This study assessed the attitudes and needs of physicians and health professional staff at a tertiary care hospital in Canada regarding the introduction of physician assisted dying (PAD) during 2015–16. This research aimed to develop an understanding of the wishes, concerns and hopes of stakeholders related to handling requests for PAD; to determine what supports/structures/resources health care professionals (HCP) require in order to ensure high quality and compassionate care for patients requesting PAD, and a supportive environment for all healthcare providers (...) across the moral spectrum. This study constituted a mixed methods design with a qualitative descriptive approach for the study’s qualitative component. A total of 303 HCPs working in a tertiary care hospital completed an online survey and 64 HCPs working in hospital units with high mortality rates participated in 8 focus group discussions. Both focus group and survey data coalesced around several themes to support the implementation of PAD following the decriminalization of this practice: the importance of high quality care; honoring moral diversity; supporting values (such as autonomy, privacy, beneficence); and developing resources, including collaboration with palliative care, education, policies and a specialized team. This study provided the foundational evidence to support the development of the PAD program described in other papers in this collection, and can be a model for gathering evidence from stakeholders to inform the implementation of PAD in any healthcare organization. (shrink)

BackgroundUse of modified texture diets—thickening of liquids and modifying the texture of foods—in the hope of preventing aspiration, pneumonia and choking, has become central to the current management of dysphagia. The effectiveness of this intervention has been questioned. We examine requirements for a valid informed consent process for this approach and whether the need for informed consent for this treatment is always understood or applied by practitioners.Main textValid informed consent requires provision of accurate and balanced information, and that agreement is (...) given freely by someone who knows they have a choice. Current evidence, including surveys of practitioners and patients in different settings, suggests that practice in this area is often inadequate. This may be due to patients’ communication difficulties but also poor communication—and no real attempt to obtain consent—by practitioners before people are ‘put on’ modified texture diets. Even where discussion occurs, recommendations may be influenced by professional misconceptions about the efficacy of this treatment, which in turn may poison the well for the informed consent process. Patients cannot make appropriate decisions for themselves if the information provided is flawed and unbalanced. The voluntariness of patients’ decisions is also questionable if they are told ‘you must’, when ‘you might consider’ is more appropriate. Where the decision-making capacity of patients is in question, inappropriate judgements and recommendations may be made by substitute decision makers and courts unless based on accurate information.ConclusionResearch is required to examine the informed consent processes in different settings, but there is ample reason to suggest that current practice in this area is suboptimal. Staff need to reflect on their current practice regarding use of modified texture diets with an awareness of the current evidence and through the ‘lens’ of informed consent. Education is required for staff to clarify the importance of, and requirements for, valid informed consent and for decision making that reflects people’s preferences and values. (shrink)

Following an initial study of the needs of healthcare providers (HCP) regarding the introduction of Medical Assistance in Dying (MAiD), and the subsequent development of an assisted dying program, this study sought to determine the efficacy and impact of MAiD services following the first two years of implementation. The first of three aims of this research was to understand if the needs, concerns and hopes of stakeholders related to patient requests for MAiD were addressed appropriately. Assessing how HCPs and families (...) perceived the quality of MAiD services, and determining if the program successfully accommodated the diverse needs and perspectives of HCPs, rounded out this quality evaluation. This research implemented a mixed-methods design incorporative of an online survey with Likert scale and open-ended questions, as well as focus groups and interviews with staff and physicians, and interviews with MAiD-involved family members. There were 356 online surveys, as well as 39 participants in six focus groups with HCP, as well as fourteen interviews with MAiD-involved family members. Participants indicated that high-quality MAiD care could only be provided with enabling resources such as policies and guidelines to ensure safe, evidence-based, standardized care, as well as a specialized, trained MAiD team. Both focus group and survey data from HCPs suggest the infrastructure developed by the hospital was effective in delivering high-quality MAiD care that supports the diverse needs of various stakeholders. This study may serve as a model for evaluating the impact and quality of services when novel and ethically-contentious clinical practices are introduced to healthcare organizations. (shrink)

