FRANCISCO SUÁREZ, THE GREAT JESUIT PHILOSOPHER AND THEOLOGIAN, has long been recognized as a pivotal figure in the development of Western philosophy. His thought is heavily indebted to the medieval philosophical tradition but also bears striking intimations of key themes in modern thought. In this paper I address one of the most controversial questions related to the thought of Suárez, namely, his relationship to the nominalist tradition. However, I shall do so rather indirectly by focusing not on explicit metaphysical questions (...) but rather on his account of our acquisition of universal concepts and its foundation in reality. By placing questions about the knowledge of singular and universal at the center of the discussion, I hope to shed new light on his account of the objectivity that we can have in our knowledge. (shrink)

Science and technology studies scholars have turned their attention to the materiality of objects and buildings in order to examine what they make users do in practice. Taking a close look at a therapeutic community in a psychiatric day care center for teenagers, this paper joins these discussions by exploring the materiality of “spaces of care” as part of the center’s everyday practice. The analysis incorporates the concepts of scripts and dispositifs to describe the conditions of possibility (...) in which caregivers and youths may position themselves in relation to others and to the space itself. This paper describes how spaces of care offer open, enticing, and variable conditions for fostering a dynamic of personal and relational responses as part of the care work. In this sense, the material environment entails potentialities in ways that are unpredictable but nonetheless consequential. Rather than arguing that material arrangements and things act, this paper draws attention to their impact via their potential within dispositifs of care that request participants’ attentiveness and responsiveness. Describing these potentialities brings out the subtler requirements of material environments in care practices that aim at circumventing the coercion of disciplinary spaces and their impersonal classifications. (shrink)

Providers and patients bring different understandings of health and disease to their encounters in the hospital setting. The literature to date only infrequently addresses patient and provider concordance on the reported reason for hospitalization, that is, whether they express this reason in similar ways. An agreement or common ground between such understandings can serve as a basis for future communication regarding an illness and its treatment. We interviewed a convenience sample of patients on the medical wards of an urban academic (...) medical center. We asked subjects to state the reason why their doctors admitted them to the hospital, and then compared their statement with the reason in the medical record. We defined concordance on reported reason for hospitalization as agreement between the patient’s report and the reason abstracted from the chart. We interviewed and abstracted chart data from a total of 46 subjects. Concordance on reported reason for hospitalization was present in 24 (52%) and discordance in 17 (37%); 5 patients (11%) could not give any reason for their hospitalization. Among the 17 patients whose report was discordant with their chart, 12 (71%) reported a different organ system than was recorded in the chart. A significant proportion of medical inpatients could not state their physicians’ reason for admission. In addition, patients who identify a different reason for hospitalization than the chart often give a different organ system altogether. Providers should explore patient understanding of the reason for their hospitalization to facilitate communication and shared decision making. (shrink)

Background Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients’ views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians. Methods We analyzed 57 semi-structured interviews conducted (...) at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant’s language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about “respect.” After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes. Results Results from this study grouped into two overarching classifications: respect manifested in physicians’ orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider’s orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy. Conclusions Findings suggest a more robust conception of what ‘respect for persons’ entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery. (shrink)

The sixteenth-century philosopher Jacopo Zabarella stands near the end of the long Aristotelian dominance of western academic philosophy. Yet, despite the fact that Aristotelianism was soon to be overwhelmed by other currents of thought, Zabarella’s influence on western thought would continue into at least the nineteenth century, and he still provides useful discussions relevant to today’s Aristotle scholars. In what follows, I discuss the existence and essence of matter, and show how Zabarella argues for his claims. What is especially notable (...) about the existence and essence of matter as a topic is that matter is clearly at the center of his well-known interest concerning the nature of scientific methodology. (shrink)

The demand for organ transplants, both globally and in South Korea, substantially exceeds the supply, a situation that might have been aggravated by the enactment of the Life-Sustaining Treatment Decision Act (LSTDA) in February 2018. This legislation may influence emergency medical procedures and the availability of organs from brain-dead donors. This study aimed to assess LSTDA’s impact, introduced in February 2018, on organ donation status in out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city and identified related factors. We (...) conducted a retrospective analysis of a regional cardiac arrest registry. This study included patients aged 16 or older with cardiac arrest and a cerebral performance category (CPC) score of 5 from January 2015 to December 2022. The exclusion criteria were CPC scores of 1–4, patients under 16 years, and patients declared dead or transferred from emergency departments. Logistic regression analysis was used to analyse factors affecting organ donation. Of the 751 patients included in this study, 47 were organ donors, with a median age of 47 years. Before the LSTDA, there were 30 organ donations, which declined to 17 after its implementation. In the organ donation group, the causes of cardiac arrest included medical (34%), hanging (46.8%), and trauma (19.2%). The adjusted odds ratio for organ donation before the LSTDA implementation was 6.12 (95% CI 3.09–12.12), with non-medical aetiology as associated factors. The enactment of the LSTDA in 2018 in South Korea may be linked to reduced organ donations among patients with OHCA, underscoring the need to re-evaluate the medical and legal aspects of organ donation, especially considering end-of-life care decisions. (shrink)

