Background In end-of-life situations, the phrase “do everything” is sometimes invoked by physicians, patients, or substitute decision-makers, though its meaning is ambiguous. We examined instances of the phrase “do everything” in the archive of the Ontario Consent and Capacity Board in Canada, a tribunal with judicial authority to adjudicate physician–patient conflicts in order to explore its potential meanings. Methods We systematically searched the CCB’s online public archive from its inception to 2018 for any references to “do everything” in the context (...) of critical care medicine and end-of-life care. Two independent assessors reviewed decisions, collected characteristics, and identified key themes. Results Of 598 cases in the archive, 41 referred to “do everything” in end-of-life situations. The phrase was overwhelmingly invoked by SDMs, typically to advocate for life-prolonging measures that contradicted physician advice. Physicians generally related “doing everything” to describe the interventions they had already performed, using it to recommend focusing on patients’ quality of life. SDMs were generally reluctant to accept death, whereas physicians found prolonging life at all costs to be morally distressing. The CCB did not interpret appeals to “do everything” legally but followed existing laws by deferring to patients’ prior wishes whenever known, or to concepts of “best interests” when not. The CCB generally recommended against life-prolonging measures in these cases, focusing on patients’ “well-being” and “best interests.” Conclusions In this unique sample of cases involving conflict surrounding resuscitation and end-of-life care, references to “do everything” highlighted conflicts over quantity versus quality of life. These appeals were associated with signs of cognitive distress on the behalf of SDMs who were facing the prospect of a patient’s death, whereas physicians identified moral distress related to the prolongation of patients’ suffering through their use of life-sustaining interventions. This divergence in perspectives on death versus suffering was consistently the locus of conflict. These findings support the importance of tools such as the Serious Illness Conversation Guide that can be used by physicians to direct conversations on the patients’ goals, wishes, trade-offs, and to recommend a treatment plan that may include palliative care. Trial Registration Not applicable. (shrink)

BackgroundPalliative sedation and analgesia are employed in patients with refractory and intractable symptoms at the end of life to reduce their suffering by lowering their level of consciousness. The doctrine of double effect, a philosophical principle that justifies doing a “good action” with a potentially “bad effect,” is frequently employed to provide an ethical justification for this practice. Main textWe argue that palliative sedation and analgesia do not fulfill the conditions required to apply the doctrine of double effect, and therefore (...) its use in this domain is inappropriate. Furthermore, we argue that the frequent application of the doctrine of double effect to palliative sedation and analgesia reflects physicians’ discomfort with the complex moral, intentional, and causal aspects of end-of-life care. ConclusionsWe are concerned that this misapplication of the doctrine of double effect can consequently impair physicians’ ethical reasoning and relationships with patients at the end of life. (shrink)

This paper advances the conception of social entrepreneurs as caring entrepreneurs. We argue that the care ethics of social entrepreneurs, implying the pursuit of caring goals through caring processes, can be challenged when they engage in the process of scaling up their ventures. We propose that social entrepreneurs can sustain their care ethics as the essential dimension of their venture only if they are able to build a caring enterprise. Organizational care designates the set of organizing principles that facilitate the (...) embedding of care ethics at an organizational level, beyond the imprinting induced by social entrepreneurs’ personal ethics. (shrink)

Gordon Barrett (GB): Research Associate, Centre for the History of Science, Technology and Medicine, University of Manchester, UK (special issue co-editor).

Cinema, thought and time -- Deleuze's cinema books -- Technology -- Essences -- Space and time -- Bergson, time, and life -- The movement-image -- The history of time and space and the history of cinema -- The movement-image and semiotics -- Styles of sign -- The whole of movement -- Image and life -- Becoming-inhuman, becoming imperceptible -- The deduction of the movement-image -- Art and time -- Destruction of the sensory motor apparatus and the spiritual automaton -- Time (...) and money -- Art and history -- Monument -- Framing, territorialization, and the plane of composition -- Politics and the origin of meaning -- Transcending life and the genesis of sense -- Beyond symbolic and imaginary -- Shit and money -- Exchange, gift, and theft -- The fiction of mind -- Collective investment and group fantasy -- The time of man -- The intense germinal influx. (shrink)

