Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

Pragmatism is a distinctive approach to clinical research ethics that can guide bioethicists and members of institutional review boards (IRBs) as they struggle to balance the competing values of promoting medical research and protecting human subjects participating in it. After defining our understanding of pragmatism in the setting of clinical research ethics, we show how a pragmatic approach can provide guidance not only for the day-to-day functioning of the IRB, but also for evaluation of policy standards, such as the one (...) that addresses acceptable risks for healthy children in clinical research trials. We also show how pragmatic considerations might influence the debate about the use of deception in clinical research. Finally, we show how a pragmatic approach, by regarding the promotion of human research and the protection of human subjects as equally important values, helps to break down the false dichotomy between science and ethics in clinical research. (shrink)

While deductive validity provides the limiting upper bound for evaluating the strength and quality of inferences, by itself it is an inadequate tool for evaluating arguments, arguing, and argumentation. Similar remarks can be made about rhetorical success and dialectical closure. Then what would count as ideal argumentation? In this paper we introduce the concept of cognitive compathy to point in the direction of one way to answer that question. It is a feature of our argumentation rather than my argument or (...) your argument. In that respect, compathy is like the harmonies achieved by an accomplished choir, the spontaneous coordination of athletic teamwork, or the experience of improvising jazz musicians when they are all in the flow together. It is a characteristic of arguments, not a virtue that can be attributed to individual arguers. It makes argumentation more than just the sum of its individual parts. The concept of cognitive compathy is brought into focus by locating it at the confluence of two lines of thought. First, we work up to the concept of compathy by contrasting it with empathy and sympathy in the context of emotions, which is then transplanted into epistemic, cognitive, and argumentative soil. Second, the concept is analytically linked to ideal argumentation by way of authenticity in communication. In the final section, we explore the extent to which argumentative virtues are conducive to producing compathetic argumentation, but reach the unhappy conclusion that the extra value of compathetic argumentation also transcends the evaluative reach of virtue argumentation theory. (shrink)

We are grateful to Jongsma et al 1 for their interest in our article analysing the case of ‘Mrs A’, a Dutch woman with Alzheimer’s disease who received euthanasia based on her advance euthanasia directive.2 Their commentary criticises two elements of our analysis. First, the authors believe our reasons for doubting that Mrs A had the capacity to write and revise an AED rely on ‘partial’ empirical data and rest on normative errors. Second, they use two of our statements to (...) suggest we must endorse some implausible claims, for example, that ‘… in all situations and for all people, current well-being should always take precedence over all other values’. Jongsma et al assert: ‘Miller et al argue that people with dementia are impaired to make decisions.’ This casts our probabilistic claim about Mrs A’s capacity as an absolute claim about persons with dementia in general. It also implies we are using an outdated diagnosis-based view of capacity. The accusation then becomes explicit : > … several empirical studies have shown that patients with dementia are able to actively participate in qualitative studies and can respond to open questions in a meaningful way,[2-8] as well that they are able to complete an advance directive in the early phases of dementia.[9, 10] One can therefore not simply conclude on the basis of the diagnosis of dementia …. (shrink)

On November 8, 1994, Oregon became the first state in the nation to legalize assisted suicide. Passage of Proposition 16 was a milestone in the campaign to make assisted suicide a legal option. The culmination of years of effort, the Oregon vote followed on the heels of failed referenda in California and Washington, and other unsuccessful attempts to enact state laws guaranteeing the right to suicide assistance. Indeed, in 1993, four states passed laws strengthening or clarifying their ban against assisted (...) suicide. No doubt, Proposition 16 is likely to renew the effort to legalize assisted suicide at the state level.The battle over assisted suicide is also unfolding in the courts. Litigation challenging Proposition 16 on the grounds that it violates the equal protection clause is ongoing in Oregon. More significantly, three cases, two in federal courts and one in Michigan state court, have been brought to establish assisted suicide as a constitutionally protected right. (shrink)

The analysis of interacting relativistic many-particle systems provides a theoretical basis for further work in many diverse fields of physics. After a discussion of the nonrelativisticN-particle systems we describe two approaches for obtaining the canonical equations of the corresponding relativistic forms. A further aspect of our approach is the consideration of the constants of the motion.

Examines interrelated topics in Medieval and Renaissance Latin literature: the status of women as writers, the status of women as rhetorical figures, and the status of women in society from the fifth to the early seventeenth century.

