AimsThis study evaluates a protocol for early, routine ethics consultation for patients on extracorporeal membrane oxygenation to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.MethodsWe conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019. Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of (...) treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.ResultsLimited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.ConclusionData from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages. (shrink)

Previous research has identified user concerns about biometric authentication technology, but most of this research has been conducted in European contexts. There is a lack of research that has investigated attitudes towards biometric technology in other cultures. To address this issue, data from India, South Africa and the United Kingdom were collected and compared. Cross-cultural attitudinal differences were seen, with Indian respondents viewing biometrics most positively while respondents from the United Kingdom were the least likely to have a positive opinion (...) about biometrics. Multiple barriers to the acceptance of biometric technology were identified with data security and health and safety fears having the greatest overall impact on respondents’ attitudes towards biometrics. The results of this investigation are discussed with reference to Hofstede’s cultural dimensions and theories of technology acceptance. It is argued that contextual issues specific to each country provide a better explanation of the results than existing theories based on Hofstede’s model. We conclude that cultural differences have an impact on the way biometric systems will be used and argue that these factors should be taken into account during the design and implementation of biometric systems. (shrink)

The minimally conscious state presents unique ethical, legal, and decision-making challenges because of the combination of diminished awareness, phenomenal experience, and diminished or absent comm...

The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile's (Practice‐based education: Perspectives and strategies, Rotterdam: Sense, 2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the healthcare assistant. In the British context, delegation and supervision are thought of as skills which are learnt (...) “on the job.” We suggest that learning “on‐the‐job” is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011 to 2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and healthcare assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the “invisible learning” which occurs as newly qualified nurses learn to delegate and supervise. (shrink)

Why me? -- Sticks and stones -- Hammer of God -- God is great -- The problem of atheists -- Guardian angels -- Nations under God -- God knows.

RESUMEN Una vez que el foco de la reflexión pasa de las teorías ideales a la aplicación de la justicia social, centrada en las instituciones de las sociedades democráticas, se requiere prestar especial atención a los estilos de vida. Estos tienen una alta incidencia en cómo la justicia es realizada y afectan tanto a la desigualdad económica como a la disponibilidad de los recursos naturales. En nuestras sociedades es posible establecer restricciones a los estilos de vida, especialmente en aquellos casos (...) en que, por el efecto de algunas dinámicas sociales, aquellos se desacoplan de las concepciones del bien. Se defiende que, en tales casos, la base normativa que permite exigir el respeto a los estilos de vida se disuelve y por ello es posible justificar su restricción. ABSTRACT Now that the focus of reflection has shifted from ideal theories to the application of social justice, centered on the institutions of democratic societies, it is necessary to pay special attention to lifestyles, since they not only influence the realization of justice, but also have an effect on economic inequality and the availability of natural resources. In our societies, it is possible to place restrictions on lifestyles, especially in those cases in which, influenced by certain social dynamics, they disengage from conceptions of the good. The article argues that, in those cases, the normative base grounding the demand that lifestyles be respected is dissolved, thus justifying their restriction. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:736 Feminist Studies 44, no. 3. © 2018 by Feminist Studies, Inc. Carol Giardina MOW to NOW: Black Feminism Resets the Chronology of the Founding of Modern Feminism The first meeting of feminist protest in the 1960s was called to order by Dorothy Height, the president of the 800,000-member National Council of Negro Women (NCNW), in Washington, DC, on August 29, 1963. It was the day after the historic (...) March on Washington for Jobs and Freedom (MOW).1 “We could hardly believe that after all we were doing in the Civil Rights Movement,” Height recalls, “the women came to feel that they were getting a kind of runaround” as they sought and were denied fair representation in the march because of their sex.2 “I was determined,” she said in her 2003 memoir, “to bring wise women together to learn and gather strength from the experience.”3 As “women talked freely of their concern about women’s participation,” Height observed, “we began to realize that if we did not... demand our rights, we were not going to get them. The women became much more aware and much more aggressive in facing up to sexism in our dealings with 1. Dorothy Height, Open Wide the Freedom Gates: A Memoir (New York: Public Affairs, 2003), 146. 2. Dorothy Height, “We Wanted the Voice of a Woman to Be Heard,” in Sisters in the Struggle: African American Women in the Civil Rights-Black Power Movement, ed. Bettye Collier-Thomas and V. P. Franklin (New York: New York University Press, 2001), 88. 3. Height, Open Wide, 146. Carol Giardina 737 the male leadership in the movement.”4 “That moment,” Height recalled, “was vital to awakening the women’s movement.”5 Black women’s fight for representation in the MOW appears narrowly framed in scholarly literature as a specific and isolated reaction to the sexism of male MOW planners. I argue, however, that the campaign of feminist protest meetings surrounding the MOW—and the political lessons that emerged—was a starting point in the chronology of the rebirth years of feminist upheaval in the 1960s. Why? Because the lessons of that campaign provided the crucial conceptual model of an “NAACP for women” that would be consciously and purposely adopted by the newly forming National Organization for Women (NOW). Together with Height, Anna Arnold Hedgeman, the only woman on the MOW planning committee, and longtime co-conspirator Pauli Murray, who spearheaded the MOW protests, were critical actors in NOW’s formation and brought the model to NOW’s more well-known white organizers. This model, and the Black women who developed it, opened the trajectory that led to NOW’s establishment in 1966, the first feminist organization of the decade. Black scholar activist Bernice Johnson Reagon called the Civil Rights Movement the “borning” struggle of its time.6 By the early 1960s, the impact of this phase of civil rights mobilization was felt nationwide from lunch counters in small towns to Congress and the Supreme Court. Since at least the 1955–1956 Montgomery Bus Boycott, many thousands of African American women had been protesting, organizing, staging sit-ins and jail-ins, writing treatises, and giving speeches for Black civil rights. Although some white women did participate in the Civil Rights Movement, there were far fewer of them than African American women. Because of African American women’s collective confrontation with white supremacy, more of them were positioned to grasp the systemic nature of male supremacy and the need to fight it collectively. They understood sexism sooner than most white women because they 4. Height, “We Wanted the Voice,” 88–89. 5. Height, Open Wide, 145. 6. Mary King, Casey Hayden, Jean Wheeler Smith, Joyce Ladner, Prathia Hall, Kathie Sarachild, Michael Thelwell, and Bernice Johnson Reagon, “SNCC Women and the Stirrings of Feminism,” in A Circle of Trust: Remembering SNCC, ed. Cheryl Lynn Greenberg (New Brunswick, NJ: Rutgers University Press, 1998), 150. 738 Carol Giardina had already learned the operations of power and exploitation. They were best prepared to challenge female oppression, as were the white women who participated in the Civil Rights Movement. After all, if the established order could be pushed back when it... (shrink)

