mass extinctions, etc. NASA played a very important role in catalyzing the rapid consolidation of exobiology, (...) both through research grants and through sponsored meetings that overcame disciplinary boundaries, bringing together scientists from diverse backgrounds. The presence of a handful of prominent senior scientists such as Joshua Lederberg, Melvin Calvin and Norman Horowitz helped gain credibility for exobiology, in the face of criticism and competition from existing life sciences disciplines. Tensions within the exobiology research community and between NASA-funded science and the academic research community are explored, as are such milestones of discipline formation as journals and professional societies. (shrink)

What are cells? How are they related to each other and to the organism as a whole? These questions have exercised biology since Schleiden and Schwann (1838–1839) first proposed cells as the key units of structure and function of all living things. But how do we try to understand them? Through new technologies like the achromatic microscope and the electron microscope. But just as importantly, through the metaphors our culture has made available to biologists in different periods and places. These (...) two new volumes provide interesting history and philosophy of the development of cell biology. Reynolds surveys the field's changing conceptual structure by examining the varied panoply of changing metaphors used to conceptualize and explain cells – from cells as empty boxes, as building blocks, to individual organisms, to chemical factories, and through many succeeding metaphors up to one with great currency today: cells as social creatures in communication with others in their community. There is some of this approach in theVisionsedited collection as well. But this collection also includes rich material on the technologies used to visualize cells and their dialectical relationship with the epistemology of the emerging distinct discipline of cell biology. This volume centres on, but is not limited to, ‘reflections inspired by [E.V.] Cowdry's [1924 volume]General Cytology’; it benefits from a conference on the Cowdry volume as well as a 2011 Marine Biological Lab/Arizona State University workshop on the history of cell biology. (shrink)

This chapter contains sections titled: Hume's Problem of Induction Hume's Negative Argument concerning Induction.

This commentary raises a number of questions in connection with Colin Koopman's paper “Conceptual Analysis for Genealogical Philosophy: How to Study the History of Practices after Foucault and Wittgenstein.” Specifically, this commentary asks about the precise relationship between concepts and practices in Koopman's account and the possibility of resisting certain practices of subjectivation.