Quality improvement (QI) is fundamental to maintaining high standards of health care. Significant debate exists concerning the necessity for an ethical approval system for those QI projects that push the boundaries, appearing more similar to research than QI. The authors discuss this issue identifying the core ethical issues in family medicine (FM), drawing upon the fundamental principles of medical ethics, including principles of autonomy, utility, justice and non-maleficence. Recent debate concerning the application of QI ethics boards is discussed with relevance (...) to primary care and issues such as general practitioner (GP) intentions, the impact of QI on patients and the use of confidential patient data and the impact of dissemination. The authors conclude that a system of QI ethical approval leaves many issues unresolved and potentially creates several barriers to implementing QI. To ensure ethical QI work is generated within FM it is essential for GPs to learn about and engage in more ethical reflection so that they can better judge and resolve these issues. (shrink)

In their analysis of how much fetal genetic information prospective parents should be able to access, Bayefsky and Berkman determine that parents should only be able to access information th...

Based on our respective research programs (psychiatry, forensic psychiatry, public health, HIV/AIDS, harm reduction) this article aims to use purposely non‐conventional means to present the substantial contribution of poststructuralist perspectives to knowledge development in nursing science in general and in our current research in particular. More specifically, we call on the work of Michel Foucault and Deleuze & Guattari to politicize nursing science using examples from our empirical research programs with marginal and often highly marginalized populations. We discuss the concepts (...) of power, discourse, and resistance to illustrate the essential contribution of poststructuralism to marginal, even “nomadic”, nursing research. (shrink)

The aim of this article is to bring to the attention of the international nursing community the discrepancy between a pervasive ‘caring’ nursing discourse and a most unethical nursing practice in the United States. In this article, we present a duality: the conflict in American prisons between nursing ethics and the killing machinery. The US penal system is a setting in which trained healthcare personnel practice the extermination of life. We look upon the sanitization ofdeathworkas an application of healthcare professionals’ (...) skills and knowledge and their appropriation by the state to serve its ends. A review of the states’ death penalty statutes shows that healthcare workers are involved in the capital punishment process and shielded by American laws (and to a certain extent by professional boards through their inaction). We also argue that the law's language often masks that involvement; and explain how states further that duplicity behind legal formalisms. In considering the important role healthcare providers, namely nurses and physicians, play in administering death to the condemned, we assert that nurses and physicians are part of the states’ penal machinery in America. Nurses and physicians (as carriers of scientific knowledge, and also as agents of care) are intrinsic to the American killing enterprise. Healthcare professionals who take part in execution protocols are state functionaries who approach the condemned body as angels of death: they constitute an extension of the state which exercises its sovereign power over captive prisoners. (shrink)

Many metaphor theorists argue that our mental experience of time is grounded in our understanding of space, including motion through space. Results from recent experiments – in which people think about motion, which in turn influences their thinking about time – support this position. Still, many questions remain about the nature of the metaphorical connection between time and space. Can the mere suggestion of motion influence how people reason about time, and if so, when and how? Three experiments investigated how (...) thinking about “abstract” motion through sequences of numbers or letters would influence reasoning about time. Our results extend earlier psychological work on the link between time and space by showing that even motion in non-physical domains can influence temporal reasoning. The results provide further evidence that metaphorical understanding is grounded in our everyday physical and conceptual experience. (shrink)

Genomic screening at population scale generates many ethical considerations. One is the normative role that people’s preferences should play in determining access to genomic information in screening contexts, particularly information that falls beyond the scope of screening. We expect both that people will express a preference to receive such results and that there will be interest from the professional community in providing them. In this paper, we consider this issue in relation to the just and equitable design of population screening (...) programs like reproductive genetic carrier screening (RGCS). Drawing on a pluralistic public health ethics perspective, we claim that generating and reporting information about genetic variants beyond the scope of the screening program usually lacks clinical, and perhaps personal, utility. There are both pragmatic and ethical reasons to restrict information provision to that which fits the stated purpose of the program. (shrink)

Systems TRC and TRCU of illative combinatory logic are introduced and shown to be equivalent in consistency strength and expressive power to Quine's set theory ‘New Foundations’ and the fragment NFU + Infinity of NF described by Jensen, respectively. Jensen demonstrated the consistency of NFU + Infinity relative to ZFC; the question of the consistency of NF remains open. TRC and TRCU are presented here as classical first-order theories, although they can be presented as equational theories; they are not constructive.

