Disorders of consciousness (DOC) are a family of related neurological syndromes characterized by deficits of varying degrees of wakefulness (e.g., sleep–wake cycles and arousal) or awareness (e.g., reacting to stimuli, interacting with the environment). Although coma rarely persists for more than a few weeks, some patients remain in a subsequent vegetative state or a minimally conscious state for months or years. Caring for patients with DOC raises ethical questions, but the perspectives of healthcare providers on these questions remain poorly documented. (...) We conducted a qualitative study involving healthcare providers with different backgrounds. Semistructured interviews were used to explore attitudes toward ethical issues. We found that contextual (e.g., time, resource allocation) and relational aspects (e.g., communication process, families) shaped how ethical challenges surfaced and were managed. We call for greater awareness of contextual, institutional and social aspects and focus on these issues in training programs. (shrink)

In the care of patients with disorders of consciousness (DOC), some ethical difficulties stem from the challenges of accurate diagnosis and the uncertainty of prognosis. Current neuroimaging research on these disorders could eventually improve the accuracy of diagnoses and prognoses and therefore change the context of end-of-life decision making. However, the perspective of healthcare professionals on these disorders remains poorly understood and may constitute an obstacle to the integration of research. We conducted a qualitative study involving healthcare professionals from an (...) acute care university medical center. A short questionnaire captured demographic data as well as the experience of participants with DOC patients. A semi-structured interview was used to explore attitudes toward ethical issues identified in a previous literature review. Qualitative content analysis of interviews was conducted with the NVivo software. Accurate diagnosis among DOC is often regarded as a challenge, but this was generally not the case for our participants because most reported high confidence in DOC diagnoses. However, participants reported struggling with prognosis, especially because of its essential role for end-of-life decision making and communication with families. Variability of opinion between healthcare professionals was reported and identified by some as a minor issue while others stressed how families struggle with different medical opinions. End-of-life decision making encompassed a large proportion of ethical challenges in these patients, and the removal of artificial nutrition and hydration created significant discomfort in a minority of participants. The concept of futility was subject to wide-ranging understandings with both favorable and unfavorable opinions. Our data suggest that to ensure the incorporation of new evidence-based advances, attention should be directed to the real-world practices and challenges of accurate diagnosis and prognosis. Given pervasive challenges in end-of-life care, we recommend improved training of healthcare professionals in the care of patients with DOC, particularly in end-of life care, understanding the context of decision making, and determining how to optimally integrate new neuroscience research on the care of patients with DOC. (shrink)

The Ways that Big History Works: Cosmos, Life, Society and our Future reflects on how Big History helps us understand the nature of our existence and consider the pathways to our future.

Our exploratory study considers whether the internal audit function is an efficient “third line of defense” for risk management and control as proposed by The Institute of Internal Auditors. To that end, we interview chief audit executives and experienced internal auditors to examine whether CAEs manage the impressions of audit committee members in the annual accountability process. We also provide an illustration of impression management techniques through a documentary case that explores a unique and exclusive dataset consisting of the main (...) guidance, framework, and accountability documents of one of these organizations. Our analysis highlights how several macro- and microimpression management techniques were used to burnish the image of internal auditors and, more importantly, the management team. Rather than monitoring managers, the CAEs team up with them. Our findings cast doubts on the conceptualization of internal audit as the independent third line of defense envisioned to be a keystone of the governance mosaic. This study supports other research that questions the effectiveness of internal auditing as a governance mechanism. It also contributes to the impression management literature by exposing impression management practices that occur through a private reporting channel—the internal audit function’s annual accountability to the audit committee. Last but not least, significant ethical concerns are raised in regard to internal audit, and research is urged in that area. (shrink)

As doctoral students from New Zealand and Australia, advised by supervision teams with a diversity of critical realist experience from limited to none, we came independently to the 2018 Critical Re...

The advanced donation program was proposed in 2014 to allow an individual to donate a kidney in order to provide a voucher for a kidney in the future for a particular loved one. In this article, we explore the logistical and ethical issues that such a program raises. We argue that such a program is ethical in principle but there are many logistical issues that need to be addressed to ensure that the actual program is fair to both those who (...) do and do not participate in this program. (shrink)

During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift—to some degree—from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by “crisis standards of care,” but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude (...) certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities. (shrink)

Teaching is not testimony. Although both convey information, they have different uptake requirements. Testimony aims to impart information and typically succeeds if the recipient believes that informationon account of having been told by a reliable informant. Teaching aims to equip learners to go beyond the information given—to leverage that information to broaden, deepen, and critique their current understanding of a topic. Teaching fails if the recipients believe the information only because it is what they have been told.

