The context of the work is the analysis of African values. The significance is the avoidance of generalizations. There are cultures in Africa and not just one culture and in each culture, there is a diversity of clans. The analysis of African values ought to have universal relevance, hence the use of phenomenological-hermeneutical method. This is the first analysis of such a value in the Igbo cultural group. It is at the same time a contribution to an important and often (...) neglected aspect of development: human development. The personality of the individual is a fundamental principle. Solidarity, philosophically formulated, can be a norm that regulates people's behavior. The personality of the individual is a fundamental principle. A person is identified with his dignity. This dignity is enriched and thus matures through his openness to others and positive contribution to the development of their personality. In order to show that our principle is not a mere abstract idealization, the second part of the work is a hermeneutical analysis of solidarity as found among the Igbo of Nigeria. Sylvanus Ifeanyichukwu Nnoruka is a Catholic priest of the Archdiocese of Onitsha (Nigeria). He has published Personal Identity: a Philosophical Survey as well as other books and articles. (shrink)

The precipitous cliffs, rolling headlands, and rocky inlets of the Big Sur coast of California prompted Robinson Jeffers to extol their wild beauty throughout his long career as a poet. This extraordinary volume brings together Jeffers’s haunting poetry with magnificent photographs of Big Sur by his friend and neighbor, famed photographer Morley Baer.

In recent years, the phenomenon of moral distress has been critically examined—and for a good reason. There have been a number of different definitions suggested, some that claimed to be consistent with the original definition but in fact referred to different epistemological states. In this paper, we re‐examine moral distress by exploring its relationship with moral agency. We critically examine three conceptions of moral agency and argue that two of these conceptions risk placing nurses' values at the center of moral (...) action when it ought to be the patient's values that shape nurses' obligations. We propose that the conception of moral agency advanced by Aimee Milliken which re‐centers patient values, should be more broadly accepted within nursing. We utilize a case example to demonstrate a situation in which the values of a patient's parents (surrogates) justifiably constrained nurses' moral agency, creating moral distress. Through an examination of constraints on nurse agency in this case, we illustrate the problematic nature of ‘narrow' moral distress and the value of re‐considering moral distress. Finally, we provide an action‐oriented proposal identifying mediating steps that we argue have utility for nurses (and other healthcare professionals) to mediate between experiences of narrow moral distress and the exercise of moral agency. (shrink)

The debate about the ethical implications of Artificial Intelligence dates from the 1960s :741–742, 1960; Wiener in Cybernetics: or control and communication in the animal and the machine, MIT Press, New York, 1961). However, in recent years symbolic AI has been complemented and sometimes replaced by Neural Networks and Machine Learning techniques. This has vastly increased its potential utility and impact on society, with the consequence that the ethical debate has gone mainstream. Such a debate has primarily focused on principles—the (...) ‘what’ of AI ethics —rather than on practices, the ‘how.’ Awareness of the potential issues is increasing at a fast rate, but the AI community’s ability to take action to mitigate the associated risks is still at its infancy. Our intention in presenting this research is to contribute to closing the gap between principles and practices by constructing a typology that may help practically-minded developers apply ethics at each stage of the Machine Learning development pipeline, and to signal to researchers where further work is needed. The focus is exclusively on Machine Learning, but it is hoped that the results of this research may be easily applicable to other branches of AI. The article outlines the research method for creating this typology, the initial findings, and provides a summary of future research needs. (shrink)

Background There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard “narrow” definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. Research aims To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. Research design (...) A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. Participants Registered nurses from four hospitals within one large healthcare system in Midwest United States. Ethical considerations IRB approval was obtained. Results 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by “other” distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. Conclusions Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed. (shrink)

In most African cultures, there is a definite and clear quest for truth through a critical method. Truth is a key value. It has moral, philosophical and social significance. One can subject an interlocutor's statements to methodic doubt and questioning. However, in some African cultures, the human intellect alone is not capable of understanding certain truth data thereby permitting the practice of divination. Nevertheless, most African cultures distinguish opinion (doxa) from (alatheia); emphasis is on objectivity rather than subjectivity. The methods (...) of arriving at the truth by most African cultures correspond basically to the correspondence and pragmatic theories of truth. (shrink)

Critical thinking plays a role in African judgement. Here, factors that influence judgement are: culture, communalism, wisdom of elders, revelation from the gods, and observation. Factors that obstruct judgement include: colonialism, modernization, and new religions. However, thanks to Kant's critical philosophy, only objectively valid knowledge is actually knowledge in African traditional thought.