An eloquent introduction to the ethical and philosophical values at stake in biological conservation, this book familiarizes readers with the general issues and possible solutions to the problems societies face in simultaneously conserving nature and promoting culture.

This article develops a model of relational happiness that challenges popular individualized definitions and emphasizes how it can enhance the sociological analysis of inequality. Many studies of happiness suggest that social inequalities are closely associated with distributions of happiness at the national level, but happiness research continues to favour individual-level analyses. Limited attention has been given to the intersubjective aspects of happiness and the correlations between it and higher social equality. Conversely, key theoretical debates about inequalities, such as Axel Honneth (...) and Nancy Fraser’s exchanges, have only indirectly touched on happiness. A relational approach to happiness is not new, but what this article offers is a new combination of a relational understanding of happiness as an intersubjectively, culturally experienced complex of emotions with discussions about recognition of marginalized groups and redistribution of material resources. This combined approach can further debates about understanding and remedying social inequalities. It argues that theories and measurements of happiness must consider how it can be achieved collectively through working at mutual respect as well as greater material equality. (shrink)

This paper opens with first‐hand accounts of critical care medical interventions in which detainees, in the custody of U.S. Immigration and Customs Enforcement (ICE), are brought to the emergency department for treatment. This case dramatizes the extent to which the provision of ethical and acceptable nursing care is jeopardized by federal law enforcement paradigms. Drawing on the scholarship of Michel Foucault and Giorgio Agamben, this paper offers a theoretical account of the power dynamics that inform the health care of patients (...) who find themselves caught in the custodial scaffolding of a vast immigration and detention apparatus. It offers an analysis of the display of sovereign and biopolitical power over the lives (and deaths) of detainees (Foucault), as well as the ways these individuals are reduced to “bare life” under the political pretext of an emergency or “state of exception” (Agamben). Our purpose here is both theoretical and practical: to better understand the often hidden agency or impersonal “will” exercised by the immigrant detention system, but also to equip clinicians in these and cognate facilities (e.g., prisons) with the critical tools by which they might better navigate incommensurable paradigms (i.e., care vs. custody) in order to deliver the best care while upholding their ethical duties as a care provider. This is all the more pressing because hospitals are not sanctuaries and given the incursion of federal law enforcement agents, nurses may find themselves conscripted as de facto agents of the state. (shrink)

BackgroundHealth research funding agencies are placing a growing focus on knowledge translation (KT) plans, also known as dissemination and implementation (D&I) plans, in grant applications to decrease the gap between what we know from research and what we do in practice, policy, and further research. Historically, review panels have focused on the scientific excellence of applications to determine which should be funded; however, relevance to societal health priorities, the facilitation of evidence-informed practice and policy, or realizing commercialization opportunities all require (...) a different lens.DiscussionWhile experts in their respective fields, grant reviewers may lack the competencies to rigorously assess the KT components of applications. Funders of health research—including health charities, non-profit agencies, governments, and foundations—have an obligation to ensure that these components of funding applications are as rigorously evaluated as the scientific components. In this paper, we discuss the need for a more rigorous evaluation of knowledge translation potential by review panels and propose how this may be addressed.ConclusionWe propose that reviewer training supported in various ways including guidelines and KT expertise on review panels and modalities such as online and face-to-face training will result in the rigorous assessment of all components of funding applications, thus increasing the relevance and use of funded research evidence. An unintended but highly welcome consequence of such training could be higher quality D&I or KT plans in subsequent funding applications from trained reviewers. (shrink)

Examines the work of Kierkegaard as an ironist, reevaluating the works he penned under pseudonyms to show both their ironic character and the serious purpose that informed the deception Kierkegaard carried out.

There are several ways one can make an appraisal of Husserl’s turn to transcendental phenomenology. One way would be to look at some of the implications of this turn, such as, whether Husserl is thereby prevented from answering certain philosophical questions. Taking this course here, I treat one of the implications that appears when one critically examines the transcendental turn, namely that Husserl’s philosophy is idealistic. This is an implication that many critics of transcendental phenomenology have alleged is philosophically intolerable (...) and requires modification or abandonment of Husserl’s transcendental turn. Important to this task is the distinction between what I shall call “epistemological idealism” and “metaphysical idealism”. As I detail later, epistemological idealism can be characterized as the thesis that consciousness is the sole medium of access to whatever is seen as actually or possibly existing and “metaphysical idealism” can be characterized as including the additional thesis that consciousness creates whatever actually or possibly exists and what exists is dependent on it. It is my contention that Husserl’s transcendental phenomenology, which he labels transcendental idealism, is epistemologically idealistic but metaphysically neutral. Also I contend that metaphysical neutrality is not a deficiency of his philosophy but that such is the necessary conclusion of any philosophy that successfully adheres to the policy of describing, explicating and accepting all objectivities only as they present themselves to the consciousness of them, and in terms of the consciousness of them. (shrink)

