In this article, we present findings from a qualitative study examining how young women experience being long‐term bedridden with myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS), during childhood and adolescence. The aim is to explore how young women who fell ill with ME/CFS during childhood and adolescence look back on their lived experience of being long‐term bedridden from the vantage point of being fully or partially recovered. Informed by a phenomenological theoretical perspective, the researchers applied a narrative (...) methodological approach involving the analysis of interviews with 13 women, aged 16–29 years at the time of the interview. Attention was particularly paid to how participants structured their narratives and to the events (telling moments) they identified as important. Four major storylines were developed: Ambivalent responses to the presence of others; A body on the edge of life; An eternity in the dark; and Recasting painful memories of being bedridden and alone. Based on our findings, we argue that the experience of being long‐term bedridden with ME/CFS during childhood and adolescence can be understood and communicated as a plot in which individuals find themselves pushed to the extreme limit of suffering and loneliness. (shrink)

Few qualitative studies explore the phenomenon of positive ethical climate and what actions are perceived as promoting it. Therefore, the aim of this study was to explore and describe actions that acute care ward nurses perceive as promoting a positive ethical climate. The critical incident technique was used. Interviews were conducted with 20 nurses at wards where the ethical climate was considered positive, according to a previous study. Meeting the needs of patients and next of kin in a considerate way, (...) as well as receiving and giving support and information within the work group, promoted a positive ethical climate. Likewise, working as a team with a standard for behaviour within the work group promoted a positive ethical climate. Future research should investigate other conditions that might also promote a positive ethical climate. (shrink)

Media representations of environmental conflicts between companies and communities play an important role in influencing ideas about the rightful exploitation of natural resources. This article examines local newspapers’ representations of fishers’ claims over resource access in a conflict between fishers and the oil industry in Tabasco, Mexico. Our analysis is based on articles from two newspapers dating from 2003–2004 and 2007–2012, and ethnographic data from 2011–2012. Drawing on Boltanski and Thévenot's theory of jus-tification, discussions on patrimonial collectivities, and studies of (...) media and social movements, we suggest that Tabascan newspapers reshape fishers’ claims over resource access by portraying fisheries and oil as patrimony. Being an ambivalent vocabulary for the defence of space and locality within a con-flict over natural-resource enclosure, the newspaper narratives of patrimony both invoke subaltern concerns and reconstrue state authority and local hierarchies. Furthermore, the newspaper narratives are interconnected with fisher leaders’ narratives, in particular, while misrepresenting different fisher groups’ arguments, and thereby contribute to political division among the fishers as a whole. (shrink)

Something is not working in ethics consultation: in certain situations, relationships within families and with careproviders and surrogates have become so emotionally charged and destabilized that attention is dominated by conflict and misunderstanding, foreshadowing a loss of dignity and hope. In a compelling, urgent article, informed by events in the Schiavo case, with examples from the literature on theory, practice, and outcomes, Caplan and Bergman address this situation: redirecting our attention to what they see as “a lack of effective mechanisms” (...) for dealing with a “painful class of disputes in which families disagree with one another, or with doctors, about the care of those who cannot communicate.”1 It is no small matter that many of these cases are situated in the immediate, intense environment of end-of-life decision making. -/- How might we understand these encounters, and their limits? What can we hope? Following the tack of Caplan and Bergman, I will extend the discussion of the complex relationships between patients, families, surrogates, and physicians, and “hope for consensual resolution,” offering a somewhat different account of what is lacking. While Caplan and Bergman foreground an apparent irreconcilability of appeals to competing biomedical principles as what is lacking, I will suggest that a “salient characteristic” among participants, what Caplan and Bergman identify as a common concern for the patient’s best interests, may be far less stable and more complex, and thereby less directive, than first imagined. When Caplan and Bergman sketch their expectations for mediation and for mediators, they are right in noting that abstract principles “articulated as dispositive by designated ‘experts’ fail to capture, and arguably respect, the unique and complex nature of each such individual decision-making process,” and that “patients and families are at the extreme end of a power imbalance.” It is less clear that their descriptions — or their hope for mediation — capture this enormous challenge. (shrink)

