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)

This study highlights an innovative educational project entitled ‘Dynamic Teaching through Communication Skills’ as well as forming part of joint initiative for Erasmus + Communities and Students Together (CaST) 2019-1-UK01-KA203-061463. The pilot study shows that there are many ways to approach teaching across the disciplines with Engaged Learning. The proposal includes discussions on the practical methodologyof integrated content and language in higher education. While bringing real worldproblem solving into the Health Engineering degree, the chapter underscores aspects of persuasion and pitch (...) development within the paradigm of English as a LinguaFranca. (shrink)

Since the 1980s, there has been an increasing acknowledgement of the importance of recognising the ethical dimension of clinical decision-making. Medical professional regulatory authorities in some countries now include ethical knowledge and practice in their required competencies for undergraduate and post graduate medical training. Educational interventions and clinical ethics support services have been developed to support and improve ethical decision making in clinical practice, but research evaluating the effectiveness of these interventions has been limited. We undertook a systematic review of (...) the published literature on measures or models of evaluation used to assess the impact of interventions to improve ethical decision making in clinical care. We identified a range of measures to evaluate educational interventions, and one tool used to evaluate a clinical ethics support intervention. Most measures did not evaluate the key impact of interest, that is the quality of ethical decision making in real-world clinical practice. We describe the results of our review and reflect on the challenges of assessing ethical decision making in clinical practice that face both developers of educational and support interventions and the regulatory organisations that set and assess competency standards. (shrink)

Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. (...) A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom -based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician’s duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to. (shrink)

This anthology of articles provides contemporary international feminist perspectives on issues of identity, agency, and difference as they pertain to both feminist politics in particular, and contemporary western politics more generally.

This is a review of Marie-Eve Morin's translation of Jean-Luc Nancy's "Ego Sum.".

The aim of this paper is to bring recent work on metaphysical grounding to bear on the phenomenon of social construction. It is argued that grounding can be used to analyze social construction and that the grounding framework is helpful for articulating various claims and commitments of social constructionists, especially about social identities, e.g., gender and race. The paper also responds to a number of objections that have been leveled against the application of grounding to social construction from Elizabeth Barnes, (...) Mari Mikkola, and Jessica Wilson. (shrink)

ABSTRACT:This article outlines the policy context for teachers’ learning and continuing professional development in Scotland and considers this in relation to the perspectives of key informants gained through interview. The analysis draws on a triple-lens conceptual framework and points to some interesting contradictions between the policy text and the expressed aspirations of the interviewees. Current policy and the associated structural arrangements are viewed as broadly positive, but interviewees express concerns that an unintended emphasis on contractual arrangements might inhibit the more (...) transformative elements of professional learning. (shrink)

R. Marie Griffith and Sarah Coakley suggest that feminist ecumenism across the evangelical-liberal spectrum is valuable for feminist studies of religion and theologies. In this context, I trace the conversation that has arisen around the idea of adopting ‘submission’ vis-à-vis the Christian notion of kenosis, and turn it in a new direction. I argue that Coakley’s apophatically cruciform understanding of submission in contemplative prayer contrasts with womanist approaches like that of Delores Williams. Drawing on Williams’ considerations of atonement and (...) Friedrich Schleiermacher’s understanding of prayer, I offer ‘incarnational submission’ as a way to acknowledge the value of prayerful submission while avoiding its potentially oppressive features. (shrink)

ABSTRACT This paper argues for a hidden way in which speech constitutes harm by enacting harmful norms. The paper then explores the potential legal consequences of uncovering such instances of harm constitution. In particular, the paper argues that some public racist speech constitutes harm and is thus harmful enough to warrant legal remedy. Such utterances are actionable, it is contended, because they enact discriminatory norms in public spaces.

Just Life reorients ethics and politics around the generativity of mothers and daughters rather than the right to property and the sexual proprieties of the Oedipal drama. Invoking two concrete universals – everyone is born of a woman and everyone needs to eat – Rawlinson rethinks labor and food as relationships that make ethical claims and sustain agency. Just Life counters the capitalization of bodies under biopower with the solidarity of sovereign bodies.

