Originally premiering in 1963, the BBC television series Doctor Who has long been criticized for essentializing colonial scenarios and failing to address issues of race and post-colonial realities. As a white male with the privilege to explore time and space, the titular Doctor stands in contrast to his human companion Martha Jones, a Black woman who represents the first and only main character in the show to be a medical professional of color. The relationship between the Doctor and Martha inherently (...) demands an exploration of the meaning of doctorhood. In studying the ways in which these characters embody the idea of “doctor,” we examine how race structures their approach to medicine, heroism, and colonialism. Whereas the Doctor personifies the figure of colonizer and post-colonial white savior, Martha emerges as a radical figure whose doctorhood potentially challenges and dismantles the colonial history of medicine. Through Afrofuturist and Afrosurrealist lenses, Martha represents a potentially subversive figure who offers a visionary medicine rooted in social justice. (shrink)

[P]layers line up in a long line and hold hands. The player at the front of the line is the ‘head’ and the player at the end of the line is the ‘tail’.… The game begins when the head begins to run wildly in any direction, making sharp turns and quick double-backs.… The force created by the twists and turns will often send the tail of the whip flying.… It may be best for the tail to hold on with both (...) hands to keep from flying off the end. Sometimes, however, the tail will go flying no matter how hard they hold on... Be prepared to get dirty if you play this game!--"Crack the Whip: Party Game CentralIf the evolution of American health policy is compared to the children’s game of Crack the Whip, then there is no question that the Medicaid program is the tail of the line. When those at the head of the line start to move. Medicaid receives whatever shocks and unintended consequences result, and when the line “begins to run wildly in any direction,” it receives them faster and harder than the players at the center.Shocks also come from other sources. When the economy slumps, an epidemic arises, or a path in another part of the system becomes a cul-de-sac, new twists and turns occur, with Medicaid absorbing much of the change. (shrink)

In Singapore’s multicultural society, a sizable proportion of the population subscribes to complementary and alternative medicine. In this article, we discuss the impact this has on medical practice in the context of the four principles of medical ethics. To uphold the principle of autonomy, we propose a non-judgmental approach towards patients who use CAM. Nevertheless, in order to promote health and prevent harm, the safety profiles of CAM must be studied through systematic research. In addition, the principle of justice is (...) one concerned with the fair distribution of scarce healthcare resources, while granting equal access to healthcare regardless of beliefs. Understanding CAM from an ethical perspective allows for the provision of safe, holistic, and culturally relevant care. (shrink)

The practice of placing men and women in the same hospital room (mixed gender rooms) has been prohibited in the UK National Health Service for over a decade. However, recent research demonstrates that the practice is common and increasing in a major New Zealand public hospital. Reports and complaints show that the practice also occurs in Australia. We argue that mixed gender rooms violate the fundamental human rights of personal security and dignity. The high rates of cognitive impairment, sensory impairment (...) and frailty in hospital wards exacerbates the risk for these violations and subsequent harm. We argue for the adoption of specific national policies prohibiting mixed gender rooms and public reporting of breaches. Importantly, these guidelines can be adopted without compromising the rights of gender minorities. In the long term, hospitals should be built with single occupancy rooms. (shrink)

Breastfeeding remains an understudied topic in research and theorizing about reproductive experience and women's bodies. This article reports on women's experiences of breastfeeding in public as revealed through in-depth interviews with 51 women. The current construction of the good maternal body requires women to carefully manage the performance of breastfeeding in specific ways and with particular attention to the dominant notion of a sexualized rather than nurturing breast. Women accommodate to, and resist, the perceived boundaries of the good maternal body (...) through their breastfeeding behaviors. (shrink)

Cultural narratives shape how we think about the world, including how we decide when the end of life begins. Hospice care has become an integral part of the end‐of‐life care in the United States, but as it has grown, its policies and practices have also imposed cultural narratives, like those associated with the “six‐month rule” that the majority of the end of life takes place in the final six months of life. This idea is embedded in policies for a range (...) of care practices and reimbursement processes, even though six months is not always a meaningful marker. In the case of people living with advanced dementia, six months is both too early in the trajectory to facilitate conversations and too late in the trajectory to ensure decision‐making capacity. This essay encourages scholars and policy‐makers to consider how cultural narratives may limit what they think is possible in care for people living with dementia. (shrink)

