For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based (...) on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed "medically inappropriate" will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience. (shrink)

Despite growing interest in emotions, organizational scholars have largely ignored the moral emotion of schadenfreude, which refers to pleasure felt in response to another’s misfortune. As a socially undesirable emotion, it might be assumed that individuals would be hesitant to share their schadenfreude. In two experimental studies involving emotional responses to unethical behaviors, we find evidence to the contrary. Study 1 revealed that subjects experiencing schadenfreude were willing to share their feelings, especially if the misfortune was perceived to be deserved. (...) Study 2 extends this work by incorporating schadenfreude targets of different status. Consistent with the “tall poppy syndrome,” subjects were more willing to share schadenfreude concerning high status targets than low status targets when the perceived severity of the target’s misconduct was low. This status effect disappeared at higher levels of perceived deservingness, however. Reported willingness to share schadenfreude was strongest at these levels but did not differ significantly between high and low status targets. These findings build on the social functional account of emotions, suggesting that sharing schadenfreude may signal normative cues to others regarding workplace behaviors that are deemed to be unethical. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Wonder, Imagination, and the Matter of Theatre in The TempestMary MooreAriel occurs. Recounting his performance of "the tempest" in Act I, scene 1 of The Tempest, he presents himself as being and action, fracturing grammar, spatial and temporal logic in ways that amaze and confound:I boarded the King's ship; now on the beak, Now in the waist, the deck, in every cabin, I flamed amazement. Sometime I'd divide, And (...) burn in many places; on the topmast, The yards, and bowsprit would I flame distinctly, Then meet and join...(1.2.195–201) 1"I flamed" means that Ariel emits or is flames, which in the normal order of things would consume him. His very narration, however, proves his survival, evoking wonder through the utterance itself. Forceful and compacted syntax, a recognized source of wonder in Classical and Renaissance accounts of style (Biester, pp. 14; 35–40), magnifies this effect. 2 Shakespeare's transitive use of the usually intransitive verb flame reflects a not uncommon practice, as E. A. Abbott shows; 3 but this syntactic device also reflects The Tempest's own logic. Ariel crosses boundaries between [End Page 496] deed and being, verb and noun, subject and object, matter and spirit: he both is and does flames. What could be more jarring to syntax and semantics than a singular subject whose utterance claims that he can flame, divide, meet and join? Just as "a" fire consists of many flames yet functions grammatically as a singular substance in English, just as the Christian Trinity is both singular and multiple, Ariel burns in many places at once. Meanwhile, this extraordinary language seems belied by the actor's very embodiment. Ariel cannot have done what he claims; yet the prior scene has represented the very storm in which Ariel flamed. In that sense, the actor's embodiment represents what we imagine to be matter's intractability, while Ariel's claims, coupled with the storm we have just witnessed, reveal matter's fluidity and permeability to imagination. Fluidity and intractability co-exist, another source of wonder. Sound mimics these paradoxes: the assonance and consonance in flame and amazement create a near rhyme that echoes the near identity of fire and human amazement. If, as Gurr and Ichikawa observe, a Renaissance audience expected to hear more than see a play, this echo calls attention to Ariel's marvelous powers. 4 Lest the noises and pleasures of the Renaissance theatre, which recent scholarship deems to be considerable, distract audience members from this bit of language, similar moments reinforce Ariel's play in and with language and matter throughout the play. Marvelous poetic language is of a piece with a "fever" that is of "the mind," with music that "creeps," actors who vanish, new found goddesses who speak the discoverers' own language.Amazement provides our cue: it and its cognates name the appropriate response to Ariel, his language, and to The Tempest itself. Attention to Ariel's poetic language reveals that it, like the plot, conforms to the marvels of the play and to the period's well documented love for marvels in several ways. Wonder, an aesthetic "'object of desire'" in itself, and a response to the inexplicable in classical and early modern views, may be evoked by the unexpected in style (and through other strategies that the era's handbooks taught). 5 The clause "I flamed amazement" epitomizes the unexpected in syntax as well as differing from one of the few sources found for The Tempest, William Strachey's 1610 letter, which describes just such a storm. 6 While St. Elmo's fire itself may elicit wonder, Shakespeare's syntax and diction reinforce that marvel. And no wonder: rhetoric and theatre alike depend upon audience attention, and wonders naturally evoke it. Jarring language also harmonizes with The Tempest's structural marvels—loose ends, disrupted actions, unforeseen futures—issues several critics explore. 7 [End Page 497]The wonders of The Tempest, however, also involve imagination—in early modern psychology, the human faculty that permits perception of the world and invention of images. 8 Wonder responds to how the perceived differs from the expected, how the imagined supplants the usual, how an... (shrink)

The paper introduces what is deemed as the general epistemological problem of measurement: what characterizes measurement with respect to generic evaluation? It also analyzes the fundamental positions that have been maintained about this issue, thus presenting some sketches for a conceptual history of measurement. This characterization, in which three distinct standpoints are recognized, corresponding to a metaphysical, an anti-metaphysical, and relativistic period, allows us to introduce and briefly discuss some general issues on the current epistemological status of measurement science.

Complete determinism is, as Karl Popper said, “a daydream of omniscience.” Determinism is usually conceived as linked with a particular science whose explanations are deemed fundamental. As Rose rightly points out, biological enquiry includes many different kinds of question. Genetic determinism, making genes central to biology, is therefore biased and misguided. The crucial unit must be the whole organism. Correspondence:c1 IA Collingwood Terrace, Newcastle on Tyne NE2 2JP, United Kingdom [email protected].

