Background:Ethics consultation is the traditional way of resolving challenging ethical questions raised about patient care in the United States. Little research has been published on the resolution process used during ethics consultations and on how this experience affects healthcare professionals who participate in them.Objectives:The purpose of this qualitative research was to uncover the basic process that occurs in consultation services through study of the perceptions of healthcare professionals.Design and Method:The researchers in this study used a constructivist grounded theory approach that (...) represents how one group of professionals experienced ethics consultations in their hospital in the United States.Results:The results were sufficient to develop an initial theory that has been named after the core concept: Moving It Along. Three process stages emerged from data interpretation: moral questioning, seeing the big picture, and coming together. It is hoped that this initial work stimulates additional research in describing and understanding the complex social process that occurs for healthcare professionals as they address the difficult moral issues that arise in clinical practice. (shrink)

Nurses make mistakes in practice despite the culturally based expectation of perfection. Such a disparity between reality and expectation calls members of the profession to question the current attitudes toward mistakes in practice. Two explanatory models of the origin of mistakes are presented. The Perfectibility Model holds that any error or harm is caused by an individual practitioner's lack of knowledge or motivation. The Faulty Systems Model offers a broader explanation of human error. I conclude that a Faulty Systems Model (...) is more comprehensive and more effective for managing mistakes. Integrating the Faulty Systems Model into practice and education can result in more ethically fitting responses to errors and ultimately better outcomes for nurses, institutions and patients. (shrink)

Efforts to decrease errors in health care are directed at prevention rather than at managing a situation when a mistake has occurred. Consequently, nurses and other health care providers may not know how to respond properly and may lack sufficient support to make a healthy recovery from the mental anguish and emotional suffering that often accompany making mistakes. This article explores the conceptualization of mistakes and the ethical response to making a mistake. There are three parts to an ethical response (...) to error: disclosure, apology and amends. Honesty and humility are discussed as important virtues that facilitate coping and personal growth for the health care provider who is involved in mistakes. In conclusion, a healthy view of nursing practice and mistake making is one that prevents error but, when prevention is not possible, accepts fallibility as part of the human condition and achieves the best possible outcome for all. (shrink)

Most incidences of dishonesty in research, financial investments that promote personal financial gain, and kickback scandals begin as conflicts of interest (COI). Research indicates that healthcare professionals who maintain COI relationships make less optimal and more expensive patient care choices. The discovery of COI relationships also negatively impact patient and public trust. Many disciplines are addressing this professional issue, but little work has been done towards understanding and applying this moral category within a nursing context. Do COIs occur in nursing (...) and are they problematic? What are the morally appropriate responses to COI for our discipline and for individual practicing nurses? In this paper I examine the nature of 'conflict of interest' as a general ethical category, its characteristics and its application to our discipline. Conflict of interest is an odd moral category that may actually or potentially result in immoral decisions. The moral justification for COI is grounded prime facie by the moral value of respect for persons and principle of fidelity from which trust is developed and maintained. In review of the historical development, there appears to be consensus on some qualities of COI that are presented. I conclude that making judgements about COI are challenging and often difficult to determine from a nursing perspective. Improving nurses' and professional organizations' awareness of COI and sharpening our ability to respond appropriately when COI arise can reduce potential harm and promote trust in those whom we serve. (shrink)

A growing number of nurse researchers travel globally to conduct research in poor and underserved populations in developing nations. These researchers, while well versed in research ethics, often find it difficult to apply traditional ethical standards to populations in developing countries. The problem of applying ethical standards across cultures is explained by a long-standing debate about the nature of ethical principles. Fundamentalism is the philosophical stance that ethical principles are universal, while the anthropologically-based ‘multicultural’ model claims the philosophical position that (...) principles are culturally bound. The authors explicate the two philosophical stances and advocate a morally sensitive but moderate position of ‘ethical multiculturalism’ rather than favouring either of the above philosophical positions. The final section suggests ways to promote ethical multiculturalism while planning and conducting nursing research. (shrink)

