Background Ethical challenges constitute an inseparable part of daily decision-making processes in all areas of healthcare. Ethical challenges are associated with moral distress that can lead to burnout. Clinical ethics support has proven useful to address and manage such challenges. This paper explores how prehospital emergency personnel manage ethical challenges. The study is part of a larger action research project to develop and test an approach to clinical ethics support that is sensitive to the context of emergency medicine. Methods We (...) explored ethical challenges and management strategies in three focus groups, with 15 participants in total, each attended by emergency medical technicians, paramedics, and prehospital anaesthesiologists. Focus groups were audio-recorded and transcribed verbatim. The approach to data analysis was systematic text condensation approach. Results We stratified the management of ethical challenges into actions before, during, and after incidents. Before incidents, participants stressed the importance of mutual understandings, shared worldviews, and a supportive approach to managing emotions. During an incident, the participants employed moral perception, moral judgments, and moral actions. After an incident, the participants described sharing ethical challenges only to a limited extent as sharing was emotionally challenging, and not actively supported by workplace culture, or organisational procedures. The participants primarily managed ethical challenges informally, often using humour to cope. Conclusion Our analysis supports and clarifies that confidence, trust, and safety in relation to colleagues, management, and the wider organisation are essential for prehospital emergency personnel to share ethical challenges and preventing moral distress turning into burnout. (shrink)

An ethics reflection group is one of a range of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the implementation process of interdisciplinary ERGs in psychiatric and general hospital departments in Denmark. To our knowledge, this is the first study of ERG implementation to include both psychiatric and general hospital departments. The implementation and evaluation strategies are inspired by action research, using a qualitative approach and systematic text condensation of (...) 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. The implementation process was influenced by both structural factors and factors related to clinicians having different values, interests and experiences. Structural barriers and promotors in the process to implement ERG included the following sub-categories: Organizational factors, recruitment and training of ethics facilitators, the deliberation model, planning and recruitment of participants to the ERGs, the support of the ward managers and the project group. Barriers and promotors found among clinicians included the following sub-categories: Expectations and pre-understandings of ERGs, understandings of a physician’s job, challenges experienced by ethics facilitators. At the end of the study, when it was decided that the ERGs should be continued, the implementation strategies were remodeled by the participants to meet new challenges. The study of ERG implementation identified important structural and professional barriers and promotors that are likely to be relevant to anyone wanting to implement ethics support services across various types of healthcare services. (shrink)

To reduce global greenhouse gas emissions in order to limit global warming to 1.5°C, individuals and households play a key role. Behavior change interventions to promote pro-environmental behavior in individuals are needed to reduce emissions globally. This systematic literature review aims to assess the a) evidence-based effectiveness of such interventions and b) the content of very successful interventions without limiting the results to specific emitting sectors or countries. Based on the “PICOS” mnemonic and PRISMA statement, a search strategy was developed, (...) and eligibility criteria were defined. Three databases were searched to retrieve and review potential literature. As a result, 54 publications from 2010 to 2021 were included in the analysis. The results show that most interventions only have small positive effects or none at all. A total of 15 very successful interventions focused on the sectors of mobility, energy, and waste and incorporated improved structures, education, feedback, enablement or made the sustainable option the default. Six evidence-based recommendations for content, timing, and setting are deducted and given for interventions on enhancing pro-environmental behavior. In summary, although the various interventions and intervention types to promote PEB differ in their effectiveness, very successful interventions have common elements. Future research should focus on high-/low-impact and high-/low-cost behavior to develop interventions that aim at high-impact but low-cost behavior changes, or avoid low-impact but high-cost behavior. (shrink)