We describe research carried out as part of a text summarisation project for the legal domain for which we use a new XML corpus of judgments of the UK House of Lords. These judgments represent a particularly important part of public discourse due to the role that precedents play in English law. We present experimental results using a range of features and machine learning techniques for the task of predicting the rhetorical status of sentences and for the task of selecting (...) the most summary-worthy sentences from a document. Results for these components are encouraging as they achieve state-of-the-art accuracy using robust, automatically generated cue phrase information. Sample output from the system illustrates the potential of summarisation technology for legal information management systems and highlights the utility of our rhetorical annotation scheme as a model of legal discourse, which provides a clear means for structuring summaries and tailoring them to different types of users. (shrink)

Social justice is put forth as a core professional nursing value, although conceptualizations within foundational documents and among nurse educators remain inconsistent and contradictory. The purpose of this study was to explore how faculty teach social justice in theory courses in Baccalaureate programs. This qualitative study utilized constructivist grounded theory methods to examine processes informing participants' teaching. Participants utilize four overarching approaches: fostering engaging classroom climates, utilizing various naming strategies, framing diversity and culture as social justice, and role modeling a (...) critical stance. They deploy specific strategies, varying largely by race, educational background, and nursing specialty. A background in social sciences supports pedagogy that interrogates health inequities rather than merely raising awareness about disparities. Findings also reveal that faculty of color navigate institutional structures predicated upon colorblind racism and problematic views of culture, which many white faculty teaching non‐Community Health Nursing courses described doing. To enact social justice and be answerable to our communities, concerted anti‐oppression efforts are needed across education, research, practice, and policy. This includes sustained commitment to address colonialism and whiteness in every institution that defines, promotes, and claims to advance nursing so that we can fulfill our responsibility to address unjust systems and structures to serve our communities. (shrink)

This article examines the artistic potential of forms of image-making that involve registering the features of real objects using mind-independent processes. According to skeptics, these processes limit an agent’s intentional control over the features of the resultant “automatic images,” which in turn limits the artistic potential of the work, and the form as a whole. I argue that this is true only if intentional control is understood to mean that an agent produces the features of the work by their own (...) bodily movements alone. Not only is this an unrealistic standard to uphold, but I show that a definition of intentional control based on the skeptic’s position does not prohibit an agent from realizing the features of an image by means beyond their own actions. An agent can exercise intentional control over the features of an image if they successfully anticipate the effect that the remote consequences of their actions will have on these. This, I argue, entails that to exert intentional control over the features of an image is to exercise “creative agency,” which is a species of executive agency. Consequently, I defend the idea that the origin of automatic images in creative agency grounds their artistic significance. (shrink)

The current research examines the emergent literature of Critical Data Studies, and particularly aligns with Michael and Lupton’s (2016) manifesto calling for researchers to study the Public Understanding of Big Data. The aim of this paper is to explore Irish stakeholders’ narratives on data sharing in agriculture, and the ways in which their attitudes towards different data sharing governance models reflect their understandings of data, the impact that data hold in their lives and in the farming sector, as well as (...) their preferences for how data should be governed within agriculture. Seven focus groups were held in 2019 with Irish stakeholders from a variety of backgrounds, including agri-researchers, those working in SMEs, and farmers of varying ages and sectors. The primary activities carried out during these focus groups centred upon asking participants to discuss four different data sharing governance models, and to work their way through a set of value cards relating to these models. Focus group results are studied using an inductive, data-driven form of thematic analysis (Braun and Clarke 2006). Five primary themes cross-cut these focus groups: 1) Desire for a data intermediary, 2) Reversing the value chain, 3) Categorisation of data, 4) The common good, and 5) Potential danger in data sharing. These themes are explored in the paper through a detailed discussion of the focus group results, in which the authors track the manifestation of these themes across focus groups, and the ways they sometimes morphed or changed depending upon the participating stakeholder group. (shrink)

Management theory is a diverse field where multiple theoretical perspectives coexist and coevolve, leading to conceptual pluralism. While conceptual pluralism is useful for grasping different aspects of the complex reality we live in, it may limit the further development of knowledge on elemental concepts. In this article, we focus on knowledge on the natural environment (NE) in management theory. We argue that management scholars and practitioners often rely on theoretical lenses that tend to reify the NE, thereby limiting the conceptualization (...) of some of the essential properties of the NE. Drawing on the example of the conceptual development of the ecosystem services (ES) at the intersection of economics and biology, we identify the advantages and the limits of interdisciplinary theory-building and testing. Finally, we discuss how tools from the philosophy of science can be useful for proposing a way forward for integrating reliable knowledge on the natural environment in management theory. (shrink)

