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Problematic substance use (PSU) among nurses has wide‐ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature and (...) that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use. (shrink)

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This paper argues that close personal relationships play an important role in our judgments about what is fair. I start with an explanation of leading theories of fairness, highlighting the potential for further work on the grounds of fairness. Next, I offer an account of close personal relationships as having the ability to generate legitimate and reasonable expectations of one or other party to a judgment about fairness, or both. I show how and when close personal relationships can ground fairness.

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Nurses’ experiences in, and the overall effectiveness of, widely used alternative‐to‐discipline programs to manage nurses’ substance‐use problems have not been adequately scrutinized. We uncovered the conflicted official and experiential ways of knowing one such alternative‐to‐discipline program in a Canadian province. We explicated this conflict through an institutional ethnography analysis. Ethnographic data from interviews with 12 nurses who were enrolled in an alternative‐to‐discipline treatment program and three program administrators, as well as institutional texts, were analyzed to explore how institutional practices and (...) power relations co‐ordinated and managed nurses’ experiences. Analysis revealed the acritical acceptance of a standardized program not based on current norms of practice. Potential and actual conflicts of interest, power imbalances, and prevailing corporate interests were rife. Nurses were not afforded the same rights to quality ethical health care as other citizens. ‘Expert’ physicians’ knowledge was privileged while nurses’ knowledge was subordinated. Conclusions were that regulatory bodies cannot rely on the taken‐for‐granted standardized treatment model in widespread use. Individualized treatment alternatives reflecting current, scientific evidence must be offered to nurses, and nurses’ knowledge, expertise, and experiences need to be included in decision‐making processes in these programs. (shrink)

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While vaccination rates in the United States are high — generally over 90 percent — rates of exemptions have been going up, and preventable diseases coming back. Aside from their human cost and the financial cost of treatment imposed on those who become ill, outbreaks impose financial costs on an already burdened public health system, diverting resources from other areas. This article examines the financial costs of non-vaccination, showing how high they can be and what they include. It makes a (...) case for requiring those who do not vaccinate to cover the costs of outbreak caused by their choice. Such recouping is justified because the choice not to vaccinate can easily be seen as negligent. But even if it is not, that choice involves imposing costs on others, and there are good reasons to require the actors to internalize those costs. The article proposes alternative statutory and regulatory schemes to cover the costs imposed on the public purse, focusing on no-fault mechanisms. We consider both ex ante mechanisms like a tax or a fee that will go into a no-fault fund to cover the costs and ex post mechanisms like a statutory authorization for recoupment of those costs by health officials. (shrink)

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The punchy central claim of Torbjörn Tännsjö's book is that act-utilitarianism best explains our considered intuitions about the moral status of different kinds of killing. An interesting aspect of this book is Tännsjö's revisionary methodology, which he names 'Applied Ethics (Turned Upside Down)'. So, why does Tännsjö choose applied ethics (turned upside down) to argue for act-utilitarianism's role in explaining our considered intuitions about killing and what, exactly, is his innovative method of moral investigation?

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Marcus Arvan’s Rightness as Fairness is a highly ambitious book. In fewer than 230 pages, hopes to demonstrate that we ought to evaluate moral theories in a similar manner to sciences, that existing moral theories fall short on that evaluation, that moral normativity reduces to instrumental rationality, and that a new theory of ‘rightness as fairness’ meets the scientific evaluative standards better than any of the alternatives.

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Previous research suggests that exposure to nature may reduce delay discounting and thereby facilitate healthier dietary intake. This pre-registered study examined the impact of online exposure to images of natural scenes on delay discounting and food preferences. It was predicted that exposure to images of natural scenes would be associated with: lower delay discounting; higher desirability for fruits and vegetables ; and delay discounting would mediate the effect of nature-image exposure on food desirability. Adult participants were recruited to an online (...) between-subjects experiment in which they viewed a timed sequence of six images either showing natural landscape scenes or urban scenes. They then completed measures of mood, delay discounting and rated their momentary desire to eat four fruits and vegetables, and four energy-dense foods. There was no statistically significant effect of experimental condition on delay discounting or food desirability. Bayes factors supported the null hypothesis for discounting, and energy-dense food desirability, but provided no strong evidence for either hypothesis for F&V desirability. These findings indicate that brief online exposure to images of nature does not affect momentary impulsivity or energy-dense food preference, whereas for preference for less-energy dense foods, the evidence was inconclusive. (shrink)

