Suicide among Veterans experiencing or at risk for homelessness remains a significant public health concern. Conducting research to understand and meet the needs of this at-risk population remains challenging due to myriad factors. To address this challenge, the United States Department of Veterans Affairs convened the Health Services Research and Development Suicide Prevention in Veterans Experiencing Homelessness: Research and Practice Development meeting, bringing together subject-matter experts in the fields of homelessness and suicide prevention, both from within and outside of VA. (...) During the meeting, attendees identified 10 potential research priorities at the intersection of suicide prevention and homelessness. After the meeting, Delphi methodology was used to achieve consensus on the relative importance of the identified research domains. Through this iterative Delphi process, agreement was reached regarding the need to increase understanding of barriers and facilitators to suicide risk assessment and emergency intervention for Veterans experiencing homelessness by examining the perspectives of both Veterans and healthcare providers. Elucidating the complex relationships between risk periods, subgroups, suicide means, and drivers of suicide among Veterans experiencing homelessness was also considered a top priority. This article documents the Delphi process and provides a research agenda for researchers, funding agencies, and policymakers to prioritize the most relevant and potentially impactful research domains aimed at preventing suicide among Veterans experiencing or at risk for homelessness. (shrink)

This study investigates the increased commercialization of African indigenous vegetables (AIV)—former subsistence crops such as African nightshade, cowpea leaves and amaranth species grown mainly by women—from a feminist economics perspective. The study aims to answer the following research question: How does AIV commercialization affect the gendered division of labor, women’s participation in agricultural labor, their decision-making power, and their access to resources? We analyze commercialization’s effects on gender relations in labor and decision-making power and also highlight women’s agency. Based on (...) a mixed method design and analyzing household-level panel data and qualitative focus groups from Kenya, we observe an economic empowerment of women that we relate to women’s individual and collective strategies as well as their retention of control over AIV selling and profits. Yet, while we see economic empowerment of women through commercialization—how they broaden their scope of action and are empowered by generating revenue—that does not contribute to a redistribution of labor or land rights, which are key for gender equality, instead it increases women’s labor burden. (shrink)

"The terrain of the self is vast," notes renowned psychiatrist Arnold Ludwig, "parts known, parts impenetrable, and parts unexplored." How do we construct a sense of ourselves? How can a self reflect upon itself or deceive itself? Is all personal identity plagiarized? Is a "true" or "authentic" self even possible? Is it possible to really "know" someone else or ourselves for that matter? To answer these and many other intriguing questions, Ludwig takes a unique approach, examining the art of (...) biography for the insights it can give us into the construction of the self. In The Biography of the Self, he takes readers on an intriguing tour of the biographer's art, revealing how much this can tell us about ourselves. Drawing on in-depth interviews with twenty-one of our most esteemed biographers--writers such as David McCullough (the biographer of Truman and Theodore Roosevelt), Wallace Stegner (John Wesley Powell), Gloria Steinem (Marilyn Monroe), Leon Edel (Henry James), Peter Gay (Freud), Diane Middlebrook (Anne Sexton), and many others--and interweaving fascinating observations of his own practice, Ludwig takes us through the labyrinthine hall of mirrors we term the self and shows us how malleable, elusive, and paradoxical it can be. In chapters such as "The 'Real' Marilyn," "Psychoanalyzing Freud," "How Did Hitler Live With Himself?" and "What Madness Reveals," we sit in as biographers talk not only about their work, but about their subjects (Allan Bullock on Hitler and Stalin, for instance, or Arnold Rampersad on Langston Hughes) and how their subjects saw themselves. Ludwig describes how biographers must impose a narrative structure on their subjects' lives to create order out of a mass of often contradictory views, baffling behavior, and inconsistent self-representations, much in the same way that psychotherapists try to foster self-awareness and understanding in their patients. In his concluding chapter, Ludwig introduces a new concept--biographical freedom--which brilliantly reconciles free will and determinism. We can, he asserts, become biographers of ourselves. Like the biographer, we are constrained to consider all the available facts of our lives--the personal experiences, cultural forces, and predetermined scripts that shape us--but we remain free to interpret, emphasize, and fashion these givens into a cohesive and meaningful narrative of our own choosing. This thought-provoking volume offers not only a wide-ranging and informative commentary on the biographer's art, but also a highly original theory of the self. Readers interested in biography and in the lives of others will come away with a new sense of what it means to be a "person" and, in particular, who they are. (shrink)

