Informed Consent: What Must Be Disclosed and What Must Be Understood seeks to challenge the “standard view” of consent. It seeks to do so by segregating the “disclosure function” from the “understa...

In this article, we develop a non-rights-based argument based on beneficence (i.e., the welfare of individuals and communities) and justice as the disposition to act justly to promote equity in health care resource allocation. To this end, we structured our analysis according to the following main sections. The first section examines the work of Amartya Sen and his equality of capabilities approach and outlines a framework of health care as a fundamental human need. In the subsequent section, we provide a (...) definition of health equity based on the moral imperative to guarantee that every individual ought to have the freedom to pursue health goals and well-being. In the later part of the article, we outline a non-right approach to health care based on three pillars: (1) human flourishing, (2) justice as a disposition not a process, and (3) solidarity. (shrink)

It is generally accepted that appropriate documentation of activities and recommendations of ethics consultants in patients’ medical records is critical. Despite this acceptance, the bioethics literature is largely devoid of guidance on key elements of an ethics chart note, the degree of specificity that it should contain, and its stylistic tenor. We aim to provide guidance for a variety of persons engaged in clinical ethics consultation: new and seasoned ethics committee members who are new to ethics consultation, students and trainees (...) in clinical ethics, and those who have significant experience with ethics consultation so that they can reflect on their practice. Toward the goal of promoting quality charting practices in ethics consultations, we propose recommendations on a broad array of questions concerning clinical ethics consultation chart notes, including whether and when to write a chart note, and practical considerations for the tenor, purpose, and content of a chart note. Our broader aim is to promote discussion about good charting practices in clinical ethics, with the hope of contributing to clear standards of excellence in clinical ethics consultation. (shrink)

This paper will argue that many survivors’ ability to take up their existence hopefully is rooted in the deeply visceral and unintegrable memory of “living the existence of a walking corpse” (Niederland 1968b, 12) that constitutes the ontic basis for their most fundamental presence to self, others, and God. I will show, secondly, that Karl Rahner’s theological formulation of witness as “an act of self transcendence in which the subject reaches up to the unsurpassable and sovereign Mystery which we call (...) God” (TI 13, 155-6) does indeed provide the basis for some survivors’ hopeful decision about and disposal of the self in relation to God to the extent that hope inscribed in the memory of “living the existence of a walking corpse” does become expressed as the “one, unifying ‘outwards from the self’ attitude into God as the absolutely uncontrollable” (TI 10, 250) by sustaining the commitment to witness. However I will also argue, finally, that the unintegrable nature of such memory prevents survivor hope-as-witness to be completely reconciled with the theological sense of witness that Rahner proposes because his vision of witness has not taken adequately into account this unintegrable memory and its long-term effects. (shrink)

This comprehensive volume marks a new standard in scholarship in the still emerging field of the philosophy of chemistry. With selections drawn from a wide range of scholarly disciplines, philosophers, chemists, and historians of science here converge to ask some of the most fundamental questions about the relationship between philosophy and chemistry. What can chemistry teach us about longstanding disputes in the philosophy of science over such issues as reductionism, autonomy, and supervenience? And what new issues may chemistry bring to (...) the forefront now that it has joined physics and biology as a serious topic for philosophical reflection? This newest addition to the prestigious Boston Studies in the Philosophy of Science series marks the true arrival of philosophy of chemistry within the corpus of the philosophy of science. (shrink)

Background:Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives, setting, and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether research nurses experience unique ethical challenges distinct from those experienced (...) by nurses in traditional patient-care settings.Research objectives:The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice.Research design:The study utilized a qualitative descriptive design with individual interviews.Participants and research context:Participating nurses self-identified as having experienced ethical challenges during screening. The majority were Caucasian, female, and worked in outpatient settings. Approximately 50% had > 10 years of research experience.Ethical considerations:The human subjects review board approved the study. Written informed consent was obtained.Findings:Predominant themes were revealed: the inability to provide a probable good, or/do no harm, and dual obligations. The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship.Discussion:Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science.Conclusion:Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

Retaliation against whistleblowers is a well-recognized problem, yet there is little explanation for why uninvolved peers choose to retaliate through ostracism. We conduct two experiments in which participants take the role of a peer third-party observer of theft and subsequent whistleblowing. We manipulate injunctive norms and descriptive norms. Both experiments support the core of our theoretical model, based on social intuitionist theory, such that moral judgments of the acts of wrongdoing and whistleblowing influence the perceived likeability of each actor and (...) ultimately influence intention to ostracize each actor and indicate more willingness to ostracize the whistleblower than the wrongdoer. When we vary norms for the wrongdoing in Experiment 1, we find that descriptive and injunctive norms indirectly influence intentions to ostracize both the wrongdoer and whistleblower. These relationships are serially mediated by the observers’ moral judgments of the act and likeability of the actor. When we vary norms for whistleblowing in Experiment 2, the injunctive norm manipulation affected moral judgment of the action of whistleblowing, and we do not observe any other significant effects of the norm manipulations on moral judgments of the actions of wrongdoing or whistleblowing. (shrink)