Introduction: We discuss Carol Gilligan's original concept of mature care in the light of the altruistic approach to caring and good clinical judgment. Discussion: In particular, we highlight how the concept of mature care can capture important challenges in today's nursing. Further, we illuminate how mature care might differ normatively from an altruistic approach to caring and the traditional prudential virtues in nursing. We also discuss similarities between mature care and virtue ethics. Conclusion: For nursing and nurses' identity, in today's (...) health care system that is increasingly pressured to ‘produce' health, we believe it is important to both developing further theories on mature care and having normative discussions about care. (shrink)

What is best for the hospitalized patient? How do we increase the prospects that a patient will receive the best care a hospital can provide, and how is this accomplished? It has been argued that what is best for the patient is to be in the care of highly functioning collaborative teams, teams with certain unique qualities, teams that have esprit de corps. But how do we get there? In furtherance of this discussion, the author, in a Quintilian-like spirit, deliberates (...) about "necessity" and "possibility" in what is best for the hospitalized patient and the challenges these teams must navigate: responsibility, accountability, team relationships, leadership, moral distress, dissent, and personal and professional risk. (shrink)

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into (...) moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded ‘grey zone articles’, in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients’ and caregivers’ views on ethical challenges, is presented. (shrink)

Investigations and commentaries on domestic violence and its sequelae have been featured in several recent medical journals. For discussion purposes, I will highlight aspects from three of them. According to Megan Bair-Merritt and her colleagues, in a recent issue of the Journal of Pediatrics, screening for domestic abuse in a pediatric practice can uncover cases that otherwise might not be identified.1 Of the women who brought their children to a pediatric clinic at Johns Hopkins Children’s Center, 23 percent disclosed that (...) they had been victims of either emotional or physical abuse; 57 percent of the abused women indicated that at least one child had been exposed to this violent interaction. (shrink)

Social media challenge--or have already redefined--conventional boundaries of public and private, personal and professional, friendship, and social relations generally. Here, I consider how these developments may affect professionalism, the physician-patient relationship, and our cultural experiences in a wholly different and unexpected way.

This interview with Jeremy Waldron covers three topics. Firstly, we dealt with the methodology debate, that is, the discussion about how to proceed in analyzing the nature of law. Does the question ‘What is law?’ require a descriptive analysis of the concept of law or, rather, a normative exercise in political philosophy? Secondly, we spoke about the role of law in response to historic injustice, especially in relation to the restitution of property rights. On this topic Waldron vindicates the ‘supersession-thesis’, (...) the idea that, due to changed circumstances and the passage of time, historic injustices become superseded. The third section of the interview is devoted to Waldron’s perspective on the citation of foreign law by national judges. (shrink)

When you enrol as a student you are assigned a ‘place’ in education. This assignment will gradually imply an assessment of you as a human being. We argue that these are processes taking place in educational practice. In our orientation in educational research an orientation towards a theory of action has been inspired by the French philosopher Paul Ricoeur. In our search for an educational practice that could describe what it is that makes the student a capable human being we (...) continue in the spirit of Ricoeur. The text is divided in two parts. In the first part, Basic Capabilities in Education, we are asking: Who is the student if education is the process where the student learns to be a capable human being? We try to answer this with the help of Ricoeur’s phenomenology of the capable human being which is structured around the capacity to speak, to act, to tell and finally to impute. In the second part, Institutional Mediations of Capabilities in Education, we try to show how the transmission of the human capacities to an actualization through education at an institutional level, represented by the teacher, is necessary. If the student shall become a capable human being s/he has to have conditions for actualizations of her capacities. A paradigm for this is found in the process of assigning and assessing in education. (shrink)

Deliberative democracy’s roots in critical theory are often invoked in relation to deliberative norms; yet critical theory also stands for an ambition to provoke tangible change in the real world of political practice. From this perspective, this paper reconsiders what deliberative democracy ought to look like as a critical theory, which has not just theoretical and practical, but also methodological implications. Against conceptions of activism as pushing through one’s pregiven convictions, recent debates in critical theory highlight the necessity for critical (...) activism to be emancipatory in way that is enabling rather than imposing, and inclusive rather than ‘enlightened’. As such deliberative democracy must be at once a critical theory of democracy and a democratic critical theory: committing itself to being an innately inclusive, itself reflexive and self-reflexive project rather than a substantive theory to be implemented. (shrink)