De 1815 - avec le Congrès de Vienne qui inaugure une ère de Restauration - à mars 1848, avec les répercussions de la révolution de février en Europe, la période du Vormârz ("avant mars") se caractérise, au sein du monde germanique, par une vie intellectuelle d'une particulière effervescence. Les grandes philosophies qui se sont construites pour dépasser Kant, avec Fichte, Schelling et Hegel, autorisent bon nombre de penseurs allemands à considérer l'Allemagne comme étant philosophiquement en avance sur son temps, ou (...) tout au moins à la pointe de la modernité. Cette avance théorique tranche pourtant avec la réalité politique et sociale de l'époque, façonnée par Metternich. Une solution de cette contradiction dans laquelle se trouve l'Allemagne semble alors résider, aux yeux de certains auteurs, dans l'idée suivant laquelle il ne resterait plus à l'Allemagne qu'à réaliser sa philosophie. Le présent ouvrage entend contribuer à l'analyse de la façon dont le thème de la réalisation de la philosophie est élaboré par, ou à partir des réflexions de plusieurs auteurs de l'époque. Il s'agit des Jeunes Hégéliens, et principalement : Eduard Gans, Heinrich Heine, Arnold Ruge, Ludwig Feuerbach, Max Stirner, David Strauss, les frères Bruno et Edgar Bauer, Moses Hess, Michel Bakounine, August von Cieszkowski, Karl Marx et Friedrich Engels."--Page 4 of cover. (shrink)

Here is, we think, the point. It doesn't matter for what reason the writer or painter or lover destroys the creation: the real point is that destruction itself, like a gigantic statement. It is, in fact, something of an excitation, a stimulation to further thought: what is this ACTION about?' What do Stéphane Mallarmé, Antonin Artaud, Meret Oppenheim, Asger Jorn, Yoko Ono, Tom Phillips and Martin Arnold have in common? Whereas a wealth of critics have diagnosed contemporary art's preoccupations (...) with madness, depression and self-abuse as well as its tendency to cultivate an (anti- )aesthetics of the negative, the excremental and the abject (say, from the Vienna Action Group to Serrano, McCarthy or Delvoye), much less attention has been paid to how modern and contemporary artists and public have thrived on the destruction, disfiguration and obliteration of work by the artists and/or by that of others. From Artaud's 'terminal' notebooks to the recent upsurge in 'erasure poetics', the history of 'undoing' art deserves to be recounted in a positive mode and rescued from popular narratives of the decline and death of the avant-garde. (shrink)

I provide an account of the cognitive attitude of trust that explains the role trust plays in the planning of rational agents. Many authors have dismissed choosing to trust as either impossible or irrational; however, this fails to account for the role of trust in practical reasoning. A can have therapeutic, coping, or corrective reasons to trust B to ${\phi}$ , even in the absence of evidence that B will ${\phi}$ . One can choose to engage in therapeutic trust to (...) inspire trustworthiness, coping trust to simplify one’s planning, or corrective trust to avoid doing a testimonial injustice. To accommodate such types of trust, without accepting doxastic voluntarism, requires an account of the cognitive attitude of trust broader than belief alone. I argue that trust involves taking the proposition that someone will do something as a premise in one’s practical reasoning, which can be a matter of believing or accepting the proposition. I defend this account against objections that it (i) provides insufficient rational constraints on trust, (ii) conflates trust and pretense of trust, and (iii) cannot account for the rationality of back-up planning. (shrink)

BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

Ann Whittle offers a fresh approach to questions about whether our actions are free and whether we are morally responsible for them. She argues that the answers to these questions depend on the contexts in which we make claims about our abilities and our control over our actions.

Background: Intensive care unit nurses are providing care to COVID-19 patients in a stressful environment. Understanding intensive care unit nurses’ sources of distress is important when planning interventions to support them. Purpose: To describe Canadian intensive care unit nurse experiences providing care to COVID-19 patients during the second wave of the pandemic. Design: Qualitative descriptive component within a larger mixed-methods study. Participants and research context: Participants were invited to write down their experiences of a critical incident, which distressed them when (...) providing nursing care. Thematic analysis was used to analyze the data. Ethical considerations: The study was approved by the ethics committee at the researchers’ university in eastern Canada. Results: A total of 111 critical incidents were written by 108 nurses. Four themes were found: (1) managing the pandemic, (2) witness to families’ grief, (3) our safety, and (4) futility of care. Many nurses’ stories also focused on the organizational preparedness of their institutions and concerns over their own safety. Discussion: Nurses experienced moral distress in relation to family and patient issues. Situations related to insufficient institutional support, patient, and family traumas, as well as safety issues have left nurses deeply distressed. Conclusion: Identifying situations that distress intensive care unit nurses can lead to targeted interventions mitigating their negative consequences by providing a safe work environment and improving nurses’ well-being. (shrink)

