In 1998 I was hired by a local health care system to evaluate the mental health of enrolled patients who requested lethal prescriptions under Oregon's newly implemented Death with Dignity Act. I drove to the trailer home of my first patient, a man in his sixties tethered to an oxygen tank for his chronic pulmonary disease who was recently diagnosed with advanced lung cancer. He told me about his abusive, alcoholic stepfather and how he left his family and church at (...) age sixteen, determined never again to be subjugated in any relationship. But in a life marked by an avoidance of intimate relationships, he corresponded regularly with his nephew and was proud to leave him a small inheritance. He shared with me his .. (shrink)

Since 1991, the Patient Self-Determination Act (PSDA) has required all health care institutions that receive Federal funds to inform patients upon admission of their rights to make decisions about medical care and to execute advance directives. Implementation of the PSDA presents a special challenge for state mental hospitals. The relevance and possible negative therapeutic impact of discussing end of life decisions at the time of an acute psychiatric admission has recently been raised in the literature. Other ethical dilemmas arising from (...) the interplay between mental illness and informed consent for medical treatment, particularly for older patients committed to state mental hospitals, have been highlighted by the PSDA. In this article we discuss some of the issues raised by implementation of the PSDA in this setting. (shrink)

Mandating psychiatric evaluation for patients who request physician‐assisted suicide may not offer the clearcut protection from possible coercion or other abuse that proponents assert. Competence itself is a complex concept and determinations of decisionmaking capacity are not straightforward, nor is the relationship between mental illness and decisionmaking capacity in dying patients clearly understood. And casting psychiatrists as gatekeepers in end‐of‐life decisions poses risks to the profession itself.

Death in the Clinic fills a gap in contemporary medical education by explicitly addressing the concrete clinical realities about death with which practitioners, patients, and their families continue to wrestle. Visit our website for sample chapters!

BackgroundIn the US, many patients forgo recommended care due to cost. The ANA Code of Ethics requires nurses to give care based on need. Therefore, US nurses are compelled to practice in a context which breaches their professional ethical code.Research ObjectivesThis study sought to determine if nurses do care for patients who forgo treatment due to cost (PFTDC) and if so, does this result in an experience of moral distress (MD).Research DesignSemi-structured interviews were transcribed and analyzed using a qualitative content (...) analysis.Participants and Research ContextA convenience sample of 20 nurses in practice for at least one year from a variety of health care setting participated.Ethical ConsiderationsThis project was approved by the Michigan State University Biomedical Institutional Review Board.ResultsThere were 19 female and one male nurse-participants, averaging 47 years old with an average of 10 years in practice. 18 reported caring for PFTDC. These 17 nurse-participants experienced a moderate degree of MD as a result, averaging 5.4 of 10 on the Moral Distress Thermometer. In the interviews, the following themes were identified, strategies to help PFTDC, and the broken US health care system which had the subthemes of preference for business over patient-oriented benefit, PFTDC using the emergency department, and limited support for treatment/management of PFTDC.ConclusionsThe existence of this phenomenon places the profession of nursing in the US in a position of moral compromise and threatens to corrupt the institution of nursing in the US. (shrink)

Nanotechnology: Considering the Complex Ethical, Legal, and Societal Issues with the Parameters of Human Performance Content Type Journal Article Pages 265-275 DOI 10.1007/s11569-008-0047-6 Authors Linda MacDonald Glenn, Albany Medical College/Center Alden March Bioethics Institute Albany NY 12208 USA Jeanann S. Boyce, Montgomery College Dept. of Computer Science and Business 7600 Takoma Avenue Takoma Park MD 20912 USA Journal NanoEthics Online ISSN 1871-4765 Print ISSN 1871-4757 Journal Volume Volume 2 Journal Issue Volume 2, Number 3.