Clinical research is a necessity if effective and safe treatments are to be developed. However, this may well include the need for research that is best described as ‘invasive’ in that it may be associated with some discomfort or inconvenience. Limitations in the undertaking of invasive research involving people with intellectual disabilities (ID) are perhaps related to anxieties within the academic community and among ethics committees; however, the consequence of this neglect is that innovative treatments specific to people with ID (...) may not be developed. Such concerns are likely to continue while there is limited published knowledge regarding the actual experiences of people with ID who have participated in invasive clinical research. As part of a pilot study trialling the novel use of a surgically inserted device to curb overeating in people with Prader–Willi syndrome (PWS) we have investigated the experience of research through semistructured qualitative interviews involving three participants and their carers. Thematic analysis revealed that the adults with PWS and their family carers rated their participation positively, seeing it as a rewarding and enriching experience. This brief report discusses findings from our interview data in order to highlight strategies which may ensure that research is acceptable to participants, meets the necessary ethical standards and is able to achieve the aims set out by the researchers. To our knowledge, this is the first study to record experiences directly from people with PWS and their carers regarding their involvement in invasive clinical research. (shrink)

I start by asking what Aristotle knew (or thought) about Heraclitus: what were the key features of Heraclitus's philosophy as far as Aristotle was concerned? In this section of the paper I suggest that there are some patterns to Aristotle's references to Heraclitus: besides the classic doctrines (flux, ekpyrosis and the unity of opposites) on the one hand, and the opening of Heraclitus's book on the other, Aristotle knows and reports a few slightly less obvious sayings, one of which is (...) in my title. Secondly, I ask some further questions. Is there any systematic connection between the bits that Aristotle reports? Do they hang together? Ought we to see here some relic of an Aristotelian understanding of what made Heraclitus tick? If we juxtapose these themes and Aristotle's comments on them, I suggest, we can generate some suggestive motifs, in particular a rather curious fascination with smoking, and the pleasures of inhaling. Finally, I suggest that smells (and the way the world would be if smells were the only differences to be discerned) are important in understanding what Heraclitus was doing. (shrink)

Sanford Goldberg’s account of epistemic coverage constitutes a special case of Douglas Walton’s view that epistemic closure arises from dialectical argument. Walton’s pragmatic version of epistemic closure depends on dialectical norms for closing an argument, and epistemic coverage operates at the limits of argument closure because it minimizes dialectical exchange. Such closure works together with a shared hypothetical consideration to justify dismissal of surprising claims.

An understanding of the nature and development of nursing intuition can help nurse educators foster it in young nurses and give clinicians more confidence in this aspect of their knowledge, allowing them to respond with greater assurance to their intuitions. In this paper, accounts from philosophy and neurophysiology are used to argue that intuition, specifically nursing intuition, is a valid form of knowledge. The paper argues that nursing intuition, a kind of practical intuition, is composed of four distinct aspects that (...) include: embodied knowledge rather like that knowledge we have when we have learned to ride a bicycle; well‐trained sensory perceptions attentive to subtle details of complex, often rapidly changing situations; a significant store of pertinent conceptual knowledge; and a history of habitual actions intentionally directed towards achieving the best outcomes for our patients. Contemporary neurophysiology research strongly suggests that human persons experience other persons such that they directly understand the meaning of a variety of different human actions, intentions, emotions, and sensations in immediate, non‐reflective, and non‐conceptual perceptions. This research is supported by the philosophical theories of Jacques Maritain and Yves R. Simon found in their accounts of practical knowledge. Together, these accounts offer us a rich view of the reality of nursing intuition that helps us understand why we find intuitive actions in some but not all nurses and gives us some specific information about how to develop intuition in young nurses. Finally, this research shows us a path for further research. (shrink)

Smoking is frequently presented as being particularly problematic when the smoker is a pregnant woman because of the potential harm to the future child. This premise is used to justify targeting pregnant women with a unique approach to smoking cessation including policies such as the routine testing of all pregnant women for carbon monoxide at every antenatal appointment. This paper examines the evidence that such policies are justified by the aim of harm prevention and argues that targeting pregnant women in (...) this way is likely to do more harm than good. Routine carbon monoxide testing is particularly problematic as it sends a message to pregnant women that they cannot be trusted either to truthfully answer questions as to whether or not they smoke, or to make decisions in the best interests of themselves and their future children in the way that non-pregnant individuals are. Further, if the aim is to reduce rates of prenatal harm, the evidence suggests that adopting a supportive and empowering approach to prenatal care is the most effective way to achieve this, something that the current policies aimed at pregnant women are in conflict with. (shrink)