ABSTRACT At the centre of Plato’s Euthydemus lie a series of arguments in which Socrates’ interlocutors, the sophists Euthydemus and Dionysodorus propose a radical account of truth (‘chopped logos’) according to which there is no such thing as falsehood, and no such thing as disagreement (here ‘counter-saying’). This account of truth is not directly refutable; but in response Socrates offers a revised account of ‘saying’ focussed on the different aspects of the verb (perfect and imperfect) to give a rich account (...) of saying, of truth and of knowledge. I argue that Socrates’ response has much to offer, notably in its amplification of the process of saying and cognition, and the development of virtue. (shrink)

This paper criticizes Langton's speech act account of MacKinnon's claim about (the subordinating force of) pornography and offers a different account of how speech might enact harmful norms and thus constitute harm.

At no time in recent decades has more attention been paid to ethical issues in pregnancy. Particularly riveting—and alarming, to many—was the passage of Senate Bill 8, a Texas law banning abortion...

In the study of gender and society, science is a strategic analytic research site—because of the hierarchical nature of gendered relations, generally, and the hierarchy of science, particularly. Academic science, especially, is crucial to, and revealing of, status in science and society. This article focuses on three questions: What is the status of women in scientific careers and the role of graduate education in these careers? What are the implications for the analysis of gender? Where can we intervene, and how? (...) In addressing these questions, the arguments concentrate on the social and organizational context of science and its relationship to gender and status. (shrink)

Developing and implementing artificial intelligence (AI) systems in an ethical manner faces several challenges specific to the kind of technology at hand, including ensuring that decision-making systems making use of machine learning are just, fair, and intelligible, and are aligned with our human values. Given that values vary across cultures, an additional ethical challenge is to ensure that these AI systems are not developed according to some unquestioned but questionable assumption of universal norms but are in fact compatible with the (...) societies in which they operate. This is particularly pertinent for AI research and implementation across Africa, a ground where AI systems are and will be used but also a place with a history of imposition of outside values. In this chapter, we thus critically examine one proposal for ensuring that decision-making systems are just, fair, and intelligible—that we adopt a principle of explicability to generate specific recommendations—to assess whether the principle should be adopted in an African research context. We argue that a principle of explicability not only can contribute to responsible and thoughtful development of AI that is sensitive to African interests and values, but can also advance tackling some of the computational challenges in machine learning research. In this way, the motivation for ensuring that a machine learning-based system is just, fair, and intelligible is not only to meet ethical requirements, but also to make effective progress in the field itself. (shrink)

Studies in the Eighteenth Century Background of Hume's Empiricism was first published in 1930. Minnesota Archive Editions uses digital technology to make long-unavailable books once again accessible, and are published unaltered from the original University of Minnesota Press editions. A scholarly review of the influence of contemporary science and thought on the various phases of Hume's philosophy. The chapter headings are as follows: I. Introduction. II. Interpretations of Newtonian Science in the Eighteenth Century. III. Reverberations of the New Science in (...) Philosophy. IV. Hume's Empiricism in Relation to Contemporary Science and Philosophy. V. Empiricism in Morals. VI. Empiricism in Politics. VII. Hume's Historical Writing. Bibliography. (shrink)

This review assesses a rare and insightful philosophical examination of the ethics of the medical management of sex-atypical children. In Making Sense of Intersex, Ellen K. Feder crafts an ethics that would shift several common foci of the contemporary debate on her topic: from questions of gender to the ethics of normalization; from individual or parental autonomy to a general corporeal vulnerability; and from parental medical proxy rights to the interdependency of parent-child relations. The review identifies some seemingly unavoidable conundrums (...) that would remain unsolved after such shifts: the continuing role of gender in normalizing medical aims, the utility of an undifferentiated concept of vulnerability in medical decision making, and the place of cosmetic medicine in general. (shrink)

ABSTRACT‘expressionist’ accounts of applied mathematics seek to avoid the apparent Platonistic commitments of our scientific theories by holding that we ought only to believe their mathematics-free nominalistic content. The notion of ‘nominalistic content’ is, however, notoriously slippery. Yablo's account of non-catastrophic presupposition failure offers a way of pinning down this notion. However, I argue, its reliance on possible worlds machinery begs key questions against Platonism. I propose instead that abstract expressionists follow Geoffrey Hellman's lead in taking the assertoric content of (...) empirical science to be irreducibly modal, using the ‘non-interference’ of mathematical objects as justification for detaching nominalistic consequences. (shrink)

In her interesting paper on cross-jurisdictional legal approaches to brain death, Ariane Lewis considers whether informed consent is required for DNC testing in the UK, and proposes that it is not...