Operational statistics is an operational theory of probability and statistics which generalizes classical probability and statistics and provides a formalism particularly suited to the needs of quantum mechanics. Within this formalism, statistical inference can be accomplished using the Bayesian inference strategy. In a hierarchical Bayesian approach, a second-order probability measure, or credibility, represents degrees of belief in statistical hypotheses. A credibility determines an assignment of simple and conditioned betting rates to events in a natural way. In the setting of operational (...) statistics, we show that a credibility is completely determined by the assignment of the betting rates it induces. This result suggests a certain unity between the Bayesian philosophy which deems that betting rates are central and the one which advocates the hierarchical approach. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Incorporating Religion into Psychiatry:Evidenced–Based Practice, Not a Bioethical DilemmaMary D. MollerFor over sixteen years I was the owner and clinical director of an advanced practice nurse–managed outpatient rural psychiatric clinic staffed by APNs, a social worker, a licensed counselor and several graduate students. Many of our patients were victims of severe and often brutal trauma and abuse suffered at the hands of family, friends, and various professionals including spiritual (...) leaders. We also uncovered sources of abuse suffered from those involved in occult practices ranging from seemingly innocent white witchcraft (Wicca, Paganism, New Age) that includes such activities as astral projection and remote viewing to the darkest possible black witchcraft (perpetrating evil, incanting evil spirits, casting spells and hexes, creating dissociative identities) such as occurs in ritual abuse and satanic rites. Both types of witchcraft also typically involved family, friends, various professionals, and spiritual leaders. Recognizing the controversy surrounding the reality of witchcraft I am sharing a story that I hope will help break down the barriers that prevent many patients from receiving the treatment that would provide the most benefit to recovery.Seeking services for these patients led me on an intense personal and professional journey that included a profound Christian born–again experience at almost 50 years of age. My professional career grew in nearly indescribable terms as a result of the incorporation of prayer and deliverance ministry as part of the services we selectively provided. Today I always include assessment of spiritual experiences a patient has as well as spiritual supports that are available with every new patient intake. For patients who indicate that prayer is one of their supports, I ask if they would like prayer at the conclusion of the session. The gratitude that is expressed by individuals who appreciate being able to pray with a psychiatric provider is often profound.In the field of psychiatry there has been a long–standing and distinct taboo regarding incorporating religious and spiritual aspects of life experience into treatment unless it is to frame most of these discussions within the context of psychosis. This stems from the advent of psychoanalysis in which religion was deemed a neurosis and atheism became the goal. Some still hold to that belief and there certainly remains controversy regarding the incorporation of prayer into routine outpatient or inpatient care. The essential starting point is the determination of accurate differential diagnosis, which can often be a lengthy process. The clinician must be careful about distinguishing between religious experiences and religious delusions, and often this takes time to sort out. The determination of the etiology of hearing the voice of God or the devil or demons must be carefully parsed and framed within the context of the situation and culture the patient describes. If the clinician denies the existence of God or the devil or demons or the practice of witchcraft, the patient’s descriptions of such experiences will be quickly [End Page 206] labeled psychotic. The patient may then experience a lengthy hospitalization and treatment with psychotropic medications that can have an extremely negative effect on the possibility of recovery. Once I witnessed the level of healing that occurs with carefully administered spiritual interventions that are related to specific spiritual experiences that are based on the patient’s belief system, there was no going back to using only allopathic medication and non–spiritual psychosocial interventions, even in spite of the criticisms from others. The key is to understand and respect the patient’s belief system, if this is not congruent with the practitioner’s belief system, then practitioner must refer out.In the United States, an increasing persecution of Christianity and a devaluing of the Judeo–Christian heritage of our Constitution are creating a climate of intolerance to the expression of religious values resulting in an expectation that Christians should compromise their beliefs for the sake of political correctness. As a doctorally prepared psychiatric–mental health advanced practice nurse I experienced a profound born–again Christian experience that ultimately led to study of the Hebrew roots of Christianity and I now worship in a Messianic Jewish synagogue. It is impossible for me to not include the concept of spirituality into... (shrink)

Drawing on managerial discretion and conflicting institutional logics literature, this study investigates the relation between the personal sustainability behaviors of owner–managers and the corporate sustainability practices of SMEs. The research proposes a contingency model that assesses the moderating effects of perceived economic advantages and environmental hostility on this relationship. Based on linear hierarchical multiple regression analyses of a cross-sectoral sample of French SMEs, the results suggest a positive influence of the manager's PSB on the SME's CS practices that appears to (...) be differently moderated depending on the type of practice considered. The influence on environmental practices is fostered through the perception of economic advantages. The influence on workplace practices is only effective when the business environment is deemed benign and the influence on community practices is dampened by the perception of environmental hostility. Highlighting the trade-off between the manager's personal values and the SME's economic constraints, these findings contribute to a better understanding of the critical antecedents of sustainability in small businesses. (shrink)

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based on the well-documented (...) tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed “medically inappropriate” will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience. (shrink)

BackgroundThe proper and ethical inclusion of PWLHIV and their young children in research is paramount to ensure valid evidence is generated to optimize treatment and care. Little empirical data exists to inform ethical considerations deemed most critical to these populations. Our study aimed to systematically review the empiric literature regarding ethical considerations for research participation of PWLHIV and their young children.MethodsWe conducted this systematic review in partnership with a medical librarian. A search strategy was designed and performed within the following (...) electronic databases: Ovid MEDLINE, Embase and CINAHL. We screened titles and abstracts using the following inclusion criteria: (1) a study population of PWLHIV or children under 5 years of age; and (2) collection of qualitative or quantitative data regarding ethics of research participation. Excluded were reviews, commentaries, policy statements, clinical care-related ethics concerns, abstracts, case studies, or studies unrelated to HIV research. Studies were appraised for quality, data were extracted, and studies were qualitatively analyzed using a principle-based ethical framework within the Belmont Report.ResultsOf the 7470 titles identified, 538 full-text articles were reviewed for eligibility and only three articles met full criteria for inclusion within this review. While we allowed for inclusion of studies involving young children born to mothers with HIV, only articles focused on PWLHIV were identified. Within the results of these studies, four themes emerged: (1) adequacy of informed consent; (2) consideration of paternal involvement; (3) balancing risks; and (4) access to research and treatment. A strength of this review is that it included perspectives of international research investigators, community leaders, and male partners. However, only two studies collected empiric data from PWLHIV regarding their experiences participating in researchConclusionResearchers and funding agencies should be aware of these considerations and appreciate the value of and critical need for formative research to ensure clinical trials involving PWLHIV promote ethical, well-informed research participation and, ultimately, improve care outcomes. More research is needed to create a comprehensive ethical framework for researchers when conducting studies with PWLHIV. (shrink)