This study examined the relationship between moral distress intensity, moral distress frequency and the ethical work environment, and explored the relationship of demographic characteristics to moral distress intensity and frequency. A group of 106 nurses from two large medical centers reported moderate levels of moral distress intensity, low levels of moral distress frequency, and a moderately positive ethical work environment. Moral distress intensity and ethical work environment were correlated with moral distress frequency. Age was negatively correlated with moral distress intensity, (...) whereas being African American was related to higher levels of moral distress intensity. The ethical work environment predicted moral distress intensity. These results reveal a difference between moral distress intensity and frequency and the importance of the environment to moral distress intensity. (shrink)

This collection of essays—the first of its kind in English—brings together the work of an international group of scholars examining the entire tradition associated with the ancient Cynics. The essays give a history of the movement as well as a state-of-the-art account of the literary, philosophical and cultural significance of Cynicism from antiquity to the present. Arguably the most original and influential branch of the Socratic tradition, Cynicism has become the focus of renewed scholarly interest in recent years, thanks to (...) the work of Sloterdijk, Foucault, and Bakhtin, among others. The contributors to this volume—classicists, comparatists, and philosophers—draw on a variety of methodologies to explore the ethical, social and cultural practices inspired by the Cynics. The volume also includes an introduction, appendices, and an annotated bibliography, making it a valuable resource for a broad audience. (shrink)

Biology and history are often viewed as closely related disciplines, with biology informed by history, especially in its task of charting our evolutionary past. Maximizing the opportunities for cross-fertilization in these two fields requires an accurate reckoning of their commonalities and differences-precisely what this volume sets out to achieve. Specially commissioned essays by a team of recognized international researchers cover the full panoply of topics in these fields and include notable contributions on the correlativity of evolutionary and historical explanations, applying (...) to history the latest causal-mechanical approach in the philosophy of biology, and the question of generalized laws that might pertain across the two subjects. The collection opens with a vital interrogation of general issues on explanation that apart from potentially fruitful areas of interaction (could the etiology of the causal-mechanical perspective in biology account for the historical trajectory of the Roman Empire?) this volume also seeks to chart relative certainties distinguishing explanations in biology and history. It also assesses techniques such as the use of probabilities in biological reconstruction, deployed to overcome the inevitable gaps in physical evidence on early evolution. Methodologies such as causal graphs and semantic explanation receive in-depth analysis. Contributions from a host of prominent and widely read philosophers ensure that this new volume has the stature of a major addition to the literature. (shrink)

While researchers have examined the types of ethical issues that arise in long-term care, few studies have explored long-term care nurses’ experiences of moral distress and fewer still have examined responses to initial moral distress. Using an interpretive description approach, 15 nurses working in long-term care settings within one city in Canada were interviewed about their responses to experiences of initial moral distress, resources or supports they identified as helpful or potentially helpful in dealing with these situations, and factors that (...) hindered nurses in their responses. Using a thematic analysis process, three major themes were identified from the nurses’ experiences: (i) the context of the situation matters; (ii) the value of coming together as a team; and (iii) looking for outside direction. The work of responding to initial moral distress was more fruitful if opportunities existed to discuss conflicts with other team members and if managers supported nurses in moving their concerns forward through meetings or conversations with the team, physician, or family. Access to objective others and opportunities for education about ethics were also identified as important for dealing with value conflicts. (shrink)

The old proverb can still more accurately be applied to their biographers.‘ Even the more plausible and psycho logically tempting details in the lives of literary figures derive from these authors’ fictional works, poems, and dramas, and not from the kind of source material biographers use today, letters, documents, eyewitness testimony. Critics and readers eager to establish some historical correlation between any ancient poet's life and his work should expect to be disappointed. But even if the ancient lives are useless (...) to the historian or critic trying to explain what in Euripides’ experience compelled him to write about Medea, these stories are of interest to mythologists. If we stop being angry at the Lives for failing to be historical, and look at them rather as myths or fairy tales, some informative patterns begin to emerge. (shrink)

Apoptosis is now widely recognized as a common form of cell death and represents a mechanism of cell clearance in many physiological situations where deletion of cells is required. Peptide growth factors, initially characterised as stimulators of cell proliferation, have now been shown to inhibit death in many cell types. Deprivation of growth factors leads to the induction of apoptosis, i.e. condensation of chromatin and degradation in oligonucleosomesized fragments, formation of plasma and nuclear membrane blebs and cell fragmentation into apoptotic (...) bodies which can be taken up by neighbouring cells. Here we discuss the mechanism(;s) by which growth factors may inhibit apoptosis. (shrink)