Abstract: Philosophers interested in Kant's relevance to contemporary debates over the nature of mental content—notably Robert Hanna and Lucy Allais—have argued that Kant ought to be credited with being the original proponent of the existence of ‘nonconceptual content’. However, I think the ‘nonconceptualist’ interpretations that Hanna and Allais give do not show that Kant allowed for nonconceptual content as they construe it. I argue, on the basis of an analysis of certain sections of the A and B editions of the (...) Transcendental Deduction, for a ‘conceptualist’ reading of Kant's Critique of Pure Reason. My contention is that since Kant's notion of empirical intuition makes essential reference to the categories, it must be true for him that no empirical intuition can be given in sensibility independently of the understanding and its categories. (shrink)

Few works have had the impact on contemporary philosophy exerted by Hegel's Phenomenology of Spirit. Twentieth-century philosophers in France were bound together by a reading of Hyppolite's translation and commentary. Sartre, Merleau-Ponty, Lacan, and Bataille were all shaped by Kojève's lectures on the book. Late twentieth-century philosophers such as Derrida, Lyotard, Deleuze, and Irigaray all operate against a Hegelian horizon. Similarly, in Germany Heidegger, Adorno, and Habermas developed their philosophies in large part through an engagement with Hegel. In the United (...) States the book has had a profound influence on feminism and gender studies. Thinkers as diverse as Butler, Benhabib, Mills, and Honig have developed political theories as well as theories of sexual difference by rereading Hegel's reading of Antigone. As Derrida suggests, this text must be read. It lays out the infrastructures and architectures of life in the modern nation state. It unfolds a grand narrative of the ways of thinking and acting that comprise human experience in "our time." The purpose of the text is to effect a transformation in readers, so that they cease to think of themselves as particular humans and come to know that their existence inheres in membership in a complex community-social, cultural, economic, religious, aesthetic, and political infrastructures that form the culture of possibilities in which self-consciousness emerges and is sustained. Rawlinson's reading reveals how Hegel's politics of the "we" is undermined both by his effacement of sexual difference and by his misappropriation of art as a "betrayal of substance." Both of these gestures discount specificity in favor of a generic subject and a mutual recognition in which the other is the same. She uses Hegel's own critique of abstraction against him to rethink the "we" as a community of difference, figured materially in the differentiated styles or signatures of art, and in so doing argues that that the task of phenomenology is never completed and that the abstract concepts of logic will always be dependent on phenomenology's productive or generative movement. In her reading Hegel is neither a metaphysician nor a subjective idealist. He is a phenomenologist, analyzing experience to articulate the ways in which humans generate narratives and material infrastructures to sustain the complexities of life. (shrink)

Philosophers like to worry about luck. And well they should. Luck poses potential difficulties for knowledge, moral appraisal, and freedom. The primary target of this paper will be the last of these concerns . Recent arguments from luck have been levied against libertarian accounts of free will, including agent-causal ones. One general goal of this paper will be to demonstrate the truth of an often overlooked claim about responsibility-undermining luck. Part of this task will include illustrating what is genuinely worrisome (...) about luck in the context of free will. It will turn out that the problem is not fundamentally a problem of explanation. Another aim will be to argue that the truth of this claim about luck reveals a problem for event-causal libertarianism but has yet to reveal a problem for the agent-causal view. For the purposes of this paper, it will be assumed that luck does indeed undermine free action and moral responsibility. But it will be argued that agent-caused actions have not been shown to be "lucky.". (shrink)

