Research on moral distress has paid limited attention to nurses’ responses and actions. In a survey of nurses’ perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and (...) distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an “inability to act due to institutional constraints” or a “failure to pursue a right course of action.” Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change. (shrink)

This edited collection recalls the events that led up to the Fitzgerald Inquiry and examines the extraordinary influence the ‘watershed' inquiry has had on police and public sector reform at the state, national and international levels.

This content analysis examines online accounts of choices of marital and child surnames to understand the predominance of exclusively patrilineal surnames. I demonstrate how surnaming processes present the classic tension between commitment to self and others as moral dilemmas of self versus family, children, and spouse. Social and cultural mechanisms create an either/or exclusive framing and a false dichotomy where women’s selves and others’ needs are incompatible. I also show how some parents reconceptualize family, children, and expectations for men and (...) women, which helps reconfigure dilemmas into a both/and inclusive framework and permits outcomes integrating self, family, children, and partnership. This study illustrates how maintaining a system that promotes giving fathers’ surnames to children as the only proper choice feeds the inertia of micro- and macro-structures that reflect and reinforce gendered differences in moral responsibility regarding self-sacrifice for family, children, and spouses. (shrink)

In evidence-based medicine (EBM), methodology has become the central means of determining the quality of the evidence base. The “gold standard” method, the randomised, controlled trial (RCT), imbues medical research with an ethos of disinterestedness; yet, as this essay argues, the RCT is itself a rhetorically interested construct essential to medical-professional boundary work. Using the example of debates about methodology in EBM-oriented research on complementary and alternative medicine (CAM), practices not easily tested by RCTs, I frame the problem of method (...) as a fundamentally rhetorical problem, situated within a boundary drama, and deeply rooted in the discursive practices of science and medicine. The genre of the RCT report, for example, idealises the research process and can tilt the course of arguments about CAM, while the notion of efficacy can function as a rhetorically mobile boundary object that can redefine the very terms of debate. I suggest herein that arguments about method in CAM debates can productively be read, metonymically, as expressions of more general anxieties in medicine about knowledge and evidence, community values, and professional boundaries; as such, these debates can illuminate some of the rhetorical dimensions of EBM. (shrink)

The purpose of this study was to assess student perceptions of self-plagiarism. Students at three university campuses offering graduate and undergraduate classes in a residential and online format were queried; 284 students responded. Overwhelmingly, students perceived they owned their own previous published works and over half reported they believed self-plagiarism should not be considered an academic honesty offense. Most faculty members did not provide information about self-plagiarism to their students. Only about one-fourth of the students reported recycling parts of an (...) assignment in the past. Students who took online courses were more likely to have been educated about self-plagiarism than those who took residential courses. Understanding students’ perceptions about academic honesty offenses such as plagiarism can help institutions develop effective policies and interventions. (shrink)

Many countries have attempted to transition to democracy following conflict or repression, but the basic meaning of transitional justice remains hotly contested. In this book, Colleen Murphy analyses transitional justice - showing how it is distinguished from retributive, corrective, and distributive justice - and outlines the ethical standards which societies attempting to democratize should follow. She argues that transitional justice involves the just pursuit of societal transformation. Such transformation requires political reconciliation, which in turn has a complex set of (...) institutional and interpersonal requirements including the rule of law. She shows how societal transformation is also influenced by the moral claims of victims and the demands of perpetrators, and how justice processes can fail to be just by failing to foster this transformation or by not treating victims and perpetrators fairly. Her book will be accessible and enlightening for philosophers, political and social scientists, policy analysts, and legal and human rights scholars and activists. (shrink)

In an effort to think through possible impossibilities, and enfold current problems within Catholicism into the luminous darkness of the cloud of the im/possible, this response to Catherine Keller's Cloud of the Impossible considers what might happen should Keller's cloud of mindful unknowing and nonseparable difference billow over and through one particular Catholic conundrum: how to respond to the terrifying reality of domestic violence in the context of a marriage defined as indissoluble, imperishable—inescapable.

