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)

Philip Kitcher’s The Ethical Project trios to vindicates ethics through an analysis of its evolutionary and cultural history, a history which in turn, he thinks, supports a particular conception of the role of moral thinking and normative practices in human social life. As Kitcher sees it, that role could hardly be more central: most of what makes human life human, and preferable to the fraught and impoverished societies of the great apes, depends on moral cognition. Prom this view of the (...) role of the ethical project as a social technology, Kitcher derives an account of moral progress and even moral truth: a normative analogue of the idea that truth is the convergence of rational enquiry. To Kitcher’s history, I present an anti-history. Most of what is good about human social life depends on the expansion of our social emotions, not on our capacities to articulate and internalise explicit norms. Indeed, since the Holocene and the origins of complex society, normative thought and normative institutions have been more prominent as tools of exploitation and oppression than as mechanisms of a social peace that balances individual desire with collective co-operation. I argue that the vindication project fails in its own terms: even given Kitcher’s distinctive pragmatic concept of vindication, history debunks rather than vindicates moral cognition. (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)

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)

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 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)

(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)

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)

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)

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)

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)

Armed conflict can destroy both a healthcare system and the people who comprise it. Where the facilities themselves may take decades to rebuild, this collection of essays is evidence of the remarkable resilience of healthcare providers working in these conflict zones. Twelve narratives are shared by doctors, nurses, and other staff working in current crises in places such as Afghanistan, Darfur, Gaza, Iraq, Myanmar, Syria, and Ukraine. The essays reveal logistical, personal, and ethical challenges of providing fundamental healthcare services under.

In this essay, Kim Niewolny, current President of AFHVS, responds to the 2020 AFHVS Presidential Address given by Molly Anderson. Niewolny is encouraged by Anderson’s message of moving “beyond the boundaries” by focusing our gaze on the insurmountable un-sustainability of the globalized food system. Anderson recommends three ways forward to address current challenges. Niewolny argues that building solidarity with social justice movements and engendering anti-racist praxis take precedence. This work includes but is not limited to dismantling the predominance of neoliberal-fueled (...) technocratic productivism in agricultural science and policy while firmly centering civil society collective action and human rights frameworks as our guiding imaginary for racial, gender, environmental, and climate justice possibilities for sustainable food systems praxis. She concludes by exploring the epistemic assertion to push beyond our professional and political imaginaries to build a more fair, just, and humanizing food system. (shrink)

Baudrillard Reframed offers the arts student and others working with Baudrillard's ideas an accessible overview of his better known arguments, as well as ...

"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)

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)

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)

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)

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)

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.

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)

Who should have a right to participate in a polity’s decision-making? Although the answers to this ‘boundary problem’ in democratic theory remain controversial, it is widely believed that the enfranchisement of tourists and children is unacceptable. Yet, the two most prominent inclusion principles in the literature – Robert Goodin’s ‘all (possibly) affected interests’-principle and the ‘all subjected to law’-principle – both enfranchise those groups. Unsurprisingly, democratic theorists have therefore offered several reasons for nonetheless exempting tourists and children from the franchise. (...) In this paper, I argue that their attempts fail. None of the proposed rationales can do the job without having unacceptable implications for the voting rights of other groups. I then develop a new specification of the affected interests-view, one that avoids such problems. According to my life plan-principle, a person is entitled to participate in a polity’s decision-making if and only if its decisions will actually affect her autonomously chosen life plans, or prevent her from developing or revising plans of that kind. I show that this principle straightforwardly avoids enfranchising tourists and children, and thus improves upon its two prominent rivals. The paper ends by considering and rejecting two objections to my new principle. (shrink)

In this article we defend the view that, on the All Affected Principle of voting rights, the weight of a person’s vote on a decision should be determined by and only by the degree to which that dec...

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.

Comments on G. Marcus' criticisms (see record 1996-24670-001) of K. Plunkett's and V. Marcham's (see record 1994-35650-001) connectionist account of the acquisition of the English past tense (verb morphology). The original model is reviewed. Graphing, overregularization, and other criticisms are addressed (PsycINFO Database Record (c) 2000 APA, all rights reserved).

Most contemporary theories of action maintain that there are basic actions. A basic action is something that one does intentionally without doing anything else intentionally as means to that end. Most contemporary theories of action also maintain that there are non-basic actions that are mistakes in performance, where a mistake in performance is a case of mucking up what one meant to do, without the failure being the result of prevention or abnormal interference. But most contemporary theories of action deny (...) that there are basic mistakes in performance: stretches of activity that would be basic actions were they to succeed, but are in fact mistakes in performance. I argue that we have reason to think that there are basic mistakes in performance, and if there are, then we must give up a key commitment common to much contemporary action theory. The commitment is that every particular imperfect expression of the will is grounded in some particular perfect expression of the will. Giving up this commitment has important metaphysical consequences for how we think of the will as a power of agency, and implies that causal deviance perhaps isn’t the main problem that causal theorists of action ought to worry about. (shrink)

Is the history of life a series of accidents or a drama scripted by selfish genes? Is there an “essential” human nature, determined at birth or in a distant evolutionary past? What should we conserve—species, ecosystems, or something else? -/- Informed answers to questions like these, critical to our understanding of ourselves and the world around us, require both a knowledge of biology and a philosophical framework within which to make sense of its findings. In this accessible introduction to philosophy (...) of biology, Kim Sterelny and Paul E. Griffiths present both the science and the philosophical context necessary for a critical understanding of the most exciting debates shaping biology today. The authors, both of whom have published extensively in this field, describe the range of competing views—including their own—on these fascinating topics. -/- With its clear explanations of both biological and philosophical concepts, Sex and Death will appeal not only to undergraduates, but also to the many general readers eager to think critically about the science of life. (shrink)

Anthropogenic climate change is an existential threat to the people of sinking island states. When their territories inevitably disappear, what, if anything, do the world's remaining territorial st...

Given the widening gap between the number of individuals on transplant waiting lists and the availability of donated organs, as well as the recent plateau in donations based on neurological criteria, there has been a growing interest in expanding donation after circulatory determination of death. While the prevalence of this form of organ donation continues to increase, many thorny ethical issues remain, often creating moral distress in both clinicians and families. In this article, we address one of these issues, namely, (...) the challenges surrounding patient and surrogate informed consent for donation after circulatory determination of death. First we discuss several general concerns regarding consent related to this form of organ donation, and then we address additional issues that are unique to three different patient categories: adult patients with medical decision-making capacity or potential capacity, adult patients who lack capacity, and pediatric patients. (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)