Nietzsche’s interest in tragedy continues throughout his work. And yet scholarship on Nietzsche’s account of tragedy has focused almost exclusively on his first book, The Birth of Tragedy – a work which is in many ways discontinuous with his more mature philosophical views. In this paper, I aim to illuminate Nietzsche’s post-Birth of Tragedy views on tragedy by setting them in the context of a particular historical conversation. Ever since Plato banished the tragic poets from the kallipolis, various philosophers have (...) attempted to respond to his challenge to offer a ‘defense of poetry’. What Nietzsche offers, I argue, is a distinctive form of response to Plato’s challenge. I show how Nietzsche takes seriously Plato’s worries, and even ends up in partial agreement with him: tragedy is not (unqualifiedly) valuable; it can be spiritually dangerous. Key to Nietzsche’s account is a distinction he draws between two types of tragic audience. For the ‘lower types’, tragedy is – as Plato feared – dangerous. For the ‘higher types’, however, tragedy can act as a regenerative force. Finally, I discuss a distinctive form of value that tragedy makes available to a modern audience: tragedy can act as a stimulus towards the process of the revaluation of values. (shrink)

Using Deleuze and Guattari's concept of stratigraphy, it is possible to open the question of the limits and range of the Anthropocene. Geological stratification has enabled a view of time and the earth that has opened new horizons, but this mode of stratification is one among others. Other stratifications are possible, not only those that would be compossible with the story of the Anthropocene, but also incompossible stratifications, at odds with the history of man.

Following the book Algebraic Set Theory from André Joyal and leke Moerdijk [8], we give a characterization of the initial ZF-algebra, for Heyting pretoposes equipped with a class of small maps. Then, an application is considered (the effective topos) to show how to recover an already known model (McCarty [9]).

Have we reached what Alexander Galloway dismissively refers to as ‘peak Deleuze’? In this essay, I argue that the arrival at end times – with the sense of mass extinction and philosophy's exhaustion – is indeed a moment of ‘peak Deleuze’, but that this gesture of exhaustion is already implicit in A Thousand Plateaus. Recognising the limits and seduction of a text is never as easy as it seems; every attempt to break up with Deleuze and Guattari, though necessary, is (...) fraught with a whole series of difficulties that were already visible in A Thousand Plateaus's own relation to its outside. (shrink)

Materialism is at once the most general of concepts, capable of gesturing to anything that seems either foundational or physicalist, and yet is also one of the most rhetorical of gestures: operating as a way of reducing, criticising or ‘‘exorcising’’ forms of idealism and ideology. Derrida's early, supposedly ‘‘textualist’’ works appear to endorse a materiality of the letter (including syntax, grammar, trace and writing) while the later works focus on matter as split between that which is posited and that which (...) will always appear as a receding ground. It is more important than ever that materialism not be accepted too readily as a way of overcoming a supposedly linguistic or textualist Derrida in order that Derrida might be smuggled into the contemporary heaven of naturalism and physicalism. On the contrary, it is the dispersed, inhuman and inorganic materiality beyond bodies, physis and substance that offers itself for genuinely deconstructive thinking. (shrink)

This article discusses the conceptualisation, organisation and philosophical orientation of academic history culture in UK higher education. It problematises the extent to which a dominant history culture in UK universities implies and uncritically reproduces normative understandings about the subject; about its epistemological standing, sociopolitical functions, and the presumed cultural value of the discipline practices that students learn to perform. We suggest that current conceptions of history degree curricula are overly thin and organised around a dominant managerialist discourse of skills, personal (...) development and learning outcomes. In a historicised world, in which history-focused behaviour has a crucial, ideological, affirmatory role, and in which historical narratives have a privileged cognitive function, we argue that it is critical for university history students to be able to deconstruct the processes by which history legitimises itself, and reinforces matrices of power in our societies. The positioning of history in higher education as a form of technocratic managerialism closes down spaces in which students can explore the potential of historical practices as a means of engaging with issues of current sociopolitical and ethical concern. We ask in this article, is this what we want an academic history culture to do? (shrink)

