A growing body of research is exploring corporate communication in relation to corporate social responsibility (CSR) activities on social media (SM). Nonetheless, while these studies have shown that SM communication may be an effective tool for reaching and engaging various stakeholders, how the design of corporate CSR communication engenders trustworthiness has yet to be examined. To address this gap, we suggest that SM communication may include important signals related to trust; thus, we investigate whether companies use sources of trustworthiness (reputation, (...) performance, and appearance) while communicating with stakeholders and the response of the latter to such communication. Our empirical analysis is based on a database containing over 66,000 CSR-related messages from eight companies focusing on communication extracted from Twitter. These data are coded according to three sources of trustworthiness and two dimensions of CSR communication (social and environmental). Our findings indicate that all three attributes of trustworthiness are used by companies in their CSR social media communication. We also document how corporate efforts to use CSR communication that engenders trustworthiness influence stakeholder engagement. Our study therefore contributes to the literature on trust in relation to CSR by illustrating the importance of signaling that includes different sources of trustworthiness or their combination in corporate communication. By analyzing how the various trust attributes included in CSR communication affect SM reactions, we also identify which attributes lead to greater stakeholder engagement overall, particularly for the two analyzed dimensions of CSR communication. (shrink)

Background: The law and literature about children’s consent generally assume that patients aged under-18 cannot consent until around 12 years, and cannot refuse recommended surgery. Children deemed pre-competent do not have automatic rights to information or to protection from unwanted interventions. However, the observed practitioners tend to inform young children s, respect their consent or refusal, and help them to “want” to have the surgery. Refusal of heart transplantation by 6-year-olds is accepted. Research question: What are possible reasons to explain (...) the differences between theories and practices about the ages when children begin to be informed about elective heart surgery, and when their consent or refusal begins to be respected? Research design, participants and context: Research methods included reviews of related healthcare, law and ethics literature; observations and conversations with staff and families in two London hospitals; audio-recorded semi-structured interviews with a purposive sample of 45 healthcare professionals and related experts; interviews and a survey with parents and children aged 6- to 15-years having elective surgery (not reported in this paper); meetings with an interdisciplinary advisory group; thematic analysis of qualitative data and co-authorship of papers with participants. Ethical considerations: Approval was granted by four research ethics committees/authorities. All interviewees gave their informed written consent. Findings: Interviewees explained their views and experiences about children’s ages of competence to understand and consent or refuse, analysed by their differing emphases on informed, signified or voluntary consent. Discussion: Differing views about children’s competence to understand and consent are associated with emphases on consent as an intellectual, practical and/or emotional process. Conclusion: Greater respect for children’s practical signified, emotional voluntary and intellectual informed consent can increase respectful understanding of children’s consent. Nurses play a vital part in children's practitioner-patient relationships and physical care and therefore in all three elements of consent. (shrink)

Globally, there are calls to increase physical activity levels in relatively sedentary populations, including via physical activity programmes, often targeted at those body-selves deemed at risk of ‘sedentariness’. Despite the salience of sensory pleasures and displeasures in engagement with (and abandonment of) these programmes, the sensory, embodied experiences of participation remain under-researched. Here, we draw on findings from a two-year ethnographic study of a national programme in Wales, which used the aesthetic attractions of ‘natural’ outdoor environments to encourage and sustain (...) physical activity. Employing insights from phenomenological sociology, we explore the programme participants’ (n=146) lived experiences, analysed via a phenomenological lens, cohering around a panoply of sensory pleasures and displeasures, and somatic learning that is shaped and reshaped by weather encounters. (shrink)

This article concerns the implementation of new EU Directives coordinating the procedures for awarding public contracts in European Union Member States. In a number of countries, including Poland, the process of their implementation (Directive 2014/24/eu of the European Parliament and of the Council of 26 February 2014 on public procurement; Directive 2014/25/eu of the European Parliament and of the Council of 26 February 2014 on procurement by entities operating in the water, energy, transport, and postal services sectors; Directive 2014/23/eu of (...) the European Parliament and of the Council of 26 February 2014 on the award of concession contracts) was delayed. In most cases, the modernization of EU regulations on public procurement required a thorough modification of national regulations in this respect. As a result of the introduction of the package of new Directives, the European Union public procurement market has undergone substantial changes. The need to adjust legal regulations to the changing political, social, and economic situations in a better way has resulted in the transposition of the modernized EU Directives concerning public procurement to the Polish legal system, affecting the final shape of the new Polish Public Procurement Law. The implementation of the package of new Directives has significantly affected the functioning of the Polish public procurement market. For the entities operating in this market, this means the necessity to expand their knowledge, so as to become familiar with the new legal solutions in this respect. (shrink)

