BackgroundHigh levels of moral distress in nursing professionals, of which oncology nurses are particularly prone, can negatively impact patient care, job satisfaction, and retention.Aim“Positive Attitudes Striving to Rejuvenate You: PASTRY” was developed at a tertiary cancer center to reduce the burden of moral distress among oncology nurses.Research DesignA Quality Improvement (QI) initiative was conducted using a pre- and post-intervention design, to launch PASTRY and measure its impact on moral distress of the nursing unit, using Hamric’s Moral Distress Scale–Revised (MDS-R.) This (...) program consisted of monthly 60-minute sessions allowing nurses to address morally distressing events and themes, such as clinicians giving “false hope” to patients or families. The PASTRY program sessions were led by certified clinicians utilizing strategies of discussion and mind-body practices.ParticipantsClinical nurses working on an adult leukemia/lymphoma unit.Ethical considerationsThis was a QI initiative, participation was voluntary, MDS-R responses were collected anonymously, and the institution’s Ethics Committee oversaw PASTRY’s implementation.FindingsWhile improvement in moral distress findings were not statistically significant, the qualitative and quantitative findings demonstrated consistent themes. The PASTRY program received strong support from nurses and institutional leaders, lowered the nursing unit’s moral distress, led to enhanced camaraderie, and improved nurses’ coping skills.DiscussionMeasurement of moral distress is innately challenging due to its complexity. This study reinforces oncology nurses have measurable moral distress. Interventions should be implemented for a safe and healing environment to explore morally distressing clinical experiences. Poor communication among multidisciplinary team members is associated with moral distress among nurses. Programs like PASTRY may empower nurses to build support networks for change within themselves and institutions.ConclusionThis QI initiative shows further research on moral distress reduction should be conducted to verify findings for statistical significance and so that institutional programs, like PASTRY, can be created. (shrink)

Feminist scholars have critically analyzed the effects of sex segregation in numerous social institutions, yet sex-segregated sport often remains unchallenged. Even critics of sex-segregated sport have tended to accept the merits of women-only teams at face value. In this article, we revisit this issue by examining the underlying assumptions supporting women’s and girls’ teams and explore how they perpetuate gender inequality. Specifically, we analyze the 14 U.S. court cases wherein adolescent boys have sought to play on girls’ teams in their (...) respective high schools. The courts’ decisions reveal taken-for-granted, essentialist assumptions about girls’ innate fragility and athletic inferiority. While the courts, policy makers, and many feminist scholars see maintaining teams for girls and women as a solution to the problem of boys’ and men’s dominance in sport, the logic supporting this form of segregation further entrenches notions of women’s inferiority. (shrink)

The impact of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 on the economic circumstances of women and children has received substantial research attention, but provisions of the act that attempt to influence women's reproductive behaviors have been much less studied. Provisions of PRWORA encouraged states to intensify efforts to restrict access to abortion and to decrease rates of nonmarital births, particularly among teenagers. Using state-level data, this study analyzes the effects of state policies enacted in the wake (...) of welfare reform, controlling for prior rates of abortion and unwed births. The authors find that economic-based incentives have only minor, and inconsistent, influence on statewide rates of abortion and nonmarital births in 2000. Results are consistent with feminist scholarship proposing that noneconomic considerations are more central in women's decision making about reproduction than economic factors. (shrink)

Grey’s Anatomy focuses on the personal and professional life of protagonist Meredith Grey. Throughout the long series, a consistent theme is that the audience is confronted with moral dilemmas in Meredith’s professional work with patients as well as in her personal life. Grey’s decision-making often breaks professional protocol in order to do what she believes is best for her patients and those close to her. We argue that Grey’s approach to morality is representative of Simone de Beauvoir’s approach in The (...) Ethics of Ambiguity. In this text, Beauvoir argues that an existentialist ethic must reject a childlike approach to morality in which moral rules are absolute and moral dilemmas have obvious answers. Instead, she argues for a rejection of universalist ethics in favor of acknowledging the ambiguity of the moral realm. By tracing Meredith’s decision-making throughout the course of different seasons of the show, we argue that Meredith exemplifies an existential authenticity compatible with Beauvoir’s existentialist approach to ethics. (shrink)

