Background: There is little research into medical students’ or doctors’ attitudes to abortion, yet knowing this is important, as policy makers should be aware of the views held by professionals directly involved in abortion provision and changing views may have practical implications for the provision of abortion in the future. Methods: We surveyed 300 medical students about their views on abortion, their beliefs about the status of the fetus and the rights of the mother, their attitude towards UK law and (...) their willingness to be involved in abortion provision as qualified doctors. Results: 62% of medical students were pro-choice, 33% pro-life and 7% undecided. Students’ views correlated with gender, year of study and holding a religious belief. Their beliefs about abortion, the status of the fetus and the rights of women significantly correlated with their attitudes towards the UK law and their willingness to be involved in abortion provision. Students’ willingness to be involved in abortion provision was related to their views on abortion, the extent of participation required, the circumstances of the pregnancy and the stage of pregnancy. Conclusions: The percentage of pro-choice students was lower than that found in research on general practitioners’ attitudes to abortion. It is unclear whether this is because students become more pro-choice as they progress through their medical career or because there is genuinely a change in attitudes to abortion. (shrink)

Objective: To determine the views of people with multiple sclerosis (MS) and professionals in relation to confidentiality, consent and access to data within a proposed MS register in the UK. Design: Qualitative study using focus groups (10) and interviews (13). Setting: England and Northern Ireland. Participants: 68 people with MS, neurologists, MS nurses, health services management professionals, researchers, representatives from pharmaceutical companies and social care professionals. Results: People with MS expressed open and altruistic views towards the use of their personal (...) information to facilitate service provision and research, placing trust in responsible guardianship and legitimate use of their information. Participant’s proposed that people with MS should be able to select their individual level of involvement in a register using levels of consent. It was agreed that access to the register should be governed by a guardianship committee composed of a range of stakeholders. People with MS did not wish their details to be used by marketing agencies and did not consider this a legitimate use of their data. Whilst participants were positive of the role a register could play in promoting research, participants felt that access to data by pharmaceutical industries should be administered by the guardianship committee. People with MS are concerned should their employers be able to access their personal information. Professionals were more cautious than people with MS in their approach to the use of patient personal data within a register. Conclusions: Whilst all stakeholders were positive of the benefits of an MS register, development of such a resource must incorporate robust data security and guardianship measures in order to ensure that, whilst opportunities are maximised, risks to the privacy of individuals and legal challenges to professionals are avoided. (shrink)

Supported decision making, as outlined by Peterson et al. highlights real-world challenges in the messy context of clinical care. We agree with Peterson et al. that patients...

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study (...) was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)

Traversing the fields of pedagogy, philosophy, and political theory, this book develops a marxist theory of education that will be useful for academics and activists alike. The second edition includes two additional chapters as well as a new preface and revisions throughout.

Background: Clinical ethics consultation services have been established in many countries during recent decades. An important task is to discuss concrete clinical cases. However, empirical research observing what is happening during such deliberations is scarce. Objectives: To explore clinical ethics committees’ deliberations and to identify areas for improvement. Design: A pilot study including observations of committees deliberating a paper case, semistructured group interviews, and qualitative analysis of the data. Participants: Nine hospital ethics committees in Norway. Results and interpretations: Key elements (...) of the deliberations included identifying the ethical problems; exploring moral values and principles; clarifying key concepts and relevant legal regulation; exploring medical facts, the patient’s situation, the therapists’ perspective, analogous clinical situations, professional uncertainties, the patient’s and relatives’ perspective, and clinical communication; identifying the involved parties and how to involve them; identifying possible courses of action, and possible conclusion and follow-up. The various elements were closely interwoven. The content and conclusions varied and seemed to be contingent on the committee members’ interpretations, experience and knowledge. Important aspects of a clinical ethics deliberation were sometimes neglected. When the committees used a deliberation procedure and a blackboard, the deliberations tended to become more systematic and transparent. Many of the committees were insecure about how to include the involved parties and how to document the deliberations. Conclusion: Clinical ethics committees may provide an important arena for multidisciplinary discussions of complex clinical ethics challenges. However, this seems to require adequate composition, adoption of transparent deliberation procedures, and targeted training. (shrink)

