Drawing on my qualitative and quantitative research I show that the motives for war have changed in the course of the last four centuries, and that the causes of war and the responses of others to the use of force are shaped by society. Leaders who start wars rarely behave with the substantive and instrumental rationality assumed by realist and rationalist approaches. For this reason, historically they lose more than half wars than they start. After 1945, the frequency of failure (...) rises to over 80 percent. Rationalists allow for miscalculation but attribute it to lack of information. In most wars, information was available beforehand that indicated, or certainly suggested, that the venture would not succeed militarily or fail to achieve its political goals. The war in Ukraine is a case in point. (shrink)

Background Artificial intelligence-driven Clinical Decision Support Systems (AI-CDSS) are increasingly being integrated into healthcare for various purposes, including resource allocation. While these systems promise improved efficiency and decision-making, they also raise significant ethical concerns. This study aims to explore healthcare professionals’ perspectives on the ethical implications of using AI-CDSS for healthcare resource allocation. Methods We conducted semi-structured qualitative interviews with 23 healthcare professionals, including physicians, nurses, administrators, and medical ethicists in Turkey. Interviews focused on participants’ views regarding the use (...) of AI-CDSS in resource allocation, potential ethical challenges, and recommendations for responsible implementation. Data were analyzed using thematic analysis. Results Participant responses are clustered around five pre-determined thematic areas: (1) balancing efficiency and equity in resource allocation, (2) the importance of transparency and explicability in AI-CDSS, (3) shifting roles and responsibilities in clinical decision-making, (4) ethical considerations in data usage and algorithm development, and (5) balancing cost-effectiveness and patient-centered care. Participants acknowledged the potential of AI-CDSS to optimize resource allocation but expressed concerns about exacerbating healthcare disparities, the need for interpretable AI models, changing professional roles, data privacy, and maintaining individualized care. Conclusions The integration of AI-CDSS into healthcare resource allocation presents both opportunities and significant ethical challenges. Our findings underscore the need for robust ethical frameworks, enhanced AI literacy among healthcare professionals, interdisciplinary collaboration, and rigorous monitoring and evaluation processes. Addressing these challenges proactively is crucial for harnessing the potential of AI-CDSS while preserving the fundamental values of equity, transparency, and patient-centered care in healthcare delivery. (shrink)

Background Person-centred care is based on ethical principles, and it is regarded as high-quality care. Care of older persons should embrace person-centredness. During the pandemic, older persons were highlighted as a vulnerable group at risk of developing serious illness and/or suffering death from COVID-19. Several pandemic-related measures were introduced in residential care facilities (RCFs) to reduce this risk, which influenced the possibilities to lead and provide a person-centred care. Aim This study’s aim was to explore ethical challenges in relation (...) to person-centredness during the COVID-19 pandemic, from the perspective of leaders in RCFs. Research design The study had a qualitative descriptive design. Participants and research context Semi-structured interviews were conducted with 26 leaders working in RCFs in Sweden. Data were analysed using conventional content analysis. Ethical considerations The study was approved by the Swedish Ethical Review Authority. The participants received oral and written information about the study and gave written consent. The study was conducted in accordance with the Declaration of Helsinki. Findings The overarching ethical challenge was Having to disregard the individual needs of the person in order to protect the group and society. This included (a) Protecting the group versus promoting the older person’s autonomy; (b) Being forced to lead care based on uncertainty instead of evidence; (c) Striving to provide dignified care but lacking opportunities; and (d) Going far beyond ordinary duty and endangering one’s own and the staff’s health. Discussion The ethical challenges meant being torn between the person’s individual needs and protecting the group and society, with clashing ethical principles as a consequence. Conclusions The leaders faced ethical situations resulting in undignified and compromised person-centred care, which has implications for stakeholders and management who need to address the work conditions in RCFs. (shrink)

The prevailing model for encouraging innovation based on patents and market-oriented raises at least two economic and ethical issues: it imposes barriers on individuals and developing countries governments' access to medicines by defining prices that do not match their income, and the unavailability of new or appropriate products to address the health problems of these populations. In the last decade, this scenario has undergone some changes due to the emergence of new actors, the contribution of aid resources, the introduction to (...) the market of new products against neglected diseases, the development of new governmental healthcare policies and research programs, etc. One example of such initiatives is the Fixed-Dose Artesunate Combination Therapy (FACT) project consortium, which brought together institutions with different natures from both the North and the South, for the development of two antimalarial fixed-dose combinations recommended by the WHO – artesunate-amodiaquine (ASAQ) and artesunate-mefloquine (ASMQ). This paper proposes to describe and analyze the ASMQ consortium, which is the result of a new pharmaceutical development approach, based on a different paradigm – needs-driven instead of market-driven –, collaborative, with strategic participation of institutions from the South, funded by alternative resources (public and philanthropic). Thus, it represents an interesting object of study for bioethical debates on intellectual property and innovation, and its analysis is justified in light of the current debate on ways of stimulating needs-driven pharmaceutical innovation. (shrink)

In this chapter, I introduce three different types of AI-based moral enhancement proposals discussed in the literature – substitutive enhancement, value-driven enhancement, and value-open moral enhancement. I analyse them based on the following criteria: effectiveness, examining whether they bring about tangible moral changes; autonomy, assessing whether they infringe on human autonomy and agency; and developmental impact, considering whether they hinder the development of natural moral skills. This analysis demonstrates that no single approach to AI enhancement can satisfy all proposed (...) criteria, suggesting a need for pluralism in devising AI-based enhancement tools. The most advisable approach to AI-based enhancement is to explore and develop a variety of tools that cater to the diverse needs of users and address different weaknesses in moral decision-making. (shrink)

With the expansion of multinational corporations, the alarming upsurge in widely publicized and notable corporate scandals involving MNCs in emerging markets has begun to draw both academic and managerial attention to look beyond home market practices to the pressing concern of CSR in emerging markets. Previous studies on CSR have focused primarily on Western markets, reserving limited discussions in addressing the issue of MNC attitudes and CSR practices in their emerging host markets abroad. Despite this incongruity in academic response to (...) CSR in emerging markets, managers of multinational companies continue to face mounting and most often conflicting pressures to weigh among multiple strategic CSR responses in emerging markets. Such a task is often further complicated by the complexity of varying business norms and standards, regulatory environments, and stakeholder demands for CSR across national boundaries. With such a challenge in mind, I attempt to examine the explanatory factors in leading MNCs, otherwise recognized for accountability and integrity in their home markets, to employ inconsistent or negligent practices under CSR pressure in Chinese emerging economy. Preliminary findings reveal that discrepancies exist in how MNCs perform in CSR in home countries versus in host countries. While MNCs do have much to improve, the institutional environment in the emerging market, including the legal framework and the ethical culture, also needs to be improved by the host country governments, the industry associations, and local firms. Meanwhile, media interest and journalists, NGOs, third party monitors, industry stakeholders as well as consumer advocacy groups can raise the visibility of MNC’s contradictory practices between their origin nations and countries with emerging economies and offer the pressures and incentives for MNCs to amend their ethical shortcomings. This article also suggests implications for both theory and practice. (shrink)

This study investigates the intersection of existing computational frameworks for zoonotic disease control within the emerging societal paradigm, Society 5.0. Technologies in human-centric computing can facilitate real-time data collection and analysis, enabling early detection and rapid response to zoonotic disease outbreaks, thereby enhancing surveillance and containment efforts for public health protection. It aims to explore challenges and opportunities within these frameworks and delineate future research directions to serve as a benchmark. Conducting a three-layered analysis, the study identifies high-level technologies, (...) second-layer technologies within those brackets, and minutely analyzes each technology in the second layer. The focus includes a comprehensive examination of the evolving landscape of zoonotic disease control and the influence of computational tools in public health. The findings highlight the potential of leveraging computational frameworks to predict, monitor, and control zoonotic diseases more effectively within Society 5.0. The major identified thrust areas include One Health and governmental integration, digital and data-driven solutions, healthcare and medical technologies, technologies for communication and information dissemination, and socio-cultural and ethical considerations. The integration of large-scale healthcare services offer a robust data source for AI-driven models, enabling early detection and dynamic response to zoonotic threats using data acquired from IoT surveillance and data acquisition infrastructures. However, challenges such as data privacy and equitable healthcare access need addressing. The study emphasizes the opportunities arising from the integration of computational frameworks with Society 5.0 for zoonotic disease control, proposing potential benefits in terms of improved disease surveillance and response. To fully realize this potential, the study suggests exploring specific technological landscapes for further investigation in the context of zoonotic disease control. (shrink)

Large-scale data systems are increasingly envisioned as tools for justice, with big data analytics offering a key opportunity to advance health equity. Health systems face growing public pressure to collect data on patient “social factors,” and advocates and public officials seek to leverage such data sources as a means of system transformation. Despite the promise of this “data-driven” strategy, there is little empirical work that examines big data in action directly within the sites of care expected to transform. (...) In this article, I present a case study on one such initiative, focusing on a large public safety-net health system’s initiation of sexual orientation and gender identity data collection within the clinical setting. Drawing from ethnographic fieldwork and in-depth interviews with providers, staff, and administrators, I highlight three main challenges that elude big data’s grasp on inequality: provider and staff’s limited understanding of the social significance of data collection; patient perception of the cultural insensitivity of data items; and clinic need to balance data requests with competing priorities within a constrained time window. These issues reflect structural challenges within safety-net care that big data alone are unable to address in advancing social justice. I discuss these findings by considering the present data-driven strategy alongside two complementary courses of action: diversifying the health professions workforce and clinical education reform. To truly advance justice, we need more than “just data”: we need to confront the fundamental conditions of social inequality. (shrink)