Globalization, an outgrowth of technology, while informing us about people throughout the world, also raises our awareness of the extreme economic and social disparities that exist among nations. As part of a global discipline, nurses are vitally interested in reducing and eliminating disparities so that better health is achieved for all people. Recent literature in nursing encourages our discipline to engage more actively with social justice issues. Justice in health care is a major commitment of nursing; thus questions in the (...) larger sphere of globalization, justice and ethics, are our discipline's questions also. Global justice, or fairness, is not an issue for some groups or institutions, but a deeper human rights issue that is a responsibility for everyone. What can we do to help reduce or eliminate the social and economic disparities that are so evident? What kind of ethical milieu is needed to address the threat that globalization imposes on justice and fairness? This article enriches the conceptualization of globalization by investigating recent work by Schweiker and Twiss. In addition, I discuss five qualities or characteristics that will facilitate the development of a viable and just global ethic. A global ethic guides all people in their response to human rights and poverty. Technology and business, two major forces in globalization that are generally considered beneficial, are critiqued as barriers to social justice and the common good. To turn human nature into humanity and righteousness is like turning the willow into cups and bowls.The book of Mencius. (shrink)

Trust in the nurse—patient relationship is maintained not by how professionals perceive their actions but rather by how the public perceives them. However, little is known about the public's view of nurses and other health care professionals who participate in pharmaceutical marketing. Our study describes public perceptions of health care providers' role in pharmaceutical marketing and compares their responses with those of a random sample of licensed family nurse practitioners. The family nurse practitioners perceived their participation in marketing activities as (...) significantly more ethically appropriate than did the public responders. Further research is warranted before conclusions can be drawn, but these early findings suggest that nurse practitioners should consider a conservative approach to participating in pharmaceutical marketing. (shrink)

is a review of 5 ethically based healthcare funding models discussed in the literature that are currently used to justify funding choices. If healthcare professionals and managers are better informed about the ethical reasoning behind funding choices, they could better determine which resource allocation alternatives to support. But where should we spend our resources? Although healthcare professionals have a duty to advocate for all healthcare recipients to receive a fair share of resources, the author concludes that our greater duty as (...) a profession is to the good of society as a whole. Balancing allocation decisions by considering all of the competing healthcare funding models and the ethical bases for them is suggested rather than to advocate too strongly for favored models.... (shrink)

To what use can causal claims established in good studies be put? We give examples of studies from which inaccurate inferences were made about target policy situations. The usual diagnosis is that the studies in question lack external validity, which means that the same results do not hold in the target as in study. That’s a label that just repeats what we already knew. We offer a deeper analysis. Our analysis points to the need for interdisciplinarity and to the demand (...) to focus not on the study – as the expression ‘external validity’ invites you to do – but on the target. The call for interdisciplinary approaches to real life problems is common since it is widely acknowledged that what happens in the real world seldom falls under the auspices of any single research domain. Our focus is on one specific real life problem: how to use causal claims from good studies to help predict whether the policies tested will work in a new situation. Our analysis of what it takes to back up these predictions points up very specific stages in the process of prediction where we are bound to get it wrong if we do not diversify our concepts, our knowledge and our methods. We isolate two reasons inferences from study to target fail. First, policy variables do not produce results on their own; they need helping factors. The distribution of helping factors is likely to be unique or local for each study, so one cannot expect external validity to be all that common. Second, researchers often give too concrete a description of the cause in the study for it to carry over to the target.ion is necessary to get causes that travel. There is no sure-fire way to guard against these problems. But the unavailability of one perfect tool does not imply there are no second best contrivances. Two general pointers for Good Practice in policy advice follow from our diagnosis: focus on the concrete details in the target and use cross discipline heuristics that diversify background knowledge. (shrink)

Who, over the age of 20, hasn’t experienced a serendipitous event: unexpected information that yields some unintended but potential value later on? Sitting next to a stranger on a plane who becomes a business partner? Stumbling onto an article in a journal or newspaper that helps tackle a nagging problem? Creating a new drug by accident?

A collection of five essays of French philosopher Nancy, originally published in 1985-86: The Inoperative Community, Myth Interpreted, Literary Communism, Shattered Love, and Of Divine Places.

