The paper questions the effectiveness of the United Kingdom Central Council's (UKCC's) Code of Professional Conduct upon the moral climate of nursing. It challenges the claim that the empowerment of nurses is significantly enhanced by the Code or that it necessarily makes them more accountable for their practice. The position is taken that the Code, in the absence of an effective support network for whistle-blowers, places an unreasonable burden upon nurses in its exhortations to report unprofessional conduct. The paper acknowledges (...) the need to retain the Code, but with more modest claims being made concerning its empowering qualities. It is argued that unless more attention is focused on ways to support potential whistle-blowers, the Code will come to be seen as an irrelevance. Cet article met en question l'effet du Code du UKCC sur le climat moral des soins infirmiers. Il conteste l'affirmation que les infirmiers/ères sont considérablement plus fort à cause du Code ou qu'il les rend plus responsables dans leur pratique. La position est prise que le Code, en l'absence d'un réseau efficace de soutien pour les 'Whistleblowers' (personnes qui dévoilent un système), met un fardeau excessif sur les infirmiers/ères dans ses exhortations de signaler une conduite contraire au Code professionnel. Cet article reconnâit la nécessité de retenir le Code, mais avec des demandes plus modestes concernant ses pouvoirs de rendre fort. Il est soutenu que si non plus d'attention est concentré sur les moyens de soutenir les 'Whistlebowers', le Code va devenir hors de propos. Dieser Artikel bezweifelt die Wirksamkeit des Kodex des UKCC über das moralische Klima der Krankenpflege. Er stellt die Behauptung in Frage, dass der Kodex das Pflegepersonal bedeutend ermächtigt, oder dass er es mehr verantwortlich macht für seine Praxis. Die Position ist hier, dass der Kodex, in der Abwesenheit von effektiver Unterstützung für 'Whistleblowers' (d.h. Leute, die ein System verpfeifen), zu viel vom Pflegepersonal verlangt, in seiner Ermahnung, berufswidrige Praxis zu melden. Dieser Artikel anerkennt die Notwendigkeit, den Kodex zu behalten, aber mit kleineren Ansprüchen für seine ermächtigenden Qualitäten. Wenn nicht mehr Aufmerksamkeit gelegt wird, auf welche Weise die 'Whistleblowers' unterstützt werden können, dann wird der Kodex als eine Nebensächlichkeit verurteilt. (shrink)

A balance needs to be struck between facilitating compassionate access to innovative treatments for those in desperate need, and the duty to protect such vulnerable individuals from the harms of untested/unlicensed treatments. We introduced a principle-based framework to evaluate such requests and describe its application in the context of recently evolved UK, US and European regulatory processes. 24 referrals were received by our quaternary children's hospital Clinical Ethics Committee over the 5-year period. The CEC-rapid response group evaluated individual cases within (...) 48-hours; the main referrers being haematology/oncology, immunology or transplant services. Most requests were for drug/vaccine/pre-trial access or biological/cellular therapies. The majority of individual requests were approved ; neutral or negative opinions were given in 5, including 3 group requests. Recently evolved regulatory processes share common criteria and conditions to our framework including: demonstration of clinical need; sound scientific basis with lack of viable alternative; risks-benefit/best interests evaluation; arrangements for fully informed consent; no compromise of arrangements to test treatment for licensing purposes; consideration of resource implications. There are differences between individual processes and with our framework, with respect to procedures, scope, application format, costs and obligation to make available all outcome data. Our experience has emphasized the need for an independent, principled, consistent, fair and transparent response to the increasing demand for innovative treatment on a compassionate basis. We believe that there is a need for harmonization of the recent proliferation of regulation and legislation in this area. (shrink)

ABSTRACT Largely as a result of public outcry, legislation has recently been passed in the UK prohibiting the sale of bodily parts. This topic was the focus of a recent article in Journal of Applied Philosophy by Ruth Chadwick, which acknowledged that difficulties might exist in trying to distinguish between the selling of one's bodily organs and the selling of one's labour. The position argued for, in the ensuing discussion, is that there is no relevant moral difference between the two (...) acts. Furthermore it contests the view that the sale of bodily organs should necessarily be prohibited. The assertion is made that the legislation does little to prevent the general exploitation of the type of person likely to be involved in such transactions, places unnecessary restrictions on the autonomy of individuals, and does nothing to promote an enhanced moral attitude by health professionals. (shrink)

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses’ opinions of the content and function of codes and their use in nursing practice. A total of 49 focus (...) groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be ‘paper tigers’ with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice. (shrink)

