BackgroundGeneral practitioners often act as gatekeeper, authorizing patients’ access to hospital care. This gatekeeping role became even more important during the current COVID-19 crisis as uncertainties regarding COVID-19 made estimating the desirability of hospital referrals (for outpatient or inpatient hospitalization) complex, both for COVID and non-COVID suspected patients. This study explored Dutch general practitioners’ experiences and ethical dilemmas faced in decision making about hospital referrals in times of the COVID-19 pandemic.MethodsSemi-structured interviews with Dutch general practitioners working in the Netherlands were (...) conducted. Participants were recruited via purposive sampling. Thematic analysis was conducted using content coding.ResultsFifteen interviews were conducted, identifying four themes: one overarching regarding (1) COVID-19 uncertainties, and three themes about experienced ethical dilemmas: (2) the patients’ self-determination vs. the general practitioners’ paternalism, (3) the general practitioners’ duty of care vs. the general practitioners’ autonomy rights, (4) the general practitioners’ duty of care vs. adequate care provision.ConclusionsLack of knowledge about COVID-19, risks to infect loved ones, scarcity of hospital beds and loneliness of patients during hospital admission were central in dilemmas experienced. When developing guidelines for future crises, this should be taken into account. (shrink)

This paper interprets the British legislative process that initiated the first comprehensive national regulation of embryo research and fertility services and examines subsequent efforts to restrain the assisted reproduction industry. After describing and evaluating British regulatory measures, I consider successive failures to control the assisted reproduction industry in the US. I discuss disparities between UK and US regulatory initiatives and their bearing on regulation in other countries. Then I turn to the political and social structures in which the assisted reproduction (...) industry is embedded. I argue that regulatory bodies are seldom neutral arbiters. They tend to respond most readily to special interests and neglect strategies that could more effectively meet the health needs of the people they represent. Neither national nor international bodies have aggressively pursued policies to harness the industry, reduce infertility rates, or meet the needs of people whose fertility is threatened by substandard healthcare and environmental neglect. In conclusion, I consider recent initiatives by activist groups to mount an alternative response to the industry's current practices and build a transnational reproductive justice movement. (shrink)

Because of the transfer of responsibility from hospitals to community-based settings, providers in home-based care have more responsibilities and a wider range of tasks and responsibilities than before, often with limited resources. The increased responsibilities and the complexity of tasks and patient groups may lead to several ethical challenges. A systematic search in the databases MEDLINE, CINAHL, and SveMed+ was carried out in February 2019 and August 2020. The research question was translated into a modified PICO (Population, Intervention, Comparison, and (...) Outcome) worksheet. A total of 40 articles were included. The review is conducted according to the Vancouver Protocol. The main findings from the systematic literature review show that ethical challenges experienced by healthcare and social care providers in home-based care are related to autonomy and balancing ethical principles, decisions regarding intensity of care, challenges related to priority settings, truth-telling, and balancing the professional role. Findings regarding ethical challenges within home-based care are in line with findings from institutional healthcare and social care settings. However, some significant differences from the institutional context are also highlighted. (shrink)

This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could ‘see’ neither their (...) role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for ‘things’ such as cost‐effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice. (shrink)

Many philosophers have defended the view that we are subject to the following evidential ought: “One ought to believe in accordance with one's evidence.” Although they agree on this, a more fundamental question keeps dividing them: from where does the evidential ought derive its normative force? The instrinsicalist answer to this question is sometimes described as the claim that "there is a brute epistemic value in believing in accordance with one's evidence" (Cowie, 2014, 4005). But what does this really mean? (...) Intrinsicalists' negative claim is that the normative source of the evidential ought has nothing to do with the fulfilment of our epistemic purposes. But what is their positive claim exactly? This paper aims at improving our understanding of intrinsicalism. Its conclusion is that there is only one possible way of being an intrinsicalist. Intrinsicalists need to be constitutivists. (shrink)