Recent events concerning Žižek at the Left Forum in New York have revealed much about the state of the Left. It appears that the Left is weaker than ever before and Žižek’s appeal to return to radical roots, yet also break some Leftist taboos, situates the liberal Left as anxious, insecure and reactionary. It also appears that Žižek is deliberately and steadily undertaking what many have accused him of failing to attain – of not going far enough. Here, Žižek is (...) breaking away from being the poster boy for the liberal Left and refining his commitment to communism through critiquing postmodern representations concerning tolerance, hyper-relativism and culturation. (shrink)

Over the past decade AIDS research has turned toward the use of pharmacology in HIV prevention, including pre-exposure prophylaxis (PrEP): the use of HIV medication as a means of preventing HIV acquisition in those who do not have it. This paper explores the contradictory reasons offered in support of PrEP—to empower women, to provide another risk-reduction option for gay men—as the context for understanding the social meaning of the experimental trials that appear to show that PrEP works in gay men (...) and heterosexual couples but not single women. The PrEP debates reveal the different ideas about “demedicalization” in the earlier gay health and women’s health movements and highlight the relationship between health activism and critique of research ethics in the context of a global pharmaceutical market. (shrink)

The child protection system in France has gradually changed along the lines of the laws enacted in 2002 and 2007 that reasserted the importance of the role played by the parents. Far from condemning the family, it henceforth seeks to provide it with accompaniment so as to ensure the child’s future reintegration. Grounded in psychoanalytical group and family theories, the article investigates the psychic function of the institution and (with case studies to support it) discusses what has to be done (...) to make arrangements within the therapeutic framework for families to make progress and maintain ties despite the absence of direct relations. For it is only after a real period of separation that work on the young person’s psychic group experience will enable the family to move forward. (shrink)

Zaller's model of public-opinion formation portrays the average citizen as an automaton who responds unthinkingly to elite cues. That is, once people have received information from political elites, they tend to abide by whatever their respective cue-givers dictate, since rejecting information is more cognitively costly than simply accepting it. Empirical research in psychology on priming supports this view of the citizen as a passive receiver of information. For example, people are likely to be unconsciously influenced by subtle cues and they (...) tend to base their opinions on the accessibility of information in memory. However, some citizens, under certain conditions, may be ?active processors? of information: actively interpreting it, elaborating on its implications, and negotiating its meaning. Whether or not Zaller's model is an accurate representation of the process of public-opinion formation depends substantially upon the inclusiveness of the researcher's views about what constitutes public opinion and how to study its determinants. (shrink)

This paper involves a case study of physicians working in an urban Midwestern region. It raises questions surrounding how physicians adapted to, encouraged and resisted the increasing presence of managed care in their work lives. The patterning of physician accommodation to managed care and the failure of physicians to mount any effective organized resistance in Metro has some important implications for theories about professional dominance and decline.

At the turn of the nineteenth century when anatomy and hands-on dissection became the prerequisite for a medical career, the medical community in England and France increasingly relied upon visual representations as part of a complex system of reinforcement of their professional goals. The production of novel illustrated textbooks that disseminated arguments through systematizing illustrations were thus integral to their professional status. Through an examination of a series of realistic diagrams that outlined the new methods of surgical and preservation techniques, (...) this paper argues that visual diagrams were instrumental in supporting the systematic codification and prestige on which nineteenth-century medical knowledge was to depend. It analyses the visual rhetoric and the complex representational languages of these intricate and equally precise illustrations by asking how these illustrations embraced new representational strategies as well as embodied idealizing aesthetic techniques. (shrink)

