Background: Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed. Objective: To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation. Methods: A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff when moral distress was present. (...) The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale. Results: Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment. Conclusions: Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness. (shrink)

Problems arise when applying the current procedural conceptualization of decision-making capacity to paediatric healthcare: Its emphasis on content-neutrality and rational cognition as well as its implicit assumption that capacity is an ability that resides within a person jeopardizes children’s position in decision-making. The purpose of the paper is to challenge this dominant account of capacity and provide an alternative for how capacity should be understood in paediatric care. First, the influence of developmental psychologist Jean Piaget upon the notion of capacity (...) is discussed, followed by an examination of Vygostky’s contextualist view on children’s development, which emphasizes social interactions and learning for decision-making capacity. In drawing parallels between autonomy and capacity, substantive approaches to relational autonomy are presented that underline the importance of the content of a decision. The authors then provide a relational reconceptualization of capacity that leads the focus away from the individual to include important social others such as parents and physicians. Within this new approach, the outcome of adults’ decision-making processes is accepted as a guiding factor for a good decision for the child. If the child makes a choice that is not approved by adults, the new conceptualization emphasizes mutual exchange and engagement by both parties. (shrink)

The pragmatic inquiry process used in the Corporantes Pathfinder Notebook (CPN) enables students and others to discern their gifts, find purpose and direction in their lives, and seek a FIT between their values and various corporate cultures before making extensive commitments in their field of studies and their employment. Based on Peirce''s theory of Pragmatism the CPN fosters investigation, interpretation, and action resulting from reflected narratives written in response to a series of questions in the CPN. The CPN was used (...) successfully as a framework in a Business Ethics course for connecting career decisions to their personal lives. Other pedagogic activities were used such as case studies, role playing, service learning, team projects investigating ethical climates of corporations, as well as Socratic questioning and discussions of moral dilemmas to develop ethical sensitivity and understanding of ethical challenges and decisions. The CPN also has been used successfully by senior executives in over fifty applications. (shrink)

Why, when asking oneself whether to believe that p, must one immediately recognize that this question is settled by, and only by, answering the question whether p is true? Truth is not an optional end for first-personal doxastic deliberation, providing an instrumental or extrinsic reason that an agent may take or leave at will. Otherwise there would be an inferential step between discovering the truth with respect to p and determining whether to believe that p, involving a bridge premise that (...) it is good to believe the truth with respect to p. But there is no such gap between the two questions within the first-personal deliberative perspective; the question whether to believe that p seems to collapse into the question whether p is true. (shrink)

Background: Pediatric guidelines recommend that children and adolescents participate in a developmentally appropriate way in end-of-life decision making. Shared decision making in pediatrics is unique because of the triadic relationship of patient, parents, and physician. The involvement of the patient may vary on a continuum from no involvement to being the sole decision maker. However, the effects of child participation have not been thoroughly studied. The aims of this literature review are to identify studies on end-of-life decision making in pediatrics, (...) to explore patient participation, and to assess the effects of such participation. Methods: Five databases—PubMed, PsycInfo, Medline, CINAHL, and Sociological Abstract—were searched for empirical studies on end-of-life decision making in pediatrics. Selected articles fulfilling the criteria were assessed for type of decision, participants’ characteristics, reports on participation of the minor patient, and outcome. Results: Fifty-seven articles on end-of-life decision making in pediatrics were identified. The majority of papers (n = 43, 75%) investigated parents’ and clinicians’ perspectives, while only 14 articles (25%) included perspectives of children and adolescents. Twenty-two articles (39%) reported some details on various forms of children's participation (e.g., receive information, plan care details, consulted before or after a decision was made). Positive (e.g., respect for patient's preferences) and negative (e.g., conflict due to diverging opinions) effects of children's participation in end-of-life decision making were reported. Conclusions: This systematic review highlights the need for research to identify factors that contribute to a favorable participation of minors in decision-making processes, as well as strategies to solve possible conflicts. More research should take into account the dynamics in the triadic process of decision making and emphasize children and adolescents’ perspectives. A better understanding of how to meaningfully involve children and adolescents in end-of-life decision making could facilitate the practice of patient participation in pediatrics. (shrink)

