By the late 1980s, Government and Binding Theory - which was central to almost all research in generative grammar - threatened to become as large and as intricate as the language it described. To counter this, Noam Chomsky introduced a minimalist program with the aim of making explanations of language as simple and general as possible. It has since gained widespread acceptance, to the extent that the most recent first-year textbook in syntax is based on it. One of the areas (...) subjected to this minimalist scrutiny has been phrase structure, the fundamental basis of grammar. This book focuses on the most controversial area of phrase structure, the notion of specifiera notion encompassing the traditional categories of subjects, possessors, determiners, auxiliaries, and adjuncts. It examines what place the notion has in the new theory and how the projection of specifiers is to be eliminated or extended. The contributors draw on empirical, theoretical research in cross-linguistic phenomena and first and second language acquisition. The substantial introductory chapter provides an up-to-date account of minimalist syntactic theory and a critical evaluation of the notion of specifier within it. (shrink)

In this paper, we consider how the notion of metalinguistic negotiation interacts with various theories of generics. The notion of metalinguistic negotiation we discuss stems from previous work from two of us (Plunkett and Sundell). Metalinguistic negotiations are disputes in which speakers disagree about normative issues concerning language, such as issues about what a given word should mean in the relevant context, or which of a range of related concepts a word should express. In a metalinguistic negotiation, speakers argue (...) about such issues implicitly, via competing “metalinguistic” usages of terms. Here, we argue that some disputes involving generics are best thought of as metalinguistic negotiations, and that these cases can be illuminating for our more general theorizing about generics. Specifically, we argue that the “contextualist” theory of generics that one of us (Sterken) has developed in other work is best equipped to account for these metalinguistic negotiations, relative to other leading views of generics. We thus argue for a “package deal” view of generics: a view that combines Plunkett and Sundell’s account of metalinguistic negotiation with Sterken’s contextualist view of generics. (shrink)

Zusammenfassung In diesem Aufsatz wird erstens der Frage nach den gesellschaftlichen Umgangsweisen von europäischen Gesellschaften der Neuzeit mit religiös gerahmter, weiblicher Nahrungsabstinenz nachgegangen. Zweitens werden Überlegungen dahingehend angestellt, welche Bedingungen und Faktoren für die Persistenz dieser relativ marginalisierten Praxis im untersuchten Zeitraum ausgemacht werden können. Dabei wird in der Argumentation für einen wissensgeschichtlichen Ansatz plädiert. Mit diesem Instrumentarium können u. a. auch hybride Erklärungsweisen der historischen Akteure rekonstruiert werden, die nicht einfach den Kategorien „natürlich“ bzw. „übernatürlich“ zugeordnet werden können. Der (...) Gegenstand der Fallstudie sind nahrungsabstinente Katholikinnen Westeuropas im Zeitraum von 1780 bis 1980. Nahrungsabstinenz hat dabei auf der objektsprachlichen Ebene sowohl die Bedeutung von Nicht-essen können oder wollen bis hin zur völligen Abwesenheit des Bedürfnisses nach „irdischer“ Nahrung. (shrink)

One important trend in political philosophy is to hold that non-human animals don't directly place demands of justice on us. Another important trend is to give considerations of justice normative priority in our general normative theorising about social/political institutions. This situation is problematic, given the actual ethical standing of non-human animals. Either we need a theory of justice that gives facts about non-human animals a non-derivative explanatory role in the determination of facts about what justice involves, or else we should (...) be wary of the default normative priority that considerations of justice have in much of contemporary political philosophy. This discussion brings out important general methodological points tied to the role of concept and word choice in normative theorising about our social/political institutions. These methodological points, I argue, matter for a range of discussions in contemporary political philosophy, including those about global justice. (shrink)

Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley’s Moral Distress Scale and Olson’s Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely (...) correlated with perceptions of ethical climate. Each of the HECS factors (peers, patients, managers, hospitals and physicians) was found to be significantly correlated with moral distress. Based on these findings, we highlight insights for practice and future research that are needed to enhance the development of strategies aimed at improving the ethical climate of nurses’ workplaces for the benefit of both nurses and patients. (shrink)