For some time we have seen a shift away from direct marketing, a core feature and dominant exchange form in the alternative food world, towards a greater role for intermediation. Yet, we still need to better understand to what extent and in what ways new mediated Alternative Food Networks represent an evolution of or departure from core tenets of alternative food systems. This paper focuses on AFNs with new intermediaries that connect small-scale producers with urban end-consumers. Based on original research (...) in Frankfurt, Berlin, and Calgary, we analyze three different types of mediated AFNs: one driven by consumers, one by an external intermediary, and one by producers. Our cases include non-capitalist, capitalist, and alternative capitalist economic practices as identified by Gibson-Graham. Conceptually, we base our analysis on the three-pillar-model of alternative agri-food systems, which we further refine. Besides comparing our cases with each other, for heuristic purposes we also compare them with an ideal-type model that adheres to core tenets of alterity in all three pillars. Our empirical analysis shows that intermediary organizations can bring important benefits and that mediated AFNs are in principle able to hold true to the core tenets of alternative agri-food systems. However, it is very important to develop models of democratic control and ownership as well as economic arrangements in which created value is fairly shared. Only then can the potentials of new mediated models be realized while the pitfalls of the conventional systems they seek to replace be avoided. (shrink)

Background: Ethics rounds are one way to support healthcare personnel in handling ethically difficult situations. A previous study in the present project showed that ethics rounds did not result in significant changes in perceptions of how ethical issues were handled, that is, in the ethical climate. However, there was anecdotal evidence that the ethics rounds were viewed as a positive experience and that they stimulated ethical reflection. Aim: The aim of this study was to gain a deeper understanding of how (...) the ethics rounds were experienced and why the intervention in the form of ethics rounds did not succeed in improving the ethical climate for the staff. Research design: An exploratory and descriptive design with a qualitative approach was adopted, using individual interviews. Participants and research context: A total of 11 healthcare personnel, working in two different psychiatry outpatient clinics and with experience of participating in ethics rounds, were interviewed. Ethical considerations: The study was based on informed consent and was approved by one of the Swedish Regional Ethical Review Boards. Findings: The participants were generally positive about the ethics rounds. They had experienced changes by participating in the ethics rounds in the form of being able to see things from different perspectives as well as by gaining insight into ethical issues. However, these changes had not affected daily work. Discussion: A crucial question is whether or not increased reflection ability among the participants is a good enough outcome of ethics rounds and whether this result could have been measured in patient-related outcomes. Ethics rounds might foster cooperation among the staff and this, in turn, could influence patient care. Conclusion: By listening to others during ethics rounds, a person can learn to see things from a new angle. Participation in ethics rounds can also lead to better insight concerning ethical issues. (shrink)

Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. Most participants report (...) positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices. (shrink)

_In this lively and groundbreaking book, arts educator Marit Dewhurst examines why art is an effective way to engage students in thinking about the role they might play in addressing social injustice._ Based on interviews and observations of sixteen high schoolers participating in an activist arts class at a New York City museum, Dewhurst identifies three learning processes common to the act of creating art that have an impact on social justice: connecting, questioning, and translating. Noting that “one of (...) the challenges of social justice art education has been the difficulty of naming effective strategies that can be used across multiple contexts,” Dewhurst outlines core strategies for an “activist arts pedagogy” and offers concrete suggestions for educators seeking to incorporate activist art projects inside or outside formal school settings. _Social Justice Art _seeks to give common language to educators and others who are looking to expand and refine their practices in an emerging field, whether they work in art education, social justice programming, or youth development. (shrink)

The ideal of trust pervades nursing. This article uses empirical material from acute psychiatry that reveals that it is distrust rather than trust that is prevalent in this field. Our data analyses show how distrust is expressed in the therapeutic environment and in the relationship between nurse and patient. We point out how trust can nonetheless be created in an environment that is characterized by distrust. Both trust and distrust are exposed as `fragile' phenomena that can easily `tip over' towards (...) their opposites. Trust is not something that nurses possess or are given; it is rather something that they earn and have to work hard to achieve. Regarding themselves as potential causes of distrust and active wielders of power can contribute to nurses developing a more realistic view of their practice. Assuming a realistic middle-way perspective can help to manoeuvre between the extremities of excellence and resignation, which in turn can lead to processes that create trust between psychotic patients and nurses. (shrink)

In response to the article by Scofield, I consider the that, how, and why of ethics consultation, moral expertise, and the rules of the game. The question still to be engaged is, how does all of this work out for patients and families?

