Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients’ homes. This greatly impacts nurses’ work in home care, making their work increasingly diverse and demanding. In this study, we explore home‐care nursing through a critical discourse analysis of focus group interviews with home‐care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of contextual changes. Nurses hold a crucial (...) position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home‐care nurses’ work. Changes have made nurses’ work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses’ work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses’ work to help shape the further development of home‐care nursing. (shrink)

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

A fact of life for farmers, hunter-gatherers, and fishermen in the rural parts of the world are that crops fail, wild resources become scarce, and winds discourage fishing. In this article we approach subsistence risk from the perspective of "coexistence thinking," the simultaneous application of natural and supernatural causal models to explain subsistence success and failure. In southwestern Madagascar, the ecological world is characterized by extreme variability and unpredictability, and the cosmological world is characterized by anxiety about supernatural dangers. Ecological (...) and cosmological causes seem to point to different risk minimizing strategies: to avoid losses from drought, flood, or heavy winds, one should diversify activities and be flexible; but to avoid losses caused by disrespected spirits one should narrow one's range of behaviors to follow the code of taboos and offerings. We address this paradox by investigating whether southwestern Malagasy understand natural and supernatural causes as occupying separate, contradictory explanatory systems (target dependence), whether they make no categorical distinction between natural and supernatural forces and combine them within a single explanatory system (synthetic thinking), or whether they have separate natural and supernatural categories of causes that are integrated into one explanatory system so that supernatural forces drive natural forces (integrative thinking). Results from three field studies suggest that (a) informants explain why crops, prey, and market activities succeed or fail with reference to natural causal forces like rainfall and pests, (b) they explain why individual persons experience success or failure primarily with supernatural factors like God and ancestors, and (c) they understand supernatural forces as driving natural forces, so that ecology and cosmology represent distinct sets of causes within a single explanatory framework. We expect that future cross-cultural analyses may find that this form of "integrative thinking" is common in unpredictable environments and is a cognitive strategy that accompanies economic diversification. (shrink)

Whether any non-human animal can attribute mental states to others remains the subject of extensive debate. This despite the fact that several species have behaved as if they have a ‘theory of mind’ in various behavioral tasks. In this paper, we review the reasons of skeptics for their doubts: That existing experimental setups cannot distinguish between ‘mind readers’ and ‘behavior readers’, that results that seem to indicate ‘theory of mind’ may come from studies that are insufficiently controlled, and that our (...) own intuitive biases may lead us to interpret behavior more ‘cognitively’ than is necessary. The merits of each claim and suggested solution are weighed. The conclusion is that while it is true that existing setups cannot conclusively demonstrate ‘theory of mind’ in non-human animals, focusing on this fact is unlikely to be productive. Instead, the more interesting question is how sophisticated their social reasoning can be, whether it is about ‘unobservable inner experiences’ or not. Therefore, it is important to address concerns about the setup and interpretation of specific experiments. To alleviate the impact of intuitive biases, various strategies have been proposed in the literature. These include a deeper understanding of associative learning, a better knowledge of the limited ‘theory of mind’ humans actually use, and thinking of animal cognition in an embodied, embedded way; that is, being aware that constraints outside of the brain, and outside of the body, may naturally predispose individuals to produce behavior that looks smart without requiring complex cognition. To enable this kind of thinking, a powerful methodological tool is advocated: Computational modeling, namely agent-based modeling and, particularly, cognitive modeling. By explicitly simulating the rules and representations that underlie animal performance on specific tasks, it becomes much easier to look past one’s own biases and to see what cognitive processes might actually be occurring. (shrink)

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

We study the notion of weak one-basedness introduced in recent work of Berenstein and Vassiliev. Our main results are that this notion characterizes linearity in the setting of geometric þ-rank 1structures and that lovely pairs of weakly one-based geometric þ-rank 1 structures are weakly one-based with respect to þ-independence. We also study geometries arising from infinite-dimensional vector spaces over division rings.