Aims:The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress.Background:Moral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon.Design:Systematic literature review and narrative synthesis (November (...) 2015–March 2016).Data sources:Ovid MEDLINE®In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO®1967–Present, CINAHL®Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education Abstracts.Review methods:Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis.Results:In all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity.Conclusion:We suggest the combination of (1) the experience of a moral event, (2) the experience of ‘psychological distress’ and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress. (shrink)

Technologies to rapidly alert people when they have been in contact with someone carrying the coronavirus SARS-CoV-2 are part of a strategy to bring the pandemic under control. Currently, at least 47 contact-tracing apps are available globally. They are already in use in Australia, South Korea and Singapore, for instance. And many other governments are testing or considering them. Here we set out 16 questions to assess whether — and to what extent — a contact-tracing app is ethically justifiable.

As the range of potential uses for Artificial Intelligence, in particular machine learning, has increased, so has awareness of the associated ethical issues. This increased awareness has led to the realisation that existing legislation and regulation provides insufficient protection to individuals, groups, society, and the environment from AI harms. In response to this realisation, there has been a proliferation of principle-based ethics codes, guidelines and frameworks. However, it has become increasingly clear that a significant gap exists between the theory of (...) AI ethics principles and the practical design of AI systems. In previous work, we analysed whether it is possible to close this gap between the ‘what’ and the ‘how’ of AI ethics through the use of tools and methods designed to help AI developers, engineers, and designers translate principles into practice. We concluded that this method of closure is currently ineffective as almost all existing translational tools and methods are either too flexible or too strict. This raised the question: if, even with technical guidance, AI ethics is challenging to embed in the process of algorithmic design, is the entire pro-ethical design endeavour rendered futile? And, if no, then how can AI ethics be made useful for AI practitioners? This is the question we seek to address here by exploring why principles and technical translational tools are still needed even if they are limited, and how these limitations can be potentially overcome by providing theoretical grounding of a concept that has been termed ‘Ethics as a Service.’. (shrink)

The Covid‐19 pandemic has highlighted many of the difficult ethical issues that health care professionals confront in caring for patients and families. The decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. Our focus is on the implications for nurses, who are the largest global health care workforce but whose perspectives are not always fully considered. This essay discusses three overarching ethical issues that create a myriad of concerns and will likely affect nurses globally (...) in unique ways: the safety of nurses, patients, colleagues, and families; the allocation of scarce resources; and the changing nature of nurses’ relationships with patients and families. We urge policy‐makers to ensure that nurses’ voices and perspectives are integrated into both local and global decision‐making so as to minimize the structural injustices many nurses have faced to date. Finally, we urge nurses to seek sources of support throughout this pandemic. (shrink)

In this essay, I examine Robert Boyle's strategies for making imperceptible entities accessible to the senses. It is well known that, in his natural philosophy, Boyle confronted the challenge of making imperceptible particles of matter into objects of sensory experience. It has never been noted, however, that Boyle confronted a strikingly similar challenge in his natural theology – he needed to make an equally imperceptible God accessible to the senses. Taking this symmetrical difficulty as my starting point, I propose a (...) new approach to thinking about the interconnections between Boyle's natural philosophy and natural theology. For the most part, studies of science and religion in the early modern period work by seeking out the influence of explicitly stated religious beliefs on scientific ideas. I argue, by contrast, that we need to focus on Boyle's representational practices, using his attempts to represent imperceptible entities as a means of uncovering metaphysical and theological presuppositions that he did not always articulate when stating his religious beliefs. With new interpretations of bothA Discourse of Things Above Reason(1681) andSome Physico-Theological Considerations about the Possibility of the Resurrection(1675), I show that there were crucial similarities between Boyle's practices for representing both God and atoms. I go on to show, moreover, that Boyle used these practices to enact an ontological stance at odds with one of his most important professed beliefs. (shrink)

By far the largest part of Nehemiah Grew?s account of a seventeenth?century collection of rarities, his Musæum Regalis Societatis (1685) is taken up with ?thick?, verbal descriptions of things in the Royal Society?s repository. Not only, Grew suggests, do his descriptions serve to signify the contents of his collection, but they enable us to discern among species and to think about the collection?s pieces in new ways. Verbal descriptions did not just signify things in the Royal Society?s collection, but had (...) the capacity to alter their meanings. The essay discusses the ?picturing? of natural things in Early Modern Europe with little direct reference to the contemporary media of graphic representation ? drawings, engravings, paintings etc. ? in order to highlight the role of the then most widely used, but now least discussed of these media, verbal descriptions. (shrink)