In lieu of an abstract, here is a brief excerpt of the content:Could Understanding Harm?Iskra Fileva, PhD (bio) and Linda A.W. Brakel, MD (bio)We would like to thank the editors for organizing this symposium and our commentators—Marga Reimer and James Phillips—for the thought-provoking feedback. Although we had thought about the ideas we discuss from many different angles, our commentators raised several interesting issues we had not considered. We are grateful for the opportunity to continue the conversation.Reply to ReimerAs Professor (...) Reimer notes, we advocate an approach to self-constitution that we dub “understanding first.” On this approach, non-moral and non-normative understanding of the origin of maladaptive traits must precede moral evaluation and attempts to free oneself—or as we say “prune”—undesirable traits. Professor Reimer presents several interesting cases meant both to extend and test the limits of our proposal. We appreciate this approach and respond to each case in turn.Genes and AlcoholismSuppose Alejandro, an adult raised by adoptive parents, struggles with alcohol addiction. He learns that his biological parents died of alcoholic liver disease and comes to believe that his alcohol problem is caused by a genetic propensity toward alcohol abuse. One can ask: “Does an understanding first approach have the potential to undermine the sense of agency that is necessary for the effective treatment of maladaptive traits?”Answer: It can be explained to Alejandro that genetic proclivities are just that—proclivities—that can be overridden. In fact, behavior can alter our very genes—although not at the sequence level— changes known as “epigenetic.” And the liver disease of the biological parents can serve as a cautionary tale. If even in light of these considerations, Alejandro’s tendency to see genetic propensities as deterministic persists, it is worth asking why. There is no evidence that “genes are destiny,” so the disposition to see them that way must have a psychological explanation. What is the explanation? A self-destructive desire? Fear of freedom? This exploration can itself be empowering. [End Page 211]Adaptive ForgettingSuppose Beata, who has an eating disorder, was molested by her own father when she was a child. Subsequently, her father shot himself and now she has no recollection of the molestation. However, Beata’s eating disorder is largely a result of those experiences. It is quite possible that if Beata were to recall being molested, that would do more harm than good. In this connection, one can ask together with Reimer: “Does an understanding first approach have the potential to undermine an adaptive ‘forgetting’ of root causes of maladaptive traits?”Answer: Here, understanding the history, instead of forgetting it, might allow Beata to gain insight into and empathize with possible motives that may have led to becoming obese. For example, she might have the phantasy that if she had been obese and unattractive, she could have prevented the molestation—hence, become that way now to prevent it from happening again, and more wishfully reverse it. (In unconscious goings-on time is thought to be in the “unexamined present” (Brakel 2009, p. 63; 2015, p. 131; 2022, p. 4; 2023, p. 404.) One benefit of this is that in gaining this type of recognition, Beata might find it easier to change her behavior that she otherwise would not have; it was never her responsibility to prevent her own molestation, and there is no reason whatsoever for her to now make herself unattractive to her deceased father, and very little reason to remain obese in an attempt to deter current day men.Ego-Syntonic Maladaptive TraitsClaire is a concert pianist and alcoholic. Importantly, Claire does not see her own desire for alcohol as destructive but rather, as something constitutive of her own identity. “I wouldn’t be myself without alcohol,” she says. Reimer asks whether our approach would “work for cases where the agent sees a maladaptive trait as constitutive of their identity?”Answer: Although no approach can guarantee success, our claim is that our approach has a better chance than the main alternative known as the pruning view. Since Claire, by stipulation, is not inclined to see her own drinking as a problem, a... (shrink)

Disaster response is a highly collaborative and critical process that requires the involvement of multiple emergency responders (ERs), ideally working together under a unified command, to enable a rapid and effective operational response. Following the 9/11 and 11/13 terrorist attacks and the devastation of hurricanes Katrina and Rita, it is apparent that inadequate communication and a lack of interoperability among the ERs engaged on-site can adversely affect disaster response efforts. Within this context, we present a scenario-based terrorism case study to (...) highlight the challenges of operational disaster command and response. In this article, which is based on the French emergency response doctrine, we outline a semantics-based common operational command system that is designed to guarantee an efficient information flow among ERs. Our focus is on offering to all ERs, a real-time operational picture of the situation in order to enable multilevel coordination among firefighters, police, healthcare units, public authorities, and other stakeholders. Our approach consolidates information to promote timely sharing of data among ERs. The proposed system is based on an ontology that has been developed to represent the different types of knowledge on the part of ERs, providing a shared vocabulary that covers a variety of interoperability concerns. (shrink)