This chapter explores the comedy of George Carlin (1937–2008) as a powerful statement about the value of truth over ignorance. Carlin challenged his audience to confront the truth, regularly using clever rhetorical strategies to force viewers to grapple with inconvenient realities about the world in which they lived. This chapter examines historical and contemporary philosophical arguments for the importance of the pursuing truth over comforting fictions. I begin with Plato’s Allegory of the Cave, which argues it is preferable to know (...) reality as it truly is over appearances of the truth, even when it’s painful or difficult. I then discuss Nozick’s argument that humans would not want to plug into a pleasurable experience machine. Last, I examine contemporary arguments that there are distinctly moral reasons for pursuing the truth. I show how there are examples of all three arguments in Carlin’s comedic work, and suggest we can consider Carlin’s work a critical commentary that reveals multiple reasons for valuing truth over enticing fictions. (shrink)

Detroit Become Human (DBH) offers a stunningly visual gameplay experience that both tells a philosophical story and stimulates the moral reasoning process in players. The game features a futuristic world where highly intelligent androids are bought and sold as workers who take on menial labor tasks for humans. In this chapter, we explore three dimensions of moral reasoning: accounts of moral agency, ethical theories or frameworks, and accounts of moral patiency. We then explore how DBH addresses all of these philosophical (...) issues in its narrative and gameplay scenarios. Issues of moral agency are explored through some of the androids gaining consciousness and autonomy. Ethical theory is explored through various ethical dilemmas that emerge in the gameplay. Moral patiency is explored by questioning if the androids, conscious and unconscious, are worthy of moral concern and why. We then show how the gameplay structure offers a unique interactive opportunity for players to engage in the moral reasoning process. Additionally, through the questions it raises and scenarios it poses, DBH makes an implicit anti-speciesist argument regarding moral patiency. Additionally, it makes a secondary argument that suffering and struggle are necessary to develop the possibility of second-order desires and true freedom and agency. The interactive structure of the game, in which players’ choices have more weight than in many gameplay experiences, makes DBH a unique work of contemporary philosophical pop culture. (shrink)

The Good Place was a historical landmark in the field of pop culture as philosophy, as it was the first mainstream sitcom to explicitly tackle the works of philosophers in its content. In addition to exposing its viewers to the works of famous philosophers, The Good Place makes its own philosophical arguments. The show is ultimately about the concept of the afterlife – what it might look like, how it would operate, and if it is even desirable. The show also (...) explores the relationship between morality and the afterlife. Essentially, The Good Place explores three focal questions: (1) Are there reasons to be morally good, irrespective of how that plays out in an afterlife? (2) What would a fair system for gaining admission to a merit-based afterlife look like? And (3) is an eternal afterlife even desirable? Ultimately the show argues that yes, virtue is worthwhile for virtue’s own sake, irrespective of the consequences in an afterlife. Second, it argues that a fair merit-based system would allow people the chance to improve and get better, given the right circumstances. Third, it argues that an eternal afterlife, in which you maintain your identity and live forever, is not desirable. (shrink)

Although it is not yet officially recognized as a clinical entity which is diagnosable, Internet Gaming Disorder (IGD) has been included in section III for further study in the DSM-5 by the American Psychiatric Association (APA, 2013). This is important because there is increasing evidence that people of all ages, in particular teens and young adults, are facing very real and sometimes very severe consequences in daily life resulting from an addictive use of online games. This article summarizes general aspects (...) of IGD including diagnostic criteria and arguments for the classification as an addictive disorder including evidence from neurobiological studies. Based on previous theoretical considerations and empirical findings, this paper examines the use of one recently proposed model, the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, for inspiring future research and for developing new treatment protocols for IGD. The I-PACE model is a theoretical framework that explains symptoms of Internet addiction by looking at interactions between predisposing factors, moderators, and mediators in combination with reduced executive functioning and diminished decision making. Finally, the paper discusses how current treatment protocols focusing on Cognitive-Behavioral Therapy for Internet addiction (CBT-IA) fit with the processes hypothesized in the I-PACE model. (shrink)

This article investigates the role of shame in shaping the epistolary form and aesthetic structure of Alice Walker's The Color Purple. I argue that the epistolary framing presents a crisis in the development of Celie's shamed self‐consciousness. To explain the connection between shame and Celie's self‐consciousness, I build on Jean Paul Sartre's theory of existentialism and explore three phases of Celie's evolution as it is represented in three phrases that I identify as significant transitions in the text: “I am,” “But (...) I'm here,” and “It mine.” The first section examines how shame fractures Celie's self‐consciousness; the second focuses on how Celie positions and locates herself in the world; and the third explains how Celie mobilizes shame by connecting her self‐consciousness to a past that is shameful but also generative. I conclude by considering the novel's emergence in the Cosby/Reagan era in order to illuminate the mutual constitution of black familial pride and black racial shame. (shrink)