BackgroundAfrica continues to bear a disproportionate share of the global HIV/AIDS, tuberculosis (TB) and malaria burden. The development and distribution of safe, effective and affordable vaccines is critical to reduce these epidemics. However, conducting HIV/AIDS, TB, and/or malaria vaccine trials simultaneously in developing countries, or in populations affected by all three diseases, is likely to result in numerous ethical challenges.MethodsIn order to explore convergent ethical issues in HIV/AIDS, TB and malaria vaccine trials in Africa, the Ethics, Law and Human Rights (...) Collaborating Centre of the WHO/UNAIDS African AIDS Vaccine Programme hosted a consultation on the Convergent Ethical Issues in HIV/AIDS, TB and Malaria Vaccine Trials in Africa in Durban, South Africa on the 10-11 February 2009.ResultsKey cross cutting ethical issues were prioritized during the consultation as community engagement; ancillary care obligations; care and treatment; informed consent; and resource sharing.ConclusionThe consultation revealed that while there have been few attempts to find convergence on ethical issues between HIV/AIDS, TB and malaria vaccine trial fields to date, there is much common ground and scope for convergence work between stakeholders in the three fields. (shrink)

Although the obligation to appoint women as judges originates from the constitutional injunction to consider “the need for the judiciary to reflect broadly the racial and gender composition of South Africa,” gender transformation has lagged behind racial transformation of the bench. During the past four years, however, the lack of women appointees has become a more contested issue. This paper investigates the relationship between gender transformation and racial transformation of the judiciary in public debates around the judiciary. Despite the (...) universally voiced concern about the lack of women judges, the most frequent and acrimonious public disputes continue to centre upon racial issues. The imperative to appoint women judges is often articulated as an alternative to appointing black judges, although the statistics show that the greatest need is for the appointment of black African women. Debates on gender transformation of the bench also remain premised on a formal notion of equality that focuses on numbers of women judges rather than on appointing male or female judges who are committed to challenging gender oppression. This means that the entrenched professional cultures, norms and structures that benefit men are left unchallenged. (shrink)

This article explores local, national and global aspects of the new national curriculum in South Sudan as reflected in the lived experiences of secondary school teachers. We draw on analyses of the curriculum, semi-structured interviews with 21 secondary school teachers, and classroom observations. We emphasize the need for critical global citizenship education addressing inequity and oppression at national and global levels. We argue that the curriculum rhetoric fostering global citizens is strongly disconnected from the lived experiences of the teachers, (...) where ethnicity is at the centre of their identity and a main obstacle to a unifying national identity and citizenship. (shrink)

South Africa is one of the most unequal societies in the world. This article is a literature study on the role of theology and the African philosophy of botho or ubuntu trying to address this social inequality. It is this situation that has led to poor (if not the absence of) cohesion in society. It shows how theology through its constructive nature has for years shifted from dogmatism to interdisciplinary dialogue with other sciences and philosophies in order to arrive (...) at facts that are helpful to building harmonious societies. Dialogue is a vehicle that makes this interaction possible. It is pointed out that dogmas, creeds, symbolics, apologetics, etc., all emanated from dialogical deliberations. Botho as life practice of humanity to others is a philosophy that emphasises togetherness or communality. It is a philosophy that puts an individual at the centre of a community. No individual can be contextually rooted without other human beings. It is the people in context that give individuals the meaning and the essence of life. The goal of this dialogue is social cohesion, which is defined as strong relationships enhanced by a sense of solidarity amongst members of a community. It is when botho is socially situated, resulting in theology constructed through dialogue towards desired social cohesion, in order to address the cosmic imbalances that threaten humans' quality of life. It can be presented in a formula: theology + botho or ubuntu = cohesive society. CONTRIBUTION: This article contributes towards the importance of dialogue between theology and the African philosophy of botho. The dialogue leads to social cohesion which is needed for harmonious co-existence in unequal society of South Africa. (shrink)

In 1882, the South Australian Baptist Missionary Society sent off its first missionaries to Faridpur in East Bengal. Miss Marie Gilbert and Miss Ellen Arnold were the first of a stream of missionary women who left the young South Australian colony to work in India. Scores of women from other Christian denominations and from other Australian colonies also went to India and indeed to other mission fields in the nineteenth and twentieth centuries. As with other western women missionaries, (...) these women intended to save souls and to bring India's daughters to Christ, often by means of medical work. But unlike their British sisters, these women came from the edge of empire to intervene in another, but different, colonial site. These missionary ventures coincided with efforts of the Australian settlers to elaborate for themselves an identity separate from and against that of the metropolitan centre. Within these debates, contestations over the meaning of ‘the colonial girl’ and ‘the Australian girl’ played a key role. The article explores why the women were drawn to India rather than to working with Aboriginal people in Australia. It begins to investigate how in seeking to reconstruct Indian womanhood they elaborated for themselves a separate colonial, Australian identity and how much in their missionary endeavours they affirmed an identity as white, Christian and ultimately British. (shrink)

In social systems or spaces, distance between the centre and the periphery breeds epistemic injustice. There are growing accounts of epistemic injustice in health-related fields, as in the article by Pratt and de Vries.1 The title of the article asks: ‘Where is knowledge from the global South?’ Like me, you may answer by saying: ‘Knowledge from the global South is in the global South’. That answer says a lot about how we right epistemic injustice done to actors (...) in the global South or the periphery, including in health ethics. Pratt and de Vries identified four sets of actors (individuals, institutions, journals and funders) responsible for righting epistemic injustice. For three of the four sets of actors, they recognised the need for—or the possibility of—symmetry between global North and global South. Except journals. They did not seriously consider that journals are either present in or could belong to the global South; to the periphery. Platforms for knowledge exchange, circulation, cultivation and curation—such as journals, conferences, publishers, blogs, archives, seminars, books and the media, social or traditional—are neither physically nor epistemically neutral. They are situated. The BBC cannot do for Nigeria or Australia what it does for Britain; neither can the BMJ. Many of us take our position at the centre or periphery as neutral, natural, necessary or permanent. But the African American writer Toni Morrison proved the opposite with her career: ‘I stood at the border, stood at the edge and claimed it as central. l claimed it as central, and let the rest of the world move over to where I was.’2 Although physically in the USA, Toni Morrison was writing …. (shrink)

