Threats to the self and personhood of people with ADRD include the disturbing images of Alzheimer’s disease as the death before death, culturally based assumption that status as a full human being is dependent upon cognition and memory, and a decrease in personal possessions with a move to a 24-h care setting. This paper presents the findings of an ethnographic study of self and personhood in Alzheimer’s disease in an American long-term care facility. It argues that the lifeworld in which (...) the self and personhood of individuals with ADRD is actualized is mediated and negotiated through engagement with everyday objects. Using a framework that integrates Material Engagement Theory with Bourdieu’s Practice Theory, it is argued that the study of the material engagement of individuals with ADRD can lead to a better understanding of the lives of individuals with ADRD by focusing on the material and non-discursive aspects of objects. Findings contribute to the understanding of current practice issues in dementia care while shifting the focus away from exclusively biomedical understanding. Paradoxically, people with ADRD, due to their cognitive impairment, may provide us with a more fundamental way to understand the importance of objects in the lives of humans in general. (shrink)

Despite the familiarity of hope in human experience, it is a phenomenon infrequently considered from a philosophical point of view. This book charts the centrality of hope in thought and action from first, second and third person perspectives. From everyday situations to extreme circumstances of trail and endings in life, the contours of hope are given a phenomenological description and subjected to conceptual analysis. This consistently secular account of hope sheds a different light on questions of agency and meaning.

Background:Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions.Objectives:An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions.Review Methods:This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies.Results:Synthesis of the scientific literature revealed (...) inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions.Conclusion:Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended. (shrink)

In the literature of collective intentions, the ‘we-intentions’ that lie behind cooperative actions are analysed in terms of individual mental states. The core forms of these analyses imply that all Nash equilibrium behaviour is the result of collective intentions, even though not all Nash equilibria are cooperative actions. Unsatisfactorily, the latter cases have to be excluded either by stipulation or by the addition of further, problematic conditions. We contend that the cooperative aspect of collective intentions is not a property of (...) the intentions themselves, but of the mode of reasoning by which they are formed. We analyse collective intentions as the outcome of team reasoning, a mode of practical reasoning used by individuals as members of groups. We describe this mode of reasoning in terms of formal schemata, discuss a range of possible accounts of group agency, and show how existing theories of collective intentions fit into this framework. (shrink)

Drawing on recent findings in the cognitive and neurosciences, this article discusses how people manage to predict each other’s actions, which is fundamental for joint action. We explore how a common coding of perceived and performed actions may allow actors to predict the what, when, and where of others’ actions. The “what” aspect refers to predictions about the kind of action the other will perform and to the intention that drives the action. The “when” aspect is critical for all joint (...) actions requiring close temporal coordination. The “where” aspect is important for the online coordination of actions because actors need to effectively distribute a common space. We argue that although common coding of perceived and performed actions alone is not sufficient to enable one to engage in joint action, it provides a representational platform for integrating the actions of self and other. The final part of the paper considers links between lower‐level processes like action simulation and higher‐level processes like verbal communication and mental state attribution that have previously been at the focus of joint action research. (shrink)

Trolley problems have been used in the development of moral theory and the psychological study of moral judgments and behavior. Most of this research has focused on people from the West, with implicit assumptions that moral intuitions should generalize and that moral psychology is universal. However, cultural differences may be associated with differences in moral judgments and behavior. We operationalized a trolley problem in the laboratory, with economic incentives and real-life consequences, and compared British and Chinese samples on moral behavior (...) and judgment. We found that Chinese participants were less willing to sacrifice one person to save five others, and less likely to consider such an action to be right. In a second study using three scenarios, including the standard scenario where lives are threatened by an on-coming train, fewer Chinese than British participants were willing to take action and sacrifice one to save five, and this cultural difference was more pronounced when the consequences were less severe than death. (shrink)

This book presents a radical and intuitive argument against the notion that intentional action, agency and autonomy are features belonging only to humans. Using evidence from research into the minds of non-human animals, it explores the ways in which animals can be understood as individuals who are aware of themselves, and the consequent basis of our moral obligations towards them. The first part of this book argues for a conception of agency in animals that admits to degrees among individuals and (...) across species. It explores self-awareness and its various levels of complexity which depend on an animals’ other mental capacities. The author offers an overview of some established theories in animal ethics including those of Peter Singer, Tom Regan, Bernard Rollin and Lori Gruen, and the ways these theories serve to extend moral consideration towards animals based on various capacities that both animals and humans have in common. The book concludes by challenging traditional Kantian notions of rationality and what it means to be an autonomous individual, and discussing the problems that still remain in the study of animal ethics. (shrink)