For centuries, heirloom rice varieties have been grown on the terraces of the Cordillera Mountains of Luzon, Philippines, terroirs known for their significant historical, cultural, and aesthetic values. However, heritage heirloom rice farming is gradually being abandoned, mainly because of its lower productivity and the struggle of the sector to create a sustainable niche market for heirloom rice by branding its cultural, social, and nutritional values. We propose several demand-side intervention strategies for the valorization of heirloom rice. To support the (...) development of a segmented marketing strategy for heritage farming, we provide evidence on urban consumers’ willingness to purchase heirloom rice. We interviewed 500 urban consumers from Metro Manila in July–August 2015, who placed a purchasing bid on a kilogram of heirloom rice. Consumers’ bids averaged PHP 72.61 kg−1, which is less than half its current market price. This explains why heirloom rice struggles to gain market share in urban markets in the Philippines. Given this bid price, we estimate a potential market size of PHP 20.3 billion that could be created for heirloom rice and tapped into by heritage farmers. Findings further indicate that women, business owners, and consumers who buy packaged rice and eat pigmented rice are willing to pay more for heirloom rice. Finally, our evidence suggests that proper information framing will be necessary to create demand and support the valorization of heirloom rice to preserve cultural heritage and in situ biodiversity of rice landraces in the Philippines. (shrink)

Dans cette étude, qui procède d’une thèse de doctorat défendue à l’Université Lyon 3 en 2008, Flore Kimmel-Clauzet interroge la survie des grands poètes grecs dans l’imaginaire religieux, politique et culturel de l’Antiquité. C’est bel et bien de survie qu’il est question, puisque la présence des poètes dans la société grecque continue de se faire sentir longtemps après leur mort. En effet, les performances répétées de leur poésie les gardent au centre des préoccupations culturelles des cités...

The commentators provide a wealth of additional neurobiological data that ought to be integrated in a comprehensive model. This response article, however, focuses on clarification of conceptual queries, thereby outlining the proposed theory of hallucinations more sharply, discussing its relationship with schizophrenia, and explaining why underconstrained thalamocortical activation may well be a candidate mechanism responsible for acute schizophrenic symptoms other than hallucinations.

The use of charged-particle radiation therapy is an increasingly important development in the treatment of cancer. One of the most pressing controversies about the use of this technology is whether randomised controlled trials are required before this form of treatment can be considered to be the treatment of choice for a wide range of indications. Equipoise is the key ethical concept in determining which research studies are justified. However, there is a good deal of disagreement about how this concept is (...) best understood and applied in the specific case of CPRT. This report is a position statement on these controversies that arises out of a workshop held at Wolfson College, Oxford in August 2011. The workshop brought together international leaders in the relevant fields , including proponents on both sides of the debate, in order to make significant progress on the ethical issues associated with CPRT research. This position statement provides an ethical platform for future research and should enable further work to be done in developing international coordinated programmes of research. (shrink)

This essay explores three deconstructive concepts – archive, anthropocene, and auto-affection – across two registers. The first is the register of what counts as readability in general, beyond reading in its narrow and actualized sense.. The second register applies to Derrida today, and what it means to read the corpus of a philosopher and how that corpus is governed by proper names. I want to suggest that the way we approach proper names in philosophy and theory is part of a (...) broader problem of our relation to what it is to read, and how readability intertwines with the human. (shrink)

One of the ways in which one might chart the force of various forms of posthuman thought is to mark a reversal in the ways we think about relationality. Rather than distinct Cartesian subje...

Gender, Power and Sexuality is a collection of original and exciting articles by well-known feminists which makes a major contribution to our understanding of the ways in which men exercise control over girls and women in their daily lives, in the home, at school, at work and in the courts. Women are seen to resent and challenge male power, but, the institutionalisation of male power is shown to mitigate against women taking control over their own lives.

This paper explores an approach to the implementation and evaluation of integrated health service delivery. It identifies the key issues involved in integration evaluation, provides a framework for assessment and identifies areas for the development of new tools and measures. A proactive role for evaluators in responding to health service reform is advocated.