Genome editing is revolutionising the field of genetics, which includes novel applications to food animals. Responsible research and innovation has been advocated as a way of ensuring that a wider-range of stakeholders and publics are able to engage with new and emerging technologies to inform decision making from their perspectives and values. We posit that genome editing is now proceeding at such a fast rate, and in so many different directions, such as to overwhelm attempts to achieving a more reflective (...) pace. An alternative location for reflection is during the much slower process of taking products from the lab to market. We suggest emphasising Responsible Innovation, putting the ‘I’ back into RRI, and encouraging companies to embrace an RRI approach. We review some previous attempts at developing industry-relevant frameworks for RRI. We then describe two examples of genome editing in livestock; hornless cattle and disease resistant pigs, and reflect on the sorts of questions that could be considered in these two genome editing examples. This paper seeks to take forward the discussion on RRI by extending it to bringing products to market in the context of genome edited livestock. (shrink)

Feminist analysis of cultural mythology surrounding organ donation offers a critical perspective on current U.S. transplant policy. My argument is three-pronged. First, I argue that organ donation is appropriately understood as a sacrifice. Structurally, donation accords both to general and to specifically Christian archetypes of sacrifice. The characterization of donation as sacrifice resonates in the cultural psyche even though it is absent in public rhetoric. Second, I characterize widespread feminist concerns about the over-glorification of sacrifice. These concerns provide a helpful (...) framework for considering whether the sacrifice of organ donation is over-glorified in our culture. Third, I consider several specific aspects of organ recruitment and organ allocation. Each demonstrates an over-glorification of sacrifice that leads to a dangerous "routinization" of sacrifice. None of these excesses are addressable without due attention to the symbolic import of organ donation and transplantation. I close by suggesting lessons my analysis offers to Christian churches who support donation, to the discourse of bioethics, and to the general public. (shrink)

As a way to address both ominous and ordinary threats of artificial intelligence, researchers have started proposing ways to stop an AI system before it has a chance to escape outside control and cause harm. A so-called “big red button” would enable human operators to interrupt or divert a system while preventing the system from learning that such an intervention is a threat. Though an emergency button for AI seems to make intuitive sense, that approach ultimately concentrates on the point (...) when a system has already “gone rogue” and seeks to obstruct interference. A better approach would be to make ongoing self-evaluation and testing an integral part of a system’s operation, diagnose how the system is in error and to prevent chaos and risk before they start. In this paper, we describe the demands that recent big red button proposals have not addressed, and we offer a preliminary model of an approach that could better meet them. We argue for an ethical core that consists of a scenario-generation mechanism and a simulation environment that are used to test a system’s decisions in simulated worlds, rather than the real world. This EC would be kept opaque to the system itself: through careful design of memory and the character of the scenario, the system’s algorithms would be prevented from learning about its operation and its function, and ultimately its presence. By monitoring and checking for deviant behavior, we conclude, a continual testing approach will be far more effective, responsive, and vigilant toward a system’s learning and action in the world than an emergency button which one might not get to push in time. (shrink)

A thoughtful meditation on the role of meaning and purpose in the development of technology.

The training relationship between sport psychology professionals (SPPs) and their students is a critical aspect of graduate training. Maintaining ethical, appropriate boundaries within training relationships is imperative, as boundary crossings can have deleterious effects on students. SPPs (N = 152) and Sport Psychology graduate students (N = 165) completed The Survey of Applied Sport Psychologists to explore their experiences and perceptions of sexual attractions and boundary crossings within training relationships. Nearly 30% of SPPs acknowledged sexual attractions toward their students, yet (...) few students (8.5%) perceived such attractions. Compared to the SPPs, the students reported higher levels of anxiety regarding the SPP’s attraction toward them; both groups reported infrequent use of supervision for this attraction. Nine students and 13 SPPs reported engaging in sexual behaviors (e.g., kissing, dating, intercourse) with the other. Within the larger sample, the three most common nonsexual boundary crossings were becoming social friends, attending social gatherings, and the SPP initiating nonsexual touching. Both groups are advised to engage in ongoing monitor their behaviors, receive training specific to ethics within training relationships, and seek consultation/supervision to ensure appropriate boundaries remain intact. (shrink)