The present study shows that the Internet functions as a gratifying context for the exchange of knowledge and values related to religious matters among youngsters in the Netherlands; they are in the midst of constructing a religious identity. Systematic content analysis complemented by qualitative research was carried out on Maroc.nl, a discussion forum primarily aimed at Moroccan youth. Inspired by Kemper's definitions of experiencing Islam, the recurrence of six dimensions of religious experience was looked into in 1,354 online messages. The (...) purpose of this study is to gain insight into the nature and the relative visibility of each of these dimensions in the online discussions under study. In addition, a number of context-bound and issue-related characteristics of the message were assessed through qualitative analysis, in an effort to find out what key issues were mainly dealt with, what normative statements were made, and how the informants related to one another. (shrink)

A dominant belief in political philosophy is that states must be entitled to authorize the use of coercion in order to justifiably coerce its subjects. Call this view the entitlement view. On this view, for a state to justifiably coerce its subjects, a necessary condition is that it is entitled to authorize the use of coercion. Sceptics hold the entitlement view. However, they deny that states are entitled to authorize the use of coercion. This denial informs their views regarding the (...) permissible use of political power. Skeptics believe that nearly all uses of political power is impermissible. In this paper, I present a challenge to the skeptical view that nearly all uses of political power is impermissible. I also present a view on the justification of certain uses of political power that is an alternate to the entitlement view. My alternate view allows me to demonstrate that a state can engage in permissible uses of political power over a broad range of domains without possessing any entitlements. (shrink)

In a recent paper, Michael Levin argues that both statements reporting causal relations and causal explanatory statements are extensional. We show that his argument for the extensionality of causal explanatory statements fails to establish that conclusion. His claim that certain 'because' statements are elliptical for statements of what he terms the 'causal explanatory' form is unsubstantiated. The argument for the referential transparency of the allegedly explanatory form, regardless of whether it is a distinct explanatory form, fails because of scope problems. (...) Finally, we argue that the apparent referential opacity of explanations, the attribution of certain kinds of properties to explanations, and our satisfaction with explanations in what appear to be disparate forms are best accounted for, not by the assumption of ellipticality of statements in various forms for statements in some inherently explanatory form, but rather by an account of explanation as a speech act, the success or failure of which may be affected by which of several co-referring expressions is employed. (shrink)