The development of genomics has dramatically expanded the scope of genetic research, and collections of genetic biosamples have proliferated in countries with active genomics research programs. In this essay, we consider a particular kind of collection, national biobanks. National biobanks are often presented by advocates as an economic ‘‘resource’’ that will be used by both basic researchers and academic biologists, as well as by pharmaceutical diagnostic and clinical genomics companies. Although national biobanks have been the subject of intense interest in (...) recent social science literature, most prior work on this topic focuses either on bioethical issues related to biobanks, such as the question of informed consent, or on the possibilities for scientific citizenship that they make possible. We emphasize, by contrast, the economic aspect of biobanks, focusing specifically on the way in which national biobanks create biovalue. Our emphasis on the economic aspect of biobanks allows us to recognize the importance of what we call clinical labor—that is, the regularized, embodied work that members of the national population are expected to perform in their role as biobank participants—in the creation of biovalue through biobanks. Moreover, it allows us to understand how the technical way in which national biobanks link clinical labor to databases alters both medical and popular understandings of risk for common diseases and conditions. (shrink)

Cognitive advancement is not always a matter of acquiring new information. It often consists in reconfiguration--in reorganizing a domain so that hitherto overlooked or underemphasized features, patterns, opportunities, and resources come to light. Several modes of reconfiguration prominent in the arts--metaphor, fiction, exemplification, and perspective--play important roles in science as well. They do not perform the same roles as literal, descriptive, perspectiveless scientific truths. But to understand how science advances understanding, we need to appreciate the ineliminable cognitive contributions of non-literal, (...) non-descriptive symbols. (shrink)

In this paper, I argue for an account of metaphorical content as what is said when a speaker utters a metaphor. First, I show that two other possibilities—the Gricean account of metaphor as implicature and the strictly semantic account developed by Josef Stern—face several serious problems. In their place, I propose an account that takes metaphorical content to cross-cut the semantic-pragmatic distinction. This requires re-thinking the notion of metaphorical content, as well as the relation between the metaphorical and the literal.

_After Writing_ provides a significant contribution to the growing genre of works which offers a challenge to modern and postmodern accounts of Christianity.

Much discussion of meaning by philosophers over the last 300 years has been predicated on a Cartesian first-person authority (i.e. “infallibilism”) with respect to what one’s terms mean. However this has problems making sense of the way the meanings of scientific terms develop, an increase in scientific knowledge over and above scientists’ ability to quantify over new entities. Although a recent conspicuous embrace of rigid designation has broken up traditional meaning-infallibilism to some extent, this new dimension to the meaning of (...) terms such as “water” is yet to receive a principled epistemological undergirding (beyond the deliverances of “intuition” with respect to certain somewhat unusual possible worlds). Charles Peirce’s distinctive, naturalistic philosophy of language is mined to provide a more thoroughly fallibilist, and thus more realist, approach to meaning, with the requisite epistemology. Both his pragmatism and his triadic account of representation, it is argued, produce an original approach to meaning, analysing it in processual rather than objectual terms, and opening a distinction between “meaning for us”, the meaning a term has at any given time for any given community and “meaning simpliciter”. the way use of a given term develops over time (often due to a posteriori input from the world which is unable to be anticipated in advance). This account provocatively undermines a certain distinction between “semantics” and “ontology” which is often taken for granted in discussions of realism. (shrink)

Testimony consists in imparting information without supplying evidence or argument to back one’s claims. To what extent does testimony convey epistemic warrant? C. J. A. Coady argues, on Davidsonian grounds, that (1) most testimony is true, hence (2) most testimony supplies warrant sufficient for knowledge. I appeal to Grice’s maxims to undermine Coady’s argument and to show that the matter is more complicated and context-sensitive than is standardly recognized. Informative exchanges take place within networks of shared, tacit assumptions that affect (...) the scope and strength of our claims, and the level of warrant required for their responsible assertion. The maxims explain why different levels of warrant are transferred in different contexts. (shrink)

Issues of balancing data accessibility with ethical considerations and governance of a genomics research biobank, Generation Scotland, are explored within the evolving policy landscape of the past ten years. During this time data sharing and open data access have become increasingly important topics in biomedical research. Decisions around data access are influenced by local arrangements for governance and practices such as linkage to health records, and the global through policies for biobanking and the sharing of data with large-scale biomedical research (...) data resources and consortia. We use a literature review of policy relevant documents which apply to the conduct of biobanks in two areas: support for open access and the protection of data subjects and researchers managing a bioresource. We present examples of decision making within a biobank based upon observations of the Generation Scotland Access Committee. We reflect upon how the drive towards open access raises ethical dilemmas for established biorepositories containing data and samples from human subjects. Despite much discussion in science policy literature about standardisation, the contextual aspects of biobanking are often overlooked. Using our engagement with GS we demonstrate the importance of local arrangements in the creation of a responsive ethical approach to biorepository governance. We argue that governance decisions regarding access to the biobank are intertwined with considerations about maintenance and viability at the local level. We show that in addition to the focus upon ever more universal and standardised practices, the local expertise gained in the management of such repositories must be supported. A commitment to open access in genomics research has found almost universal backing in science and health policy circles, but repositories of data and samples from human subjects may have to operate under managed access, to protect privacy, align with participant consent and ensure that the resource can be managed in a sustainable way. Data access committees need to be reflexive and flexible, to cope with changing technology and opportunities and threats from the wider data sharing environment. To understand these interactions also involves nurturing what is particular about the biobank in its local context. (shrink)