Working within the tradition of continental philosophy, this article argues in favour of a phenomenological understanding of language as a crucial component of bioethical inquiry. The authors challenge the ‘commonsense’ view of language, in which thinking appears as prior to speaking, and speech the straightforward vehicle of pre-existing thoughts. Drawing on Maurice Merleau-Ponty's (1908–1961) phenomenology of language, the authors claim that thinking takes place in and through the spoken word, in and through embodied language. This view resituates bioethics as a (...) matter of bodies that speak. It also refigures the meaning of ethical self-reflexion, and in so doing offers an alternative view on reflexivity and critique. Referring to the Kantian critical tradition and its reception by Hannah Arendt and Michel Foucault, we advance a position we call ‘critical ethical reflexivity’. We contend that Merleau-Ponty's phenomenology of language offers valuable insight into ethical reflexivity and subject formation. Moreover, his understanding of language may foster new qualitative empirical research in bioethics, lead to more nuanced methods for interpreting personal narratives, and promote critical self-reflexion as necessary for bioethical inquiry. (shrink)

This paper extends the results of an earlier paper by the author . New subsystems of the combinatory logic TRC shown in that paper to be equivalent to NF are introduced; these systems are analogous to subsystems of NF with predicativity restrictions on set comprehension introduced and shown to be consistent by Crabbé. For one of these systems, an exact equivalence in consistency strength and expressive power with the analogous subsystem of NF is established.

A problem of paramount importance to understanding John Dewey’s ethics is to clarify his conception of judgment and his distinction between judgments and propositions. Depending upon how one interprets him on this matter, different answers suggest themselves to some of the most basic questions underlying his ethical theory, particularly those dealing with the relationship between science and ethics, the relationship between practical judgments and descriptive statements, and the differentiae of moral and scientific judgments within the genus practical judgment. Oversimplified answers (...) are usually given to these, the stock interpretation being that he believes that ethics is reducible to science, that practical judgments are descriptive and hence that moral judgments are essentially scientific in nature. Although he undeniably says much to invite such an interpretation, it nonetheless fails to do justice to his considered view, and a probe of his account of the nature of judgments and propositions reveals that he views the whole relationship of moral to scientific judgments, hence of ethics to science, in a different light than is generally supposed. In consequence, much of his ethics needs reappraisal, particularly as having relevance to topics in the forefront of contemporary British and American ethical thought. (shrink)

Philosophical ethics comprises metaethics, normative ethics and applied ethics. These have characteristically received analytic treatment by twentieth-century Anglo-American philosophy. But there has been disagreement over their interrelationship to one another and the relationship of analytical ethics to substantive morality – the making of moral judgments. I contend that the expertise philosophers have in either theoretical or applied ethics does not equip them to make sounder moral judgments on the problems of bioethics than nonphilosophers. One cannot "apply" theories like Kantianism or (...) consequentialism to get solutions to practical moral problems unless one knows which theory is correct, and that is a metaethical question over which there is no consensus. On the other hand, to presume to be able to reach solutions through neutral analysis of problems is unavoidably to beg controversial theoretical issues in the process. Thus, while analytical ethics can play an important clarificatory role in bioethics, it can neither provide, nor substitute for, moral wisdom. Keywords: abortion, applied ethics, bioethics, metaethics, normative ethics CiteULike Connotea Del.icio.us What's this? (shrink)

Nurses working in forensic psychiatric settings face unique challenges in practice, where they take on a dual role of custody and caring. Patient resistance is widespread within these restrictive settings and can take many forms. Perhaps the most disturbing form of resistance entails a patient's weaponization of their bodily fluids, with nurses as their target. The tendency in assigning motive for this act is to relegate to the psychopathology of the patient. This paper will adopt a poststructuralist perspective to reexamine (...) this phenomenon as an act of resistance through the lens of Kristeva's concept of abjection. Patients confined in these settings have little sense of control, and in resistance may resort to the only thing available: their bodily fluids. By weaponizing the abject, patients actively violate and permeate the physical and psychological boundaries of nurses—the very boundaries considered crucial to safe and professional forensic psychiatric nursing practice. By recognizing this phenomenon as an act of resistance to confinement and loss of control, nurses may reorient their approach to care in forensic psychiatric settings. (shrink)