Hegemonic masculinity, a framework where stereotypically masculine traits are over-emphasized, plays a central role in sport, partly due to an excessive focus on winning. This type of masculinity marginalizes those that do not possess specific traits, including many women and men. I argue sport reform focused on mitigating hypercompetitive attitudes can reduce this harmful and marginalizing hegemonic masculinity in sport. I make this argument first by challenging the dichotomous nature of sport, especially in recognizing that all outcomes are a blend (...) of winning and losing, that ties are relevant and informative outcomes to contests, and that winning and losing do not always tell accurate stories of the outcome. Secondly, I contend that expanding the potential outcomes in sport can help broaden the emphasis of competitive sport to take into account playing well and improving, in terms of both the test and the contest. I conclude that these reforms decrease hegemonic masculinity, making sport better for all. (shrink)

Abstract Medical futility is commonly understood as treatment that would not provide for any meaningful benefit for the patient. While the medical facts will help to determine what is medically appropriate, it is often difficult for patients, families, surrogate decision-makers and healthcare providers to navigate these difficult situations. Often communication breaks down between those involved or reaches an impasse. This paper presents a set of practical strategies for dealing with cases of perceived medical futility at a major cancer center. Content (...) Type Journal Article Pages 1-8 DOI 10.1007/s10730-011-9168-3 Authors Colleen M. Gallagher, Section for Integrated Ethics in Cancer Care, Unit 1430, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX 77230-1402, USA Ryan F. Holmes, St. Louis University, St. Louis, MO, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

In their article “Racial Justice Requires Ending the War on Drugs,” Earp, Lewis, and Hart argue for the end of our War on Drugs in order to alleviate our reliance on mass incarceration, harm...

Since the Supreme Court upheld the partial birth abortion ban in 2007, more U.S. abortion providers have begun performing intraamniotic digoxin injections prior to uterine dilation and evacuations. These injections can cause medical harm to abortion patients. Our objective is to perform an in-depth bioethical analysis of this procedure, which is performed mainly for the provider’s legal benefit despite potential medical consequences for the patient.

In the previous four papers in this series, individual versus structural or contextual factors have informed various understandings of moral distress. In this final paper, we summarize some of the key tensions raised in previous papers and use these tensions as springboards to identify directions for action among practitioners, educators, researchers, policymakers and others. In particular, we recognize the need to more explicitly politicize the concept of moral distress in order to understand how such distress arises from competing values within (...) power dynamics across multiple interrelated contexts from interpersonal to international. We propose that the same socio-political values that tend to individualize and blame people for poor health without regard for social conditions in which health inequities proliferate, hold responsible, individualize and even blame health care providers for the problem of moral distress. Grounded in a critical theoretical perspective of context, definitions of moral distress are re-examined and refined. Finally, recommendations for action that emerge from a re-conceptualized understanding of moral distress are provided. (shrink)

The Flint water crisis demonstrates the importance of adequate legal preparedness in dealing with complicated legal arrangements and multiple statutory responsibilities. It also demonstrates the need for alternative accountability measures when public officials fail to protect the public's health and explores mechanisms for restoring community trust in governmental public health.

Following extended periods of conflict or repression, political reconciliation is indispensable to the establishment or restoration of democratic relationships and critical to the pursuit of peacemaking globally. In this book, Colleen Murphy offers an innovative analysis of the moral problems plaguing political relationships under the strain of civil conflict and repression. Focusing on the unique moral damage that attends the deterioration of political relationships, Murphy identifies the precise kinds of repair and transformation that processes of political reconciliation ought to (...) promote. Building on this analysis, she proposes a normative model of political relationships. A Moral Theory of Political Reconciliation delivers an original account of the failure and restoration of political relationships, which will be of interest to philosophers, social scientists, legal scholars, policy analysts, and all those who are interested in transitional justice, global politics, and democracy. (shrink)

