Throughout March and April 2020, debate raged about how best to allocate limited intensive care unit (ICU) resources in the face of a growing COVID-19 pandemic. The debate was dominated by utility-based arguments for saving the most lives or life-years. These arguments were tempered by equity-based concerns that triage based solely on prognosis would exacerbate existing health inequities, leaving disadvantaged patients worse off. Central to this debate was the assumption that ICU admission is a valuable but scarce resource in the (...) pandemic context.In this paper, we argue that the concern about achieving equity in ICU triage is problematic for two reasons. First, ICU can be futile and prolong or exacerbate suffering rather than ameliorate it. This may be especially true in patients with COVID-19 with emerging data showing that most who receive access to a ventilator will still die. There is no value in admitting patients with poor prognostic indicators to ICU to meet an equity target when intensive critical care is contrary to their best interests. Second, the focus on ICU admission shifts focus away from important aspects of COVID-19 care where there is greater opportunity for mitigating suffering and enhancing equitable care.We propose that the focus on equity concerns during the pandemic should broaden to include providing all people who need it with access to the highest possible standard of end-of-life care. This requires attention to culturally safe care in the following interlinked areas: palliative care, communication and decision support and advanced care planning. (shrink)

This essay – a collection of contributions from 10 scholars working in the field of biosemiotics and the humanities – considers nature in culture. It frames this by asking the question ‘Why does biosemiotics need the humanities?’. Each author writes from the background of their own disciplinary perspective in order to throw light upon their interdisciplinary engagement with biosemiotics. We start with Donald Favareau, whose originary disciplinary home is ethnomethodology and linguistics, and then move on to Paul Cobley’s contribution on (...) general semiotics and Kalevi Kull’s on biosemiotics. This is followed by Cobley with Frederick Stjernfelt who contribute on biosemiotics and learning, then Gerald Ostdiek from philosophy, and Morten Tønnessen focusing upon ethics in particular. Myrdene Anderson writes from anthropology, while Timo Maran and Louise Westling provide a view from literary study. The essay closes with Wendy Wheeler reflecting on the movement of biosemiotics as a challenge, often via the ecological humanities, to the kind of so-called ‘postmodern’ thinking that has dominated humanities critical thought in the universities for the past 40 years. Virtually all the matters gestured to in outline above are discussed in much more satisfying detail in the topics which follow. (shrink)

Background: Limited knowledge of the experiences of conflicts of conscience found in nursing literature. Objectives: To explore the individual experiences of a conflict of conscience for neonatal nurses in Alberta. Research design: Interpretive description was selected to help situate the findings in a meaningful clinical context. Participants and research context: Five interviews with neonatal nurses working in Neonatal Intensive Care Units throughout Alberta. Ethical consideration: Ethics approval from the Health Research Ethics Board at the University of Alberta. Findings: Three common (...) themes emerged from the interviews: the unforgettable conflict with pain and suffering, finding the nurse’s voice, and the unique proximity of nurses. Discussion and conclusion: The nurses described a conflict of conscience when the neonate in their care experienced undermanaged pain and unnecessary suffering. During these experiences, they felt guilty, sad, hopeless, and powerless when they were unable to follow their conscience. Informal ways to follow their conscience were employed before declaration of conscientious objection was considered. This study highlights the vital importance of respecting a conflict of conscience to maintain the moral integrity of neonatal nurses and exposes the complexities of conscientious objection. (shrink)

"Is it meaningful to call oneself a democrat? And if so, how do you interpret the word?" -/- In responding to this question, eight iconoclastic thinkers prove the rich potential of democracy, along with its critical weaknesses, and reconceive the practice to accommodate new political and cultural realities. Giorgio Agamben traces the tense history of constitutions and their coexistence with various governments. Alain Badiou contrasts current democratic practice with democratic communism. Daniel Bensaid ponders the institutionalization of democracy, while Wendy (...) Brown discusses the democratization of society under neoliberalism. Jean-Luc Nancy measures the difference between democracy as a form of rule and as a human end, and Jacques Rancière highlights its egalitarian nature. Kristin Ross identifies hierarchical relationships within democratic practice, and Slavoj Zizek complicates the distinction between those who desire to own the state and those who wish to do without it. -/- Concentrating on the classical roots of democracy and its changing meaning over time and within different contexts, these essays uniquely defend what is left of the left-wing tradition after the fall of Soviet communism. They confront disincentives to active democratic participation that have caused voter turnout to decline in western countries, and they address electoral indifference by invoking and reviving the tradition of citizen involvement. Passionately written and theoretically rich, this collection speaks to all facets of modern political and democratic debate. (shrink)