Commercialization of medicine is a growing trend that threatens to undermine physicians’ commitments to patient care in favor of personal financial interests. Bemoaned by Arnold Relman as early as 1980, growing for-profit sectors of health care have been reshaping medicine from a profession into a business, forming the foundation of what he terms a “medical-industrial complex” that threatens to undermine professional identity and reshape health care funding. Commercialization poses new ethical challenges for health care providers who have a financial (...) stake in their health care decisions and may undermine their fiduciary duties to patients.Certainly, commercialization has brought about new trends in medicine — one need only to look as far as the rise in for-profit hospitals, diagnostic laboratories, and proprietary nursing homes to see how opportunities for financial gain reposition physicians’ orientations vis-à-vis patients. (shrink)

A major concern of public health authorities is to also encourage adults to be exposed to enriched environments during the pandemic lockdown, as was recently the case worldwide during the COVID-19 outbreak. Games for adults that require physical activity, known as exergames, offer opportunities here. In particular, the output of the gaming industry nowadays offers computer games with extended reality which combines real and virtual environments and refers to human-machine interactions generated by computers and wearable technologies. For example, playing the (...) game in front of a computer screen while standing or walking on a force plate or treadmill allows the user to react to certain infrastructural changes and obstacles within the virtual environment. Recent developments, optimization, and minimizations in wearable technology have produced wireless headsets and sensors that allow for unrestricted whole-body movement. This makes the virtual experience more immersive and provides the opportunity for greater engagement than traditional exercise. Currently, XR serves as an umbrella term for current immersive technologies as well as future realities that enhance the experience with features that produce new controllable environments. Overall, these technology-enhanced exergames challenge the adult user and modify the experience by increasing sensory stimulation and creating an environment where virtual and real elements interact. As a therapy, exergames can potentially create new environments and visualizations that may be more ecologically valid and thus simulate real activities of daily living that can be trained. Furthermore, by adding telemedicine features to the exergame, progress over time can be closely monitored and feedback provided, offering future opportunities for cognitive-motor assessment. To more optimally serve and challenge adults both physically and cognitively over time in future lockdowns, there is a need to provide long-term remote training and feedback. Particularly related to activities of daily living that create opportunities for effective and lasting rehabilitation for elderly and sufferers from chronic non-communicable diseases. The aim of the current review is to envision the remote training and monitoring of physical and cognitive aspects for adults with limited mobility, through the implementation of concurrent telehealth and exergame features using XR and wireless sensor technologies. (shrink)

ABSTRACT:What more can be said about COVID-19 and the social determinants of health? This article describes neglected perspectives that derive from the history of social epidemiology, a field that identifies the social etiology of disease and variations in disease incidence among people differentially located in the social structure. The "discovery" of social determinants of diseases like COVID-19 is nothing new for epidemiology: debate over how to analyze structural determinants versus individual-level risk factors persisted throughout the 19th and 20th centuries. (...) By the late 20th century, research had highlighted fundamental causes of health disparities, such as social conditions and structural racism; these are structural factors, embedded in the social fabric of life. Measurement of structured inequalities within systems faces complex and challenging problems, as research aims to better account for these lived realities at different levels of analysis and as multiple factors merge to influence outcomes (revealed in intersectionality theory). At each of these intersections, there are opportunities for bioethicists to consider their ethical implications. It is imperative to understand the social and ethical roots of our present conversations about health inequalities, in order to partner intelligently with researchers on the forefront of advocating for change. (shrink)

On 8th August 2019, Secretary of State for Health and Social Care, Matt Hancock, announced the creation of a £250 million NHS AI Lab. This significant investment is justified on the belief that transforming the UK’s National Health Service (NHS) into a more informationally mature and heterogeneous organisation, reliant on data-based and algorithmically-driven interactions, will offer significant benefit to patients, clinicians, and the overall system. These opportunities are realistic and should not be wasted. However, they may be missed (one (...) may recall the troubled Care.data programme) if the ethical challenges posed by this transformation are not carefully considered from the start, and then addressed thoroughly, systematically, and in a socially participatory way. To deal with this serious risk, the NHS AI Lab should create an Ethics Advisory Board and monitor, analyse, and address the normative and overarching ethical issues that arise at the individual, interpersonal, group, institutional and societal levels in AI for healthcare. (shrink)

Background The rapidly growing quantity of health data presents researchers with ample opportunity for innovation. At the same time, exploitation of the value of Big Data poses various ethical challenges that must be addressed in order to fulfil the requirements of responsible research and innovation (Gerke et al. 2020 ; Howe III and Elenberg 2020 ). Data sovereignty and its principles of self-determination and informed consent are central goals in this endeavor. However, their consistent implementation has enormous consequences (...) for the collection and processing of data in practice, especially given the complexity and growth of data in healthcare, which implies that artificial intelligence (AI) will increasingly be applied in the field due to its potential to unlock relevant, but previously hidden, information from the growing number of data (Jiang et al. 2017 ). Consequently, there is a need for ethically sound guidelines to help determine how data sovereignty and informed consent can be implemented in clinical research. Methods Using the method of a narrative literature review combined with a design thinking approach, this paper aims to contribute to the literature by answering the following research question: What are the practical requirements for the thorough implementation of data sovereignty and informed consent in healthcare? Results We show that privacy-preserving technologies, human-centered usability and interaction design, explainable and trustworthy AI, user acceptance and trust, patient involvement, and effective legislation are key requirements for data sovereignty and self-determination in clinical research. We outline the implications for the development of IT solutions in the German healthcare system. (shrink)

Mental health challenges appear to be extremely problematic among correctional service employees, affecting persons working in community, institutional, and administrative correctional services. Focusing specifically on giving voice to correctional workers employed by the Ontario Ministry of Community Services and Corrections, we shed light on their interpretations of the complexities of their occupational work and of how their work affects staff. We show that participants encounter barriers to treatment seeking, which they describe as tremendous, starting with benefits, wages, and shift (...) work. We let the voices of staff elucidate what is needed to create a healthier correctional workforce. Recommendations include more training opportunities and programs; quarterly, semi-annual, or annual appointments with a mental health professional who can assess changes in the mental health status of employees; off-site assessments to ensure confidentiality; and team building opportunities to reduce inter-personal conflict at work and increase moral by improving the work environment. (shrink)

Normative welfare economics commonly assumes that individuals’ preferences can be reliably inferred from their choices and relies on preference satisfaction as the normative standard for welfare. In recent years, several authors have criticized welfare economists’ reliance on preference satisfaction as the normative standard for welfare and have advocated grounding normative welfare economics on opportunities rather than preferences. In this paper, I argue that although preference-based approaches to normative welfare economics face significant conceptual and practical challenges, opportunity-based approaches fail (...) to provide a more reliable and informative foundation for normative welfare economics than preference-based approaches. I then identify and rebut various influential calls to ground normative welfare economics on opportunities rather than preferences to support my qualified defence of preference-based approaches. (shrink)

Precision Medicine is driven by the idea that the rapidly increasing range of relatively cheap and efficient self-tracking devices make it feasible to collect multiple kinds of phenotypic data. Advocates of N = 1 research emphasize the countless opportunities personal data provide for optimizing individual health. At the same time, using biomarker data for lifestyle interventions has shown to entail complex challenges. In this paper, we argue that researchers in the field of precision medicine need to address (...) the performative dimension of collecting data. We propose the fun-house mirror as a metaphor for the use of personal health data; each health data source yields a particular type of image that can be regarded as a ‘data mirror’ that is by definition specific and skewed. This requires competence on the part of individuals to adequately interpret the images thus provided. (shrink)

We report three studies in which we applied a value dictionary to narratives. Our objective was to test a theory-driven value dictionary for extracting valuable information from autobiographical and narrative texts. In Studies 1 and 2, participants wrote short autobiographical narratives and in Study 3, participants wrote narratives based on ambiguous stimuli. Participants in all three studies also completed the Portrait Value Questionnaire as a self-report measure of values. Overall, our results demonstrate that it is possible to extract value-relevant (...) information from these narratives. Extracted values from autobiographical narratives showed average correlations of 0.07 and 0.12 with self-reports compared to an average correlation of 0.01 for the extracted values from implicit motive tasks. The correlations with self-reports were in line with previous validation studies. The most salient values in narratives diverged somewhat, with a stronger emphasis on achievement values compared to self-reports, probably due to the nature of salient episodes within one's life that require demonstrating success according to social standards. Benevolence values were consistently most important in both self-ratings and text-based scoring. The value structure emerging from narratives diverged from the theoretically predicted structure, yet broad personally vs. socially focused value dimensions were qualitatively discernible. We highlight opportunities and challenges for future value research using autobiographical stories. (shrink)

This is an introduction to the Symposium on “The New Scientific Study of Religion Moving On.” The introduction briefly indicates why the cognitive science of religion (CSR) needs re‐evaluation. It subsequently gives an overview of the contributions of the symposium's articles.