This experiment investigated the effect of format (line vs. bar), viewers’ familiarity with variables, and viewers’ graphicacy (graphical literacy) skills on the comprehension of multivariate (three variable) data presented in graphs. Fifty-five undergraduates provided written descriptions of data for a set of 14 line or bar graphs, half of which depicted variables familiar to the population and half of which depicted variables unfamiliar to the population. Participants then took a test of graphicacy skills. As predicted, the format influenced viewers’ interpretations (...) of data. Specifically, viewers were more likely to describe x–y interactions when viewing line graphs than when viewing bar graphs, and they were more likely to describe main effects and “z–y” (the variable in the legend) interactions when viewing bar graphs than when viewing line graphs. Familiarity of data presented and individuals’ graphicacy skills interacted with the influence of graph format. Specifically, viewers were most likely to generate inferences only when they had high graphicacy skills, the data were familiar and thus the information inferred was expected, and the format supported those inferences. Implications for multivariate data display are discussed. (shrink)

This important and comprehensive work of 18th-century Islamic religious thought written in Arabic by a pre-eminent South Asian scholar provides an extensive and detailed picture of Muslim theology and interpretive strategies on the eve of the modern period.

Believing that p, assuming that p, and imagining that p involve regarding p as true—or, as we shall call it, accepting p. What distinguishes belief from the other modes of acceptance? We claim that conceiving of an attitude as a belief, rather than an assumption or an instance of imagining, entails conceiving of it as an acceptance that is regulated for truth, while also applying to it the standard of being correct if and only if it is true. We argue (...) that the second half of this claim, according to which the concept of belief includes a standard of correctness, is required to explain the fact that the deliberative question whether to believe that p is transparent to the question whether p. This argument raises various questions. Is there such a thing as deliberating whether to believe? Is the transparency of the deliberative question whether to believe that p the same as the transparency of the factual question whether I do believe that p? We will begin by answering these questions and then turn to a series of possible objections to our argument. (shrink)

تشخيص فكري ومعرفي لمفهوم الأسرة ومكانتها في الفكر الإسلامي، وتفحّصٌ علمي ومنهجي لأسس البناء الأسري ومقاصده، وكشفٌ عن تأثير التحوّلات الاجتماعية في الأسرة والتحديات التي تواجهها، وتتبعٌ لانعكاسات الفكر الغربي في المنظومة القيمية للأسرة، وتبيّنٌ لبعض التجارب والخبرات في مجال المحافظة على دور الأسرة، لا سيما بعد هيمنة النموذج المعرفي الغربي، ومحاولة طمسه للخصوصيات الثقافية والمجتمعية. حاولت بحوث هذا الكتاب أن تجيب عن تساؤلات معرفية ومجتمعية مهمة مثل: ما أهم التحديات التي تواجه الأسرة المسلمة في الراهن المعاصر وكيفية مواجهتها، وما (...) التغيرات التي طرأت على الأسرة المسلمة في ظل التطورات والتسارعات المجتمعية والاقتصادية والتقنية إلخ، وما التصوّر الإسلامي لدور الأسرة في بناء المجتمع، وما دور مؤسسات المجتمع المدني في الحد من تأثير الاستلاب الثقافي، وما الإسهام الذي قدمته حركات الإصلاح الإسلامية في مجال المحافظة على الدور المحوري للأسرة في تشكيل الشخصية الإسلامية القادرة على تفعيل النهوض الحضاري؟ وقد أسهم المشاركون في هذا العمل الجماعي، الذين بلغ عددهم واحداً وعشرين باحثاً، في محاورة هذه الأسئلة المعرفية، وفي التأسيس لمنظومة معرفية مجتمعية قادرة على الإسهام في البناء الحضاري، وفي توجيه دفة الأسرة بما ينسجم مع التوجيهات الربانية والفطرة الإنسانية. (shrink)