This article brings together two excerpts from the forthcoming book, The Weary Sons of Freud (Verso/new Left Books, 1987) by Catherine Clément, translated from the French by Nicole Ball. It also includes an edited version of the book's Introduction by Ann Rosalind Jones. Feminist Review would like to thank her for her help in editing this piece, and also Verso/new Left Books for permission to reproduce these extracts.

Poststructuralism changes the way we understand the relations between human beings, their culture, and the world. Following a brief account of the historical relationship between structuralism and poststructuralism, this Very Short Introduction traces the key arguments that have led poststructuralists to challenge traditional theories of language and culture. Whilst the author discusses such well-known figures as Barthes, Foucault, Derrida, and Lacan, she also draws pertinent examples from literature, art, film, and popular culture, unfolding the poststructuralist account of what it means (...) to be a human being. (shrink)

A study of Hippolytus of Rome and his treatment of Presocratic Philosophy, used as a case study to argue against the use of collections of fragments and in favour of the idea of reading "embedded texts" with attention to the interpretation and interests of the quoting author. A study of methodology in early Greek Philosophy. Includes novel interpretations of Heraclitus and Empedocles, and an argument for the unity of Empedocles's poem.

Having only emerged in the past few decades, Feminist Philosophy is rapidly developing its own thrust in areas of particular importance to feminism-and women more generally-while also reevaluating and reshaping most other fields of philosophy, from ethics to logic and Marxism to environmentalism.

This article proposes three new decompositions of inequality measures, drawn from the framework of cooperative game theory. It allows the impact of players’ interactions, rather than players’ contributions to inequality, to be taken into consideration. These innovative approaches are especially suited for the study of income inequality when the income has a hierarchical structure: the income is composed of several primary sources, with the particularity that each of them is also composed of secondary sources. We revisit the Shapley–Owen value that (...) quantifies the importance of each of these secondary sources in the overall income inequality. Our main contribution is to decompose this importance into two parts: the pure marginal contribution of the considered source and a weighted sum of pairwise interactions. We then provide an axiomatic characterization of each additive interaction decomposable (AID) coalitional value considered in this paper. We give an application of these decompositions in the context of inequality theory. (shrink)

Comment répondre à la crise environnementale et aux menaces qu’elle fait peser sur la poursuite de notre mode de vie? Devons-nous mobiliser nos forces pour lutter contre la crise, changer radicalement nos comportements? Ne faudrait-il pas plutôt veiller à nous adapter à une situation transformée? Ces deux pôles sont présents dans les politiques environnementales. Pour répondre au changement climatique on envisage à la fois des politiques d’atténuation (mitigation) des émissions de gaz à ef...

ABSTRACTThe negativity bias is the tendency for individuals to give greater weight, and often exhibit more rapid and extreme responses, to negative than positive information. Using the Deese-Roediger-McDermott illusory memory paradigm, the current study sought to examine how the negativity bias might affect both correct recognition for negative and positive words and false recognition for associated critical lures, as well as how trait neuroticism might moderate these effects. In two experiments, participants studied lists of words composed of semantic associates of (...) an unpresented word. Half of the lists were comprised of positive words and half were comprised of negative words. As expected, individuals remembered negative list words better than positive list words, consistent with a negativity bias in correct recognition. When tested immediately, individuals also exhibited greater false memory for negative versus positive critical lures. When tested after a 24-hr delay... (shrink)

This paper explores the concept of potential through a Deleuzean lens and argues that what is commonly understood as potential is often confused with possibility. It moves through four parts: an introduction exploring the language and context in which potential is ordinarily used in order to uncover underlying presuppositions; the next section explores key concepts from Difference and Repetition- namely the Dogmatic Image of Thought, Virtuality and Actuality- to illuminate ways in which a more nuanced concept of potential might be (...) understood, arguing that it is a creative process, rather than a fixed characteristic. Next, it explores how improvisation is a way in which potential can be experienced, before finally considering how changes to education practice- specifically a move towards a more mechanised, digitally-orientated world- might be wholly irreconcilable with potential as a creative process of encountering, and risks a much more impoverished concept that is liable to concretion. (shrink)