Objective Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment that they consider to be futile is sometimes provided at the end of a patient9s life. Design Semistructured in-depth interviews. Setting Three large tertiary public hospitals in Brisbane, Australia. Participants 96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration departments. Participants were recruited using purposive maximum variation sampling. (...) Results Doctors attributed the provision of futile treatment to a wide range of inter-related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk and poor communication skills. Second, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty and lack of information about patient wishes. Third, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the _main_ reasons for futile care. Conclusions Doctors believe that a range of factors contribute to the provision of futile treatment. A combination of strategies is necessary to reduce futile treatment, including better training for doctors who treat patients at the end of life, educating the community about the limits of medicine and the need to plan for death and dying, and structural reform at the hospital level. (shrink)

Christian development agencies have been the primary vehicle of choice for holistic involvement and witness. This has played straight into an Enlightenment manner of thinking that compartmentalizes values, limiting the opportunities for explaining the theological and conceptual foundations for development practice and for public witness concerning religious faith. New institutional models appropriate to witness and holistic Christian service need to be considered. An `S4' type organization, explored in practice in Indonesia in an interfaith setting, allows for a more effective sharing (...) of the gospel and robust development work. (shrink)

Robert Putnam's work was a double-edged sword for social capital scholars. It brought unprecedented attention to the research agenda but also created conceptual confusion. Many scholars have tried to disentangle Coleman's concept of social capital from what some described as Putnam's “fuzzy psychological notion” of civic culture values. Despite the rigour of these efforts, Putnam's influence remains, because scholars and policy makers are drawn to the benefits his work promised. This article takes a different tack, and seeks to extricate Putnam's (...) early ideas from the social capital debates by offering an alternate theorization of his original findings. It returns to Making Democracy Work and argues that Putnam mis-stepped when he took the rational choice route and invoked Coleman's concept of social capital. It takes an ideational approach to explaining civic culture. The resulting “ideational social capital” suggests a different research agenda, which just might deliver on Putnam's early promise. (shrink)

Since the mid-twentieth century, the ‘Scientific Revolution’ has arguably occupied centre stage in most Westerners’, and many non-Westerners’, conceptions of science history. Yet among history of science specialists that position has been profoundly contested. Most radically, historians Andrew Cunningham and Perry Williams in 1993 proposed to demolish the prevailing ‘big picture’ which posited that the Scientific Revolution marked the origin of modern science. They proposed a new big picture in which science is seen as a distinctly modern, western phenomenon rather (...) than a human universal, that it was invented in the Age of Revolutions 1760–1848, and that science be de-centred within the new big picture: treated as just one of many forms of human knowledge-seeking activity. Their paper is one of the most highly cited in the history of science field, and has the potential to transform the way that science educators, science communicators, science policy-makers and scientists view science. Yet the paper and historians’ scholarly response to it are not well-known outside the history discipline. Here I attempt to bridge that disciplinary gap with a review of scholarly papers published 1994–2014 that cited Cunningham and Williams or otherwise discussed the Scientific Revolution, to gauge the extent of support for the old and new big pictures. I find that the old big picture is disintegrating and lacks active defenders, while many scholars support aspects of the new big picture. I discuss the significance of this for scholars in ‘applied’ fields of science studies such as education, communication and policy. (shrink)

The aim of this thematic literature review is to explore nurses' perceptions of ethical issues in the care of older people. Electronic databases were searched from September 1997 to September 2007 using specific key words with tight inclusion criteria, which revealed 17 primary research reports. The data analysis involved repeated reading of the findings and sorting of those findings into four themes. These themes are: sources of ethical issues for nurses; differences in perceptions between nurses and patients/relatives; nurses' personal responses (...) to ethical issues; and the patient—nurse relationship. The findings reveal that ageism is one of the major sources of the ethical issues that arise for nurses caring for older people. Education and organizational change can combat ageist attitudes. Wider training is required in the care of older people, workplace skills, palliative care and pain management for older people. The demands of a changing global demography will necessitate further research in this field. (shrink)