The Association of Research Ethics Committees is one of the leading providers of training and education for members of Research Ethics Committees. The introduction of the research governance strategy and the increasing complexity of ethical review place great demands on research ethics committee members that in turn creates challenges for training providers. This paper presents the outcome of an audit of REC members' views about training. Findings demonstrate that REC members are not a homogenous group. Several distinct sub-groups, each (...) with particular training needs emerged. All showed a preference for short, easily accessible events in which there were opportunities for discussion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response to Randall Allsup, “Music Teacher Quality and Expertise”Bennett ReimerI am delighted to have this opportunity to reflect on Randall Allsup’s excellent, incisive, and wise paper. The issues he raises reach to the core of who we have been, where we are now, and how we must adapt ourselves to new challenges that deeply question both our ideals and our practices.Allsup’s opening questions relate directly to the (...) most pressing matters our profession is now facing—questions philosophical in essence. What kind of music teachers do our students deserve? What is the purpose of public education? And how do we get beyond our continuing and understandable desire for better-trained music teachers to ask the more pertinent question of what constitutes effective music teaching and learning in what the musical world is swiftly becoming. He has the courage to address this level of complexity seriously, and to make significant progress toward clarification. That deserves my respect and, I am quite sure, the respect of all of us.Allsup approaches his central premise on the significant changes needed in our professional identity by reminding us that we have “a long and distinguished [End Page 108] commitment to teaching and teachers.” That commitment, however, is based on the established assumption that music education is founded on excellence of performance as its ultimate goal and its greatest value. To achieve this musical end, he points out, requires mastery, attained through prolonged, careful apprenticeship. This “long running pedagogy of mastery and excellence appears closed to, or at least hostile to, innovation and popular input.”In addition, he argues, this belief system embroils all of us, teachers and their students, in the dichotomy of, on the one hand, replication of existing excellence as our goal, and, on the other, the need for emancipation from what was and what is, toward what might be; the need, that is, for transformation. The past, he recognizes, cannot simply be ignored: it is too precious for that. The future, however, also cannot be excluded. Within this antinomy we must find our way, honoring the past while not allowing it to constrict our future.At this point in his exposition Allsup approaches the proposition he is harboring, a proposition I want to explore for its potential in both clarity and complication. The basis of his key proposal is our need for teachers who are able “to think openly and less certainly about the design and implementation of musical instruction. Our pluralistic society,” he continues, “makes it imperative that we multiply the methods employed in the pursuit and construction of knowledge.”To accomplish this, Allsup presents a foundational dichotomy. There are “open forms of music” relating to “new and evolving ways of aesthetic participation that break with our traditional processes and our established codes and standards.” Contrasting with open forms are “closed forms,” representing the authoritative, the certain, and the canonic. “Closed forms,” he says, “represent culturally-structured and norm-driven literacies, where valuations of goodness pre-exist any aesthetic encounters.” Closed forms, he argues, are based on culturally agreed-upon modes of participation that are rigid in nature, such as in the prescribed and proscribed sequence of musical events proceeding inexorably in the order of composer-conductor-performer-audience.Such past (and present) rigidities, he points out, have become increasingly irrelevant. In every dimension of our lives significant and fast-occurring changes have become dominant, even expected, leaving us, as citizens and as educators, in confusion and uncertainty, and therefore in distress. We encounter aesthetic forms that are open-sourced and de-authored, unconnected to shared standards of practice. Technologies of music making and taking, he points out, have overthrown tradition to a startling degree, erasing distinctions among expert and amateur, between master and apprentice, between process and product, specialist and generalist, the classical and the vernacular.All this, and much more, is argued cogently and, I think, persuasively. It leads us to a central conception influencing how we must act as professionals. Our [End Page 109] obligation is to not only incorporate openness of musical engagements into our present culture of musical “closedness,” but to recognize the advent of openness as being a... (shrink)

Along with the social acceptance and geographical spread of revealed religions, their relationship with social values, institutions and scientific approaches has began to be discussed. Throughout the history of Islamic thought, this process is known as the period of rationalization. The epistemic relations between reason and revelation, philosophy and religion have continued with acceptance and rejection since the emergence of Islam. Our study deals with the factors that enable rationalization such as the scientific curiosity of the ulama and the umara, (...) the conquest campaign that expanded in a short time, translations, as well as socio-cultural barriers such as jahiliyya idea, tribalism and illiteracy in the rationalization process of religious belief in the earlier periods of Islam. The aim of our article is try to reveal the needs, possibilities and difficulties in the rationalization process. And to point out that some current religious and philosophical problems aren’t be able to be solved without taking into account the conditions of the early rationalization period. We have applied both to the historical data of the early and middle ages and to analytical methods that would make this process understandable by studying this paper. (shrink)

The modern world space, which is affected by the post-pandemic consequences, is noted by the globalization of society, the increasing role of citizenship in making important state and international decisions has become possible in the context of the information revolution and has its own characteristics of communication in information and communication networks. The importance and need for a thorough study of the chosen topic is that the widespread use of various forms and methods of civil communication, free access of (...) citizens to information at all stages of decision-making and the functioning of central and local governments, the participation of civil society institutions in the work of expert, consultative, and advisory public councils on the expression and protection of the rights and freedoms of citizens, public control, direct electronic receipt of public services, etc. are important factors in the democratization of government in post-pandemic modern times. After all, we are talking about a deliberate orientation to new values - the person and the collective, their direct participation in the democratic organization of life of the state and society. The main thing in this context is that the rational consensus of civil society and the state is a factor in universal social discourse and a strategic resource for democratic development in the context of post-pandemic modernity. The aim of the article is to consider the epistemological and sociocultural aspects of the functioning of the communication capabilities of civil society institutions in the context of revealing the possibility and significance of their involvement in the processes of implementing state security policy. (shrink)

The challenge of excellence in community health services has been taken up by medical educators in Colombia. Confronted with a nation where the primary indicators of disease mortality and morbidity (cardiovascular disease and infant mortality) were characteristic of First and Third World patterns, respectively, the Ministry of Health and La Asociacion Colombiana de Facultades de Medicina (ASCOFAME), representatives of institutions of medical education, have collaborated to conduct a needs assessment of the country's health needs and devised an implementation plan designed (...) to better address the needs of the majority of that nation's people. -/- As a model, the Colombian reorganization of medical education is an example which could be emulated by the U.S. where policy makers are struggling with troublesome questions of cost, equity and quality. (shrink)

Our research wants to show the emergence of the Act affects the status of the child laborers through economic, socio-cultural and psychosocial factors. Progress is noted in spite of the issues that still must be addressed to protect children.The new Child Labor Act can address most of the problems of children. The Act is successful in halting the children from coming to the urban areas.The new Child Labor Act is a way to prohibit the engagement of children and to make (...) the necessary provisions for their health, safety and facilities. The Act tries to make the parents aware that their children should go to school up to grade 10, to make the factory owner aware not to employ children, to make the local government aware of the need to stop the migration of children from rural villages to towns. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Growing Up With Autism: Challenges and Opportunities of Parenting Young Adult Children with Autism Spectrum DisordersKayhan Parsi and Nanette ElsterAs the parent and stepparent of a child with autism, we witness a world that is quite different from parents with only neurotypical children. Tantrums don’t vanish after the age of three. Aggression is a way of life. Simple communication is a constant challenge. And dreams of a child’s (...) future have to be altered and adapted. In the narratives that accompany this commentary, we see that the challenges of raising a child with autism do not necessarily diminish with age; they may, however, change because children with autism become adults with autism and this presents a new set of both challenges and opportunities.The current epidemic of young children with autism is giving rise to yet another epidemic—the rising number of young adults who are autistic. As one of the authors here mentioned, “the system is in for a tsunami of new individuals needing medical care of all types, needing continued supports for housing and vocational training, communication, occupational and physical therapy” (Cornell). According to a recent study published in Pediatrics, “[y]outh with an ASD have poor postsecondary employment and education outcomes, especially in the first 2 years after high school” (Shattuck, 2012). With the rising number of children being diagnosed with autism, this employment disparity is likely to be exacerbated until or unless the workforce adapts to and accommodates the needs and skills of persons with autism.The needs of young adults with autism are only recently beginning to receive more attention from the media. But for these children’s parents, this issue has always been personal. The emotions on display in these narratives are heartfelt—even raw at times—and seem to swell like the wave of a tsunami itself as parents are now confronting what should be the independence of adulthood. With barriers to employment, health care and housing, young adults with autism remain largely dependent upon their parents. While the topic of transition to adulthood for those with autism is a vast one, implicating the need for wide scale policy change, certain themes emerge in these personal narratives that we wish to focus on here, which may well serve as a guide for that change.The Advocate MotherThe Advocate Mother is a common theme in many narratives of autism and the ones presented here are not different. In fact, nearly all of the narratives presented are written by mothers. Mothers in these narratives exemplify sacrifice, dashed hopes, and even heartbreak. Although there is steely determination in many of these narratives, there is also [End Page 207] self–doubt, anxiety and guilt. As Laura Shumaker recounts the story of taking her adult son to Washington, DC, she experiences great anxiety when her son is mocked. She speaks of “the heavy feeling in [her] chest that mothers get when people laugh at their children.”The advocate mother can easily become the overly consumed mother. Take, for example, the powerful narrative of Nancy Coughlin. She confesses that her daughter’s autism took over her life and the life of her family: “my own mental health was disintegrating, as was my marriage, and in our family’s last–ditch effort to ease the burden we bought a second home; a cheap little place just a few blocks down the road from where we lived. We called it our ‘respite house’.”Others confess that raising a child with autism becomes a “full time job.” (Van der Poel). And the demands of this job do not diminish simply because the child reaches adulthood; it may, in fact, become not only a personal job for some parents but their vocation as well. For instance, Anonymous Four states, “I felt so strongly that parents and young adults needed to know about CIP [College Internship Program], that I applied for a part time job there where I could utilize my background in marketing to help parents like me find the services their son or daughter may desperately need.”While the inability to express appropriate emotions is a hallmark feature of autism, it seems that mothers in particular compensate by... (shrink)