The two assumptions of this article are that the mainstream ecumenical paradigm of the 20th century is no longer viable, and that the gifts of global Christianity are adequate for the cause of mission and unity. The Christian landscape has vastly changed. Its centre of gravity has shifted to the South. A new form of ecumenism is needed. The vision of unity ‘made visible as all in each place who are baptized into Jesus Christ’, which involves death and rebirth, (...) is now a calling for a new generation. Constructing a new ecumenical table requires re-conception and re-visioning. North and South are henceforth equal partners.The gifts of Christianity in North and South must be re-conceived.The journey toward Christian unity must be re-visioned. For a viable future there will need to be conversion, openness and humility. (shrink)

Theologians speak of the silence of churches' prophetic voice in the 'new' South Africa, whilst the country features amongst the socio-economically most unequal countries in the world, and the urban areas in particular continue to be characterised by segregation. In this context I ask: where is liberation theology? I spell out my reading of some of the recent voices in the liberationist discourse. In dialogue with these scholars I, firstly, argue for the faith community to be made a conscious (...) centre of liberationist debates and praxis. Secondly, I do this by suggesting two theoretical building blocks for local faith communities that wish to grow in a liberationist fashion. (shrink)

This study discusses the growing role of women from the Church of the global South. With the shift of the centre of global Christianity towards the South, today, two-thirds of the world’s Christians live in the southern hemisphere, namely Africa, Asia and Latin America. This implies growing and significant roles for southern churches to play. The role of women from the South is the focus of this study. It attempts to answer the following question: In what areas (...) can the women from the South contribute both in local and global settings? The study explores specific areas of potential contribution by the women from the global South, particularly reflecting on the author’s own mission engagements in diverse areas of academic circumstance. The study is to challenge and encourage them to actively pursue academic careers in international platforms to provide active leadership in the shaping of future global Christianity. (shrink)

South Africa continues to be plagued by gender-based violence (GBV). Recurring incidents of GBV cram news tabloids, social and electronic media, creating the impression of a country at war with itself. Of great concern is that, at the centre of these killings, men are allegedly the main culprits. This then has unleashed national protest campaigns, one notably, by the name #menaretrash, led by activists, mostly women, who angrily voice their disquiet against men. As a response, it was followed by (...) another, namely, #notinmyname, led by those, mostly men, who say, there are many good and proud men who will not allow the image of manhood to be tarnished. At risk is ‘trust’ which is an important social asset, the demise of which plunges any society into a state of parody. This article then seeks to establish the damage GBV causes in terms of trust, especially of women to men. To do this, a survey was conducted to test levels of trust under different circumstances and in respect of different categories of people and public figures. The findings partly confirm existing surveys elsewhere whilst also making contradicting and worrying revelations. The article tries to reconcile these divergent positions socioculturally and theologically and conclude with proposals towards addressing the scourge of GBV. (shrink)

This article develops an argument about what it defines as the ‘third phase of modernity’ and tackles, in a comparative manner, the cases of Latin America (especially Brazil), South Asia (especially India) and China. It tries to identify specific modernizing moves which imply individualizing comparisons as well as encompassing comparisons in relation to these areas and countries. It builds its argument from a few theoretical assumptions and moves in an inductive manner in order to dislocate the discussion of modernity (...) from its strong referents in the West and the conceptual definitions that stem from this. The article tries also to connect the discussion of modernity to debates about development. It proposes a multidimensional approach and analyzes the main dimensions of contemporary modernity and modernizing moves in those regions and countries. (shrink)

This article will reveal how local scientific determination and ambition, in the face of rejection by funders, navigated a path to success and to influence in national policy and international medicine. It will demonstrate that Birmingham, England's ‘second city’, was the key centre for cutting-edge biological psychiatry in Britain in the 1920s and 1930s. The ambitions of Frederick Mott – doyen of biochemistry, neuropathology and neuropsychiatry, until now celebrated as a London figure – to revolutionize psychiatric treatment through science, (...) chimed with those of the City and University of Birmingham's Joint Board of Research for Mental Diseases. Under Mott's direction, shaped by place and inter-professional working, the board's collaborators included psychiatrist Thomas Chivers Graves and world-renowned physiologist J.S. Haldane. However, starved of external money and therefore fresh ideas, as well as oversight, the ‘groupthink’ that emerged created the classic UK focal sepsis theory which, it was widely believed, would yield a cure for mental illness – a cure that never materialized. By tracing the venture's growth, accomplishments and contemporary potential for biochemical, bacterial and therapeutic discoveries – as well as its links with scientist and key government adviser Solly Zuckerman – this article illustrates how ‘failure’ and its ahistorical assessment fundamentally obscure past importance, neglect the early promise offered by later unsuccessful science, and can even hide questionable research. (shrink)