Nous avons cherché à identifier un aspect du refoulement du cosmopolitismel'des Lumières, complémentaire de la fabrique des identités nationales enl'Europe au XIXe siècle et dans l'entre-deux-guerres. L'idée de civilisation communel'serait maintenue par la capacité réciproque de traduction des langues nationales, dul'fait de leurs origines communes indo-européennes. L'utopie de la langue remplaceraitl'le parcours matériel des Lumières. C'est l'échec de la construction du mythe indianistel'européen et non pas son succès qui explique le dévoiement idéologique des relationsl'entre langue et nation. La promotion manquée (...) de la langue tsigane dans le mondel'académique illustre bien cet échec. Après la Première Guerre mondiale, la transformationl'du principe des nationalités en ethnopolitique fit disparaître jusqu'au souvenirl'de cette ambition commune. (shrink)

The author traces the ways in which various patients and collective associations of patients come to regard themselves as the users of future stem cell technologies. The author uses Althusser’s notion of interpellation, whereby an identity is the result of the situated encounter of a subject and an authority, to analyze the ways in which patient associations’ current involvement with basic research is related to the enactment of science as a series of technology development projects. The author argues that this (...) ‘‘project-ness’’ forms a certain privileged logic that interpellates patients and their associations in specific ways. Through the listings of illnesses circulated in the mass media, which are hoped to be treatable or curable with stem cell therapies, patients come to recognize themselves as the projected users of stem cell technologies. The author fleshes out the process of this userfication and the various responses made by patients and their associations when hailed by the entrepreneurial projects of stem cell research. (shrink)

Fred. L. Polak explored the mechanisms of social change in terms of “future—visions” held by a community. The future, says Polak, participates actively in the present, providing part of the context within which today's decisions are made. Barbara McClintock acquired her insights in maize genetics by developing “a feeling for the organism.” New insights, she maintains, emerge through a mutual relationship between researcher and subject. Though scholars in different fields, both acknowledge the power of images in the creative process. There (...) is a difference in the extent to which each scientist perceives this power to be available to create new ideas. (shrink)

During the last two years several committees discussed the question of enlarging patients' autonomy in living wills. The problern is to tind a way to grant patients' wishes without violating the state's duty to preserve human life. One basic question in the debate is the meaning of human dignity. Deducing from the Christian image of man the author describes chances and Iimits of living wills and presents a way of handling them. In her opinion living wills represent a chance for (...) a succeeding, trusting physician-patient- relationship in the age of high-tech medicine. (shrink)

ZusammenfassungIn der Erfahrung, Kommunikation und Bewältigung von Krankheit spielen Metaphern eine wichtige Rolle: Als Denkkonzepte spiegeln sie zugrundeliegende Haltungen gegenüber den durch sie beschriebenen Vorgängen wider. Susan Sontag hat mit ihrem Essay „Illness as Metaphor“ nachhaltig die moralisch kritischen Implikationen einer unreflektierten Metaphernverwendung im Umgang mit Erkrankung aufgezeigt, indem sie deren stigmatisierende und hierin zusätzlich belastende Wirkung für Erkrankte reflektiert.In der gegenwärtigen Situation der Covid-19-Pandemie trifft ein bisher unbekanntes Virus mit der Macht und Dynamik der Globalisierung auf die hierauf nicht (...) vorbereiteten spätmodernen Gegenwartsgesellschaften, die nun nach Erklärung und Sinnzuschreibung suchen. Auch hier fungieren Metaphern als Denkkonzepte und Vehikel von Interpretation. Im Rückgriff auf die Perspektive Susan Sontags und ihren Appell für einen entmystifizierten Umgang mit Krankheit geht dieser Beitrag folgenden Fragen nach: Welche Bilder werden in der Berichterstattung über CoV‑2 vermittelt? Welche Einstellung gegenüber Gesundheit und Krankheit wird mit den Metaphern transportiert, und welche Lebenshaltung liegt dieser zugrunde? Welche Einsichten für einen gesunden Umgang mit Covid-19 und Krankheit generell ergeben sich, wenn man die Pandemie aus ihren Metaphern und zugrundliegenden Denkkonzepten herausschält? (shrink)

