This study was an investigation of which distinctive elements would best describe good and bad death, preferences for life-sustaining treatment, and advance directives. The following elements of a good death were identified by surveying 185 acute-care hospital nurses: comfort, not being a burden to the family, a good relationship with family members, a readiness to die, and a belief in perpetuity. Comfort was regarded as the most important. Distinctive elements of a bad death were: persistent vegetative state, sudden death, pain (...) and agony, dying alone, and being a burden to the family. Of the 185 respondents, 90.8% answered that they did not intend to receive life-sustaining treatment if they suffered from a terminal illness without any chance of recovery; 77.8% revealed positive attitudes toward advance directives. Sixty-seven per cent of the respondents stated that they were willing to discuss their own death and dying; the perception of such discussions differed according to the medical condition (p = 0.001). The elements of a bad death differed significantly depending on the disease state (p = 0.003) and on economic status (p = 0.023). (shrink)

BackgroundThis study aimed to identify the healthcare providers’ experience and perspectives toward end-of-life care decisions focusing on end-of-life discussion and physician’s order of life-sustaining treatment documentation in Korea which are major parts of the Life-Sustaining Treatment Act.MethodsA cross-sectional survey was conducted using a questionnaire developed by the authors. A total of 474 subjects—94 attending physicians, 87 resident physicians, and 293 nurses—participated in the survey, and the data analysis was performed in terms of frequency, percentage, mean and standard deviation using the (...) SPSS 24.0 program.ResultsStudy results showed that respondents were aware of terminal illness and physician’s order of life-sustaining treatment in Korea well enough except for some details. Physicians reported uncertainty in terminal state diagnosis and disease trajectory as the most challenging. Study participants regarded factors (related to relationships and communications) on the healthcare providers’ side as the major impediment to end-of-life discussion. Study respondents suggested that simplification of the process and more staff are required to facilitate end-of-life discussion and documentation.ConclusionBased on the study results, adequate education and training for better end-of-life discussion are required for future practice. Also, a simple and clear procedure for completing a physician’s order of life-sustaining treatment in Korea should be prepared and legal and ethical advice would be required. Since the enactment of the Life-Sustaining Treatment Act, several revisions already have been made including disease categories, thus continuous education to update and support clinicians is also called for. (shrink)

This book, based on Jaegwon Kim's 1996 Townsend Lectures, presents the philosopher's current views on a variety of issues in the metaphysics of the mind...

Responsible leadership is rare. It is not that most leaders are irresponsible, but responsibility in leadership is frequently defined so that an important connotation of responsible leadership is ignored. This article equates responsible leadership with virtuousness. Using this connotation implies that responsible leadership is based on three assumptions—eudaemonism, inherent value, and amplification. Secondarily, this connotation produces two important outcomes—a fixed point for coping with change, and benefits for constituencies who may never be affected otherwise. The meaning and advantages of responsible (...) leadership as virtuous leadership are discussed. (shrink)

Direction of fit theories usually claim that beliefs are such that they “aim at truth” or “ought to fit” the world and desires are such that they “aim at realization” or the world “ought to fit” them. This essay argues that no theory of direction of fit is correct. The two directions of fit are supposed to be determinations of one and the same determinable two-place relation, differing only in the ordering of favored terms. But there is no such determinable (...) because of ineliminable asymmetries between the way that beliefs “aim at truth” and the way that desires “aim at realization.” This essay traces the ills of direction of fit theory to a misunderstanding of Anscombe and proposes a cure that distinguishes theoretical and practical thought by appeal to a distinction between thought in the form of a state and thought in the form of an event. (shrink)

Is Anscombean practical knowledge independent of what the agent actually does on an occasion? Failure to understand Anscombe’s answer to this question is a major obstacle to appreciating the subtlety and plausibility of her view. I argue that Anscombe’s answer is negative, and turns on the nature of mistakes in performance, and reveals a distinctive implicit metaphysics of mind and knowledge, structured by related capacities and exercises of capacities. If my interpretation is correct, then practical knowledge shares features with knowledge-how (...) and knowledge-that, but deserves its own epistemic category. (shrink)

In an age where previous frames of reference lose their certainty nurses are finding themselves rethinking their relations to the ‘real’. In this paper I interrogate an empirical ‘text’ of a local nursing cultural practice through a poststructural critique of the ways in which language, discourses, representation and experience intersect to construct ‘reality’ for us with specific consequences. I do this in an attempt to disclose the micro‐politics at work in the processes of signifying and thus representing nursing to a (...) world of potential students. The discourses of science and caring find themselves exposed in particular representational technologies and practices that mark nursing's collusion with the ‘truths’ of science at the expense of those we loosely name ‘caring’. This cultural theoretical work constitutes a provisional and historical fragment of analysis designed to trouble the relations we often unwittingly sustain with dominant ‘regimes of truth’. (shrink)