How does our conception of possibility contribute to our understanding of self and world? In what sense does the possible differ from the merely probable, and what would it mean to treat possibility as part of the real? This book is an opportunity to see Kierkegaard as contributing to a distinctive phenomenology, ontology, and psychology of possibility that addresses the question of our existential relationship to the possible. The term 'possibility' (Mulighed) and its variants occur with curious frequency across Kierkegaard's (...) writings. Key to Kierkegaard's understanding of the self, possibility is linked to a number of core concepts in his works: from imagination, anxiety, despair, and 'the moment' to the idea in The Sickness Unto Death that “God is that all things are possible”. Responding to what he sees as a Hegelian and Aristotelian misunderstanding of possibility, Kierkegaard offers a novel reading of the possible that, in turn, directly influences 20th-century philosophers such as Heidegger, Deleuze, and Derrida. Kierkegaard gives a rich account of how anxiety and despair, as lived experiences of possibility, not only show us the contingency and fragility of the systems and identities we presently inhabit but also reveal a more fundamental contingency that demands a new way of relating to the possible. For Kierkegaard, hope, faith, and love are attitudes in which meaning is forged by embracing contingency. In a time of political, social, and environmental uncertainty Kierkegaard's work on radical possibility seems more relevant than ever. (shrink)

Take “legal reality” to be the part of reality that actual legal thought and talk is dis- tinctively about, such as legal institutions, legal obligations, and legal norms. Our goal is to explore whether legal reality is disunified. To illustrate the issue, consider the possibility that an important metaphysical thesis such as positivism is true of one part of legal reality (legal institutions), but not another (legal norms). We offer two arguments that suggest that legal reality is disunified: one concerns (...) the heteroge- neity of different entities that are part of legal reality; the other concerns variation within legal thought and talk. We then show that taking the possibility of the disunity of legal reality seriously has important upshots for how we think about the positivist and antipositivist traditions, the debate between them, and their relation to other parts of legal theory, such as critical legal theory and legal realism. (shrink)

Conceptual engineering and conceptual ethics are branches of philosophy concerned with questions about how to assess and ameliorate our representational devices (such as concepts and words). It's a part of philosophy concerned with questions about which concepts we should use (and why), how concepts can be improved, when concepts should be abandoned, and how proposals for amelioration can be implemented. Central parts of the history of philosophy have engaged with these issues, but the focus of this volume is on applications (...) to work in contemporary philosophy of language and mind, epistemology, gender and race theory, ethics, philosophy of science, and philosophical logic. This is the first volume devoted entirely to conceptual engineering and conceptual ethics. The volume explores the possibilities, benefits, problems, and applications of conceptual engineering and conceptual ethics. It consists of twenty chapters written by leading philosophers. (shrink)

The question of what it means to love the dead touches both our relationships to specific others and our relationship to history as such. To address the question at the level of the individual, I examine Søren Kierkegaard’s account of loving the dead as a non-reciprocal love that deepens the consciousness of the lover. I then re-examine reciprocity within a phenomenological framework of being for others, specifically Jan Patočka’s account in “Phenomenology of Afterlife”. With a better understanding of what it (...) means to remain open to the other who has died and of how the other lives on through me, I turn to Kierkegaard and Patočka’s combined reflections on relating to historical events and on the meaning of history for the present, drawing from Kierkegaard’s idea of “becoming contemporary with” the past and Patočka’s philosophy of history. (shrink)

In recent years, there has been growing discussion amongst philosophers about “conceptual engineering”. Put roughly, conceptual engineering concerns the assessment and improvement of concepts, or of other devices we use in thought and talk (e.g., words). This often involves attempts to modify our existing concepts (or other representational devices), and/or our practices of using them. This paper explores the relation between conceptual engineering and conceptual ethics, where conceptual ethics is taken to encompass normative and evaluative questions about concepts, words, and (...) other broadly “representational” and/or “inferential” devices we use in thought and talk. We take some of the central questions in conceptual ethics to concern which concepts we should use and what words should mean, and why. We put forward a view of conceptual engineering in terms of the following three activities: conceptual ethics, conceptual innovation, and conceptual implementation. On our view, conceptual engineering can be defined in terms of these three activities, but not in a straightforward, Boolean way. Conceptual engineering, we argue, is made up of mereologically complex activities whose parts fall into the categories associated with each of these three different activities. (shrink)

Which concepts should we use to think and talk about the world and to do all of the other things that mental and linguistic representation facilitates? This is the guiding question of the field that we call ‘conceptual ethics’. Conceptual ethics is not often discussed as its own systematic branch of normative theory. A case can nevertheless be made that the field is already quite active, with contributions coming in from areas as diverse as fundamental metaphysics and social/political philosophy. In (...) this pair of papers, we try to unify the field, reflecting on its basic nature, structure, and methodology. (shrink)

In this Introduction, we aim to introduce the reader to the basic topic of this book. As part of this, we explain why we are using two different expressions (‘conceptual engineering’ and ‘conceptual ethics’) to describe the topics in the book. We then turn to some of the central foundational issues that arise for conceptual engineering and conceptual ethics, and finally we outline various views one might have about their role in philosophy and inquiry more generally.