One of the popular missional consensuses in the context of migration is seeing migrants as “moving targets” for evangelism. There is an urge to respond differently realising that migrants are not merely workers for economic welfare but persons created in the image of God. To reconstruct a model of mission that is embedded in the complex reality of migration, this paper will look into the details of three narratives of Indonesian and Filipino migrants who live and attend a Charismatic church (...) in Sabah, Malaysia. It will give insights into the process of othering and discover the quality of compassion in their lives. Based on their experiences, I argue mission as a compassionate presence provides a sound theological basis for churches to respond to the continuous othering of migrants. It invites us to rethink evangelism, not solely as winning souls for Christ, but to embody Christ by being present. (shrink)

It is recalled that serious doubts can be raised concerning the status of theories such as those pertaining to the rights of future generations, or the constraints imposed on us by theories of intergenerational justice. At the same time, we do have moral obligations to future generations. But these must be based on an appraisal of what are likely to be the main interests that future generations will have and which of these are most likely to be under permanent threat. (...) These, it is argued, will be in the field of human relations rather than in the field of the environment. It is concluded, therefore, that the most important bequest we can make to future generations is to leave them a society in which there is a greater respect for basic human rights than is the case today throughout most of the world. And since the best way of bequeathing a more decent society to future generations is, of course, to improve the respect for human rights today, there is no conflict of interest between the present generation and future generations. Hence, theories of intergenerational distributive justice are not only untenable but are also unnecessary. (shrink)

Recent behavioral studies revealed an interesting phenomenon concerning the influence of affect on the interpretation of ambiguous stimuli. In a paradigm, where the participants’ task was to read a word, remember its meaning for a while, and then choose one of two pictorial-alphabet-like graphical signs best representing the word sense, we observed that the decisions involving trials with reflective-originated verbal stimuli were performed significantly longer than decisions concerning other stimuli (i.e., automatic-originated). The origin of an affective reaction is a dimension (...) which allows speaking of an affect as automatic (you feel it in your guts) or reflective (you feel it comes from your mind). The automatic affective reaction represents the immediate and inescapable as opposed to the reflective, i.e., the delayed and controllable affective responses to stimuli. In the current experiment, we investigated the neural correlates of performance in an QR-signs-selection ambiguous task. We found the effects of valence and origin in the N400/FN400 potential by means of a stimuli-locked analysis of the initial part of the task, that is, the remembering of a certain word stimulus in a working memory. The N400/FN400 effects were separated in space on scalp distribution. Reflective originated stimuli elicited more negative FN400 than other conditions, which means that such stimuli indeed are associated with conceptual incongruence or higher affective complexity of meaning, but distinct from purely cognitive concreteness. Moreover, the amplitude of the potential preceding the decision, analyzed in the response-locked way, was shaped by the origin of an affective state but not valence. Trials involving decisions concerning reflective-originated words were characterized by a more negative amplitude than trials involving automatic-originated and control word stimuli. This corresponds to the observed pattern of response latencies, where we found that latencies for reflective stimuli were longer than for automatic originated or control ones. Additionally, this study demonstrates that the proposed new ambiguous paradigm is useful in studies concerning the influence of affect on decisions. (shrink)

Antimicrobial resistance is a major and increasing problem globally. Economics has engaged with this issue increasingly over the last 20 years. Much of this concerns assessments of the cost of various forms of resistance, but it also includes economic analyses of interventions and policies designed to contain resistance. Analysis has, however, thus far largely neglected possible distributional issues associated with such interventions and analysis. The article explores three normative bases for the conduct of economic analysis: welfarism; extra-welfarism focused on health (...) gain; and extra-welfarism focused on capability assessment. It then considers issues intrinsic to antimicrobial resistance in terms of the distributional implications and how these might be handled within economic analyses from each of the normative perspectives, before considering the actual focus of empirical studies on these distributional issues. The article concludes that the different normative starting points for economic analysis will affect how distributional issues are incorporated into analysis, but suggests that all analyses could benefit from greater discussion of these issues. (shrink)

Paying research subjects for their participation in biomedical studies is an increasingly common and acceptable practice. Nevertheless, it continues to raise numerous conceptual, ethical, and pract...