According to Xenophon, the hetaira "gratified" her patron as a philos, participating in an aristocratic network of gift exchange , while the pornê, as her name signified, trafficked in sex as a commodity. Recent writers on Greek prostitution have acknowledged that hetaira vs. pornê may be as much a discursive opposition as a real difference in status, but still, very little attention has been paid to the period of the "invention" of this binary. Hetaira meaning "courtesan" first occurs in Herodotus (...) and does not exist in Homer: hence, the conceptual category of the hetaira is an invention of the archaic period. What needs generated the constitution of this category? And what conceptual "work" was the opposition hetaira-pornê doing in Greek culture in the period of its inception? This paper addresses these questions through a reading of fragments of archaic lyric-predominantly those of Anakreon-as well as consideration of Attic vase painting. I suggest that the hetaira-pornê opposition participates in the overarching tension between the aristocratic symposium and the public sphere in archaic Greece. Oswyn Murray has suggested that the symposium constitutes itself as a kind of anti-city with its own rules and conventions. Part of the discursive exclusion of the public sphere is the complete suppression of the city's monetarized economy from the domain of the aristocratic symposium, and it is this impulse to mystify economic relations for sex that generates the category of the hetaira within a framework of gift exchange. But if the motives for this discursive invention are economic, they are also political: the hetaira affirms and embodies the circulation of charis within a privileged elite, while the pornê figures the debased and promiscuous exchanges of the agora. (shrink)

In our article, “The Faces of Reason and Its Critics”, Dialogue 25/1, 105–118, Elizabeth Trott and I said that, in his presidential address to the Canadian Philosophical Association, Francis Sparshott “mysteriously seemed to have confused … John Clark Murray … with John Macmurray”. In footnote 6, we reported Martyn Estall's theory that there might, indeed, have been no confusion because Sparshott probably did mean Macmurray who was being “promoted” at Queen's at the time. Professor Sparshott reports that Professor Estall's (...) surmise is the correct solution to the “mystery”. He also reminds us that, when he came to Canada in 1950 he was at University College, Toronto. Later, from 1955 onwards, he was John Irving's colleague at Victoria College. (shrink)

In Reconstructing Reason and Representation, Murray Clarke offers a detailed study of the philosophical implications of evolutionary psychology. In doing so, he offers new solutions to key problems in epistemology and philosophy of mind, including misrepresentation and rationality. He proposes a naturalistic approach to reason and representation that is informed by evolutionary psychology, and, expanding on the massive modularity thesis advanced in work by Leda Cosmides and John Tooby, argues for a modular, adapticist account of misrepresentation and knowledge. Just (...) as the reliability of representation can be defended on the basis of an account of the proper function of cognitive modularity, misrepresentation can be explained through an appeal to the "gap theory," by noting the divergence between the proper and actual domains of cognitive modules in a massively modular mind.Clarke argues for an externalist, modular reliabilism by suggesting that evolution has equipped us with generally reliable inferential systems even if they do not always produce true beliefs. He argues that reliable deductive and inductive inference occurs only when cognitive modules deal with actual domains that are sufficiently similar to their proper domains. This psychologically informed, naturalized adapticism leads to the suggestion that knowledge is a set of natural kinds housed in the modules of a massively modular mind. Typically, the proper function of these cognitive modules is to provide us with truths that enable us to satisfy our basic biological needs. Beyond reasoning modules, other cognitive modules discussed include the ability to orient ourselves in space, and our abilities with language, numbers, object reasoning, and social understanding. Clarke also defends Cosmides and Tooby's massive modularity hypothesis against such critics as Jerry Fodor by demonstrating that these critics consistently misrepresent Cosmides and Tooby's position. (shrink)

