A limiting factor in ethics education in medical training has been difficulty in assessing competence in ethics. This study was conducted to test the concept that content analysis of pediatric residents’ personal reflections about ethics experiences can identify changes in ethical sensitivity and reasoning over time. Analysis of written narratives focused on two of our ethics curriculum’s goals: 1) To raise sensitivity to ethical issues in everyday clinical practice and 2) to enhance critical reflection on personal and professional values as (...) they affect patient care. Content analysis of written reflections was guided by a tool developed to identify and assess the level of ethical reasoning in eight domains determined to be important aspects of ethical competence. Based on the assessment of narratives written at two times (12 to 16 months/apart) during their training, residents showed significant progress in two specific domains: use of professional values, and use of personal values. Residents did not show decline in ethical reasoning in any domain. This study demonstrates that content analysis of personal narratives may provide a useful method for assessment of developing ethical sensitivity and reasoning. (shrink)

This article critiques Elizabeth Grosz's understanding that queer theory is unproductive insofar as it disrupts the specific identities of gay and lesbian. Reconsidering ideas about desire, the body, and identity that Grosz takes from Gilles Deleuze's work on Friedrich Nietzsche and Baruch Spinoza, this essay argues that, despite her productive reworking of homophobia in terms of “active” and “reactive” forces, Grosz's application of Spinoza is only partial. Focusing on Spinoza's evaluation of bodies, the essay both critiques Grosz's approach to experimental (...) desire and observes Spinozist preoccupations in order to talk about the experimental body. It concludes that if Grosz were to attend more seriously to the Spinozist imperative to analyze a body in terms of its capabilities—that is, its power to be affected—the epistemological basis of her argument would change. It would be difficult to dismiss the plurality and sensibility of a queer body or its challenge to lesbian and gay as the source of a primary identity. (shrink)

This dissertation is designed to discuss central issues raised by two of the evolutionary behavioral sciences, sociobiology and evolutionary psychology. Both sciences purport to be able to explain the origins of human behavioral and cognitive adaptations respectively and give us some insight into "human nature." My purpose is to go some way towards determining how well these two sciences do as means of determining human evolutionary origins, both by examining some of the central issues that they face, and by examining (...) several case studies in which their methods have been applied to specific human behaviors. ;Sociobiology in particular has had a bad reputation, at least in part because s few of its proponents have used the project as a forum for pushing conservative social values. It has attracted a lot of criticism: in particular for being unwarrantedly adaptationist, and for addressing its explanations at behavior, rather than at psychology. Evolutionary psychology, on the other hand, has been better received; there is some belief that it is a more appropriate, less "behaviorist" project than sociobiology. I spend the first part of the dissertation examining some of these criticisms; however, I believe the charge adaptationism to be founded on the practices of individuals rather than being a central commitment of the project; I also conclude that the claim that behaviors cannot be adaptations to be unfounded. Furthermore, far from being a better project than sociobiology, I conclude that evolutionary psychology relies on a flawed central commitment to universal domain-specificity to establish its psychological conclusions, and its models rely on an unanalyzed notion of good design. ;In the second part of the dissertation I evaluate three well known and controversial studies that use sociobiological or evolutionary psychological methods to try to account for some bard to understand elements of human behavior: namely infanticide, art and altruism, and rape. Although the quality of this work is rather mixed, I conclude there is reason to think that natural selection is implicated to some degree in the origins of some of these behaviors. (shrink)

A dearth of literature focuses on the relationship between acculturation, power distance and liminality for migrant nurses entering foreign workplaces. Expectations are for migrant nurses to be practice‐ready swiftly. However, this aspiration is naïve given the complex shifts that occur in deeply held cultural beliefs and practices and is dependent on an organisational climate of reciprocal willingness to adapt and learn. This exploratory study identified that although a plethora of literature addresses challenges migrant nurses face, there are limited data that (...) link these transitional processes to concepts that might usefully guide transitions. This study draws from the overarching concept of acculturation, together with Hofstede's (2011) notion of power distance and the theory of liminality to explore the experiences of eight migrant nurses. Data highlighted that adjusting to altered hierarchical relationships took many months because negotiating power distance challenged deeply held beliefs and assumptions about professional and organisational hierarchies. Migrant nurses’ accounts indicated a paucity of organisational processes to address these difficulties; therefore, they navigated this liminal space of adjustment to power distance differences in an ad hoc manner. Their acculturation experiences, arguably unnecessarily prolonged, indicate the value in workplace commitment to exploring a collaborative, critically reflective approach to optimise transitions. (shrink)