Objective: To determine the views of people with multiple sclerosis (MS) and professionals in relation to confidentiality, consent and access to data within a proposed MS register in the UK. Design: Qualitative study using focus groups (10) and interviews (13). Setting: England and Northern Ireland. Participants: 68 people with MS, neurologists, MS nurses, health services management professionals, researchers, representatives from pharmaceutical companies and social care professionals. Results: People with MS expressed open and altruistic views towards the use of their personal (...) information to facilitate service provision and research, placing trust in responsible guardianship and legitimate use of their information. Participant’s proposed that people with MS should be able to select their individual level of involvement in a register using levels of consent. It was agreed that access to the register should be governed by a guardianship committee composed of a range of stakeholders. People with MS did not wish their details to be used by marketing agencies and did not consider this a legitimate use of their data. Whilst participants were positive of the role a register could play in promoting research, participants felt that access to data by pharmaceutical industries should be administered by the guardianship committee. People with MS are concerned should their employers be able to access their personal information. Professionals were more cautious than people with MS in their approach to the use of patient personal data within a register. Conclusions: Whilst all stakeholders were positive of the benefits of an MS register, development of such a resource must incorporate robust data security and guardianship measures in order to ensure that, whilst opportunities are maximised, risks to the privacy of individuals and legal challenges to professionals are avoided. (shrink)

In the surviving plays of Aeschylus and Sophocles the gods appear to men only rarely. In the Eumenides Apollo and Athena intervene to bring acquittal to Orestes. In Sophocles' Philoctetes Heracles appears ex machina to ensure that the hero returns to Troy, and we learn from a messenger how the gods have summoned the aged Oedipus to a hero's tomb. In Sophocles' Ajax Athena drives Ajax mad and taunts him cruelly. Prometheus Bound might seem to be an exception, since all (...) but one of its characters are gods. But nonetheless the intervention of the gods in the life of the one human character, Io, brings pain and trouble as well as promise of benefit. Io has been driven mad because she has refused to obey the dreams that tell her to go to the meadow where Zeus wants to have intercourse with her. The god does not make his request in person, and it is only in the course of her wanderings that Io learns how Zeus will bring a gentle end to her sufferings. Her informant is another god, Zeus' adversary Prometheus, who answers her questions, at times grudgingly , and in ways that are not immediately clear to her. (shrink)

Water famine. -- The only possibility. -- The three gift, author.

Coastal ecosystems are increasingly dominated by humans. Consequently, the human dimensions of sustainability science have become an integral part of emerging coastal governance and management practices. But if we are to avoid the harsh lessons of land management, coastal decision makers must recognize that humans are one of the more coastally dependent species in the biosphere. Management responses must therefore confront both the temporal urgency and the very real compromises and sacrifices that will be necessary to achieve a sustainable coastal (...) ecosystem, one that is economically feasible, socially just, and ecologically sound. (shrink)

Clinical experience suggests that adult survivors of childhood trauma arrive at their memories in a number of ways, with varying degrees of associated distress and uncertainty and, in some cases, after memory lapses of varying duration and extent. Among those patients who enter psychotherapy as a result of early abuse, three general patterns of traumatic recall are identified: relatively continuous and complete recall of childhood abuse experiences coupled with changing interpretations of these experiences, partial amnesia for abuse events, accompanied by (...) a mixture of delayed recall and delayed understanding, and delayed recall following a period of profound and pervasive amnesia. These patterns are represented by three composite clinical vignettes. Variations among them suggest that the phenomena underlying traumatic recall are continuous not dichotomous. Future research into the nature of traumatic memory should be informed by clinical observation. (shrink)

Volume 20, Issue 5, June 2020, Page 72-74.

Pindar, perhaps more than any other ancient poet, seems to demand from his interpreters declarations of their critical premises. In recent years scholars customarily have made initial acknowledgment to the work of E. R. Bundy, as psychoanalysts must to Freud, before they begin to offer their own modifications to and expansions of his fundamental work. Much contemporary scholarship has concentrated on the identification and classification in the odes of the elements whose function Bundy labelled and explained. But useful as this (...) type of analysis has been for exorcising the demon of biographical interpretation, it has, like all orthodoxies, prevented perception of other equally important truths. It constitutes no radical heterodoxy to try to account for the fact that each individual ode, for all its dependence on common conventions of structure and of content, makes a different impression. Nor is it unreasonable to try to explain what makes Pindar's style and approach distinctive.In my own work I have argued, though perhaps not always convincingly, that language as well as structure contributes to an ode's coherence. Scholars trained in America are more willing to assume that repetition of phrase or theme within a poem has significance, and that metaphors can simultaneously bear more than one connotation. The issues at stake have most recently been delineated by Michael Silk, in his discussion of the effect of metaphor in archaic poetry: ‘By “patent”, I mean effects whose existence is not in doubt, though their character may be disputed; by “latent”, those whose effective significance is so tenuous or marginal that one resents the impression of solidity that even mentioning them produces. Such insensitivity is more common than it should be among American classicists, many of whom have also been influenced by the “New Criticism”…’ As illustration of the erroneous American approach Silk cites Cedric Whitman's description of the thematic relation of fires in theIliad.Silk himself avoids the trap Whitman falls into by considering only ‘patent’ metaphors, and these consistentlyout of context, so that there is no necessity to comment on the existence or non-existence of thematic connections among them. But it is possible—at least logically—to frame the question differently, and to ask whether a metaphor cannot have patent and latent associations at the same time. (shrink)