Susanne K. Langer contributed an exhaustive account of aesthetics, Feeling and Form, in which she articulated her schema of the virtual and wove together the aesthetic elements of music, visual arts, dance, and literature/theater. This analysis of her work centers on two key concepts within her philosophy: the virtual as the aesthetic effect of the work and the perception of the work through intuition. In this paper, I re-read Langers philosophy through a perspective built on intersections between phenomenology, pragmatism, and (...) post-structuralist theory in order to reveal the relevance of her work to current understandings of how the dancing body produces and conveys meaning. I endeavor to show how her work provides a practical, conceptual system for understanding dance as an a-linguistic form of meaning-making, bodily experience, and knowledge. (shrink)

A number of sport philosophers have noted the potential of sport as meaningful narrative and storytelling. While these arguments are convincing, they fail to acknowledge that not all athletes exper...

While ethical quandaries and dilemmas are commonplace for nurses, recent advances in human genetics have and will continue to create new challenges and controversies. Throughout time, nursing has been an ethical endeavour, with nurses viewing the ethical mandates of their responsibilities on a par with other core dimensions of their professional life. The profession’s code of ethics, Code for nurses with interpretive statements, provides direction for practice and for the fulfilment of ethical obligations. The explication of these ethical norms and (...) values that shape professional practice is necessary as nurses confront the integration of genetic services into health care. The goal of preserving professional integrity and ethical soundness in the context of genetic health care mandates that nurses rely on and act upon the profession’s national and international codes of ethics. (shrink)

Children at about age 18 months experience acceleration in word learning. This vocabulary explosion is a robust phenomenon, although the exact shape and timing vary from child to child. One class of explanations, which we term collectively as leveraged learning, posits that knowledge of some words helps with the learning of others. In this framework, the child initially knows no words and so learning is slow. As more words are acquired, new words become easier and thus it is the acquisition (...) of early words that fuels the explosion in learning. In this paper we examine the role of leveraged learning in the vocabulary spurt by proposing a simple model of leveraged learning. Our results show that leverage can change both the shape and timing of the acceleration, but that it cannot create acceleration if it did not exist in the corresponding model without leveraging. This model is then applied to the Zipfian distribution of word frequencies, which confirm that leveraging does not create acceleration, but that the relationship between frequency and the difficulty of learning a word may be complex. (shrink)

In this paper, we present a Capabilities-based Approach to the acceptability and the tolerability of risks posed by natural and man-made hazards. We argue that judgments about the acceptability and/or tolerability of such risks should be based on an evaluation of the likely societal impact of potential hazards, defined in terms of the expected changes in the capabilities of individuals. Capabilities refer to the functionings, or valuable doings and beings, individuals are able to achieve given available personal, material, and social (...) resources. The likely impact of a hazard on individuals’ capabilities should, we argue, be compared against two separate thresholds. The first threshold specifies the minimum level of capabilities attainment that is acceptable in principle for individuals to have in the aftermath of a hazard over any period of time. This threshold captures the level that individuals’ capabilities ideally should not fall below. A risk is acceptable if the probability that the attained capabilities will be less than the acceptable level is sufficiently small. In practice, it can be tolerable for some individuals to temporarily fall below the acceptable threshold, provided this situation of lower capabilities attainment is temporary, reversible, and the probability that capabilities will fall below a tolerability threshold is sufficiently small. This second, tolerable threshold delimits an absolute minimum level of capabilities attainment below which no individual in a society should ever fall, regardless of whether that level of capabilities attainment is temporary or reversible. In this paper, we describe and justify this Capabilitiesbased Approach to the acceptability and tolerability of risks. We argue that the proposed theoretical framework avoids the limitations in current approaches to.. (shrink)

Cognitive control constrains retrieval processing and so restricts what comes to mind as input to the attribution system. We review evidence that older adults, patients with Alzheimer's disease, and people with traumatic brain injury exert less cognitive control during retrieval, and so are susceptible to memory misattributions in the form of dramatic levels of false remembering.