Global health research partnerships have many benefits, including the development of research capacity and improving the production and use of evidence to improve global health equity. These partnerships also include many challenges, with power and resource differences often leading to inequitable and unethical partnership dynamics. Responding to these challenges and to important gaps in partnership scholarship, the Canadian Coalition for Global Health Research conducted a three-year, multi-regional consultation to capture the research partnership experiences of stakeholders in South Asia, Latin America, (...) and sub-Saharan Africa. The consultation participants described persistent inequities in the conduct of global health research partnerships and called for a mechanism through which to improve accountability for ethical conduct within partnerships. They also called for a commitment by the global health research community to research partnership ethics. The Partnership Assessment Toolkit is a practical tool that enables partners to openly discuss the ethics of their partnership and to put in place structures that create ethical accountability. Clear mechanisms such as the PAT are essential to guide ethical conduct to ensure that global health research partnerships are beneficial to all collaborators, that they reflect the values of the global health endeavor more broadly, and that they ultimately lead to improvements in health outcomes and health equity. (shrink)

In the UK an increasing number of Clinical Ethics Committees (CECs) have been developed mainly in response to local need and interest. Their functions include education of health professionals, of policy and guideline development, and case review (both retrospective analysis of topics and advice on acute cases). The UK Clinical Ethics Network, a charitable foundation provides CEC s with help, support and advice and enables them to share their experience The legal status of UK CECs is unclear but some legal (...) commentators have suggested that CECs lack competencies and procedural rules necessary for acute case review. The UKCEN has proposed core competencies for CECs that lists the ethical, operational and procedural skills, knowledge and personal attributes required and how they may be acquired, assessed and maintained. Their implementation might lead to the development of ethical and legal governance which should benefit to future patient care. (shrink)

WHAT DOES RESPECT REQUIRE OF RELIGIOUSLY MOTIVATED CITIZENS AS they support coercive public policies? In his recent work, Christopher Eberle argues against the doctrine of restraint, a norm that requires citizens to refrain from supporting laws for which public reasons are unavailable. Against Eberle, I defend the doctrine of restraint as a necessary corollary to liberal democratic respect. For this defense, I draw from one imaginary case, Robert Audi's example of "sacred dandelions" and laws banning lawn maintenance, and one real-world (...) dispute, current debates about same-sex marriage policies. I argue that the doctrine of restraint when coupled with an inclusive definition of public reason better accords with our intuitive sense of what respect requires in both cases. (shrink)

William James' investigation of religious experience neglected consideration of immortality. This was likely because, as James saw it, belief in personal immortality often engenders what can be called spiritual provincialism. In Human Immortality: Two Supposed Objections to the Doctrine (1897/1979), James brings up the phenomenon of psychological overload that occurs when an individual considers the immense numbers of humans who would inhabit Heaven if spiritual merit were determined democratically. Consideration of James' example shows the beginnings of his pragmatic notion of (...) immortality, one that is influenced by the religious philosophy of Henry James, Sr., and which focuses on the undeniable connections among people on earth rather than the immutable persistence of individual souls in Heaven. Those who have considered the implications of James' notion of immortality as it relates to the notion of worldly embeddedness include French writer Romain Rolland, who, inspired in part by the work of James, advocates a socialistic religious philosophy. With reference to Rolland and the elder James, as well as contemporary Christian pragmatist Cornel West, James' view can be more clearly understood. (shrink)

A majority of Americans say they are Christians. In fact, when you ask what they really believe about God you find that almost half are really deists. Let’s look at the data. A 2006 Pew survey reports that about 50 percent of Americans are Protestants and another 25 percent Catholics, which would indicate a strong Christian majority of 75 percent. Like most such surveys, however, Pew simply asked people to state their religious affiliations. A 2005 survey by Baylor University tried (...) something different and questioned people about what they actually believe. The results were surprising and have great significance in properly comprehending religious belief in the U.S. For some reason, they have received little attention. (shrink)

The Judeo-Christian tradition testifies to a God that cries out, demanding that justice "roll down like waters, righteousness like an ever-flowing stream" (Amos 5:24). Christians agree that being advocates for justice is critical to the Christian witness. And yet one need not look widely to see that Christians disagree about what social justice entails. What does justice have to do with healthcare reform, illegal immigration, and same-sex marriage? Should Christians support tax policies that effectively require wealthy individuals to fund programs (...) that benefit the poor? Does justice require that we acknowledge and address the inequalities borne out of histories of gender and ethnic exclusivity? Is the Christian vision distinct from non-Christian visions of social justice? Christians disagree over the proper answer to these questions. In short, Christians agree that justice is important but disagree about what a commitment to justice means. Christian Faith and Social Justice makes sense of the disagreements among Christians over the meaning of justice by bringing together five highly regarded Christian philosophers to introduce and defend rival perspectives on social justice in the Christian tradition. While it aspires to offer a lucid introduction to these theories, the purpose of this book is more than informative. It is purposefully dialogical and is structured so that contributors are able to model for the reader reasoned exchange among philosophers who disagree about the meaning of social justice. The hope is that the reader is left with a better understanding of range of perspectives in the Christian tradition about social justice. (shrink)