How the new conspiracists are undermining democracy—and what can be done about it Conspiracy theories are as old as politics. But conspiracists today have introduced something new—conspiracy without theory. And the new conspiracism has moved from the fringes to the heart of government with the election of Donald Trump. In A Lot of People Are Saying, Russell Muirhead and Nancy Rosenblum show how the new conspiracism differs from classic conspiracy theory, how it undermines democracy, and what needs to be (...) done to resist it. (shrink)

What does it mean to think critically about politics at a time when inequality is increasing worldwide, when struggles for the recognition of difference are eclipsing struggles for social equality, and when we lack any credible vision of an alternative to the present order? Philosopher Nancy Fraser claims that the key is to overcome the false oppositions of "postsocialist" commonsense. Refuting the view that we must choose between "the politics of recognition" and the "politics of redistribution," Fraser argues for (...) an integrative approach that encompasses the best aspects of both. (shrink)

PARTI The Philosophical Situation: A Critical Appraisal We must begin with the mistake and find out the truth in it. That is, we must uncover the source of ...

Most traditional accounts of Aristotle's theory of ethical education neglect its cognitive aspects. This book asserts that, in Aristotle's view, excellence of character comprises both the sentiments and practical reason. Sherman focuses particularly on four aspects of practical reason as they relate to character: moral perception, choicemaking, collaboration, and the development of those capacities in moral education. Throughout the book, she is sensitive to contemporary moral debates, and indicates the extent to which Aristotle's account of practical reason provides an alternative (...) to theories of impartial reason. (shrink)

Purpose ‐ The purpose of this paper is to explore the "resource curse" problem as a counter-example of creative performance and innovation by examining reliance on capital and physical resources, showing the gap between expectations and ex-post actual performance that became clearer under conditions of economic turmoil. Design/methodology/approach ‐ The analysis uses logistic regressions with dichotomous response and predictor variables on structured tables of count data, representing firm performance as an outcome of capital resources, physical resources and innovation where appropriate. (...) Findings ‐ Key findings relevant to economic and business practice follow. First, a typical characteristic of successful Vietnamese firms in the transition period is their reliance on either capital resources or physical asset endowments. Second, poor performers exhibit evidence of over-reliance on both capital and physical assets. Third, firms that relied on both types of resources tended to downplay creative performance. Some evidence suggests that firms face more acute problem caused by the law of diminishing returns in troubled times. Fourth, the "innovation factor" has not been tapped as a source of economic growth. Research limitations/implications ‐ This study has some limitations. The size of the survey sample is approximately 150 firms, while the potential sample of > 300 should be possible in the future. When the size increases, the research could be expanded to include further variables that will help investigate more deeply into the related issues and business implications. With regard to the implications of the study, the absence of innovations has made the notion of "resource curse" identical to "destructive creation" implemented by ex-ante resource-rich firms, and worsened the problem of resource misallocation in transition turmoil. The Vietnamese corporate sector's addiction to resources may contribute to economic deterioration, through a downward spiral of lower efficiency leading to consumption of more resources. Practical implications ‐ Insights obtained from this study could save transition economies' resources which have almost always been considered sine qua non before any critical major policymaking, while this is not necessarily true, and in many cases, even counterproductive. Originality/value ‐ Original data set on Vietnam stock market are collected, processed, prepared and used by the authors. Original design by the authors for regression equations with dichotomous predictor variables: dependence on endowed physical assets, reliance on capital resources and significant signs of creative performance/innovations. Original idea of viewing "resource curse" as absence of innovation and due to uncreative "destructive creation" of poor-performing commercial operations by resource-rich firms is used in the paper. We have searched the literature in business research and found that the empirical results have not been previously reported. (shrink)

In this essay, we share our experience and learning about the value of, and the difficulty associated with, conducting and presenting scientific studies in ways that are both simple (understandable) and beautiful (appealing to the reader). We describe some “aha moments” of insight that led to changes in the way we approach and present research, some of the actions we took, and lessons we learned.