A Contemporary Look at Business Ethics provides a 'present day' look at business ethics to include the challenges, opportunities and increased need for ethical leadership in today's and tomorrow's organizations. The book discusses current and future business ethics challenges, issues and opportunities which provides the context leaders and their organizations must navigate. The book includes an in‐depth look at lessons learned about the causes of unethical behavior by examining a number of real‐world examples of ethical scandals from (...) around the world that have taken place over the past few decades. The analysis of the various ethical scandals focuses on concepts like ethical versus unethical leadership, received wisdom, the bottom‐line mentality, groupthink and moral muteness, all of which contribute to the kind of organizational culture and ethical behavior one finds in an organization. The book discusses ethical decision making in general and the increased role of religion and spirituality, in confronting unethical behavior in contemporary organizations. The book also takes an in‐depth look at the impact ethical scandals have on employees and more specifically the psychological contract and person‐organization ethical fit with the goal of identifying, along with other things, what leaders can do to restore relationships with employees and rebuild the organization's reputation in the eyes of various stakeholders. (shrink)

Brain death certification can be a clinically and ethically challenging affair. Healthcare workers are expected to refer patients for brain death certification to identify potential organ donors, but family members may be ill-prepared for this turn of events. Already distraught families may not appreciate delays in brain death certification, but such delays are common because of the need to manage the patient’s altered physiological state to allow testing. Opportunities for donation are sometimes lost because of the unnecessary delay. With (...) focus on an opt-out organ donation law, we discuss causes of delays in brain death certification, and the ethical issues faced by clinicians in using tests to certify patients. To resolve the issues, we argue for the use of supplementary confirmatory tests as part of a more protocol-driven approach to brain death certification to avoid delays. Such tests should be regarded as part of the donation process funded by the state. (shrink)

The theme of this issue of Ethical Perspectives is the French tradition in liberal thought, and the unique contribution that this tradition can make to debates in contemporary liberalism. It is inspired by a colloquium held at the Katholieke Universiteit Leuven in December of 2008 entitled “In Search of a Lost Liberalism: Constant, Tocqueville, and the singularity of French Liberalism.” This colloquium was held in conjunction with the retirement of Leuven professor and former Dean of the Institute of Philosophy, André (...) Van de Putte, who found much inspiration in this tradition. A revised version of his valedictory lecture from the conference serves as the final contribution to this issue. Much contemporary liberal political philosophy is currently done in conversation with a line of liberal thinkers starting with John Locke, running through Immanuel Kant and John Stuart Mill, and culminating in the work of John Rawls and his followers. The reasons for the enormous appeal of this philosophical tradition are, among other things, the combination of the central role of the intuitively appealing value of individual liberty with a strong rationalistic, universalistic, and normative character. The thread running through most of these liberal theories is a commitment to what the French liberal Benjamin Constant referred to as “the liberty of the moderns,” that is, liberty in a negative sense, as a lack of interference in one’s activity from others and from government. This focus has expanded over time to include a richer body of civil, political, social, economic and cultural rights, for instance, in the work of liberal thinkers who have tried to integrate the insights of communitarian thought and discourse ethics in their work. However, the emphasis on individual liberty in the negative sense continues to be the normative and theoretical touchstone and default position for many contemporary liberal theories. The limitation of the canon of liberal thought to the aforementioned authors and themes deprives the contemporary debate of a rich source of ideas: the French liberal tradition. Montesquieu, considered to be the father of this tradition, provides a good example of how it can enrich current debates in liberal theory. Montesquieu’s work evinces a keen eye for the dynamics of power relations and the limitations of the power of the better rational argument. His insight that power can sometimes only be checked by an equal and opposing power, so that a system of separation and balance of powers is necessary in order to preserve liberty, is reflected in the foundations of most modern democracies. Montesquieu also argues that contingent environmental, historical, social and economic conditions play a dramatic role in determining what kind of government is appropriate for a particular society. On his view, ignoring these facts when framing a government can inadvertently end in despotism. Montesquieu’s observations challenge us to reexamine some of contemporary liberalism’s universalist and rationalist claims. Benjamin Constant is most famous for his distinction between two kinds of liberty: the liberty of the ancients and the liberty of the moderns. The ancient form of liberty manifested itself in the active political participation of citizens in the ancient republic. While this form of government and decision-making was suitable for small, homogeneous city-states, Constant argues that it is impracticable for large modern nation-states. Hence, the concept of modern liberty shifts to an emphasis on the rule of law and the non-interference of the state in private matters. This form of liberty is familiar to us from contemporary liberalism – and Constant cherishes this form of freedom as much as any liberal does today. However, his position is complex: he also argues that the liberty of the ancients should not be neglected. Active political participation is needed to ensure that the government is executing its duty of preserving the modern form of liberty by publicly pointing out violations. The contemporary relevance of Constant’s work is clear when we consider the alleged “democratic deficit” that plagues the EU and international institutions such as the UN, the IMF, and the World Bank. Not only does this democratic deficit threaten the modern form of liberty by placing decision-making processes out of sight of the people, it also threatens citizens’ sense of self-respect derived from self-governance. Constant’s argument for the necessity of combining the liberty of the ancients with that of the moderns provides a fruitful resource for confronting these contemporary issues. Tocqueville’s work on liberalism benefits from his opportunity to observe a society founded on liberal democratic principles – the United States of America – in action. In his Democracy in America, he examines the social consequences, both intended and unintended, of building a society on ‘the equality of conditions’, as he defines ‘democracy’. Tocqueville sees a tension between the democratic value of equality and the aristocratic value of the rule of the best. He observes that democratic societies do not necessarily choose the best leaders and instead promote mediocrity instead of virtue, talent, and excellence. Democracy also confronts citizens with the threat of ‘soft despotism’, where a government that preserves the outer signs of the liberty of the moderns nevertheless controls the behavior of its citizens in minute detail through a system of detailed rules ostensibly aimed at their welfare. This paternalism is an even more insidious threat to liberal values than the hard variety of despotism, since it is so difficult to detect and done in the name of liberal values themselves. Taking Tocqueville’s observations seriously would add complexity to attempts to theorize about the modern social-democratic welfare state. The contributions to this issue supplement and critique mainstream liberal thought and its relation to contemporary issues through a serious engagement with the French liberal tradition. Annelien De Dijn’s contribution discusses Bertrand de Jouvenel, a lesser-known 20th Century representative of the French political tradition she terms ‘aristocratic liberalism’. This tradition has its roots in the work of Montesquieu, and emphasizes the importance of intermediary bodies, most importantly the aristocracy, in providing a check to the top-down power of despotic state authorities and the bottom-up power of revolutionary leveling tendencies, both of which threaten liberty. De Dijn situates Jouvenel in this tradition, but then indicates an important difference between his thought and that of his predecessors: his most significant work, On Power, is not only on French history, but on European history. Pointing to the enthusiastic reception of this work in the Anglophone world, she suggests that the rise of totalitarianism in Europe gave the anti-totalitarian features of aristocratic liberalism a broader appeal. Valentino Lumowa’s paper concerns Constant’s classic text, The Liberty of the Ancients Compared with that of the Moderns. Lumowa argues that in order to understand Constant’s piece, we must be aware that its two parts were written under different historical circumstances and decipher the argumentative thrust inherent in the text. Following Stephen Holmes, he argues that to understand the shift Constant made in the second part of the text, we should read it within the context of the increasing influence of the ultra-Royalists in the legislature during the Bourbon Restoration. However, in contrast to Holmes, he contends that the spirit of both civic and individual freedom, which enlivens representative system, is the backbone of the text in its unity. Demin Duan’s essay investigates an apparent ambivalence between liberal and imperialist tendencies in the work of Alexis de Tocqueville, which has already drawn some attention from Tocquevillian scholars. These interpretations of Tocqueville and his writings on empire generally agree that Tocqueville stands in a recognized tradition of liberalism, which is characterized by respect for human rights, individual freedom and a sense of universal humanism. On this standard view, Tocqueville’s support of imperialism represents nothing but an unfortunate breach of his own otherwise consistent liberal thinking. Duan’s article questions this standard position. By questioning the assumption of Tocqueville’s liberalism in the first place, he tries to gauge the influence of both the old republican tradition and the new liberal perspective on his thinking. In conclusion, he argues that Tocqueville’s overall thought, especially his notion of freedom, is very much informed by an old republican tradition. His support of French imperialism could be better understood from this perspective rather than be rendered simply as a deviation from liberal norms. Pawel Marczewski’s contribution is an attempt to show that Tocqueville’s conception of liberty transcends the divisions between negative and positive aspects of freedom. He begins by juxtaposing this conception with the opposition drawn by Constant between liberty of the ancients and liberty of the moderns. While Tocqueville and Constant shared a concern for the preservation of individual rights, Tocqueville was much more reluctant to accept the modern loss of the communal dimension of liberty. He did not accept the view that jouissances privées, private pleasures, are the main compensation that the modern world has to offer for the lost ancient treasure of political participation. The essay then looks into the relevance of Tocqueville’s standpoint for current debates between liberal defenders of negative freedom and republican advocates of freedom as non-domination. Participants on both sides of the debate seem to be so devoted to showing that their particular approach provides the best guarantees against actual and possible threats to liberty that they overlook the fact that their definitions of freedom remain significantly similar. By arguing that ‘to be free is to be guided by one’s own will’, contemporary republicans, as well as their liberal counterparts, move along the lines drawn by Constant towards private pleasures. By questioning the inevitability of this turn, Tocqueville provides us with a valuable contribution to these discussions in contemporary political philosophy. Finally, André Van de Putte’s contribution, an adaptation of his emeritus speech that closed the conference on French Liberalism, appeals to Tocqueville in order to draw attention to the importance of intermediary, dialogical bodies in mitigating the implicit despotic tendencies of the democratic drive to equality. In Tocqueville’s view, the transition from the feudal corporate inequality to democratic individual equality was not a clean break. Rather, this transition is a continual process of democratization that is driven by a desire for equality, or egalité des conditions. This dissolution of distinctions of estate, class and status has the unintended consequence of concentrating the diffuse power of these entities into a centralized state, which is responsible for ensuring the equality of all under the law. This process leaves increasingly isolated and atomized individuals to face the power of a monolithic state in defense of their freedom, and moves toward a soft, paternalistic despotism. Constant’s freedom of the moderns is not sufficient to protect individuals from this centralized power. Democracy also requires the political freedom of the ancients. Van de Putte argues for a system in which atomized individuals organize themselves into intermediary bodies that, in a Montesquieuian balance of powers, can enter into dialogue with each other and the state on more equitable terms. Van de Putte’s contribution closes with a plea for a conception of democracy as a regime of dialogue. (shrink)