Summary With regard to the dynamics of human experience and behavior, Gestalt theoretical psychotherapy (GTP) relies mainly on Kurt Lewin’s dynamic field theory of personality. GTP is carried out by including a re-interpretation of Lewin’s theory in some aspects of psychotherapeutic practice in relation to critical realism. Human experience and behavior are understood to be functions of the person and the environment (including the other individuals therein) in a psychic field (life space), which encompasses both of these mutually dependent factors. (...) The anthropological model of this approach is, therefore, not mono-personal but, a priori, structural and relational in nature. It does not one-sidedly focus on the “inner components” of a person, but on the interrelation of the individual and a given environment, which affects experience and behavior. After a brief introduction of these basic concepts, this lecture will focus especially on Lewin’s concept of tension-systems, which may be considered as the Gestalt theoretical counterpart of Freud’s drive theory. Further, we define the basic assumptions which underlie GTP and explain how the person moves through her/his life experience in terms of Gestalt psychology. (shrink)

Family members do not have an official position in the practice of euthanasia and physician assisted suicide in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could serve as a starting point (...) for further empirical and ethical inquiry. A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families’ experiences and grief after EAS. 4) Family and ‘the good euthanasia death’ according to Dutch physicians. Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making. (shrink)

Approaches to business ethics can be roughly divided into two streams: ‹codes of behavior’ and ‹forms of subjectification’, with code-oriented approaches clearly dominating the field. Through an elaboration of poststructuralist approaches to moral philosophy, this paper questions the emphasis on codes of behaviour and, thus, the conceptions of the moral and responsible subject that are inherent in rule-based approaches. As a consequence of this critique, the concept of a practice-based ‹ethics of responsiveness’ in which ethics is never final but rather (...) always ‹to come’, is investigated. In such an approach the ethical self is understood as being continuously constituted within power/knowledge relations. Following this line, we ask how one can become a responsible subject while also acknowledging certain limits of full responsibility. We thereby explore responsibility as a considered but unconditional openness in response to the other. (shrink)

Which concepts should we use to think and talk about the world and to do all of the other things that mental and linguistic representation facilitates? This is the guiding question of the field that we call ‘conceptual ethics’. Conceptual ethics is not often discussed as its own systematic branch of normative theory. A case can nevertheless be made that the field is already quite active, with contributions coming in from areas as diverse as fundamental metaphysics and social/political philosophy. In (...) this pair of papers, we try to unify the field, reflecting on its basic nature, structure, and methodology. (shrink)

L’itinéraire de Jeanne Kœhler-Lumière l’a conduite de la philanthropie à la collaboration avec les pouvoirs publics pour la réalisation d’une politique sociale à Lyon après la Première Guerre mondiale. Fille et sœur d’industriels, elle participe aux œuvres mises en place pour le personnel de l’usine familiale, puis élargit son action en faveur de l’enfance à l’échelle de la ville. Cependant, l’ancrage de la famille Lumière dans le camp de la République laïque isole Jeanne Kœhler-Lumière des milieux traditionnels de la philanthropie (...) conservatrice et catholique. La guerre constitue un tournant durant lequel elle s’engage dans les services de santé, travaillant avec des sommités du monde médical lyonnais. Son expérience et sa notabilité lui valent dans les années 1920 d’être sollicitée par la municipalité radicale en quête de compétences pour impulser une politique sociale. Dame d’œuvres puis ambassadrice du social, Jeanne Kœhler-Lumière illustre une forme originale de participation des femmes à la vie politique. (shrink)

Which concepts should we use to think and talk about the world, and to do all of the other things that mental and linguistic representation facilitates? This is the guiding question of the field that we call ‘conceptual ethics’. Conceptual ethics is not often discussed as its own systematic branch of normative theory. A case can nevertheless be made that the field is already quite active, with contributions coming in from areas as diverse as fundamental metaphysics and social/political philosophy. In (...) this pair of papers, we try to unify the field, reflecting on its basic nature, structure, and methodology. (shrink)