This essay considers more closely Nigel Biggar’s account of the role love plays in orienting and qualifying the moral experience of just warriors. The evidence that Biggar employs is highly selective and belies a more complex picture of the motivations of soldiers, the experience of killing, and the moral ends of training for modern warfare. This essay argues that a more ambivalent account of love can be reconciled more easily with recent research on the experience of moral injury among combat (...) veterans and is a more useful starting point for grounding the Christian community’s service to combat veterans. (shrink)

The need for dignity is frequently mentioned in policy documents relating to the care of the elderly. It is also described as an important value in professional codes. Yet concerns about the standards of care for an important number of elderly people abound, despite global ageing being a challenging phenomenon. Not least among these is how to ensure that the elderly will be able to live out their days with dignity.In the present paper, we begin with an empirical exploration of (...) the meaning of human dignity as experienced by older Europeans and their professional caregivers. Thereafter, we discuss the meaning and relevance of these empirical research findings from a care ethics perspective. (shrink)

: William James' investigation of religious experience neglected consideration of immortality. This was likely because, as James saw it, belief in personal immortality often engenders what can be called spiritual provincialism. In Human Immortality: Two Supposed Objections to the Doctrine (1897/1979), James brings up the phenomenon of psychological overload that occurs when an individual considers the immense numbers of humans who would inhabit Heaven if spiritual merit were determined democratically. Consideration of James' example shows the beginnings of his pragmatic notion (...) of immortality, one that is influenced by the religious philosophy of Henry James, Sr., and which focuses on the undeniable connections among people on earth rather than the immutable persistence of individual souls in Heaven. Those who have considered the implications of James' notion of immortality as it relates to the notion of worldly embeddedness include French writer Romain Rolland, who, inspired in part by the work of James, advocates a socialistic religious philosophy. With reference to Rolland and the elder James, as well as contemporary Christian pragmatist Cornel West, James' view can be more clearly understood. (shrink)

The management of child protection concerns arouses strong emotions and controversies and creates ethical tensions for all concerned. This paper provides a rational analysis of some of the issues involved and suggests responses to them. The ethical and legal duties of health-care professionals are to act in the best interests of the child by safeguarding children and reporting concerns. But this may involve conflicts with parents and produce reluctance of professionals to become involved, especially in controversial types of abuse. Mandatory (...) reporting of concerns might overcome such reluctance, but may be ineffective in the face of diagnostic uncertainties. Assembly of a stronger diagnostic evidence base would seem ethically justified, but organization of the necessary case controlled studies might be problematic. Even with a comprehensive evidence base, individual diagnoses of abuse will always involve value judgements that should be underpinned by effective training and assessment of core competencies of professionals. These manoeuvres are unlikely to prevent both justified and vexatious complaints, often in relation to breaches in professional duties or concerning professional misconduct. The tendency to blame experts may have contributed to a reluctance of other professionals to become involved, despite proposals for reforms in the expert witness and court systems. Current approaches to child protection may neither promote greater understanding nor be in the best interests of children. A revised social contract for the effective protection of children could include: a duty of care that adequately addresses the primacy of the child's welfare; the acquisition of a sound evidence base; professional transparency and accountability (but with protection from malicious and vexatious complaints); and a shift emphasis towards a more inquisitorial system that embraced the principles of truth and reconciliation. (shrink)

Since 1964, the Declaration of Helsinki has been accepted internationally as the cornerstone for research ethics. As such it has been incorporated into a number of guidance documents for research undertaken on human subjects. In 1999, the American Medical Association put forward a proposal for wide-ranging revision of the document, which would significantly weaken the rights of research subjects and lower the standards for research on human subjects. This article discusses the probable effects of the most significant proposals for change (...) and argues against them. It also urges nurses, especially those involved in research, to become involved in the international consultation currently being undertaken by the World Medical Association. (shrink)

In the study of Chinese thought, the products of the Han dynasty have historically been identified as those most antithetical to Western rationalism. In many of these narratives, the commentarial t...