In this paper we develop a general theory of algorithmic fairness. Drawing on Johnson King and Babic’s work on moral encroachment, on Gary Becker’s work on labor market discrimination, and on Strawson’s idea of resentment and indignation as responses to violations of the demand for goodwill toward oneself and others, we locate attitudes to fairness in an agent’s utility function. In particular, we first argue that fairness is a matter of a decision-maker’s relative concern for the plight of people (...) from different groups, rather than of the outcomes produced for different groups. We then show how an agent’s preferences, including in particular their attitudes to error, give rise to their decision thresholds. Tying these points together, we argue that the agent’s relative degrees of concern for different groups manifest in a difference in decision thresholds applied to these groups. (shrink)

Chapter 8 argues against the view that the moral rightness of an act is not a reason to perform it, and our reasons are instead the features that make the act right. Philosophers typically defend this view by noting that it seems redundant to take rightness to be an additional reason, once it has been acknowledged that the right-making features are already reasons. The author shows that this argument dramatically overgeneralizes, ruling out all cases in which two or more reasons (...) are arranged in relationships of metaphysical constitution. She then proposes an alternative way of thinking about these metaphysical hierarchies: Rather than assuming that at most one of the facts in each hierarchy is the “real” reason, bearing all the normative weight, it should be accepted that these facts can all be genuine reasons, whose normative weight is shared in virtue of the metaphysical relationships between them. Some tests are offered that can be used to determine which facts occur in metaphysical hierarchies with shared weight, and it is argued that the fact that an act is morally right passes the tests. The author then explains what she takes to be some kernels of truth underlying the redundancy argument, arguing that these phenomena are pragmatic, not metaphysical. (shrink)

Contrary to what many philosophers believe, Calvinism neither makes the problem of evil worse nor is it obviously refuted by the presence of evil and suffering in our world. Or so most of the authors in this book claim. While Calvinism has enjoyed a resurgence in recent years amongst theologians and laypersons, many philosophers have yet to follow suit. The reason seems fairly clear: Calvinism, many think, cannot handle the problem of evil with the same kind of plausibility as other (...) more popular views of the nature of God and the nature of God's relationship with His creation. This book seeks to challenge that untested assumption. With clarity and rigor, this collection of essays seeks to fill a significant hole in the literature on the problem of evil. (shrink)