The generation of novel refined scientific conceptions of intelligence, creativity and consciousness is of paramount importance at a time where many scientists deem the technological singularity and the achievement of self-improving superintelligent algorithms to be immanent while numerous other scientists characterize present-day algorithms as the mere implementation of superficial mimicry incapable of yielding outcomes such as superintelligence. The precarious epistemic state of affairs reflected in this discrepancy became increasingly palpable in the unfolding deepfake era even though informed safety- and security-relevant (...) actions need requisite variety in the near-term. Divergently, historically speaking, from the perspective of cosmology, science is described to already have successfully navigated from the geocentric model to the acentric model of the universe representing the currently best known explanation for the structure of the expanding cosmos. In analogy, this autodidactic paper expounds the scientific need for a broader contextualization of the current epistemic situation and explicates why acentric civilization-level epistemic relativity and invariance considerations can enable a more rigorous scientific evaluation of algorithmic superintelligence achievement claims – constraining the latter scientifically. (shrink)

The right to conceive and bear children has been protected both in law and in policy. Human society has from its earliest time valued children and defended procreation as a basic right.Modern health technology offers the possibility of conception to the estimated 2.5 million infertile couples who may wish to have children. For these persons, infertility treatment offers the hope of having children, an activity deemed basic and essential in human society.In general, the state has been reluctant to directly interfere (...) in the reproductive decisions of individuals. However, the state may act to increase or reduce access to reproductive services in a variety of ways. For example, recent legislation regulating fertility clinics affects the distribution of assisted reproductive technology in the United States. The purpose of this paper is to describe this legislation, project its probable effects on the distribution of ART services, and analyze these effects based on distributive theories of justice. (shrink)

This essay uses the philosophy and theology of John Paul II to argue that re-enchanting the world requires various modes depending on whether disenchantment is due to religious beliefs being deemed false or irrelevant. The former is countered through philosophical arguments for God's existence and the plausibility of religious belief, the latter through accepting the human condition and the connection between self-fulfillment and adherence to the laws of life, reason, other-centered love, and God-centered spirituality. These laws, especially as embodied in (...) Christianity, facilitate the familial love of God that is so necessary for re-enchanting the world. (shrink)

Le sacramentalisme qu’on s’accorde, depuis longtemps déjà, à reconnaître comme excessif à la fin du Moyen Âge devait conduire Luther puis les autres Réformateurs à dénoncer la « captivité babylonienne » de l’Eglise, notamment sous l’espèce d’une sorte d’emprisonnement de la « Parole de Dieu » dans l’institution sacramentelle, emprisonnement qui fut analogiquement dénoncé, à l’époque moderne, dans l’institution magistérielle de l’Eglise. Cette opposition entre Parole et Sacrement a en outre connu au XXe siècle une sorte de redoublement avec la (...) dichotomie entre la « foi » et la « religion », dichotomie qui a d’ailleurs traversé aussi bien le camp « catholique » que le camp « protestant », la foi étant mise du côté de la Parole, censée être nécessairement plus « pure » que les sacrements, lesquels relèveraient plutôt de la « religion » avec toutes les ambiguïtés que prend alors le terme devenu proche de la « magie ». La donne ayant aujourd’hui considérablement changé, il semble clair que l’on peut, dans la fidélité à la régulation dogmatique de la foi catholique, penser théologiquement les sacrements dans le sillage direct de la Parole.For a long time an agreement to recognize sacramentalism as excessive at the end of the Middle Ages would lead Luther and the other Reformers to denounce the “Babylonian captivity” of the Church, notably as a kind of imprisonment of the “Word of God” in the sacramental institution, imprisonment that was denounced analogically, in modern times, in the magisterial institution of the Church. This opposition between Word and Sacrament has moreover resurfaced in the 20th century, as a dichotomy between “faith” and “religion.” This dichotomy passed through both the “Catholic” and the “Protestant” camps. Faith was allied with the Word, because it was deemed to be necessarily “purer” than the sacraments, which were more a product of “religion” with all its ambiguities, which then takes on a connotation close to “magic.” Perspectives have considerably changed today, so it seems clear that it is possible to remain faithful to the dogmas of the Catholic faith and theologically view the sacraments as flowing directly from the Word. (shrink)

Spiritual life and community engagement animation services have existed since 2001. These services replaced pastoral animation in schools and are intended to promote the spiritual development and community engagement of all students, whether or not they are affiliated with a religion. This article presents the historical background that led to development of this service, as well as the professional concerns of its stakeholders. The concerns raised are based on awareness of great diversity among those who provide this service - diversity (...) in both their training and their understanding of the meanings of the terms that define their work. Presently working towards the professionalization that they deem essential to their very survival, they are using professional strategies that are largely not aligned with their reality nor their abilities. This article hopes to demonstrate the relevance of changing perspectives so that this profession would not be understood through functionalist or conflictualist paradigms, nor limited only to community engagement, but would rather adopt an interactionist point of view, focused on the spiritual aspect of this role. (shrink)