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Transient receptor potential vanilloid 4 (TRPV4), a member of the TRP superfamily, is a broadly expressed, cell surface‐localized cation channel that is activated by a variety of environmental stimuli. Importantly, TRPV4 has been increasingly implicated in the regulation of cellular morphology. Here we propose that TRPV4 and the cytoskeletal remodeling small GTPase RhoA together constitute an environmentally sensitive signaling complex that contributes to pathological cell cytoskeletal alterations during neurological injury and disease. Supporting this hypothesis is our recent work demonstrating direct (...) physical and bidirectional functional interactions of TRPV4 with RhoA, which can lead to activation of RhoA and reorganization of the actin cytoskeleton. Furthermore, a confluence of evidence implicates TRPV4 and/or RhoA in pathological responses triggered by a range of acute neurological insults ranging from stroke to traumatic injury. While initiated by a variety of insults, TRPV4–RhoA signaling may represent a common pathway that disrupts axonal regeneration and blood–brain barrier integrity. These insights also suggest that TRPV4 inhibition may represent a safe, feasible, and precise therapeutic strategy for limiting pathological TRPV4–RhoA activation in a range of neurological diseases. (shrink)

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Charlotte Wolff was born in Riesenburg, West Prussia into a middle-class Jewish family. She studied philosophy and then medicine at several German universities, completing her doctorate in Berlin in 1926. Working in various institutions over the next few years, she was also interested in psychotherapy and had a small private medical and psychotherapeutic practice. In 1933 she was forced to leave Germany because of the Nazi regime, and settled for a few years in Paris. As a German refugee she (...) was unable to practice medicine, so she began her research into the correlation between hand traits and personality. In 1936 she went to London to continue her research work and lived there until her death. An active lesbian from an early age, her later research turned to sexology and her writing on lesbianism and bisexuality were influential early works in the field. This is a great opportunity to rediscover her early work, including her first autobiography. (shrink)

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Recent longitudinal observations show that human menstrual cycles, sleep‐wake cycles and manic‐depressive cycles can become synchronized with lunar cycles, but do so in uniquely complex and heterogeneous ways that are unlikely to have been detected by past studies. Past studies’ negative results have given rise to a scientific consensus that human biology and behavior are unaffected by lunar cycles. The recent observations show that synchrony can be temporary, and can occur with more than one type of lunar cycle, more than (...) one phase of a lunar cycle and more than one resonant frequency of a lunar cycle. Given the variability of human responses to lunar cycles, aggregate analyses used in almost all previous studies would likely have cancelled out individuals’ responses and led to false negative results. In light of these observations, the question of lunar influence should be investigated further, with longitudinal observations and case‐by‐case analyses of individuals’ data. (shrink)

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BackgroundConcerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking.AimTo analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors.DesignThe data presented in this paper were collected as part of a wider research study of end-of-life care in an acute (...) hospital setting. Data collection comprised ethnographic non-participant observation on two acute hospital wards and individual interviews with patients, relatives and healthcare professionals caring for patients thought to be approaching the end of life. Data were analysed using a constructivist grounded theory approach.ResultsDiscussions and decision making about resuscitation present many challenges for those involved on acute medical wards. The data highlight the potential for multiple interpretations of legal precedents, creating misunderstandings that may impact patient care in less positive ways.ConclusionsThis paper provides unique insights into how doctors respond to the changing medico-legal culture and the subsequent effects on patient care. It demonstrates how the juridification of medical practice can occur. It highlights the potential benefit of a structure to support clinicians, patients and relatives in discussing and navigating decisions around care at the end of life in line with the patient’s wishes and preferences. Recommendations for future research are made and legal ramifications are discussed. (shrink)

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This article examines the human placenta not only as a scientific, medical and biological entity but as a consumer bio-product. In the emergent placenta economy, the human placenta is exchanged and gains potentiality as food, medicine and cosmetics. Drawing on empirical research from the United States, the United Kingdom, Denmark and Japan, the authors use feminist cultural analysis and consumer theories to discuss how the placenta is exchanged and gains commodity status as a medical supplement, smoothie, pill and anti-ageing lotion. (...) Placenta preparers and new mothers cite medical properties and spirituality as reasons for eating or encapsulating the placenta, reinstating ideas of the liberated good mother. Meanwhile, the cosmetics industry situates the placenta as an extract and hence a commodity, re-naturalizing it as an anti-ageing, rejuvenating and whitening bio-product. The authors conclude that, in the emergent bio-economy, the dichotomy between the inner and the outer body is deconstructed, while the placenta gains clinical and industrial as well as affective value. (shrink)