This article focuses on Sartre’s concept of the practicoinert in his major work A Critique of Dialectical Reason, Vol. 1. I first show the progression from Sartre’s previous conception of in-itself to his concept of practico-inert. I identify five different layers of the practico-inert: human-made objects, language, ideas, social objects and class being. I show how these practico-inert layers form the possibilities for our subjectivity and how this represents a change from Sartre’s view of in-itself in Being and Nothingness. I (...) then explore the relationship of freedom to the practico-inert and how Sartre argues that the practico-inert places limits on our freedom. Lastly, I argue that despite the pessimistic picture Sartre paints in CDR, the practico-inert has the potential to both limit and enhance our freedom. I appeal to Sartre’s post-CDR essay ‘A Plea for Intellectuals’ to argue that a Sartrean account of progress requires the utilisation of the practico-inert. (shrink)

In this article I present a comparative analysis of Schopenhauer’s concept of a human’s intelligible character and Sartre’s concept of a human’s fundamental project. My examination reveals that both Schopenhauer and Sartre posit a groundless, baseless choice of identity which unifies a human’s future conscious states into an integrated whole. I also identify the primary difference between the two accounts: Schopenhauer’s intelligible character is permanent, while Sartre’s theory of fundamental project is capable of being transformed or transcended. Last, I show (...) that the divergence on this point can be explained by the position the two philosophers hold with respect to the relationship of existence to essence. For Schopenhauer’s account, I use The World as Will and Representation, Vol. 1 and Vol. 2, and his Prize Essay on the Freedom of the Will. For the analysis of Sartre, I rely on Being and Nothingness and his biography of French writer Jean Genet, titled Saint Genet. (shrink)

A Sartrean existentialist ethics of authenticity model can serve as an alternative to tradi­tional approaches to the issue of moral responsibilities to future generations. Traditional utilitarian and rights-based positions can fall short when addressing future-persons concern, both through technical problems and their failure to show our interconnectedness with other generations. Sartrean concepts of freedom, responsibility, and authenticity can offer an alternative approach which focuses on interpersonal adoption of the Other’s projects. There is bad faith present in the typical discussion about (...) future generations. We need to rid ourselves of this bad faith in order to engage in authentic relationships with humans of the past, present, and future. (shrink)

Dive into the moral philosophy at the heart of all four seasons of NBC’s The Good Place, guided by academic experts including the show’s philosophical consultants Pamela Hieronymi and Todd May, and featuring a foreword from creator and showrunner Michael Schur Explicitly dedicated to the philosophical concepts, questions, and fundamental ethical dilemmas at the heart of the thoughtful and ambitious NBC sitcom The Good Place Navigates the murky waters of moral philosophy in more conceptual depth to call into question what (...) Chidi’s ethics lessons—and the show—get right about learning to be a good person Features contributions from The Good Place’s philosophical consultants, Pamela Hieronymi and Todd May, and introduced by the show’s creator and showrunner Michael Schur Engages classic philosophical questions, including the clash between utilitarianism and deontological ethics in the “Trolley Problem,” Kant’s categorical imperative, Sartre’s nihilism, and T.M Scanlon's contractualism Explores themes such as death, love, moral heroism, free will, responsibility, artificial intelligence, fatalism, skepticism, virtue ethics, perception, and the nature of autonomy in the surreal heaven-like afterlife of the Good Place Led by Kimberly S. Engels, co-editor of Westworld and Philosophy. (shrink)

In Westworld, viewers learn that the timid and mild‐mannered William is the younger version of the violent, sinister, mission‐driven Man in Black. This chapter considers what it means for William to have, as Sartre calls it, an existential project. It shows how Sartre's theory explains quite cogently William's change in essence from his young self to the violent Man in Black. In a Sartrean framework, William did not discover himself in the park, rather, his experience in the park, or new (...) “situation”, led him to make a new choice of himself in the world and pursue a new set of ends. The chapter then examines Maeve's choice to leave the train at the end of the “The Bicameral Mind”. Although Maeve is a programmed android, she is able to resist her programming and formulate her own goal and, perhaps, start her own existential journey. (shrink)