The general typology for the dialogue between religion and science is built on the assumption that there is an objective world, one reality that can be described. In this paper, I present an alternative epistemological framework for the dialogue that understands all descriptions of reality as symbolic. Therefore, this understanding creates a new possibility for mutual enrichment between the two dialogue partners. I demonstrate the usefulness of this framework by applying it to the dialogue between artificial intelligence (AI) and theology. (...) I discuss an advanced AI project: Cog, a humanoid robot. After briefly describing this project, its assumptions, and the emotions it creates (mainly hope and fear), I show how the project can be enriched by theological insight. The concept ofimago Dei—the understanding of humans created in the image of God—can be applied to the Cog project especially when it is presented in a way that takes the metaphorical character of both theological and scientific theories seriously. (shrink)

Debates in metaethics about metanormative realism, quasi-realism, anti-realism, and nihilism mostly focus on epistemic reasons for beliefs about values. Very little has been said about our practical reasons for metaethical beliefs, and even less is said about practical reasons for other attitudes we might take toward metaethical views. This paper shows why a recent argument bucking that trend fails to show that we have practical reasons to believe realism over nihilism, but that for many of us, we do have practical (...) reason to hope that what I call Optimistic Realism is true. (shrink)

Reproductive tourism is a manifestation of a larger, more inclusive trend toward globalization of capitalist cultural and material economies. This paper discusses the development of cross-border assisted reproduction within the globalized economy, transnational and local structural processes that influence the trade, social relations intersecting it, and implications for the healthcare systems affected. I focus on prevailing gender structures embedded in the cross-border trade and their intersection with other social and economic structures that reflect and impact globalization. I apply a social (...) connection model of responsibility for unjust outcomes and consider strategies to counter structural injustices embedded in this industry. The concluding section discusses policy reforms and proposals for collaborative action to preclude further injustices and extend full human rights to all. (shrink)

Research has established that the burdens of externalities associated with industrial production are disproportionately borne by socially and politically vulnerable groups, and this is particularly true for farmworkers who are at high risk for environmental exposures and illnesses. The impacts of these risks are often compounded by farmworker communities’ social vulnerability. Yet, less is known about how the intersection of race, class, and gender can position some farmworkers to be at higher risk for particular types of oppressions. We extend the (...) literature by analyzing the case of Black women farmworkers in Apopka, Florida, which was historically home to a large agricultural community. Drawing on the concept of critical environmental justice, we investigate the lived experiences of these women in the context of racialized, gendered, and economic oppressions during their time working on the farms. We use the case of Apopka to ask: how the policies and socio-historical context of the agricultural industry in the American South contributed to injustices experienced by Black women farmworkers in Apopka, Florida; and how race, gender, and class intersected and intersect to create and legitimize environmental injustices in the workplace for these farmworkers. Our data include semi-structured in-depth interviews, newspaper and media coverage, and archival materials. Our analysis advances work on critical environmental justice and intersectionality by mapping the relationship between structural and environmental intersectional oppressions for Black women farmworkers. (shrink)

This article proposes that the urgent task for feminist sociology is to recuperate those lost or residual `body matters' which lurk, unattended to, on the sidelines of the social. Feminist sociology must carefully negotiate the complex space between sociality and corporeality. The new feminist philosophies of the body tend sometimes to grate against this project by valorizing the body but de-valorizing gender. The new sociology of the body is recuperating the body within sociology, but pays insufficient attention to the ways (...) in which gendered bodies have always enjoyed varying degrees of absence or presence in the sociological imaginary - in the guise of `female corporeality' and `male embodiment'. By revisiting the classical texts of sociology, such as those of Durkheim, Weber and particularly Simmel, I explore the textual strategies whereby `the body' and `the social' were dissociated in the first place and how, simultaneously, woman is saturated with, while man is divested of, corporeality and she is divested while he is invested with sociality. The absent women in sociology were the women in the body excluded from the social. It is male bodies which animate the social - they appear for a fleeting moment, only to disappear immediately, in the space between `corporeality' and `sociality'. Thus, it is not simply a case of recuperating bodies into the social, but of excavating the gendered subtexts whereby gendered bodies were differently inscribed into and out of the social in the first place. The crucial point here is not the more familiar story of her saturation with corporeality but the less familiar one of what happened to his body - how, that is, did male sociologists effect the disappearance of their own bodies in the textual strategies of sociology? (shrink)