Current formal dialectical models postulate normative rules that enable discussants to conduct dialogical interactions without committing fallacies. Though the rules for conducting a dialogue are supposed to apply to interactions between actual arguers, they are without exception theoretically motivated. This creates a gap between model and reality, because dialogue participants typically leave important content-related elements implicit. Therefore, analysts cannot readily relate normative rules to actual debates in ways that will be empirically confirmable. This paper details a new, data-driven method for (...) describing discussants’ actual reply structures, wherein corpus studies serve to acknowledge the complexity of natural argumentation. Rather than refer exclusively to propositional content as an indicator of arguing pro/contra a given claim, the proposed approach to dialogue structure tracks the sequence of dialogical moves itself. This arguably improves the applicability of theoretical dialectical models to empirical data, and thus advances the study of dialogue systems. (shrink)

Globalization has increased the need for managers (and future managers) to predict the potential for country corruption. This study examines the relationship between Hofstede''s cultural dimensions and how country corruption is perceived. Power distance, individualism and masculinity were found to explain a significant portion of the variance in perceived corruption. A significant portion of country''s risk, trade flow with U.S.A., foreign investment, and per capita income was explained by perceived corruption.

Writing the Mughal World: Studies on Culture and Politics. Muzzafar Alam and Sanjay Subrahmanyam. New York: Columbia University Press, 2011. Pp. xviii + 516. $89.50, £62 ; $29.50, £20.50.

Does ethical content in organizational mission statements make a difference? Research regarding the effectiveness and results of mission statements is mixed. Krohe concluded that much of the good results do not come from the mission statements themselves but from the strategic re-education that happens in producing one. We attempted to discover whether universities that explicitly state their ethical orientation and vision in their mission statements had students with higher perceived character trait importance and activities that reinforce character than universities that (...) did not. While the faculty and administration may receive benefits from mission statement development through strategic re-education as Krohe suggested, do the statements influence the students at the university who may have had no role in its creation? Using a sample of senior business students at 16 universities we found that students at universities with ethical statements in their mission statements had significantly higher perceived character trait importance and character reinforcement than those at universities whose missions lacked ethical statements. This research suggests that schools that explicitly stated ethical content in their mission statements do influence student ethical orientation. (shrink)

It is common for philosophers to claim that doxastic voluntarism, the view that an agent can form beliefs voluntarily, is false, and therefore that agents do not have the kind of control over their beliefs required for a straightforward application of deontological concepts such as obligation or duty in the domain of epistemology. The role that the denial of doxastic voluntarism plays in an argument to the effect that agents do not have obligations with respect to belief is simply this.

Why, when asking oneself whether to believe that p, must one immediately recognize that this question is settled by, and only by, answering the question whether p is true? Truth is not an optional end for first-personal doxastic deliberation, providing an instrumental or extrinsic reason that an agent may take or leave at will. Otherwise there would be an inferential step between discovering the truth with respect to p and determining whether to believe that p, involving a bridge premise that (...) it is good (in whichever sense of good one likes, moral, prudential, aesthetic, allthings-considered, etc.) to believe the truth with respect to p. But there is no such gap between the two questions within the first-personal deliberative perspective; the question whether to believe that p seems to collapse into the question whether p is true. (shrink)

Taylor and Francis Ltd TSEP_A_151217.sgm..

When we deliberate whether to believe some proposition, we feel immediately compelled to look for evidence of its truth. Philosophers have labelled this feature of doxastic deliberation 'transparency'. I argue that resolving the disagreement in the ethics of belief between evidentialists and pragmatists turns on the correct explanation of transparency. My hypothesis is that it reflects a conceptual truth about belief: a belief that p is correct if and only if p. This normative truth entails that only evidence can be (...) a reason for belief. Although evidentialism does not follow directly from the mere psychological truth that we cannot believe for non-evidential reasons, it does follow directly from the normative conceptual truth about belief which explains why we cannot do so. (shrink)