There has been increasing debate in recent years about the conceptualization of moral distress. Broadly speaking, two groups of scholars have emerged: those who agree with Jameton’s ‘narrow definition’ that focuses on constraint and those who argue that Jameton’s definition is insufficient and needs to be broadened. Using feminist empirical bioethics, we interviewed critical care nurses in the United Kingdom about their experiences and conceptualizations of moral distress. We provide our broader definition of moral distress and examples of data that (...) both challenge and support our conceptualization. We pre‐empt and overcome three key challenges that could be levelled at our account and argue that there are good reasons to adopt our broader definition of moral distress when exploring prevalence of, and management strategies for, moral distress. (shrink)

By mid-2019 there were more than 80 AI ethics guides available in the public domain. Despite this, 2020 saw numerous news stories break related to ethically questionable uses of AI. In part, this is because AI ethics theory remains highly abstract, and of limited practical applicability to those actually responsible for designing algorithms and AI systems. Our previous research sought to start closing this gap between the ‘what’ and the ‘how’ of AI ethics through the creation of a searchable typology (...) of tools and methods designed to translate between the five most common AI ethics principles and implementable design practices. Whilst a useful starting point, that research rested on the assumption that _all_ AI practitioners are aware of the ethical implications of AI, understand their importance, and are actively seeking to respond to them. In reality, it is unclear whether this is the case. It is this limitation that we seek to overcome here by conducting a mixed-methods qualitative analysis to answer the following four questions: what do AI practitioners understand about the need to translate ethical principles into practice? What motivates AI practitioners to embed ethical principles into design practices? What barriers do AI practitioners face when attempting to translate ethical principles into practice? And finally, what assistance do AI practitioners want and need when translating ethical principles into practice? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Political Economy and Classical AntiquityNeville MorleyThe literature of the ancients, their legislation, their public treaties, and their administration of the conquered provinces, all proclaim their utter ignorance of the nature and origin of wealth, of the manner in which it is distributed, and of the effects of its consumption.... The steadily increasing progress of different branches of industry, the advancement of the sciences, whose influence upon wealth we shall (...) have occasion hereafter to notice, and the direction of public opinion, at length estimating national prosperity as being of some importance, caused the science of political economy to enter into the contemplation of a great number of writers.J.-B. Say 1I. The science of political economy offered an entirely new way of understanding human society. 2 Say’s account of its emergence is teleological and self-serving, figuring his own work as the logical culmination of earlier enquiries, but it accurately reflects the way in which political economy was perceived and presented as a modern innovation. The more that eighteenth- and nineteenth-century political economists turned their attention towards the economic rather than the political state of the nation, the more they became aware of their own originality in doing so. The writings of the ancients might still dominate discussions of political theory, but the moderns noted with satisfaction the failings and fumblings of classical authors in the study of the economy; they alone had discerned its significance and developed the tools with which to [End Page 95] analyze it. Moreover, there was no obvious reason why this new science should confine its attentions to the contemporary world; the economies of the past could be studied in the same manner, and thus political economy offered the possibility of understanding ancient society better than the ancients did themselves.Students of ancient society were slow to respond to this challenge. Neither Edward Gibbon nor George Grote had much to say about the ancient economy, despite their close relationships with economists of the Scottish Enlightenment and the Philosophic Radicals respectively. Gibbon was well aware of contemporary debates on luxury (see below), and he also disputed Montesquieu’s theory that taxes decrease according to the level of despotism in a state, but that was all. 3 A letter written by Grote’s wife suggests that his chapter on Greek colonization was intended to infuse useful doctrines on political economy and the principle of population, but in the published version this intent is limited to vague statements about the importance of agriculture in sustaining a colony. 4 Grote’s advocacy of comparative history—“not omitting the points of resemblance as well as of contrast with the better-known forms of modern society”—was in practice limited to politics and the history of ideas, above all in the debate on the merits of democracy. 5 The sole exception was a comparison of Solon’s legislation restricting Athenian exports with the British Corn Laws, to the advantage of the former. 6With the lone exception of Boeckh’s 1817 treatise on The Public Economy of Athens, the subject of the ancient economy was almost entirely ignored by historians until the middle of the nineteenth century. 7 Their own interests and those of the ancient sources on which they relied led them to conceive of history in terms of events, above all of events in the fields of politics and war. Economic matters were touched upon in their accounts of certain episodes—the reforms of Solon, for example, or the Roman agrarian laws—but never in detail or with much analytical sophistication, let alone drawing upon the theoretical insights of political economy. William Ramsay’s Manual of Roman Antiquities in 1851 devoted much more space to economic topics than had been customary, but was otherwise indistinguishable from its predecessors; the chapter on Roman agriculture was little more than a paraphrase of the writings [End Page 96] of Vergil and Varro, and his account of state revenues merely compiled information from the ancient sources as an end in itself. 8The drought was not ended until 1854, when Theodor Mommsen’s History of Rome not only devoted considerable attention to such subjects as agriculture, commerce, and... (shrink)