Some people of colour feel shame in response to racist incidents. This phenomenon seems puzzling since, plausibly, they have nothing to feel shame about. This puzzle arises because we assume that targets of racism feel shame about their race. However, I propose that when an individual is racialised as non-White in a racist incident, shame is sometimes prompted, not by a negative self-assessment of her race, but by her inability to choose when her stigmatised race is made salient. I argue (...) that this can make sense of some shame responses to racism. My account also helps to highlight some of the emotional and cognitive costs of racism that have their root in shame as well as a new form of hermeneutical injustice and distinctive communicative harms, contributing to a fuller picture of what is objectionable about racism. (shrink)

In this article we defend the view that, on the All Affected Principle of voting rights, the weight of a person’s vote on a decision should be determined by and only by the degree to which that dec...

This book is part of the growing field of practical approaches to philosophical questions relating to identity, agency and ethics, working across continental and analytical traditions. Kim Atkins explains and justifies the basis of the practical approach through an explication of the structures of human embodiment and an account of how those structures necessitate a narrative model of selfhood, understanding and ethics. She highlights how recent work on agency and autonomy implicitly draws upon conceptions of embodiment and intersubjectivity that underpin (...) the narrative view. (shrink)

The essays collected in this volume address a range of issues that arise when the focus of philosophical reflection on identity is shifted from metaphysical to practical and evaluative concerns. They also explore the usefulness of the notion of narrative for articulating and responding to these issues. The chapters, written by an outstanding roster of international scholars, address a range of complex philosophical issues concerning the relationship between practical and metaphysical identity, the embodied dimensions of the first-personal perspective, the kind (...) of reflexive agency involved in the self-constitution of one’s practical identity, the relationship between practical identity and normativity, and the temporal dimensions of identity and selfhood. In addressing these issues, contributors engage with debates in the literatures on personal identity, phenomenology, moral psychology, action theory, normative ethical theory, and feminist philosophy. (shrink)

This book is part of the growing field of practical approaches to philosophical questions relating to identity, agency and ethics--approaches which work across continental and analytical traditions and which Atkins justifies through an explication of how the structures of human embodiment necessitate a narrative model of selfhood, understanding, and ethics.

In men and women sexual arousal culminates in orgasm, with female orgasm solely from sexual intercourse often regarded as a unique feature of human sexuality. However, orgasm from sexual intercourse occurs more reliably in men than in women, likely reflecting the different types of physical stimulation men and women require for orgasm. In men, orgasms are under strong selective pressure as orgasms are coupled with ejaculation and thus contribute to male reproductive success. By contrast, women's orgasms in intercourse are highly (...) variable and are under little selective pressure as they are not a reproductive necessity. The proximal mechanisms producing variability in women's orgasms are little understood. In 1924 Marie Bonaparte proposed that a shorter distance between a woman's clitoris and her urethral meatus (CUMD) increased her likelihood of experiencing orgasm in intercourse. She based this on her published data that were never statistically analyzed. In 1940 Landis and colleagues published similar data suggesting the same relationship, but these data too were never fully analyzed. We analyzed raw data from these two studies and found that both demonstrate a strong inverse relationship between CUMD and orgasm during intercourse. Unresolved is whether this increased likelihood of orgasm with shorter CUMD reflects increased penile–clitoral contact during sexual intercourse or increased penile stimulation of internal aspects of the clitoris. CUMD likely reflects prenatal androgen exposure, with higher androgen levels producing larger distances. Thus these results suggest that women exposed to lower levels of prenatal androgens are more likely to experience orgasm during sexual intercourse. . (shrink)

At the International Legal Ethics Conference IV held at Stanford Law School between 15 and 17 July 2010, one of the two opening plenary sessions consisted of a panel who debated the proposition that legal ethics should be mandatory in legal education. The panel included leading legal ethics academics from jurisdictions around the world—both those where legal ethics is a compulsory part of the law degree and those where it is not. It comprised Professors Andrew Boon, Brent Cotter, Christine Parker, (...) Stephen L Pepper and Richard Wu, and was organised and chaired by Professor Kim Economides. This is an edited version of the panel's discussion. It provides a useful summary of the state of legal ethics teaching in the jurisdictions represented as well as a marshalling of the arguments for and against legal ethics as a required course in the university law degree. (shrink)

The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants’ experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place’s moral climate as well as by two aspects of the mental health staff’s moral sensitivity. The (...) nurses’ experience of ‘moral burden’ or ‘moral support’ increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency. Copyright © 2011 by SAGE Publications. (shrink)