This paper empirically investigates whether people’s implicit decision theory is more like causal decision theory or more like a non-causal decision theory (such as evidential decision theory). We also aim to determine whether implicit causalists, without prompting and without prior education, make a distinction that is crucial to causal decision theorists: preferring something _as a news item_ and preferring it _as an object of choice_. Finally, we investigate whether differences in people’s implicit decision theory correlate with differences in their level (...) of _future bias_: the preference for positively valenced events to be located in the future and not the past, and negatively valenced events to be located in the past and not the future. We find that people are overwhelmingly non-causalists. We also find that implicit causalists _do not_ make the distinction between news items and objects of choice, and that there is little to no correlation between people’s future bias and their implicit decision theory. We end by discussing the philosophical upshots of this work. (shrink)

It has widely been assumed, by philosophers, that our first-person preferences regarding pleasurable and painful experiences exhibit a bias toward the future (positive and negative hedonic future-bias), and that our preferences regarding non-hedonic events (both positive and negative) exhibit no such bias (non-hedonic time-neutrality). Further, it has been assumed that our third-person preferences are always time-neutral. Some have attempted to use these (presumed) differential patterns of future-bias—different across kinds of events and perspectives—to argue for the irrationality of hedonic future-bias. This (...) paper experimentally tests these descriptive hypotheses. While as predicted we found first-person hedonic future-bias, we did not find that participants were time-neutral in all other conditions. Hence, the presumed asymmetry of hedonic/non-hedonic and first/third-person preferences cannot be used to argue for the irrationality of future-bias, since no such asymmetries exist. Instead, we develop a more fine-grained approach, according to which three factors—positive/negative valence, first/third-person, and hedonic/non-hedonic—each independently influence, but do not determine, whether an event is treated in a future-biased or time-neutral way. We discuss the upshots of these results for the debate over the rationality of future-bias. (shrink)

Philosophers working on time-biases assume that people are hedonically biased toward the future. A hedonically future-biased agent prefers pleasurable experiences to be future instead of past, and painful experiences to be past instead of future. Philosophers further predict that this bias is strong enough to apply to unequal payoffs: people often prefer less pleasurable future experiences to more pleasurable past ones, and more painful past experiences to less painful future ones. In addition, philosophers have predicted that future-bias is restricted to (...) first-person preferences, and that people’s third-person preferences are time-neutral. Philosophers disagree vigorously about the normative status of these preferences—i.e., they disagree about whether first-person future-bias is rationally permissible. Time-neutralists, for example, have appealed to the predicted asymmetry between first- and third-person preferences to argue for the rational impermissibility of future-bias. We empirically tested these predictions, and found that while people do prefer more past pain to less future pain, they do not prefer less future pleasure to more past pleasure. This was so in both first and third-person conditions. This suggests that future-bias is typically non-absolute, and is more easily outweighed in the case of positive events. We connect this result to the normative debate over future-bias. (shrink)

In recent years, a disagreement has erupted between two camps of philosophers about the rationality of bias toward the near and bias toward the future. According to the traditional hybrid view, near bias is rationally impermissible, while future bias is either rationally permissible or obligatory. Time neutralists, meanwhile, argue that the hybrid view is untenable. They claim that those who reject near bias should reject both biases and embrace time neutrality. To date, experimental work has focused on future-directed near bias. (...) The primary aim of this paper is to shed light on the debate by investigating past-directed near bias. If people treat the past and future differently with respect to near bias, by being future-directed but not past-directed near biased, then this supports a particular version of the hybrid view: temporal metaphysic hybridism. If people treat the past and future the same with respect to near bias, then this supports a simple version of time neutralism, which explains both future bias and near bias in terms of the functioning of a single mechanism: the anticipatory/retrospectory mechanism. Our results undermine the claim that people are future-directed, but not past-directed, near biased, and hence do not support temporal metaphysic hybridism. They also fail to support simple time-neutralism; instead, they suggest that there are multiple mechanisms that differently shape future- and past-directed preferences. (shrink)

Future-biased individuals systematically prefer pleasures to be in the future and pains to be in the past. Empirical research shows that negative future-bias is robust: people prefer more past pain to less future pain. Is positive future-bias robust or fragile? Do people only prefer pleasures to be located in the future, compared to the past, when those pleasures are of equal value, or do they continue to prefer that pleasures be located in the future even when past pleasures outweigh future (...) ones? Some arguments against the rationality of future-bias require positive future-bias to be robust, while others require it to be fragile. We empirically investigate and show that positive future-bias is robust. (shrink)