Each year thousands of individuals enrol in clinical trials as healthy volunteers to earn money. Some of them pursue research participation as a full-time or at least a part-time job. They call themselves professional or semiprofessional guinea pigs. The practice of paying healthy volunteers raises numerous ethical concerns. Different payment models have been discussed in literature. Dickert and Grady argue for a wage-payment model. This model gives research subjects a standardised hourly wage, and it is based on an assumption that (...) research participation is morally indistinguishable from other forms of unskilled labour. In this paper, I will challenge this assumption. I will argue that human guinea pigging has particular characteristics which taken together make it significantly different from other forms of labour. Participation in research is skill-independent. Healthy volunteers are valuable not because they are skilful persons, but because they are human bodies. The role of research volunteers is mainly passive. They are not asked to produce goods or deliver services. They are paid for enduring unpleasant, painful and risky interventions performed by investigators. Research volunteering involves inherent risks and uncertainties, and subjects have little or no control over their minimisation and materialisation. I conclude that participation in clinical research is a specific kind of activity. It is more like renting out one’s body to strangers, than working. Thus, research participation should not be treated on par with other forms of employment. (shrink)

In this paper non-Hausdorff manifolds as potential basic objects of General Relativity are investigated. One can distinguish four stages of identifying an appropriate mathematical structure to describe physical systems: kinematic, dynamical, physical reasonability, and empirical. The thesis of this paper is that in the context of General Relativity, non-Hausdorff manifolds pass the first two stages, as they enable one to define the basic notions of differential geometry needed to pose the problem of the evolution-distribution of matter and are not in (...) conflict with the Einstein equations. With regard to the third stage, various potential conflicts with physical reasonability conditions are considered with a tentative conclusion that non-Hausdorff manifolds are more likely to pass this stage than is typically assumed. When dealing with some of these problems, the modal interpretation of non-Hausdorff manifolds is invoked, according to which they represent bundles of alternative possible spacetimes rather than single spacetimes. (shrink)

In contrast to most publications on the ethics of paying research subjects, which start by identifying and analyzing major ethical concerns raised by the practice (in particular, risks of undue inducement and exploitation) and end with a set of—more or less well-justified—ethical recommendations for using payment schemes immune to these problems, this paper offers a systematic, principle-based ethical analysis of the practice. It argues that researchers have aprima faciemoral obligation to offer payment to research subjects, which stems from the principle (...) of social beneficence. This principle constitutes an ethical “spine” of the practice. Other ethical principles of research ethics (respect for autonomy, individual beneficence, and justice/fairness) make up an ethical “skeleton” of morally sound payment schemes by providing additional moral reasons for offering participants (1) recompense for reasonable expenses; and (2a) remuneration conceptualized as a reward for their valuable contribution, provided (i) it meets standards of equality, adequacy and non-exploitation, and (ii) it is not overly attractive (i.e., it does not constitute undue inducement for participation or retention, and does not encourage deceptive behaviors); or (2b) remuneration conceptualized as a market-driven price, provided (i) it is necessary and designed to help the study achieve its social and scientific goals, (ii) it does not reinforce wider social injustices and inequalities; (iii) it meets the requirement of non-exploitation; and (iv) it is not overly attractive. The principle of justice provides a strong ethical reason for not offering recompenses for lost wages (or loss of other reasonably expected profits). (shrink)

Conferring legal personhood on purely synthetic entities is a very real legal possibility, one under consideration presently by the European Union. We show here that such legislative action would be morally unnecessary and legally troublesome. While AI legal personhood may have some emotional or economic appeal, so do many superficially desirable hazards against which the law protects us. We review the utility and history of legal fictions of personhood, discussing salient precedents where such fictions resulted in abuse or incoherence. We (...) conclude that difficulties in holding “electronic persons” accountable when they violate the rights of others outweigh the highly precarious moral interests that AI legal personhood might protect. (shrink)