The purpose of this text is to tell the story of the implementation of the _Act Respecting End-of-Life Care,_ referred to hereafter as _Law 2_ (Gouvernement du Québec, 2014) with an emphasis on the ambiguous role of ethics in the Interdisciplinary Support Groups (ISGs), created by Quebec's _Ministère de la santé et des services sociaux_ (MSSS). As established, ISGs provide “clinical, administrative and ethical support to health care professionals responding to a request for Medical aid in dying (MAiD)” (Gouvernement du (...) Québec, 2015). It is suggested that their composition includes the participation of a person with an expertise in ethics. These ISGs represent an important innovation for stakeholders involved in MAiD. To date, no scientific research has specifically addressed ISGs and little research has been conducted in other jurisdictions on the roles, operations and practices of MAiD support structures, especially the implication of ethics. Several ISGs have certainly developed promising practices that could benefit all stakeholders in the wider field of ethics and end of life. We will explore the development of ISGs in Quebec as a support structure for MAiD by highlighting the role that ethics has played (and should play) in these morally and humanly challenging situations. (shrink)

Background: Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives (to implement research protocols and advance science), setting (research facilities), and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether (...) research nurses experience unique ethical challenges distinct from those experienced by nurses in traditional patient-care settings. Research objectives: The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice. Research design: The study utilized a qualitative descriptive design with individual interviews. Participants and research context: Participating nurses (N = 12) self-identified as having experienced ethical challenges during screening. The majority were Caucasian (90%), female (83%), and worked in outpatient settings (67%). Approximately 50% had > 10 years of research experience. Ethical considerations: The human subjects review board approved the study. Written informed consent was obtained. Findings: Predominant themes were revealed: (1) the inability to provide a probable good, or/do no harm, and (2) dual obligations (identity as a nurse vs a research nurse). The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship. Discussion: Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science. Conclusion: Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

Respect and dignity are central to moral life, and have a particular importance in health care settings such as the intensive care unit (ICU). We conducted 15 semistructured interviews with 21 participants during an ICU admission to explore the definition of, and specific behaviors that demonstrate, respect and dignity during treatment in the ICU. We transcribed interviews and conducted thematic qualitative analysis. Seven themes emerged that focused on what it means to be treated with respect and/or dignity: treated as a (...) person; Golden Rule; acknowledgement; treated as family/friend; treated as an individual; treated as important/valuable; and treated as equal. Participants described particular behaviors or actions that were considered related to demonstrating treatment with respect and dignity: listening; honesty/giving information; attention to body/modesty/appearance; caring/bedside manner; patient and family as an information source; attention to pain; and responsiveness. These behaviors provide a framework for improving experiences with care in the ICU. (shrink)

The outcome of very preterm infants is marked by the development of complications that can have an impact on the quality of life of the children and their families. The concept of quality of life and its evaluation in the long term raise semantic and ethical problems for French physicians in perinatal care. Our reflection aims to gain a better understanding of the representations surrounding quality of life in neonatal medicine.

This paper analyses the ethical performance of foreign-investment enterprises operating in China in comparison to that of the indigenous state-owned enterprises, collectives and private enterprises. It uses both the deontological approach and the utilitarian approach in conceptualization, and applies quantitative and econometric techniques to ethical evaluations of empirical evidences. It shows that according to various ethical performance indicators, foreign-investment enterprises have fared well in comparison with local firms. This paper also tries to unravel the effect of a difference in business (...) culture and competitive market forces on ethical performance by comparing the behavior of foreign-investment enterprises with that of the indigenous state-owned enterprises and collectives on the one hand, and with that of the indigenous private enterprises on the other. (shrink)

Deux étapes dans la construction de corpus scolaires : problèmes récurrents et perspectives nouvelles L’article met en perspective des recherches qui ont pour objectif commun la constitution de corpus scolaires recueillis dans des conditions écologiques. Il expose les questions méthodologiques qui se sont posées au départ concernant le choix et l’organisation des données, la définition d’une unité d’observation, les différentes possibilités de transcription. Les limites rencontrées dans l’exploitation de transcriptions non annotées ont conduit à l’identification de problèmes récurrents : la (...) caractérisation des genres scolaires, genres dialogiques et multi-auctoriaux, la tension entre normalisation et prise en compte de la textualité des écrits. L’analyse d’un sous corpus numérisé et transcrit montre comment les décisions méthodologiques prises pour l’exploitation du corpus Ecriscol prennent acte de ces difficultés. (shrink)

Unethical decision-making behavior within organizations has received increasing attention over the past ten years. As a result, a plethora of studies have examined the relationship between gender and business ethics. However, these studies report conflicting results as to whether or not men and women differ with regards to business ethics. In this article, we propose that gender identity theory [Spence: 1993, Journal of Personality and Social Psychology 64, 624–635], provides both the theory and empirical measures to explore the influence of (...) psychological gender traits and gender-role attitudes on ethical perceptions of workplace behaviors. Statistical analyses of the data reveal that based on sex alone, no differences occur between men and women in their ethical perceptions. Yet, when a multidimensional approach to gender is applied, results show that expressive traits and egalitarian gender-role attitudes contribute to both men’s and women’s propensity to perceive unethical workplace behaviors as unethical. The implications of these findings and suggestions for future research are presented. (shrink)

My thinking in this essay, written in 1977, reflects the 1968 Wenner-Gren Conference on Conscious Purpose and Human Adaptation, organized by Gregory, about which I wrote Our Own Metaphor, as well as later conversations, but I had not yet worked with Gregory on Mind and Nature. Here, I explore Gregory’s idiosyncratic definitions of evocative terms like “love”, “mind”, and “wisdom” in terms of a cybernetically-based epistemology. The style and context are reflective of his Father-Daughter “metalogues”, composed to explore concepts he (...) was not yet ready to define fully, one of which is quoted as an introduction. Most of the sub-headings have been added. (shrink)