The distinction between a type and its tokens is a useful metaphysical distinction. In §1 it is explained what it is, and what it is not. Its importance and wide applicability in linguistics, philosophy, science and everyday life are briefly surveyed in §2. Whether types are universals is discussed in §3. §4 discusses some other suggestions for what types are, both generally and specifically. Is a type the sets of its tokens? What exactly is a word, a symphony, a species? (...) §5 asks what a token is. §6 considers the relation between types and their tokens. Do the type and all its tokens share the same properties? Must all the tokens be alike in some or all respects? §7 explains some problems for the view that types exist, and some problems for the view that they don't. §8 elucidates a distinction often confused with the type-token distinction, that between a type (or token) and an occurrence of it. It also discusses some problems that occurrences might be thought to give rise to, and one way to resolve them. (shrink)

Abstract In light of the complexity of unfolding disasters, the diversity of rapidly evolving events, the enormous amount of generated information, and the huge pool of casualties, emergency responders (ERs) may be overwhelmed and in consequence poor decisions may be made. In fact, the possibility of transporting the wounded victims to one of several hospitals and the dynamic changes in healthcare resource availability make the decision process more complex. To tackle this problem, we propose a multicriteria decision support service, based (...) on the Analytic Hierarchy Process (AHP) method, that aims to avoid overcrowding and outpacing the capacity of a hospital to effectively provide the best care to victims by finding out the most appropriate hospital that meets the victims’ needs. The proposed approach searches for the most appropriate healthcare institution that can effectively deal with the victims’ needs by considering the availability of the needed resources in the hospital, the victim’s wait time to receive the healthcare, and the transfer time that represents the hospital proximity to the disaster site. The evaluation and validation results showed that the assignment of hospitals was done successfully considering the needs of each victim and without overwhelming any single hospital. (shrink)

This book provides an accessible comprehensive exploration of phenomenological theory and research methods and is geared specifically to the needs of therapists ...

People typically show excellent memory for information that is central to an emotional event but poorer memory for peripheral details. Not all studies demonstrate memory narrowing as a result of emotion, however. Critically important emotional information is sometimes forgotten; seemingly peripheral details are sometimes preserved. To make sense of both the general pattern of findings that emotion leads to memory narrowing, and findings that violate this pattern, this review addresses mechanisms through which emotion enhances and impairs memory. Divergent approaches to (...) characterising information as central versus peripheral are also addressed. By directly contrasting these approaches, and the evidence supporting them, this review helps to clarify when and how emotion enhances memory and provides directions for future research. Evidence shows that memory narrowing as a result of emotion, and a number of violations of the memory narrowing pattern, can be explained by the view that emotion enhances memory for information relevant to currently active goals. (shrink)

The traditional Western understanding of life and death as a strict dichotomy is challenged by a more descriptively accurate model of life's progressive cessation. Dying can be defined by a bounded zone of residual states of life that fits better with moral intuition and more sensitively guides action toward the dying.

What purpose is served by renovation or redesign of professionalism, and how successful a process is it likely to be? This article addresses these questions by examining the effectiveness as a professional development mechanism of the imposition of changes to policy and/or practice that require modification or renovation of professionalism. The 'new' professionalisms purported to have been fashioned over the last two or three decades across the spectrum of UK education sectors and contexts have been the subject of extensive analysis, (...) and this article avoids going over old ground and revisiting issues that have already been much debated. Nevertheless, the example of UK government education policy during this period is used as a basis for considering the pitfalls associated with mechanisms for modifying professionalism through a reform and standards agenda. The article's analysis incorporates redefinition and examination of the concept and substance of professionalism and offers new perspectives in the form of three distinct conceptions: demanded, prescribed and enacted professionalism. Exploring the existentialist status of 'new' or 'modified' professionalisms and the relationship between professionality, professional culture and professionalism, it examines how professionalism may be interpreted and utilised for the development of education professionals. (shrink)