Si l’on s’accorde à voir dans l’ouvrage du clergyman mélancolique Robert Burton paru en 1621 une sorte d’aboutissement et de consécration de la mode mélancolique, l’on a toutefois tendance à négliger le fait que l’anatomiste utilise le discours médical et la tradition mélancolique pour attirer l’attention de ses contemporains sur l’existence d’un désordre qui se manifeste, au niveau de la collectivité, par une crise religieuse, politique, sociale et économique. C’est sous le patronage de l’un des premiers représentants du courant mercantiliste (...) que Burton se place pour justifier l’emploi de la notion de « mélancolie politique » : celui de Giovanni Botero. La lecture de la « Préface » de L’Anatomie de la Mélancolie permet de constater l’existence d’une forte convergence entre les méthodes et les analyses des premiers mercantilistes anglais et le diagnostic de Robert Burton sur la crise économique que traverse l’Angleterre de Jacques Ier. Comment expliquer alors la coexistence dans le même texte de ce discours économique qui propose des réformes concrètes pour remédier à une situation de crise et d’un discours utopique qui préconise une forme autoritaire et disciplinaire de pouvoir comme remède à la mélancolie politique tout en affirmant le caractère chimérique et irréalisable de tout changement radical? (shrink)

In this article, we question to what extent origin-food labels, namely Geographical Indications and Slow Food Presidia, may effectively account for cultural biodiversity. Building on Foucault’s discourse theory, we question how the Slow Food movement and GI promoters have developed their own discourse and practice on CB, how these discourses contrast, and how they inform projects. Focusing on the practices to cultivate the microbiological life of three origin labeled cheeses, we have revealed the gap between these institutional discourses and what (...) happens on the ground. We argue that how actors’ relationships in the marketplace unfold, from public authorities to the collectives of producers to consumers, may threaten the effects that these experiences of alternative food productions may have in the defense of biodiversity, causing, for instance, the loss of diversity of the invisible microbial ecosystems of artisan raw milk cheese. However, we conclude that, despite limitations, the mediatized institutional narrative on CB can amplify the political voice of local actors by fostering community and social relationships between the farmers. (shrink)

Respectfulness is demanded of doctors and predicts more positive patient health-related outcomes, but research is scarce on ways to promote it. This study explores two ways to conceptualize unconditional respect from medical students, defined as respect paid to people on the basis of their humanity, in order to inform strategies to increase it. Unconditional respect conceptualized as an attitude suggests that unconditional respect and conditional respect are additive, whereas unconditional respect conceptualized as a personality trait suggests that people who are (...) high on unconditional respect afford equal respect to all humans regardless of their merits. One hundred and eighty-one medical students completed an unconditional respect measure then read a description of a respect-worthy or a non-respect-worthy man and indicated their respect towards him. The study found a main effect for unconditional respect and a main effect for target respect-worthiness but no interaction between the two when respect paid to the target was assessed, supporting the attitude-based conceptualization. This suggests that unconditional respect can be increased through relevant interventions aimed at increasing the relative salience to doctors of the human worth of individuals. Interventions to increase unconditional respect are discussed. (shrink)

Academic freedom is seriously under threat. Here I will consider how the marketisation of Higher Education has exacerbated the decline of ‘academic freedom’. While the effects of a ‘cancel culture’ on university provision are difficult to ignore, threats to academic freedom raise a number of questions, such as: ‘who is allowed to speak on campus?’, ‘to whom?’, and ‘about what?’. These questions are fundamental to the academic profession, and therefore have clear implications for teaching and learning in Higher Education. Through (...) an analysis of Netflix’s The Chair (2021), and drawing on the works of Martin Buber, I argue that academics’ freedom to teach is implicitly constrained by student-consumer desires, and in turn this reduces the space for genuine dialogue on university campuses. Rather than closing down debate and the discussion of ‘controversial’ topics, universities instead need to cultivate a climate of trust, openness, and reciprocity on campuses, such that genuine staff-student dialogue can flourish. University campuses are precisely the places where academics should be able to engage in scholarly debate on matters of importance – where students may be exposed to radically different viewpoints and perspectives – and film and TV series can be used to initiate such conversations. (shrink)

De nombreux professionnels de divers champs, de nombreuses institutions sont interpellés par des individus ou des familles en détresses multiples. Ils offrent des espaces singuliers, compartimentés et étanches. Les membres des familles en détresses multiples distribuent leur demande auprès de différents guichets et tentent d’explorer les rapports entre les différents services. Y a-t-il un génie créateur dans ce mouvement? Faut-il accepter la convocation à l’élargissement et à l’ouverture réciproque des pratiques? Quels espaces nouveaux à construire pour créer des contextes de (...) travail basés sur la concertation? (shrink)