Preston's (2011) challenge to the moral presumption against geoengineering is applied to carbon dioxide capture and storage (CCS) in Scotland, United Kingdom. Qualitative data is analysed to assess if and how Preston's arguments play out in practice. We argue that the concepts of 'lesser evil' and prioritising human well-being over non-interference in natural processes do bring different value positions together in support of CCS, but that not all people see short-term carbon abatement as the 'least worst' option or a suitable (...) way to prioritise human well-being. (shrink)

This study applied psychographic segmentation theory to explore the psychological type profile of 1082 visitors to four cathedrals (three in England and one in Wales) and to set this profile alongside the published national normative data. Data provided by the Francis Psychological Type Scales demonstrated that among cathedral visitors there were more introverts (60%), sensing types (72%) and judging types (80%), with a balance between thinking types (49%) and feeling types (51%). Comparisons with the population norms demonstrated that extraverts and (...) perceiving types were significantly underrepresented among visitors to these four cathedrals. The implications of these findings are discussed for enhancing the visitor experience of those currently visiting and for attracting those psychological types currently less likely to visit. CONTRIBUTION: Situated within the science of cathedral studies, this article demonstrates (by means of applying psychographic segmentation theory and gathering data from four cathedrals) that extraverts and perceiving types were significantly under-represented among cathedral visitors. These data are important for understanding limitations on the reach of cathedrals within the wider community. (shrink)

I argue that athletes should neither be taken as role models nor present themselves as such. Indeed, they should resist any attempt to take them as such on the grounds that seeing athletes (or other celebrities) as role models abrogates the existential and ethical responsibilities of both parties. Whether one takes on the role of being a model to others or whether one chooses to model one’s own behaviour on that of another, except in respect of the development of technical (...) skill, one engages in bad faith and fails to act in an existentially ethical way. To this end, I consider the inclination to influence and admiration, as well as self-respect, agency, motivation, and envy. I argue that while celebrity sportspersons and similar others do not have duties that others do not have just by virtue of their notoriety alone, they may have situational responsibilities commensurate with their social reach. More importantly, however, since social influence is not a transformation of inert matter, there are also responsibilities belonging to their audiences, those who merely observe and those who choose to imitate. (shrink)

This compelling study of the origins of all that exists, including explanations of the entire material world, traces the responses of philosophers and scientists to the most elemental and haunting question of all: why is _anything_ here—or anything _anywhere_? Why is there something rather than nothing? Why not nothing? It includes the thoughts of dozens of luminaries from Plato and Aristotle to Aquinas and Leibniz to modern thinkers such as physicists Stephen Hawking and Steven Weinberg, philosophers Robert Nozick and Derek (...) Parfit, philosophers of religion Alvin Plantinga and Richard Swinburne, and the Dalai Lama. The first accessible volume to cover a wide range of possible reasons for the existence of all reality, from over 50 renowned thinkers, including Plato, Aristotle, Aquinas, Descartes, Leibniz, Hume, Bertrand Russell, Stephen Hawking, Steven Weinberg, Robert Nozick, Derek Parfit, Alvin Plantinga, Richard Swinburne, John Polkinghorne, Paul Davies, and the Dalai Lama Features insights by scientists, philosophers, and theologians Includes informative and helpful editorial introductions to each section Provides a wealth of suggestions for further reading and research Presents material that is both comprehensive and comprehensible. (shrink)

Carter’s anthropic principle reminds us that intelligent life can find itself only in life-permitting times, places or universes. The principle concerns a possible observational selection effect, not a designing deity. It has no special concern with humans, nor does it say that intelligent life is inevitable and common. Barrow and Tipler, who discuss all this, are not biologically ignorant. As argued in "Universes" (Leslie, 1989) they may well be right in thinking that "fine tuning" of force strengths and particle (...) masses, without which life would be impossible, proves the reality of God or else of multiple universes plus observational selection. (shrink)