BackgroundThe phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice.Research aimTo explore the concept of moral (...) distress in nursing both empirically and conceptually.MethodologyFeminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis.Ethical considerationsThe study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom.FindingsThe empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas.DiscussionWe suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress.ConclusionThe empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’. (shrink)

This article highlights the limitations of the tendency to frame health- and wellbeing-related digital tools (mHealth technologies) as empowering devices, especially as they play an increasingly important role in the National Health Service (NHS) in the UK. It argues that mHealth technologies should instead be framed as digital companions. This shift from empowerment to companionship is advocated by showing the conceptual, ethical, and methodological issues challenging the narrative of empowerment, and by arguing that such challenges, as well as the risk (...) of medical paternalism, can be overcome by focusing on the potential for mHealth tools to mediate the relationship between recipients of clinical advice and givers of clinical advice, in ways that allow for contextual flexibility in the balance between patiency and agency. The article concludes by stressing that reframing the narrative cannot be the only means for avoiding harm caused to the NHS as a healthcare system by the introduction of mHealth tools. Future discussion will be needed on the overarching role of responsible design. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 87-90 [Access article in PDF] Phenomenological and Biological Psychiatry:Complementary or Mutual? James Morley Keywords: phenomenology, psychiatry, psychoanalysis, ontology. We feel that even if all possible scientific questions be answered the problems of life have still not been touched at all. (Witgenstein, Tractatus, 6.52) IF ONE WAS TO PERFORM a thought experiment by imagining a scientifically explained universe, how would this explained universe (...) resolve my issues of value and meaning? Would it help me to live a better life? In one sentence, Witgenstein expressed exactly the issues dividing, and defining, the phenomenological and biophysical approaches to psychiatry. (Natural) scientific questions are concerned with relations of physical causality while phenomenology is aimed at the problems of life, i.e., the elucidation of lived personal meanings.Clarifying the relation between phenomenology and the general psychiatric literature is clearly a significant undertaking. At this juncture in the history of psychiatry where the biophysical model is so dominant, the authors' efforts are especially welcome, as I wholeheartedly appreciate, and thank the authors for this endeavor. I only wish to explicate a few issues latent within the article and perhaps add a few supportive points. Explicitly or implicitly, the need for phenomenology in psychiatry is long enduring and will always persist (Ellenberger 1981, 1993). The integration of phenomenology with general psychiatric practice would certainly serve the needs of patients and society generally. But, in the present state of affairs where the biological model is so preeminent, a full accounting of the dramatic divergences between the two approaches is necessary if there is to be authentic dialogue between them.Essentially, I want to stress that phenomenology and natural science medicine are genuinely distinct paradigms for construing reality and organizing knowledge. As distinct scientific paradigms, each one is holistically self-contained. Like soap bubbles, if pushed together too forcefully one or the other may burst. In this case, it is more likely that the smaller, less prevalent paradigm would burst by becoming absorbed into the more dominant paradigm. I believe that this is precisely the risk when phenomenology is introduced to conventional psychiatry as "complementary." Whereas one could hardly object to any application of empathy and understanding toward the experiences of patients, it would be tragic if the [End Page 87] full philosophical power of phenomenology were to be overlooked in favor of its mere utility as a preliminary stage of diagnosis and assessment, a framework for bedside manners, or worst of all, an appendage to neuroscience or pharmacology. This would not be phenomenology but the very symptomatology that the authors have has so clearly distinguished from true phenomenology.This equation of phenomenology with symptomatology is exactly the misunderstanding that the authors so effectively address. However, I would hesitate to join the authors' optimism in regard to phenomenology's potential complementary role to conventional psychiatric practice. Furthermore, in the process of paradigm mix, certain constituents of each paradigm may be taken out of context and the strength of each paradigm thus diluted. For example, the very power of the experimental method is its reduction of phenomena to measurable variables that can be altered in order to discern causality. Unmeasurable variables detract form the rigor of this entire approach. Then on the other hand, phenomenological empathy is only possible within a standpoint that is severed from the causal thinking of experimental science. This is the holistic perceptual shift that cannot be accomplished when one only appends phenomenological insights to an otherwise materialist approach to psychiatry. Thus, it is not at all clear how one can be both phenomenological and nonphenomenologically natural scientific. Instead of positioning phenomenology as a potential complimentary component of natural-science psychiatry, both world views need to be examined, on their own terms, in a framework of mutuality.Empathy or the understanding of other peoples subjective experience is indeed an essential component of the application of phenomenology to clinical assessment and especially therapeutic treatment. But, to limit phenomenology to this theme alone may not honor the profoundly radical character of this paradigm. As the authors point out, phenomenology asks the practitioner to... (shrink)