This paper discusses a sequence of extensions ofNFU, Jensen's improvement of Quine's set theory “New Foundations” (NF) of [16].The original theoryNFof Quine continues to present difficulties. After 60 years of intermittent investigation, it is still not known to be consistent relative to any set theory in which we have confidence. Specker showed in [20] thatNFdisproves Choice (and so proves Infinity). Even if one assumes the consistency ofNF, one is hampered by the lack of powerful methods for proofs of consistency and (...) independence such as are available for use withZFC; very clever work has been done with permutation methods, starting with [18] and [5], and exemplified more recently by [14], but permutation methods can only be applied to show the consistency or independence of unstratified sentences (see the definition ofNFUbelow for a definition of stratification). For example, there is no method available to determine whether the assertion “the continuum can be well-ordered” is consistent with or independent ofNF. There is one substantial independence result for an assertion with nontrivial stratified consequences, using metamathematical methods: this is Orey's proof of the independence of the Axiom of Counting fromNF(see below for a statement of this axiom).We mention these difficulties only to reassure the reader of their irrelevance to the present work. Jensen's modification of “New Foundations” (in [13]), which was to restrict extensionality to sets, allowing many non-sets (urelements) with no elements, has almost magical effects. (shrink)

Nurses working in correctional and forensic mental health settings face unique challenges in the provision of care to patients within custodial settings. The subjectivities of both patients and nurses are subject to the power relations, discourses and abjection encountered within these practice milieus. Using a poststructuralist approach using the work of Foucault, Kristeva, and Deleuze and Guattari, this paper explores how both patient and nurse subjectivities are produced within the carceral logic of this apparatus of capture. Recognizing that subjectivities are (...) fluid and dynamic, and capable of change, Deleuze and Guattari's concept of deterritorialization will illustrate opportunities for resistance, where nurses can begin to practice outside the dominant carceral logic (and restrictions) of the system. (shrink)

The increasing popularity of local food consumption can be attributed to the heightened awareness of food safety concerns, carbon emissions produced from food transportation, and an understanding of how large corporations’ obtain their food supplies. Although there is increasing discussion on both the local and organic food movement independently, there is not a wide availability of literature examining the motivations and perceptions of consumers with regard to farmers’ markets. Issues such as perceptions about what type of food consumers are purchasing (...) at markets, nor the main motivations for frequenting such establishments are discussed. Therefore the purpose of this study was to determine consumer motivations, benefits, and perceptions of farmers’ markets. Using the case study location of Toronto, Canada, this study surveyed 300 participants during the fall of 2011. Findings indicated that the main purpose for visiting famers’ markets is not solely to fulfill grocery needs. Quality of products offered and the ability to support the local community were the primary motivators to visit the markets. (shrink)

PREFACE. THE Author of this very practical treatise on Scotch Loch - Fishing desires clearly that it may be of use to all who had it. He does not pretend to have written anything new, but to have attempted to put what he has to say in as readable a form as possible. Everything in the way of the history and habits of fish has been studiously avoided, and technicalities have been used as sparingly as possible. The writing of this (...) book has afforded him pleasure in his leisure moments, and that pleasure would be much increased if he knew that the perusal of it would create any bond of sympathy between himself and the angling community in general. This section is interleaved with blank shects for the readers notes. The Author need hardly say that any suggestions addressed to the case of the publishers, will meet with consideration in a future edition. We do not pretend to write or enlarge upon a new subject. Much has been said and written-and well said and written too on the art of fishing but loch-fishing has been rather looked upon as a second-rate performance, and to dispel this idea is one of the objects for which this present treatise has been written. Far be it from us to say anything against fishing, lawfully practised in any form but many pent up in our large towns will bear us out when me say that, on the whole, a days loch-fishing is the most convenient. One great matter is, that the loch-fisher is depend- ent on nothing but enough wind to curl the water, -and on a large loch it is very seldom that a dead calm prevails all day, -and can make his arrangements for a day, weeks beforehand whereas the stream- fisher is dependent for a good take on the state of the water and however pleasant and easy it may be for one living near the banks of a good trout stream or river, it is quite another matter to arrange for a days river-fishing, if one is looking forward to a holiday at a date some weeks ahead. Providence may favour the expectant angler with a good day, and the water in order but experience has taught most of us that the good days are in the minority, and that, as is the case with our rapid running streams, -such as many of our northern streams are, -the water is either too large or too small, unless, as previously remarked, you live near at hand, and can catch it at its best. A common belief in regard to loch-fishing is, that the tyro and the experienced angler have nearly the same chance in fishing, -the one from the stern and the other from the bow of the same boat. Of all the absurd beliefs as to loch-fishing, this is one of the most absurd. Try it. Give the tyro either end of the boat he likes give him a cast of ally flies he may fancy, or even a cast similar to those which a crack may be using and if he catches one for every three the other has, he may consider himself very lucky. Of course there are lochs where the fish are not abundant, and a beginner may come across as many as an older fisher but we speak of lochs where there are fish to be caught, and where each has a fair chance. Again, it is said that the boatman has as much to do with catching trout in a loch as the angler. Well, we dont deny that. In an untried loch it is necessary to have the guidance of a good boatman but the same argument holds good as to stream-fishing... (shrink)