This paper is concerned with the relation between two important metaphysical notions, ‘truthmaking’ and ‘grounding’. I begin by considering various ways in which truthmaking could be explicated in terms of grounding, noting both strengths and weaknesses of these analyses. I go on to articulate a problem for any attempt to analyze truthmaking in terms of a generic and primitive notion of grounding based on differences we find among examples of grounding. Finally, I outline a more complex view of how truthmaking (...) and grounding could relate. On the view explored, truthmaking is a species of grounding differentiated from other species of grounding by the unique form of dependence it involves. (shrink)

With the challenge of communicating climate science in the United States and making progress in international negotiations on climate change there is a need for other approaches. The moral issues of ecological degradation and climate justice need to be integrated into social consciousness, political legislation, and climate treaties. Both science and religion can contribute to this integration with differentiated language but shared purpose. Recognizing the limits of both science and religion is critical to finding a way forward for addressing the (...) critical challenges of climate change. How we value nature and human–Earth relations is crucial to this. We need a broader environmental ethics in dialogue with the science of climate change. (shrink)

This book offers a critique of power feminism using the critical theories of Theodor Adorno and Jacques Derrida. It counters a triumphalist reading of female empowerment using the negative, parergonal philosophies of these two authors and advocates listening to the sufferer rather than celebrating the triumphalism of the reigning neoliberal order.

This article examines the participation of women in the 1985 labor strike at Wheeling-Pittsburgh Steel. The author views the strike as a deeply gendered act of protest where the issues, strategies, tactics, and resources used by women workers differ from those used by men, and simultaneously, as the occupational site that provided workers an opportunity to affirm, to modify, and to contest their understandings of gender. Paradoxically, women both challenge and conform to normative gender scripts for protest. They resisted the (...) efforts of men to impose a gender division of labor and sought to mobilize the community in support of the strike. (shrink)

The medicalization of risk rests on foundational assumptions shared by economics and public health. Economists, however, think in terms of pursuing an array of goods, and hence, they offer useful critiques of the irrationality involved in trying to subordinate all goods to one narrow good, like avoiding death from a particular disease. Many of our approaches to health do not appear to be fully rational, suggesting that the deeper motivation lying behind our concerns about health are to be found in (...) something other than the impulse to extend human lives as much as possible. This paper draws on the theology of St. Thomas Aquinas to sketch a richer way of thinking about the goods we pursue in health care that can help us to avoid the pitfalls associated with the medicalization of risk. (shrink)

At the heart of recent feminist theorizing about art is the claim that various forms of representation--painting, photography, film--assume a "male gaze." The notion of the gaze has both a literal and a figurative component. Narrowly construed, it refers to actual looking. Broadly, or more metaphorically, it refers to a way of thinking about, and acting in, the world. . . . In examining this key feminist notion more carefully, I shall make clear the intrinsic interest of this approach to (...) aesthetics and suggest why its concerns merit serious consideration. To this end, I investigate how gendered vision work in one specific representational practice: film. Film is a natural choice for such a study because it is a medium so fundamentally built around the activity of looking. It is also, not surprisingly, the medium where the male gaze has been most extensively discussed. The relationship of gender and cinematic vision is extremely complicated. A complete analysis of this topic would require several hundred pages. In what follows, I focus on two key claims: that in cinema the gaze is male, and that the cinematic text is a male text. I make clear how these claims should be understood and situate them philosophically. In confining myself to the core claims of this debate, I shall of necessity leave aside many important, but internal, issues in film theory. (shrink)

Medicine is the art of healing, aesthetics the study of our response to art and beauty. What happens when the two come together in the practice of cosmetic surgery? This is my question, a foray into what I will call "medical aesthetics." In what follows, I examine how practitioners of cosmetic surgery and related specialties have appropriated the language of medicine and healthcare to reframe and legitimize various nonmusical elective procedures designed to modify appearance. I being with a short discussion (...) of the history and terminology of cosmetic surgery. Against this background, I critically assess the claim that cosmetic surgery qualifies as a form of healthcare, and hence a legitimate branch of medicine . . . In pressuring medical professionals to place beauty above health, cosmetic surgery and related specialties such as cosmetic dentistry unavoidably raise questions about the definition of medicine itself. In particular, patient demand for what I am labeling "medical aesthetics" may collide with the Hippocratic requirement that physicians "do no harm." It is to those harms and related concerns that I turn in the final section. (shrink)