The inconsistency between pro-environmental attitudes and behaviours, known as the “attitude-behaviour” gap, is exceptionally pronounced in scenarios associated with “green” choice. The current literature offers numerous explanations for the reasons behind the “attitude-behaviour” gap, however, the generalisability of these explanations is complex. In addition, the answer to the question of whether the gap occurs between attitudes and intentions, or intentions and behaviours is also unknown. In this study, we propose the moral dimension as a generalisable driver of the “attitude-behaviour” gap (...) and investigate its effectiveness in predicting attitudes, pro-environmental intentions and subsequent behaviours. We do so by using Hunt–Vitell’s moral philosophy-based framework of ethical decision-making, which conceptualises morality as the central decision-making parameter. The results from 557 US MTurk participants revealed that the manipulation of moral dimensions, specifically deontology and teleology, impacted ethical evaluation of presented dilemmas, however, failed to translate into subsequent intentions and behaviours. This finding suggests (i) that the moral dimension has an effect in shaping attitudes toward environmental issues, and (ii) that gap occurs between attitudes and intentions rather than intentions and behaviours. Further investigation of what strengthens and/or overrides the effects of the moral dimension would help understand the reasons why moral attitudes do not always translate into subsequent intentions and behaviours in the pro-environmental domain. (shrink)

Internationally, primary health care has in recent years gained a more central position in political priorities to ensure sustainable health care for the population. Thus, more people receive health care locally and in their own homes, where home‐care nursing plays a large role. In this article, we investigate how home‐care nursing is articulated and made visible in contemporary Norwegian policy documents. The study is a Fairclough‐inspired critical discourse analysis seeking to uncover the position of nursing in the prevailing political ideologies (...) on current primary health care. In the documents, we identified several complementary and conflicting understandings about home‐care nursing. Home‐care nursing is presented as a basic part of a municipality's health services, but at the same time, its content and contribution are unclear and almost invisible. We argue that the absence of nursing leads to significant perspectives being left out and tie this to the fact that some patient groups and tasks seem to be disadvantaged. The political placement of home‐care nursing in the health‐care landscape is thus not just about nursing as a professional practice but also concerns fundamental care values in our society in relation to disadvantaged groups and work tasks. (shrink)

IntroductionThe National Institute for Health and Care Excellence guidelines acknowledge the importance of the parent–infant relationship for child development but highlight the need for further research to establish reliable tools for assessment, particularly for parents of children under 1 year. This study explores the acceptability and psychometric properties of a co-developed tool, ‘Me and My Baby’.Study designA cross-sectional design was applied. The MaMB was administered universally with mothers during routine 6–8-week Health Visitor contacts. The sample comprised 467 mothers. Dimensionality of (...) instrument responses were evaluated via exploratory and confirmatory ordinal factor analyses. Item response modeling was conducted via a Rasch calibration to evaluate how the tool conformed to principles of ‘fundamental measurement’. Tool acceptability was evaluated via completion rates and comparing ‘completers’ and ‘non-completers’ demographic differences on age, parity, ethnicity, and English as an additional language. Free-text comments were summarized. Data sharing agreements and data management were compliant with the General Data Protection Regulation, and University of York data management policies.ResultsHigh completion rates suggested the MaMB was acceptable. Psychometric analyses showed the response data to be an excellent fit to a unidimensional confirmatory factor analytic model. All items loaded statistically significantly and substantially on a single underlying factor. The item response modeling showed that most MaMB items fitted the Rasch model. item reliability was high yet the test yielded little information on each respondent, as highlighted by the relatively low ‘person separation index’ of 0.1.Conclusion and next stepsMaMB reliably measures a single construct, likely to be infant bonding. However, further validation work is needed, preferably with ‘enriched population samples’ to include higher-need/risk families. The MaMB tool may benefit from reduced response categories and some modest item wording amendments. Following further validation and reliability appraisal the MaMB may ultimately be used with fathers/other primary caregivers and be potentially useful in research, universal health settings as part of a referral pathway, and clinical practice, to identify dyads in need of additional support/interventions. (shrink)

We explore physiological linkage among 34 same-sex male couples. Interbeat interval, an indicator of cardiovascular arousal, was collected across four conversational contexts in the lab: a baseline period that did not involve conversation, a conversation about body image, a conversation about health goals, and a recovery period that allowed for unstructured conversation. We used a newly developed R statistical package that simplifies the use of dynamic models for investigating interpersonal emotional processes. We identified two different PL patterns: a simple one (...) that was characterized by stable synchronization and low frequency of oscillation; and a complex one that was characterized by drifting synchronization, high frequency of oscillation, and eventual damping. Guided by social baseline theory and the reactive flexibility perspective, we explored the interactions between couple relationship functioning and conversational context as predictors of the PL patterns. The results suggest that partners in well-functioning relationships and emotionally challenging situations may be especially likely to show complex PL patterns that may reflect coregulatory processes. (shrink)