Genetic modification of crop plants is frequently described by its proponents as a continuation of the ancient process of domestication. While domestication, crop breeding, and GM all modify the genomes and phenotypes of plants, GM fundamentally differs from domestication in terms of the biological and sociopolitical processes by which change occurs, and the subsequent impacts on agrobiodiversity and seed sovereignty. We review the history of domestication, crop breeding, and GM, and show that crop breeding and GM are continuous with each (...) other in many important ways, but represent a momentous break from domestication because they move plant evolution off of farms and into centralized institutions. The social contexts in which these processes unfold dictate who holds rights to germplasm and agricultural knowledge, shape incentives to effect particular kinds of changes in our crops, and create or constrict biodiversity. Presenting GM as a continuation of domestication puts forward a false equivalency that fundamentally misrepresents how domestication, crop breeding, and GM occur. In doing so, this narrative diminishes public understanding of these important processes and obscures the effects of industrial agriculture on in situ biodiversity and the practice of farming. This misrepresentation is used in public-facing science communication by representatives of the biotechnology industry to silence meaningful debate on GM by convincing the public that it is the continuation of an age-old process that underlies all agricultural societies. (shrink)

Universities and other research institutions are increasingly providing additional training in research integrity to improve the quality and reliability of research. Various training courses have been developed, with diverse learning goals and content. Despite the importance of training that focuses on moral character and professional virtues, there remains a lack of training that adopts a virtue ethics approach. To address this, we, a European Commission-funded consortium, have designed a train-the-trainer programme for research integrity. The programme is based on (1) virtue (...) ethics, (2) the ethos of science, (3) learning by doing and (4) learner-centred teaching. The blended learning programme combines e-learning modules with participatory group sessions. Trainers are taught how to guide researchers through a series of structured exercises for fostering reflection on scientific virtues, and how to promote understanding and application of the European Code of Conduct for Research Integrity. Trainers are provided with adaptable tools and resources that can be used and combined in different ways. The programme implementation began in Spring 2020 and 470 trainers have participated to date. When trainers were asked to grade – between 0 (very bad) and 10 (excellent) – the e-learning modules and the participatory exercises, 60% scored a grade 8 or higher (median = 8, IQR = 2) for the e-learning modules, whereas 80% scored a grade 8 or higher (median = 9, IQR = 1) for the participatory exercises. A majority felt that the training helped them as a trainer to learn about ways to organise and teach a research integrity course (82%) and would recommend the interactive exercises to others (92%). Trainers have educated over 3300 researchers in Europe using our virtue-based approach. The VIRT2UE train-the-trainer programme fosters research integrity by providing trainers with exercises and tools which enable them to stimulate the development of good researchers across Europe. (shrink)

This paper presents a novel view of the concept of cognitive enhancement by taking a population health perspective. We propose four main modifiable healthy lifestyle factors for optimal cognitive functioning across the population for which there is evidence of safety and efficacy. These include i) promoting adequate sleep, ii) increasing physical activity, iii) encouraging a healthy diet, including minimising consumption of stimulants, alcohol and other drugs including nicotine, iv) and promoting good mental health. We argue that it is not ethical (...) to promote or sanction the use of pharmaceutical drugs as putative cognitive enhancers without acknowledging the adverse effects on population cognitive health of failing to encourage the pursuit of healthy behaviours. We conclude with recommendations to increase the public health relevance of bioethical analyses of the cognitive enhancement debate. (shrink)

The concept of artificial intelligence is not new nor is the notion that it should be granted legal protections given its influence on human activity. What is new, on a relative scale, is the notion that artificial intelligence can possess citizenship—a concept reserved only for humans, as it presupposes the idea of possessing civil duties and protections. Where there are several decades’ worth of writing on the concept of the legal status of computational artificial artefacts in the USA and elsewhere, (...) it is surprising that law makers internationally have come to a standstill to protect our silicon brainchildren. In this essay, it will be assumed that future artificial entities, such as Sophia the Robot, will be granted citizenship on an international scale. With this assumption, an analysis of rights will be made with respect to the needs of a non-biological intelligence possessing legal and civic duties akin to those possessed by humanity today. This essay does not present a full set of rights for artificial intelligence—instead, it aims to provide international jurisprudence evidence aliunde ab extra de lege lata for any future measures made to protect non-biological intelligence. (shrink)