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This chapter offers a reinterpretation of Heidegger’s conception of the social world in order to overcome the tension between its conflicting positive and negative characterisations in Being and Time. Rejecting a purely positive or a purely negative reading of das Man, the chapter follows Stephen Mulhall in carving out a middle ground between the two. The chapter takes seriously Heidegger’s claim that it is possible for das Man to undergo an authentic transformation, exploring how best to conceive of this idea. (...) It is argued that the authentic transformation of das Man and the everyday way of being it engenders, is most productively understood with reference to Dasein’s relation to das Man and the way Dasein grasps the world as meaningful. Through this reading it is shown how both an authentic and an inauthentic mode of everydayness can be accommodated. The chapter concludes with an examination of the consequences of this interpretation, arguing for the critical and political potential of authenticity as an attentive and engaged mode of being-in-the-world. (shrink)

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Background When anti-cancer treatments have been given market authorization, but are not (yet) reimbursed within a healthcare system, physicians are confronted with ethical dilemmas. Arranging access through other channels, e.g., hospital budgets or out-of-pocket payments by patients, may benefit patients, but leads to unequal access. Until now, little is known about the perspectives of physicians on access to non-reimbursed treatments. This interview study maps the experiences and moral views of Dutch oncologists and hematologists.Methods A diverse sample of oncologists and hematologists (...) (n = 22) were interviewed. Interviews were analyzed thematically using Nvivo 12 qualitative data software.Results This study reveals stark differences between physicians’ experiences and moral views on access to anti-cancer treatments that are not (yet) reimbursed: some physicians try to arrange other ways of access and some physicians do not. Some physicians inform patients about anti-cancer treatments that are not yet reimbursed, while others wait for reimbursement. Some physicians have principled moral objections to out-of-pocket payment, while others do not.Conclusion Oncologists and hematologists in the Netherlands differ greatly in their perspectives on access to expensive anti-cancer treatments that are not (yet) reimbursed. As a result, they may act differently when confronted with dilemmas in the consultation room. Physicians working in different healthcare systems may face similar dilemmas. (shrink)

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In the field of placebo studies residual disagreement about the terminology ‘placebo’ and ‘placebo effect’ still persists. We differentiate between the conceptualization of placebos in clinical trials; and placebo effects understood as a psychobiological phenomenon. With respect to the latter, we argue that a scientific ‘placebo paradigm’ has emerged, indicating that—at least among placebo scientists—there exists relatively stable consensus about how to conceive of placebo effects. We claim that existence of a placebo paradigm does not protect concepts from revision; nonetheless, (...) we argue that scientific progress is dependent on, and guided by relative conceptual stability. Therefore, to mount persuasive arguments for conceptual revision in respect of ‘placebo effects’ we argue, critics either need to defend the claim that a placebo paradigm is not underway, or that there are major scientific failings in respect of it. With these considerations in mind we examine three alternative proposals for conceptual reform: Grünbaum/Howick’s relativity models of placebo concepts; Moerman/Brody’s meaning response; and Nunn/Turner’s proposal for conceptual eliminativism. We derive two conclusions from this evaluation. First, we conclude that no convincing arguments have so far been presented for conceptual overhaul of ‘placebo effects.’ Notwithstanding this analysis, we conclude that refinement of this concept is likely. Second, we agree with Turner and Nunn that the term ‘placebo’ in the context of randomized controlled trials remains a source of confusion for many researchers, risking the design and scientific integrity of clinical findings. Therefore, in these contexts, replacing the term ‘placebo’ with ‘control’ is justified. (shrink)

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BackgroundIn childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals have expressed a need for clinical ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe (...) the MCD-related outcomes that healthcare professionals in childhood cancer care considered important, before MCDs were implemented, in order to facilitate the implementation of MCDs in childhood cancer care in Sweden.MethodsThis study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content validated European MCD Outcomes Instrument, before participating in regular MCDs. Answers to the main open-ended question, included in the questionnaire, was analysed according to systematic text condensation.ResultsData was collected from 161 responses from the healthcare professionals. The responses included healthcare professionals’ perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows:Interprofessional well-being in team interactionson a team level;Professional comfort when dealing with moral challengeson a personal level; andImproved quality of care for the child and the familyon a care level.ConclusionsHealthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used in current and future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then create relevant working conditions for clinical ethics support. (shrink)