For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) (...) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress. (shrink)

"Friendship", for Aristotle, is a term with "focal meaning" which denominates relationships as casual as fellow travelers on a voyage, as permanent as spouses, and whose motives are as various as the commercial, military, religious, sexual, political and the virtuous. What can be said of all these relationships is that they involve a solidarity, a concordat, a reciprocity, which has its foundation in a common field between the parties and which produces common actions or exchanges. All friendships tend to equality (...) in the sense that they do not insist on what is due as an ultimate end; friendship, like equity, surpasses justice in the fulfillment of what is owed. Because friendship fosters solidarity and justice it is politically important as a virtue-context, according to Aristotle. Is it possible that friendship can function as a virtue-context within economic life as well? Aristotle's notion of a type of useful friendship which functions through expectation of moral behavior will be shown to provide both motive and context for the performance of acts of virtue in a business setting. (shrink)

BackgroundThe proper and ethical inclusion of PWLHIV and their young children in research is paramount to ensure valid evidence is generated to optimize treatment and care. Little empirical data exists to inform ethical considerations deemed most critical to these populations. Our study aimed to systematically review the empiric literature regarding ethical considerations for research participation of PWLHIV and their young children.MethodsWe conducted this systematic review in partnership with a medical librarian. A search strategy was designed and performed within the following (...) electronic databases: Ovid MEDLINE, Embase and CINAHL. We screened titles and abstracts using the following inclusion criteria: (1) a study population of PWLHIV or children under 5 years of age; and (2) collection of qualitative or quantitative data regarding ethics of research participation. Excluded were reviews, commentaries, policy statements, clinical care-related ethics concerns, abstracts, case studies, or studies unrelated to HIV research. Studies were appraised for quality, data were extracted, and studies were qualitatively analyzed using a principle-based ethical framework within the Belmont Report.ResultsOf the 7470 titles identified, 538 full-text articles were reviewed for eligibility and only three articles met full criteria for inclusion within this review. While we allowed for inclusion of studies involving young children born to mothers with HIV, only articles focused on PWLHIV were identified. Within the results of these studies, four themes emerged: (1) adequacy of informed consent; (2) consideration of paternal involvement; (3) balancing risks; and (4) access to research and treatment. A strength of this review is that it included perspectives of international research investigators, community leaders, and male partners. However, only two studies collected empiric data from PWLHIV regarding their experiences participating in researchConclusionResearchers and funding agencies should be aware of these considerations and appreciate the value of and critical need for formative research to ensure clinical trials involving PWLHIV promote ethical, well-informed research participation and, ultimately, improve care outcomes. More research is needed to create a comprehensive ethical framework for researchers when conducting studies with PWLHIV. (shrink)

Discusses mental processes, the role of humans in nature, experience, and the connection between myth, religion, and science.

Figuring Animals is a collection of fifteen essays concerning the representation of animals in literature, the visual arts, philosophy, and cultural practice. At the turn of the new century, it is helpful to reconsider our inherited understandings of the species, some of which are still useful to us. It is also important to look ahead to new understandings and new dialogue, which may contribute to the survival of us all. The contributors to this volume participate in this dialogue in a (...) variety of ways--through personal experience, natural history, cultural studies, philosophical inquiry, art history, literary analysis, film studies, and theoretical imagining, and through a combination of these trains of thought. The essays expose weaknesses in western epistemological frames of reference that for centuries have limited our views and, thus, our experiences of animal being, including our own. (shrink)

Michael A. Petersa and Fazal Rizvib aBeijing Normal University, Beijing, PR China; bMelbourne University, Melbourne, Australia Our minds are still racing back and forth, longing for a return to ‘no...

This paper addresses three factors that have contributed to shifts in decision making in health care. First, the notion of patient autonomy, which has changed due to the rise of patient-centred approaches in contemporary health care and the re-conceptualization of the physician-patient relationship. Second, the understanding of patient autonomy has broadened to better engage patient participation. Third, the need to develop cross-cultural health care ethics. Our paper shows that the shift in the West from the individual to the relational self (...) indicates an important change in the understanding of autonomy through the lens of culture. Practices that recognize the notion of the relational self allow for a more balanced view of autonomy and a richer conception of moral agency. (shrink)

Children and pregnant women are often excluded from clinical research. This has resulted in a paucity of evidence on how medicines work for fetuses, neonates, infants, and adolescents. It also raises bioethics, scientific, and public health concerns. For over half a century, doctors have prescribed medicines to children largely on the basis of how they work in adults, despite children’s varied physiologies and differences in how their bodies absorb and metabolize drugs. Regulations and legislation have led to an increase in (...) the number of pediatric studies and to better drug labeling. However, children at all stages of their lives often remain “therapeutic orphans” owing to insufficient evidence about how medicines work for them. (shrink)