Psychologists have traditionally approached phenomenology by describing perceptual states, typically in the context of vision. The control of actions has often been described as 'automatic', and therefore lacking any specific phenomenology worth studying. This article will begin by reviewing some historical attempts to investigate the phenomenology of action. This review leads to the conclusion that, while movement of the body itself need not produce a vivid conscious experience, the neural process of voluntary action as a whole has distinctive phenomenological consequences. (...) The remainder of the article tries to characterise this phenomenology. First, the planning of actions is often conscious, and can produce a characteristic executive mode of awareness. Second, our awareness of action often arises from the process of matching what we intended to do with what actually happened. Failures of this matching process lead to particularly vivid conscious experience, which we call 'error awareness'. These features of action phenomenology can be directly related to established models of motor control. This allows an important connection between phenomenology and neuroscience of action. Third, whereas perceptual phenomenology is normally seen as caused or driven by the sensory stimulus, a much more fluid model is required for phenomenology of action. Several experimental results suggest that phenomenology of action is partly a post hoc reconstruction, while others suggest that our awareness of action represents an integration of several processes at multiple levels of motor processing. Fourth, and finally, studies of the phenomenology of action, unlike those of perception, show a strong linkage between primary awareness and secondary awareness or self-consciousness: awareness of action is specifically and inextricably awareness of my action. We argue that the concepts of agency and of proprioaction are fundamental to this linkage. For these reasons, action represents a much more promising field than perception for attacking the problematic question of the relation between primary and secondary consciousness. Some promising directions for future research are indicated. (shrink)

Drawing on conceptual tools from philosophical bioethics, economics, and materialist feminism, we advocate viewing transnational commercial surrogacy as labor and consider what it means to compensate women for this work. We find two distinct but interrelated concerns emerge in our discussion of wages for surrogates: how to value and compensate for social reproduction, and how to establish a fair wage for surrogates. We explore limitations of minimum wage policy in addressing the undervaluation of biological and emotional labor in the transnational (...) commercial surrogacy industry. We argue that subsidization is a superior method of addressing at least one cause of undervaluation. (shrink)

Book reviewed in this article: Just War Tradition and the Restraint of War: A Moral and Historical Inquiry. By James Turner Johnson.

What holds together the various fields that are supposed to consititute the general intellectual discipline that people now call cognitive science? In this book, Erneling and Johnson identify two problems with defining this discipline. First, some theorists identify the common subject matter as the mind, but scientists and philosophers have not been able to agree on any single, satisfactory answer to the question of what the mind is. Second, those who speculate about the general characteristics that belong to cognitive (...) science tend to assume that all the particular fields falling under the rubric--psychology, linguistics, biology, and son on--are of roughly equal value in their ability to shed light on the nature of mind. This book argues that all the cognitive science disciplines are not equally able to provide answers to ontological questions about the mind, but rather that only neurophysiology and cultural psychology are suited to answer these questions. However, since the cultural account of mind has long been ignored in favor of the neurophysiological account, Erneling and Johnson bring together contributions that focus especially on different versions of the cultural account of the mind. (shrink)

To date, bioethics and health policy scholarship has given little consideration to questions of aging and intergenerational justice in the developing world. Demographic changes are precipitating rapid population aging in developing nations, however, and ethical issues regarding older people’s claim to scarce healthcare resources must be addressed. This paper posits that the traditional arguments about generational justice and age-based rationing of healthcare resources, which were developed primarily in more industrialized nations, fail to adequately address the unique challenges facing older persons (...) in developing nations. Existing philosophical approaches to age-based resource allocation underemphasize the importance of older persons for developing countries and fail to adequately consider the rights and interests of older persons in these settings. Ultimately, the paper concludes that the most appropriate framework for thinking about generational justice in developing nations is a rights-based approach that allows for the interests of all age groups, including the oldest, to be considered in the determination of health resource allocation. (shrink)

The late twentieth century has provided both reasons and occasions for reassessing just war theory as an organizing framework for the moral analysis of war. Books by G. Scott Davis, James T. Johnson, and John Kelsay, together with essays by Jeffrey Stout, Charles Butterworth, David Little, Bruce Lawrence, Courtney Campbell, and Tamara Sonn, signal a remarkable shift in war studies as they enlarge the cultural lens through which the interests and forces at play in political violence are identified and (...) evaluated. In his review of the contribution made by these texts, the author focuses on the cohesion of just war theory, the asymmetry between Christian and Islamic attitudes toward holy war, and the need to develop just war theory into a tool adequate to assist in the moral evaluation of violent conflicts within, not just between, nation-states. (shrink)