It has been three years since we held the Feminism, Legality and Knowledge seminar to respond to our developing frustrations and excitement around feminist legal studies and academic publishing. In the wake of our 25th anniversary in 2018, we critically reflect further on our original intention to stock up on decolonising techniques to mix feminism, legality and knowledge whilst building on previous consideration of our self-proclaimed ‘international’ status. These reflections are prompted by editorial board members’ experiences as participants in the (...) Cardiff Law and Global Justice Centre’s British Academy-funded Global South Socio-Legal Writing Workshops in Accra, Nairobi and Recife in 2018. Following an explanation of the concerns with academic publishing that have prompted this reflection, we provide a narrative of our experiences in each of the three workshops exploring the lessons learned and their impact on our practice as editors and scholars in feminist legal studies. We finish with a renewal of our commitment to decolonise our minds and practices by continuing to struggle to earn the label ‘international’ for the journal now and in future. A brief introduction to the contents of this issue of FLS follows the reflection. (shrink)

This paper will reflect on the possibility of epistemic decolonization, particularly in terms of curriculum, as a transformative educational process in the context of the South African university, and with respect to my own positionality. The argument will centre around two difficult interdependent positions. On the one hand I will argue for the university’s task as transformational, even offering, via Cornel West, the ‘salvific’ possibility that knowledge offers those who seek it. To develop this claim, I will draw on (...) and develop the notion of paideia though the work of Plato and Heidegger.On the other hand, within the postcolonial African university, the question of decolonization in the tertiary space cannot be elided, particularly since the 2015 #RhodesMustFall and #FeesMustFall movements. The university is a powerful colonial relic, and it can be used to reinforce and perpetuate epistemic violence through unreflective or unconscious pedagogical and curriculum decisions. Here I draw on decolonial thinkers such as Santos, Mignolo, Maldonado-Torres, and Mbembe: I argue for a reckoning with the forces of coloniality, and advocate for epistemic justice and criticality, as part of the decolonizing project. In conclusion, working with ideas from Cornel West, I argue to reconcile paideia, as the ‘turning of the soul’, with the decolonizing African university. (shrink)

The environmental crisis, ecological injustice and climate change are some of the biggest challenges to humanity and sustainable development worldwide. The youth are at the centre of the ecological justice, environmental consciousness and climate change discourse. For the youth to participate and influence development with regard to the climate crisis in a favourable way, they must understand their role and the issues and challenges that they face in this regard.Contribution: The aim of this explorative article is twofold. It highlights the (...) involvement of the South African youth in ecological matters. It also offers insights on why the youth can be regarded as game-changing role-players with regard to the climate crisis and being environmentally conscious. (shrink)

© The Author. Published by Oxford University Press on behalf of the Oxford Centre for Islamic Studies. All rights reserved. For Permissions, please email: [email protected] title of this book is slightly deceptive, for apart from the last two chapters, which concern recent conversions to Shiʿism in Indonesia, and a chapter on Persian and Indian Shiʿis in Thailand, it does not really deal with actual Shiʿi communities but mostly describes expressions of piety focussing on ʿAlī and the ahl al-bayt in otherwise (...) Sunni contexts. The editors and contributors provide a comprehensive overview of the various phenomena that by earlier generations of scholars were described as Shiʿi or influenced by Shiʿism. These include references to ʿAlī, Fāṭima, Ḥasan and Ḥusayn in early Malay texts and oral traditions, popular practices associated with ʿĀshūrā, and veneration for the ahl al-bayt. Scholars have assumed that among the various cultural flows that went... (shrink)

The aim of this paper is to examine the strategies used by peer facilitators in improving students’ academic performance in a previously disadvantaged university in South Africa. It also assesses whether peer facilitators are succeeding in this quest. This paper stems from a larger study on the implementation of peer academic support programmes, which used the qualitative research approach and a sample of 31 participants made up of peer facilitators, students and programme coordinators. The study made use of in-depth (...) interviews and focus group discussions as well as documentary analyses as methods of data collection. Data was analysed thematically using the main and sub themes that emerged from the data coding. The results indicate that peer facilitators use different strategies to engage students in an interactive manner in order to improve their academic performance. Some of these strategies include ethically acceptable discussions, questioning, and answering and redirecting questioning. The findings further show that these strategies are succeeding in improving students’ academic performance to an extent. This is through improved pass rates and skill proficiency in various areas of academic learning. However, the participants reported that the strategies are not satisfactorily yielding the desired results because of certain impediments, which include the behaviour of some facilitators, poor relations between the Teaching and Learning Centre and various departments, and less individual attention paid to students by the peer facilitators, some of which raise ethical concerns. Consequently, these hinder satisfactory achievement of students’ academic overall performance at the university. Among other recommendations, the Teaching and Learning Centre should forge better relations with departments to attract needy students for academic support, and there is need to ensure better preparation of peer facilitators with necessary acumen to guide students effectively. (shrink)

There is a shortage of clergy, at least in the Roman Catholic Church. Protestant churches in general are experiencing more of a distribution or placement challenge than a shortage. The two greatest hindrances to addressing the Protestant clergy distribution challenge are a lack of adequate compensation for clergy and the undesirable geographical location of a number of churches, as perceived by clergy. Influences such as secularisation, duality of vocation, time management, change in type of ministry, family issues, congregational and denominational (...) conflict, burnout, sexual misconduct, divorce or marital problems, and suicide, affect clergy. Studies on the shortage of clergy have been conducted mostly in the USA and Europe and not in South Africa. This article focuses on the research gap by means of a practical theological grounded theory exploration of the exodus of clergy. Grounded theory methodology is used to identify the reasons why clergy trained at a Bible college of a Protestant charismatic mega church leave full-time pastoral ministry. Findings correspond to previous studies with two reasons appearing more frequently than others: responding to a call and leadership related issues. Firstly, respondents differed in their replies with respect to reconciling their exit from full-time pastoral ministry with their call. The replies included not being called, a dual call, or called but left anyway. Secondly, respondents indicated that leadership influence was mostly negative with regard to affirming their call. (shrink)