In constructing semantic theories of normative and evaluative terms, philosophers have commonly deployed a certain type of disagreement -based argument. The premise of the argument observes the possibility of genuine disagreement between users of a certain normative or evaluative term, while the conclusion of the argument is that, however differently those speakers employ the term, they must mean the same thing by it. After all, if they did not, then they would not really disagree. We argue that in many of (...) the cases in which this argument is deployed, the conclusion not only fails to follow from the premises, but is very likely false. Disagreements between speakers who do not mean the same things by their words are common, genuine, and not easily distinguished from ordinary disagreements over the truth of literally expressed content. We make this case by developing the notion of a metalinguistic negotiation, an exchange in which speakers tacitly negotiate the proper deployment of some linguistic expression in a context. Metalinguistic negotiations express disagreements over information that is conveyed pragmatically and about what concepts should be deployed in the context at hand. We argue that neither of these features poses any obstacle to metalinguistic negotiations serving to express genuine, substantive disagreements that can be well worth engaging in. Contrary to what has been widely assumed in the literature, many normative and evaluative disputes—among ordinary speakers and even among philosophers themselves—may be of exactly this type, a conclusion with important consequences for both the subject matter and the methodology of metanormative theory. (shrink)

In many countries grappling with the politics of equal recognition, the experiences, beliefs and reasons for action of people who identify as non-binary are starting to be seen as valid and intelligible.1 And, despite some gender clinics still responding cautiously to requests for non-standard medical interventions, their treatment needs are now recognised in major clinical guidelines. This is the current social context in which Notini and colleagues outline the case of ‘Phoenix’, an 18-year-old birth-assigned woman, who has requested the indefinite (...) continuation of puberty suppression, a treatment that was initiated when the client was 11 years old to mitigate their intense distress at the onset of puberty. Drawing on a conception of health as overall well-being, the authors conclude that OPS is ‘consistent with the proper goals of medicine’, and that there are ‘equity-based reasons’ for offering OPS to adults as a group. They concede that the physical risks are greater for OPS than for hormonal interventions generally provided to people with a binary gender identity. They also acknowledge the need for ‘a fine-grained ethical evaluation of Phoenix’s particular situation’ to assess whether the potential benefits of OPS outweigh the potential harms for this individual. Here I respectfully raise three points to amplify the authors’ discussion. First, there seem to be significant ethical issues of a general, not a particular, kind arising from the type of individual evaluation they call for. Following initial screening for significant mental distress and other major vulnerabilities, the key undertaking …. (shrink)

" Façonner le monde atome par atome " : tel est l'objectif incroyablement ambitieux affiché par les promoteurs américains de la " National Nanoinitiative ", lancée en 1999. Un projet global de " convergence des sciences ", visant à " initier une nouvelle Renaissance, incorporant une conception holiste de la technologie fondée sur [..] une analyse causale du monde physique, unifiée depuis l'échelle nano jusqu'à l'échelle planétaire. " Ce projet démiurgique est aujourd'hui au coeur de ce qu'on appelle la " (...) technoscience ", étendard pour certains, repoussoir pour d'autres. En précisant dans ce livre la signification de ce concept, pour sortir enfin du sempiternel conflit entre technophiles et technophobes, son auteur propose d'abord une sorte d'archéologie du terme " technoscience ". Loin d'être un simple renversement de hiérarchie entre science et technique, il s'agit d'un changement de régime de la connaissance scientifique, ayant désormais intégré la logique entrepreneuriale du monde des affaires et mobilisant des moyens considérables. Surtout, Bernadette Bensaude-Vincent montre que le brouillage de la frontière entre science et technique n'est que la manifestation d'un tremblement plus général, marqué par l'effacement progressif des distinctions traditionnelles : nature/artifice, inerte/vivant, matière/esprit, homme/machine, etc. Alors que nos sociétés sont silencieusement reconfigurées par les nanotechnologies, Internet, le génie génétique ou les OGM, ce livre montre l'importance de faire enfin pleinement entrer les questions de choix technologiques et scientifiques dans la sphère du politique et dans l'arène publique. Car la technoscience est un processus historique qui engage la nature en la refaçonnant et qui implique la société dans son ensemble. (shrink)