While ethics and evidence‐based medicine are often viewed as separate domains of inquiry and practice, what we know influences what we can ethically justify doing, and what we see as our moral obligations shapes the way we interpret evidence. The boundaries between the moral and epistemic spheres become particularly blurred when the health of people is at stake and even more so when no “officially” recommended medical intervention is available to help a patient in need. The treatment of major hemorrhages (...) using recombinant factor VIIa (rFVIIa), which was originally approved under orphan drug legislation to treat hemophilia, is a case in point.Following reports in the late 1990s that rFVIIa was success­fully used to stop bleeding in gunshot trauma, there was much excitement about its potential to help patients with uncontrolled bleeding in other clinical settings, leading to wide‐spread off‐label use of the drug. In recent years, new evidence has raised questions about the off‐label use of rFVIIa for severe bleeding. Nonetheless, while some clini­cians are now adamantly opposed to prescribing rFVIIa for massive bleed­ing, many remain determined to continue the practice. This raises the question: why do clinicians have such variable responses to the same body of evidence?We analyzed the debate around off‐label use of rFVIIa and character­ized its main conceptual features and tensions. We did not seek to provide a normative analysis as to whether the evidence supports the case for off‐label prescribing, nor did we try to provide a historical analysis of how attitudes and clinical practice have changed. Rather, we sought to make visible the moral and epistemic values underpinning stakeholders’ opinions and practices. On the basis of our analysis, which is described in this ar­ticle, we suggest that debates such as those surrounding rFVIIa will not be resolved simply by conducting more studies and that, therefore, there is also a need for conceptual and pro­cedural frameworks that more sys­tematically incorporate values into clinical policy‐making. (shrink)

The analysis and understanding of multilingualism, and its relationship to identity in the face of globalization, migration and the increasing dominance of English as a lingua franca, makes it a complex and challenging problem that requires insights from a range of disciplines. With reference to a variety of languages and contexts, this book offers fascinating insights into multilingual identity from a team of world-renowned scholars, working from a range of different theoretical and methodological perspectives. Three overarching themes are explored – (...) situatedness, identity practices, and investment – and detailed case studies from different linguistic and cultural contexts are included throughout. The chapter authors' consideration of 'multilingualism-as-resource' challenges the conception of 'multilingualism-as-problem', which has dogged so much political thinking in late modernity. The studies offer a critical lens on the types of linguistic repertoire that are celebrated and valued, and introduce the policy implications of their findings for education and wider social issues. (shrink)

El presente trabajo estudió la relación entre el derecho a la identidad en toda su esfera y la prohibición del anonimato de donantes de gametos en la aplicación de técnicas de reproducción humana asistida. La metodología se desarrolló desde un enfoque cualitativo, se utilizaron los métodos inductivo-deductivo, dogmático, histórico-lógico, comparativo y analítico-sintético, la técnica aplicada fue la revisión bibliográfica de ley, doctrina y jurisprudencia. Como conclusión se estableció la vulneración de derechos al inexistir una ley que regule el anonimato de (...) donantes. Adicionalmente se sugiere que, el Estado ecuatoriano cuente con una normativa completa, rígida y sobre todo garantista de los derechos de los intervinientes en las técnicas de reproducción humana asistida, de manera especial a las personas nacidas a través de gametos donados. (shrink)

On the twelfth anniversary of the name of Mexican Gastronomy as intangible cultural heritage of humanity, its safeguarding continues in different contexts. Nayarit stands out for its natural and cultural wealth which is reflected in the local gastronomy, whose recognition attracts locals and foreigners to taste the delicious dishes. This text contains research results whose purpose is to document the cultural and natural elements that make up the gastronomic heritage of Nayarit with potential for the development of tourism products. Through (...) a qualitative, applied, descriptive research, historical sources were consulted and contrasted with the information collected through interviews, for the integration of a non-exhaustive inventory of the north coast region of Nayarit, which serves as a basis for the tourist product design. (shrink)

Many of the most pressing moral problems that face our world are structural problems. Problems of this nature present difficulties for Christian ethicists because structural features tend to undermine conditions for the attribution of individual moral responsibility. This essay proposes an approach to this problem that reconciles a social account of sin with individual moral responsibility. Two key moves drive this proposal. First, I argue for a sharper distinction between sin and moral wrongdoing than is common. Second, I argue that (...) both sin and individual moral responsibility ought to be understood socially. This proposal addresses deep conceptual problems and points practical efforts in a new direction. (shrink)