SummaryThe Gainj of highland Papua New Guinea do not use contraception but have a total fertility rate of only 4·3 live births per woman, one of the lowest ever recorded in a natural fertility setting. From an analysis of cross-sectional demographic and endocrinological data, the causes of low reproductive output have been identified in women of this population as: late menarche and marriage, a long interval between marriage and first birth, a high probability of widowhood at later reproductive ages, low (...) effective fecundability and prolonged lactational amenorrhoea. These are combined with near-universal marriage, a low prevalence of primary sterility and a pattern of onset of secondary sterility similar to that found in other populations. Of all the factors limiting fertility, by far the most important are those involved in birth spacing, especially lactational amenorrhoea. (shrink)

ABSTRACT:Despite widespread attention to corruption and organizational change in the literature, to our knowledge, no research has attempted to understand the linkages between these two powerful organizational phenomena. Accordingly, we draw on major theories in ethics, sociology, and management to develop a theoretical framework for understanding how organizational change can sometimes generate corruption. We extend anomie theory and ethical climate theory to articulate the deinstitutionalization of the normative control system and argue that, through this deinstitutionalization, organizations have the potential to (...) become incubators for corruption. We qualify this process by proposing conditions more ripe for anomie and under which this deinstitutionalization is more likely to occur, propounding moderating relationships that influence organizational reconfiguration. Examples of turbulence in the contemporary business environment that can trigger change highlight our discussion. We conclude with managerial implications, offering means by which the deleterious effects of corruption may be arrested or controlled. (shrink)

Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide (...) advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: impacts on healthcare costs, the outsourcing of expertise and issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries. (shrink)

Autoethnography is a qualitative research method that utilizes data about self and context to gain an understanding of the connectivity between self and others. This introductory article exposes the reader to our own praxis of collaborative autoethnography which we used to interrogate how we navigate the US academy as immigrant women faculty. Before introducing the articles in this special issue, we explore the autoethnography continuum, provide sample areas covered by autoethnographers, and explicate the practice of collaborative autoethnography. We conclude this (...) piece with implications for future use of autoethnography as research method. (shrink)

Volume 20, Issue 8, August 2020, Page 46-49.

In spring 2020, COVID-19 and the ensuing social distancing and stay-at-home orders instigated abrupt changes to employment and educational infrastructure, leading to uncertainty, concern, and stress among United States college students. The media consumption patterns of this and other social groups across the globe were affected, with early evidence suggesting viewers were seeking both pandemic-themed media and reassuring, familiar content. A general increase in media consumption, and increased consumption of specific types of content, may have been due to media use (...) for coping strategies. This paper examines the relationship between the stress and anxiety of university students and their strategic use of media for coping during initial social distancing periods in March-April 2020 using data from a cross-sectional survey. We examine links between specific types of media use with psychological well-being concepts, and examine the moderating roles of traits as buffers against negative relationships between stress and anxiety and psychological well-being. Our findings indicate that stress was linked to more hedonic and less eudaimonic media use, as well as more avoidant and escapist media-based coping. Anxiety, on the other hand, was linked to more media use in general, specifically more eudaimonic media use and a full range of media-based coping strategies. In turn, escapist media was linked to negative affect, while reframing media and eudaimonic media were linked to positive affect. Avoidant coping was tied to poorer mental health, and humor coping was tied to better mental health. Hedonic and need-satisfying media use were linked to more flourishing. Hope, optimism, and resilience were all predictive of media use, with the latter two traits moderating responses to stress and anxiety. The findings give a nuanced portrait of college students’ media use during a pandemic-induced shutdown, showing that media use is closely intertwined with well-being in both adaptive and maladaptive patterns. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 44, no. 1. © 2018 by Feminist Studies, Inc. 125 Corey Hickner-Johnson The Color Run On the path to North Liberty, it was gray and was sallow as I pounded 400s on the hills. My body was lethargic, unwilling at first, and then, after I felt sick, I ran even harder. I was claiming some last home for my heart out there—there in those anemic, gray (...) prairie fields—some thing I did not know but could make for myself, some masterpiece no one would ever see but that I could store up in my ribs to pulse against the world. After weeks of intellectual plodding, letters saying “no,” scraps of thoughts that find me in the night while I’m dreaming about concrete, I wanted a run that would nearly break me. I wanted to feel my body—to feel my own sovereignty, if that is even a thing left in this world. With lactic acid oozing in my mouth, a wrench in my belly, I broke through on the second interval. I knew then on the path, that my viscera had colors, and if they could be seen, I would be like an oil-painted smear to the cars on the highway. I knew that if my banging heart were to explode, it would be red, and my liver kind of blue, and if my guts were to spill out my mouth to the ground, they would be green and maybe yellow. My bones would be white, forged in a melancholy I caught in the womb, my muscles purple and brown. My sweat not a color, but maybe a shimmer. My back and neck like chrome. I wanted to see myself, a tiny fire on that prairie like the Monet with the little sun on the gray, gray water. And when I knew I was enough alive, when I felt my belly start to swirl, my brain start to blink, I turned around after the little hill to make more intervals, and to feel more like a sun. When I got back home, I felt sleepy again, but not faded, because I had made something. And I wrapped it all up in my skin, feeling its warmth and sickness, color and pain, and I went back to the gray dream, knowing there are colors beneath my surface.... (shrink)