This paper addresses the significance of the general class of diffeomorphisms in the theory of general relativity as opposed to the Poincaré group in a special relativistic theory. Using Anderson's concept of an absolute object for a theory, with suitable revisions, it is shown that the general group of local diffeomorphisms is associated with the theory of general relativity as its local dynamical symmetry group, while the Poincaré group is associated with a special relativistic theory as both its global dynamical (...) symmetry group and its geometrical symmetry group. It is argued that the two groups are of equal significance as symmetry groups of their associated theories. (shrink)

Identifying patterns in the world requires noticing not only unusual occurrences, but also unusual absences. We examined how people learn from absences, manipulating the extent to which an absence is expected. People can make two types of inferences from the absence of an event: either the event is possible but has not yet occurred, or the event never occurs. A rational analysis using Bayesian inference predicts that inferences from absent data should depend on how much the absence is expected to (...) occur, with less probable absences being more salient. We tested this prediction in two experiments in which we elicited people's judgments about patterns in the data as a function of absence salience. We found that people were able to decide that absences either were mere coincidences or were indicative of a significant pattern in the data in a manner that was consistent with predictions of a simple Bayesian model. (shrink)

Much attention in philosophy of religion has been devoted to the question of whether faith is epistemically rational. But is it morally and practically permissible? This paper explores a response to a family of arguments that Christian faith is morally impermissible or practically irrational, even if epistemically justified. After articulating the arguments, I consider how they would fare if they took seriously the traditional notion that genuine faith is always accompanied by Christian hope. I show how the norms of hope (...) regulate Christian faith in such a way that it does not involve, and certainly does not entail, the morally and practically problematic attitudes and behaviors with which it is associated. (shrink)

In recent years, an increasing number of medical books and papers attempting to analyse the concepts of health and disease from the perspective of evolutionary biology have been published.This paper introduces the evolutionary approach to health and disease in an attempt to illuminate the premisses and the framework of Darwinian medicine. My primary aim is to analyse to what extent evolutionary theory provides for a biological definition of the concept of disease. This analysis reveals some important differences between functional explanations (...) in the field of evolutionary biology and functional explanations in the field of medicine. Moreover, I shall argue that the biological functions relevant to the health of an organism cannot be determined on the basis of evolutionary theory. Accordingly, it seems that Darwinian medicine does not provide for the definition of a biological concept of disease. Still,Darwinian medicine may suggest why we are susceptible to certain diseases; it might also prove a suggestive heuristic on the basis of which new hypotheses concerning relevant treatments of various diseases might be advanced. (shrink)

While there is considerable support for integrating ethics education in accounting curricula, research presents conflicting evidence on how best to incorporate it. A review of accounting ethics scholarship highlights criticisms of the literature, including limited research into actual behavior and a lack of theory. We report the results of a study that is theory based, captures behaviors rather than attitudes, and explores the effect of repeated practice to develop voice efficacy. We examine the impact of two types of ethics instructions. (...) Across four classes in an accounting curriculum, one student cohort participated in traditional ethics instruction, while the other cohort participated in Giving Voice To Values instruction. We collected student responses to an ethical challenge and conduct a between-subject analysis. The results reveal consistent unethical behavior in the traditional cohort but not in the GVV cohort, indicating that faculty should consider the use of this pedagogy in accounting ethics education. (shrink)

This article is a contribution to the critical sociology of science perspective introduced and developed by Pierre Bourdieu. The paper proposes a transversalist theory of science and technology production and diffusion. It is here argued that science and technology are comprised of multiple regimes where each regime is historically grounded, possesses its own division of labour, modes of cognitive and artifact production and has specific audiences. The major regimes include the disciplinary regime, utilitarian regime, transitory regime and research-technology regime. Though (...) each regime is autonomous, they are simultaneously closely interlaced. In science and technology, autonomy is not antithetical to interdependence and reciprocity. This study demonstrates for the four specified regimes of production and diffusion that differentiation is not contrary to interaction. In science, differentiation and interaction comprise two sides of the same coin. All regimes exhibit a measure of transversality. (shrink)