Background: Nurses and midwives have a professional obligation to promote health and prevent disease, and therefore they have an essential role to play in vaccination. Despite this, some nurses and midwives have been found to take an anti-vaccination stance and promulgate misinformation about vaccines, often using Facebook as a platform to do so. Research question: This article reports on one component and dataset from a larger study – ‘the positives, perils and pitfalls of Facebook for nurses’. It explores the specific (...) issue of nurses and midwives who take an anti-vaccination stance, deemed to be unprofessional by crossing professional boundaries and by providing medical information on Facebook that is not within their scope of practice. Participants: Data were collected via an online worldwide survey from nurse and midwife participants, distributed and ‘snowballed’ through relevant nursing and midwifery groups on Facebook. In total, 1644 Registered Nurses and Midwives, and Enrolled Nurses worldwide attempted the online survey. There were 1100 (66.9%) completed surveys and 54 partially (33.1%) completed surveys. Semi-structured interviews were also conducted online using Skype® with 17 participants in Australia. Ethical considerations: Ethical processes and procedures have been adhered to relating to privacy, confidentiality and anonymity of the participants. Findings/results: A mixed-methods approach was used, including descriptive and content analysis of the quantitative survey data and thematic analysis of the qualitative interview data. The main theme ‘blurred boundaries’ was generated, which comprised three sub-themes: ‘follow the science, ‘abuse of power and erosion of trust’ and ‘the moral and ethical responsibility to safeguard public health’. The results offer an important and unique understanding of how nurses and midwives interpret the conduct of fellow health professionals as unprofessional and crossing the professional boundary if they used Facebook to promulgate anti-vaccination messages and/or give medical advice online. Conclusion: There are many positives and negatives for nurses and midwives associated with using Facebook for personal and professional communication, which is in keeping with the results of the larger study from which this article is taken. Professional behaviour is a key theme in the larger research as is the ethical construct of ‘every act has a consequence’; however, in this article, the theme ‘blurred boundaries’ offers an overall understanding of how nurses and midwives interpret the behaviour of their colleagues who espouse anti-vaccination sentiment and/or give medical advice online that is outside their scope of practice and education. (shrink)

Delirium, a common syndrome in terminally ill people, presents specific challenges to a good death in end‐of‐life care. This paper examines the relational engagement between hospice nurses and their patients in a context of end‐of‐life delirium. Ethnographic fieldwork spanning 15 months was conducted at a freestanding residential hospice in eastern Canada. A shared value system was apparent within the nursing community of hospice; patients’ comfort and dignity were deemed most at stake and therefore commanded nurses’ primary attention. This overarching commitment (...) to comfort and dignity shaped all of nursing practice in this hospice, including practices related to end‐of‐life delirium. The findings of this study elaborate the ways in which hospice nurses interpreted and responded to the discomfort of their patients in delirium, as well as the efforts they made to understand their patients’ subjective experiences and to connect with them in supportive ways. In addition to what is already known about clinical assessment and treatment of delirium in palliative care settings, the findings of this study offer points of reflection for nurses anywhere who are contending with the relational challenges that delirium presents in end‐of‐life care. (shrink)

BackgroundThe advent of learning healthcare systems (LHSs) raises an important implementation challenge concerning how to request and manage consent to support secondary use of data in learning cycles, particularly research activities. Current consent models in Quebec were not established with the context of LHSs in mind and do not support the agility and transparency required to obtain consent from all involved, especially the citizens. Therefore, a new approach to consent is needed. Previous work identified the meta-consent model as a promising (...) alternative to fulfill the requirements of LHSs, particularly large-scale deployments. We elicited the public’s attitude toward the meta-consent model to evaluate if the model could be understood by the citizens and would be deemed acceptable to prepare for its possible implementation in Quebec.MethodsEight focus groups, with a total of 63 members of the general public from various backgrounds were conducted in Quebec, Canada, in 2019. Explicit attention was given to literacy levels, language spoken at home and rural vs urban settings. We assessed attitudes, concerns and facilitators regarding key components of the meta-consent model: predefined categories to personalized consent requests, a dynamic web-based infrastructure to record meta-consent, and default settings. To analyse the discussions, a thematic content analysis was performed using a qualitative software.ResultsOur findings showed that participants were supportive of this new approach of consent as it promotes transparency and offers autonomy for the management of their health data. Key facilitators were identified to be considered in the implementation of a meta-consent model in the Quebec LHSs: information and transparency, awareness campaigns, development of educational tools, collaboration of front-line healthcare professionals, default settings deemed acceptable by the society as well as close partnerships with recognized and trusted institutions.ConclusionsThis qualitative study reveals the openness of a sample of the Quebec population regarding the meta-consent model for secondary use of health data for research. This first exploratory study conducted with the public is an important step in guiding decision-makers in the next phases of implementing the various strategies to support access and use of health data in Quebec. (shrink)

BackgroundThe aim of this survey was to determine the level of awareness and understanding of peer review and peer review models amongst junior hospital doctors and whether this influences clinical decision-making.MethodsA 30-question online anonymous survey was developed aimed at determining awareness of peer review models and the purpose of peer review, perceived trustworthiness of different peer review models and the role of peer review in clinical decision-making. It was sent to 800 trainee doctors in medical specialties on the University College (...) London Partners trainee database.ResultsThe response rate was (178/800) 22%. Most respondents were specialist registrars. Checking that research is conducted correctly (152/178, 85%) and the data interpreted correctly (148/178, 83%) were viewed as the most important purposes of peer review. Most respondents were aware of open (133/178, 75%), double-blind (125/178, 70%) and single-blind peer review (121/178, 68%). 101/178 (57%) had heard of collaborative, 87/178 (49%) of post publication and 29/178 (16%) of decoupled peer review. Of those who were aware of double-blind, single-blind open and collaborative peer review, 85 (68%), 82 (68%), 74 (56%) and 24 (24%), respectively, understood how they worked. The NEJM, Lancet and The BMJ were deemed to have most trustworthy peer review, 137/178 (77%), 129/178 (72%) and 115/178 (65%), respectively. That peer review had taken place was important for a journal content to be used for clinical decision-making 152/178 (85%), but the ability to see peer review reports was not as important 22/178 (12%). Most felt there was a need for peer review training and that this should be at the specialist registrar stage of training.ConclusionsJunior hospital doctors view peer review to be important as a means of quality control, but do not value the ability to scrutinize peer review themselves. The unquestioning acceptance of peer review as final validation in the field of medicine emphasises not only the responsibility held by medical journals to ensure peer review is done well but also the need to raise awareness amongst the medical community of the limitations of the current peer review process. (shrink)

French end-of-life law aims at protecting patients from unreasonable treatments, but has been used to force caregivers to prolong treatments deemed unreasonable. We describe six cases (five intensi...