This article presents the findings of research conducted on ‘forgiveness’ as a spiritual construct, religious survival strategy and meaning-giving tool during incarceration. The research was conducted with 30 men serving long-term sentences in Zonderwater, a correctional centre outside Pretoria, South Africa. A review of literature showed that forgiveness has mainly been seen as something the perpetrator owed the victim and that asking for and granting forgiveness were religious imperatives. However, this study shows that offenders, in the troubled space of (...) incarceration, survived by putting themselves in control of forgiveness. They found peace of mind by granting forgiveness to those who caused them to be incarcerated, whilst at the same time taking responsibility for their own actions. Semi-structured interviews were conducted with the participants. Applying an interpretative phenomenological analysis methodology, the collected data were analysed and the following themes were identified: forgiving those who transgressed against me; the role of politics in forgiveness; God’s role in forgiveness; and the effects of forgiveness on the self.Contribution: This article contributes to an understanding of the construction of forgiveness as experienced by offenders, independent from the traditional victim-offender relations. Living in a troubled, unforgiving space, these men are expected to practice forgiveness by set standards. From their shared narratives, it is illustrated that their spiritual navigation with this phenomenon is not a chronological, time dependent process, but a multi-dimensional, personal journey to self-discovery. (shrink)

The introduction of nurse‐led telephone helplines for patients to have access to information and advice has led to the development of a new kind of practise for nurses. This study focuses on the ways NHS Direct (NHSD) nurses construct a nursing identity and shape their work in a call‐centre environment. The empirical findings are drawn from a study investigating the impact of NHSD on professional nursing issues that was part of a wider evaluation of the service in South Wales, (...) UK. Data were gathered from responses to free text questions included in a questionnaire sent to nurses in three NHSD sites. Further data were collected from focus groups held with NHSD nurses. The nurses defend their identity as nurses rather than call‐centre workers. The discourses of the nurses show a strong alignment with the traditional values of nursing, encompassing holistic and empathetic practise that has moved with the nurses across locales. We argue that the nurses frame a nursing identity in NHSD around the importance of previous experience and claim to practise holistic nursing. However, the development of new skills and adaptation of old skills in response to the demand of NHSD work challenges normative notions of traditional ‘hands‐on’ models of practise and indicates a possible movement towards a cognitive model of nursing based upon knowledge, analytical and communication skills that reflects the transformative and dynamic nature of professional identity and boundaries. (shrink)

OCMS, started to address the potential drain of leadership in the Global South Churches through post-graduate studies in the West, is an institution to advance the holistic gospel through research and publications. Studies were rooted in mission engagement with access to the global conversation and with university validation. The Centre’s home in St Philip and St James is traced as well as its culture of community, hospitality and prayer.

SummaryThe aim of this study was to investigate marriage behaviour from 1825 to 1924 in an Alpine valley inhabited by Ladin speakers, where the particular geographic, linguistic and economic characteristics may have influenced the level of reproductive isolation. A total of 2183 marriage acts from the two main parishes of Santa Cristina and Ortisei were examined. Birth and residence endogamy, inbreeding coefficients from dispensations and from isonymy, birth place distribution of the spouses and isonymic relationships were analysed in four 25-year (...) sub-periods. All the indicators considered point to a lower level of reproductive isolation at Ortisei, a main centre for the woodcarving industry, which appeared to be experiencing an early and effective breakdown of isolation. Marriage behaviour in the Gardena Valley between 1825 and 1924 seems to have been mostly influenced by socioeconomic factors rather than linguistic and cultural ones. (shrink)