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This book presents a series of informal biographies about major figures in the history of psychology. A unique combination of expertise and human appeal, the volume places the contributions of each pioneer in a new and fascinating perspective. For instance, several of the authors use the novel approach of having the pioneers return to the present day to reflect back on their work as it relates to the here and now. Revisions of speeches given in a popular series of invited (...) addresses at psychological conventions, the chapters offer appealing glimpses into the lives of individuals who made a difference in the early years of psychology as a field of study. Each of the five volumes in this series contains different profiles thereby bringing more than 100 of the pioneers in psychology more vividly to life. (shrink)

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From the beginning of chaos research until today, the unpredictability of chaos has been a central theme. It is widely believed and claimed by philosophers, mathematicians and physicists alike that chaos has a new implication for unpredictability, meaning that chaotic systems are unpredictable in a way that other deterministic systems are not. Hence, one might expect that the question ‘What are the new implications of chaos for unpredictability?’ has already been answered in a satisfactory way. However, this is not the (...) case. I will critically evaluate the existing answers and argue that they do not fit the bill. Then I will approach this question by showing that chaos can be defined via mixing, which has never before been explicitly argued for. Based on this insight, I will propose that the sought-after new implication of chaos for unpredictability is the following: for predicting any event, all sufficiently past events are approximately probabilistically irrelevant. (shrink)

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My paper challenges an influential distinction between pain and suffering put forward by physician-ethicist, Eric Cassell. I argue that Cassell’s distinction is philosophically untenable because he contrasts suffering with an outdated theory of pain. In particular, Cassell focuses on one type of pain, the interpretation of nociception induced by noxious stimuli such as heat or sharp objects; yet since the late 1970s, pain scientists have rendered both nociception and noxious stimuli unnecessary for pain. I argue that this discrepancy between Cassell’s (...) distinction and pain science produces three philosophical problems for his distinction: first, he frames his distinction too generally, concentrating on only one type of pain (interpreted nociception) to the neglect of others, such as neuropathy; second, it is possible that Cassell’s understanding of pain may include suffering; and third, Cassell gives examples of pain and suffering manifesting independently of each other, but it is possible that these cases may instead exemplify differences between nociceptive and non-nociceptive types of pain. Due to these problems, I conclude that Cassell’s distinction currently lacks a difference. I call for new efforts to articulate the differences, if any, between pain and suffering. (shrink)

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Compared with mainstream medicine and complementary and alternative therapies, the practice of psychotherapy has enjoyed a relative pass when it comes to ethical evaluation. Therefore, contributions to the, although slowly growing, body of literature on psychotherapy ethics are to be welcomed. In his paper ‘Psychotherapy, placebos, and informed consent’, Garson Leder takes issue with what he calls the ‘go open’ project in psychotherapy ethics—the idea that the so-called ‘common factors’ in therapy should be disclosed to prospective patients. Although Leder does (...) not give a detailed list, the common factors include therapist characteristics, patient characteristics, and the working alliance. He argues that the project advocating disclosure of these factors is flawed on two grounds: that information about common factors is not necessary for informed consent; and clarity about specific mechanisms of change in therapy is consistent with ‘many theory-specific forms of psychotherapy’. There are multiple serious problems with Leder’s critique of the recent literature, including how he represents the contours of the debate, which I list, and address in this response. (shrink)

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“How can it be that the female is both functional and a failure?”. Sophia Connell’s response comes in the form of a careful, thorough, and philosophically sensitive interpretation of Aristotle’s treatise on animal generation. By pursuing the topic of what Aristotle says about female animals and their role in reproduction, Connell casts light into many difficult corners of his theory: What does it mean to say that the male is the “hê archê [tês] kinêseos” of the generation? How should we (...) think of the motions in the semen that “construct” the embryo? Are these motions the same? According to Connell, they are not. The efficient cause of the generation is the male; he is the origin... (shrink)

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Stem cells may have a special importance in the neoplastic behavior of certain lineages as well as in the normal development of these tissues. The role of oncogenes, and their normal cellular analogues, in stem cell behavior is therefore of special interest. This review describes recent results on the effects of virally‐mediated src‐gene transfer into hemopoietic stem cells in the physiological and developmental properties of these cells.