Within this paper, we discuss Moral Distress Reflective Debriefs as a promising approach to address and mitigate moral distress experienced by healthcare professionals. We briefly review the empirical and theoretical literature on critical incident stress debriefing and psychological debriefing to highlight the potential benefits of this modality. We then describe the approach that we take to facilitating reflective group discussions in response to morally distressing patient cases (“Moral Distress Reflective Debriefs”). We discuss how the debriefing literature and other clinical ethics (...) activities influenced the development of our approach. In particular, we focus on the role of the clinical ethicist as a facilitator with particular emphasis on encouraging perspective-taking and nurturing ethical attunement in a supportive manner. We suggest that this approach reduces the narrowing effects of frustration and anger that are often reported when individuals experience moral-constraint distress. Finally, we provide an example of Moral Distress Reflective Debriefs, elucidating how this supportive process complements ethics consultation and can mitigate the negative effects of moral distress. (shrink)

As the range of potential uses for Artificial Intelligence (AI), in particular machine learning (ML), has increased, so has awareness of the associated ethical issues. This increased awareness has led to the realisation that existing legislation and regulation provides insufficient protection to individuals, groups, society, and the environment from AI harms. In response to this realisation, there has been a proliferation of principle-based ethics codes, guidelines and frameworks. However, it has become increasingly clear that a significant gap exists between the (...) theory of AI ethics principles and the practical design of AI systems. In previous work , we analysed whether it is possible to close this gap between the ‘what’ and the ‘how’ of AI ethics through the use of tools and methods designed to help AI developers, engineers, and designers translate principles into practice. We concluded that this method of closure is currently ineffective as almost all existing translational tools and methods are either too flexible (and thus vulnerable to ethics washing) or too strict (unresponsive to context). This raised the question: if, even with technical guidance, AI ethics is challenging to embed in the process of algorithmic design, is the entire pro-ethical design endeavour rendered futile? And, if no, then how can AI ethics be made useful for AI practitioners? This is the question we seek to address here by exploring why principles and technical translational tools are still needed even if they are limited, and how these limitations can be potentially overcome by providing theoretical grounding of a concept that has been termed ‘Ethics as a Service’. (shrink)

Reflecting the Past: Place, Language, and Principle in Japan’s Medieval Mirror Genre. By Erin L. Brightwell. Harvard East Asian Monograph Series, vol. 433. Cambridge, MA: Harvard University Asia Center, 2020. Pp. xiii + 327. $60.

Social work is a contested tradition, torn between the demands of social governance and autonomy. Today, this struggle is reflected in the division between the dominant, neoliberal agenda of service provision and the resistance offered by various critical perspectives employed by disparate groups of practitioners serving diverse communities. Critical social work challenges oppressive conditions and discourses, in addition to addressing their consequences in individuals’ lives. However, very few recent critical theorists informing critical social work have advocated revolution. A challenging exception (...) can be found in the work of Cornelius Castoriadis (1922–97), whose explication of ontological underdetermination and creation evades the pitfalls of both structural determinism and post-structural relativism, enabling an understanding of society as the contested creation of collective imaginaries in action and a politics of radical transformation. On this basis, we argue that Castoriadis’s radical-democratic revisioning of revolutionary praxis can help in reimagining critical social work’s emancipatory potential. (shrink)

While the phenomenon of ‘moral distress’ has been of interest to the nursing community since Jameton first described it in 1984, moral distress is now understood to effect healthcare professionals...