In the last few years, off-line simulation has become an increasingly important alternative to standard explanations in cognitive science. The contemporary debate began with Gordon (1986) and Goldman's (1989) off-line simulation account of our capacity to predict behavior. On their view, in predicting people's behavior we take our own decision making system `off line' and supply it with the `pretend' beliefs and desires of the person whose behavior we are trying to predict; we then let the decision maker reach a (...) decision on the basis of these pretend inputs. Figure 1 offers a `boxological' version of the off-line simulation theory of behavior prediction.(1). (shrink)

The federal regulations that govern biomedical research, most notably those enshrined in the Common Rule, are a product of their time. Born in the aftermath of wartime atrocities committed by Nazi doctors, and influenced by domestic research scandals like the Willowbrook and Tuskegee studies, the regulations express a protectionist ethos aimed at safeguarding subjects of human experimentation from the potential harms of research participation. Requirements for informed consent, risk minimization, equitable subject selection, and peer review of proposed research rest on (...) the presumption that the research enterprise owes subjects a duty of protection. (shrink)

Although the concept of dignity is commonly invoked in clinical care, there is not widespread agreement—in either the academic literature or in everyday clinical conversations—about what dignity means. Without a framework for understanding dignity, it is difficult to determine what threatens patients’ dignity and, conversely, how to honor commitments to protect and promote it. This article aims to change that by offering the first conceptual model of dignity for patients in the intensive care unit. The conceptual model we present is (...) based on the notion that there are three sources of patients’ dignity—their shared humanity, personal narratives, and autonomy—each of which independently warrants respect. The article describes each source of dignity and draws on examples to illustrate how clinician attitudes, actions, and behaviors can either contribute to, or detract from, expressions of respect for patient dignity. (shrink)

La pensée conventionnaliste de l’environnement se heurte à un problème central : l’absence d’un ordre de grandeur écologiste qui obéisse à la même grammaire que les six autres. Cet article propose une piste afin de surmonter ce problème. Il s’agit d’envisager l’écologisme, non plus sous le modèle idéal de la cité, mais comme une critique du capitalisme. Dans cette perspective, les fondements théoriques et l’effectivité historique de la critique écologiste du capitalisme sont étudiés. Codes JEL : B5, N5, O13, O440, (...) P10, Q5. (shrink)

This study examines the association between mystical experience, as captured by the Francis-Louden Mystical Orientation Scale, and psychological health, as captured by the Eysenckian three dimensional model of personality, among 329 students attending a state university in Turkey. The data reported no significant association between mystical orientation and psychoticism scores, and a small but significant positive association between mystical orientation and neuroticism scores, after controlling for sex differences. This finding suggests that there may be a small inverse association between mystical (...) experience and psychological health among students in Turkey. (shrink)

The United States, like other countries facing rising health care costs, is pursuing a commitment to interoperable electronic health records. Electronic records, it is thought, have the potential to reduce the risks of error, improve care coordination, monitor care quality, enable patients to participate more fully in care management, and provide the data needed for research and surveillance. Interoperable electronic health records on a national scale — the ideal of a national health information network — seem likely to magnify these (...) advantages. Thus, the recent economic stimulus package contains considerable funding for the development of “health information technology architecture that will support the nationwide electronic exchange and use of health information in a secure, private, and accurate manner.”. (shrink)

After a brief introduction to Philosophical Practice, I explain why I use it in my courses and elaborate on some of the material and techniques I present to students in the hope that it helps them to become better-adjusted and happier people. As an example of the sorts of assignments I create for these courses I present a semester-long assignment called “Everyday Philosophical Practice” that is based on the practice of mindfulness and requires intentional metacognition from the students. This approach (...) has shown success not only at helping students to gain self-knowledge, but also at awakening and strengthening different positive cognitive dispositions such as desiring to think about difficult things, acceptance of the need for effort in clarifying thought, and the like. (shrink)

