“The current crisis in home care suggests we must meet immediately to discuss how Ontario can best meet its commitment to all those who require home care services and to the workers who provide the...

“The current crisis in home care suggests we must meet immediately to discuss how Ontario can best meet its commitment to all those who require home care services and to the workers who provide the...

1. A World of Difference: Travel Narratives and the Inscription of Culture -- 2. Fair Texts/Dark Ladies: Renaissance Lyric and the Poetics of Color -- 3. "Commerce and Intercourse": Dramas of Alliance and Trade -- 4. The Daughters of Eve and the Children of Ham: Race and the English Woman Writer -- 5. "An Object in the Midst of Other Objects": Race, Gender, Material Culture -- Epilogue: Oil "Race," Black Feminism, and White Supremacy -- Appendix: Poems of Blackness.

Most jurisdictions require that a mental capacity assessment be conducted using a functional model whose definition includes several abilities. In England and Wales and in increasing number of countries, the law requires a person be able to understand, to retain, to use or weigh relevant information and to communicate one’s decision. But interpreting and applying broad and vague criteria, such as the ability ‘to use or weigh’ to a diverse range of presentations is challenging. By examining actual court judgements (...) of capacity, we previously developed a descriptive typology of justifications used in the application of the Mental Capacity Act criteria. We here critically optimise this typology by showing how clear definitions—and thus boundaries—between the criteria can be achieved if the ‘understanding’ criterion is used narrowly and the multiple rationales that fall under the ability to ‘use or weigh’ are specifically enumerated in practice. Such a typology-aided practice, in theory, could make functional capacity assessments more transparent, accountable, reliable and valid. It may also help to create targeted supports for decision making by the vulnerable. We also discuss how the typology could evolve legally and scientifically, and how it lays the groundwork for clinical research on the abilities enumerated by the MCA. No data are available. This paper does not report any original data. (shrink)

The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients would have decided over even their best interests. In England and Wales, the Mental Capacity Act 2005 follows this trend of prioritising the patient’s prior wishes, values and beliefs but the dominant interpretation in life-sustaining treatment cases does so by in effect calling those values the ‘best interests’ of the (...) patient and focusing nearly exclusively on the ‘subjective’ viewpoint of the patient. In this article, we examine the recent Court of Protection judgment inBarnsley Hospitals NHS Foundation Trust v MSP[2020] EWCOP 26, which adhered closely to this approach, to suggest that it could have unexpected negative consequences. These include insufficient information gathering about and attention to patients’ objective medical interests, inadequacy of the evidentiary standard used for the substituted decision-making and, in some cases, even prioritising a surrogate’s current substituted judgment over the potential for an actual judgment by the patient. (shrink)

Parmi les études, de plus en plus nombreuses, consacrées à l’histoire des jeunes, les travaux centrés uniquement sur la jeune fille médiévale sont rares. On a tenté de construire son histoire en exploitant des sources qui, a priori, offraient davantage de renseignements : contrats d’apprentissage, récits de miracles, sources littéraires, traités de médecine ou de pédagogie, etc. De précieux renseignements ont été obtenus sur sa vie quotidienne : relations familiales, éducation, travail, et su...

Bernard Williams’ Shame and Necessity (1993) was an influential early contribution to what has become a broader movement to rehabilitate shame as a moral emotion. But there is a tension in Williams’ discussion that presents an under-appreciated difficulty for efforts to rehabilitate shame. The tension arises between what Williams takes shame in its essence to be and what shame can do—the role that shame can be expected to play in ethical life. Williams can—and we argue, should—be read as avoiding the (...) difficulties stemming from this tension, but this requires a reevaluation of several of his central claims about shame’s role in ethical thought and experience. For instance, his broad claims that the “structures of shame” can “give a conception of one’s ethical identity” (93), and that shame “mediates … between ethical demands and the rest of life” (102), cannot be taken at face value. What emerges is a view that is in a sense less ambitious, but also more in tune with the spirit of Williams’ larger project. There may also, we suggest, be a more general lesson: We should be suspicious of the temptation to seek some special affinity between shame and ethical life, lest we distort our understanding of both. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