The significance of political-economic context for scientific citizenship is argued through an analysis of New Zealand’s Royal Commission on Genetic Modification. My intention is not to provide an account of why the commission came to the decisions it did but to illustrate how the political-economic context and the culture of regulatory science both exacerbate public concerns about unacknowledged uncertainty and commercial influence and make it difficult for those concerns to influence the outcomes of public dialogues. The discursive flexibility of science (...) as alternately predictive and provisional silences concerns about uncertainty, while a further interpretive choice of science as the autonomous activities of individuals unconstrained by political-economic context occludes the nature of concerns about commercial influence. Rather than the increasingly prevalent focus on processes of engagement, I argue that it is essential that researchers in this area attend to how public dialogue is placed in relation to the cultures and structures of regulatory science and neoliberalism. (shrink)

Who was truly capable of experiencing pain? In this article, I explore ideas about the distribution of bodily sensitivity in patients from the early nineteenth century to 1965 in Anglo-American societies. While certain patients were regarded as “truly hurting,” other patients’ distress could be disparaged or not even registered as being “real pain.” Such judgments had major effects on regimes of pain-alleviation. Indeed, it took until the late twentieth century for the routine underestimation of the sufferings of certain groups of (...) people to be deemed scandalous. Often the categorizations were contradictory. For instance, the humble status of workers and immigrants meant that they were said to be insensitive to noxious stimuli; the profound inferiority of these same patients meant that they were especially likely to respond with “exaggerated” sensitivity. How did physicians hold such positions simultaneously? Pain-assignation claimed to be based on natural hierarchical schemas, but the great Chain of Feeling was more fluid than it seemed. (shrink)

Volume 19, Issue 9, September 2019, Page 46-48.

Unprecedented advances in medicine, genetic engineering, and demographic forecasting raise new questions that strain the categories and assumptions of traditional ethical theories. Heyd's approach resolves many paradoxes in intergenerational justice, while offering a major test case for the profound problems of the limits of ethics and the nature of value.

In the decades since the Science Wars of the 1990s, climate science has become a crucible for the negotiation of claims about reality and expertise. This negotiation, which has drawn explicitly on the ideas and techniques of science and technology studies, has taken place in genres of fiction as well as non-fiction, which intersect in surprising ways. In this case study, I focus on two interwoven strands of this history. One follows Michael Crichton’s best-selling 2004 novel, State of Fear and (...) its reception by neo-conservatives as a commentary on the mis-uses of facts to stoke fear about anthropogenic climate change. The other considers Naomi Oreskes and Erik M. Conway’s 2010 publishing success Merchants of Doubt as the inverse, a demonstration of the forms of disinformation that have been used to undermine scientific consensus around climate change. I show that both Crichton’s as well as Oreskes and Conway’s approaches were critiqued by academic STS even as their accounts constituted the most high-profile performances of its stakes and the politics of knowledge since the Science Wars. In highlighting the STS practices deployed by each, as well as how those practices were differently linked to accusations of fear-mongering and a perversion of the purity of STS, I demonstrate the need for a reflexive history of STS. Such an approach, I argue, can better consider the social life of STS ideas and practices amidst calls for more politically-engaged approaches to knowledge production. (shrink)

W artykule pragnę zwrócić uwagę na oddziaływanie twórczości T. Kotarbińskiego na dorobek naukowy M. Ossowskiej, w perspektywie polemiki, którą prowadzili między sobą uczeni, a także wskazać na znaczące podo bieństwa między ich stanowiskami, zwłaszcza w sferze wartości. Wskazuję również na dzielące ich różnice m.in. w podejściu do przedmiotu etyki, ujmowaniu charakteru oceny i normy moralnej oraz w wymogach metodologicznych. Zwracam uwagę na wspólną obu filozofom postawę wyrażającą konieczność kształtowania „kręgosłupa moralnego”, niezależnie od okoliczności, polegającą na wierności wyznawanym wartościom. Prezentuję podobieństwa (...) w poglądach etycznych T. Kotarbińskiego i M. Ossowskiej dotyczących etyki walki, w pojmowaniu idei godności i jej wtórności względem innych wartości, w rozumieniu sumienia jako rodzaju wstydu przed pogardą, wreszcie wspólny pogląd na rolę i naturę cnót. Staram się pokazać, że w przypadku obojga myślicieli kompetencje naukowe szły w parze z kompetencjami moralnymi — jasność myślenia z jasnością działania. (shrink)