This paper defends the possibility of dirty hands against the longstanding skepticism that an action cannot be simultaneously right and wrong and that dirty hands cases are therefore impossible. While skeptics are right to recognize that prima facie reasons against violating moral duties may be overridden, they are wrong to deny that actions required by necessity may nevertheless remain wrong. Dirty hands cases capture the simultaneous necessity of disregarding moral duties in certain circumstances and the reprehensibility of wronging people even (...) in cases in which this is all-things-considered permissible. Rather than indicating any deficiency in our moral reasoning, the capacity to accommodate the possibility of dirty hands, along with the reality of moral conflict, is a strength of a moral theory. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 3. © 2015 by Kathryn Kein 671 Kathryn Kein Recovering Our Sense of Humor: New Directions in Feminist Humor Studies At the 2014 annual meeting of the American Studies Association (ASA), the Humor Studies Caucus held a panel titled “Female Comedians and the Critical Power of Laughter.” After listening to presentations on Gilda Radner, Lily Tomlin, and Black women comedians’ 1960s comedy albums, one audience (...) member asked the panel if the classic theories of humor—Freud’s theory of the joke, Bergson’s thoughts on laughter (all conceived of in relation to the work of men)—applied when analyzing female comedic performers. One panelist immediately responded that she found none of those theories useful to her work on female comedians, and that instead she used queer theory to aid her analysis. This exchange at ASA points to many of the questions that scholars of humor and feminism are currently facing as they work to address a dearth of scholarship dealing with women, feminism, and comedy. The nods in agreement around the room spoke to the notion that scholarship on the topic of women in comedy is not merely filling in gaps, but breaking new ground. With a few notable exceptions, scholars have been relatively silent on topics involving women and/in comedy.1 The meager 1. See Susanne Lavin, Women and Comedy in Solo Performance: Phyllis Diller, Lily Tomlin, and Roseanne (New York: Routledge, 2004); June Sochen, ed., Women’s Comic Visions (Detroit, MI: Wayne State University Press, 1991); John Limon, “Skirting, Kidding: Ellen Degeneres and Paula Poundstone,” in 672 Kathryn Kein scholarly space devoted to feminism and humor is likely shaped by the fraught relationship women and feminism have had with humor in our cultural imagination. Women have long battled a perception that they, as a sex, are biologically not funny. Men have always vastly outnumbered women on stand-up stages and in comedy writers’ rooms. Former Saturday Night Live writer Anne Beatts recalled that star John Belushi, being of the “chicks-aren’t-funny” school, often requested that the women writers be fired.2 In her bestselling Bossypants, Tina Fey recalls that the gender imbalance of the sketch comedy teams at Chicago’s Second City were due to the fact that directors believed “the audience doesn’t want to see a scene between two women.”3 In his 2007 piece in Vanity Fair brashly titled “Why Women Aren’t Funny,” Christopher Hitchens went so far as to call women and humor “antithetical.”4 In particular, feminist women have been painted as humorless and unable to take a joke. In The Promise of Happiness, Sarah Ahmed, defining her figure of the feminist killjoy, observes that “feminists are typically represented as grumpy his Stand-Up Comedy in Theory, or, Abjection in America (Durham, NC: Duke University Press, 2000). 2. For further accounts of women comedy writers’ and performers’ experiences, see Yael Kohen, We Killed: The Rise of Women in American Comedy: A Very Oral History (New York: Sarah Crichton Books, 2012). 3. Tina Fey, Bossypants (New York: Little, Brown, and Company, 2011), 87. 4. Christopher Hitchens, “Why Women Aren’t Funny,” Vanity Fair 557 (2007): 54 Books Discussed in This Essay All Joking Aside: American Humor and Its Discontents. By Rebecca Krefting. Baltimore, MD: Johns Hopkins University Press, 2014. Pretty/Funny: Women Comedians and Body Politics. By Linda Mizejewski. Austin: University of Texas Press, 2014. The Queer Cultural Work of Lily Tomlin and Jane Wagner. By Jennifer Reed. New York: Palgrave Macmillan, 2013. Kathryn Kein 673 and humorless.”5 In a variation of the age-old joke, when a jokester asks, “How many feminists does it take to change a light bulb?” the respondent doesn’t say “How many?” but instead deadpans, “That’s not funny.” In different ways, the three books reviewed in this essay take up the conversation at ASA and tackle these same questions: How do we analyze humor produced by (and for?) women when our understanding of humor is decidedly male? What omissions have the gendered assumptions about humor caused in scholarship on feminism? How does humor work to address these assumptions? And how does the backdrop of these assumptions influence the comedy... (shrink)