The fact that Internet companies may record our personal data and track our online behavior for commercial or political purpose has emphasized aspects related to online privacy. This has also led to the development of search engines that promise no tracking and privacy. Search engines also have a major role in spreading low-quality health information such as that of anti-vaccine websites. This study investigates the relationship between search engines’ approach to privacy and the scientific quality of the information they return. (...) We analyzed the first 30 webpages returned searching “vaccines autism” in English, Spanish, Italian, and French. The results show that not only “alternative” search engines but also other commercial engines often return more anti-vaccine pages (10–53%) than Google (0%). Some localized versions of Google, however, returned more anti-vaccine webpages (up to 10%) than Google. Health information returned by search engines has an impact on public health and, specifically, in the acceptance of vaccines. The issue of information quality when seeking information for making health-related decisions also impact the ethical aspect represented by the right to an informed consent. Our study suggests that designing a search engine that is privacy savvy and avoids issues with filter bubbles that can result from user-tracking is necessary but insufficient; instead, mechanisms should be developed to test search engines from the perspective of information quality (particularly for health-related webpages) before they can be deemed trustworthy providers of public health information. (shrink)

REIMER‐KIRKHAM S, SHARMA S, PESUT B, SAWATZKY R, MEYERHOFF H and COCHRANE M. Nursing Inquiry 2012; 19: 202–212 Sacred spaces in public places: religious and spiritual plurality in health careSeveral intriguing developments mark the role and expression of religion and spirituality in society in recent years. In what were deemed secular societies, flows of increased sacralization (variously referred to as ‘new’, ‘alternative’, ‘emergent’ and ‘progressive’ spiritualities) and resurgent globalizing religions (sometimes with fundamentalist expressions) are resulting in unprecedented plurality. These shifts (...) are occurring in conjunction with increasing ethnic diversity associated with global migration, as well as other axes of difference within contemporary society. Democratic secular nations such as Canada are challenged to achieve social cohesion in the face of growing religious, spiritual and ethnic diversity. These challenges are evident in the high‐paced, demanding arena of Health care. Here, religious and spiritual plurality enter in, sometimes resulting in conflict between medical services and patients’ beliefs, other times provoking uncertainties on the part of healthcare professionals about what to do with their own religiously or spiritually grounded values and beliefs. In this paper, we present selected findings from a 3‐year study that examined the negotiation of religious and spiritual pluralism in Health care. Our focus is on the themes of ‘sacred’ and ‘place’, exploring how the sacred – that which is attributed as special and set apart as it pertains to the divine, transcendence, God or higher power – takes form in social and material spaces in hospitals. (shrink)

Introduction Quality improvement is the systematic seeking of improvements in care and experience. This discussion paper will explore how the principles of good clinical care and the established ethical frameworks for research can help guide its practice, using examples from palliative care. Quality improvement in palliative care Palliative care is well positioned to be at the vanguard of quality improvement in healthcare. But it holds ethical particularities which require specific considerations, that are helpful for other specialities. The experiences of two (...) improvement activities in palliative care, the Liverpool Care Pathway and Do Not Attempt Resuscitation status reviews, illustrate potential dangers of QI. Implications for ethical practice Recommendations for ethically sound quality improvement projects in palliative care include paying attention to the burden of time, viewing informed consent as a tool, monitoring for vulnerability and coercion and transparency in the use of data. The ethics and practices in clinical encounters provide a framework for approaching consent and protecting those with palliative care needs who are deemed as vulnerable. It is explicit in palliative care that time and energy are precious and finite resources. These must be valued and respected in any quality improvement projects. Respect for beneficence and autonomy is essential to avoid coercion and for any project to be ethically sound. Conclusion Quality improvement processes are an integral part of good healthcare practices. High ethical standards, a supportive culture, transparency and candour are needed for the promotion and sustainability of quality improvement in palliative care. (shrink)