Questions that arise in the doctor-patient relationship may be transforming. The discussion begins with a compelling example: When parents ask, “Doctor, if this were your child, what would you do?” it is always a “high-stakes” question. What the question means and how it is understood depends on how we understand, and how sensitive we are, to the context and the complexity of several different relationships, and what each uniquely asks or requires. -/- Working from the parents’ question, “What would you (...) do . . . ?” the present discussion will develop a broader understanding of questions within the doctor-patient relationship and the possibilities for finding meaning that they introduce. A clinical narrative is used to show that questions are most meaningful when they are understood in the context of a unique relationship--and a "potential space"--that is both interpersonal and ontological. (shrink)

Background: To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature. Methods: A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included. Ethical considerations: The review is conducted according to the Vancouver Protocol. (...) Results: There are few studies that study ethical challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good (beneficence) and inflicting harm (maleficence). In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion. Conclusion: There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress. (shrink)

With the rising of the reported cases of COVID-19 and home quarantine being implemented, the Internet became a channel for effective human interaction. Doing most of the work online brought an increasing number of online fraudsters to exploit the public fear of the pandemic to attack people through cybercrime. This paper introduces what cybersecurity is all about. It also lists some of the cybersecurity issues that are being faced at this time. Further, it discusses forms of attacks being encountered and (...) lists recommendations on how to be safe online. (shrink)

Grammatical categories represent implicit knowledge, and it is not known if such abstract linguistic knowledge can be continuously grounded in real-life experiences, nor is it known what types of mental states can be simulated. A former study showed that attention bias in peripersonal space affects reaction times in grammatical congruency judgments of nominal classifiers, suggesting that simulated semantics may include reenactment of attention. In this study, we contrasted a Chinese nominal classifier used with nouns denoting pinch grip objects with a (...) classifier for nouns with big object referents in a pupil dilation experiment. Twenty Chinese native speakers read grammatical and ungrammatical classifier-noun combinations and made grammaticality judgment while their pupillary responses were measured. It was found that their pupils dilated significantly more to the pinch grip classifier than to the big object classifier, indicating attention simulation in PPS. Pupil dilations were also significantly larger with congruent trials on the whole than in incongruent trials, but crucially, congruency and classifier semantics were independent of each other. No such effects were found in controls. (shrink)

__Teachers Bridging Difference_ describes how educators can move out of their comfort zones and practice connecting with others across differences to become culturally responsive teachers. _Based on a course developed for preservice teachers, the book illustrates how educators can draw on the visual arts as a resource to explore their own identities and those of their students, and how to increase their understanding of the ways our lives intersect across sociocultural differences. Drawing on scholarship from multiple disciplines and from her (...) own experience, Marit Dewhurst identifies four stances designed to help educators connect with students in today’s multicultural classrooms. To practice these stances, the book introduces eight arts-based activities that can be used by educators in multiple contexts. Ranging from community maps and conversation portraits to scenario comics and reflection zines, the activities are designed to be accessible to even those with little arts experience and can be executed with a wide variety of materials and media. Unique and timely, _Teachers Bridging Difference _is an arts-based tool kit for teachers interested in exploring issues of identity and difference as a foundation for creating a more just and equal society. (shrink)

In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?