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Den sthetischen Kategorien "Umriss" und "Kontur" kommt innerhalb sthetischer und erkenntnistheoretischer Diskussionen verschiedenster Epochen zentrale Bedeutung zu. Besonders an Epochenschwellen werden Reflexionen ber die erkenntnistheoretischen und produktions- wie wirkungs sthetischen Implikationen von Umrissph nomenen als Medium kunsttheoretischer Abgrenzung ausgestaltet. Anhand der Problemgeschichte dieser Kategorien ergeben sich Diagramme einer Geschichte sthetischen Denkens in seinen Konstanten, Br chen und Modifikationsmechanismen. Die Dissertation zeichnet die Geschichte der sthetischen Denkfigur 'Kontur' in signifikanten Stationen nach, von der antiken Wahrnehmungstheorie und berlieferungen zur Entstehung der Kunst (...) ber die Kunsttheorie der italienischen Renaissance und des franz sischen Klassizismus hin zum Hauptteil der Studie, deren Schwerpunkt die Entwicklung der deutschsprachigen Kunstliteratur bildet: von den Anf ngen bei Rivius und Sandrart ber Winckelmann und die Kunsttheorie von Klassik, Fr hromantik und Realismus bis zu Rilkes Rodin-Studien. Die der Studie zugrundeliegende Dissertation wurde mit dem Scherer-Preis 2012 der Richard M. Meyer-Stiftung ausgezeichnet (Nachwuchspreis f r deutsche Philologie). (shrink)

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We are all immersed in a sea of social norms, but they are sometimes tricky to observe with any clarity. They are often invisible to us and emerge only when they are not observed. Social norms are important to understand because they are both limiting of our freedom, such as gendered and racialized norms, and at the same time the very conditions of our agency. Social Goodness presents an original, externalist answer to the question of the source or origin of (...) social role normativity. Rather than grounding social normativity in the attitudes of persons, the book argues for an externalism that roots social role normativity in the social world itself: in its positions, institutions, and larger architecture. The core insight of externalism is that the function or structural feature of an enterprise or activity can bring with it normative demands quite independently of the attitudes of those who engage with it. According to the artisanal model, just as a carpenter, ceramicist, or chef is responsive to and evaluable under a set of artisanal norms or techniques, so too is a mother and or an academic or a President. The source of normativity is this technique or expertise, independent of the preferences, endorsements, or recognitive attitudes of individuals. The artisanal model for social role normativity has resources to explain both the "stickiness" or persistence of social norms and our ability to criticize existing norms and to engage in normative self-creation--to create new normative selves. The artisanal model also has resources to capture and express the social situatedness, locality, and materiality of social roles. The relational ontology of social roles, implicit in the artisanal model, provides a useful frame to consider both hierarchical and oppressive social relations. (shrink)

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Animals do a wide range of work in our society, but they are rarely recognized as workers or accorded any labour rights, and their working conditions are often oppressive and exploitative. Drawing on law, ethics, and labour studies, the essays in this volume explore the potential and dangers of animal labour.

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ABSTRACT When does a state of affairs constitute a harm to someone? Comparative accounts say that being worse off constitutes harm. The temporal version of the comparative account is seldom taken seriously, due to apparently fatal counterexamples. I defend the temporal version against these counterexamples, and show that it is in fact more plausible than the prominent counterfactual version of the account. Non-comparative accounts say that being badly off constitutes harm. However, neither the temporal comparative account nor the non-comparative account (...) can correctly classify all harms. I argue that we should combine them into a hybrid account of harm. The hybrid account is extensionally adequate and presents a unified view on the nature of harm. (shrink)

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The commentary provides contextual information about the seminar which Bourdieu and Passeron gave in the École Normale Supérieure on 6 December 1963. It appears that the intended series of seminars was curtailed, perhaps because the initial seminar of 6 December exposed the extent to which Althusser was formally managing the intentions of his guest speakers and resisting the implications of their ongoing research on students and their studies. The commentary argues that the conflict between Althusser and Bourdieu/Passeron was inter-generational in (...) that Althusser’s attitudes had been shaped by his experience as a victim of Nazi oppression whereas those of Bourdieu/Passeron were defined, instead, by their unwilling participation in the French colonial oppression of indigenous Algerians. Althusser was intent on examining philosophically the validity of various contemporary versions of social science whereas Bourdieu and Passeron were engaged in educational research which was scrutinizing sociologically the validity of precisely this supposedly detached philosophical perspective. In short, the commentary is aligned with the Bourdieu/Passeron position in that it seeks to offer an historical sociology of the encounter of December 1963. (shrink)

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