The concept of the ‘material’ was the focus of much feminist work in the 1970s. It has always been a deeply contested one, even for feminists working within a broadly materialist paradigm of the social. Materialist feminists stretched the concept of the material beyond the narrowly economic in their attempts to develop a social ontology of gender and sexuality.Nonetheless, the quality of the social asserted by an expanded sense of thematerial – its ‘materiality’ – remains ambiguous. New terminologies of materiality (...) and materialization have been developed within post-structuralist feminist thought and the literature on embodiment. The quality of ‘materiality’ is no longer asserted – as inmaterialist feminisms – but is problematized through an implicit deferral of ontology in these more contemporary usages, forcing us to interrogate the limits of both materialist and post-structuralist forms of constructionism. What really matters is how these newer terminologies of ‘materiality’ and ‘materialization’ induce us to develop a fuller social ontology of gender and sexuality; one that weaves together social, cultural, experiential and embodied practices. (shrink)

Some beliefs seem more significant than others. This paper suggests an approach to explaining this apparent fact. As there are multiple senses in which one belief may be more significant than another, multiple possible sources of such significance, and, moreover, no prima facie reason to expect a single, unified account under which all these senses and sources can be subsumed, I propose the modest approach of articulating just one feature in virtue of which a belief may fairly be called significant: (...) that of bearing a certain relation to human flourishing, a relation that more trivial truths do not bear. From such modest projects can a complete solution to the problem (or, more accurately, problems) of significance emerge. (shrink)

The book argues for the relevance of Mary Wollstonecraft’s intellectual legacy for the contemporary debate on ethics. The study is based on the whole of Wollstonecraft’s literary corpus and is char...

This third volume completes the text of the cycle of 294 English Wycliffite sermons; the first two volumes appeared in 1983 and 1987 respectively. The 120 sermons here were intended to provide material for all the weekday occasions for which the Sarum rite offers a separate gospel reading; such complete coverage of ferial days is unparalleled in English medieval homiliaries, and seems unknown elsewhere in contemporary European cycles of sermons. The introduction to the present book, which is intended to be (...) used along with the material in the previous volumes, describes the state of the text in these manuscripts and their relation to each other. Two further chapters consider questions relating to the whole cycle: the fidelity of the biblical translation in the sermons to the Vulgate texts; and the complicated issue of the relation between these English sermons and the Latin sermons of John Wyclif himself. A fourth volume will provide a commentary on the individual sermons, consider the recurrent issues discussed within them, and offer suggestions concerning the origins of the collection. (shrink)

Humanistic management requires an expansion of economistic management to focus on flourishing for all at work through dignity and well-being. A dignity framework engaging the humanistic management perspective is used to explore mattering in organizational contexts. The framework acknowledges moral and spiritual levels of the human experience and incorporates transcendent and religious motivations, representing a more fully humanistic conception. Existential and interpersonal mattering are linked to various levels of the dignity experience at work, providing a practical way of understanding a (...) highly philosophical concept. Implications of mattering at work for humanistic management research, theory, and practice are discussed. Dignity and mattering provide important, human-centered, relationally-oriented concepts to help us understand how people live and experience their lives at work. (shrink)

La Grèce de l’Antiquité fournit une toile de fond à l’entreprise de Nietzsche dans la Généalogie de la morale. La connaissance approfondie que le philologue en avait lui a donné accès à une pluralité de jugements de valeurs, antérieurs à la domination du christianisme et de la morale qui en est sortie. Au moyen d’une investigation de la poésie de Théognis, citée dans la Généalogie de la morale, mais aussi de la pensée sophistique et de la médecine hippocratique (absentes de (...) la Généalogie), on montre ici dans quelle mesure les perspectives ouvertes par Nietzsche sont fécondes pour la compréhension des questions morales dans l’Antiquité grecque. (shrink)

The disruptions of life in late modernity render self-identity fragile. Consequently, individuals must reflexively manage their emotions and periodically reinvent themselves to maintain a coherent narrative of the self. The rise of psychology as a discursive regime across the 20th century, and its intersections with a plethora of wellness industries, has furnished a new language of selfhood and greater public attention to emotions and personal narratives of suffering. Celebrities, who engage in public identity work to ensure their continued relatability, increasingly (...) provide models for navigating emotional trials. In this article we explore representations of selfhood and identity work in celebrity interviews. We focus on media veterans Nigella Lawson and Ruby Wax, both of whom are skilled in re-storying the self after personal crises. We argue that interpretive capital as a peculiarly late modern resource confers emotional advantages and life chances on individuals as they navigate upheavals, uncertainties, and intimate dilemmas. (shrink)