AimThis study aimed to examine the dimensionality of the BCFQOL-AR using Rasch analysis.MethodThe sample consisted of 320 families having a member with intellectual or developmental disabilities. Rasch analysis was used to validate the dimensionality of the scale. The participants were from Riyadh, Saudi Arabia.ResultsThe BCFQOL-AR 25-item scale was multidimensional. Rasch analyses support the unidimensionality of the five subscales. There were no indicators of differential item function for any of the items, regardless of sex or age.ConclusionThe BCFQOL-AR is a multidimensional scale (...) that measures families with members who are satisfied with their quality of life. Therefore, obtaining a total score at the subscale level is supported and showed that each of the five subscales of the BCFQOL can be used alone. This study partially supports the practices used with other versions of the scale, by providing the statistical base, where means were used at the subscale level in different countries. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Deflating Psychiatric ClassificationClaudio E. M. Banzato (bio)Keywordsnosography, comorbidity, utility, pragmatismSystems of classification bring order into the world. They are a key part of the informational working infrastructure of the world we inhabit (Bowker and Star 1999). Thus, much of the human interaction hinges on these ordering—pattern identifying and creating—systems. Formal or informal, standardized or ad hoc, visible or invisible, enforced or optional, there are a myriad of classifications (...) we necessarily live by.Typically, classifications convey representations of states of affairs to make interventions on them feasible and, to some extent, predictable. In other words, classificatory systems and schemes try to confer intelligibility to the world. By succeeding in such task, they may provide rational grounds to human operation on reality (toward the most diverse ends). This account fully applies to medical classifications, which struggle to sort out all kinds of diseases, ailments, complaints, and sufferings that can possibly be targeted by medical interventions. This means classifications are instrumental to the ends pursued by medicine, quintessential modificatory activity. In sum, classifications are cognitive tools devised to build up knowledge by making relevant distinctions, which may prove helpful to guide human action.By working well, classifications eventually tend to become invisible. They end up looking just natural, as if they were carved by nature itself. But indeed purpose is the touchstone here. Even if a given class of objects fully qualifies as a 'natural kind' and necessary and sufficient criteria for class membership can be definitely established, it does not entail that it constitutes the best way to classify these objects irrespective of the context. Peter Zachar (2002) offers a compelling example from natural sciences, the utmost practical importance of distinguishing between hydrogen and its isotopes (hydrogen, deuterium, and tritium). In this case, the classificatory thrust stretches beyond the shared atomic number. In his words, "A crucial factor in recognizing them as distinct is that they are used in distinct activities and practices. We get a better neutron bounce with heavy water or D2O. Deciding what aspects of internal structure are important therefore cannot be isolated from external factors." (p. 220)In contemporary psychiatry, diagnostic classification has been center stage for several reasons. But before addressing them, however, a brief historical detour is necessary. Back in the nineteenth century, putting forward a new classification of mental diseases was taken somewhat as a token of psychiatric proficiency according to the witty remark by the French physician and publicist Philippe Buchez: "Upon believing that they have [End Page 23] completed their studies, rhetoricians will compose a tragedy and alienists a classification" (Berrios 1999, 152). By the middle of the twentieth century, many psychiatric classifications (based on diverse principles and underlying theoretical orientations) were still used across the world. The British psychiatrist Erwin Stengel (1959), in his influential report on classification of mental disorders, pointed out that the issue of difficulty of communication was then the order of the day for psychiatry, because it was widely perceived as one of the most serious obstacles to the progress in the field.The broad, worldwide survey carried out by Stengel made it clear that classifications of all shapes were used in different contexts, but they were seldom appealing outside the boundaries of the respective centers that generated them. Such diversity of classifications reflected not only different functions or purposes they were meant to serve, but also the role played by the history of a given problem within a particular medical tradition and cultural background. Thus, Stengel's aims for an acceptable statistical international classification were relatively modest: it should simply ground epidemiological work.Stengel's stance on classification was frankly pragmatic and utilitarian. He understood well the difficulties posed by the 'disease entity' assumption in psychiatry and asked the straight question: "Firstly, what do we classify in this field? Are we classifying diseases or people?", to which he offered a compromised answer: "It may be said that the material the psychiatrist has to classify consists neither of diseases nor of people but of a variety of disorders or reactions, a material which does not readily lend itself to classification" (Stengel 1959, 612). For him, the pursued agreement on the... (shrink)

Along with political, economic, ethical, rehabilitative and military dimensions, psychopathological sequelae of war and terrorism also deserve our attention. The terrorist attack on the World Trade Centre ( W.T.C.) in 2001 and the Gulf War of 1990-91 gave rise to a number of psychiatric disturbances in the population, both adult and children, mainly in the form of Post-traumatic Stress disorder (PTSD). Nearly 75,000 people suffered psychological problems in South Manhattan alone due to that one terrorist attack on the (...) WTC in New York and the Pentagon in Washington. In Gulf War I, more that 1,00,000 US veterans reported a number of health problems on returning from war, whose claims the concerned government has denied in more than 90% cases. Extensive and comprehensive neurological damage to the brain of Gulf War I veterans has been reported by one study, as has damage to the basal ganglia in another, and Amyotrophic Lateral Sclerosis (ALS) in a third, possibly due to genetic mutations induced by exposure to biological and chemical agents, fumes from burning oil wells, landfills, mustard or other nerve gases. The recent Gulf War will no doubt give rise its own crop of PTSD and related disorders. In a cost-benefit analysis of the post Gulf War II scenario, the psychopathological effects of war and terrorism should become part of the social audit any civilized society engages in. Enlightened public opinion must become aware of the wider ramifications of war and terrorism so that appropriate action plans can be worked out. (shrink)