Background Victoria was the first Australian state to legalize voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). Some institutions indicated they would not participate in voluntary assisted dying. The Victorian government issued policy approaches for institutions to consider Objective To describe and analyse publicly available policy documents articulating an institutional objection to voluntary assisted dying in Victoria. Methods Policies were identified using a range of strategies, and those disclosing and discussing the nature of an institutional objection were thematically (...) analysed using the framework method. Results The study identified fifteen policies from nine policymakers and developed four themes: (1) extent of refusal to participate in VAD, (2) justification for refusal to provide VAD, (3) responding to requests for VAD, and (4) appeals to state-sanctioned regulatory mechanisms. While institutional objections were stated clearly, there was very little practical detail in most documents to enable patients to effectively navigate objections in practice. Conclusion This study demonstrates that despite having clear governance pathways developed by centralized bodies (namely, the Victorian government and Catholic Health Australia), many institutions’ public-facing policies do not reflect this guidance. Since VAD is contentious, laws governing institutional objection could provide greater clarity and regulatory force than policies alone to better balance the interests of patients and non-participating institutions. (shrink)

Existing regulation of end-of-life care is flawed. Problems include poorly-designed laws, policies, ethical codes, training, and funding programs, which often are neither effective nor helpful in guiding decision-making. This leads to adverse outcomes for patients, families, health professionals, and the health system as a whole. A key factor contributing to the harms of current regulation is a siloed approach to regulating end-of-life care. Existing approaches to regulation, and research into how that regulation could be improved, have tended to focus on (...) a single regulatory instrument (e.g., just law or just ethical codes). As a result, there has been a failure to capture holistically the various forces that guide end-of-life care. This article proposes a response to address this, identifying “regulatory space” theory as a candidate to provide the much-needed holistic insight into improving regulation of end-of-life care. The article concludes with practical implications of this approach for regulators and researchers. (shrink)

This article reviews the outstanding and thought-provoking work by Roberta De Monticelli (2021), _Towards a Phenomenological Axiology. Discovering What Matters_. The article addresses the reasons why it should be read by everyone but especially by help professions practitioners. Although we all deal with morality and value judgments on on mundane, everyday bases, the professional life of education and care practitioners is namely a series of morally-loaded practices and decision-making informed by morally oriented (expert) knowledge. Beyond the thesis advanced in the (...) book, its major contribution consists in making the reader think the inescapability of morality in everyday thinking and acting and the need for a reflective positioning towards this issue. By aligning with “the hedgehog vs. the fox” struggle proposed by the author as the framework of her theoretical proposal, the article advances what would be the doubts and counterarguments of a fox-like scholar in education. It illustrates why her “professional vision” cannot but notice what appears to be under-thematized by the hedgehog, i.e., the unavoidable mediation of language and social interaction that _precedes_ and therefore impacts the constitution of what the hedgehog convincingly notices: the entanglement of fact and value. The conclusion is dedicated to the (underestimated?) place of social sciences in such a debate, their tension between implicit normativity and presumed descriptivity, as well the challenges of the increasingly explicit normativity of applied social sciences. (shrink)

The evidence-based turn in education reveals renewed consensus on empiricism and shared trust in science as if it were the allegedly value-free basis for decision-making: good, justifiable governance should be a non-discretional corollary of scientific knowledge. The article focuses on some risks implied in pursuing the de-moralization of educational decision-making, namely the realistic, the reductionist, and the perspective fallacies, as well as the minimization of individual responsibility in favor of the third-person perspective implied in following protocols and guidelines. In the (...) discussion I address some possible reasons for the appeal of the evidence-based turn despite these risks: the contemporary pressure for “accountability” and the need to justify social policies and practices with consensual criteria. In the conclusion, I claim that educational decision-making should deploy rather than conceal its moral bases despite their being potentially highly divisive. Consequently, I make a case for “moral accountability”: making publicly inspectable what evidence-based education tries to conceal, i.e. the unavoidable value-ladeness of educational policies and practices. (shrink)

Dalla figura di Macbeth emerge l'idea di un'epoca crudele e violenta, che tende a esaltare gli aspetti brutali e malvagi dell'uomo.