The claims of randomized controlled trials to be the gold standard rest on the fact that the ideal RCT is a deductive method: if the assumptions of the test are met, a positive result implies the appropriate causal conclusion. This is a feature that RCTs share with a variety of other methods, which thus have equal claim to being a gold standard. This article describes some of these other deductive methods and also some useful non-deductive methods, including the hypothetico-deductive method. (...) It argues that with all deductive methods, the benefit that the conclusions follow deductively in the ideal case comes with a great cost: narrowness of scope. This is an instance of the familiar trade-off between internal and external validity. RCTs have high internal validity but the formal methodology puts severe constraints on the assumptions a target population must meet to justify exporting a conclusion from the test population to the target. The article reviews one such set of assumptions to show the kind of knowledge required. The overall conclusion is that to draw causal inferences about a target population, which method is best depends case-by-case on what background knowledge we have or can come to obtain. There is no gold standard. (shrink)

This essay looks closely at metaphors and other figures of speech that often feature in how Americans talk about dementia, becoming part of cultural narratives: shared stories that convey ideas and values, and also worries and fears. It uses approaches from literary studies to analyze how cultural narratives about dementia may surface in conversations with family members or health care professionals. This essay also draws on research on a notable social effect of legalizing medical aid in dying: patients may find (...) it easier to bring up a range of concerns, regardless of whether they have any interest in hastening their own death. The essay proposes that health care professionals rethink an idea prominent within their own culture: that conversations about the end of a person's life are inherently difficult. This framing may make it hard for people facing dementia to bring up their concerns about what lies ahead. We suggest a different way to think about these conversations, using the metaphor of “opening the door” to represent inviting a patient to bring up issues of deepest concern. (shrink)

Thought experiments have played a prominent role in numerous cases of conceptual change in science. I propose that research in cognitive psychology into the role of mental modeling in narrative comprehension can illuminate how and why thought experiments work. In thought experimenting a scientist constructs and manipulates a mental simulation of the experimental situation. During this process, she makes use of inferencing mechanisms, existing representations, and general world knowledge to make realistic transformations from one possible physical state to the next. (...) The simulation reveals the impossibility of integrating multiple constraints drawn from existing representations and the world and pinpoints the locus of the required conceptual reform. (shrink)

In their rich and intricate paper ‘Independence, Invariance, and the Causal Markov Condition’, Daniel Hausman and James Woodward ([1999]) put forward two independent theses, which they label ‘level invariance’ and ‘manipulability’, and they claim that, given a specific set of assumptions, manipulability implies the causal Markov condition. These claims are interesting and important, and this paper is devoted to commenting on them. With respect to level invariance, I argue that Hausman and Woodward's discussion is confusing because, as I point out, (...) they use different senses of ‘intervention’ and ‘invariance’ without saying so. I shall remark on these various uses and point out that the thesis is true in at least two versions. The second thesis, however, is not true. I argue that in their formulation, the manipulability thesis is patently false and that a modified version does not fare better. Furthermore, I think their proof that manipulability implies the causal Markov condition is not conclusive. In the deterministic case it is valid but vacuous, whereas it is invalid in the probabilistic case. 1 Introduction 2 Intervention, invariance and modularity 3 The causal Markov condition: CM1 and CM2 4 From MOD to the causal Markov condition and back 5 A second argument for CM2 6 The proof of the causal Markov condition for probabilistic causes 7 ‘Cartwright's objection’ defended 8 Metaphysical defenses of the causal Markov condition 9 Conclusion. (shrink)