Cell line immortalisation is a growing component of African genomics research and biobanking. However, little is known about the factors influencing consent to cell line creation and immortalisation in African research settings. We contribute to addressing this gap by exploring three questions in a sample of Xhosa participants recruited for a South African psychiatric genomics study: First, what proportion of participants consented to cell line storage? Second, what were predictors of this consent? Third, what questions were raised by (...) participants during this consent process? 760 Xhose people with schizophrenia and 760 controls were matched to sex, age, level of education and recruitment region. We used descriptive statistics to determine the proportion of participants who consented to cell line creation and immortalization. Logistic regression methods were used to examine the predictors of consent. Reflections from study recruiters were elicited and discussed to identify key questions raised by participants about consent. Approximately 40% of participants consented to cell line storage. The recruiter who sought consent was a strong predictor of participant’s consent. Participants recruited from the South African Eastern Cape, and older participants, were more likely to consent; both these groups were more likely to hold traditional Xhosa values. Neither illness nor education were significant predictors of consent. Key questions raised by participants included two broad themes: clarification of what cell immortalisation means, and issues around individual and community benefit. These findings provide guidance on the proportion of participants likely to consent to cell line immortalisation in genomics research in Africa, and reinforce the important and influential role that study recruiters play during seeking of this consent. Our results reinforce the cultural and contextual factors underpinning consent choices, particularly around sharing and reciprocity. Finally, these results provide support for the growing literature challenging the stigmatizing perception that people with severe mental illness are overly vulnerable as a target group for heath research and specifically genomics studies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Hospitalization—Bridging the Gap Between Respect and ControlPaul P. ChristopherIntroductionThis issue of Narrative Inquiry in Bioethics offers varied and somewhat unique perspectives on the experience of psychiatric hospitalization. This commentary highlights a number of salient themes that emerge from reading these essays and attempts to explore how they relate to the broader academic literature on psychiatric hospitalization, particularly with regard to ethical considerations. In reading these (...) narratives, each several times, I was repeatedly struck by the courage required of the authors, both to share their stories publicly and to endure the challenges that the writing process no doubt demanded of them—revisiting and suspending themselves in deeply emotional and, at times, traumatic experiences in order to share the most compelling narrative. Their hard work clearly paid off—the stories are at once intimate and indelible. Still, in many instances, I found myself wanting to know more; to enter the story and sit with the individual through these events; to ask what they were thinking or feeling in a particular situation; to see and hear the world in which they found themselves. Such is the nature of good story telling—the reader, left with the lingering vision created in his mind, turns over the last page, eagerly hoping for more.Narrative ThemesI. Loss of Autonomy or ControlPerhaps the most notable theme had to do with the loss of control or freedom that followed from hospitalization. On first consideration, it may seem odd that this issue appears so often since patient autonomy constitutes one of the fundamental principles of medical ethics. Only under specific circumstances—e.g., when there is a risk of imminent harm—may autonomy be curtailed, and even then only to the extent that is minimally necessary. Yet, as these narratives highlight, there are a multitude of ways in which psychiatric hospitalization engenders actual or perceived restrictions in freedom (Newton-Howes & Mullen, 2011).Consistent with prior research (Goodwin et al., 1999), many of the authors describe a fear or the actual experience of not being able to leave the hospital freely, even when the admission seems to have been voluntary. For example, one writer worries, “I was so afraid that if I ever went ‘in,’ I would never get ‘out’... I thought I would never taste freedom again... alive.” Another describes:When it came time for my possible discharge they told me that I might not get discharged because I was ‘acting up the previous evenings.’ My anxiety level at this point went through the roof. The only reason I was discharged was because my father knew some politicians. If not [End Page 29] for him I would have been a patient there for perhaps years and my life would have been ruined.A third gives this example: “When I asked to sign the form to leave after three days, [the psychiatrist] told me if I did that she would have me committed.” Another writer fears not having any control of how the psychiatrist might approach the treatment: “... I was totally vulnerable... would the doctors blame me, drug me, shock me, kill me?”Somewhat surprising, however, was the fact that so few of the narratives take issue with the decision to hospitalize. This omission is especially striking in light of the fact that prior reports consistently note that a substantial minority (up to nearly half) of voluntarily admitted patients nevertheless experience their admission as coerced (Bonsack & Borgeat, 2005; Hiday et al., 1997; Katsakou et al., 2010; Rogers et al., 1993; Sheehan & Burns, 2011). Because many of these narrators had been hospitalized more than once, the relative absence of expressed resistance to being hospitalized seems strange, particularly when earlier hospital experiences or their aftermath are often described as negative. For example, one individual characterized the time after being released from the hospital as, “My sense of self was questioned. I felt as if I lost my soul.” Another put it this way:When I got out of the private hospital, I felt like my soul had been ripped out of me. I felt like I had a gaping hole in the center of my body... I felt psychically raped, dazed, and confused.Given these... (shrink)

Patients with psychiatric illness feel the brunt of the intersection of many of our society's and our health care system's disparities, and the vulnerability of this population during the Covid‐19 pandemic cannot be overstated. Patients with psychiatric illness often suffer from the stigma of mental illness and receive poor medical care. Many patients with severe and persistent mental illness face additional barriers, including poverty, marginal housing, and food insecurity. Patients who require psychiatric hospitalization now face the risk (...) of transmission of Covid‐19 due to the inherent difficulties of social distancing within a psychiatric hospital. Patients whose freedom and self‐determination have been temporarily overruled as they receive involuntary psychiatric treatment deserve a setting that maintains their health and safety. While tele‐mental health has been rapidly expanded to provide new ways to access psychiatric treatment, some patients may have limitations in technological literacy or access to devices. The social isolation, economic fallout, and potential traumatization related to the current pandemic will disproportionately affect this vulnerable population, and society's duties to them must be considered. (shrink)

On 6 September 1966, the prime minister of South Africa, Dr HF Verwoerd was killed by Mr Tsafendas, a Portuguese national of Greek descent, in parliament by stabbing him in the chest. Mr Tsafendas was a messenger in parliament. At the enquiry trial of Mr Tsafendas, he was found unfit to stand trial on the ground that he suffered from schizophrenia. The psychiatric evidence during the enquiry trial was reviewed and discussed under the following headings: Diagnosis of schizophrenia; (...) Consideration of cultural factors in forensic psychiatric settings; Delusional infestation v. extreme overvalued beliefs; Simulation of psychosis; Ethical considerations in criminal capacity and trial competency assessments. Lessons from the Mr Tsafendas enquiry trial for forensic psychiatrists where a defendant previously diagnosed with schizophrenia commits a prominent political murder, are summarised. It is emphasised that the personhood of an accused referred for forensic observation should be respected and protected, instead of focusing exclusively on a specific diagnosis. (shrink)