Direction of fit theories usually claim that beliefs are such that they “aim at truth” or “ought to fit” the world and desires are such that they “aim at realization” or the world “ought to fit” them. This essay argues that no theory of direction of fit is correct. The two directions of fit are supposed to be determinations of one and the same determinable two-place relation, differing only in the ordering of favored terms. But there is no such determinable (...) because of ineliminable asymmetries between the way that beliefs “aim at truth” and the way that desires “aim at realization.” This essay traces the ills of direction of fit theory to a misunderstanding of Anscombe and proposes a cure that distinguishes theoretical and practical thought by appeal to a distinction between thought in the form of a state and thought in the form of an event. (shrink)

Is Anscombean practical knowledge independent of what the agent actually does on an occasion? Failure to understand Anscombe’s answer to this question is a major obstacle to appreciating the subtlety and plausibility of her view. I argue that Anscombe’s answer is negative, and turns on the nature of mistakes in performance, and reveals a distinctive implicit metaphysics of mind and knowledge, structured by related capacities and exercises of capacities. If my interpretation is correct, then practical knowledge shares features with knowledge-how (...) and knowledge-that, but deserves its own epistemic category. (shrink)

The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants’ experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place’s moral climate as well as by two aspects of the mental health staff’s moral sensitivity. The (...) nurses’ experience of ‘moral burden’ or ‘moral support’ increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency. Copyright © 2011 by SAGE Publications. (shrink)

In this paper, we argue that engineering ethics education does have moral implications. More specifically, practices in engineering ethics education can lead to negative moral consequences if not conducted appropriately. Engineering ethics educators are often passionate about teaching students ways to examine the ethical implications of engineering and technology. However, ethics educators may overlook the moral significance of their instructional classroom practices. In this paper, we discuss two issues: First, we discuss the moral impacts of ethics curriculum and pedagogies on (...) students’ learning experiences. Then we discuss the professional responsibilities of educators who are involved in designing ethics learning experiences for engineering students. The reflections presented in this paper will serve as catalysts for more comprehensive discussions regarding the impact of engineering ethics education on the ethical development of engineering students. (shrink)

The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the (...) research team’s understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills. (shrink)

Alvarez and Steward think the power of agency is a two-way power; Lowe thinks the will is. There is a problem for two-way powers. Either there is a unified description of the manifestation-type of the power, or not. If so, two-way powers are really one-way powers. If not, two-way powers are really combinations of one-way powers. Either way, two-way powers cannot help distinguish free agents from everything else. I argue the problem is best avoided by an Aristotelian view, which posits (...) a distinctive unity of explanation proper to two-way powers, grounded in a distinctive form of reasoning. (shrink)

(From the Press's Website) -/- Winner of the 2004 Lakatos Prize, Thought in a Hostile World is an exploration of the evolution of cognition, especially human cognition, by one of today's foremost philosophers of biology and of mind. Features an exploration of the evolution of human cognition. Written by one of today’s foremost philosophers of mind and language. Presents a set of analytic tools for thinking about cognition and its evolution. Offers a critique of nativist, modular versions of evolutionary psychology, (...) rejecting the example of language as a model for thinking about human cognitive capacities. Applies to the areas of cognitive science, philosophy of mind, and evolutionary psychology. -/- . (shrink)

The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient’s vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses feel that (...) they have no control over the specific situation. The findings from this analysis are supported by recent research on stress in the workplace but differ in that the imperatives directing work are moral in nature. Stress researchers have found that persons who experience that they have no control over their work situation and at the same time experience high demands may be prone to cardiovascular diseases. An important question raised by this study is whether moral stress should be recognized as a health risk in nursing. Further research is required in order to generate intervention models to prevent or deal with moral stress. (shrink)

Responsible leadership is rare. It is not that most leaders are irresponsible, but responsibility in leadership is frequently defined so that an important connotation of responsible leadership is ignored. This article equates responsible leadership with virtuousness. Using this connotation implies that responsible leadership is based on three assumptions—eudaemonism, inherent value, and amplification. Secondarily, this connotation produces two important outcomes—a fixed point for coping with change, and benefits for constituencies who may never be affected otherwise. The meaning and advantages of responsible (...) leadership as virtuous leadership are discussed. (shrink)