Diogenes, Ahead of Print. In the study of Chinese thought, the products of the Han dynasty have historically been identified as those most antithetical to Western rationalism. In many of these narratives, the commentarial tradition and systems of complementary yin and yang receive the most attention. The present work draws on Mawangdui texts, the writings of Dong Zhongshu, the Huainanzi, and ultimately Heshanggong’s Commentary on the Daodejing to complexify this view. Within these examples one discovers divergent philosophies of opposites and (...) yin and yang that confound the notion of a monolithic and solely holistic Han cosmology. Ultimately, this paper seeks to promote Heshanggong’s Commentary as an exemplar of Eastern Han Daoist yin-yang theory that subdivides these two principles into mode and substance. Such an interpretive move explains the commentary’s valorization of yin modes but not yin substances, and yang substances but not yang modes. Furthermore, this approach unveils new insights about the relationship of the Dao and Heaven, the history of Daoism, and the varieties of correlative cosmologies in the Han. (shrink)

In the study of Chinese thought, the products of the Han dynasty have historically been identified as those most antithetical to Western rationalism. In many of these narratives, the commentarial t...

We outline a process, undertaken at a large tertiary children's hospital, intended to provide practical guidance and support for those involved in the management of children with life-limiting conditions. Initial discussions with representatives of clinical and support services identified communication problems and ethical dilemmas as key issues. These were further explored in multidisciplinary hospital meetings, culminating in a conference (Living Well, Dying Well) where individual perspectives - clinical, multi-faith, parental and legal - and cases were presented. Communication problems were found (...) to involve unrealistic expectations, failures of anticipation and difficulties in discussing sensitive issues, while ethical dilemmas arose from balancing burdens and benefits, clinical uncertainty, respecting autonomy and achieving equity and justice in delivery of care. An integrated service has been developed that is intended to provide clinical and spiritual care, psychosocial and ethical support, advice and mediation for children, families and staff, and to address the latter's educational and training needs. (shrink)

Caplan has argued that the philosophy of medicine does not exist. Although I will not deny the points he makes, I will argue that the philosophy of medicine has characteristics of a developing field with the potential to meet all of Caplan's criteria. The argument is based on Dewey's established views on logical development for a field of inquiry, as well as pointing out how other criteria Caplan imposes can be fulfilled.

Childbearing trans and nonbinary people are confronted with the heteronormative and cisgender frameworks that underpin “maternity” services. We explored the educational needs of 108 perinatal staff in the United Kingdom as related to the needs of trans and nonbinary service users. Participants were most confident in formulating care plans and least confident about the provision of colleagues’ perinatal care in this context. While the majority of participants were positive toward the trans and nonbinary communities, they considered that those communities remain (...) marginalized in perinatal services. Transphobic, anti-trans, and nonbinary attitudes were highlighted by our respondents. Our findings suggest that caregivers witnessed transphobia among colleagues and were apprehensive themselves about providing care to childbearing trans and nonbinary people. They reported a cisheteronormative model of care that lacked awareness of trans and nonbinary issues. The educational needs identified included information about the practicalities of childbearing as a trans or nonbinary person, how to use inclusive language effectively, and creating policies and processes for supporting childbearing trans and nonbinary people. These caregivers’ preferences included hearing from trans and nonbinary people and sharing best practices among themselves, with open discussions about how to be inclusive. (shrink)

Near the end of Nathaniel Hawthorne’s The Scarlet Letter, the Reverend Arthur Dimmesdale stands on the scaffold of shame and tears away his shirt to reveal something to the community. The narrator exclaims: “It was revealed! But it were irreverent to describe that revelation.”1 The actual manner in which this revelation is manifest is hidden, allowing readers to fill in the details. What is presumed, however, is that there indeed was some mark on the minister’s chest, and the narrator provides (...) three explanations, derived from eyewitnesses, as to how it came into existence. It was the result of Dimmesdale’s self-flagellation, or the effects of Chillingworth’s evil potions, or the seemingly supernatural transference .. (shrink)

Among theologians and philosophers in the American tradition, the idea of Hell is understood best through the works of Jonathan Edwards and William James. Both Edwards and James understood the idea of Hell as part of a worldview in which humans were humbled by their fallible nature. There are important differences between the views of Edwards and James, however, and these differences involve how each of them apprehends the suffering of other people. Edwards remains aesthetically aloof regarding the suffering of (...) others, while James remains tragically tied to such suffering. (shrink)

The best example of a Saturday Night Live (SNL) impressionist who goes beyond "spot on" to offer a creative impression is Dana Carvey. Just consider his impression of George H.W. Bush. Carvey performed Bush in cold opens and other sketches, developing a character that was not, in the ordinary sense of the term, spot on. To better understand the difference between creative representations and spot on representations, readers should consider for a moment the subject of music, and specifically the phenomenon (...) of tribute bands. A tribute band is one that attempts, as accurately as possible, to represent a famous band to a concert audience. Some might argue that Darrell Hammond was one of SNL's greatest impressionists, but the author argues that he was much like a tribute band. Hammond was available to offer a spot on impression of whomever the show might need for a given sketch. (shrink)