Ce texte s’intéresse aux conditions de réussite des mécanismes de type commission de vérité et de réconciliation. Il présente deux grilles à partir desquelles il analyse et compare trois cas : la Truth and Reconciliation Commission d’Afrique du Sud, les tribunaux gacaca au Rwanda et la Commission de vérité et réconciliation du Canada sur les pensionnats indiens. La première grille évalue la capacité d’une CVR à promouvoir la justice et la responsabilité. La seconde, leur capacité à favoriser la réconciliation nationale. (...) La thèse défendue est que les CVR relèvent davantage de l’éthique que du droit et du politique. La première grille applique des critères qui relèvent de ces deux derniers registres. Ce faisant, elle ne prend pas en compte la finalité de réconciliation des CVR et faillit à les évaluer correctement. La seconde grille, qui emprunte aux modalités de la justice réparatrice et à l’éthique, corrige ces lacunes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Threat to Selfhood: Moral Distress and the Psychiatric Training CultureEsther NathansonWhile many medical specialties offer to heal, or even cure, psychiatry—uniquely—places the doctor–patient relationship at the center of the therapeutic effort. Psychiatrists must possess a complex and challenging combination of broad medical knowledge, finely honed interpersonal and analytic skills and confidence in their abilities, despite limited understanding of the workings of the brain. Inpatient psychiatry in (...) particular demands a degree of strength to withstand emotional, and sometimes physical, assault from patients who may be suicidal, desperate, paranoid, aggressive or delusional. Beyond these abilities, a good psychiatrist must have robust but ‘therapeutically porous’ emotional boundaries that allow genuine empathy for the patient but, at the same time, limit internalization of the patient’s anguish as the practitioner’s own: the exquisite balance of ‘self–versus–other’ in the therapeutic encounter.Unfortunately, during my psychiatry residency in the UK, development of these intangible but essential boundaries was entirely absent from the curriculum. Early in training I struggled with my tendency to become an emotional chameleon with feelings and energies buffeted around by the prevailing emotions of each patient that walked through the door. I felt that patients expected me to offer tidy explanations for their suffering and provide answers to profound questions of meaning; to make the world a safe and understandable place. Given the complexity of mental illness and its interplay with social circumstances this was naïve and, I now realize, often unnecessary, but the weight of responsibility was unbearable. I was also completely unprepared for the intensity of human suffering I saw, and wholly unready to provide the level of interpersonal engagement required for genuine healing. My own emotional integrity felt threatened by the depth of patients’ needs, and my response—both physical and emotional—was intense and frightening.Much of my distress resulted from the profound and inevitable tension between the empathy necessary to comprehend patients’ experiences, which were often extreme and bewildering, and the need for resilience and self–protection at a time when my grasp of psychological theories and treatment practices was still rudimentary. I felt guilty that patients bore the brunt of my inexperience, and duplicitous purporting to help while burdening them with intolerable drug side–effects and stigmatizing, albeit effective, treatments such as electroconvulsive therapy (ECT). Time constraints and guidance from senior faculty encouraged expediency over treatment efficacy or durability; psychopharmacology was prioritized over the psychotherapeutic techniques and psychosocial interventions I found more effective for many patients. During the phase of our training that took place in a rambling, now defunct, asylum in the U.K, visits to the locked ward, which was reserved for patients considered a danger to others, were usually prompted by nurses’ requests for chemical restraint, the ‘pharmaceutical strait–jacket’. I was deeply uncomfortable with the role of ‘restrainer’ but had insufficient experience or seniority to propose other methods. It was only when, years later, I investigated re–training in the U.S that the senior psychiatry resident at a well–known program told me gently, ‘Oh, we assume that students will have a breakdown in their first year, so we have systems in place to help’. I’ll never forget those words; they are, to this day, the only validation of the emotional toll of my early training years.Adding to my discomfort were various ethically dubious administrative practices, the most troubling being the clinic’s unwillingness to disclose to patients that we were trainees, with little clinical experience. Senior faculty were dismissive when I asked whether my first psychotherapy patient had been told I was a trainee, indeed that I had never conducted psychotherapy before. My question was greeted with amusement and an assurance that, although she had not been told, I (not the patient, interestingly) would do fine.Due to the large number of no–shows in psychiatric outpatient clinics it was also standard practice to triple–book appointment times on the [End Page 115] assumption that one or more patients would fail to attend. Not uncommonly, more than one patient would arrive for the same appointment, leaving others to suffer agonizing waits that were often intensified by the deep discomfort... (shrink)

This article uses the example of South Africa to explore how inequality, institutions, identity, and polarization interact. The first 15 years of the country’s constitutional democracy was characterized by a virtuous spiral fueled by hope that a thriving, inclusive society was in reach, an embrace of win-win cooperation, and a surge of civic confidence in the legitimacy of the public domain. The next 15 years witnessed rising discontent in response to continuing massive inequality and economic hardship – plus sustained (...) efforts by populist political entrepreneurs to use economic discontent to fuel identity-based polarization and weaken institutions. In both periods, contrary to the either/or discourse of much scholarship, change was fueled by the ways in which economic expectations and identity politics interacted with one another. Renewal of the political center needs both reforms that address economic imbalances and engagement at the level of ideas. (shrink)