Until recently, philosophers debating the rationality of time-biases have supposed that people exhibit a first-person hedonic bias toward the future, but that their non-hedonic and third-person preferences are time-neutral. Recent empirical work, however, suggests that our preferences are more nuanced. First, there is evidence that our third-person preferences exhibit time-neutrality only when the individual with respect to whom we have preferences—the preference target—is a random stranger about whom we know nothing; given access to some information about the preference target, third-person (...) preferences mirror first-person preferences. As a result, the simulation hypothesis has been proposed, according to which third-person preferences will mirror first-person preferences when we can simulate the mental states of the preference target. Second, there is evidence that we prefer negative hedonic events to be in our past (we are first-person negatively hedonically future-biased) only when we view future events as fixed and in no way under our control. By contrast, when we perceive it to be within our power to mitigate the badness of future events, we are first-person negatively hedonically past-biased. This is the mitigation hypothesis. We distinguish two versions of the mitigation hypothesis, the squirrelling version and the heuristic version. We ran a study which tested the simulation hypothesis, and which aimed to determine whether the squirrelling or the heuristic version of the mitigation hypothesis enjoys more empirical support. We found support for the heuristic version of the hypothesis, but no support for the squirrelling version. (shrink)

This study examined the relationship between individual differences in executive functions (EF; assessed by measures of working memory, Stroop, trail making, and verbal fluency) and ability to down-regulate and up-regulate responses to emotionally evocative film clips. To ensure a wide range of EF, 48 participants with diverse neurodegenerative disorders and 21 older neurologically normal ageing participants were included. Participants were exposed to three different movie clips that were designed to elicit a mix of disgust and amusement. While watching the films (...) they were either instructed to watch, down-regulate, and up-regulate their visible emotional responses. Heart rate and facial behaviours were monitored throughout. Emotion regulatory ability was operationalised as changes in heart rate and facial behaviour in the down- and up-regulation conditions, controlling for responses in the watch condition. Results indicated that higher verbal fluency scores were related to greater ability to regulate emotion in both the down-regulation and up-regulation conditions. This finding remained significant even after controlling for age and general cognitive functioning. No relationships were found between emotion regulation and the other EF measures. We believe these results derive from differences among EF measures, with verbal-fluency performance best capturing the complex sequence of controlled planning, activation, and monitoring required for successful emotion regulation. These findings contribute to our understanding of emotion–cognition interaction, suggesting a link between emotion-regulatory abilities and individual differences in complex executive functions. (shrink)

Many philosophers have assumed that our preferences regarding hedonic events exhibit a bias toward the future: we prefer positive experiences to be in our future and negative experiences to be in our past. Recent experimental work by Greene et al. (ms) confirmed this assumption. However, they noted a potential for some participants to respond in a deviant manner, and hence for their methodology to underestimate the percentage of people who are time neutral, and overestimate the percentage who are future biased. (...) We aimed to replicate their study using an alternative methodology that ensures there are no such deviant responses, and hence more accurately tracks future bias and time neutrality. Instead of finding more time neutrality than Greene et al., however, we found vastly more past bias. Our explanation for this surprising finding helps to reveal the rationale behind both future and past biased preferences, and undermines the generalisability of one of the most influential motivations for the rationality of hedonic future bias: Parfit’s My Past or Future Operations. (shrink)

All else being equal, most of us typically prefer to have positive experiences in the future rather than the past and negative experiences in the past rather than the future. Recent empirical evidence tends not only to support the idea that people have these preferences, but further, that people tend to prefer more painful experiences in their past rather than fewer in their future (and mutatis mutandis for pleasant experiences). Are such preferences rationally permissible, or are they, as time-neutralists contend, (...) rationally impermissible? And what is it that grounds their having the normative status that they do have? We consider two sorts of arguments regarding the normative status of future-biased preferences. The first appeals to the supposed arbitrariness of these preferences, and the second appeals to their upshot. We evaluate these arguments in light of the recent empirical research on future-bias. (shrink)

The recent high-profile financial difficulties of Harvard Pilgrim Health Care, the largest HMO in Massachusetts and consistently rated as one of the top ten HMOs in the nation, shed light on many problems common to health insurers throughout the country. This article explores those difficulties in the context of the short but complicated history of Harvard Pilgrim, and its regulatory and competitive environments. The state legislation which made a receivership proceeding possible for Harvard Pilgrim offered some protection for subscribers, but (...) failed to provide the means for achieving a long term solution. The statute merely presented a method for staving off immediate collapse by temporarily protecting the plan from dissolution, and forcing the plan's contracting providers to continue delivering care even if owed money by the plan. The article concludes by drawing lessons for understanding and ideally avoiding similar managed care nearfatalities in the future. (shrink)