All articles in May 2019’s special issue of Bioethics offer profound insights into the issue of “being a burden to others” in relation to wishes to die, which are highly relevant for ethical debates about end‐of‐life care and physician‐assisted dying. In this reply, we wish to stress the importance of acknowledging and analyzing the sociopolitical context of the phenomenon “being a burden” in relation to wishes to die and we will show how this analysis could benefit from a care ethical (...) approach. As discussions in care ethics have made clear, caring practices are both social and political practices. An empirical and ethical analysis of “being a burden” therefore needs to take institutional and societal norms and structures into account, in addition to first‐person experiences and concepts such as caring needs, relational autonomy, and interdependency. Besides the relevance of the sociopolitical context for the phenomenon “being a burden” as such, the sociopolitical context also seems relevant for the investigation of the phenomenon, which we will illustrate by reflecting on “being a burden” in relation to the practice of physician‐assisted dying in the Netherlands. (shrink)

Which concepts should we use to think and talk about the world, and to do all of the other things that mental and linguistic representation facilitates? This is the guiding question of the field that we call ‘conceptual ethics’. Conceptual ethics is not often discussed as its own systematic branch of normative theory. A case can nevertheless be made that the field is already quite active, with contributions coming in from areas as diverse as fundamental metaphysics and social/political philosophy. In (...) this pair of papers, we try to unify the field, reflecting on its basic nature, structure, and methodology. (shrink)

This paper is about philosophical disputes where the literal content of what speakers communicate concerns such object-level issues as ground, supervenience, or real definition. It is tempting to think that such disputes straightforwardly express disagreements about these topics. In contrast to this, I suggest that, in many such cases, the disagreement that is expressed is actually one about which concepts should be employed. I make this case as follows. First, I look at non-philosophical, everyday disputes where a speaker employs a (...) metalinguistic usage of a term. This is where a speaker uses a term to express a view about the meaning of that term, or, relatedly, how to correctly use that term. A metalinguistic negotiation is a metalinguistic dispute that concerns a normative issue about what a word should mean, or, similarly, about how it should be used, rather than the descriptive issue about what it does mean. I argue that the same.. (shrink)

In recent work, we have argued that a number of disputes of interest to philosophers – including some disputes amongst philosophers themselves – are metalinguistic negotiations. Prima facie, many of these disputes seem to concern worldly, non-linguistic issues directly. However, on our view, they in fact concern, in the first instance, normative questions about the use of linguistic expressions. This will strike many ordinary speakers as counterintuitive. In many of the disputes that we analyze as metalinguistic negotiations, speakers might quite (...) strongly resist the idea that their debate is in any sense about language. In this paper, we explore and provide responses to what we take to be the best versions of an objection that our view involves an unacceptable attribution of false beliefs to ordinary speakers. (shrink)

The current empirical research and normative arguments on physician-assisted dying in the Netherlands seem insufficient to provide ethical guidance to general practitioners in the practice of PAD, due to a gap between the evidence and arguments on the one hand and the uncertainties and complexities as found in everyday practice on the other. This paper addresses the problems of current ethical arguments and empirical research and how both seem to be profoundly influenced by the Dutch legislative framework on PAD and (...) a certain view on ethics. Furthermore, the paper elaborates on how other approaches to empirical research in bioethics, such as found in the broad field of narrative research, could supplement the empirical and ethical evaluation of PAD in the Netherlands. This paper also addresses the challenging question of how empirical data—in this case narratives—relate to normativity. The paper is written in the form of a personal narrative of the author, a young Dutch general practitioner and researcher in bioethics. This style is intentionally chosen, to illustrate how work context and professional background influence the observations one makes and the questions one may ask about the topic of PAD. In addition, by using this style, this paper not only gives a different perspective on a much-contested bioethical issue, but also on the challenges faced when a physician–bioethicist has to navigate different disciplinary fields and epistemological paradigms, especially since the ‘empirical turn’ in bioethics. (shrink)

La notion de médiation culturelle s'est institutionnalisée dans le monde culturel et dans le monde universitaire. Son analyse concerne la situation de médiation et le système de médiations comme répertoire d'actions, ce qui engage deux dimensions: la dimension historique et la dimension politique. Il est donc nécessaire, tant dans la recherche que dans les formations, de maintenir une distance critique envers certaines conceptions mythiques de la notion.The concept of cultural mediation has become an institutionalized part of the worlds of both (...) culture and the university. Analysis of the concept covers the context of mediation and the general system of mediations, understood as a repertoire of actions. This brings into play two dimensions, historical and political. It is therefore necessary to maintain a critical distance from certain mythologizing versions of this notion, as much in research as in education and training. (shrink)