This book is a profound and eagerly anticipated investigation into what is left of a monotheistic religious spirit—notably, a minimalist faith that is neither confessional nor credulous. Articulating this faith as works and as an objectless hope, Nancy deconstructs Christianity in search of the historical and reflective conditions that provided its initial energy. Working through Blanchot and Nietzsche, re-reading Heidegger and Derrida, Nancy turns to the Epistle of Saint James rather than those of Saint Paul, discerning in it (...) the primitive essence of Christianity as hope. -/- The “religion that provided the exit from religion,” as he terms Christianity, consists in the announcement of an end. It is the announcement that counts, however, rather than any finality. In this announcement there is a proximity to others and to what was once called parousia. But parousia is no longer presence; it is no longer the return of the Messiah. Rather, it is what is near us and does not cease to open and to close, a presence deferred yet imminent. -/- In a demystified age where we are left with a vision of a self-enclosed world—in which humans are no longer mortals facing an immortal being, but entities whose lives are accompanied by the time of their own decline—parousia stands as a question. Can we venture the risk of a decentered perspective, such that the meaning of the world can be found both inside and outside, within and without our so-immanent world? -/- The deconstruction of Christianity that Nancy proposes is neither a game nor a strategy. It is an invitation to imagine a strange faith that enacts the inadequation of life to itself. Our lives overflow the self-contained boundaries of their biological and sociological interpretations. Out of this excess, wells up a fragile, overlooked meaning that is beyond both confessionalism and humanism. (shrink)

Cognition in work teams has been predominantly understood and explained in terms of shared cognition with a focus on the similarity of static knowledge structures across individual team members. Inspired by the current zeitgeist in cognitive science, as well as by empirical data and pragmatic concerns, we offer an alternative theory of team cognition. Interactive Team Cognition (ITC) theory posits that (1) team cognition is an activity, not a property or a product; (2) team cognition should be measured and studied (...) at the team level; and (3) team cognition is inextricably tied to context. There are implications of ITC for theory building, modeling, measurement, and applications that make teams more effective performers. (shrink)

WE AIM HERE to outline a theory of evidence for use. More specifically we lay foundations for a guide for the use of evidence in predicting policy effectiveness in situ, a more comprehensive guide than current standard offerings, such as the Maryland rules in criminology, the weight of evidence scheme of the International Agency for Research on Cancer (IARC), or the US ‘What Works Clearinghouse’. The guide itself is meant to be well-grounded but at the same time to give practicable (...) advice, that is, advice that can be used by policy-makers not expert in the natural and social sciences, assuming they are well-intentioned and have a reasonable but limited amount of time and resources available for searching out evidence and deliberating. (shrink)

Dual process theorists in psychology maintain that the mind’s workings can be explained in terms of conscious or controlled processes and automatic processes. Automatic processes are largely nonconscious, that is, triggered by environmental stimuli without the agent’s conscious awareness or deliberation. Automaticity researchers contend that even higher level habitual social behaviors can be nonconsciously primed. This article brings work on automaticity to bear on our understanding of habitual virtuous actions. After examining a recent intuitive account of habitual actions and habitual (...) virtuous actions, the author offers her own explanation in terms of goal-dependent automaticity. This form of automaticity provides an account of habitual virtuous actions that explains the sense in which these actions are rational, that is, done for reasons. Habitual virtuous actions are rational in the sense of being purposive or goal-directed and are essentially linked with the agent’s psychological states. Unlike deliberative virtuous actions, the agent’s reasons for habitual virtuous actions are not present to her conscious awareness at the time of acting. (shrink)

Imagining the Course of Life offers a rich portrait of rural life in contemporary Southeast Asia and an accessible introduction to the complexities of Theravada Buddhism as it is actually lived and experienced. It is both an ethnography of indigenous views of human development and a theoretical consideration of how any ethnopsychology is embedded in society and culture. Drawing on long-term fieldwork in a Shan village in northern Thailand, Nancy Eberhardt illustrates how indigenous theories of the life course are (...) connected to local constructions of self and personhood. In the process, she draws our attention to contrasting models in the Euro-American tradition and invites us to reconsider how we think about the trajectory of a human life. Moving beyond the entrenched categories that can hamper our understanding of other views, Imagining the Course of Life demonstrates the real-life connections between the "religious" and the "psychological." Eberhardt shows how such beliefs and practices are used, sometimes strategically, in people's constructions of themselves, in their interpretations of others' behavior, and in their attempts at social positioning. Individual chapters explore Shan ideas about the overall course of human development, from infancy to old age and beyond, and show how these ideas inform people's understanding of personhood and maturity, gender and social inequality, illness and well-being, emotions and mental health. (shrink)