After decades of epistemological inquiry on the social construction of science, we have observed a renewed consensus on empiricism in application-oriented social sciences and a growing trust in evidence-based practice and decision-making. Drawing on the long-standing debate on value-ladenness, evidence and normativity in sciences, this article theoretically discusses and empirically illustrates the Life-World origins of methods in a domain of inquiry strongly characterized by an empiricist epistemic culture and a normative stance: Children and Media Studies. Adopting a reflexive approach to (...) their own research in such an epistemologically underexplored field, the authors analyze a standard research instrument and two procedures. The analysis illustrates how background assumptions shape the research method and how the procedures routinely conceal this work of shaping. In the discussion the authors cast light on the role scientific procedures play in the naturalization of a given moral order, and put forward the question of whether and how this “morality-building” feature of methods should be taken into account in the assessment of their appropriateness. In the conclusion the authors advance that the situated nature of scientific knowledge, rather than discrediting its relevance, is what makes it relevant, here and now, for the larger community the research may impact on. The authors discuss the risks of such a pragmatic outcome and propose the adoption of an oscillating epistemic stance as a way to cope with them. (shrink)

Starting from the distinction between concept and conception, the author proposes a pluralistic view of toleration focussed on the equality of individuals and cultures and on legal‐rational control of social relationship. Analyzing the basic marks of toleration (toleration and power, the costs of toleration, toleration and value) the author shows how the option for toleration is a choice for subjecting social relations to reason and rules (law) instead of passions and violence (war).

Starting from the distinction between concept and conception, the author proposes a pluralistic view of toleration focussed on the equality of individuals and cultures and on legal‐rational control of social relationship. Analyzing the basic marks of toleration (toleration and power, the costs of toleration, toleration and value) the author shows how the option for toleration is a choice for subjecting social relations to reason and rules (law) instead of passions and violence (war).

This is an exclusive interview with the film-maker Nurith Aviv. Her last film Misafa Lesafa, on the plural linguistic identity in Israel, is linked to her former work and analysed through its cultural background, its symbolic dimension and its technical realization.

The author summarizes here the main theme of the papers gathered in the second part of this issue. It describes the dual identities they deal with (linguistic identities,métissages, masked exiles and social intermingling) and places them in the context of an ongoing seminar work carried out at the Maison des sciences de l’homme in Paris.

In questo articolo ci si occupa di come il regno e la vita di due califfi abbasidi siano ritratti e valutati dalle fonti narrative arabe medievali. Hārūn al-Rashīd e al-Muqtadir divennero, pochi decenni dopo la loro morte, il paradigma del buono e del cattivo califfo rispettivamente; tuttavia, i loro lunghi califfatia le loro biografie personali presentano diversi elementi comuni. Un'analisi di temi simili presenti nelle rappresentazioni dei due sovrani illustrano mezzi e strategie narrativi impiegati dalle fonti, nel tentativo di stabilire (...) quali fattori determinino lo sviluppo di una reputazione post-mortem positiva o negativa.This paper looks at how the lives and reigns of two Abbasid caliphs are portrayed and evaluated in medieval Arabic narrative sources. Hārūn al-Rashīd and al-Muqtadir became, only a few decades after their death, the paradigm of the good and the bad caliph respectively. However, their long caliphates as well as their personal biographies share several elements. An analysis of similar themes in the portrayals of the two rulers illustrates narrative means and strategies employed by the sources, in an attempt to establish which factors determine the development of a positive or negative post-mortem reputation. (shrink)