What if depression, in the Americas at least, could be traced to histories of colonialism, genocide, slavery, exclusion, and everyday segregation and isolation that haunt all of our lives, rather than to biochemical imbalances? This article seeks alternatives to the medical model found in most depression memoirs by considering how the epistemological and methodological struggles faced by a scholar of the African diaspora confronted by the absent archive of slavery are relevant to discussions of political depression. Combining scholarly investigation and (...) personal memoir, Saidiya Hartman’s Lose Your Mother exemplifies feminism’s affective turn not only by bringing personal narrative into scholarship, but by seeking reparation for the past in the affective dynamics of cultural memory rather than in legal reform or state recognition. Stubbornly refusing to find solace in an African past before slavery, though, Hartman provides a model of emotional reparation in which feelings of loss and alienation persist. Her work suggests the relevance of political depression to both the ordinary life of racism and to what gets called clinical depression. (shrink)

Nursing is a complicated and multifaceted profession that sets high demands in preparing nursing students for the profession. In today's education, the emphasis is often on knowledge and skills, that is, epistemology. In caring science another approach is sought, an approach based on human sciences in which knowledge will serve a more profound understanding, that is, the ontology. Consequently, the question of what this ‘understanding’ in clinical education is and how it is promoted in clinical nursing education becomes important to (...) clarify. Therefore, the aim here is to explicate the phenomenon of understanding in clinical education as experienced by third‐year undergraduate nursing students ready for graduation. This study, with a hermeneutic approach, is based on a secondary analysis of focus group interviews with undergraduate nursing students. The analytical expansion of the original material suggests three interrelated themes that illuminate the phenomenon of understanding in clinical education. These findings are deepened and enriched through philosophical abstraction. In the process of understanding, episteme, techne and phronesis can be viewed as inherent parts of the structure of thought in nursing. The perspective advanced in this study adds new aspects to the phenomenon of understanding and its meaning and significance in the dynamic process of formation and becoming in clinical education. The focus in clinical nursing education should be on learning reflective, critical thinking and the ways of being a nurse, rather than drilling students on particular skills. In the rapidly changing world of the 21st century, an understanding‐based education is needed as a more meaningful and authentic approach. Therefore, an ontological turn in nursing education, through which the main focus shifts from a traditional epistemology to an epistemology in the service of ontology, is suggested. Further studies are needed in the development and implementation of an understanding‐based, interpretative education in nursing. (shrink)

Two significant, apparently unrelated, trends have emerged in American society and medicine. First, American medicine is reexamining its approach to dying. The Institute of Medicine, the American Medical Association and private funding organizations have recognized that too many dying people suffer from pain and other distress that clinicians can prevent or relieve. Second, this past decade has marked a sharp increase in the number of physicians prosecuted for criminal negligence based on arguably negligent patient care. The case often cited as (...) a watershed is People u. Einaugfer, which involved a New York nursing home patient whose physician was convicted in 1993 of two criminal misdemeanors after he ordered an elderly dialysis patient to be tube fed through a peritoneal dialysis Catheter.How is the growing awareness of dying patients’ pain and the increasing willingness of prosecutors to charge physicians with crimes connected? Pain at the end of life is frequently treated with narcotics, prescription drugs that are closely regulated by state and federal law. That complex web of laws—and a growing fear of legal sanctions—has deterred physicians from prescribing controlled substances. As those legal sanctions move from disciplinary actions to criminal charges, physicians’ fears may expand. (shrink)

Since its publication in 1935, Kenneth Burke's Permanence and Change, a text that can serve as an introduction to all of Burke's theories, has become a landmark of rhetorical study. Using new archival sources and by contextualizing the theory in the past and present, Ann George offers the first sustained exploration of Burke's work and seeks to clarify the notoriously difficult book for both amateurs and scholars of rhetoric in Kenneth Burke's Permanence and Change: A Critical Companion.

_This illuminating account of contemporary American Buddhism shows the remarkable ways the tradition has changed over the past generation_ The past couple of decades have witnessed Buddhist communities both continuing the modernization of Buddhism and questioning some of its limitations. In this fascinating portrait of a rapidly changing religious landscape, Ann Gleig illuminates the aspirations and struggles of younger North American Buddhists during a period she identifies as a distinct stage in the assimilation of Buddhism to the West. She observes (...) both the emergence of new innovative forms of deinstitutionalized Buddhism that blur the boundaries between the religious and secular, and a revalorization of traditional elements of Buddhism, such as ethics and community, that were discarded in the modernization process. Based on extensive ethnographic and textual research, the book ranges from mindfulness debates in the Vipassana network to the sex scandals in American Zen, while exploring issues around racial diversity and social justice, the impact of new technologies, and generational differences between baby boomer, Gen X, and millennial teachers. (shrink)