The diagnostic category of borderline personality disorder (BPD) has come under increasing criticism in recent years. In this paper, we analyze the role and impact of epistemic injustice, specifically testimonial injustice, in relation to the diagnosis of BPD. We first offer a critical sociological and historical account, detailing and expanding a range of arguments that BPD is problematic nosologically. We then turn to explore the epistemic injustices that can result from a BPD diagnosis, showing how they can lead to experiences (...) of testimonial injustice which impede patient engagement in meaning-making activities, thereby undermining standard therapeutic goals. We conclude by showing how our arguments bolster ongoing efforts to replace the diagnostic category of BPD with alternatives such as complex post-traumatic stress disorder. (shrink)

This book engages with some of the most pressing ethical issues that arise from the use of animals in various business practices, providing interdisciplinary approaches to improving the nonhuman and human lives in animal-related industries. The chapters in this volume provide conceptual, theoretical and practical analyses of these issues that will shape the future direction of business ethics to more fully reflect the impacts and implications of animal-based businesses on society, its members, and nature. The authors in this volume engage (...) with topics including animal suffering and emotions, the commodification of animals, vegetarian and vegan businesses and diets, technological innovations such as gene editing and lab-cultured meat, as well as captivity, corporate disclosure of animal welfare policies, and the possibility of humane jobs as well as the consideration of animals as stakeholders. (shrink)

This paper proposes a refocusing of consent for clinical genetic testing, moving away from an emphasis on autonomy and information provision, towards an emphasis on the virtues of healthcare professionals seeking consent, and the relationships they construct with their patients. We draw on focus groups with UK healthcare professionals working in the field of clinical genetics, as well as in-depth interviews with patients who have sought genetic testing in the UK’s National Health Service. We explore two aspects of consent: first, (...) how healthcare professionals consider the act of ‘consenting’ patients; and second how these professional accounts, along with the accounts of patients, deepen our understanding of the consent process. Our findings suggest that while healthcare professionals working in genetic medicine put much effort into ensuring patients’ understanding about their impending genetic test, they acknowledge, and we show, that patients can still leave genetic consultations relatively uninformed. Moreover, we show how placing emphasis on the informational aspect of genetic testing is not always reflective of, or valuable to, patients’ decision-making. Rather, decision-making is socially contextualised – also based on factors outside of information provision. A more collaborative on-going consent process, grounded in virtue ethics and values of honesty, openness and trustworthiness, is proposed. (shrink)

Feminist epistemologies hold that differences in the social locations of inquirers make for epistemic differences, for instance, in the sorts of things that inquirers are justified in believing. In this paper we situate this core idea in feminist epistemologies with respect to debates about social constructivism. We address three questions. First, are feminist epistemologies committed to a form of social constructivism about knowledge? Second, to what extent are they incompatible with traditional epistemological thinking? Third, do the answers to these questions (...) raise serious problems for feminist epistemologies? We argue that some versions of two of the main strands in feminist epistemology – feminist standpoint theory and feminist empiricism – are committed to a form of social constructivism, which requires certain departures from traditional epistemological thinking. But we argue that these departures are less problematic than one might think. Thus, (some) feminist epistemologies provide a plausible way of understanding how (some) knowledge might be socially constructed. (shrink)

The experiences of 90 individuals who self-identify as “excessive” or “maladaptive” fantasizers are summarized in this report. Our sample consisted of 75 female and 15 male participants, ranging in age from 18 to 63 who responded to online announcements. Participants completed a 14-question emailed survey requesting descriptions of their fantasy habits and causes of potential distress regarding fantasy. Results demonstrated that participants shared a number of remarkably specific behaviors and concerns regarding their engagement in extensive periods of highly-structured, immersive imaginative (...) experiences, including the use of kinesthetic activity which accompanies the fantasies of 79% of participants. Participants reported distress stemming from three factors: difficulty in controlling the need or desire to engage in fantasizing; concern that the quantity of fantasizing interfered with actual relationships and endeavors; and intense shame and exhaustive efforts to keep this behavior hidden from others. It is hoped that this report will encourage interest in this elusive syndrome. (shrink)