Change is inevitable, and increasingly rapid and continuous in healthcare as organizations strive to adapt, improve and innovate. Organizational change challenges healthcare providers because it restructures how and when patient care delivery is provided, changing ways in which nurses must carry out their work. The aim of this doctoral study was to explore frontline nurses’ experiences of living with rapid and continuous organizational change. A critical hermeneutic approach was utilized. Participants described feeling voiceless, powerless and apolitical amidst rapid and continuous (...) organizational changes which fuelled apathy, cynicism and disengagement from the organization. However, critical analysis of the data showed that nurses actively engaged with power, voice and politics through resistant and transgressive behaviours in micro‐ethical moments of practice. There is a need to reconceptualize the concepts of voice, power and politics in nursing as there is dissonance between nurses’ beliefs about these concepts and what they are enacting in practice. Recognizing their enactment of power, voice and political agency at the micro‐level may empower nurses. Empowerment would mitigate the high levels of reports of powerlessness experienced in practice during organizational changes. (shrink)

If within the borders of human life the truth is, as Vico has said, what is made, then the task of a student of human life can be and should be to find out from what human beings have made what manner of makers they are and what sorts of production their circumstance allows.

We report the results of an investigation of nurses’ and physicians’ sensitivity to ethical dimensions of clinical practice. The sample consisted of 113 physicians working in general medical settings, 665 psychiatrists, 150 nurses working in general medical settings, and 145 nurses working in psychiatry. The instrument used was the Moral Sensitivity Questionnaire (MSQ), a self-reporting Likert-type questionnaire consisting of 30 assumptions related to moral sensitivity in health care practice. Each of these assumptions was categorized into a theoretical dimension of moral (...) sensitivity: relational orientation, structuring moral meaning, expressing benevolence, modifying autonomy, experiencing moral conflict, and following the rules. Significant differences in responses were found between health care professionals from general medical settings and those working in psychiatry. The former agreed to a greater extent with the assumptions in the categories ‘meaning’ and ‘autonomy’ and to a lesser degree with the categories ‘benevolence’ and ‘conflict’. Moreover, those from the psychiatric sector agreed to a greater extent to the use of coercion if necessary. Significant differences were also found for some of the MSQ categories, between physicians and nurses, and between males and females. (shrink)

This book is part of the growing field of practical approaches to philosophical questions relating to identity, agency and ethics, working across continental and analytical traditions. Kim Atkins explains and justifies the basis of the practical approach through an explication of the structures of human embodiment and an account of how those structures necessitate a narrative model of selfhood, understanding and ethics. She highlights how recent work on agency and autonomy implicitly draws upon conceptions of embodiment and intersubjectivity that underpin (...) the narrative view. (shrink)

In men and women sexual arousal culminates in orgasm, with female orgasm solely from sexual intercourse often regarded as a unique feature of human sexuality. However, orgasm from sexual intercourse occurs more reliably in men than in women, likely reflecting the different types of physical stimulation men and women require for orgasm. In men, orgasms are under strong selective pressure as orgasms are coupled with ejaculation and thus contribute to male reproductive success. By contrast, women's orgasms in intercourse are highly (...) variable and are under little selective pressure as they are not a reproductive necessity. The proximal mechanisms producing variability in women's orgasms are little understood. In 1924 Marie Bonaparte proposed that a shorter distance between a woman's clitoris and her urethral meatus (CUMD) increased her likelihood of experiencing orgasm in intercourse. She based this on her published data that were never statistically analyzed. In 1940 Landis and colleagues published similar data suggesting the same relationship, but these data too were never fully analyzed. We analyzed raw data from these two studies and found that both demonstrate a strong inverse relationship between CUMD and orgasm during intercourse. Unresolved is whether this increased likelihood of orgasm with shorter CUMD reflects increased penile–clitoral contact during sexual intercourse or increased penile stimulation of internal aspects of the clitoris. CUMD likely reflects prenatal androgen exposure, with higher androgen levels producing larger distances. Thus these results suggest that women exposed to lower levels of prenatal androgens are more likely to experience orgasm during sexual intercourse. . (shrink)