The process by which auditors consider fraud risk in assessing management’s motivation and character remains under-addressed. This is problematic given the rising tide of narcissism, as well as recent research documenting that both self- and other-perceptions of narcissism influence an array of judgments. While a skeptical attitude is fundamental to the auditor’s gatekeeper role, it remains unclear how auditors form and act on perceptions of client narcissism. With a large sample of experienced accountants as participants, we leverage insights from current (...) narcissism and perceiver effects research to predict (and find) that auditor skepticism responds in a divergent manner to both the auditor’s (1) own antagonistic versus agentic narcissism and (2) perceptions of the client’s antagonistic and agentic narcissism. We discuss the observed opposing behavioral externalities related to these distinct forms of grandiose narcissism, particularly in dynamic interactions between clients and auditors. (shrink)

Gadamer’s notion of dialogical truth relies on the claim that self and world “belong together” as aspects of a single, unitary phenomenon, one which is made manifest in language. This view has difficulty, however, accounting for that which is untruthful. To get past this obstacle I suggest that we turn to Nishida’s work, which shows how we can bring self and world together into a kind of harmony such that the cultivation of perception makes possible truthful expression.

Social impact investing is transforming the availability of private capital for nonprofits and social enterprises, but demand is not yet meeting supply. This paper analyzes the perceived barriers faced by nonprofits in engaging with SII, arguing the need to assess differences using a policy field framework. Four parameters of a subsector are conceptualized as shaping participation in SII: the scale of investment required, embeddedness in place, the need for radical innovation, and the configuration of intermediaries. Based on 25 interviews with (...) leaders of nonprofits and intermediaries in affordable housing and community economic development in Canada, the study finds that significant barriers are a lack of knowledge of the market, inadequate financial literacy, and the challenges of measuring and valuing social impacts. In addition, nonprofits report that, in spite of the inherent importance of social impact in this form of investing, they currently make limited use of evaluation and impact metrics, and perceive that intermediaries and investors, particularly in affordable housing, still put a greater emphasis on financial over social returns. (shrink)

This is the Second Edition of a well-received book that reflects a fresh, integrated coverage of the concepts and scientific measurement of stress and welfare of animals including humans. This book explains the basic biological principles of coping with many forms of adversity. The major part of this work is devoted to explaining scientifically usable concepts in stress and welfare. A wide range of welfare indicators are highlighted in detail with examples being drawn from man and other species. The necessity (...) for combining information from disciplines is emphasized with a one-health, one-welfare approach. This information forms the basis for a synthesis of new ideas. Among the issues covered are: - How brain and body systems regulate using feelings, physiological responses, behaviour and responses to pathology - Limits to adaptation - Assessing positive and negative welfare during both short-term and long-term situations - Ethical problems and suggested solutions A proper assessment of animal welfare is essential to take informed decisions about what is morally acceptable in terms of practice and in the development of a more effective legislation. This work encapsulates a very wide body of literature on scientific aspects of animal welfare and will thus prove a valuable asset for animal welfare scientists, psychologists, students and teachers of all forms of biology, behaviour, medicine, veterinary medicine and animal usage. (shrink)

These essays showcase the value of the narrative arts in investigating complex conflicts of value in moral and political life, and explore the philosophical problem of moral dilemmas as expressed in ancient drama, classic and contemporary novels, television, film, and popular fiction. From Aeschylus to Deadwood, from Harriet Beecher Stowe to Harry Potter, the authors show how the narrative arts provide some of our most valuable instruments for complex and sensitive moral inquiry.