This exciting collection offers a range of perspectives from some of the most prominent feminist voices of our time, including Rosi Braidotti, Judith Butler, Claire Colebrook, Elizabeth Grosz, and Jack Halberstam. Employing experimental modes of thinking and writing, the contributors remain faithful to the feminist tradition of subversion and resistance, while refusing to submit to its political tradition of a loving sisterhood or dutiful daughterhood. Through productive disagreement and cognitive dissonance, the essays presented here reflect the specific circumstances of our (...) present, and attempt to dream and envision possible alternatives for the future. The volume thus invites us to think of the becoming of feminism itself, and the possibilities of future feminisms-to-come. (shrink)

"One might say that 'chance' is anything but blind in forking-path narratives."Fictional worlds attract the attention of debaters in particular when they are supposed to activate the viewers' reflections in a special way. Thus, movies that are most likely to irritate the audience and seem to animate people to reflect on their own personality and life are of major interest. In the following, I want to discuss a certain type of movie that meets these criteria: forking-path or multiple-draft narratives. On (...) the one hand they rely on well-known narrative schemata, and on the other hand they comprise something that is actually impossible: alternative futures. One central thesis raised by spokespersons of the .. (shrink)

ZusammenfassungBedingt durch den demographischen Wandel wird der Anteil an alten Patienten in Kliniken und Arztpraxen zunehmen. Damit müssen sich Ärzte verstärkt auf die spezifischen Anforderungen der Behandlung von alten Patienten einstellen. Diese sind wesentlich durch die Faktoren Alter, Multimorbidität und Demenz geprägt. Die Abhandlung analysiert die hiermit gegebenen sozial- und personalethischen Implikationen für Ausbildung und Arbeitsalltag der Ärzte sowie für das Gesundheitssystem.

Abordagem do protagonismo social, analisando sua relação com a informação, concluindo pela compreensão deste como objetivo do trabalho informacional, situando a mediação da informação como sua ação central. Parte da apresentação das origens conceituais em torno do protagonismo, buscando, à medida que debate as referências acerca do tema, demonstrar a relação do desenvolvimento do protagonismo social com o trabalho informacional, assim como sua posição de meta da atividade da mediação da informação, executada nas suas cinco dimensões e na condição de (...) elemento central desse trabalho. As assertivas apresentadas são resultado do estudo crítico da bibliografia da área da Ciência da Informação que aborda o protagonismo e a mediação da informação, assim como de estudos de filósofos e pensadores que abordam os aspectos sociais e políticos da comunicação e da formação de sujeitos socialmente ativos, permitindo a identificação das relações entre protagonismo e mediação da informação, como também que a mediação consciente favorece o primeiro, concluindo que o apoio ao seu desenvolvimento representa a principal responsabilidade social do trabalho com a informação. (shrink)

In the summer of 2017, wildflower seeds were spread on a large, empty open space close to a motorway flyover just outside Copenhagen, Denmark. This was an effort to use non-mechanical methods to prepare the soil for an ‘urban forest’ to be established on the site, since the flowers’ roots would penetrate the ground and enable the planned new trees to settle. As a result, the site was transformed into a gorgeous meadow, and all summer long Copenhageners were invited to (...) come and pick the flowers. In this article, I critically examine different aspects of this project – including the role of design, the perception of nature–culture relationships, climate change, and flower-picking as an event – in relation to my personal experience of visiting this meadow both on-site and on social media. The different temporalities that clash at the site give rise to conflicting interpretations, and I suggest that the meadow can be seen as a living plant archive of the Anthropocene, both physically and digitally. In doing so, I introduce and critique key conceptual pairs, including archive/death and bloom/decay, suggested by Lee Edelman’s queer cross-reading of Jacques Derrida’s ‘Archive Fever’ and Shakespeare’s Hamlet. I thereby contrast flower motifs pertaining to the cycles of blooming, decay, and nature’s (failed) eternal return in the meadow with the expansive futurity of the digitally mediated archive. (shrink)