With the rise of incivility in organizational settings, coupled with an increase in discriminatory behavior around the world, we explain how these concerns have merged to become a pervasive workplace ethical issue. An ethical-decision making model is presented that is designed to help employees address issues of incivility with a moral response action, using Islamophobia and/or anti-Muslimism as an example. By adopting a proactive moral strength-based approach to embrace and address this issue, we hope to promote respect while also mitigating (...) the lack of its presence. We explicate potential cognitive and affective influences that support an organizational member’s desire and decision to respond to incivility in a reverential manner. Given the propensity for employees to turn away, become apathetic, or to simply ignore wrongdoing, scholars need to illustrate how a path to respectful behavior can be achieved. Our model highlights variables like group norms and anticipated emotions, punctuated by different forms of self-regulation. A Kantian view, underscoring the worth of every person, underpins our appeal. (shrink)

Might we be parts of a divine mind? Could anything like an afterlife make sense? Starting with a Platonic answer to why the world exists, _Immortality Defended_ suggests we could well be immortal in all of three separate ways. Tackles the fundamental questions posed by our very existence, among them, "why does the cosmos exist?", "is there a divine mind or God?", and "in what sense might we have afterlives?" Defends a belief in immortality, without the need for a religious (...) affiliation or rejection of modern science Explores the ideas of "Einsteinian immortality", the divine afterlife, and the theory of an infinite and divine mind Draws from the work of a wide-range of philosophers, from ancient Greece to the present day, and incorporates up-to-date scientific findings Written in a thought-provoking and engaging manner, accessible to anyone intrigued by the wonder of our being. (shrink)

This book offers the first fully documented and historically contextualised account of the origins and implications of the concept of community in the work of Nancy and Blanchot. It analyses in detail the underlying philosophical, political, literary, and religious implications of the often misrepresented debate between Blanchot and Nancy.

Presents findings from a survey conducted among 30,000 13-15 year olds throughout England and Wales, giving particular attention to social, personal and moral issues.

In the last decade, advances in technology have significantly disrupted the way firms provide goods and services. At the forefront of this technological disruption is the sharing economy, where individuals earn income by providing services or sharing assets through peer-to-peer platforms. With global revenues in the sharing economy projected to increase substantially in the next decade, income from this economy will continue to be an important source of tax revenues for governments around the world. However, sceptics argue that the sharing (...) economy inherently lends itself to dishonest reporting of taxable income. We employ an online experiment, using 746 taxpayers, to observe whether the prosocial benefits often promoted by P2P platforms reduce honest reporting of taxable sharing economy income. Consistent with moral licensing theory, we find that earning income from a prosocial-oriented P2P platform liberates taxpayers to dishonestly report their sharing economy income, and this result is fully driven by taxpayers whose personal values are incongruent with values promoted by the P2P platform. Our paper contributes to the limited but growing research on the sharing economy and its implications for ethical decisions. It also adds to the moral licensing literature by identifying value congruency as an important moderator for moral licensing effect. (shrink)

United States Air Force planes fly across mountains of green forest; behind them, fine white streams of chemical spray fill the sky. The planes fly alone or in formation covering wide swaths of the entire landscape. These images of the herbicide spraying during the United States-Vietnam War are ubiquitous in media material about Agent Orange, the most heavily used of the fifteen herbicides sprayed during the war. This representation of the war does not include guns, grenades, tanks, bombs, or dead (...) bodies. Instead, contemporary documentary filmmakers offer images of airplanes and chemical barrels to provide evidence of another weapon of war, pan dead and leafless forests in an otherwise lush landscape of green, and zero in on children’s deformed bodies to show the lasting environmental and health effects of Agent Orange. In this essay I share preliminary thoughts from my new project on Agent Orange and film in the United States and Vietnam. The bulk of social science writing on Agent Orange has focused on American veterans and their fight to secure benefits, while film scholars have analyzed the Vietnam War in Hollywood movies and television. I investigate documentary film, the transnational activism that generates these films, and the representations of gender, disabilities, bodies, history and culture within them. Here I offer a close reading of two turn-of-the-twenty-first-century documentaries about Agent Orange in Vietnam. (shrink)