The World Health Organisation declared COVID-19 a global pandemic on 11th March 2020, recognising that the underlying SARS-CoV-2 has caused the greatest global crisis since World War II. In this chapter, we present a framework to evaluate whether and to what extent the use of digital systems that track and/or trace potentially infected individuals is not only legal but also ethical.

Austerity, by its very nature, imposes constraints by limiting the options for action available to us because certain courses of action are too costly or insufficiently cost effective. In the context of healthcare, the constraints imposed by austerity come in various forms; ranging from the availability of certain treatments being reduced or withdrawn completely, to reductions in staffing that mean healthcare professionals must ration the time they make available to each patient. As austerity has taken hold, across the United Kingdom (...) and Europe, it is important to consider the wider effects of the constraints that it imposes in healthcare. Within this paper, we focus specifically on one theorised effect—moral distress. We differentiate between avoidable and unavoidable ethical challenges within healthcare and argue that austerity creates additional avoidable ethical problems that exacerbate clinicians’ moral distress. We suggest that moral resilience is a suitable response to clinician moral distress caused by unavoidable ethical challenges but additional responses are required to address those that are created due to austerity. We encourage clinicians to engage in critical resilience and activism to address problems created by austerity and we highlight the responsibility of institutions to support healthcare professionals in such challenging times. (shrink)

This essay reconsiders the links between medicine, connoisseurship, and aesthetic theory in early eighteenth-century Britain. Taking a satire on the body of the physician and collector John Woodward as its starting point, I show that medicine and connoisseurship shared a deep preoccupation with the possibility that the animal body could excessively influence the workings of the mind. Pursuing this line of argument, moreover, I will reconsider the place of mind–body dualism in eighteenth-century British medicine and aesthetics. With the exception of (...) materialists such as the philosopher-physician Bernard Mandeville, medics and aesthetic theorists tended to identify the exercise of judgment with the operations of a disembodied mind, unsullied by the embodied mechanisms of the lower body. In practice, however, the insistence that the most refined forms of judgment depended on the presence and activity of a disembodied, immaterial soul was less meaningful than it seems. When confronted by failures of judgment, medics and connoisseurs alike sought explanations in the mechanisms of the animal body. Whether or not they believed in the immateriality of the soul, they pictured the mind as a malfunctioning animal machine, to be cured through the material agency of medical therapeutics. (shrink)

In July 2017, China’s State Council released the country’s strategy for developing artificial intelligence, entitled ‘New Generation Artificial Intelligence Development Plan’. This strategy outlined China’s aims to become the world leader in AI by 2030, to monetise AI into a trillion-yuan industry, and to emerge as the driving force in defining ethical norms and standards for AI. Several reports have analysed specific aspects of China’s AI policies or have assessed the country’s technical capabilities. Instead, in this article, we focus on (...) the socio-political background and policy debates that are shaping China’s AI strategy. In particular, we analyse the main strategic areas in which China is investing in AI and the concurrent ethical debates that are delimiting its use. By focusing on the policy backdrop, we seek to provide a more comprehensive and critical understanding of China’s AI policy by bringing together debates and analyses of a wide array of policy documents. (shrink)

It has been suggested that to overcome the challenges facing the UK’s National Health Service (NHS) of an ageing population and reduced available funding, the NHS should be transformed into a more informationally mature and heterogeneous organisation, reliant on data-based and algorithmically-driven interactions between human, artificial, and hybrid (semi-artificial) agents. This transformation process would offer significant benefit to patients, clinicians, and the overall system, but it would also rely on a fundamental transformation of the healthcare system in a way that (...) poses significant governance challenges. In this article, we argue that a fruitful way to overcome these challenges is by adopting a pro-ethical approach to design that analyses the system as a whole, keeps society-in-the-loop throughout the process, and distributes responsibility evenly across all nodes in the system. (shrink)