Natural languages make prolific use of conventional constituent‐ordering patterns to indicate “who did what to whom,” yet the mechanisms through which these regularities arise are not well understood. A series of recent experiments demonstrates that, when prompted to express meanings through silent gesture, people bypass native language conventions, revealing apparent biases underpinning word order usage, based on the semantic properties of the information to be conveyed. We extend the scope of these studies by focusing, experimentally and computationally, on the interpretation (...) of silent gesture. We show cross‐linguistic experimental evidence that people use variability in constituent order as a cue to obtain different interpretations. To illuminate the computational principles that govern interpretation of non‐conventional communication, we derive a Bayesian model of interpretation via biased inductive inference and estimate these biases from the experimental data. Our analyses suggest people's interpretations balance the ambiguity that is characteristic of emerging language systems, with ordering preferences that are skewed and asymmetric, but defeasible. (shrink)

Personal health technologies such as apps and wearables that generate health and behavior data close to the individual patient are envisioned to enable personalized healthcare - and self-care. And yet, they are consumer devices. Proponents of these devices presuppose that measuring will be helpful, and that data will be meaningful. However, a growing body of research suggests that self-tracking data does not necessarily make sense to users. Drawing together data studies and digital health research, we aim to further research on (...) data ambivalence, a term we use to refer to the ambiguities and uncertainties people experience when interpreting their own data, as well as the critical obligation towards cultivating ethically sound uses and responses to such data in context. We develop the relationship between data, interpretation, and context as a central theoretical and practical problem in the datafication of healthcare. We then show how interpretation and context matter for data ambivalence through an empirical study of heart patients with an implanted advanced pacemaker who were offered a Fitbit wristband for self-tracking as part of a research project. We argue that the hope, anxiety, and doubt connected to the promise and accuracy of data are tempered by the context and purpose of self-tracking, and by individual circumstances. Finally, we link the findings on context-sensitivity in data interpretation to questions about response-ability in cloud-based care infrastructures. We discuss the ethical dilemmas associated with the use of commercial wellness-technologies in healthcare, and with researching such emerging practices. (shrink)

A study of the rhetorical and political strategy adopted by the Roman orator and statesman Cicero as a newcomer in Roman republican politics. Henriette van der Blom argues that Cicero advertised himself as a follower of chosen models of behaviour from the past - his role models - and in turn presented himself as a role model to others.

Clinical fields of the “sciences of the mind” (psychotherapy, psychiatry, etc.) lack integrative conceptual frameworks that have explanatory power. Mainly descriptive-classificatory taxonomies like DSM dominate the field. New taxonomies such as Research Domain Criteria (RDoC) aim to collect scientific knowledge regarding “systems” for “processes” of the brain. These terms have a supradisciplinary” meaning if they are considered in context of Systems Science. This field emerges as a platform of theories like general systems theory, catastrophe theory, synergetics, chaos theory, etc. It (...) provides a lot of abstract concepts, constructs, methods and models. We assume that these tools also enable theoretical integration in the diversified field of clinical practice in the sciences of the mind. Additionally, systems thinking in clinical psychology improves conceptual links to currently network-oriented neurobiology. However, clear definitions of systemic terms are necessary to emerge from their mainly metaphorical use. Here we revise mainly terms like “structure”, “process” and “dynamics” as they are used already in psychology, psychoanalysis, psychopathology and psychiatry in an ill-defined way. For instance, affective-cognitive structures like “life space” or “object representations” can be seen as products of mental processing. These structures, in turn, modulate dynamics of mental processes. Additionally, we suggest a coupled network concept of emotions and motivations as the main subsystem that modulates mental dynamics that results in a qualitative systemic model of the mind. Finally, we assume that a revisited systemic approach could improve interdisciplinary understanding of the mental. ystem for mental dynamics. In this context, we assume that a revisited systemic approach could improve interdisciplinary understanding of the mental. (shrink)

The term "Philosophic lyric".--Introductory chapter.--The "return to nature"; Wordsworth's "philosophy of nature".--The period between Wordsworth and Meredith.--Wordsworth and Meredith as poets of nature.--Browning and Meredith as poets of man.--Conclusion.