The essays collected in this volume address a range of issues that arise when the focus of philosophical reflection on identity is shifted from metaphysical to practical and evaluative concerns. They also explore the usefulness of the notion of narrative for articulating and responding to these issues. The chapters, written by an outstanding roster of international scholars, address a range of complex philosophical issues concerning the relationship between practical and metaphysical identity, the embodied dimensions of the first-personal perspective, the kind (...) of reflexive agency involved in the self-constitution of one’s practical identity, the relationship between practical identity and normativity, and the temporal dimensions of identity and selfhood. In addressing these issues, contributors engage with debates in the literatures on personal identity, phenomenology, moral psychology, action theory, normative ethical theory, and feminist philosophy. (shrink)

This chapter contains sections titled: Zack's Sensitivity Zack's Race Zack's Desire Zack's Violence Music Conclusion Notes.

Philosophers ask just whose expression, if anyone’s, we hear in lyric poetry. Walton provides a novel possibility: it’s the reader who “uses” the poem (just as a speech giver uses a speech) who makes the language expressive. But worries arise once we consider poems in particular social or political settings, those which require a strong self-other distinction, or those with expressions that should not be disassociated from the subjects whose experience they draw from. One way to meet this challenge is (...) to consider the poem expressive of a plural subject, which frees us from looking for a particular individual whose voice we hear in the work, whether she be fictional or actual. Some lyrics give voice to a group whose experience is attended to in the work. This may be done through a posited fictional speaker, but the ontology of the speaker is shown to be less important. Attending to a group whose concerns are voiced allows us to explain how poems can manage to address our-worldly concerns even when lacking actual persons whose expressions we encounter in the poems. (shrink)

The acquisition of English noun and verb morphology is modeled using a single-system connectionist network. The network is trained to produce the plurals and past tense forms of a large corpus of monosyllabic English nouns and verbs. The developmental trajectory of network performance is analyzed in detail and is shown to mimic a number of important features of the acquisition of English noun and verb morphology in young children. These include an initial error-free period of performance on both nouns and (...) verbs followed by a period of intermittent over-regularization of irregular nouns and verbs. Errors in the model show evidence of phonological conditioning and frequency effects. Furthermore, the network demonstrates a strong tendency to regularize denominal verbs and deverbal nouns and masters the principles of voicing assimilation. Despite their incorporation into a single-system network, nouns and verbs exhibit some important differences in their profiles of acquisition. Most importantly, noun inflections are acquired earlier than verb inflections. The simulations generate several empirical predictions that can be used to evaluate further the suitability of this type of cognitive architecture in the domain of inflectional morphology. (shrink)

This book is part of the growing field of practical approaches to philosophical questions relating to identity, agency and ethics--approaches which work across continental and analytical traditions and which Atkins justifies through an explication of how the structures of human embodiment necessitate a narrative model of selfhood, understanding, and ethics.

This study reports the results of a study of Swedish psychiatrists’ responses to moral statements related to decision making in the psychiatric context. Use was made of the Moral Sensitivity Questionnaire, a modified instrument previously constructed from a theory of moral sensitivity. This Likert-type scale contains 30 items constructed from the following categories: interpersonal orientation, structuring moral meaning, benevolence, modifying autonomy, experiencing moral conflict, and trust in medical knowledge and principles of care. The purpose was to identify possible differences in (...) responses rather than to evaluate right or wrong responses. The analysis is based on 754 completed questionnaires. The results of the study showed some significant differences in the item and category levels; for example, male psychiatrists experienced more conflicts than female psychiatrists and agreed to a greater extent that medical knowledge was most important in deciding what was best for the patient. The results also showed that more female than male psychiatrists thought that the relationship with the patient was most important in psychiatric practice. (shrink)