Purpose-driven businesses have a stated objective to contribute to the welfare of society and the planet alongside generating shareholder value. As interest in purpose-driven businesses grows, an emerging “purpose ecosystem” of advisers, investors, and enablers offers different types of support for businesses wanting to transition to sustainability. This paper examines how the transition towards purpose-driven business in Australia and the United Kingdom requires addressing challenges facing this support ecosystem at three levels. First, at the individual level (...) where support providers need to build the capabilities of managers who are experiencing tensions around integrating societal and environmental purpose while facing pressure for maximizing shareholder value. Second, the support providers working within the purpose ecosystem offering professional advice and finance face their own tensions between environmental or social objectives and commercial pressures. Third, there are challenges facing actors in the ecosystems aiming to change the wider policy and institutional environment but facing lobbying from those wanting to keep “business as usual.” We identify practical implications for those parts of the purpose-driven business ecosystem providing support. This includes building capabilities to combine social, environmental, and commercial purpose; coordination among support providers; and creating an institutional environment to avoid “purpose wash.”. (shrink)

Definition of the problem Refugees show a high prevalence of mental health burden. Catering to the need for mental health services is made difficult by access barriers. These barriers consist of structural factors as well as culturally different attitudes towards mental health, mental illness, and therapeutic interventions. One option to overcome these access barriers and to provide mental healthcare services in an appropriate manner is seen in digital interventions. In the form of interactive websites or smartphone apps, these interventions (...) have proven to be effective in mental healthcare. There are also promising examples of successful use of these technologies with refugees. However, the ethical aspects of digital interventions for refugees have scarcely been studied yet. Arguments Aim of this paper is to tackle this research desiderate. The instrument of the ethical analysis to be conducted is the concept of agency. According to the concept of agency, persons have to be seen as actors capable of acting based on their own resources and competencies. Agency is the guiding principle here for analyzing the opportunities and risks of digital interventions for refugees. In addition, I will attempt to point out prospects for an agency-based application of digital interventions. Conclusion The ethical analysis could be used as the blueprint for developing therapeutic concepts that contribute to the improvement of mental healthcare services for refugees from an ethical perspective. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Response to Susan Laird, “Musical Hunger: A Philosophical Testimonial of Miseducation”Estelle R. JorgensenSusan Laird’s lament of her “musical under-education,” her youthful lack of opportunity for the sorts of experiences for which she hungered and its life-long after-effects, and her invocation of hunger as a metaphor for music education raise compelling questions. In a feminized field such as music, particularly piano playing, her hunger is particularly poignant. Also, (...) the notion of “musical taste” takes on new meaning, and the musical, educational, and ethical questions this metaphor evokes reveal its richness as a means of thinking about music education. This metaphor joins others such as Barbara Thayer Bacon’s metaphor of the quilt, Jane Roland Martin’s metaphor of the home, Iris Yob’s metaphor of pilgrimage, Elizabeth Gould’s metaphor of the nomad, Virginia Richardson’s metaphor of the steward, and Randall Allsup’s metaphor of the garage band, each of which illumines music education differently.1 Without one, we miss important insights into the thought and practice of music education; when taken together, they offer a richer view than were we to see music education in terms of one alone. [End Page 75]Although metaphor evokes imaginative thought and practice in music education, it is also limited. As Nelson Goodman aptly puts it, metaphor is a “matter of teaching an old word new tricks” and an “expedition abroad in which associations with one realm are applied in another.”2 Its power lies in its evocative and imaginative quality as it startles and surprises, challenges familiar ways of thinking and doing, and opens new possibilities for how we might think, act, and be differently. Although Laird would not want to literalize musical hunger or equate it with physical hunger—physical and spiritual realms intersect but they are not equivalent—it is possible to freeze a metaphor or literalize the vitality out of it. Testing it systematically, we enter the ground between metaphor and model, or what Iris Yob thinks of as the metaphorical model.3 While metaphor may prompt an intellectual journey, it cannot take us the entire way. In its particularistic and imaginative appeal, it opens reflection though it cannot suffice. A metaphor may also have a dark side. For example, envisaging the teacher’s role as salvific in providing bread for the hungry or preventing gluttony or food addictions may foster a paternalistic view that substitutes the teacher’s view of a student’s long term interests for the student’s directly-known and immediately perceived needs and interests, thereby subverting Laird’s expressed interest in the student’s desires. The educational “sin” of addiction may also be “redeemed” in Schefflerian fashion by pointing to important contributions of musicians who were doubtless excessive in their musical engagements.4 These possibilities suggest that we shall need to examine critically the metaphor and what it means for music education and move beyond the metaphor to its related models of music education.One of the interesting questions that Laird’s metaphor of hunger raises is the possibility of spiritual hunger, especially in a pervasively materialistic world. Matters related to spirituality have been addressed variously by writers in music education, whether it be the “healing” and ecologically-oriented approach of June Boyce-Tillman, the evolutionary and anthropologically grounded holistic approach of Anthony Palmer, the ethically-based approach of David Carr, the introspective and politically-charged writing of Cathy Benedict and Randall Allsup, the feminist perspectives of Elizabeth Gould, Charlene Morton, Roberta Lamb, and Deanne Bogdan, or the religiously grounded work of Iris Yob.5 Notions of spiritual hunger might be seen differently within the various lenses that these writers bring to music education but they all underscore the importance of knowing that goes beyond the literal, utilitarian, generalizable, and vocational to address the life of mind and body that Susanne Langer terms “feeling” and with which the arts, myths, rituals, and religions have to do.6 As such, they rebuke general education that is limited to reading, writing, and arithmetic, and driven by tests, standards, and mandates that often give short shrift to matters of human spirituality. Still, as the recent unanimous resolution in favor of... (shrink)

The ethical standard for informed consent is fostered within a shared decision-making process. SDM has become a recognized and needed approach in health care decision-making. Based on an ethical foundation, the approach fosters the active engagement of patients, where the clinician presents evidence-based treatment information and options and openly elicits the patient’s values and preferences. The SDM process is affected by the context in which the information exchange occurs. Rural settings are one context that impacts the delivery of health care (...) and SDM. Rural health care is significantly influenced by economic, geographical and social characteristics. Several specific distinctive features influence rural health care decision-making—poverty, access to health care, isolation, over-lapping relationships, and a shared culture. The rural context creates challenges as well as fosters opportunities for the application of SDM as a natural dynamic within the rural provider–patient relationship. To fulfill the ethical requirements of informed consent through SDM, it is necessary to understand its inherent challenges and opportunities. Therefore, rural clinicians and ethicists need to be cognizant of the impact of the rural setting on SDM and use the insights as an opportunity to achieve SDM. (shrink)

The application of advanced biopreservation to organs donated for transplantation may make possible their indefinite storage and thereby improve the utility and equity they provide to patients. The technology is still at a preclinical stage, with many difficult, scientific issues that remain to be answered. At the moment, however, the actual capabilities of the technology are too indefinite to begin formulating the statutes, regulations, and ethical guidance that will be needed to obtain the benefits expected from its use.

