Moral distress is one of the core topics of clinical ethics. Although there is a large and growing empirical literature on the psychological aspects of moral distress, scholars, and empirical investigators of moral distress have recently called for greater conceptual clarity. To meet this recognized need, we provide a philosophical taxonomy of the categories of what we call ethically significant moral distress: the judgment that one is not able, to differing degrees, to act on one’s moral knowledge about what one (...) ought to do. We begin by unpacking the philosophical components of Andrew Jameton’s original formulation from his landmark 1984 work and identify two key respects in which that formulation remains unclear: the origins of moral knowledge and impediments to acting on that moral knowledge. We then selectively review subsequent literature that shows that there is more than one concept of moral distress and that explores the origin of the values implicated in moral distress and impediments to acting on those values. This review sets the stage for identifying the elements of a philosophical taxonomy of ethically significant moral distress. The taxonomy uses these elements to create six categories of ethically significant moral distress: challenges to, threats to, and violations of professional integrity; and challenges to, threats to, and violations of individual integrity. We close with suggestions about how the proposed philosophical taxonomy of ethically significant moral distress sheds light on the concepts of moral residue and crescendo effect of moral distress and how the proposed taxonomy might usefully guide prevention of and future qualitative and quantitative empirical research on ethically significant moral distress. (shrink)

Incivility among physicians, between physicians and learners, and between physicians and nurses or other healthcare professionals has become commonplace. If allowed to continue unchecked by academic leaders and medical educators, incivility can cause personal psychological injury and seriously damage organisational culture. As such, incivility is a potent threat to professionalism. This paper uniquely draws on the history of professional ethics in medicine to provide a historically based, philosophical account of the professional virtue of civility. We use a two-step method of (...) ethical reasoning, namely ethical analysis informed by pertinent prior work, followed by identifying the implications of clearly articulated ethical concepts, to meet these goals. The professional virtue of civility and the related concept of professional etiquette was first described by the English physician-ethicist Thomas Percival (1740–1804). Based on a historically informed philosophical account, we propose that the professional virtue of civility has cognitive, affective, behavioural and social components based on a commitment to excellence in scientific and clinical reasoning. Its practice prevents a dysfunctional organisational culture of incivility and sustains a civility-based organisational culture of professionalism. Medical educators and academic leaders are in a pivotal and powerful position to role model, promote and inculcate the professional virtue of civility as essential to an organisational culture of professionalism. Academic leaders should hold medical educators accountable for discharge of this indispensable professional responsibility. (shrink)

Photocopy of typescript pages 203-250 of Theory and Methodology in Semiotics, v.26: 3-4, 1979 stapled in covers, 2 copies of the prefinal draft of Aug. 21 [1979] (1 in covers).

The Genesis of God: A Theological Genealogy. By Thomas J.J. Altizer. Louisville: Westminster/John Knox Press, 1993. pp.200.

This chapter examines the status of psychopathy as a scientific kind. I argue that the debate on the question whether psychopathy is a scientific kind as it is conducted at present (i.e., by asking whether psychopathy is a natural kind), is misguided. It relies too much on traditional philosophical views of what natural kinds (or: legitimate scientific kinds) are and how such kinds perform epistemic roles in the sciences. The paper introduces an alternative approach to the question what scientific (or: (...) natural) kinds are. On this alternative approach, the Grounded Functionality Account of natural kinds, psychopathy emerges as a “good” scientific kind that is best understood as a region on a multidimensional space of behaviors rather than as a traditional natural kind. (shrink)

Beginning with a Cuban Catholic ritual in Miami, this book takes readers on a momentous theoretical journey toward a new understanding of religion.

The dissertation explores the philosophical, literary, and stylistic similarities between the twentieth century American writer Sherwood Anderson and the nineteenth century Danish philosopher Soren Kierkegaard. These similarities suggest that the Ohio writer's work and aesthetic were deeply influenced by the Danish thinker, and the connection between them lies in the immigrant rural religious communities of the American Middle West. Ultimately, these interrelations reveal a "religious-aesthetic" unique to the entire range of Midwestern literature of the late-nineteenth and early-twentieth centuries, and they (...) also reveal a politics and an aesthetic of Midwestern art available yet today. (shrink)