Les événements culturels internationaux constituent-ils un système symbolique indépendant des médias? Le propos de cet article s'inscrit dans une théorie générale de la trivialité, c'est-à-dire de la circulation des concepts entre la sphère de la production culturelle et celle des médias. Sans remettre en cause l'apport fondamental de Davidson à la théorie de l'événement - à savoir qu'un événement existe indépendamment de toute reconstruction ultérieure notamment par les médias - et, au contraire, en soulignant les apports d'une sémantique de l'histoire (...) pour comprendre une production culturelle, il cherche à mettre en évidence les interactions entre ces deux sphères, notamment les rôles du dispositif et du répertoire d'actions dans la pré-construction de l'information et l'incorporation de certains éléments du débat mené dans les médias par la sphère culturelle. S'il ne peut pas proposer une définition arrêtée de l'événement culturel international, en revanche, le chercheur peut observer le travail permanent de reconfiguration que couvre la catégorisation de ces événements.The international cultural events they are a symbolic system independent media? The purpose of this article is part of a general theory of triviality, that is to say, the circulation of concepts between the sphere of cultural production and the media. Without jeopardizing the fundamental contribution of Davidson's theory of the event - ie an event exists independently of any subsequent reconstruction by the media - and, instead, highlighting the contributions of the semantics history to understand cultural production, it seeks to highlight the interactions between these two spheres, including the roles of the device and directory actions in the pre-construction information and the incorporation of some elements of the debate conducted in the media by the cultural sphere. If they can not provide a conclusive definition of the international cultural event, however, the researcher can observe the work of permanent reconfiguration covers the categorization of these events. (shrink)

Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and other health care practitioners (...) have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care. (shrink)

The feminist sex wars have been characterized by debates between radical feminists and sex radical feminists about women's experiences of empowerment versus oppression in the sex industry. Based on a qualitative study of the experiences of exotic dancers, this article introduces a new theoretical paradigm to the feminist sex wars that values the contributions of both sex radicals and radical feminists. It articulates a twofold temporal dimension of sex workers' experiences: how women's feelings of pleasure and empowerment gradually decline over (...) time and how good and bad experiences rapidly transform into their opposites over the course of a single evening, making the strip bar a volatile and unsettling space for performers. (shrink)

One of the core goals of Digital Health Technologies (DHT) is to transform healthcare services and delivery by shifting primary care from hospitals into the community. However, achieving this goal will rely on the collection, use and storage of large datasets. Some of these datasets will be linked to multiple sources, and may include highly sensitive health information that needs to be transferred across institutional and jurisdictional boundaries. The growth of DHT has outpaced the establishment of clear legal pathways to (...) facilitate the collection, use and transfer of potentially sensitive health data. Our study aimed to address this gap with an ethical code to guide researchers developing DHT with international collaborative partners in Singapore. We generated this code using a modified Policy Delphi process designed to engage stakeholders in the deliberation of health data ethics and governance. This paper reports the outcomes of this process along with the key components of the code and identifies areas for future research. (shrink)

Four experiments investigate the folk concept of “understanding,” in particular when and why it is deployed differently from the concept of knowledge. We argue for the positions that people have higher demands with respect to explanatory depth when it comes to attributing understanding, and that this is true, in part, because understanding attributions play a functional role in identifying experts who should be heeded with respect to the general field in question. These claims are supported by our findings that people (...) differentially withhold attributions of understanding when the object of attribution has minimal explanatory information. We also show that this tendency significantly correlates with people’s willingness to defer to others as potential experts. This work bears on a pressing issue in epistemology concerning the place and value of understanding. Our results also provide reason against positing a simple equation of knowledge and understanding. We contend that, because deference plays a crucial role in many aspects of everyday reasoning, the fact that we use understanding attributions to demarcate experts reveals a potential mechanism for achieving our epistemic aims in many domains. (shrink)

There are competing ethical concerns when it comes to designing any clinical research study. Clinical trials of possible treatments for Ebola virus are no exception. If anything, the competing ethical concerns are exacerbated in trying to find answers to a deadly, rapidly spreading, infectious disease. The primary goal of current research is to identify experimental therapies that can cure Ebola or cure it with reasonable probability in infected individuals. Pursuit of that goal must be methodologically sound, practical and consistent with (...) prevailing norms governing human subjects research. Some maintain that only randomized controlled trials with a placebo or standard-of-care arm can meet these conditions. We maintain that there are alternative trial designs that can do so as well and that sometimes these are preferable to RCTs. (shrink)