Dans la presse des trois pays analysés, une approche commune de l'événement émerge, reposant sur des valeurs, des croyances et des symboles communs qui ont certes existé auparavant, mais qui ont émergé sur la place publique à l'occasion de cet événement. Il s'agit principalement de la solidarité humaine, de ce qu'on peut qualifier « d'esprit humanitaire», porté avant tout par les jeunes regroupés au sein de ce qu'on appelle de plus en plus souvent la « génération JP2 ». En revanche, (...) les différences sautent aux yeux quand on analyse la réappropriation culturelle de l'événement dans les trois pays analysés. Chaque peuple fait appel à son histoire ancienne ou récente et à la sensibilité politique qui lui est propre. La mobilisation d'archétypes, de symboles nationaux ou religieux qui en résulte est particulière à chacune des cultures. Mais ce qui semble commun dans le traitement médiatique de la mort de Jean-Paul II c'est l'émergence d'une certaine sensibilité cosmopolite parmi la jeune « génération JP2 ». C'est sans doute le phénomène le plus frappant de cet événement international qu'est la mort du pape.In the press three countries analyzed, a common event emerges, based on values, beliefs and common symbols which certainly existed before, but which have emerged on the public during this event. It is mainly human solidarity, of what may be termed "humanitarian spirit", carried primarily by young grouped in what is called more often "JP2 generation". However, the differences are obvious when analyzing the cultural reappropriation of the event in the three countries analyzed. Every nation uses its ancient history and recent political sensitivity of its own. Mobilization of archetypes, national or religious symbols that results is unique to each culture. But what seems to be common in the media treatment of the death of John Paul II is the emergence of a certain cosmopolitan sensibility among the young "JP2 generation". This is probably the most striking phenomenon of this international event the death of the pope. (shrink)

In the recent philosophical literature, several counterexamples to the interpretative principle that symmetry-related models are physically equivalent have been suggested The Oxford handbook of philosophy of physics, Oxford University Press, Oxford, 2013, Noûs 52:946–981, 2018; Fletcher in Found Phys 50:228–249, 2020). Arguments based on these counterexamples can be understood as arguments from scientific practice of roughly the following form: because in scientific practice such-and-such symmetry-related models are treated as representing distinct physical situations, these models indeed represent distinct physical situations. In (...) this paper, a strategy for analysing arguments of this type is presented and applied to the examples that can be found in the literature. I argue that if we are exclusively interested in models understood as representing entire possible worlds, arguments from scientific practice should involve some additional assumptions to guarantee they are relevant for models understood in this way. However, none of the examples presented in the literature satisfy all these additional assumptions, which leads to the conclusion that arguments from scientific practice based on these examples do not undermine the interpretative principle that different symmetry-related models represent the same possible world. (shrink)

A blueprint for social change showing how we can reverse the destructive attitudes that threaten our world.

Reigning regulatory frameworks for biomedical research impose on researchers and research ethics committees an obligation to protect research participants from risks that are unnecessary, disproportionate to potential research benefits, and non-minimized. Where the research has no potential to produce results of direct benefit to the subjects and the subjects are unable to give consent, these requirements are strengthened by an additional condition, that risks should not exceed a certain minimal threshold. In this article, I address the question of whether there (...) should be limits of permissible risks in non-therapeutic research involving competent and healthy subjects. Some commentators argue that competent and informed individuals should have a right to participate even in extremely risky research and that research ethics committees should never reject studies because they are too dangerous. To use David Shaw's expression, competent volunteers should have ‘a right to participate in high-risk research’. I argue that this idea is ill-founded, as it does not take into account the social mission and complex collaborative nature of research practice as well as the inequity of power between researchers and subjects. Imposition of limits on permissible risks for healthy volunteers is justified by the need to protect research enterprise and the need to protect the weaker party, namely the subjects. Also, I suggest that the best way to set boundaries on research risks is to leave the judgment of risk acceptability to research ethics committees. (shrink)

Haneke’s film Funny Games is a reflection on the nature of pain and representation. I argue that the film closely follows Elaine Scarry’s arguments about the structure of torture. Further, by refusing to appeal to categories of generalization such as ‘sadism’ and ‘psychopathy’, Haneke undermines the process of finding meaning in violence. Haneke positions his audiences as more than just witnesses to torture, but active participants in cruelty.