The recent high-profile financial difficulties of Harvard Pilgrim Health Care, the largest HMO in Massachusetts and consistently rated as one of the top ten HMOs in the nation, shed light on many problems common to health insurers throughout the country. This article explores those difficulties in the context of the short but complicated history of Harvard Pilgrim, and its regulatory and competitive environments. The state legislation which made a receivership proceeding possible for Harvard Pilgrim offered some protection for subscribers, but (...) failed to provide the means for achieving a long term solution. The statute merely presented a method for staving off immediate collapse by temporarily protecting the plan from dissolution, and forcing the plan's contracting providers to continue delivering care even if owed money by the plan. The article concludes by drawing lessons for understanding and ideally avoiding similar managed care nearfatalities in the future. (shrink)

In the Statesman , Plato brings together--only to challenge and displace--his own crowning contributions to philosophical method, political theory, and drama. In his 1980 study, reprinted here, Mitchell Miller employs literary theory and conceptual analysis to expose the philosophical, political, and pedagogical conflict that is the underlying context of the dialogue, revealing that its chaotic variety of movements is actually a carefully harmonized act of realizing the mean. The original study left one question outstanding: what specifically, in the metaphysical (...) order of things, motivated the nameless Visitor from Elea to abandon bifurcation for his consummating non-bifurcatory division of fifteen kinds at the end of the dialogue? Miller addressed in a separate essay, first published in 1999 and reprinted here. In it, he opens the horizon of interpretation to include the new metaphysics of the Parmenides , the Philebus , and the "unwritten teachings." "This study demonstrates how the Statesman is the culminating expression of Plato's lifelong effort, both in Athens and in the Academy, to bring metaphysical insight to the unending political crisis of his times."The Philosopher in Plato's Statesman a trail-blazing work. While not every reader will agree with the lessons Miller himself draws from this approach, none should fail to be impressed by its interpretive power. All this is exciting stuff. The interpretive pathway on which Miller has embarked has the potential for changing the face of scholarship on the late Platonic dialogues. Parmenides [Publishing] is to be commended for making these two important contributions available under a single cover." -- Kenneth Sayre, Professor of Philosophy, University of Notre Dame "Miller casts considerable light on virtually every aspect of the dialogue. . . . All in all, this book is an outstanding contribution to our understanding of the Statesman." -- Stanley Rosen, Borden Parker Bowne Professor of Philosophy, Boston University MITCHELL MILLER is Professor of Philosophy at Vassar College. He is the author of Plato's Parmenides. (shrink)

A letter to the editor from Howard Brody, David Buchanan, and Franklin G. Miller in response to the recent article by Erik Malmqvist Understanding Exploitation," March-April 2011).

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

The separation, uniformization, and other properties of the Borel and projective hierarchies over hyperfinite sets are investigated and compared to the corresponding properties in classical descriptive set theory. The techniques used in this investigation also provide some results about countably determined sets and functions, as well as an improvement of an earlier theorem of Kunen and Miller.

Authorising euthanasia and assisted suicide with advance euthanasia directives is permitted, yet debated, in the Netherlands. We focus on a recent controversial case in which a Dutch woman with Alzheimer’s disease was euthanised based on her AED. A Dutch euthanasia review committee found that the physician performing the euthanasia failed to follow due care requirements for euthanasia and assisted suicide. This case is notable because it is the first case to trigger a criminal investigation since the 2002 Dutch euthanasia law (...) was enacted. Thus far, only brief descriptions of the case have been reported in English language journals and media. We provide a detailed description of the case, review the main challenges of preparing and applying AEDs for persons with dementia and briefly assess the adequacy of the current oversight system governing AEDs. (shrink)

One approach to understanding model-based reasoning in science is to examine how it develops during infancy, childhood, and adolescence. The way in which thinking changes sometimes provides clues to its nature. This paper examines cognitive developmental aspects of modeling practices and discusses how a developmental perspective can enrich the study of model-based scientific reasoning in adults. The paper begins with issues concerning developmental change, followed by a model of model-based reasoning. The rest of the paper describes how several key concepts (...) from recent developmental work could contribute to current work on model-based reasoning. Specifically, developmental research shows that (a) social processes are involved in model-based reasoning and scientific discovery, (b) the development of a theory of mind contributes to the development of scientific reasoning, (c) changes in scientific reasoning are characterized by cognitive variability, and (d) microgenetic methods could clarify conceptual change during model-based reasoning. (shrink)

This work presents an annotated text of the most comprehensive and detailed arguments in Erasmus's conflict with the Catholic, conservative, scholastic theologians, the _Declarationes_. It also shows the contrast between the scholastic/logical and the humanist/rhetorical approach to Scripture and to theological questions.

This work presents an annotated text of the most comprehensive and detailed arguments in Erasmus's conflict with the Catholic, conservative, scholastic theologians, the _Declarationes_. It also shows the contrast between the scholastic/logical and the humanist/rhetorical approach to Scripture and to theological questions.