Background The first COVID-19 wave started in February 2020 in France. The influx of patients requiring emergency care and high-level technicity led healthcare professionals to fear saturation of available care. In that context, the multidisciplinary Ethics- Support Cell (EST) was created to help medical teams consider the decisions that could potentially be sources of ethical dilemmas. Objectives The primary objective was to prospectively collect information on requests for EST assistance from 23 March to 9 May 2020. The secondary aim was (...) to describe the Cell’s functions during that period. Research design This observational, real-time study of requests for Cell consultations concerned ethical dilemmas arising during a public health crisis. The EST created a grid to collect relevant information (clinical, patient’s/designated representative’s preferences and ethical principles strained by the situation), thereby assuring that each EST asked the same questions, in the same order. Participants and research context Only our university hospital’s clinicians could request EST intervention. Ethical considerations The hospital Research Ethics Committee approved this study (no. CER-2020-107). The patient, his/her family, or designated representative was informed of this ethics consultation and most met with EST members, which enabled them to express their preferences and/or opposition. Findings/results 33 requests (patients’ mean age: 80.8 years; 29 had COVID-19: 24 with dyspnea, 30 with comorbidities). 17 Emergency Department solicitations concerned ICU admission, without reference to resource constraints; others addressed therapeutic proportionality dilemmas. Discussion Intervention-request motives concerned limited resources and treatment intensity. Management revolved around three axes: the treatment option most appropriate for the patient, the feasibility of implementation, and dignified care for the patient. Conclusions COVID-19 crisis forced hospitals to envisage prioritization of ICU access. Established decision-making criteria and protocols do not enable healthcare professionals to escape ethical dilemmas. That acknowledgement highlights ethical risks, enhances the added-value of nursing and encourages all players to be vigilant to pursue collective deliberations to achieve clear and transparent decisions. (shrink)

The aim of the article is to illustrate concrete problems in the asymmetrical nurse–patient power relationship. It is an ethical demand that the nurse is faced with the challenges that the power in the relation is administered so that the patient's room for action is expanded and trust maintained. It is an essential message in care philosophy, but in clinical practice, success is not always achievable. A hidden and more or less unconscious restriction of the patient's room for action may (...) result in the excesses of care. Three selected aspects: dependence, trust, and power described by the Danish philosopher K.E. Løgstrup and the Norwegian nursing philosopher Kari Martinsen's care philosophy has inspired this empirically based examination of some current barriers in the asymmetrical nurse–patient relationship. On the basis of qualitative interviews with six patients and six nurses, the research thus provides an identifying and problem‐exploratory examination of some current obstacles in which the handling of trust and power reflects the excesses of care. The findings develop three themes. ‘Being a burden’ acknowledges that the balance of power will always tip to the nurse's advantage. The second theme, ‘Doing only what's absolutely necessary’, shows how a fixation with ‘technicalism’ creates a distance between people that may constrain the patient's room for action. The last theme is concerning the nurse's ability to navigate between closeness and distance is essential in avoiding ‘the excesses of care’, paternalism, and overprotectiveness. A situation in which distance takes the upper hand and care turns into paternalism. A different situation would arise if the nurse's emotions became sentimental or intimate with the result that closeness gets the upper hand. To avoid a harmful exercise of power and the excesses of care, the findings have demonstrated that a relationship‐based caring is a demand for situation‐specific sensitive attention skills. (shrink)

The central question of this paper is: are deterministic and indeterministic descriptions observationally equivalent in the sense that they give the same predictions? I tackle this question for measure-theoretic deterministic systems and stochastic processes, both of which are ubiquitous in science. I first show that for many measure-theoretic deterministic systems there is a stochastic process which is observationally equivalent to the deterministic system. Conversely, I show that for all stochastic processes there is a measure-theoretic deterministic system which is observationally equivalent (...) to the stochastic process. Still, one might guess that the measure-theoretic deterministic systems which are observationally equivalent to stochastic processes used in science do not include any deterministic systems used in science. I argue that this is not so because deterministic systems used in science even give rise to Bernoulli processes. Despite this, one might guess that measure-theoretic deterministic systems used in science cannot give the same predictions at every observation level as stochastic processes used in science. By proving results in ergodic theory, I show that also this guess is misguided: there are several deterministic systems used in science which give the same predictions at every observation level as Markov processes. All these results show that measure-theoretic deterministic systems and stochastic processes are observationally equivalent more often than one might perhaps expect. Furthermore, I criticise the claims of the previous philosophy papers Suppes (1993, 1999), Suppes and de Barros (1996) and Winnie (1998) on observational equivalence. (shrink)