Depression experienced by older adults is proving an increasing global health burden, with rates generally 7% and as high as 27% in the USA. This is likely to significantly increase in coming years as the number and proportion of older adults in the population rises all around the world. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama and music modalities, are utilised internationally (...) to target depression and depressive symptoms in older adults. This includes interventions led by trained arts therapists as well as other health and arts professionals. However, to date there has not been a systematic review that reports effects and examines the processes (why) and mechanisms (how) of creative arts interventions are used to address depression in this older age group. This systematic review of studies on creative arts interventions for older adults experiencing depression examined: outcomes of four creative arts modalities (art, dance movement, drama, and music); with particular attention paid to processes documented as contributing to change in each modality; and mechanisms considered to result from these processes. Our analysis of 75 articles (17 art, 13 dance, 4 drama and 41 music) indicates mostly significant quantitative or positive qualitative findings, particularly for interventions led by creative arts therapists. Mechanisms of change gleaned from the studies that were common across modalities include physical (e.g. increased muscle strength; neurochemical effects, such as endorphin release), intra-personal (e.g. enhanced self-concept, strengthened agency and mastery; processing and communication of emotions), cultural (e.g. creative expression, aesthetic pleasure), cognitive (e.g. stimulation of memory) and social (e.g. increased social skills and connection), that were all considered to contribute to reduced depression and symptoms. Recommendations for future research include a stronger focus on testing of processes and mechanisms. (shrink)

"No human now gathers for himself or herself the essential resources for life: food, shelter, clothing, and the like. Humans are obligate co-operator, and this has been true for tens of thousands of years; probably much longer. In this regard, humans are very unusual. Cooperation outside the family is rare: though it can be very profitable, it is also very risky, as cooperation makes an agent vulnerable to incompetence and cheating. This book presents a new picture of the emergence of (...) cooperation in our lineage, developing through four fairly distinct phases from a baseline that was probably fairly similar to living great apes, who cooperate, but in fairly minimal ways. As adults, they rarely depend on others when the outcome really matters. This book suggests that cooperation began to be more important for humans through an initial phase of cooperative foraging generating immediate returns from collective action in small mobile bands. This established in our lineage about 1.8 million years ago, perhaps earlier. Over the rest of the Pleistocene, cooperation became more extended in its social scale, with forms of cooperation between bands gradually establishing, and in spatial and temporal scale too, with various forms of reciprocation becoming important. The final phase was the emergence of cooperation in large scale, hierarchical societies in the Holocene, beginning about 12,000 years ago. This picture is nested in a reading of the archaeological and ethnographic record, and twinned to an account of the gradual elaboration of cultural learning in our lineage, making cooperation both more profitable and more stable"--. (shrink)

In this study, we examine the philosophical bases of one of the leading clinical psychological methods of therapy for anxiety, anger, and depression, Cognitive Behavioral Therapy (CBT). We trace this method back to its philosophical roots in the Stoic, Buddhist, Taoist, and Existentialist philosophical traditions. We start by discussing the tenets of CBT, and then we expand on the philosophical traditions that ground this approach. Given that CBT has had a clinically measured positive effect on the psychological well-being of individuals, (...) it becomes important to study the philosophical foundations on which this therapy is based. (shrink)

This paper discusses two perspectives, each of which recognises the importance of environmental resources in enhancing and amplifying our cognitive capacity. One is the Clark–Chalmers model, extended further by Clark and others. The other derives from niche construction models of evolution, models which emphasise the role of active agency in enhancing the adaptive fit between agent and world. In the human case, much niche construction is epistemic: making cognitive tools and assembling other informational resources that support and scaffold intelligent action. (...) I shall argue that extended mind cases are limiting cases of environmental scaffolding, and while the extended mind picture is not false, the niche construction model is a more helpful framework for understanding human action. (shrink)

This book is not a conventional introduction to the philosophy of mind, nor is it a contribution to the physicalist/ dualist debate. Instead The Representational Theory of Mind demonstrates that we can construct physicalist theories of important aspects of our mental life. Its aim is to explain and defend a physicalist theory of intelligence in two parts: the first six chapters consist of an exposition, elaboration and defence of human sentience (the functionalist theory of mind), and the second part considers (...) rivals and objections to this theory. Kim Sterelny aims to introduce people to this area of philosophy by exemplifying it, to show that philosophical and empirical investigations can be synthesized to the benefit of both. --From publisher's description. (shrink)