The question whether memory aberrations in posttraumatic stress disorder also manifest as an increased production of false memories is important for both theoretical and practical reasons, but is yet unsolved. Therefore, for the present study we investigated veridical and false recognition in PTSD with a new scenic variant of the Deese–Roediger–McDermott paradigm, which was administered to traumatized individuals with PTSD , traumatized individuals without PTSD , and non-traumatized controls . The PTSD group neither produced higher rates of false memories nor (...) expressed more confidence in errors, but did show inferior memory sensitivity. Whereas depressive symptoms did not correlate with veridical nor false recognition, state dissociation was positively associated with false memories. (shrink)

The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician—nurse collaboration, lack of (...) confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed. (shrink)

. A space for ‘who’ – a culture of ‘two’: speculations related to an ‘in-between knowledge’. Ethics and Education: Vol. 7, Creating spaces, pp. 251-260. doi: 10.1080/17449642.2013.767084.

Amsterdam University Press is a leading publisher of academic books, journals and textbooks in the Humanities and Social Sciences. Our aim is to make current research available to scholars, students, innovators, and the general public. AUP stands for scholarly excellence, global presence, and engagement with the international academic community.

In this article we explore a notion of relationship which exists between humans. This notion of relationship takes as a point of departure that differences in human relations and interaction have to be safeguarded. Starting with the Irigarayan notion of ‘two’ as a gendered difference, opposed to an understanding of humans as one and same (gender), we elaborate an understanding of otherness which opens a space where both self and other are welcomed. This relational space cannot be appropriated by either (...) one for it to exist. We continue by drawing from Harry G. Frankfurt's discussion of care in order to understand human (inter)actions in this space. Through an elaboration of how love as a special form of care represents a motivational drive, a way in which a person's will is formed, we try to show how this attentiveness towards the other is possible. Our point of departure is two statements by female head teachers that prompted these theoretical inquiries into other possibilities for interpreting human (inter)action in leadership in education. (shrink)

Inhaltsübersicht: Vorwort, Göttin, Tod und Geburt, Mensch, Subjekt, Leib, Sprache, Vernunft, Differenz, Ethik, Freiheit, Gerechtigkeit, Glück, Liebe, Arbeit, Kunst, Zeit, Anhang: Literaturverzeichnis, Kommentiertes Personenverzeichnis, Bildnachweise, Sach- und Personenregister.

In the debate around ecological democracy, a pivotal point of contention has long been the question why democracy should actually be expected, as some claim, to deliver (more) ecological outcomes. This point is empirical as well as conceptual: it is difficult to conceive why voters would support any policies that – as is often (perceived to be) the case with environmental legislation – would leave them worse off; whilst democracy conceptually must remain open to all outcomes rather than being tied (...) to any particular agenda ex ante. Yet both empirically and conceptually, the nature and extent of this key puzzle has always hinged on the particular definitions used. This paper reconsiders the link between democracy and ecological sustainability from a cultural angle: I argue that conceiving of both sustainability and democratisation as essentially cultural transformations resolves the puzzle and thus makes a renewed case for ecological democracy. Only as cultural processes – the creation of new meanings of sustainable prosperity in people's everyday lives, and a culturally rather than institutionally based form of democratisation – can these transformations be deep-seated rather than superficial, and thus self-perpetuating rather than merely enforced. (shrink)

Informed consent represents a cornerstone of the endeavours to make health care research ethically acceptable. Based on experience of qualitative research on power dynamics in nursing care in acute psychiatry, we show that the requirement for informed consent may be practised in formalistic ways that legitimize the researcher's activities without taking the patient's changing perception of the situation sufficiently into account. The presentation of three patient case studies illustrates a diversity of issues that the researcher must consider in each situation. (...) We argue for the necessity of researchers to base their judgement on a complex set of competencies. Consciousness of research ethics must be combined with knowledge of the challenges involved in research methodology in qualitative research and familiarity with the therapeutic arena in which the research is being conducted. The article shows that the alternative solution is not simple but must emphasize the researcher's ability to doubt and be based on an awareness of the researcher's fallibility. (shrink)

Henrich Steffens (1773-1845) war einer der frühen politischen Professoren Deutschlands. Er war Verfechter der souveränen Wissenschaft, Fürsprecher der individuellen Pädagogik, Gegner des ideologischen Turnens Friedrich Ludwig Jahns und Verteidiger einer natürlichen Nationsbildung.