This paper provides an analysis of conscience-based refusals in healthcare from a Sartrean view, with an emphasis on the tension between individual responsibility and professional role morality. Conscience-based refusals in healthcare involve healthcare workers refusing to perform actions based on core moral beliefs. Initially this appears in line with Sartrean authenticity, which requires acknowledgment that one is not identical with professional role. However, by appealing to Sartre’s later social thought, I show that professional role morality is authentic when one considers (...) common group practices, which Sartre refers to as pledged group praxis. I demonstrate that for healthcare providers, authenticity mandates putting the goals and generally accepted praxis of healthcare front and center in the workplace decision process. I conclude by strengthening Andrew West’s existentialist decision-making model with Sartre’s later social thought. With the updated model, I show that for healthcare workers most often the authentic decision is to perform generally accepted healthcare procedures in spite of individual moral qualms. This is because working in healthcare necessitates viewing one’s professional tasks in their broader social context—as unified, communal group praxis. (shrink)

Rejecting an eternal, unchanging soul or essence, Jean Paul Sartre praises the beauty of the human experience and definitively declares his preference for a temporary life of change and transformation over an eternity of certainty. In The Good Place, Michael is an immortal demon called an architect, who takes on the ambitious task of designing a neighborhood that will prompt condemned humans Eleanor, Chidi, Tahani, and Jason to unknowingly torture each other. Sartre's existentialism is characterized by his rejection of a (...) pre‐given human essence as well as his focus on the power of individual freedom. In Sartre's view, there is no divine creator, no final judge, and no supernatural moral fabric holding everything together. Throughout the course of four seasons of The Good Place, Michael decides that the project of an eternal certainty is less preferable than a possibly limited lifetime of risk, change, and transformation. (shrink)

This article utilizes the Foucauldian concepts of biopower and normalization to give an analysis of the debate surrounding the controversial administration of the HPV vaccine to adolescents. My intention is not to solve the problem, rather to utilize a Foucauldian framework to bring various facets of the issue to light, specifically the way the vaccine contributes to strategies of power in reference to how young adults develop within relationships of power. To begin, the article provides an overview of the Foucauldian (...) concepts of biopower and normalization, including how these two strategies of power were present in the administration of the smallpox vaccine in the 19th century. Next, information about HPV and the history of the current controversy in the United States is presented. Lastly, the article presents an analysis of the strategies of biopower and normalization present in the debate on HPV, including an emphasis on how the vaccination is similar to, and different from, 19th century smallpox vaccination. It also explores the way that mechanisms of disease control affect and are affected by individual subjects, in this case, adolescents. (shrink)

Saturday Night Live (SNL) has become a staple of each political season. In this chapter, the authors show how late night comedy programs such as SNL have joined traditional TV news programs as authorities of delimination for defining the boundaries of political truth in historical epoch. SNL is different from other comedy programs such as the The Daily Show because of its focus on parody. SNL featured many sketches focused on the election, which also contributed to the production of the (...) truth. As an authority of delimination for political truth, SNL emphasized the sexist double standard to which Hillary Clinton was held. In short, SNL will continue to play a role in the production of political truth and knowledge. Michel Foucault famously argued that truth and knowledge are neither static nor objective. Foucault shows that different historical epochs and different geographical locations have different frameworks of verification for something to be considered true. (shrink)

This article explores the patient experience of medically unexplained symptoms (MUS) from an existentialist standpoint. Drawing on the work of Jean-Paul Sartre and Simone de Beauvoir, I explore their concepts of existential situation, existential project, authenticity, and praxis. I then analyze the situation of MUS patients in the current cultural and institutional context, elucidating that a lack of explanation for their symptoms puts MUS patients in an existential bind. I illustrate the effects of the experience of MUS on patients’ existential (...) projects. Last, I develop an ethical response in the existentialist tradition from the perspective of patients, providers, and society at large. I argue that there is a collective responsibility to foster conditions more conducive to authentic patient well-being and to improve the experience of patients with medically unexplained symptoms. (shrink)

While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to (...) fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters. (shrink)

Phoebe Waller-Bridge is not an unknown name. The writer, actor, and producer has been a part of various comedy TV series and films. However, she has a pattern in her comedy writing and character creation that is obvious in the TV series – Fleabag (2016–2019) and Crashing (2016). In both these series, one cannot miss the obvious similarity between the characters she wrote and played – characters who knew what they wanted and did not hesitate to make attempts to achieve (...) it, even when it meant defying the conventional rules of social relationships and breaking out of the gender identities set by society for women. In fact, other characters created around these female characters seem to lack the same courage, which leads to the creation of comical situations but also often results in these characters facing emotional obstacles that they eventually overcome. The women in both shows not only choose to reject predefined gender identities, but also make choices and take risks while being aware of the consequences. Throughout their journeys of embracing their free consciousnesses, these characters illustrate Jean Paul Sartre’s and Simone de Beauvoir’s process of transcending their facticity, thus avoiding bad faith. Implicit in Waller-Bridge’s work is the argument that we could do better to be – and encourage other women to be – the types of women that her protagonists are. (shrink)