This paper addresses the actual practice of justifying definitions in mathematics. First, I introduce the main account of this issue, namely Lakatos's proof-generated definitions. Based on a case study of definitions of randomness in ergodic theory, I identify three other common ways of justifying definitions: natural-world justification, condition justification, and redundancy justification. Also, I clarify the interrelationships between the different kinds of justification. Finally, I point out how Lakatos's ideas are limited: they fail to show how various kinds of justification (...) can be found and can be reasonable, and they fail to acknowledge the interplay among the different kinds of justification. (shrink)

The doctor-patient relationship is built on an implicit covenant of trust, yet it was not until the post-World War Two era that respect for patient autonomy emerged as an article of mainstream medical ethics. Unlike their medical forebears, physicians today are expected to furnish patients with adequate information about diagnoses, prognoses and treatments. Against these dicta there has been ongoing debate over whether placebos pose a threat to patient autonomy. A key premise underlying medical ethics discussion is the notion that (...) the placebo effect necessitates patient deception. Indeed, the American Medical Association guidelines imply that placebo treatment necessary entails a form of deception. As a consequence of this assumption, the fulcrum of debate on the use of placebo treatment has hinged on whether that deception is ever justified. Recently performed experiments with open-label transparently prescribed placebos have begun to challenge the notion that deception is necessary in eliciting the placebo effect and such effects necessarily involve a binary distinction between autonomy and beneficence. In this article we focus on the content of disclosures in distinctive open-label, transparently disclosed placebo studies and inquire whether they might be said to invoke deception in clinical contexts, and if so, whether the deception is unethical. We find that open placebos may be said to involve equivocation over how placebos work. However, drawing on surveys of patient attitudes we suggest that this equivocation appears to be acceptable to patients. We conclude that open placebos fulfil current American Medical Association guidelines for placebo use, and propose future research directions for harnessing the placebo effect ethically. (shrink)

In March 2020, the Government produced a document entitled “Responding to COVID-19: The Ethical Framework for Adult Social Care”(‘The Ethical Framework’). In this article, we summarise the key features of the proposed ethical framework and subject it to critical analysis. We highlight three primary issues. First, the emphasis placed on autonomy as the primary ethical principle. We argue if ever there was a context in which autonomy should dominate the ethical analysis, this is not it. Second, we examine the interface (...) between ethics and law which is largely overlooked in the document. Finally, we explore the surprising lack of attention paid to the concept of responsibility and communal obligations within the framework. (shrink)

Your Digital Rebel XSi/450D, with its 12.2 megapixel resolution, 3-inch view screen, and the option for "Live View" shooting, is designed for simplicity without sacrificing creative freedom. This guide is ideal for helping you use that creative control and get great shots anywhere, anytime. If you’re new to dSLRs, it makes the transition easy. If you’re already comfortable with the various modes and settings, the book helps you make the most of every one. Set up your camera and learn when (...) to choose automatic, semi-automatic, and manual modes Understand the camera's controls, menus, and when to use different metering and autofocus modes Explore Canon Picture Styles and custom functions Learn to manipulate ISO, exposure, depth of field, and shutter speed Create intriguing night and low-light images, capture sports action, portraits, and get tips for better macro photography. (shrink)

In this article I consider how our experiences of bodily privacy are changing in the contemporary surveillance society. I use biometric technologies as a lens for tracking the changing relationships between the body and privacy. Adopting a broader genealogical perspective, I retrace the role of the body in the constitution of the modern liberal political subject. I consider two different understandings of the subject, the Foucauldian political subject, and the Lacanian psychoanalytic subject. The psychoanalytic perspective serves to appraise the importance (...) of hiding for the subject effects of excessive exposure to the Other’s gaze. I conclude to the importance of the subject’s being able to hide, even when it has nothing to hide. By considering these two facets of subjectivity, political and psychic, I hope to make sense of our enduring and deeply political passionate attachment to privacy. (shrink)

This highly original book examines, for the first time, how the patient movement, which works to improve the quality of healthcare, can actually be considered an emancipation movement when led by its radical elements.