In the first monograph on Lyotard and education, Derek R. Ford approaches Lyotard's thought as pedagogical in itself. The result is a novel, soft, and accessible study of Lyotard organized around two inhuman educations: that of "the system" and that of "the human." The former enforces an interminable process of development, dialogue and exchange, while the latter finds its force in the mute, secret, opaque, and inarticulable. Threading together a range of Lyotard's work through four pedagogical processes-reading, writing, voicing, (...) and listening-the author insists on the distinct educational logics that can uphold or interrupt different ways of being-together in the world, touching on a range of topics from literacy and aesthetics to time and political-economy. While Inhuman Educations can serve as an introduction to Lyotard's philosophy, it also constitutes a singular, provocative, and fresh take on his thought. (shrink)

This book is the first to articulate and challenge the consensus on the right and left that knowledge is the key to any problem, demonstrating how the left’s embrace of knowledge productivity keeps it trapped within capital’s circuits. As the knowledge economy has forced questions of education to the forefront, the book engages pedagogy as an underlying yet neglected motor of capitalism and its forms of oppression. Most importantly, it assembles new pedagogical resources for responding to the range of injustices (...) that permeate our world. Building on yet critiquing the Marxist notion of the general intellect, Derek R. Ford theorizes stupidity as a necessary alternative pedagogical logic, an anti-value that is infinitely mute and unproductive. (shrink)

Complex clinical ethics cases require a blend of compassion, sensitivity, and tenacity in order to navigate the hard work required of stakeholders. Each person comes to the table with rich historie...

Background Nursing students must graduate prepared to bravely enact the art and science of nursing in environments infiltrated with ethical challenges. Given the necessity and moral obligation of nurses to engage in discourse within nursing ethics, nursing students must be provided a moral supportive learning space for these opportunities. Situating conversations and pedagogy within a brave space may offer a framework to engage in civil discourse while fostering moral courage for learners. Research Objective The aim of this research is to (...) explore the influence of a structured self-assessment tool called the ESA “Engagement Self-Assessment” on the alignment and creation of a brave space in a nursing ethics course. Research Design This study used an exploratory, cross-sectional survey design. Participants and Study Setting Data from 39 undergraduate nursing students enrolled in a nursing healthcare ethics & law course using the ESA were recruited. Ethical Considerations Participation was voluntary and informed without coercion. Written consent was obtained prior to participation. Research ethics approval was obtained by the Institutional Research Ethics Board of the recruited participants (Ethics # 2022-23-03). Findings The ESA provided structured self-reflection on the impact of shared vulnerability within a brave space. However, commitment to a brave space was not strongly influenced by the ESA, but rather by a mutual “commitment to others.” Conclusion A teaching tool such as an ESA can be used to facilitate instructor expectations of civil discourse and discussion of difficult topics. Rules of engagement such as those found in brave spaces can help transform fear of vulnerability into authentic growth for learners. A morally supportive learning space can support critical opportunities for ethical development. This study provides insight into how self-assessment and the use of a brave space in nursing ethics education can facilitate a morally supportive learning space. (shrink)

Background: Medicine is full of value conflicts. Limited resources and legal regulations may place doctors in difficult ethical dilemmas and cause moral distress. Research on moral distress has so far been mainly studied in nurses. Objective: To describe whether Norwegian doctors experience stress related to ethical dilemmas and lack of resources, and to explore whether the doctors feel that they have good strategies for the resolution of ethical dilemmas. Design: Postal survey of a representative sample of 1497 Norwegian doctors in (...) 2004, presenting statements about different ethical dilemmas, values and goals at their workplace. Results: The response rate was 67%. 57% admitted that it is difficult to criticise a colleague for professional misconduct and 51% for ethical misconduct. 51% described sometimes having to act against own conscience as distressing. 66% of the doctors experienced distress related to long waiting lists for treatment and to impaired patient care due to time constraints. 55% reported that time spent on administration and documentation is distressing. Female doctors experienced more stress that their male colleagues. 44% reported that their workplace lacked strategies for dealing with ethical dilemmas. Conclusion: Lack of resources creates moral dilemmas for physicians. Moral distress varies with specialty and gender. Lack of strategies to solve ethical dilemmas and low tolerance for conflict and critique from colleagues may obstruct important and necessary ethical dialogues and lead to suboptimal solutions of difficult ethical problems. (shrink)

We now live in a world where digital technology is no longer ‘separate, virtual, [or] “other” to a ‘natural’ human and social life’ (Jandrić et al., 2018, p. 893). Contemporary information and comm...