In asking what it means to be an empiricist, the present volume does not seek to provide a definitive or authoritative introduction to the foundation and establishment of empiricism. Instead, our objectives are to deconstruct some misleading preconceptions and to propose some new perspectives on this much used but still somehow ambiguous concept. It marks the beginning of a new reflection rather than a conclusion.Throughout this volume, we aim to present empiricism as the result of two parallel dialogues. First, it (...) was born out of an exchange between several distinct observational and experimental traditions in Europe. We therefore advocate speaking in the plural about empirical methods, underlining the distinctions between local uses and grand, national standards, while also highlighting the complex discussion around the values and norms of empiricism.Secondly, it emerged as part of a dialog between several positions within the theory of knowledge which for too long have been reduced to a simple dualism. The most important lesson to be learned from the eighteenth century is that there wasn’t such a thing as a war between rationalism and empiricism, but rather a constant attempt to accommodate both. This forces us to conceive of a more complex and fruitful relationship, but also a much more interesting one. (shrink)

The question of what kind of city we are trying to have is an urgent one as the world continues its dramatic urbanization. Urban Visions presumes that an understanding of our urban experience is a prerequisite for envisioning what the city could be. In assembling work by distinguished authors from different disciplines and countries, Urban Visions offers a patient examination of what urban experience is and of the city’s necessity, with explicit and implicit propositions about what it could be. The (...) book is illustrated in full color. (shrink)

Background: Due to the major changes occurring in the demographic composition of the world’s population, the number of older individuals is increasing, which puts pressure on the healthcare systems in many different countries. The involvement of volunteers and family members may become necessary to fulfil a patient’s needs for follow-up treatments and long-term care in their homes. Aim: This study aimed to explore how nurses and physicians experienced and addressed ethical challenges when they dealt with relatives in what have traditionally (...) been one-on-one consultations at two Norwegian hospital outpatient clinics. Research Design and Methods: A total of eight nurses and two physicians from two different hospitals participated in individual in-depth interviews. The transcribed interviews were analysed using an eclectic approach called ‘bricolage’ inspired by Kvale and Brinkmann. We combined cross-case thematic and theoretical normative analyses. Ethical considerations: The principles of voluntariness, confidentiality, withdrawal and anonymity were respected throughout the research process. In addition, the Norwegian Social Science Data Services approved this study. Findings: The findings showed that respect for a patient’s autonomy was used as an argument for delimiting the relatives’ access to the patient’s consultations. We found that there were insufficient routines in place for inviting and involving relatives in the patient consultations in the outpatient clinics. Discussion: The traditional Western attitudes towards the principles of patient autonomy will likely be challenged due to the growing need for family involvement in the care of a patient in the future. Conclusion: This study’s description of the nurses and physicians’ interpretations of ‘patient autonomy’ as a phenomenon uncover the need for systematic ethical deliberation in the clinical setting. On an organisational level, there is a strong indication of the need to discuss the routines that are in place to invite the next of kin to participate in such patient’s healthcare consultations. (shrink)

I distinguish between the classical Gricean approach to conversational implicatures , which I call the action-theoretic approach, and the approach to CIs taken in contemporary cognitive science. Once we free ourselves from the AT account, and see implicating as a form of what I call “conversational tailoring”, we can more easily see the many different ways that CIs arise in conversation. I will show that they arise not only on the basis of a speaker’s utterance of complete sentences but also (...) on the basis of sub-sentential clauses—cases of so-called embedded implicatures—as well as from discourse segments containing several sentences—cases that Geurts calls ‘multiplicatures’. I will argue that they arise also from contents that are themselves implicit, such as presupposed contents or other implicatures. All but the first sort of case are difficult for the traditional Gricean AT account to handle, whereas they fall naturally out of an account that sees conversational participants as engaged in conversational tailoring—i.e., as engaged in a process of shaping informational and discourse structural properties of utterances in their successive conversational turns, and hence shaping their interlocutors’ cognitive environments. (shrink)