It has been proposed that performance in the think – no think task represents a laboratory analogue of the voluntary form of memory repression. The central prediction of this repression hypothesis is that performance in the TNT task will be influenced by emotional characteristics of the material to be remembered. This prediction was tested in two experiments by asking participants to learn paired associates in which the first item was either emotionally positive or emotionally negative . The second word was (...) always emotionally neutral . Consistent with the repression hypothesis, significant memory suppression was observed in both experiments following ‘no think’ instructions for memories associated with emotionally negative material. No suppression was observed for memories associated with emotionally positive information. Implications of these findings for the relationship between performance in the TNT task and the controversial notion of memory repression are considered. (shrink)

Many individuals have experienced a multitude of chronic stressors and diminished psychological functioning during COVID-19. The current study examined whether biases towards positive social media or positive autobiographical memories was related to increases in psychological functioning during COVID-19. Participants were 1071 adults (Mage = 46.31; 58% female; 78% White) recruited from MTurk. Participants reported on their social media consumption and autobiographical recall, positive and negative affect, and dysphoria symptoms. Results indicated that, at the first assessment collected in the spring and (...) summer of 2020, positively biased social media consumption was cross-sectionally related to higher levels of positive affect, and positively biased autobiographical recall was cross-sectionally related to lower levels of negative affect and dysphoria symptoms. Sensitivity analyses examined cross-sectional relations from a second assessment collected in fall 2020, and prospective cross-lagged analyses. The findings point to potential psychological benefits of positive biases during chronic stressors. (shrink)

This workshop introduced the concept of global business citizenship and explored several ways to use the model, its underlying theory, and cases representing it in classroom teaching. Links to peace studies, organizational change exercises, accountability resources, and the use of United Nations Global Compact case studies all received attention.

Affective variables have been shown to impact working memory and cognitive control. Theoretical arguments suggest that the functional impact of emotion on cognition might be mediated through shifting action dispositions related to changes in motivational orientation. The current study examined the effects of positive and negative affect on performance via direct manipulation of motivational state in tasks with high demands on cognitive control. Experiment 1 examined the effects of monetary reward on task-switching performance, while Experiment 2 examined the effects of (...) both rewards and punishments on working memory, using primary (liquid) reinforcers. In both experiments, dissociable trial-by-trial and contextual (block-related) enhancements of cognitive control during task performance were observed in relationship to motivational incentive value. Performance enhancements were equivalent in the reward and punishment conditions, but were differentially impacted by individual difference measures of trait reward and punishment sensitivity. Together, the results suggest both common and specific mechanisms by which approach and avoidance motivational states influence cognitive control, via activation of reward and punishment processing systems. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

Anhedonia is a risk factor for suicide and poor treatment response in depressed individuals. Most evidence-based psychological therapies target symptoms of heightened negative affect instead of deficits in positive affect and typically show little benefit for anhedonia. Viewing positive scenes through virtual reality has been shown to increase positive affect and holds great promise for addressing anhedonic symptoms. In this pilot study, six participants with clinically significant depression completed 13 sessions of exposure to positive scenes in a controlled VR environment. (...) Significant decreases were found in self-reported anhedonia, depression, anxiety, and impairments in functioning from baseline to 1-month follow-up. Negative affect decreased over all 13 sessions, and positive affect increased over sessions 8–13. Results suggest that positive experiences in VR may be a novel avenue for the treatment of anhedonia in depressed individuals. (shrink)

Clinical ethics training programs are responsible for preparing their trainees to be competent ethics consultants worthy of the trust of patients, families, surrogates, and healthcare professionals. While the American Society for Bioethics and Humanities (ASBH) offers a certification examination for healthcare ethics consultants, no tools exist for the formal evaluation of ethics trainees to assess their progress toward competency. Medical specialties accredited by the Accreditation Council for Graduate Medical Education (ACGME) use milestones to report trainees’ progress along a continuum of (...) professional development as a means of “operationalizing and implementing” medical competencies. Utilizing the Core Competencies for Healthcare Ethics Consultation and the ACGME and American Board of Pediatrics’ (ABP) Pediatric Milestones Project, we developed milestones for 17 subcompetencies in clinical ethics consultation and academic bioethics. As the field of clinical ethics becomes more standardized, such tools will be needed to promote the development of robust training programs and to certify that their graduates are competent practitioners. (shrink)