Research has shown that men and women are similar in their capabilities and management competence; however, there appears to be a glass ceiling which poses invisible barriers to their promotion to management positions. One explanation for the existence of these barriers lies in stereotyped, biased attitudes toward women in executive positions. This study supports earlier findings that attitudes of men toward women in executive positions are generally negative, while the attitudes of women are generally positive. Additionally, we found that an (...) individual's level of cognitive moral development correlates significantly with attitudes toward women executives. Limitations of the present study and implications for ethics and diversity training in organizations are discussed. (shrink)

Now available from Rowman & Littlefield, the third edition of this introductory critical thinking text features streamlined chapters, Think for Yourself activities, and a complete glossary of critical thinking terms.

Moving beyond the traditional feminist ethics of care, Linda A. Bell places an existentialist conception of liberation at the heart of ethics and argues that only an ethics of freedom sufficiently allows for feminist critique and opposition ...

It is generally accepted that the notion of inclusion derived or evolved from the practices of mainstreaming or integrating students with disabilities into regular schools. Halting the practice of segregating children with disabilities was a progressive social movement. The value of this achievement is not in dispute. However, our charter as scholars and cultural vigilantes is to always look for how we can improve things; to avoid stasis and complacency we must continue to ask, how can we do it better? (...) Thus, we must ask ourselves uncomfortable questions and develop a critical perspective that Foucault characterised as an 'ethic of discomfort' by following the Nietzschean principle where one acts 'counter to our time and thereby on our time... for the benefit of a time to come'. This paper begins with a fundamental question for those participating in inclusive education research and scholarship—when we talk of including, into what do we seek to include? (shrink)

To guide treatment decisions for incompetent patients who have no advance directives, health care institutions should look to the preferences of their own communities of patients. That is the best way to ensure that incompetent patients' wishes will be followed.

Much has been written on Michel Foucault's reluctance to clearly delineate a research method, particularly with respect to genealogy (Harwood, 2000; Meadmore, Hatcher & McWilliam, 2000; Tamboukou, 1999). Foucault (1994, p. 288) himself disliked prescription stating, ‘I take care not to dictate how things should be’ and wrote provocatively to disrupt equilibrium and certainty, so that ‘all those who speak for others or to others’ no longer know what to do. It is doubtful, however, that Foucault ever intended for researchers (...) to be stricken by that malaise to the point of being unwilling to make an intellectual commitment to methodological possibilities. Taking criticism of ‘Foucauldian’ discourse analysis as a convenient point of departure to discuss the objectives of poststructural analyses of language, this paper develops what might be called a discursive analytic; a methodological plan to approach the analysis of discourses through the location of statements that function with constitutive effects. (shrink)

This paper examines whether the prospect of compensation may render otherwise disproportionate harms proportionate. It argues that we should reject this possibility. Instead, it distinguishes duties of compensation as a requirement of rectificatory justice from a harm’s degree of compensability, and argues that only the latter is relevant to proportionality. On this view, failing to compensate constitutes a distinct wrong, while harms that are not adequately compensable carry extra weight in proportionality calculations. This explains how the prospect of compensation affects (...) permissions to harm, without relying on the dubious assumption that disproportionate harms may be rendered proportionate by future compensation. (shrink)