Failings of a categorical systemFor decades, standardized classification systems have attempted to define psychiatric disorders in our mental health care system, with the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association (APA), 2013) and International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10; World Health Organization, 2010) being internationally best-known. One of the major advantages of the DSM must be that it has seriously diminished the international linguistic confusion regarding psychiatric disorders. Since (...) its introduction, it contributed extensively towards one common international language for defining and conceptualizing psychiatric disorders. Strikingly, within the field of psychological testing a similar step forward seems to have not yet been taken. At present, there exists no international standard for the use of psychological tests that takes the definition of a specific symptom as listed in DSM-5 as its starting point, and reliably and validly measures this symptom. Rather, the majority of tests are measuring constructs consisting of a multitude of symptoms. For example, the Beck’s Depression Inventory (Beck et al., 1996) measures core symptoms of depression summing up to a depression score. Accordingly, we believe it is time for a change. The diagnostics of psychiatric disorders, where disorders are defined as nosological units with a single cause, a single organic substrate, and a single time course, has been problematic for centuries. The field of psychiatry has always been ambivalent about its desire to follow a medical model (Blaney, 2015), but afflicted due to its definitions of pathology. The definition of a psychiatric disorder in DSM-5 offers little room for a clear cut pathogenesis and harsh demarcation of syndromes. This is reflected in the DSM-5, where it states: “A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (APA, 2013, p.20). An unfortunate and recognized consequence of this definition within the current system is that many symptoms overlap within categories of psychiatric disorders and patients end up diagnosed with many co-morbid disorders.Two fundamental problemsRegardless of new attempts to improve the diagnostics of psychiatric disorders, the DSM-5 represents the status quo. Consequently, the distinction between diagnosis and classification remains substantial and more than a discussion on semantics. We identify two fundamental problems within the current framework. Generally, a psychiatric diagnosis is considered to be descriptive (Hengeveld and Schudel, 2003). The clinician will describe a syndrome (its nature, timespan, and severity) within the framework of a disorder, and often include a differential diagnosis, predisposing protective or vulnerability factors, and provoking or maintaining factors. Within the DSM-5 framework, a similar ‘approach to clinical case formulation’ is taken (APA, 2013, p. 19). Evidently, a descriptive diagnosis has a hypothetical character. It consists of the clinician’s hypothesis and is based on his or hers professional considerations according to the abovementioned factors. Once the clinician has formulated a descriptive diagnosis, it is then complementary ‘translated’ into a DSM-5 classification. Herein lies the problem. For the layman, the existence of this distinction between diagnosis and classification is usually unknown. Preceding treatment, the clinician will give the client a classification of the existing psychiatric problems and the client may attribute more meaning to it than appropriate, thereby fostering the risk of reification. Second, the DSM-5 is a categorical system. Thus, individual disorders are regarded as discrete units – ‘you either have it, or you don’t’. DSM-5 states about this: “(…) scientific evidence places many, if not most, disorders on a spectrum with closely related disorders that have shared symptoms, shared genetic and environmental risk factors (…)”. And “(…) we have come to recognize that the boundaries between disorders are more porous than originally perceived.” (APA, 2013, p. 6). This leads to a fundamental problem. Because the overwhelming majority of psychiatric disorders examined thus far using taxometric methods appear to be dimensional in nature (Haslam, 2003; Widiger and Samuel, 2005), consequently all of their categorizations become artificial and debatable. Even though DSM-5 took a modest step towards a more dimensional approach, its core remains categorical. To illustrate, consider the Borderline Personality Disorder (BPD). This classification consists of nine diagnostic criteria of which a minimum of five need to be present for the diagnosis of BPD. A simple numerical combination algorithm leads to a staggering number of 256 distinct presentations of BPD (Albion et al., 2013). Due to this chameleon-like nature, the disorder’s diagnostic validity becomes questionable. Strikingly, this number is relatively small when compared to other conditions, e.g., there are 636,120 ways to have posttraumatic stress disorder (Galatzer-Levy and Bryant, 2013).DSM-5 does propose an alternative model for personality disorders based on personality functioning and traits (APA, 2013, p. 761), as a possible answer to the problem that most patients fit with multiple co-morbid personality disorders or to the category of personality disorder not otherwise specified. In November 2012, the chair committee of APA decided to move this alternative model to section III of DSM-5 and to sustain the categorical system in section II. A potential solutionDSM-5 and its predecessors have brought about an invaluable improvement regarding the formulation of a common international language for psychiatric disorders. However, the individual disorders fit poorly with its starting point of discrete units and strict boundaries. Van Os (2014) has argued for a better balance between the categorical and personalized aspects of psychiatric disorders. We argue for a two-step approach.Particularly due to the ‘weak boundaries’ between disorders, it might be beneficial to limit ourselves by merely categorizing clients into the main categories of the DSM-5 according to their most prominent symptoms (Van Os, 2014), i.e. their main complaint. In other words, clinicians could first ask themselves whether the symptomatology is concerning a neurodevelopmental disorder, or a bipolar and related disorder, or a depressive disorder, and so on. It will drastically reduce the over 400 classifications in DSM-5 down to 20 categories. Van Os (2014) even argues to combine some of the main categories, reducing this number even further to 15 categories. The advantages of reducing the over 400 classifications are fivefold: 1) a syndrome, being an aggregation of symptoms, creates a false relation between symptoms that are that are already heterogeneous themselves; 2) 15 broad categories are functional: it results into a very heterogeneous group of clients within a category and thus prevents stereotypes and invites further personalizing of complaints; and 3) a dimensional measure of a symptom rather than a syndrome will correspond better with the client regardless of it not providing the complete picture. Focusing on the main complaint will indicate where there is an immediate need for care (Van Os, 2014); 4) it will allow clinicians to recognise subthreshold conditions more easily (Magruder and Calderone, 2000); and 5) it might facilitate the development of clear demarcations between normal and abnormal functioning (Kessler, 2002; Widiger and Samuel, 2005). Please, see also Table 1.This also fits well within scientific advances, as thus far strongest evidence has been found for a distinction between internalizing and externalizing disorders, even superseding these 15 main categories (DSM-5; APA, 2013, p.13, but see Weiss et al., 1998). The second step would concern the personalized aspect, which we argue to define on a level of core symptoms of the specific main category, to be agreed upon later. To assess these core symptoms, the field of psychological testing could develop an internationally applicable instrument to reliably and validly measure each (core) symptom on a dimensional scale. Many of these instruments are readily available and have proven its psychometric properties within scientific research. Elements from these instruments could be easily transformed to work within the new system. Within the field of psychology, this approach could aid development of a common international language to define symptoms, analogous to the field of psychiatry. Importantly, current psychological testing mainly implies the use of self-report measures. This leads to an abundance of auto-amnestic information. To increase the reliability and validity of psychological tests to assess DSM-5 symptoms, it may be important to add two additional information resources. This would entail psychological tests where a next of kin answers questions about the symptom of the client, and psychological tests that include the clinicians’ judgment, such as structured clinician-based interviews. Conversely, we also need to acknowledge the well-known limitations of clinical judgment (e.g., Faust, 1986; Garb, 1998). Advantages of a new frameworkThe changes we suggest have big implications and are not easily implemented in the current framework. Clients may prefer the comfort of a single clear label, similar to what they are used to in other areas of medicine. Health insurance providers and policy makers may argue for single labels as well. Therefore, it would require a lot of explanation from our clinicians to promote a change. Our suggestions for broader categories may not disambiguate the current situation better than the existing approach, but it will promote personalisation of health care. Difficulties in diagnostic reliability will remain in disorders that fall on the boundaries of the taxons, e.g., schizoaffective disorder versus bipolar disorder with psychotic characteristics, which may benefit from further study. There are also some politically tinged questions to keep in mind: How will we finance our health care, and how will we ensure a gradual transition from the current financing system, including clients who already have their labels? What about visitations from insurers and health inspection? How can they control for a good standard of quality in health care when considering the increasing heterogeneity? Nevertheless, we argue that the benefits outweigh the disadvantages. We will see a shift from a categorical to a personalized approach, which will lead to less (self) stigmatizing, less estrangement, and it will challenge reification thinking. DSM-V states that “a reformulation of research goals should also keep DSM-5 central to the development of dimensional approaches to diagnosis that will likely supplement or supersede current categorical approaches to diagnosis in coming years” (APA, 2013, p. 13). Our proposition for psychological testing on symptom level could contribute to this development. Furthermore, this new approach will do more justice to the heterogeneity of symptoms within and outside of classification categories, see also Table 1. Moreover, in this new approach we join forces of expert knowledge from the fields of psychiatry and psychological science. Finally, it offers new and potentially better opportunities to map health care needs. This in turn will lead to a better interface for allocation of appropriate treatment. It will present a clearer picture of when preventative care is preferred over treatment and vice versa. Importantly, health care needs will be more closely attuned to the ‘own story’ of the client.We argue for the national and international psychological associations in Europe and the United States of America to support the idea of a collective approach to develop an internationally standardized psychological testing battery to reliably assess all the core symptoms of the main categories in DSM-5. (shrink)

Innovation is disruptive and a deeply social phenomenon. As a result, discussions of innovation in the Anglo-American philosophical tradition are often tightly bound up with concerns about individual freedom and pluralism, including pluralism about ethical values. In response, stakeholders looking to evaluate and assess ethical aspects of the innovation ecosystem are often driven to pragmatic approaches that utilize a set of ethical values that can be regarded as “free-standing,” or “thin” in the sense that they are not tied to (...) any particular, substantive conception of the good. This set often includes values such as beneficence, nonmaleficence, respect for autonomy, fairness, and justice. Discussions focused on justice, however, are the least extensive and least well-developed. As a result, most approaches are well-suited to surfacing first-order or direct effects of the discrete activities of a relatively narrow set of stakeholders. Paradoxically, however, such analyses are often not well-suited to identifying and evaluating (a) quintessentially social or higher-order effects (such as network-level or institutional level effects), (b) the role of a larger number of stakeholders who shape the innovation ecosystem in more indirect ways, and (c) some of the positive ethical claims of individuals that are relevant to evaluating innovation. After articulating these shortcomings, I argue that they might be overcome by adopting a justice-led framework for evaluating innovation. (shrink)

As the world’s most populous country, China is experiencing unprecedented magnitude and speed of population ageing since it entered the ageing society two decades ago. The rapid population ageing- driven by decreasing fertility rate and prolonged life expectancy- has profound impacts on economic development and poses significant challenges for formal and informal care provision. Although the Chinese government has implemented a series of progressive policy reforms on pension, healthcare, and long-term care systems, the capacity gaps regarding the coverage, (...) adequacy, affordability, and sustainability remain large. At the same time, social and economic changes have eroded the supportive role of family, especially for rural-dwelling, childless, and empty-nest older adults. This chapter documents the statistical and social reality of ageing in China, introduces a series of policy reforms implemented by the Chinese government in response to population ageing, and describes the family dynamics and intergenerational support patterns under the changing socioeconomic background. Besides pressing challenges of ageing for family and society, this chapter also looks at the emerging lifestyle and proactivity for active ageing in China. (shrink)

Biomarkers can be powerful tools to guide diagnosis, treatment, and research. However, prudent use of biomarkers requires formal validation efforts. Although the data needed for biomarker validation has traditionally been hard to access, new research initiatives can ease this process.