Natural languages make prolific use of conventional constituent‐ordering patterns to indicate “who did what to whom,” yet the mechanisms through which these regularities arise are not well understood. A series of recent experiments demonstrates that, when prompted to express meanings through silent gesture, people bypass native language conventions, revealing apparent biases underpinning word order usage, based on the semantic properties of the information to be conveyed. We extend the scope of these studies by focusing, experimentally and computationally, on the interpretation (...) of silent gesture. We show cross‐linguistic experimental evidence that people use variability in constituent order as a cue to obtain different interpretations. To illuminate the computational principles that govern interpretation of non‐conventional communication, we derive a Bayesian model of interpretation via biased inductive inference and estimate these biases from the experimental data. Our analyses suggest people's interpretations balance the ambiguity that is characteristic of emerging language systems, with ordering preferences that are skewed and asymmetric, but defeasible. (shrink)

Automated decision-making (ADM) systems can be worn in and on the body for various purposes, such as for tracking and managing chronic conditions. One case in point is do-it-yourself open-source artificial pancreas systems, through which users engage in what is referred to as “looping”; combining continuous glucose monitors and insulin pumps placed on the body with digital communication technologies to develop an ADM system for personal diabetes management. The idea behind these personalized systems is to delegate decision-making regarding insulin to (...) an algorithm that can make autonomous decisions. Based on interviews and photo diaries with Danish “loopers”, this paper highlights two interrelated narratives of how users have to care for the loop by _maintaining_ a stable communication circuit between body and ADM system, and by _modifying_ the loop through analysis and reflection. It shows how the human takes turns with the ADM system through practical doings and anticipation to safeguard continuous management of chronic disease. (shrink)

Current debate and policy surrounding the use of genetic editing in humans often relies on a binary distinction between therapy and human enhancement. In this paper, we argue that this dichotomy fails to take into account perhaps the most significant potential uses of CRISPR-Cas9 gene editing in humans. We argue that genetic treatment of sporadic Alzheimer’s disease, breast- and ovarian-cancer causing BRCA1/2 mutations and the introduction of HIV resistance in humans should be considered within a new category of genetic protection (...) treatments. We find that if this category is not introduced, life-altering research might be unnecessarily limited by current or future policy. Otherwise ad hoc decisions might be made, which introduce a risk of unforeseen moral costs, and might overlook or fail to address some important opportunities. (shrink)

(1996). Stereotype discourse in Israel. The European Legacy: Vol. 1, Fourth International Conference of the International Society for the study of European Ideas, pp. 680-688.

Reflete sobre o potencial da mediação da informação como via de fortalecimento para o mundo social da vida ante ao processo colonizador do mundo dos sistemas, considerando as atuais demandas sociais em âmbito informacional. A Ciência da Informação é cada vez mais convidada a encontrar caminhos para refletir sobre seu objeto como motor do desenvolvimento cultural e fortalecimento do mundo social da vida, de maneira a reafirmar seu lugar enquanto ciência social. Desse modo, a mediação da informação, estando presente em (...) todas as ações do ciclo informacional, constitui-se base sustentadora de ações que contribuem para que a Ciência da Informação cumpra com sua missão e responsabilidade sociais ante as ambivalências da sociedade. Assim, a teoria da ação comunicativa de Jürgen Habermas pode nos proporcionar um diálogo possível com as abordagens teóricas da mediação da informação, no sentido de encontrar pontos que convergem para eixos integradores do mundo social da vida. Nesse sentido, entende-se que o trabalho com a informação demanda pesquisadores e mediadores conscientes que, no âmbito da Ciência da Informação, desenvolvam e tomem como referência estudos da mediação da informação que envolvam esferas apontadas por Habermas como espaços em estado de vulnerabilidade. (shrink)