Healthcare systems across the globe are struggling with increasing costs and worsening outcomes. This presents those responsible for overseeing healthcare with a challenge. Increasingly, policymakers, politicians, clinical entrepreneurs and computer and data scientists argue that a key part of the solution will be ‘Artificial Intelligence’ (AI) – particularly Machine Learning (ML). This argument stems not from the belief that all healthcare needs will soon be taken care of by “robot doctors.” Instead, it is an argument that rests on the classic (...) counterfactual definition of AI as an umbrella term for a range of techniques that can be used to make machines complete tasks in a way that would be considered intelligent were they to be completed by a human. Automation of this nature could offer great opportunities for the improvement of healthcare services and ultimately patients’ health by significantly improving human clinical capabilities in diagnosis, drug discovery, epidemiology, personalised medicine, and operational efficiency. However, if these AI solutions are to be embedded in clinical practice, then at least three issues need to be considered: the technical possibilities and limitations; the ethical, regulatory and legal framework; and the governance framework. In this article, we report on the results of a systematic analysis designed to provide a clear overview of the second of these elements: the ethical, regulatory and legal framework. We find that ethical issues arise at six levels of abstraction (individual, interpersonal, group, institutional, sectoral, and societal) and can be categorised as epistemic, normative, or overarching. We conclude by stressing how important it is that the ethical challenges raised by implementing AI in healthcare settings are tackled proactively rather than reactively and map the key considerations for policymakers to each of the ethical concerns highlighted. (shrink)

Well-designed pragmatic clinical trials (PCTs) are critical for improving healthcare delivery and patient outcomes (Haff and Choudhry 2018), and the article written by Garland et al. (2023) advance...

An interpretation of the yoga practice of prāṇāyāma (breath control) that is influenced by the existential phenomenology of Merleau-Ponty is offered. The approach to yoga is less concerned with comparing his thought to the classical yoga texts than with elucidating the actual experience of breath control through the constructs provided by Merleau-Ponty's philosophy of the lived body. The discussion of yoga can answer certain pedagogical goals but can never finally be severed from doing yoga. Academic discourse centered entirely on the (...) theoretical concepts of yoga philosophies must to some extent remain incomplete. Patañjali's "Yoga Sūtra" is itself a manual of practice. For this reason, the commentary of the scholar-practitioner T. K. V. Desikachar has been chosen as the basis for this study, rather than a more exclusively theoretical commentary. In so doing, yoga will be approached as an experience or phenomenon, not just in the context of a series of academic debates. (shrink)

The idea of a role in nursing that includes expertise in ethics has been around for more than 30 years. Whether or not one subscribes to the idea that nursing ethics is separate and distinct from bioethics, nursing practice has much to contribute to the ethical practice of healthcare, and with the strong grounding in ethics and aspiration for social justice considerations in nursing, there is no wonder that the specific role of the nurse ethicist has emerged. Nurse ethicists, expert (...) in nursing practice and the application of ethical theories and concepts, are well positioned to guide nurses through complex ethical challenges. However, there is limited discussion within the field regarding the specific job responsibilities that the nurse ethicist ought to have. The recent appearance of job postings with the title “nurse ethicist” suggest that some healthcare institutions have identified the value of a nurse in the practice of ethics and are actively recruiting. Discomfort about the possibility of others defining the role of the nurse ethicist inspired this paper (and special issue). If the nurse ethicist is to be seen as an integral part of addressing ethical dilemmas and ethical conflicts that arise in healthcare, then nurse ethicists ought to be at the forefront of defining this role. In this paper, we draw upon our own experiences as nurse ethicists in large academic healthcare systems to describe the essential elements that ought to be addressed in a job description for a nurse ethicist practicing in a clinical setting linked to academic programs. Drawing upon our experience and the literature, we describe how we perceive the nurse ethicist adds value to healthcare organizations and teams of professional ethicists. (shrink)

While Jameton’s (1984) definition of moral distress has been embraced by researchers and scholars for recognizing the many constraints that nurses experience on their moral agency, it has also been...

Digital Health Tools (DHTs), also known as patient self-surveilling strategies, have increasingly been promoted by health-care policy makers as technologies that have the capacity to transform patients’ lives. At the heart of the debate is the notion of empowerment. In this paper, we argue that what is required is not so much empowerment but rather a shift to enabling DHTs as digital companions. This will enable policy makers and health-care system designers to provide a more balanced view—one that capitalises on (...) the benefits of DHTs, while minimising the risks of potential harms. -/- . (shrink)