The COVID-19 pandemic in 2020 has had a lasting impact on all areas of personal life. However, the political, economic, legal and healthcare system, as well as the education system have also experienced the effects. Universities had to face new challenges and requirements in teaching and examinations as quickly as possible in order to be able to guarantee high-quality education for their students.This study aims to examine how the German-speaking medical faculties of the Umbrella Consortium of Assessment Network have (...) dealt with the challenges but also the opportunities that the outbreak of the COVID-19 pandemic created in medical education and whether digitalisation has been driven forward as a result. In an initial online-survey we focused our questions on the current teaching situation with regard to digitised teaching content, the support or establishment of adequate framework conditions by the medical faculties and IT facilities and also the execution of examinations during the summer semester 2020.Between August and September 2020, a total of 88 examiners, educators, dean of study and/or technical admins from 32 partner faculties took part in the survey. Students were not included in our survey. Most respondents stated that a switch to a digital semester had worked, the use of e-learning increased compared to previous semesters and that most courses could be converted, with the exception of practical courses, which were largely cancelled. The respondents also indicated that most examinations could still be taken, with the exception of practical examination formats, like Objective Structured Clinical Examinations. However, in the case of face-to-face examinations, strict distance and hygiene conditions had to be obeyed or there had to be a switch to distance-online examinations, which raised many open issues such as equal opportunities of students and attempts at deception.In conclusion, we identified several issues regarding the rapid transition to a digital semester due to COVID-19 which were categorised into the following topics: Face-to-face teaching could not take place, know-how of educators, integrity aspects, technical aspects, additional personnel required, additional time and effort required for implementation of digital teaching. Our study shows that a switch to digital teaching and distance online examinations is feasible, but many problems were encountered concerning academic integrity and basic ethical principles still need to be solved. In order to investigate whether above mentioned issued could be solved one year after the transition to a digital semester, we conducted a second survey in which the 32 initially surveyed institutions were questioned again. (shrink)

Engineering programs in the United States have been experimenting with diverse pedagogical approaches to educate future professional engineers. However, a crucial dimension of ethics education that focuses on the values, personal commitments, and meaning of engineers has been missing in many of these pedagogical approaches. We argue that a value-based approach to professional ethics education is critically needed in engineering education, because such an approach is indispensable for cultivating self-reflective and socially engaged engineers. This paper starts by briefly comparing two (...) prevalent approaches to ethics education in science and engineering: professional and philosophical. While we acknowledge that both approaches help meet certain ethics education objectives, we also argue that neither of these is sufficient to personally engage students in authentic moral learning. We make the case that it is important to connect ethics education to the heart, which is extensively driven by values, and present a value-based approach to professional ethics education. We provide some classroom practices that cultivate a safe, diverse, and engaging learning environment. Finally, we discuss the implications of a value-based approach to professional ethics education for curriculum design and pedagogical practice, including opportunities and challenges for engineering faculty eager to incorporate value-based inquiry into their classrooms. (shrink)

Healthcare provision, like many other sectors of society, is undergoing major changes due to the increased use of data-driven methods and technologies. This increased reliance on big data in medicine can lead to shifts in the norms that guide healthcare providers and patients. Continuous critical normative reflection is called for to track such potential changes. This article presents the results of an interview-based study with 20 German and Swiss experts from the fields of medicine, life science research, informatics and (...) humanities of digitalisation. The aim of the study was to explore expert opinions regarding current challenges and opportunities related to data-driven medicine and medical research and to provide a methodological framework for empirically grounded, continuous normative reflection. To this end, we developed a heuristic tool to map and structure empirical findings for normative analysis. Using this tool, our interview material points to a polarisation between individualistic and collectivistic orientated argumentations among experts. The study shows that a multilevel analysis is required to deal with complex normative implications of data-driven approaches in medical research and healthcare. (shrink)

There is a growing recognition in society that more needs to be done to support LGBTQ youth in schools. In particular, school climate reports reveal that this need is particularly pressing for transgender individuals who are little understood and often rendered invisible or made to conform to gender-normative social standards. This mixed methods study surveyed and interviewed preservice teachers at three Catholic institutions. In particular, we focus on the shifting landscape of Catholic education in Canada as it relates to (...) the support of transgender youth. The content of the study is framed by a common first grade social studies theme: family diversity, and takes its lead from the recent papal urging to pursue topics of discomfort at the peripheries of Catholic thinking. We explore how Catholic preservice teachers respond to the idea of teaching about transgender-parent families. The findings show there is dissonance between the personal and professional beliefs of new Catholic teachers. This dissonance is reflective of the beliefs held by North American Catholics at large, thus further illuminating the challenges and opportunities that are present in the emerging discussion about how to best support transgender students in Catholic school contexts. (shrink)

Anyone involved in youth ministry will be able to testify to the fact that no perfect youth ministry model exists. Youth ministry models employed should consider the vision, mission and needs of the contexts in which they are to be used. Although not new, the term 'decolonise' has become a prominent part of African discourses after the 2015 and 2016 student protests at various university campuses in South Africa. A strong call to decolonise theology and how we do church has (...) been included in these calls. Students have argued against a theology and ecclesiology that is exclusively based on European and other international foundations. My challenge with all these discussions has been discerning the difference between decolonisation and contextualisation within theology. I have often wondered whether those calling for a decolonised theology are actually referring to problems connected to a theology that is not correctly contextualised. When I ask whether youth ministry models in Africa should be decolonised, I do so in the awareness that these models have brought with them both challenges and opportunities for ministry on this continent. Youth ministry models employed in Africa need to stem from the contextual situations and readings of the biblical text in which they find themselves. This article is aimed at exploring the work of Scripture Union as a mission-based youth ministry model in Africa in view of the present call to decolonise theology. (shrink)

Have the large-scale evolutionary patterns illustrated by the fossil record been driven by fluctuations in environmental opportunity, by biotic factors, or by changes in the types of phenotypic variants available for evolutionary change? Since the Modern Synthesis most evolutionary biologists have maintained that microevolutionary processes carrying on over sufficient time will generate macroevolutionary patterns, with no need for other pattern-generating mechanisms such as punctuated equilibrium or species selection. This view was challenged by paleontologists in the 1970s with (...) proposals that the differential sorting and selection of species and clades, and the effects of biotic crises such as mass extinctions, were important extensions to traditional evolutionary theory. More recently those interested in macroevolution have debated the relative importance of abiotic and biotic factors in driving macroevolutionary patterns and have introduced comparative phylogenetic methods to analyze the rates of change in taxonomic diversity. Applying Peter Godfrey-Smith’s distinction between distributional explanations and explanations focusing on the origin of variation, most macroevolutionary studies have provided distributional explanations of macroevolutionary patterns. Comparative studies of developmental evolution, however, have implicated the origin of variants as a driving macroevolution force. In particular, the repatterning of gene regulatory networks provides new insights into the origins of developmental novelties. This raises the question of whether macroevolution has been pulled by the generation of environmental opportunity, or pushed by the introduction of new morphologies. The contrast between distributional and origination scenarios has implications for understanding evolutionary novelty and innovation and how macroevolutionary process may have evolved over time. (shrink)

There is growing global consensus that inequality is making sustainable development goals unattainable. Social inclusion of the historically marginalized and equality of opportunity is crucial for sustainable development. Inclusive quality education for all is therefore considered as one of the three main targets for sustainable development according to UNESCO’s Incheon declaration in 2015. This paper draws on an institutional ethnography of a globally interconnected old colonial school’s inclusive pedagogic work in postcolonial India. The school’s work has been much celebrated (...) in existing research by academics, global donor agencies and also by the Indian government’s Sarva Shikshya Abhiyan office. This paper analyses how the school conceptualized a distinct inclusive pedagogy to educate the hearts and the minds of children driven by local community needs for social inclusion within a context of extreme inequality. This paper argues that the school’s conception of inclusive education addressing the diverse learning needs of children developed as a syncretic cultural formation drawing on its institutional mission for social justice, as well as indigenous history of educational reform and philosophy of community engagement. In doing so, this paper engages with the ‘philosophy of context’ and draws on the ‘southern theory’ of inclusive education as envisioned by Rabindranath Tagore, indigenous education reformer and Nobel Laureate poet activist during early twentieth-century colonial British India, who challenged both local and global inequality through his creative and educational work. (shrink)