For over two centuries, consequentialism has been among the most influential approaches to ethics and public policy in the Anglophone world. It is often seen as the paradigmatic rational and secular ethic. In The Best Effect, Ryan Darr reveals that a consequentialist approach to ethics is not, as is often assumed, self-evidently rational once religious morality is stripped away. Rather, consequentialist morality itself had to be invented. In this new account of the origins of consequentialism, Darr traces the (...) development of this new consequentialist morality, revealing its decidedly theological history. The Best Effect portrays the emergence in the mid-seventeenth century of the consequentialist moral cosmology, a richly theological vision of a world created by a consequentialist Creator, through to its eventual breakdown in the early eighteenth century in the face of a new version of the theological problem of evil. The book concludes with an intervention in contemporary debates about consequentialism in both religious ethics and moral philosophy, arguing for an alternative approach to teleological ethics. (shrink)

Many critiques of consumerism inadequately consider the complex interactions between individuals, their desires, and their social practices. Christine Darr provides an analysis of desire within consumer culture by integrating insights from moral theology and sociology and offers intellectual resources for more deliberate decision-making.

Increasingly there are calls for climate services to be “co-produced” with users, taking into account not only the basic information needs of users but also their value systems and decision contexts. What does this mean in practice? One way that user values can be incorporated into climate services is in the management of inductive risk. This involves understanding which errors in climate service products would have particularly negative consequences from the users’ perspective (e.g., underestimating rather than overestimating the change in (...) an impact variable) and then prioritizing the avoidance of those errors. This essay shows how inductive risk could be managed in climate services in ways that serve user values and argues that there are both ethical and practical reasons in favor of doing so. (shrink)

The interaction between evidence-based medicineand doctors' duty of care to patients iscomplex. One the one hand, there is surely anobligation to take account of the bestavailable evidence when offering health care topatients. On the other hand, it is equallyimportant to be aware of important shortcomingsin the processes and practices ofevidence-based medicine. There are tensionsbetween the population focus of evidence-basedmedicine and the duties that doctors have toindividual patients. Implementingevidence-based medicine may have unpredictableconsequences upon the overall quality of healthcare. Patients may have (...) a range of reasons forpreferring one form of treatment over another,not all of which are captured by currentformulations of evidence. This paper examinesthese issues, using relevant examples fromevidence-based medicine. (shrink)

Whether in characterizing Catharine MacKinnon's theory of gender as itself pornographic or in identifying liberalism as unable to make good on its promises, Wendy Brown pursues a central question: how does a sense of woundedness become the basis for a sense of identity? Brown argues that efforts to outlaw hate speech and pornography powerfully legitimize the state: such apparently well-intentioned attempts harm victims further by portraying them as so helpless as to be in continuing need of governmental protection. "Whether (...) one is dealing with the state, the Mafia, parents, pimps, police, or husbands," writes Brown, "the heavy price of institutionalized protection is always a measure of dependence and agreement to abide by the protector's rules." True democracy, she insists, requires sharing power, not regulation by it; freedom, not protection.Refusing any facile identification with one political position or another, Brown applies her argument to a panoply of topics, from the basis of litigiousness in political life to the appearance on the academic Left of themes of revenge and a thwarted will to power. These and other provocations in contemporary political thought and political life provide an occasion for rethinking the value of several of the last two centuries' most compelling theoretical critiques of modern political life, including the positions of Nietzsche, Marx, Weber, and Foucault. (shrink)

Over the last two decades, a growing philosophical literature has subjected virtue ethics to empirical evaluation. Drawing on results in social psychology, a number of critics have argued that virtue ethics depends upon false presuppositions about the cross‐situational consistency of psychological traits. Alasdair MacIntyre’s After Virtue has been a prime target for the situationist critics. This essay assesses the situationist critique of MacIntyre’s account of virtue. It argues that MacIntyre’s social teleological account of virtue is not what his situationist critics (...) take it to be. Virtues, for MacIntyre, are not reducible to psychological traits. They are qualities of one’s socially constituted character, and their intelligibility as virtues derives from their role in the narrative of one’s life. Recognizing this both clarifies and complicates debates about the implication of situationist social psychology for virtue ethics. It also grants a new significance to MacIntyre’s attention to the socio‐historical context of virtue, a significance that should be especially interesting to religious ethicists. (shrink)

In his widely read book, Five Types of Ethical Theory (1930), C.D. Broad introduced the distinction between two approaches to ethics: teleology and deontology. In the second half of the twentieth century, these terms found their way into Christian ethics, giving rise to a problem. Christian ethics seems to be straightforwardly teleological, but it also seems to be straightforwardly deontological. In this article, I argue that the problem is largely a product of the way teleology is construed: the ends in (...) teleological ethics are implicitly assumed to be outcomes or states of affairs. I demonstrate the point through a reading of both the early philosophical sources and the more recent works of Charles Camosy and John Perry. I then argue that major sources in the Christian tradition, including those used by Camosy and Perry, are better understood as offering a more expansive picture of teleology in which ends are not always outcomes or states of affairs. I conclude by arguing that this more expansive picture of teleology resolves some important problems that have plagued debates about teleology and deontology in Christian ethics. (shrink)