In this study, we examine the philosophical bases of one of the leading clinical psychological methods of therapy for anxiety, anger, and depression, Cognitive Behavioral Therapy (CBT). We trace this method back to its philosophical roots in the Stoic, Buddhist, Taoist, and Existentialist philosophical traditions. We start by discussing the tenets of CBT, and then we expand on the philosophical traditions that ground this approach. Given that CBT has had a clinically measured positive effect on the psychological well-being of individuals, (...) it becomes important to study the philosophical foundations on which this therapy is based. (shrink)

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)

Courting competency: nursing and the politics of performance in practiceNurses have long anguished over how best to assess performance in clinical practice. The ‘competency’ movement appears to have provided a solution to this problem. In this paper I undertake a ‘radical hermeneutic’ interrogation of the cultural text of clinical practice doubled with a poststructuralist interpretation of the literal text of the Australian competency project. Through this work I attempt to expose some of the deeply embedded assumptions that underwrite the competency (...) movement and amplify the problems posed by an uncritical appropriation of competency based training and assessment in nursing education. (shrink)

The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the (...) research team’s understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills. (shrink)

(From the Press's Website) -/- Winner of the 2004 Lakatos Prize, Thought in a Hostile World is an exploration of the evolution of cognition, especially human cognition, by one of today's foremost philosophers of biology and of mind. Features an exploration of the evolution of human cognition. Written by one of today’s foremost philosophers of mind and language. Presents a set of analytic tools for thinking about cognition and its evolution. Offers a critique of nativist, modular versions of evolutionary psychology, (...) rejecting the example of language as a model for thinking about human cognitive capacities. Applies to the areas of cognitive science, philosophy of mind, and evolutionary psychology. -/- . (shrink)

The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient’s vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses feel that (...) they have no control over the specific situation. The findings from this analysis are supported by recent research on stress in the workplace but differ in that the imperatives directing work are moral in nature. Stress researchers have found that persons who experience that they have no control over their work situation and at the same time experience high demands may be prone to cardiovascular diseases. An important question raised by this study is whether moral stress should be recognized as a health risk in nursing. Further research is required in order to generate intervention models to prevent or deal with moral stress. (shrink)

I claim that the balance of nature metaphoris shorthand for a paradigmatic view of natureas a beneficent force. I trace the historicalorigins of this concept and demonstrate that itoperates today in the discipline of populationecology. Although it might be suspected thatthis metaphor is a pre-theoretic description ofthe more precisely defined notion ofequilibrium, I demonstrate that balance ofnature has constricted the meaning ofmathematical equilibrium in population ecology.As well as influencing the meaning ofequilibrium, the metaphor has also loaded themathematical term with values.Environmentalists (...) and critics use thisconflation of meaning and value to theiradvantage. This interplay between the balanceof nature and equilibrium fits aninteractionist interpretation of the role ofmetaphor in science. However, it seems theinteraction is asymmetric, and the balance ofnature metaphor has had a larger influence onmathematical equilibrium than vice versa. Thisdisproportionate influence suggests that themetaphor was and continues to be a constitutivepart of ecological theories. (shrink)

We provide new findings that add to the growing body of empirical evidence that important epistemic intuitions converge across cultures. Specifically, we selected three recent studies conducted in the US that reported surprising effects of knowledge attribution among English speakers. We translated the vignettes used in those studies into Mandarin Chinese and Korean and then ran the studies with participants in Mainland China, Taiwan, and South Korea. We found that, strikingly, all three of the effects first obtained in the US (...) also emerged in the East Asian cultures we studied. Our findings not only cohere with but also provide—at least moderate—support for the existence of extensive convergences of important epistemic intuitions across cultures. (shrink)

Evidence‐based practice (EBP) first appeared on the healthcare horizon just over a decade ago. In 2003 its presence has intensified and extended beyond its initial relation to medicine embracing as it does now, nursing and the allied health disciplines. In this paper, I contend that its appearance and subsequent growth and development are the effects of potent ‘regimes of truth’, four of which bear the names: positivism, empiricism, pragmatism and economic rationalism. My aim is to show how EBP generates the (...) controversy it does because its nature and methods are inextricably interwoven with the way it has become politicised and professionalised. This exegesis is an attempt to outline how the combined effects of the four forms of rationality mentioned above allow for both the methods and objectives of EBP to be constructed as they are, while at the same moment producing the particular effects of knowledge and power in terms of who sells and who buys the idea of EBP in the culture of contemporary healthcare. (shrink)

The aim of this thoroughly unconventional work is to demonstrate that Herman Melville's Moby Dick and Ludwig Wittgenstein's Philosophical Investigations share the same projects and are, in effect, one and the same book.