Many commentators have contrasted the way that sociability is theorized in the writings of Mary Astell and Damaris Masham, emphasizing the extent to which Masham is more interested in embodied, worldly existence. I argue, by contrast, that Astell's own interest in imagining a constitutively relational individual emerges once we pay attention to her use of religious texts and tropes. To explore the relevance of Astell's Christianity, I emphasize both how Astell's Christianity shapes her view of the individual's relation to (...) society and how Masham's contrasting views can be analyzed through the lens of her charge that Astell is an “enthusiast.” In late seventeenth-century England, “enthusiasm” was a term of abuse that, commentators have recently argued, could function polemically to dismiss those deemed either excessively social or antisocial. By accusing Astell of enthusiasm, I claim, Masham seeks to marginalize the relational self that Astell imagines and to promote a more instrumental view of social ties. I suggest some aspects of Astell's thought that may have struck contemporaries as “enthusiastic” and contrast her vision of the self with Masham's more hedonistic subject. I conclude that, although each woman differently configures the relation between self and society, they share a desire to imagine autonomy within a relational framework. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Last Man by Mary ShelleyJennifer A. Wagner-LawlorMary Shelley. The Last Man. 1826. Edited by Chris Washington. Norton Critical Editions. New York: W. W. Norton, 2023. xxiv + 571 pp. Paperback, ISBN 9780393887822.New critical editions of well-known literary works serve several important functions, and those designed specifically for students serve two of the most important: to introduce readers to texts that were overlooked during and since the (...) author’s time, but that might find greater favor today; and to re-introduce to a new generation of students classic texts that have lost critical favor or been neglected. Mary Shelley’s The Last Man (1826) is a novel long overshadowed by brilliance and resilient legacy of her first novel, Frankenstein (1818), written at a mere eighteen years of age. As so often happened to nineteenth-century women who published under their own names, both Frankenstein and The Last Man were hammered critically by male reviewers (and often by the few female ones) unable to believe any woman, and certainly no “good” woman, could compose these stories. And by 1826, Mary Shelley had already gained notoriety thanks to her association with the radical politics and “free-loving” Shelley-Byron circle). No wonder then that contemporaneous reviewers—even as they brought themselves to compliment the narratological and formal accomplishment the novel represents—could not countenance either its content or its author, as the novel “violated” certain forms of literary and gender propriety: indeed, the novel was deemed the product of a “diseased imagination” (The Monthly Review).Modern assessments of the novel are far more admiring of Shelley’s sophisticated examination of national and cultural mythic structuralizations, and receptive to the boldness of Shelley’s profoundly ironical assessments of them. In this new Norton Critical Edition of The Last Man, Chris Washington comes to the text with a refreshingly undeferential approach to Shelley’s Romantic forebears and immediate companions. Not because they [End Page 582] deserve being knocked off their pedestals, but because—granting all that—Shelley’s text has a lot more to give to us. This is the first time the Norton Critical Edition series has produced an annotated critical edition of The Last Man (Broadview’s appeared in 1996), and it is therefore both welcome and well overdue. For this reader, The Last Man is in some ways arguably superior to Frankenstein, certainly better written and developed. Frankenstein packs the greater punch, but The Last Man picks up and reweaves, on a much larger loom, the same thematic threads: justice and judgment; hospitality and generosity; family love and ethical obligation to community and nation; “civilized” and “wild” spaces. These themes are figured not only in terms of landscape but also in terms of geopolitical organization (i.e., the West vs. “the East,” presumed source of the virus); the bounded- vs. unbound-ness of the creative imagination (also tied to cultural notions of civilization and wilderness); solitude and loneliness; alienness and otherness; alienation and self-alienation and/as dehumanization; the human and the posthuman. While part of Frankenstein’s greatness is its narrative concision and stylistic spareness, the greatness of The Last Man, written by the more mature writer, intellectually and technically (and without the interference of Percy Shelley), is how fully Shelley “fleshes out” those entanglements in this later novel.Setting aside therefore the inclusion of “the usual suspects” (xx) of earlier editions, Washington gives space to critical approaches that are not focused so intensely on the influences of Shelley’s biography. In an excellent introduction Washington emphasizes the various ways in which this novel opens up to (still) intractable political and human rights issues: slavery, imperialism, nonheteronormative genders and sexualities, and precarious lives.Washington addresses particularly what Shelley’s text has to offer—and does offer—to today’s students. He shares his own experience of teaching this novel during COVID times, finding the students, used to speed of communication and multimedia delivery, resistant initially to the narrative’s pacing, and reintroducing them to the pleasures of the slow build-up of plot and setting, as well as the excruciating tension of watching a slow-burn approach to seemingly unavoidable catastrophe. But Washington rejects... (shrink)

Mary Kate McGowan’s Just Words offers an interesting account of exercitives. On McGowan’s view, one of the things we do with words is change what’s permitted, and we do this ubiquitously, without any special authority or specific intention. McGowan’s account of exercitives is meant to identify a mechanism by which ordinary speech is harmful, and which justifies the regulation of such speech. It is here that I part ways. I make three main arguments. First, McGowan’s focus on harm is (...) misguided; that ordinary speech is harmful is harder to support, and in turn does not less to support conclusions about whether it is wrong and warrants regulation, than Just Words suggests. Second, if the speech is harmful, McGowan’s account of exercitives is ill-suited to explain why; the relevant instances of ordinary speech seem to express speakers’ views about moral norms, not change social norms. Third, McGowan’s argument for why ordinary speech should be regulated because it is a form of discrimination presupposes a great deal that is controversial about what makes discrimination wrong and legally actionable, and even if it is right it may license the regulation of more speech than many, including McGowan, would deem acceptable. (shrink)

Plato famously promised to complement the Sophist and the Statesman with another work on a third sort of expert, the philosopher--but we do not have this final dialogue. Mary Louise Gill argues that Plato promised the Philosopher, but did not write it, in order to stimulate his audience and encourage his readers to work out, for themselves, the portrait it would have contained. The Sophist and Statesman are themselves members of a larger series starting with the Theaetetus, Plato's investigation (...) of knowledge, and the whole series relies on the Parmenides, the second part of which presents a philosophical exercise, introduced as the first step in a larger philosophical program. Gill contends that the dialogues leading up to the missing Philosopher, though they reach some substantive conclusions, are philosophical exercises of various sorts designed to train students in dialectic, the philosopher's method; and that a second version of the Parmenides exercise, closely patterned on it, spans parts of the Theaetetus and Sophist and brings the philosopher into view. This is the exercise about being, the subject-matter studied by Plato's philosopher. Plato hides the pieces of the puzzle and its solution in plain sight, forcing his students (and modern readers) to dig out the pieces and reconstruct the project. Gill reveals how, in finding the philosopher through the exercise, the student becomes a philosopher by mastering his methods. She shows that the target of Plato's exercise is internally related to its pedagogical purpose. (shrink)

This book presents the views of 22 women philosophers from outside the Greco-Roman and Judeo-Christian worlds. These eminent thinkers are from Mesopotamia, India, Tibet, China, Korea, Japan, Australia, America, the Philippines and Nigeria. Six philosophers, the earliest of whom predates the Greek pre-Socratics by two thousand years, lived at “the dawn of philosophy”; another six from late Antiquity through the Classical period; five more taught and wrote during the Middle Ages up to the Age of Exploration, and yet five others (...) were active during the modern period to the mid-twentieth century. Most belonged to major philosophical traditions: Hinduism, Buddhism, Confucianism, Taoism, Zen, or Sufism. The chapters of the book describe the life and views of the philosophers, outline the fundamental features of their respective schools, and contain translations of their writings. The book is intended for scholars of philosophy and women’s studies who wish to expand their knowledge of non-Western philosophical traditions and is ideally suited for undergraduate education. Comprehensive multilingual bibliographies of carefully documented sources offer scholars many promising resources for further research. (shrink)