In response to contagion, competing and contradictory movements emerge that engender openness to new modes of life and reactionary defenses of old ones, that acknowledge mutual dependency and vulnerability and that heighten the policing and surveillance of borders. Through reading the Empire project, this article articulates these as struggles over measure that unfold on the terrain of sovereignty and biopolitical economy. We show that the passage from modern to imperial sovereignty hinges on the former’s inability to adequately impose calculatory regimes, (...) to which the latter’s flexibility and fluidity responds. This accompanies the passage from industrial to biopolitical command, from regulation through the wage to rearbitration through extractivism. Having articulated the contemporary coordinates within which the multitude finds itself, we then propose an educational weapon for the struggle against sovereignty and capital: stupidity. Turning to Jean-François Lyotard, we demonstrate just how fundamentally the rule of Empire depends on the outside of measure for its continual reproduction, and how Empire frames the communicative networks of biopolitical labor, a framing from which Hardt and Negri haven’t adequately broken. As the other of thought, as that which can’t be articulated, commanded, or absorbed by capital, stupidity remains totally useless and unproductive for Empire, which is exactly where its potency lies for the multitude. By critically engaging stupidity, we can refrain from reducing the pandemic to a need for heightened immunity and enclosure achieved through articulation. (shrink)

Decisions about targeting medical assistance in humanitarian contexts are fraught with dilemmas ranging from non-availability of basic services, to massive demographic and epidemiological shifts, and to the threat of insecurity and evacuations. Aid agencies are obliged, due to capacity constraints and competing priorities, to clearly define the objectives and the beneficiaries of their actions. That aid agencies have to set limits to their actions is not controversial, but the process of defining the limits raises ethical questions. In MSF, frameworks for (...) resource allocation are subject to constant reflection and reiteration, and perspectives are sought at all levels, from implementers at the programme level to the operational directors at headquarters. The perspectives of the programmes staff hold considerable weight as they have the knowledge and experience with particular communities to assess the degree of vulnerability and need, and are also the people who ultimately have to give explanations to beneficiaries when changes or closures are going to be instituted. Humanitarian agencies have a responsibility to ensuring that their workers are prepared to reflect on these dilemmas, and challenge the status quo when it costs lives. (shrink)

Air is an immersive substance that envelopes us and binds us together, yet it has dominantly been taken for granted and left out of educational and other theorizations. This article develops a conceptualization of the pneumatic common in order to address this gap. The specific intervention staged is within recent educational literature on the common by Noah De Lissovoy, Tyson E. Lewis, and Alexander Means. This literature is surveyed and analyzed in relation to educational theory, curriculum, pedagogy, and policy. Claiming (...) that the air is a central feature of and paradigm for the common, I then concentrate on making the air conditions of the educational common explicit. I do this through a theoretical, historical, and sociological reading of air conditioning. While this explicitation is itself educational, I return to the educational common at the end of the article to ask how and what we can learn in, with, and from the air. (shrink)

The Centre for Communist Studies, an academic research centre staffed by an artistic and comradely collection of early-career researchers, lecturers, educators and workers, started several years ag...