This article focuses on three recent discussions on determinism in the philosophy of science. First, determinism and predictability will be discussed. Then, second, the paper turns to the topic of determinism, indeterminism, observational equivalence and randomness. Finally, third, there will be a discussion about deterministic probabilities. The paper will end with a conclusion.

Hume is committed, By one of his criticisms of reason as the route to moral knowledge, To an internalist position. In the argument from motivation, Hume starts by observing that morality is practical--That morals excite passions and produce or prevent actions. But, Hume argues, Rationalist moral theories cannot explain how moral considerations motivate. This is because reason alone is incapable of motivating us. The premise that morality is practical, However, May be interpreted in two ways--Either in an externalist or internalist (...) manner. Charity requires us to adopt the internalist reading because only then is the argument valid. An internalist reading of the argument, However, Commits hume, In his constructive phase, To construing the moral sentiments of approval and disapproval as possessing motivational influence by themselves. But an examination of what hume has to say about the motives that prompt us to do what is right shows that he fails to provide such an account himself. This points to an inconsistency in hume's moral theory. (shrink)

Charlotte Sabourin | : Cet article vise à souligner l’importance du rôle joué par la conception kantienne des Lumières dans la Critique de la raison pure. On verra en effet que la connaissance de soi au coeur du projet critique gagne à être comprise en relation avec l’idée de penser par soi-même. Cette connaissance de soi dévoile cependant certaines erreurs tenaces commises par la raison, qui doivent précisément être rectifiées sous peine de compromettre la liberté de penser. La conception (...) kantienne des Lumières nous permettra ainsi de faire sens de la nature réflexive de l’entreprise critique. | : The aim of this paper is to show that the Kantian conception of enlightenment plays an important role in the Critique of Pure Reason. I will show that the self-knowledge central to Kant’s critical philosophy can be better understood by considering it in relation with the idea of thinking for oneself. Moreover, this self-knowledge reveals some deep-rooted errors made by pure reason that must be rectified in order not to compromise freedom of thought. I will thus use Kant’s conception of enlightenment to make sense of the reflexive nature of the critical project. (shrink)

The article examines the construction of “Big Data” in media discourse. Rather than asking what Big Data really is or is not, it deals with the discursive work that goes into making Big Data a socially relevant phenomenon and problem in the first place. It starts from the idea that in modern societies the public understanding of technology is largely driven by a media-based discourse, which is a key arena for circulating collectively shared meanings. This largely ignored dimension invites us (...) to appreciate what matters to journalists and the wider public when discussing the collection and use of data. To this end, our study looks at how Big Data is framed in terms of the governmental use of large datasets as a contentious area of data application. It reconstructs the perspectives surrounding the so-called “Handygate” affair in Germany based on broadcast news and social media conversations. In this incident, state authorities collected and analyzed mobile phone data through a radio cell query during events to commemorate the Dresden bombing in February 2011. We employ a qualitative discourse analysis that allows us to reconstruct the conceptualizations of Big Data as a proper instrument for criminal prosecution or an unjustified infringement of constitutional rights. (shrink)

A common observation in placebo studies is that definitional disagreement is rife. Philosopher and historian of science Robin Nunn recently argued that "Nobody who came and saw the placebo has conquered its definition". Nunn insists that "the placebo construct conceals more than it clarifies," and that we need to prepare for "a post-placebo paradigm". Pronouncements that disagreement is endemic are often the prologue for new definitions of placebo and "placebo effect": for example, in the opening of a recent philosophical paper (...) on the issue, Jeremy Howick observed that debates about placebos "rage," and that "there is currently no widely accepted definition of the 'placebo'".... (shrink)

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

The past twenty five years have seen an explosion of feminist writing on the philosophical canon, a development that has clear parallels in other disciplines like literature and art history. Since most of the writing is, in one way or another, critical of the tradition, a natural question to ask is: Why does the history of philosophy have importance for feminist philosophers? This question assumes that the history of philosophy is of importance for feminists, an assumption that is warranted by (...) the sheer volume of recent feminist writing on the canon. This entry explores the different ways that feminist philosophers are interacting with the Western philosophical tradition. (shrink)

The Metaphysics of Gender is a book about gender essentialism: what it is and why it might be true.