"Charming, interesting, thought-provoking and a great read." Rosalind Hursthouse The daughter of a pacifist rector who answered "No!" when his congregation asked him "Is everything in the bible true?", perhaps Mary Midgley was destined to become a philosopher. Yet few would have thought this inquisitive, untidy, nature-loving child would become "one of the sharpest critical pens in the west." This is her remarkable story. Probably the only philosopher to have been in Vienna on the eve of its invasion by (...) Nazi Germany in 1938 and dance in Trafalgar Square on VE day seven year later, she studied philosophy at Oxford in the same year as Iris Murdoch, Elizabeth Anscombe and Philippa Foot, all of whom became close friends. Midgley tells us in vivid and humorous fashion how they cut a swathe through the arid landscape of 1950s British philosophy, writing and arguing - often with each other - about the grand themes of character, beauty and the meaning of rudeness while the spectral figure of Ludwig Wittgenstein hovered in the background. She also charts the highs and lows of philosophy and academia in Britain. On joining the Reading philosophy department on £400 a year in 1949, she doubled its staff complement. But her many years at Newcastle University - where Mike Brearley, who later captained England at cricket, also used to teach - were rewarded with the closure of the philosophy department in the 1980s. The mother of three children, her journey is also one of a woman who in the 1950s and 1960s was fighting to combine a professional career with raising a family. In startling contrast to many of the academic stars of her generation, we learn that Midgley nearly became a novelist and started writing philosophy only when in her fifties, suggesting that Minerva's owl really does fly at dusk. Plainly told like her philosophy, this is an elegiac and moving account of friendships found and lost, bitter philosophical battles and of a profound love of teaching all too rarely acknowledged today. (shrink)

Reading the Shape of Nature vividly recounts the turbulent early history of the Museum of Comparative Zoology at Harvard and the contrasting careers of its founder Louis Agassiz and his son Alexander. Through the story of this institution and the individuals who formed it, Mary P. Winsor explores the conflicting forces that shaped systematics in the second half of the nineteenth century. Debates over the philosophical foundations of classification, details of taxonomic research, the young institution's financial struggles, and the (...) personalities of the men most deeply involved are all brought to life. In 1859, Louis Agassiz established the Museum of Comparative Zoology to house research on the ideal types that he believed were embodied in all living forms. Agassiz's vision arose from his insistence that the order inherent in the diversity of life reflected divine creation, not organic evolution. But the mortar of the new museum had scarcely dried when Darwin's Origin was published. By Louis Agassiz's death in 1873, even his former students, including his son Alexander, had defected to the evolutionist camp. Alexander, a self-made millionaire, succeeded his father as director and introduced a significantly different agenda for the museum. To trace Louis and Alexander's arguments and the style of science they established at the museum, Winsor uses many fascinating examples that even zoologists may find unfamiliar. The locus of all this activity, the museum building itself, tells its own story through a wonderful series of archival photographs. (shrink)

Children show increasing control of emotions and behavior during their early years. Our studies suggest a shift in control from the brain’s orienting network in infancy to the executive network by the age of 3—4 years. Our longitudinal study indicates that orienting influences both positive and negative affect, as measured by parent report in infancy. At 3—4 years of age, the dominant control of affect rests in a frontal brain network that involves the anterior cingulate gyrus. Connectivity of brain structures (...) also changes from infancy to toddlerhood. Early connectivity of parietal and frontal areas is important in orienting; later connectivity involves midfrontal and anterior cingulate areas related to executive attention and self-regulation. (shrink)

Developing and implementing artificial intelligence (AI) systems in an ethical manner faces several challenges specific to the kind of technology at hand, including ensuring that decision-making systems making use of machine learning are just, fair, and intelligible, and are aligned with our human values. Given that values vary across cultures, an additional ethical challenge is to ensure that these AI systems are not developed according to some unquestioned but questionable assumption of universal norms but are in fact compatible with the (...) societies in which they operate. This is particularly pertinent for AI research and implementation across Africa, a ground where AI systems are and will be used but also a place with a history of imposition of outside values. In this paper, we thus critically examine one proposal for ensuring that decision-making systems are just, fair, and intelligible—that we adopt a principle of explicability to generate specific recommendations—to assess whether the principle should be adopted in an African research context. We argue that a principle of explicability not only can contribute to responsible and thoughtful development of AI that is sensitive to African interests and values, but can also advance tackling some of the computational challenges in machine learning research. In this way, the motivation for ensuring that a machine learning-based system is just, fair, and intelligible is not only to meet ethical requirements, but also to make effective progress in the field itself. (shrink)

Bruno Latour, as part of his advocacy of science studies urges us to move beyond what he calls ‘the Modernist Settlement’ that, among other things, separated science from politics and subject from object. As part of this project he has frequently called for the abolition of epistemology, including quite specifically the historical epistemology/epistemological history of Gaston Bachelard and Georges Canguilhem. Pierre Bourdieu, on the other hand, deploys the resources of historical epistemology, to dismiss Latour’s science studies. After examining the charges (...) against historical epistemology and their rebuttal, I rule in favor of the defense. However, I also suggest that Latour raises genuine concerns about how to equip ourselves to tackle problems such as those associated with climate change; these are problems that require engagement with the politics of nature, with the politics of the sciences of nature and with the epistemological challenges associated with the need to deploy multiple disciplines in the service of complex, practical, policy-relevant problem solving. (shrink)

In this paper, we argue that to properly understand our commitment to a principle of free speech, we must pay attention to what should count as speech for the purposes of such a principle. We defend the view that ‘speech’ here should be a technical term, with something other than its ordinary sense. We then offer a partial characterization of this technical sense. We contrast our view with some influential views about free speech , and show that our view has (...) distinct advantages. Finally, we consider racist hate speech. Here, we argue that if certain theorists are right about what some racist hate speech does, then such speech should fall outside the scope of the free speech principle, and so, should be as regulable as any non-speech action. (shrink)