Recovery is a model of care in (forensic) mental health settings across Western nations that aims to move past the paternalistic and punitive models of institutional care of the 20th century and toward more patient‐centered approaches. But as we argue in this paper, the recovery‐oriented services that evolved out of the early stages of this liberating movement signaled a shift in nursing practices that cannot be viewed only as improvements. In effect, as “recovery” nursing practices became more established, more codified, (...) and more institutional(ized), a stasis developed. Recovery had been reterritorialized. The purpose of this paper is to examine some of the threads of recovery, from its early days of antipsychiatry activism to its codification into mental health—including forensic mental health—institutions through the lens of poststructuralist philosophers Gilles Deleuze and Felix Guattari. We believe that Deleuze and Guattari's scholarship provides the necessary, albeit uncomfortable, framework for this critical examination. From a conceptualization of recovery as an assemblage, we critically examine how we can go about creating something new, caught in a tension between stasis and change. (shrink)

How does talk work, and can we engage the public in a dialogue about the scientific study of talk? This article presents a history, critical evaluation and empirical illustration of the public science of talk. We chart the public ethos of conversation analysis that treats talk as an inherently public phenomenon and its transcribed recordings as public data. We examine the inherent contradictions that conversation analysis is simultaneously obscure yet highly cited; it studies an object that people understand intuitively, yet (...) routinely produces counter-intuitive findings about talk. We describe a novel methodology for engaging the public in a science exhibition event and show how our ‘conversational rollercoaster’ used live recording, transcription and public-led analysis to address the challenge of demonstrating how talk can become an informative object of scientific research. We conclude by encouraging researchers not only to engage in a public dialogue but also to find ways to actively engage people in taking a scientific approach to talk as a pervasive, structural feature of their everyday lives. (shrink)

What constitutes a scientific discovery? What role do discoveries play in science, its dynamics and social practices? Must every discovery be attributed to an individual discoverer (or a small number of discoverers)? The paper explores these questions by first critically examining extant philosophical explications of scientific discovery—the models of scientific discovery, propounded by Kuhn, McArthur, Hudson, and Schindler. As a simple, natural and powerful alternative, we proffer the “change-driver model”: in a nutshell, it takes discoveries to be cognitive scientific results (...) that have epistemically advanced science. The model overcomes the shortcomings of its precursors, whilst preserving their insights. We demonstrate its intensional and extensional superiority, especially with respect to the link between scientific discoveries and the dynamics of science, as well as the award system of science. Both as an illustration, and as an application to a recent scientific and political controversy, we apply the considered models of discovery to one of the most momentous discoveries of science: the expansion of the universe. We oppose the 2018 proposal of the International Astronomers’ Union as too simplistic vis-`a-vis the historical complexity of the episode. The change- driver model yields a more nuanced and circumspect verdict: (i) The redshift-distance relation shouldn’t be named the “Hubble-Lemaître Law”, but “Slipher-Lundmark-Hubble-Humason Law”; (ii) Its interpretation in terms of an expanding universe, however, Lemaître ought to be given credit for; but (iii) The establishment of the expansion of the universe, as an evidentially sufficiently warranted result, is a communal achievement, emerging in the 1950s or 1960s. (shrink)