Conscience in World Religions is a unique collection of papers which allows the reader to compare and contrast the origins and development of the concept of conscience within different Christian traditions, Judaism, Islam, and Buddhism. The first part of the book, based upon extensive research of the Christian debate of conscience, explores the dynamic relation between authority, revelation, and education for both the individual and the community. It provides the reader with an insight into approaches to and interpretations of sources (...) found within Roman Catholicism, Protestantism, and Orthodoxy. The second part of the text provides an enthralling and scholarly study of the previously relatively unexplored Jewish, Islamic, and Buddhist viewpoints on the concept of conscience. This book is a thought-provoking collection for all those interested in exploring the many facets of this most fascinating of subjects. (shrink)

This collaborative essay experimentally applies the insights of Mary Shelley's 1818 gothic fantasy Frankenstein to clinical interactions between present-day physicians and the patients they, akin to Shelley's human protagonist, so often seem to bring to life. Because that process is frequently fraught with unspoken elements of ambivalence, disappointment, frustration, and failure, we find in Shelley's speculative fiction less a cautionary tale of overreach than a dynamic parable of the role that the unspoken, the invisible, and the unknown might play in (...) contemporary physician/patient relationships. Playing with that parable, we consider its relevance to four often unacknowledged dynamics that shape physician/patient interaction: commitment to a false binary of life and death; the tyranny of normative aesthetics; shared negative affect; and the ethics of care and care-denial. To "speak with Frankenstein" is, we show, to make space for the otherwise unspeakable. The result is a more complete model of narrative medicine that accommodates to its ideal of open communication and full attention the persistence of what cannot be said, seen, or known--only imagined and approximated. (shrink)

ABSTRACTAttentional bias to uncertain threat is associated with anxiety disorders. Here we examine the extent to which emotional face distractors and individual differences in intolerance of uncertainty, impact saccades in two versions of the “follow a cross” task. In both versions of the follow the cross task, the probability of receiving an emotional face distractor was 66.7%. To increase perceived uncertainty regarding the location of the face distractors, in one of the tasks additional non-predictive cues were presented before the onset (...) of the face distractors and target. We did not find IU to impact saccades towards non-cued face distractors. However, we found IU, over Trait Anxiety, to impact saccades towards non-predictive cueing of face distractors. Under these conditions, IU individuals’ eyes were pulled towards angry face distractors and away from happy face distractors overall, and the speed of this deviation of the eyes was determined by the combination of the c... (shrink)

Uncertainty and emotion are an inevitable part of everyday life and play a vital role in mental health. Yet, our understanding of how uncertainty and emotion interact is limited. Here, an online survey was conducted to examine whether uncertainty evokes and modulates a range of negative and positive emotions. The data show that uncertainty is predominantly associated with negative emotional states such as fear/anxiety. However, uncertainty was also found to modulate a variety of other negative and positive emotional states, depending (...) on the valence of an anticipated outcome and the sub parameter of uncertainty. Uncertainty increased the intensity of negative emotional states and decreased the intensity of positive emotional states. These findings support prior research suggesting that uncertainty is aversive and associated with negative emotional states such as fear and anxiety. However, the findings also revealed that uncertainty is involved in eliciting and modulating a wide array of emotional phenomena beyond fear and anxiety. This study highlights an opportunity for further study of how uncertainty and emotion interactions are conceptualised generally and in relation to mental health. (shrink)

The American Journal of Bioethics, Volume 12, Issue 6, Page 44-45, June 2012.

In this paper I make the case for a feminist hinge epistemology in three steps. My first step is to explain hinge epistemologies as contemporary epistemologies that take Wittgenstein’s work in On Certainty as their starting point. My second step is to make three criticisms of this literature as it currently stands. My third step is to introduce feminist epistemologies, which argue that social factors like race and gender affect what different people and groups justifiably believe, and argue that developing (...) a feminist hinge epistemology is both plausible and desirable. (shrink)