* INTRODUCTION This book seeks to add dimension to our understanding of Greek Skepticism by concentrating attention on a particular area that is of ...

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

On the observational equivalence of continuous-time deterministic and indeterministic descriptions Content Type Journal Article Pages 193-225 DOI 10.1007/s13194-010-0011-5 Authors Charlotte Werndl, Department of Philosophy, Logic and Scientific Method, London School of Economics, Houghton Street, London, WC2A 2AE UK Journal European Journal for Philosophy of Science Online ISSN 1879-4920 Print ISSN 1879-4912 Journal Volume Volume 1 Journal Issue Volume 1, Number 2.

Patients in around 20 countries worldwide are now offered online access to at least some of their medical records. Access includes test results, medication lists, referral information, and/or the very words written by clinicians (so-called ‘open notes’). In this paper, I discuss the possibility of one unintended negative consequence of patient access to their clinical notes—the potential to increase ‘nocebo effects’. A growing body of research shows that nocebo effects arise by engaging perceptual and cognitive processes that influence negative expectancies, (...) and as a consequence, adverse health effects. Studies show that increased awareness about the side effects of medications, the framing of information and the socioemotional context of care can increase the risk of nocebo effects. Connecting research into the nocebo effect with open notes provides preliminary support for the hypothesis that patient access to clinical notes might be a forum for facilitating unwanted nocebo effects. Furthermore, current findings indicate that we might expect to see systematic differences in how nocebo effects are experienced among different patient populations. The ethical implications of the tension between transparency and the potential for harm are discussed, with an emphasis on what open notes might mean for justice and equity in clinical care for a range of already marginalised patient populations. I argue that to resolve these challenges does not thereby justify ‘closed notes’, and conclude with suggestions for how health systems and clinicians might adapt to this innovation to reduce the risk of potential nocebo effects arising via this novel route. (shrink)

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

Leadership plays an essential part in creating competitive advantage and well-being among employees. One way in which formal leaders can deal with the variety of responsibilities that comes with their role is to share their responsibilities with team members (i.e., shared leadership). Although there is abundant literature on how high-quality peer leadership benefits team effectiveness (TE) and well-being, there is only limited evidence about the underpinning mechanisms of these relationships and how the formal leader can support this process. To address (...) this lacuna, we conducted an online survey study with 146 employees from various organizations. The results suggest that an empowering leadership style of the formal leader is associated with higher perceived peer leadership quality (PLQ) on four different leadership roles (i.e., task, motivational, social, and external leader). In addition, formal leaders who empower their team members are also perceived as better leaders themselves. Moreover, the improved PLQ was in turn positively related to TE and work satisfaction, while being negatively related to burnout. In line with the social identity approach, we found that team identification mediated these relationships. Thus, high-quality peer leaders succeeded in creating a shared sense of “us” in the team, and this team identification in turn generated all the positive outcomes. To conclude, by sharing their lead and empowering the peer leaders in their team, formal leaders are key drivers of the team’s effectiveness, while also enhancing team members’ health and well-being. (shrink)

Garrett Cullity contends that fairness is appropriate impartiality (See Cullity (2004) Chapters 8 and 10 and Cullity (2008)). Cullity deploys his account of fairness as a means of limiting the extreme moral demand to make sacrifices in order to aid others that was posed by Peter Singer in his seminal article ‘Famine, Affluence and Morality’. My paper is founded upon the combination of (1) the observation that the idea that fairness consists in appropriate impartiality is very vague and (2) the (...) fact that psychological studies show the self-serving bias is especially likely to infect one’s judgements when the ideas involved are vague. I argue that Cullity’s solution to extreme moral demandingness is threatened by these findings. I then comment on whether some other theories of fairness are vulnerable to the same objection. (shrink)

Patients have to be respected with dignity as the masters of their own lives. The problem, however, is that autonomy may become so dominant and the fundamental value of caring in professional nursing that the patient’s dignity is affected. The aim of this article is to point out some of the issues with the interplay between autonomy, also called self-management and dignity. Given voice to the patient perspective the background is provided by cases from research conducted through qualitative interviews with (...) patients and expanded by summarizing empirical research concerning the interplay between autonomy and dignity. The search strategy and the research question gave five empirical research papers and three theoretical studies and concept analyses. A concise overview of the relevant research contains information about all the major elements of the studies. The background research and an interpretative summary address new issues to be taken into account in dignity conserving care. (shrink)