In this volume we provide rich examples of non-western philosophy written by women over the last four thousand years. We begin by defining the scope of our non-western terrain: philosophy created outside the Greco-Roman, Judeo-Christian traditions. The philosophers who are the subjects of inquiry here hail from places as distant as pre-colonial Africa, the Americas, Asia and Australia. Together with our expert contributing authors we demonstrate through inquiry and analysis how these women philosophers advanced human thought about profound issues, some (...) to include the nature and treatment of women themselves. (shrink)

Conscientious objection has become a divisive topic in recent bioethics publications. Discussion has tended to frame the issue in terms of the rights of the healthcare professional versus the rights of the patient. However, a rights-based approach neglects the relational nature of conscience, and the impact that violating one’s conscience has on the care one provides. Using medical assistance in dying as a case study, we suggest that what has been lacking in the discussion of conscientious objection thus far is (...) a recognition and prioritising of the relational nature of ethical decision-making in healthcare and the negative consequences of moral distress that occur when healthcare professionals find themselves in situations in which they feel they cannot provide what they consider to be excellent care. We propose that policies that respect the relational conscience could benefit our healthcare institutions by minimising the negative impact of moral distress, improving communication among team members and fostering a culture of ethical awareness. Constructive responses to moral distress including relational cultivation of moral resilience are urged. (shrink)

This paper argues that linguistic oppression is coherent; speech can oppress. Moreover, even though oppression is a structural phenomenon, a single utterance can nevertheless be an act of oppression. This paper also argues that ordinary utterances can oppress. That is, speakers do not need to have and be exercising authority in order for their speech to be oppressive. Furthermore, ordinary speech can oppress even though the speakers do not intend to oppress, even though the hearers do not take it to (...) oppress, even though the oppressed do not hear it, and even though the oppressed are unaware of being oppressed. On the account offered here, linguistic oppression is sneaky, hidden, and surprisingly widespread. (shrink)

Are there genuine mathematical explanations of physical phenomena, and if so, how can mathematical theories, which are typically thought to concern abstract mathematical objects, explain contingent empirical matters? The answer, I argue, is in seeing an important range of mathematical explanations as structural explanations, where structural explanations explain a phenomenon by showing it to have been an inevitable consequence of the structural features instantiated in the physical system under consideration. Such explanations are best cast as deductive arguments which, by virtue (...) of their form, establish that, given the mathematical structure instantiated in the physical system under consideration, the explanandum had to occur. Against the claims of platonists such as Alan Baker and Mark Colyvan, I argue that formulating mathematical explanations as structural explanations in this way shows that we can accept that mathematics can play an indispensable explanatory role in empirical science without committing to the existence of any abstract mathematical objects. (shrink)

This book explores the ethical implications of managing uncertainty in clinical decision-making during the COVID-19 pandemic. It develops an ethics of clinical uncertainty that brings together insights from the clinical and biomedical ethical literatures. The book sets out to recognize the central role uncertainty plays in clinical decision-making and to acknowledge the different levels, kinds, and dimensions of clinical uncertainty. It also aims to aid clinicians and patients in managing clinical uncertainty, and to recognize the ethical duty they have to (...) manage clinical uncertainty. The book addresses four ethical duties related to clinical uncertainty: (1) the duty to advance the welfare of those in clinical medicine, (2) to respect the rights of those in clinical medicine, (3) to promote just access to health care, and (4) to care for one another in clinical medicine. These duties took on select urgency during the COVID-19 pandemic because clinical risk assessments about COVID-19 were limited, we were asked to give informed consent in the context of limited and changing knowledge, the pandemic unearthed myriad problems about the distribution of health care, and the pandemic raised questions about how we care for each other in medicine. An Ethics of Clinical Uncertainty will appeal to scholars, advanced students, and medical professionals working in philosophy of medicine, biomedical ethics, clinical medicine, nursing, public health care, and gerontology. (shrink)