Background:Ethical conflict and subsequent nurse moral distress and burnout are common in the intensive care unit (ICU). There is a gap in our understanding of nurses’ perceptions of how organizational resources support them in addressing ethical conflict in the intensive care unit.Research question/objectives/methods:The aim of this qualitative, descriptive study was to explore how nurses experience ethical conflict and use organizational resources to support them as they address ethical conflict in their practice.Participants and research context:Responses to two open-ended questions were collected (...) from critical care nurses working in five intensive care units at a large, academic medical center in the Midwestern region of the United States.Ethical considerations:This study was approved by the Institutional Review Board at the organization where the study took place.Findings:Three main interwoven themes emerged: nurses perceive (1) intensive care unit culture, practices, and organizational priorities contribute to patient suffering; (2) nurses are marginalized during ethical conflict in the intensive care unit; and (3) organizational resources have the potential to reduce nurse moral distress. Nurses identified ethics education, interprofessional dialogue, and greater involvement of nurses as important strategies to improve the management of ethical conflict.Discussion:Ethical conflict related to healthcare system challenges is intrinsic in the daily practice of critical care nurses. Nurses want to be engaged in discussions about their perspectives on ethical conflict and play an active role in addressing ethical conflict in their practice. Organizational resources that support nurses are vital to the resolution of ethical conflict.Conclusion:These findings can inform the development of interventions that aim to proactively and comprehensively address ethical conflict in the intensive care unit to reduce nurse moral distress and improve the delivery of patient and family care. (shrink)

A shift towards more environmentally friendly and socially responsible food systems is a key step in the achievement of global sustainable development goals. To obtain significant results, however, it is essential to find participative ways to frame food sustainability objectives, so they can speak to a wide array of actors of change. This article addresses the promising potential of empowering actors across the food system to make a shift in their food choices, by facilitating the association of food sustainability values (...) with contemporary moral issues. In this context, a conceptual framework for a transition towards food sustainability is proposed, based upon the concept of the moral circle. This approach transcends the human-centred methods enacted in traditional sustainable development agendas, offering an alternative with a more holistic perspective. It is expected that emphasising moral reflection around sustainability might encourage societal participation in the creation of sustainable, fair and healthier food systems. (shrink)

A shift towards more environmentally friendly and socially responsible food systems is a key step in the achievement of global sustainable development goals. To obtain significant results, however, it is essential to find participative ways to frame food sustainability objectives, so they can speak to a wide array of actors of change. This article addresses the promising potential of empowering actors across the food system to make a shift in their food choices, by facilitating the association of food sustainability values (...) with contemporary moral issues. In this context, a conceptual framework for a transition towards food sustainability is proposed, based upon the concept of the moral circle. This approach transcends the human-centred methods enacted in traditional sustainable development agendas, offering an alternative with a more holistic perspective. It is expected that emphasising moral reflection around sustainability might encourage societal participation in the creation of sustainable, fair and healthier food systems. (shrink)

Information theory and statistical mechanics II.

Standard game theory cannot explain the selection of payoff-dominant outcomes that are best for all players in common-interest games. Theories of team reasoning can explain why such mutualistic cooperation is rational. They propose that teams can be agents and that individuals in teams can adopt a distinctive mode of reasoning that enables them to do their part in achieving Pareto-dominant outcomes. We show that it can be rational to play payoff-dominant outcomes, given that an agent group identifies. We compare team (...) reasoning to other theories that have been proposed to explain how people can achieve payoff-dominant outcomes, especially with respect to rationality. Some authors have hoped that it would be possible to develop an argument that it is rational to group identify. We identify some large—probably insuperable—problems with this project and sketch some more promising approaches, whereby the normativity of group identification rests on morality. (shrink)

Questions about when to limit unhelpful treatments are often raised in general medicine but are less commonly considered in psychiatry. Here we describe a survey of U.S. psychiatrists intended to characterize their attitudes about the management of suicidal ideation in patients with severely treatment-refractory illness. Respondents (n = 212) received one of two cases describing a patient with suicidal ideation due to either borderline personality disorder or major depressive disorder. Both patients were described as receiving all guideline-based and plausible emerging (...) treatments. Respondents rated the expected helpfulness and likelihood of recommending each of four types of intervention: hospitalization, additional medication changes, additional neurostimulation, and additional psychotherapy. Across both cases, most respondents said they were likely to provide each intervention, except for additional neurostimulation in borderline personality disorder, while fewer thought each intervention would be helpful. Substantial minorities of respondents indicated that they would provide an intervention they did not think was likely to be helpful. Our results suggest that while most psychiatrists recognize the possibility that some patients are unlikely to be helped by available treatments, many would continue to offer such treatments. (shrink)