It’s not uncommon for people to make reference to atmospheres, including in relationship with educational spaces. In this article, we investigate educational atmospheres by turning to Western and Chinese literature on the air and wind. We pursue this task in three phases. First, we examine the Western literature to see the possible strings of thought that would help us reinvigorate the element of air/atmosphere as a foundational component of an educational sphere. Second, we historicize the Chinese notion of wind as (...) a style of reasoning which structures ancient Chinese cosmology, tempo-spatiality, teaching, and governing into a grid of intelligibility. Third, we argue for a bracketing of a trap of philology and a signifier-signified representational logic through reconceptualizing the atmosphere as a thing that blurs the material-figural boundary and that pushes into a new genre of educational life. (shrink)

As clinical trials end, little is understood about how participants exiting from clinical trials approach decisions related to the removal or post-trial use of investigational brain implants, such as deep brain stimulation (DBS) devices. This empirical bioethics study examines how research participants experience the process of exit from research at the end of clinical trials of implanted neural devices. Using a modified grounded theory study design, we conducted semi-structured, in-depth interviews with 16 former research participants from clinical trials of DBS (...) and responsive neurostimulation (RNS). Open-ended questions elicited motivations for joining the trial, understanding of study procedures at the time of initial informed consent, the process of exiting from research, and decisions about device removal or post-trial device use. Thematic analysis identified categories related to: limited preparedness for the end of research participation, straightforwardness of decisions to explant or keep the device, reconciling with the end of research participation, reconciling post-trial expectations, and achieving a sense of closure after exit from research. A preliminary theoretical model describes contextual factors influencing the process and experience of exit from research. Experiences of clinical trial participants should guide research practices to enhance the ethical design and conduct of clinical trials in DBS and other brain devices. (shrink)

While there was a flurry of articles throughout the 1990s in philosophy of education on Lyotard, there are still several key concepts in his oeuvre that have import for but remain largely underdeveloped or absent in the field. One of the most interesting of these absent concepts is Lyotard’s notion of the figural. In this paper, I take the figural as an educational problematic and ask what new educational insights it can generate in regard to the existing literature. As such, (...) this article begins with a survey and synthesis of educational literature on Lyotard and the primary work on which most of it is based, exploring the relationship between knowledge, performativity, the differend, and “the system.” I then examine conceptions of education oriented toward defending the differend and disrupting the system and claim that, while helpful, these conceptions are limited in that they do not mention how educators and students might engage the alterity that the system seeks to repress. I believe that it is here that Lyotard’s notion of the figural can be productively engaged. The next section of the paper performs a partial and educationally partisan reading of Discourse, Figure. After this reading I move to formulate a figural education, which is composed of three educational processes and modes of engagement: reading, seeing, and blindness. A figural education, I argue, holds each of these practices in an uncertain and unsettling relation and, in so doing, can help educators defend the figural and the differend against the discursive demands of the system. (shrink)

This paper largely engages with Brian Ellis’s description of categorical dimensions as put forward in his paper in this volume. The New Essentialism advocated by Ellis posits the ontologically-robust existence of both dispositional and categorical properties. I have argued that the distinction that Ellis draws between the two is unpersuasive, and that the causal role of categorical dimensions—what they do—is inseparable from what they are. This observation is reinforced by the fact that absolute physical quantities permit re-interpretations of measurement that (...) remove a clear differentiation between categoricity and dispositionality. Distinguishing between ‘pure power’ and ‘dispositionality’, I further argue that: i) there are no ontologically-robust categorical properties, although their apparent existence is explicable as higher-order and supervenient; ii) that the fundamental ingredients of the world may be accounted for in terms of pure-power that is neither categorical nor dispositional; and iii) that the categorical-dispositional distinction arises only at the higher-order level of objects, and does not in any case constitute ontologically-robust partitioning of reality. -/- . (shrink)

This paper reads Marx’s distinction between the method of inquiry and presentation as distinct and Marxist pedagogical logics that take the form of learning and studying. After articulating the differences and their current conceptualizations in educational theory, I turn to different interpretations of the Grundrisse and Capital. While I note the differences, I maintain these result from Marx’s alternation between learning and studying, to the different weights Marx gives to both. Marx sought to understand, articulate, learn, and relay the precise (...) logics of capital, of its contradictions, and of how the working class has and can seize on these contradictions to institute the revolutionary transition to communism. At the same time, he knew he couldn’t do this because no one can fully delineate and learn about capitalism so long as it exists, as capital is by definition a dynamic social relation. I show how readings of both books are products and productive of Marx’s own pedagogical constellation through their content and form of presentation. The argument is that this is a political and constellational pedagogy that’s contingent and singular rather than resolvable and unifiable. (shrink)