Robert Card argues that although Susan Okin’s analysis in Justice, Gender and the Family leads to the conclusion that justice within the family requires elimination of gendered roles within marriage, this conclusion is not compatible with a conception of justice in which neutrality between reasonable conceptions of the good, and protection of individuals’ contractual capabilities are taken to be fundamental values. Although Card is right that there is tension in Okin’s work between where the analysis of injustice within the gender-structured (...) family leads and where, as a reformer, Okin is willing to go, and he is right to locate the source of that tension in Okin’s attempt to remain within Rawlsian liberalism, Okin’s view has more resources to respond to this critique than Card acknowledges. In the end, these additional resources may not be sufficient to address the problems that Card notes, but they do suggest a more complex relationship between Okin’s view and the liberal tradition than Card allows.. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Who Tells the StoryCindy BitterThirty years later, I do not remember her name, but I definitely remember her face, and this is how I remember her story.She came into the office for her flu shot. She was in her 70s and had a mild case of COPD attributed [End Page 87] to years of exposure to pesticides on the family farm. She said she was trying to stay healthy, (...) as the grandkids were due for a visit, and everyone had gotten a cold after Thanksgiving the year before. I was a sub-intern doing a required rural medicine rotation and diligently did an exam, finding asymptomatic new-onset atrial fibrillation of uncertain duration. We admitted her to the hospital and started anticoagulation. My attending also ordered a calcium channel blocker to slow her pulse, which was running 90–100 while she was at rest. The attending insisted that it would convert her back to sinus rhythm. The nurses were not experienced with the medication and were uncomfortable giving it. I was pretty sure the calcium channel blocker was not indicated, and a quick check of my pocket manual confirmed the drug would lower her heart rate and maybe her blood pressure but that it would not fix the abnormal rhythm. I refused to administer it. The attending came in, pushed the medication, and returned home. A few minutes later, the patient was struggling to speak. Her pulse fell to in the 30s, and her blood pressure had dropped dangerously low. I asked for the crash cart and calcium, and my attending, then started CPR when she lost her pulse. Half an hour later, my attending called her time of death.Hers was not the first death I'd witnessed, but it was the first time I felt like my patient would have been better off without our interventions. As a medical student hundreds of miles from the main hospital campus, I felt powerless to contradict the attending, and did not know where to turn for support in the moment. I rationalized it by saying that I had not actively contributed to her death by pushing the medication, but I held myself morally culpable for doing the exam and finding an asymptomatic abnormality that started her down that path. I felt I should have known the pathophysiology and medication side effects better, or been more assertive, or called for help.One could argue whether I was suffering from a grief reaction or falling into depression, but I questioned my calling to medicine and seriously considered leaving the field. But I was quite certain that I did not want another patient to be put at risk, or a student to feel cornered into taking actions against their better judgment. After returning to the main hospital, I met with the clerkship director and helped develop a pathway for students to raise safety concerns in real-time. Now I recognize the feeling I experienced as moral injury, but we weren't using that term at the time, or talking about Six Sigma safety, or stopping the line.Ultimately, I continued through medical school and trained as an emergency physician. My prior reverence for my attendings moderated to a healthier respect that had to be earned. I read voraciously, trying to prepare myself for unexpected situations. I became an advocate for patient safety and was an early adopter of shared decision-making. I strive to be a physician who welcomes questions and respects the concerns of all team members. Many of the principles that ground my career in medicine grew out of my exposure to this patient.It was always my least favorite of the tropes common to television medical dramas—the circumstances of the patient-of-the-week illuminated some aspect of our main characters' lives, providing a very important life lesson. I felt it positioned patients to be in service of the physician's aims, using patients as a means to our ends, when we should be using our knowledge and experience to further the patient's goals. Very un-Kantian, in addition to transgressing against multiple other philosophers and medical ethicists. As medicine learns more about the power of... (shrink)

Background Current requirements for ethical research in Canada, specifically the standard of active or signed parental consent, can leave Indigenous children and youth with inequitable access to research opportunities or health screening. Our objective was to examine the literature to identify culturally safe research consent processes that respect the rights of Indigenous children, the rights and responsibilities of parents or caregivers, and community protocols. Methods We followed PRISMA guidelines and Arksey and O’Malley’s approach for charting and synthesizing evidence. We searched (...) MEDLINE, PsycINFO, ERIC, CINAHL, Google Scholar, Web of Science, Informit Indigenous Collection, Bibliography of Native North Americans, and Sociological Abstracts. We included peer-reviewed primary and theoretical research articles written in English from January 1, 2000, to March 31, 2022, examining Indigenous approaches for obtaining informed consent from parents, families, children, or youth. Eligible records were uploaded to Covidence for title and abstract screening. We appraised the findings using a Two-Eyed Seeing approach. These findings were inductively coded using NVivo 12 and analyzed thematically. Results We identified 2,984 records and 11 eligible studies were included after screening. Three key recommendations emerged: addressing tensions in the ethics of consent, embracing wise practices, and using relational approaches to consent. Tensions in consent concerned Research Ethics Board consent requirements that fall short of protecting Indigenous children and communities when culturally incongruent. Wise practices included allowing parents and children to consent together, land-based consenting, and involving communities in decision-making. Using relational approaches to consent embodied community engagement and relationship building while acknowledging consent for Indigenous children cannot be obtained in isolation from family and community. Conclusions Very few studies discussed obtaining child consent in Indigenous communities. While Indigenous communities are not a monolith, the literature identified a need for community-driven, decolonized consent processes prioritizing Indigenous values and protocols. Further research is needed to examine nuances of Indigenized consent processes and determine how to operationalize them, enabling culturally appropriate, equitable access to research and services for all Indigenous children. (shrink)