Advances in life-saving technologies in the past few decades have challenged our traditional understandings of death. Traditionally, death was understood to occur when a person stops breathing, their heart stops beating and they are cold to the touch. Today, physicians determine death by relying on a diagnosis of ‘total brain failure’ or by waiting a short while after circulation stops. Evidence has emerged, however, that the conceptual bases for these approaches to determining death are fundamentally flawed and depart substantially from (...) the established biological conception of death. We argue that the current approach to determining death consists of two different types of unacknowledged legal fictions. These legal fictions were developed for practices that are largely ethically legitimate but need to be reconciled with the law. The considerable debate over the determination of death in the medical and scientific literature has not informed the public that vital organs are being procured from still-living donors and it seems unlikely that this information can remain hidden for long. Given the instability of the status quo and the difficulty of making the substantial legal changes required by complete transparency, we argue for a second-best policy solution: acknowledging the legal fictions involved in determining death to move in the direction of greater transparency. This may someday result in more substantial legal change to directly confront the challenges raised by life-sustaining and life-preserving technologies without the need for fictions. (shrink)

Examining the coverage of the 2016 US Presidential election of the highest circulating New Zealand newspaper—the New Zealand Herald (NZH)—this study argues that this newspaper sets agenda against Donald Trump—the Republican Party candidate in the 2016 US election. Examining all news, editorials and photographs published in NZH, it discursively argues that this newspaper overshadowed and dehumanized Trump and especially his leadership ability. The other major candidate—the Democratic Party candidate Hillary Clinton—was applauded in the coverage. The NZH repeatedly focused upon the (...) activities of Trump through news, views and images to dehumanize him. The repetition, therefore, does not necessarily mean that a particular media outlet favors a particular candidate. It also argues that the media outlet of a distant nation that cannot influence its reader to vote for a particular candidate may still set the agenda in favor of a candidate. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:From Impatience to EmpathyStephanie Pierce and Kavita Shah AroraWe gave J.H. a label the first time we met her, as many often do—“Uncooperative.” She was a patient with autism and intellectual delay who had presented to the emergency department (ED) with vaginal bleeding. After receiving the gynecology consult request from the emergency medicine physicians, we were already mentally formulating our recommendations based on the information they told us (...) over the phone. “Does not cooperate with exam,” “no acute surgical intervention is currently warranted,” and “recommend outpatient follow–up.”When we arrived in her room, she was sitting in the hospital bed surrounded by a protective shield of caregivers from her group home. We introduced ourselves as the gynecology team but it was obvious that J.H. could not communicate verbally. Upon speaking with her caregivers we learned that she had Cowden syndrome, a genetic disease that confers significantly increased risks for several types of cancer including endometrial, thyroid, and breast cancers. J.H. had also been having heavy vaginal bleeding, which was difficult for her caregivers to manage, and this was the reason she was brought into the emergency department. After attempting to gain as much information as we could from the caregivers, we started to perform an abdominal exam, which made J.H. extremely agitated. We quickly stopped the exam and the caregivers helped to calm J.H. We remember our mixture of emotions—bewilderment at the agitation and commotion in the exam room full of people, frustration at not being able to complete our exam fully, and annoyance that this “difficult patient” was taking up our limited time between surgical cases. Thankfully, these knee–jerk reactions were quickly replaced by feelings of concern for the patient and the realization of how frightening an experience this must be for her—being in a strange place with white walls and unfamiliar people, unable to communicate her thoughts.J.H.’s mother, her surrogate decision–maker, was not at the hospital that day but the caregivers told us that she had expressed a strong desire for her daughter to have a prophylactic hysterectomy due to her lifetime risk for developing uterine cancer as well as a permanent solution to the bleeding concerns. What had initially started as a simple ED consult was now turning into a complex question. The ethical and legal dilemma was obvious—whether to perform a major surgery that would irreversibly sterilize a patient who could not consent on her own behalf in order to minimize the potential risk of cancer later in life. While medical management could improve the bleeding and potentially reduce the risk of cancer, frequent exams would be necessary [End Page 19] to ensure that the medication was working and that premalignant changes were not occurring in J.H.’s uterus. However, based on our experience in the emergency department, J.H. would need anesthesia for such exams and it was doubtful the medications would completely normalize her elevated risk of uterine malignancy. We knew that in order to address this question, we would need to see J.H. again along with her mother to have a frank discussion about the risks and benefits of such a decision, and so we made plans to see her in our outpatient clinic.Several days later, J.H., her mother, and the group home caregivers arrived in the office. Anticipating a complex discussion, we had requested a representative from the hospital ethics committee to join us at the visit. We didn’t know what to expect meeting J.H.’s mother for the first time but as we sat in the room talking, it was obvious that she was truly trying to act in her daughter’s best interest. Similarly, it was touching to watch the faces of the caregivers from the group home as they nodded in solidarity with J.H.’s mother, also clearly wanting what was best for her and supporting her mother in this difficult decision. J.H., meanwhile, seemed content to sit silently with us during the discussion, surrounded as she was by people who cared deeply for her well–being.After extensive partnership with the ethics consultants... (shrink)