Unable to answer the call of our patients: mental health nurses’ experience of moral distress When health practitioners’ moral choices and actions are thwarted by constraints, they may respond with feelings of moral distress. In a Canadian hermeneutic phenomenological study, physicians, nurses, psychologists and non‐professional aides were asked to identify care situations that they found morally distressing, and to elaborate on how moral concerns regarding the care of patients were raised and resolved. In this paper, we describe the experience of (...) moral distress related by nurses working in mental healthcare settings who believed that lack of resources (such as time and staff) leads to dispiritedness, lack of respect, and absence of recognition (for both patients and staff) which severely diminished their ability to provide quality care. The metaphors of flashlight and hammer are used to elaborate nurses’ possible responses to intolerable situations. (shrink)

The article examines the use of semiotics in media theory, advancing a critique of Saussurian approaches to media and harnessing Peirce's sign theory as a way to analyze media, with reference to the sign “terrorist.” The tiered model of media representation based on Saussure's sign relation is found to under-theorize the materiality of the sign, the indeterminacy of meaning, the significance of the speaking subject, and the ideological and institutional forces that work on the sign. The interpretant in Peirce's model (...) allows an alternate approach to media analysis in which media can be considered a kind of material culture, produced by people in regulated settings and encountered by interpreting minds in various contexts. Metasemiotic frameworks are found to operate on the sign “terrorist,” but the ongoing process of semiosis also allows for the possibility of change. (shrink)

Wendy Brown's work commands widespread attention and respect, and there has been considerable interest as to how it would develop after "States of Injury." This book will not disappoint.

In this paper we explore the nature of the emerging purpose ecosystem and its role in transforming and supporting business to help address the UN Sustainable Development Goals. We argue that interactions among its ‘private actors’, who share efforts and belief in changing and redefining the purpose and nature of business by advocating broader non-financial performance outcomes, have the potential to contribute to a wider sustainability-oriented transformation of the business sector. Through interview data collected in the UK and Australia, we (...) identify six main roles that characterise the activities and interactions among its actors and their stakeholders. Our research contributes to expanding knowledge on the emerging phenomenon of the purpose ecosystem and how its actors support the achievement of the UN SDGs by seeking to change the purpose of business and integrating the goals into their operations and engagements with stakeholders. (shrink)

_John Stuart Mill_ investigates the central elements of the 19th century philosopher’s most profound and influential works, from _On Liberty_ to _Utilitarianism_ and _The Subjection of Women_. Through close analysis of his primary works, it reveals the very heart of the thinker’s ideas, and examines them in the context of utilitarianism, liberalism and the British empiricism prevalent in Mill’s day. • Presents an analysis of the full range of Mill’s primary writings, getting to the core of the philosopher’s ideas. • (...) Examines the central elements of Mill’s writings in easily accessible prose • Places Mill’s work and thought within the larger cultural and social context of 19th century Britain • Illustrates the continued relevance of Mill’s philosophy to today’s reader. (shrink)

Intellectual property law tends to be viewed as the only (or most significant) mechanism for achieving policy goals relating to innovation assets. Yet more creative and effective solutions are often available. When analysed from a transdisciplinary perspective, relying on the cooperative efforts of researchers from fields other than law, innovation governance is characterized not simply as the product of legal rules, but as a function of the interaction of legal rules, practices and institutions. When policy-makers seek to identify conditions under (...) which the creation, use and exchange of innovation assets flourishes, care should be taken to focus on this combination of factors. This article describes the development of an ontology—a computerized method of representing knowledge as concepts and relations between concepts—to convey such understanding. Policy makers (and researchers) are provided with an organized, accessible representation of innovation governance that enriches their understanding and improves their decision-making. (shrink)

To study Earth’s climate, scientists now use a variety of computer simulation models. These models disagree in some of their assumptions about the climate system, yet they are used together as complementary resources for investigating future climatic change. This paper examines and defends this use of incompatible models. I argue that climate model pluralism results both from uncertainty concerning how to best represent the climate system and from difficulties faced in evaluating the relative merits of complex models. I describe how (...) incompatible climate models are used together in ‘multi-model ensembles’ and explain why this practice is reasonable, given scientists’ inability to identify a ‘best’ model for predicting future climate. Finally, I characterize climate model pluralism as involving both an ontic competitive pluralism and a pragmatic integrative pluralism. (shrink)

I introduce a distinction between general and local model-data symbiosis and offer three examples of local symbiosis in the fields of meteorology and climate science. Local model-data symbiosis ref...