The question of whether AI systems such as robots can or should be afforded moral agency or patiency is not one amenable either to discovery or simple reasoning, because we as societies constantly reconstruct our artefacts, including our ethical systems. Consequently, the place of AI systems in society is a matter of normative, not descriptive ethics. Here I start from a functionalist assumption, that ethics is the set of behaviour that maintains a society. This assumption allows me to exploit the (...) theoretical biology of sociality and autonomy to explain our moral intuitions. From this grounding I extend to consider possible ethics for maintaining either human- or of artefact-centred societies. I conclude that while constructing AI systems as either moral agents or patients is possible, neither is desirable. In particular, I argue that we are unlikely to construct a coherent ethics in which it it is ethical to afford AI moral subjectivity. We are therefore obliged not to build AI we are obliged to. (shrink)

Background:Data representing people’s behaviour, attitudes, feelings and relationships are increasingly being harvested from social media platforms and re-used for research purposes. This can be ethically problematic, even where such data exist in the public domain. We set out to explore how the academic community is addressing these challenges by analysing a national corpus of research ethics guidelines and published studies in one interdisciplinary research area.Methods:Ethics guidelines published by Research Councils UK, its seven-member councils and guidelines cited within these were reviewed. (...) Guidelines referring to social media were classified according to published typologies of social media research uses and ethical considerations for social media mining. Using health research as an exemplar, PubMed was searched to identify studies using social media data, which were assessed according to their coverage of ethical considerations and guidelines.Results:Of the 13 guidelines published or recom... (shrink)

FADYL JK and NICHOLLS DA. Nursing Inquiry 2013; 20: 23–29 Foucault, the subject and the research interview: a critique of methodsResearch interviews are a widely used method in qualitative health research and have been adapted to suit a range of methodologies. Just as it is valuable that new approaches are explored, it is also important to continue to examine their appropriate use. In this article, we question the suitability of research interviews for ‘history of the present’ studies informed by the (...) work of Michel Foucault – a form of qualitative research that is being increasingly employed in the analysis of healthcare systems and processes. We argue that several aspects of research interviewing produce philosophical and methodological complications that can interfere with achieving the aims of the analysis in this type of study. The article comprises an introduction to these tensions and examination of them in relation to key aspects of a Foucauldian philosophical position, and discussion of where this might position researchers when it comes to designing a study. (shrink)

Abstract:Antarctica has long been associated with the sublime and it has also been imagined as the site of catastrophe—of both the deaths of early explorers and as a current indicator of global warming. This essay examines how trauma is a structural element of the sublime in accounts and images of Antarctica. It focuses on the literary and artistic works of two periods when representation of the experience of the continent has been articulated with discourses of trauma: the ‘Heroic Age’ of (...) Antarctic exploration and from the 1990s to the present day. In this latter period writers, photographers and artists have returned to the matrix of the traumatic sublime that the work of explorers such as R. F. Scott, Apsley Cherry-Garrard, and Herbert Ponting created to explore the relationship between humans and the non-human environment and of Antarctica to modernity. (shrink)

The paper reports results of the very first survey-based study on the prevalence, frequency and nature of ethical or other non-medical difficulties faced by Polish physicians in their everyday clinical practice. The study involved 521 physicians of various medical specialties, practicing mainly in inpatient healthcare. The study showed that the majority of Polish physicians encounter ethical and other non-medical difficulties in making clinical decisions. However, they confront such difficulties less frequently than their foreign peers. Moreover, Polish doctors indicate different circumstances (...) as a source of the experienced problems. The difficulties most often reported relate to (i) patients (or their proxies) requests for medically non-indicated interventions; (ii) problems with communication with patients (or their proxies) due to the patients’ negative attitude, unwillingness to cooperate, or aggression; and (iii) various difficulties with obtaining informed consent. Polish physicians report difficulties associated with disagreements among care givers or scarcity of resources less frequently than doctors from other countries. The study’s findings provide support for the thesis that a significant portion of Polish physicians still follow a traditional, paternalistic, and hierarchical model of healthcare practice. Instead of promoting patient’s empowerment, engagement, and rights, they often consider these ideas as a threat to physicians’ professional authority and autonomy. The study leads to the conclusion that due to insufficient training in medical ethics, communication skills, and medical law, many Polish physicians lack the knowledge and competence necessary to adequately respond to challenges posed by modern healthcare practice. (shrink)