The aim of this paper is to define some new operation laws for the trapezoidal linguistic cubic fuzzy number and Hamming distance. Furthermore, we define and use the trapezoidal linguistic cubic fuzzy TOPSIS method to solve the multi criteria decision making (MCDM) method. The new ranking method for trapezoidal linguistic cubic fuzzy numbers (TrLCFNs) are used to rank the alternatives. Finally, an illustrative example is given to verify and prove the practicality and effectiveness of the proposed method.

Visual masking of primes lowers prime visibility but spares processing of primes as reflected in prime–target congruence and prime–response compatibility effects. However, the question is how to appropriately measure prime visibility. Here, we tested the influence of three procedural variables on prime visibility measures: prime–target similarity, prime–response similarity, and the variability of prime–response mappings. Our results show that a low prime–target similarity is a favorable condition for a prime visibility measure because it increases the sensitivity of this measure in comparison (...) to a high prime–target similarity. (shrink)

This paper proposes two formal models for understanding real-life dialogues, aimed at capturing argumentative structures performatively enacted during conversations. In the course of the investigation, two types of discourse with a high degree of well-structured argumentation were chosen: moral debate and financial communication. The research project found itself confronted by a need to analyse, structure and formally describe large volumes of textual data, where this called for the application of computational tools. It is expected that the results of the proposed (...) research will make a contribution to formal systems modelling and the evaluation of communication from the point of view of argument soundness. (shrink)

Volume 20, Issue 6, June 2020, Page 17-19.

Popper is well known for rejecting a logic of discovery, but he is only justified in rejecting the same type of logic of discovery that is denied by consequentialism. His own account of hypothesis generation, based on a natural selection analogy, involves an error-eliminative logic of discovery and the differences he admits between biological and conceptual evolution suggest an error-corrective logic of discovery. These types of logics of discovery are based on principles of plausibility that are used in the generation (...) as opposed to the preliminary evaluation of hypotheses. The normative relevance of these principles is grounded in the distinction between strategic and definitory rules. (shrink)

A series of imitation games involving 3-participant (simultaneous comparison of two hidden entities) and 2-participant (direct interrogation of a hidden entity) were conducted at Bletchley Park on the 100th anniversary of Alan Turing’s birth: 23 June 2012. From the ongoing analysis of over 150 games involving (expert and non-expert, males and females, adults and child) judges, machines and hidden humans (foils for the machines), we present six particular conversations that took place between human judges and a hidden entity that produced (...) unexpected results. From this sample we focus on features of Turing’s machine intelligence test that the mathematician/code breaker did not consider in his examination for machine thinking: the subjective nature of attributing intelligence to another mind. (shrink)

Two prejudices have hampered our understanding of John Stuart Mill’s central argument for free speech. One prejudice is that arguments for free speech can only be made in terms of values or rights. This prejudice causes us to miss the depth of Mill’s argument. He does not argue that silencing speech is harmful or violates rights, but instead that silencing speech is a uniquely self-undermining act; it undermines the ground upon which it is based. But even if we overcome this (...) prejudice and appreciate the self-undermining character of Mill’s argument, the prejudice that epistemic justification is a completable task blinds us to the role of open-mindedness in his argument; and failing to see this leads us to wrongly conclude that his argument is invalid. It is only once we have overcome both prejudices that we can appreciate the depth and power of Mill’s argument for free speech. (shrink)