To discover a unifying theory of biology, it is necessary first to believe in its existence and second to seek its elements. Such a theory would explain the regulation of the cell cycle, differentiation and the origin of life. Some elements of the theory may be obtained by considering both eukaryotic and prokaryotic cell cycles. These elements include cytoskeletal proteins, calcium, cyclins, protein kinase C, phosphorylation, transcriptional sensing, autocatalytic gene expression and the physical properties of lipids. Other more exotic candidate (...) elements include the dynamic enzoskeleton, ATP generation, mechanotransduction, the piezoelectric effect and resonance. Bringing these disparate elements together — and discovering others — will require extensive collaborations between specialists from different sciences. This can only be achieved within the context of an integrated approach to biology. (shrink)

What is biological complexity? How many sorts exist? Are there levels of complexity? How are they related to one another? How is complexity related to the emergence of new phenotypes? To try to get to grips with these questions, we consider the archetype of a complex biological system, Escherichia coli. We take the position that E. coli has been selected to survive adverse conditions and to grow in favourable ones and that many other complex systems undergo similar selection. We invoke (...) the concept of hyperstructures which constitute a level of organisation intermediate between macromolecules and cells. We also invoke a new concept, competitive coherence, to describe how phenotypes are created by a competition between maintaining a consistent story over time and creating a response that is coherent with respect to both internal and external conditions. We suggest how these concepts lead to parameters suitable for describing the rich form of complexity termed hypercomplexity and we propose a relationship between competitive coherence and emergence. (shrink)

As do all forms of science, medical theories have a factual as well as a logical basis. New information is presented in medical research articles. These papers have three separate arguments: the argument of the hypothesis, the argument of the experimental protocol, and the argument of the hypothesis's judgment. These arguments may be examples of the hypothetico-deductive or confirmational model of scientific inference. The logical form of these arguments are informal and inductive rather than formal and deductive. Understanding the nature (...) of the logic of the medical research article may help avoid erroneous conclusions. (shrink)

Research involving human participants has been conducted in the Philippines since the beginning of the Spanish colonial period. Such studies are expected to adhere to internationally accepted ethical guidelines. This paper discusses trends in clinical research ethics in the Philippines during the American colonial period (1898‐1946). Specifically, studies were assessed on: 1) their observance of ethical protocols, including review; 2) identification of inclusion and exclusion criteria in the selection of participants; 3) use of vulnerable subjects; and 4) practice of the (...) informed consent process. Only the informed consent process had a significant logistic correlation with progression of years. Recruitment of vulnerable groups was common during this period; children and prisoners were the most common participants. Trends in medical ethics in the Philippines reflected those in the United States prior to the publication of the Nuremberg Code, which served as a milestone in the protection of human welfare in clinical research. (shrink)

By considering various case studies drawn from contemporary culture, I propose the idea of victim-blaming shaming, which, like victim blaming, involves replicating injustice by focusing attention on the particular situation rather than the general problem. In cases of victim-blaming shaming, a person is criticized for in any way addressing a problem by addressing the victim. Victim-blaming not only involves an inconsistent ethic, but because of this inconsistency promotes that which it opposes. It responds to a social problem by directing attention (...) to an individual within that problematic social situation. (shrink)

it seems like it would be easy to be a pragmatist and difficult to be a pacifist. In the commonsense understanding of "pragmatism," the term is nearly synonymous with "compromise," and compromise is usually thought to involve denying one's ideals in order to get things done. This could be getting things done for what is believed to be the common good, and both dictators and utilitarians can be called pragmatists. If it is said that a pragmatist sacrifices her ideals for (...) the sake of the greater good, this is a little misleading, since such sacrifice is merely an expression of one's natural disposition, and thus hardly tragic.On the other hand, "pacifism" is often understood to be a type of idealism, as the term is... (shrink)

"William James had always been attracted to interesting women," writes biographer Robert D. Richardson. "Women found him attractive too." He quickly notes that "there has never been so much as a breath of scandal about these friendships. . . . But even if James never ran off for a fling . . . James's women friends were an important part of his life." Yet James was spontaneous and reckless, "a natural philanderer, with a philanderer's lack of interest in settled arrangements" (...) (Richardson 353). What follows is not addressed to any potential scandal in James's personal life; it is, however, a response to what some might consider a scandal in James's professional life, namely, the close relationship that he had with .. (shrink)