In C.S. Lewis's science fiction parable Perelandra was a planet which had no solid ground. At all times the floating landscape was continually swirling and moving, chasms would appear where a minute before there had been safe standing. The rational beings who lived there hopped nimbly on to another little island when the one on which they stood disappeared under their feet. They were used to it and took it for granted that nothing was certain. The visitor from our planet (...) had to learn a completely new way of existence. But where did he get his idea of certainty in a fixed environment? It is more plausible that uncertainty is normal and the whole idea of certainty an illusion. Today gives an opportunity to reflect on how people deal with skepticism, doubt and uncertainty.The questions apply to a current debate in the UK on risk. Opinion polls constantly reveal that the public lacks trust in government, and particularly it does not trust the government to reveal the information needed to assess important risks. From which the risk analysts conclude that the government should grant access to information more freely and encourage enquiry. They believe that openness would foster a better understanding on the part of the public which at present does not know what to believe. More information would create certainty, more certainty and the public would trust its spokesmen, unreasonable fears would be calmed. This is the advice of an expert enquiry.Certainty is not a mood, or a feeling, it is an institution: this is my thesis. Certainty is only possible because doubt is blocked institutionally: most individual decisions about risk are taken under pressure from institutions. If we recognize more uncertainty now, it will be because of things that have happened to the institutional underpinning of our beliefs. And that is what we ought to be studying. In my student days the hottest controversies in anthropology were about why `other people' — that is people not living in advanced capitalist society — had certainty about their absurd beliefs.When trying to explain their misfortunes, why did they neglect the physical and scientific evidence, and draw instead on their beliefs in spirits, magic, and taboos? How could they be so obstinate in error? Anthropologists spent their energies on defending the allegedly irrational beliefs of other people, and I shall continue the tradition. (shrink)

M. M. McCabe presents a selection of her essays which explore the Platonic method of conversation: how it may inform our understanding both of Plato and of his predecessors and successors, and how its centrality accounts for the connections between argument, knowledge, and virtue in the texts McCabe examines.

Personalised medicine has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these challenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells so as to make individualised treatment predictions. We compare this strategy to two main PM strategies—stratified medicine and (...) computational models. Drawing on epistemological work in the philosophy of medicine, we explain why these two methods, while powerful, are neither truly personalised nor, epistemologically speaking, novel strategies. Both are forms of correlational black box. We then argue that the iPSC models would count as a new kind of black box. They would not rely entirely on mechanistic knowledge, and they would utilise correlational evidence in a different way from other strategies—a way that would enable personalised predictions. In arguing that the iPSC models would present a novel method of gaining evidence for clinical practice, we provide an epistemic analysis that can help to inform the practical, regulatory, and ethical challenges of developing an iPSC system. (shrink)

Cover -- Half Title -- Title Page -- Copyright Page -- Contents -- Notes on Contributors -- Introduction to the Series -- Acknowledgements -- 1. Introduction -- 2. Oral History as Genre -- 3. Silences -- 4. A Brazilian Worker's Autobiography in an Unexpected Form -- 5. Family Fables -- 6. Anecdote as Narrative Resource in Working-Class Life Stories -- 7. My Life as Consumer -- 8. Distant Homes, Our Genre -- 9. The Oral History Interview in a Cross-Cultural Setting (...) -- 10. In the Archieve, In the Field -- 11. Sharing and Resharing Life Stories -- Raphael Samuel -- Raphael Samuel -- A Call for Contributors -- Index. (shrink)

A long-standing tradition presents economic activity in terms of the flow of fluids. This metaphor lies behind a small but influential practice of hydraulic modelling in economics. Yet turning the metaphor into a three-dimensional hydraulic model of the economic system entails making numerous and detailed commitments about the analogy between hydraulics and the economy. The most famous 3-D model in economics is probably the Phillips machine, the central object of this paper.

In the preface to the Principia (1687) Newton famously states that “geometry is founded on mechanical practice.” Several commentators have taken this and similar remarks as an indication that Newton was firmly situated in the constructivist tradition of geometry that was prevalent in the seventeenth century. By drawing on a selection of Newton's unpublished texts, I hope to show the faults of such an interpretation. In these texts, Newton not only rejects the constructivism that took its birth in Descartes's Géométrie (...) (1637); he also presents the science of geometry as being more powerful than his Principia remarks may lead us to believe. (shrink)

Conscientious objection has become a divisive topic in recent bioethics publications. Discussion has tended to frame the issue in terms of the rights of the healthcare professional versus the rights of the patient. However, a rights-based approach neglects the relational nature of conscience, and the impact that violating one’s conscience has on the care one provides. Using medical assistance in dying as a case study, we suggest that what has been lacking in the discussion of conscientious objection thus far is (...) a recognition and prioritising of the relational nature of ethical decision-making in healthcare and the negative consequences of moral distress that occur when healthcare professionals find themselves in situations in which they feel they cannot provide what they consider to be excellent care. We propose that policies that respect the relational conscience could benefit our healthcare institutions by minimising the negative impact of moral distress, improving communication among team members and fostering a culture of ethical awareness. Constructive responses to moral distress including relational cultivation of moral resilience are urged. (shrink)

Philosophers of science studying scientific practice often consider it a methodological requirement that their conceptualization of "model" closely connects with the understanding and use of models by practicing scientists. Occasionally, this connection has been explicitly made (Hutten 1954, Suppes 1961, Morgan and Morrison 1999, Bailer-Jones 2002, Lehtinen and Kuorikoski 2007, Kuorikoski 2007, Morgan 2012a). These studies have been dominated by a focus on the—relatively similar forms of—mathematical models in physics and economics. Yet it has become increasingly evident that the way (...) models are conceptualized is very different in some other sciences, where philosophers' accounts of models' characteristics and .. (shrink)