Este estudio buscó describir e interpretar las teorías subjetivas sobre la identidad profesional docente que se construyen y difunden noticiosamente durante la educación de emergencia por la pandemia de COVID 19. Se utilizó un estudio de análisis documental, metodología cualitativa y un diseño de estudio de casos. El muestreo intencionado y por conveniencia corresponde a 40 noticias de prensa escrita en español, sobre el profesor(a) en pandemia y publicadas en diferentes medios que fueron recolectadas a través de Google Noticias desde (...) el 11 de marzo de 2020 y hasta el 01 de noviembre de 2020. A partir de una codificación temática, los resultados evidenciaron teorías subjetivas asociadas a las exigentes características, roles, funciones y valores con los que se identifica al profesorado durante la pandemia. El análisis mostró los distintos sentidos del ejercicio profesional y las competencias asociadas a su desempeño en la prensa. En la discusión, se utilizaron estudios relativos a la práctica docente para interpretar estos resultados. (shrink)

Chronic poverty comes in a variety of forms. It is multi-dimensional in its causes and multi-dimensional in its impacts . Although poverty "has an irreducible economic connotation," this connotation "does not necessarily imply the primacy of economic factors" . For example, violent conflict, access to land, and social relations of power are among the most important factors in food security . Integration into global economic markets is as likely to be a source of immiseration and impoverishment as it is a (...) solution . Access to safe drinking water and basic sanitation are significantly impacted by displacement and violent conflict and its aftermath; displacement and violent conflict often have an ethnic dimension. (shrink)

In Global Justice: A Cosmopolitan Account Gillian Brock makes three important claims: that we have duties of justice to all human beings and not only those with whom we share a state; that our duties to those outside our states are of the same scope and normative weight as our duties to those with whom we share a state; and that the existing framework of international institutions affords us a number of straightforward and accessible means to act on our duties (...) to persons outside our states that we ought to pursue. These claims are important in themselves, but the real interest of Brock’s book lies with the argumentative strategy she uses in support of them. This strategy, which includes emphasizing the compellingness of specific institutional and policy prescriptions and distancing her arguments from debates about the structure and plausibility of Rawlsian internationalism, bears interesting fruit in a number of respects. However, it also raises difficult questions about the coherence of the distinction between cosmopolitanism and nationalism on which Brock relies, and about the value of institutionalist approaches to justice more generally. (shrink)

A popular strategy for answering the question of why and how laws bind is to use the concept of political justification: to argue that laws bind when they can be justified in the political domain. Being defensible in the political domain is supposed to make laws emotionally compelling in virtue of their being justified for each member of the community, and intellectually compelling in virtue of their having emerged from a process that is subject to constraints of rationality such as (...) consistency and coherence. However, being politically justifiable does not and cannot explain why it is reasonable to expect individuals to conform because it places too much emphasis on deference to the judgments of public actors. In this paper I use a distinction between general availability and general acceptability accounts of publicity to explain why the answer to what makes laws binding lies in developing an account of good reasons, not an account of why political reasons should take priority. (shrink)

Maintaining academic integrity is a growing concern for higher education, increasingly so due to the pivot to remote learning in 2020 caused by the COVID-19 pandemic. We canvassed students, faculty, and tutors at an online Canadian university about their perspectives on academic integrity and misconduct. The survey asked how the university could improve policies concerning issues of academic integrity, how faculty and tutors handled cases of misconduct, about satisfaction with how academic violations were treated, and about the role of students, (...) faculty, and tutors in encouraging academic integrity. As well, we collected suggestions from respondents for reducing cheating, addressing academic misconduct, and general ideas about academic integrity. The distinction between misconduct and integrity was not always clear in their comments. We received responses from 228 students and 73 faculty and tutors, generating hundreds of comments. In this paper we focus only on the answers to open-ended questions. Using content analysis, we categorized the replies into similar threads. After multiple iterations of analysis, we extracted three general recommendation groupings: Policy and Procedures, Compliance and Commitment, and Resources. Based on respondents’ views, we propose a balanced approach to supporting academic integrity. Although we conducted the study pre-COVID-19, the recommendations apply to current and future academic integrity practices in our context and beyond. (shrink)