An examination of Carnap's Aufbau in the context of Schlick's Allgemeine Erkenntnislehre of ten years earlier, suggests that Carnap's focus there on the sign-relation (Zeichenbeziehung) is an effort to retrieve a verificationist account of the meaning of individual scientific statements from the abyss of meaning-holism entailed by Schlick's proposal that scientific concepts be implicitly defined. The Aufbau's antipodal aspects, its reductive phenomenalism and quasi-Kantian concern with the constitution of objectivity, are seen as complementary moments of the marriage of empiricism and (...) a new emphasis on scientific concepts as "free creations of the human mind". (shrink)

Planned home birth has been considered by some to be consistent with professional responsibility in patient care. This article critically assesses the ethical and scientific justification for this view and shows it to be unjustified. We critically assess recent statements by professional associations of obstetricians, one that sanctions and one that endorses planned home birth. We base our critical appraisal on the professional responsibility model of obstetric ethics, which is based on the ethical concept of medicine from the Scottish and (...) English Enlightenments of the 18th century. Our critical assessment supports the following conclusions. Because of its significantly increased, preventable perinatal risks, planned home birth in the United States is not clinically or ethically benign. Attending planned home birth, no matter one’s training or experience, is not acting in a professional capacity, because this role preventably results in clinically unnecessary and therefore clinically unacceptable perinatal risk. It is therefore not consistent with the ethical concept of medicine as a profession for any attendant to planned home birth to represent himself or herself as a “professional.” Obstetric healthcare associations should neither sanction nor endorse planned home birth. Instead, these associations should recommend against planned home birth. Obstetric healthcare professionals should respond to expressions of interest in planned home birth by pregnant women by informing them that it incurs significantly increased, preventable perinatal risks, by recommending strongly against planned home birth, and by recommending strongly for planned hospital birth. Obstetric healthcare professionals should routinely provide excellent obstetric care to all women transferred to the hospital from a planned home birth. The professional responsibility model of obstetric ethics requires obstetricians to address and remedy legitimate dissatisfaction with some hospital settings and address patients’ concerns about excessive interventions. Creating a sustained culture of comprehensive safety, which cannot be achieved in planned home birth, informed by compassionate and respectful treatment of pregnant women, should be a primary focus of professional obstetric responsibility. (shrink)

A major issue in philosophical debates on the species problem concerns the opposition between two seemingly incompatible views of the metaphysics of species: the view that species are individuals and the view that species are natural kinds. In two recent papers in this journal, Olivier Rieppel suggested that this opposition is much less deep than it seems at first sight. Rieppel used a recently developed philosophical account of natural kindhood, namely Richard Boyd’s “homeostatic property cluster” theory, to argue that every (...) species taxon can be conceived of as an individual that constitutes the single member of its own specific natural kind. In this paper I criticize Rieppel’s approach and argue that it does not deliver what it is supposed to, namely an account of species as kinds about which generalized statements can be made. (shrink)

This work argues for the need to close the gap between the fields of the philosophy of religion and religious studies. Thomas A. Lewis takes up what, in recent years, has often been seen as a fundamental reason for excluding religious ethics and philosophy of religion from religious studies: their explicit normativity. Against this presupposition, Lewis argues that normativity is pervasive--not unique to ethics and philosophy of religion--and therefore not a reason to exclude them from religious studies. He bridges (...) more philosophical and historical subfields by arguing for the importance of history to the philosophy of religion. He considers the future of religious ethics, explaining that the field as whole should learn from the methodological developments associated with recent work in comparative religious ethics and 'comparative religious ethics' should no longer be conceived as a distinct subfield. The concluding chapter engages broader, post-9/11 arguments about the importance of studying religion, arguing that prominent contemporary notions of 'religious literacy' actually hinder our ability to grasp the significance of religion and impact in the world today. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 59-61, December 2011.

On February 3, 2010, a “Letter of Concern from Bioethicists,” organized by fetaldex.org, was sent to report suspected violations of the ethics of human subjects research in the off-label use of dexamethasone during pregnancy by Dr. Maria New. Copies of this letter were submitted to the FDA Office of Pediatric Therapeutics, the Department of Health and Human Services (DHHS) Office for Human Research Protections, and three universities where Dr. New has held or holds appointments. We provide a critical appraisal of (...) the Letter of Concern and show that it makes false claims, misrepresents scientific publications and websites, fails to meet standards of evidence-based reasoning, makes undocumented claims, treats as settled matters what are, instead, ongoing controversies, offers “mere opinion” as a substitute for argument, and makes contradictory claims. The Letter of Concern is a case study in unethical transgressive bioethics. We call on fetaldex.org to withdraw the letter and for co-signatories to withdraw their approval of it. (shrink)