Background The principles of dynamic consent are based on the idea of safeguarding the autonomy of individuals by providing them with personalized options to choose from regarding the sharing and utilization of personal health data. To facilitate the widespread introduction of dynamic consent concepts in practice, individuals must perceive these procedures as useful and easy to use. This study examines the user experience of a dynamic consent-based application, in particular focusing on personalized options, and explores whether this approach may be (...) useful in terms of ensuring the autonomy of data subjects in personal health data usage. Methods This study investigated the user experience of MyHealthHub, a dynamic consent-based application, among adults aged 18 years or older living in South Korea. Eight tasks exploring the primary aspects of dynamic consent principles–including providing consent, monitoring consent history, and managing personalized options were provided to participants. Feedback on the experiences of testing MyHealthHub was gathered via multiple-choice and open-ended questionnaire items. Results A total of 30 participants provided dynamic consent through the MyHealthHub application. Most participants successfully completed all the provided tasks without assistance and regarded the personalized options favourably. Concerns about the security and reliability of the digital-based consent system were raised, in contrast to positive responses elicited in other aspects, such as perceived usefulness and ease of use. Conclusions Dynamic consent is an ethically advantageous approach for the sharing and utilization of personal health data. Personalized options have the potential to serve as pragmatic safeguards for the autonomy of individuals in the sharing and utilization of personal health data. Incorporating the principles of dynamic consent into real-world scenarios requires remaining issues, such as the need for powerful authentication mechanisms that bolster privacy and security, to be addressed. This would enhance the trustworthiness of dynamic consent-based applications while preserving their ethical advantages. (shrink)

This article provides a review and a perspective on the interaction between neuroscience and the media. It situates public discourse and the communication of neuroscience in an intricate web of social expectations and ethical responsibilities that converge and diverge between different stakeholders such as academic researchers, public sponsors of research, and the interested public. The article highlights some of the key ethical and social challenges that emerge when neuroscientists interact with the media. This study shows that the media manifests (...) important shortcomings in matters of neuroscience explanations and fosters some unrealistic expectations for the outcomes of neuroscience. It concludes with attention to some of the research and practical questions that need further attention in matters of ethics and communication in neuroscience. This article relies on a number of assumptions that need to be acknowledged from the onset. They explain the view that the communication of neuroscience is of crucial importance for neuroethics. (shrink)

Photo by Thought Catalog on Unsplash INTRODUCTION The coronavirus pandemic is a challenge to educators, policy makers, and ordinary people. In facing the threat from COVID-19, school systems and global institutions need “to address the essential matter of each human being and how they are interacting with, and affected by, a much wider set of biological and technical conditions.”[1] Educators must grapple with the societal issues that come with the intent of ensuring the safety of the public. To some, (...) “these are actually as important as the biological concerns of people.”[2] The current global crisis shows that “scientifically, socially, and politically the economy and technosphere are not just related, they are integral to a comprehensive response to major challenges.”[3] In developing these responses, scientists, government leaders, and policy makers need to consider the vulnerabilities of people, especially those in “thrown away” groups.[4] Jerome Ravetz explains that “microscopic viral predators cull our populations, as ever, but with a selection that is not natural but social and political.”[5] Educators must address the underlying vulnerabilities and evaluate the virus as a threat to academic experiences and access to a fair education. ANALYSIS • Critical Pedagogy By definition, the critical approach to teaching is about the problem-posing method of education developed by Paolo Freire. In his Pedagogy of the Oppressed, he proposed a paradigm shift away from the banking method of learning wherein teachers deposit knowledge into the minds of students. Critical pedagogy is an educational approach that challenges students to develop the ability to recognize and criticize dominating theories and evaluate them in their social context. Teachers press students to recognize oppression and try to remedy oppression in their culture.[6] Despite the lack of in-person interaction between the teacher and the students, the effort to use innovative teaching techniques like critical pedagogy should continue. Online learning is not just about the use of technology, although the internet is crucial in the delivery of content. Since human beings are creators of value, they determine the meaning and purpose of technology. In this way, the set of values people have will influence online learning. Teachers cannot be more concerned about outcomes than about the process itself. The process is crucial since the ability of the student to think critically is developed in the exchange between the student and the teacher. The teacher cannot simply dump loads of information (deposit knowledge) but must pose problems to test the analytical and critical skills of students.[7] Education is about how people humanize the world. Policy makers miss the point when they focus on the delivery but do not pay attention to the substantive aspect of learning, which is human empowerment. Education is meant to expand the freedom of people. Education should be seen as an integrative activity. Learning is a formative process that aims to develop the human person. Without the face-to-face encounter between teacher and students, the challenge is finding ways to make learning an effective means to mold the values of young people. • Online Critical Pedagogy & the Role of Technology Physical distance appears to be an impediment in realizing the ideals of learning. The lack of contact between the teacher and the students may prevent a more meaningful interaction since online instruction is impersonal. It can be argued that there is no alternative to some classroom activities, especially laboratory experiments in science courses. The total classroom environment naturally influences the behavior of students when it comes to academic work: the look in the eyes of the professor, the caring ways of a teacher, or the pressure while taking exams contribute to an experience that only a classroom setting can provide. If implemented properly, technology can facilitate the personal relationships between teachers and students while providing meaningful experiences. With the current need for online learning during the COVID-19 pandemic, gadgets are indispensable. Some would even consider gadgets an extension of the human body. A mobile phone is not just any instrument; it has evolved into a novel way of being in the world. Our gadgets are a means of seeing how the outside world unfolds. Modern technological tools allow the interface of people in many fields of experience in a globalized environment. Computers and other digital devices extend the meaning and value of human freedom. For example, a laptop provided to a poor child can redefine the meaning of and what the future might hold for that child. The device is crucial to the whole learning process. Modern tools are critical to self-discovery and greater freedom. The values that people embrace will matter in the new normal. The internet has provided a new democratic space that empowers groups and individuals to express themselves and to understand the world.[8] In an online class, students and teachers alike need to analyze big picture questions and layers of information. For example, the student in an ethics or philosophy class can reflect on the realities of life. With the proper guidance, online education should help define the meaning of moral commitment and human responsibility. CONCLUSION Before the pandemic, policy makers had been pursuing the goals of a globalized economy. They had been fashioning and promoting programs that cater to the interests of a consumer-driven world that has deprived the poor of opportunity. When the pandemic struck, globalization suddenly came to a halt and people realized the things that truly matter in life – family, love, and life itself. The new normal must now emphasize the role of education as a source of inner strength that can empower the person to live well reinforcing values based on a social consciousness. Critical pedagogy is possible under the new normal. The distance between the teacher and student does not make the educational process less real and in the absence of a vaccine, online learning is the safest strategy. Governments cannot freeze an entire school year since education is the only way out from poverty for millions. The COVID-19 pandemic provides a reason to re-imagine teaching using technology to encourage all students to question systems of oppression or greed, as the persistent pursuit of the truth is what education is all about. [1] Hartsell, Layne, Krabbe, Alexander, & Pastreich, Emmanuel. “Covid-19, Global Justice, and a New Biopolitics of the Anthropocene.” Social Ethics Society Journal of Applied Philosophy 6, no. 2 (2020), 3. [2] Ravetz, Jerome. “Science for a Proper Recovery: Post-Normal, not New Normal.” Issues in Science and Technology [Internet] July 15, 2020. https://issues.org/post-normal-science-for-pandemic-recovery/ [3] Hartsell, et al. “Covid-19, Global Justice, and a New Biopolitics of the Anthropocene,” 6. [4] Ravetz, “Science for a Proper Recovery: Post-Normal, not New Normal.” [5] Ibid. [6] Freire, Paolo. Pedagogy of the Oppressed. (New York: Continuum Books, 1993). [7] Freire writes that in such a situation “instead of communicating, the teacher issues communiqués and makes deposits which the students patiently receive, memorize, and repeat.” See his Pedagogy of the Oppressed. [8] Bakardjieva, Maria. Internet Society. (London: Sage Publications, 2005). (shrink)

International dispute resolution in general and international arbitration, in particular, is highly affected by the emergence and fast development of innovation-driven technologies. On the one hand, such technologies are cost and time-effective. To name a few, they allow online filing of a case, collecting of e-evidence and remote hearings, among others. On the other hand, they also may lead to some challenges that need to be addressed. The primary concerns comprise e-arbitration agreements and e-awards, as well as (...) cybersecurity and data protection. Therefore, this begs the question of whether such new technologies will significantly impact the dispute resolution landscape and thus become a game-changer therein. This analysis leads to the conclusion that the emergence of new technologies provides an opportunity to establish a long-lasting new standard for international arbitration. (shrink)

Demographic change, change in family structures, growing ethnic plurality resulting from migration, social inequality and so on require new ways of addressing spiritual and social needs in many Western European countries. In view of these current social changes, increasingly more effort is being put into strengthening cooperation between church congregations and diaconal institutions at the local level. This article will focus on the reciprocal relationship between the church and its immediate local context by focusing on one of the church’s ministries (...) – diaconia – as a service of God’s people to the world. Although diaconia is part of the church, it has developed in organisations separate from the church and thus as a parallel structure to the institutionalised church structure in many countries. The current changes offer opportunities for the church and diaconia to join forces and to overcome cooperational difficulties at the local level. The objective of this article is to draw attention to the potential of the social space for collaboration, to analyse hindrances to collaborative efforts on a practical level and to point out what steps the church and diaconia may take to further local collaboration.Contribution: The contribution of this article is to analyse the social space with regard to the collaboration between local churches and diaconal organisations, and thereby to point out its potential for their further development in line with the journal’s focus on original ideas in practical theology. (shrink)