Epistemic trustworthiness is defined as a complex character state that supervenes on a relation between first- and second-order beliefs, including beliefs about others as epistemic agents. In contexts shaped by unjust power relations, its second-order components create a mutually supporting link between a deficiency in epistemic character and unjust epistemic exclusion on the basis of group membership. In this way, a deficiency in the virtue of epistemic trustworthiness plays into social/epistemic interactions that perpetuate social injustice. Overcoming that deficiency and, along (...) with it, normalized practices of epistemic exclusion, requires developing a self-critical perspective on the partial, socially-located character of one's perspective and the consequent epistemic value of inclusiveness. (shrink)

The paper argues that the practice of thought experintenting enables scientists to follow through the implications of a way of representing nature by simulating an exemplary or representative situation that is feasible within that representation. What distinguishes thought experimenting from logical argument and other forms of propositional reasoning is that reasoning by means of a thought experiment involves constructing and simulating a mental model of a representative situation. Although thought experimenting is a creative part of scientific practice, it is a (...) highly refined extension of a mundane form of reasoning. It is not a mystery why scientific thought experiments are a reliable source of empirical insights. Thought experimenting uses and manipulates representations that derive from real-world experiences and our conceptualizations of them. (shrink)

This unique volume presents a debate between four of the top feminist theorists in the US today, discussing the key questions facing contemporary feminist theory, responding to each other, and distinguishing their views from others.

Designing, building, and experimenting with physical simulation models are central problem‐solving practices in the engineering sciences. Model‐based simulation is an epistemic activity that includes exploration, generation and testing of hypotheses, explanation, and inference. This paper argues that to interpret and understand how these simulation models function in creating knowledge and technologies requires construing problem solving as accomplished by a researcher–artifact system. It draws on and further develops the framework of “distributed cognition” to interpret data collected in ethnographic and cognitive‐historical studies (...) of two biomedical engineering research laboratories, and articulates the notion of distributed model‐based cognition to answer the question posed in the title. (shrink)

In the course of the last thirty years, feminist theories of gender have shifted from quasi-Marxist, labor-centered conceptions to putatively “post-Marxist”culture- and identity-based conceptions. Reflecting a broader political move from redistribution to recognition, this shift has been double-edged. On the one hand, it has broadened feminist politics to encompass legitimate issues of representation, identity, and difference. Yet, in the context of an ascendant neoliberalism, feminist struggles for recognition may be serving to less to enrich struggles for redistribution than to displace (...) the latter. I aim to resist that trend. In this essay, I propose an analysis of gender that is broad enough to house the full range of feminist concerns, those central to the old socialist-feminism as well as those rooted in the cultural turn. I also propose a correspondingly broad conception of justice, capable of encompassing both distribution and recognition, and a non-identitarian account of recognition, capable of synergizing with redistribution. I conclude by examining some practical problems that arise when we try to envision institutional reforms that could redress gender maldistribution and gender misrecognition simultaneously. (shrink)

Mary Astell’s theory of friendship has been interpreted either as a version of Aristotelian virtue friendship, or as aligned with a Christian and Platonist tradition. In this paper, I argue that Astell’s theory of friendship is determinedly anti-Aristotelian; it is a theory of spiritual friendship offered as an alternative to Aristotelian virtue friendship. By grounding her conception of friendship in a Christian–Platonist metaphysics, I show that Astell rejects the Aristotelian criteria of reciprocity and partiality as essential features of the friendship (...) bond and that she develops a theory of friendship that is neither reciprocal nor partial. Further, I argue that Astell’s theory of friendship advances her feminist aims by providing a justification for female–female spiritual bonds in contradistinction to female–male marriage bonds. Astell argues that the female–female bond of spiritual friendship is sanctioned by God, and is, therefore, a divinely authorized alternative to the male–female bond of marriage. Through her theory of spiritual friendship, Astell marks out a central place for female–female bonds and provides women with a justification for resisting marriage. (shrink)

' this volume will make a significant contribution to a more adequate understanding of the 'nature of scientific knowledge and inquiry' ' ISIS Vol.79,No.1,1988.