BackgroundDespite rapid growth of the scientific literature, no consensus guidelines have emerged to define the optimal criteria for editors to grade submitted manuscripts. The purpose of this project was to assess the peer reviewer metrics currently used in the surgical literature to evaluate original manuscript submissions.MethodsManuscript grading forms for 14 of the highest circulation general surgery-related journals were evaluated for content, including the type and number of quantitative and qualitative questions asked of peer reviewers. Reviewer grading forms for the seven (...) surgical journals with the higher impact factors were compared to the seven surgical journals with lower impact factors using Fisher’s exact tests.ResultsImpact factors of the studied journals ranged from 1.73 to 8.57, with a median impact factor of 4.26 in the higher group and 2.81 in the lower group. The content of the grading forms was found to vary considerably. Relatively few journals asked reviewers to grade specific components of a manuscript. Higher impact factor journal manuscript grading forms more frequently addressed statistical analysis, ethical considerations, and conflict of interest. In contrast, lower impact factor journals more commonly requested reviewers to make qualitative assessments of novelty/originality, scientific validity, and scientific importance.ConclusionSubstantial variation exists in the grading criteria used to evaluate original manuscripts submitted to the surgical literature for peer review, with differential emphasis placed on certain criteria correlated to journal impact factors. (shrink)

The most interesting, and problematic, claim made by film-philosophy, for me, is the proposition that film thinks. This claim is interesting because it asserts that film has something philosophical to offer that philosophy itself lacks. It is problematic because we tend to think that where there is thinking, there must be a someone doing that thinking. And whatever film is, it is not a someone. This paper brings Karl Poppers model of objective knowledge what he calls knowledge in the absence (...) of a knowing subject to bear on the proposition that film thinks, in order to sketch out an account of film as a process of objective thinking distinct from that of philosophy or any other merely human mode of thought. (shrink)

This essay offers a diagnosis of what may be at stake in the current preoccupation with defining science‐based educational research. The diagnosis unfolds in several readings: The first is a charitable and considerate appraisal that draws attention to the fact that advocating experimental methods as important to a science of educational research is not an inherently evil thing to do. Subsequent readings are grimmer, suggesting more deleterious consequences of the science‐based research movement for the entire enterprise of educational practice and (...) research. The central thesis of the essay is that making arguments about method and science the focal point in the current quarrel may be largely beside the point. Instead, educational researchers should join the political and public conversation about the place of educational science in society and about how science is both implicated in and confronts the politics of what counts as knowledge. (shrink)

In Civic Liberalism, prominent political theorist Thomas A. Spragens, Jr. asserts that most versions of democratic ideals—libertarianism, liberal egalitarianism, difference liberalism, and the liberalism of fear—lead our polity significantly astray. Spragens offers another alternative. He argues that we should recover the multiple and complex aspirations found within the tradition of democratic liberalism and integrate them into a more compelling public philosophy for our time—or what he calls civic liberalism.

Since March of 2020, the world has been brought to its knees by unscientific and unethical mandates. These mandates have destroyed the world economy and the lives of countless innocent individuals. The “cure” that has been offered by medical bureaucrats and politicians has been more deadly than the disease (COVID-19). The imposition of ludicrous lockdowns, mask-wearing, coerced vaccination, and vaccine passports have not only proved to be ineffective, but also much more harmful than SARS-CoV-2 and all its variants. COVID-19 has (...) a recovery rate of close to 99% for most of the world’s population, however, despite this, institutions and power-hungry individuals have trampled upon our civil liberties and ignored our inalienable human rights. It is precisely as Thomas Paine famously stated: “The greatest tyrannies are always perpetrated in the name of the noblest causes.” -/- Many lives have been gratuitously lost because of the administration of deadly medical treatments, and the rejection of effective treatments that follow genuine science. In the process, informed consent has been disparaged and desecrated. For over two years, we were instructed to “trust the science,” but the “science” advocated by medical bureaucrats and greedy politicians was the reason why the world was turned upside-down. In the face of these crimes against humanity, justice will only be brought by real courts and real judges, but this will require the awakening of a critical mass. This book serves as an instrument for this awakening. (shrink)