Objectives: To summarise the types of case brought to the Clinical Ethics Committee of the National Hospital of Norway from 1996 to 2002 and to describe and discuss to what extent issues of information/communication have been involved in the ethical problems. Design: Systematic review of case reports. Findings: Of the 31 case discussions, (20 prospective, 11 retrospective), 19 cases concerned treatment of children. Twenty cases concerned ethical problems related to withholding/withdrawing of treatment. In 25 cases aspects of information/communication were involved (...) in the ethical problem, either explicitly (n = 3) or implicitly (n = 22). Conclusion: Problems related to information/communication may underlie a classic ethical problem. Identification of these “hidden” problems may be important for the analysis, and hence, the solution to the ethical dilemma. (shrink)

Seeking to derive the manifestly qualitative world of objects and entities without recourse to fundamental categoricity or qualitativity, I offer an account of how higher-order categorical properties and objects may emerge from a pure-power base. I explore the possibility of ‘fields’ whose fluctuations are force-carrying entities, differentiated with respect to a micro-topology of curled-up spatial dimensions. Since the spacetime paths of gauge bosons have zero ‘spacetime interval’ and no time-like extension, I argue that according them the status of fundamental entities (...) would support a pure-power ontology. Such entities, circulating within self-sustaining micro-topological ‘networks’, feasibly maintain definite spatial configurations of conserved physical quantities, including energy-momentum. Perceived as time-like and massy, and representing fermionic entities, they give rise to the manifest world. (shrink)

Background: Theoretically, the principle of justice is strong in healthcare priorities both nationally and internationally. Research, however, has indicated that questions can be raised as to how this principle is dealt with in clinical intensive care. Objective: The objective of this article is to examine how significant others may affect the principle of justice in the medical treatment and nursing care of intensive care patients. Method: Field observations and in-depth interviews with physicians and nurses in intensive care units (ICU). Emphasis (...) was placed on eliciting the underlying rationale for prioritisations in clinical intensive care with particular focus on clinicians’ considerations when limiting ICU treatment. Results: Significant others could induce an unintentional discrimination of ICU patients. Family members who were demanding received more time and attention for both the patient and themselves. Patients’ and families’ status and position and/or an interesting medical diagnosis seemed to govern the clinicians’ priorities of patients and families—consciously as well as unconsciously. The clinicians emphasised that patient information given through families was important. However, patients’ preferences and values conveyed to clinicians through their families were not always taken seriously. This even applied in cases with very serious prognoses and an explicit patient wish to forego life-prolonging treatment. Conclusion: The principle of justice was violated when qualified attention was given to significant others, and through this also to patients. Attention given to significant others was influenced by the healthcare workers’ professional and personal values, attitudes and interests. (shrink)

In her review of my book, Weili Zhao sheds a new light on what it means to study like a communist, particularly by focusing on the concept of the encounter and the dao movement. In this response, I build on her insights by proposing that the binary and the planar be heterogeneously blocked together. Rather than critical pedagogy, critical education, liberal education, and postmodern education, we need to see pedagogy and politics as hanging together in a confrontational negotiation.

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

In an effort to theorize educational logics that are oppositional to capitalism, this article explores what it means to study like a communist. I begin by drawing out the tight connection between learning and capitalism, demonstrating that education is not a subset but a motor of political-economic relations. Next, I turn to the concept of study, which is being developed as an educational alternative to learning. While studying represents an educational challenge to capitalism, I argue that there are political limitations (...) to studying for which we need to account. Specifically, studying is not in itself political, but only represents the possibility of politics. To make this claim and to address these limitations, I turn to Jodi Dean’s work on the communist Party. Dean posits the Party not as a master, director, or prophet, but as an infrastructure of affective intensity that maintains a gap in the order of things. I show that the Party is one way to organize and to defend study. Throughout the article, I illuminate the ways in which educational philosophers can contribute to political movement building by showing, developing, and refining the educational components of politics that many organizers and theorists neglect. (shrink)