This article analyzes the experiences of ecologists who used data they did not collect themselves. Specifically, the author examines the processes by which ecologists understand and assess the quality of the data they reuse, and investigates the role that standard methods of data collection play in these processes. Standardization is one means by which scientific knowledge is transported from local to public spheres. While standards can be helpful, the results show that knowledge of the local context is critical to ecologists' (...) reuse of data. Yet, this information is often left behind as data move from the private to the public world. The knowledge that ecologists acquire through fieldwork enables them to recover the local details that are so critical to their comprehension of data collected by others. Social processes also play a role in ecologists' efforts to judge the quality of data they reuse. (shrink)

Political oeconomy in the 18th century operated in the absence of the conception of an autonomous social order articulated in the later concepts of `the economy' and `society'. Without a self-sustaining mechanism oriented to stability and endogenous economic growth, national prosperity and social order were assumed to depend upon the detailed interventions in economic life that are characteristic of mercantilism and the police of the poor. Smith's theory that autonomous economic growth underpinned a stable order of social interdependencies based upon (...) the division of labour allowed him to move beyond or modify these assumptions. It freed him from the ideas that constant interference in the relationship between agriculture and manufacturing was necessary in order to guarantee food security and that social order and national prosperity depended upon enforcing constraints upon the interests of wage earners. (shrink)

A few weeks ago, a rural hospital administrator phoned with a question posed by his management team. “If you were going to give us some ethics resources,” he queried, “just exactly what would they...

Three periods in the development of Whitehead's thought are generally recognized : ()-: The period of the writing of Universal Algebra, ...

This paper answers the title question, “Yes,” on both counts. The first part of the paper argues that modern liberals are socialists, and the second part argues that they are also social democrats. The main idea behind the first argument is that the state has effectively taken control of the incidents of ownership through its taxation, spending, and regulatory policies. The main idea behind the second argument is that the institutions of social democracy are replicated by the institutions favored by (...) modern American liberalism. Specifically, the takeover of the American healthcare system, Social Security, employers' mandatory contributions to unemployment insurance, and workers' compensation insurance replicate the institutions of social democracy. (shrink)

Despite the skepticism of many mathematicians and logicians as to the possibility of any test which will show conclusively the consistency or independence of the members of a postulate set, several methods have nevertheless been devised and employed, e.g., the empirical methods of Russell and Huntington, the internal method of Hilbert, and the reflective method of Royce. However, with the possible exception of Hilbert's method, these techniques require us to forsake the purely formal or abstract mode of analysis, and instead (...) to rely in some sense on “concrete representations” or “interpretations” or “modes of action” which are said to “satisfy” the postulates in question. In short, they are all interpretational methods—and here is the crux of the problem. “Is it possible,” queries Weiss, “that the only way we can determine whether a set is consistent is by seeing all the postulates actually exemplified in some object? If so, we must arbitrarily assume that the object is self-consistent, so that the proof of consistency must ultimately rest on a dogma. As independence rests on consistency there are therefore no satisfactory proofs as yet of either independence or consistency.” The question “is thus answered,” according to Young, “only by reference to a concrete representation of the abstract ideas involved, and it is such concrete representations that we wished especially to avoid. At the present time, however, no absolute test for consistency is known.” Moreover, “suppose,” says the late Dr. Eaton, “that the system has no interpretation: how can the consistency independence … of the postulates be shown? There should be some analytic way—purely in the realm of the abstract, without interpretation—of establishing these properties of a set of postulates. This is an important problem that awaits solution.”. (shrink)

Derrida's discourse on forgiveness is importantly a discourse on heritage. More precisely, he is interested in our split inheritance of this concept and what this inheritance implies. Of concern to Derrida is the link that he draws between our Abrahamic religious inheritance and the proliferation of various therapeutic discourses in the political realm. Derrida's deconstruction of forgiveness turns on his understanding of what is in fact unforgivable, of those deeds that are so horrendous that it is inconceivable or unthinkable that (...) forgiveness would be granted. By far and away the Derridean project to which the deconstruction of forgiveness is most proximate is Derrida's deconstruction of the gift. This proximity exceeds that which is gestured to by the etymological bond between the two, don and pardon, forgiveness and gift. In spite of Derrida's criticisms of phenomenology, he remains relatively attuned to the experiences that are implied by his various deconstructive projects. (shrink)