Managing complex disaster situations is a challenging task because of the large number of actors involved and the critical nature of the events themselves. In particular, the different terminologies and technical vocabularies that are being exchanged among Emergency Responders may lead to misunderstandings. Maintaining a shared semantics for exchanged data is a major challenge. To help to overcome these issues, we elaborate a modular suite of ontologies called POLARISCO that formalizes the complex knowledge of the ERs. Such a shared vocabulary (...) resolves inconsistent terminologies and promotes semantic interoperability among ERs. In this work, we discuss developing POLARISCO as an extension of Basic Formal Ontology and the Common Core Ontologies. We conclude by presenting a real use-case to check the efficiency and applicability of the proposed ontology. (shrink)

This article explores the nature of "the phenomenological attitude," which is understood as the process of retaining a wonder and openness to the world while reflexively restraining pre-understandings, as it applies to psychological research. A brief history identifies key philosphical ideas outlining Husserl's formulation of the reductions and subsequent existential-hermeneutic elaborations, and how these have been applied in empirical psychological research. Then three concrete descriptions of engaging the phenomenological attitude are offered, highlighting the way the epoché of the natural sciences, (...) the psychological phenomenological reduction and the eidetic reduction can be applied during research interviews. Reflections on the impact and value of the researcher's stance show that these reductions can be intertwined with reflexivity and that, in this process, something of a dance occurs—a tango in which the researcher twists and glides through a series of improvised steps. In a context of tension and contradictory motions, the researcher slides between striving for reductive focus and reflexive self-awareness; between bracketing pre-understandings and exploiting them as a source of insight. Caught up in the dance, researchers must wage a continuous, iterative struggle to become aware of, and then manage, pre-understandings and habitualities that inevitably linger. Persistance will reward the researcher with special, if fleeting, moments of disclosure in which the phenomenon reveals something of itself in a fresh way. (shrink)

Disaster response requires the cooperation of multiple emergency responder organizations (EROs). However, after‐action reports relating to large‐scale disasters identity communication difficulties among EROs as a major hindrance to collaboration. On the one hand, the use of two‐radio communication, based on multiple orthogonal frequencies and uneven coverage, has been shown to degrade inter‐organization communication. On the other hand, because they reflect different areas of expertise, EROs use differing terminologies, which are difficult to reconcile. These issues lead to ambiguities, misunderstandings, and inefficient (...) exchange of data and information among those involved, which can impede the response process and slow decision making. We, therefore, hypothesize that promoting semantic interoperability across ERO information systems might improve information exchange among stakeholders and thereby allow a more coherent response to the disaster. We propose an ontology‐based messaging service on the basis of the Emergency Data Exchange Language (EDXL) standards. The parties involved will continue to use the terminologies to which they are accustomed, but the system will resolve inconsistencies and thereby enhance mutual understanding among EROs by ensuring semantic translation of the exchanged information. The evaluation of the semantic translation demonstrated the effectiveness and accuracy of the proposed service. (shrink)

ignette and autobiographical recall studies have often been used to test models of the appraisals associated with specific emotions. Recently, critiques of both methodologies have called into question the applicability of appraisal theory to naturally-occurring emotional responses. This study examined supporter's responses to Ross Perot's withdrawal from the 1992 presidential race to assess the extent to which appraisal models accurately capture responses to a naturally-occurring event. Supporters in Riverside County, California (N = 227) completed questionnaires concerning their interpretations of the (...) event, their initial emotional reactions, changes in their reactions in the weeks immediately following Perot's withdrawal, and their plans. Appraisal models correctly predicted the dimensions of agency and coping potential that served to differentiate sadness from anger, and the appraisals and plans associated with hope. Appraisal models did not predict the strong focus of sad supporters on their past goals and beliefs, and the plans associated with sadness and anger. Changes in emotional intensity occurred as a function of changes in goals and plans rather than merely as a function of time. These findings demonstrate the applicability of appraisal theory to naturally-occurring emotional responses, but also show that models may understate the complexity of the planning processes associated with emotions. (shrink)