First published in 1982. Routledge is an imprint of Taylor & Francis, an informa company.

DIVA reader aimed at revitalizing left legal and political critique./div.

Moral injury occurs when a person perpetrates, bears witness to, or fails to prevent an act that transgresses their deeply held moral beliefs. The deeply held moral belief that physicians share is the oath they take when completing their lengthy training and embarking on their career: Put the needs of patients first. In today's American healthcare system, doctors, nurses, and other healthcare providers are increasingly forced to consider the demands of other stakeholders -- insurers, hospitals, even their own financial security (...) -- before the needs of their patients. Whenever they are forced to make a decision that contravenes their patient's best interest, they feel a sting of moral injustice. Over time, these repetitive insults amass into moral injury. Moral injury and its causes help explain why healthcare workers started leaving the field in droves long before the COVID-19 pandemic exposed weaknesses in the US system, why a rich country has such poor outcomes in certain categories, why there is a shortage of young doctors training for critical areas, and why patients feel so frustrated. In If I Betray These Words, Wendy Dean explores and exposes the impacts of moral injury through vividly told stories that are at once bewildering and eye-opening. Her book serves as a roadmap through a healthcare landscape that can be confounding, and at times even hellish, for those who must navigate it, and it suggest alternative routes for healers and their patients. (shrink)

We invoke the ideal of tolerance in response to conflict, but what does it mean to answer conflict with a call for tolerance? Is tolerance a way of resolving conflicts or a means of sustaining them? Does it transform conflicts into productive tensions, or does it perpetuate underlying power relations? To what extent does tolerance hide its involvement with power and act as a form of depoliticization? Wendy Brown and Rainer Forst debate the uses and misuses of tolerance, an (...) exchange that highlights the fundamental differences in their critical practice despite a number of political similarities. Both scholars address the normative premises, limits, and political implications of various conceptions of tolerance. Brown offers a genealogical critique of contemporary discourses on tolerance in Western liberal societies, focusing on their inherent ties to colonialism and imperialism, and Forst reconstructs an intellectual history of tolerance that attempts to redeem its political virtue in democratic societies. Brown and Forst work from different perspectives and traditions, yet they each remain wary of the subjection and abnegation embodied in toleration discourses, among other issues. The result is a dialogue rich in critical and conceptual reflections on power, justice, discourse, rationality, and identity. (shrink)

Wendy Donner contends here that recent commentators on John Stuart Mill's thought have focused on his notions of right and obligation and have not paid as much attention to his notion of the good. Mill, she maintains, rejects the quantitative hedonism of Bentham's philosophy in favor of an expanded qualitative version. In this book she provides an account of his complex views of the good and the ways in which these views unify his moral and political thought.

A summary of the existing literature related to moral distress (MD) and the paediatric intensive care unit (PICU) reveals a high-tech, high-pressure environment in which effective teamwork can be compromised by MD arising from different situations related to: consent for treatment, futile care, end-of-life decision making, formal decision-making structures, training and experience by discipline, individual values and attitudes, and power and authority issues. Attempts to resolve MD in PICUs have included the use of administrative tools such as shift worksheets, the (...) implementation of continuing education, and encouragement to report. The literature does not yet show these approaches to be effective in the resolution of MD. The need to acknowledge MD among PICU teams is discussed and an argument made that, to facilitate understanding among team members, practice stories need to be shared. (shrink)

On the 24th June 2015, Feminist Legal Studies and the London School of Economics Law Department hosted an afternoon event with Professor Wendy Brown, Class of 1936 First Professor of Political Science, University of California. Professor Brown kindly agreed to discuss her scholarship on feminist theory, and its relationship to both the law and neoliberalism. The event included an interview by Dr Katie Cruz and a Q&A session, which are presented here in an edited version of the transcript. Sumi (...) Madhock, Professor of Gender Studies, LSE chaired the interview and discussion and introduced Professor Brown’s work. Katie Cruz asked Wendy Brown to reflect upon topics that span her scholarship and activism, including the state of critical, feminist, and Left approaches to rights, neoliberalism, despair and utopianism, and the future of feminist theory and practice in the context of neoliberalism and current debates about intersectionality. Participants in the discussion asked questions on a wide range of issues, including the limits of feminist engagement with law as a tool for social change, the dominance of neoliberalism, imperialist feminism, Islamophobia, secularism, and our attachment to the figure of homo politicus. (shrink)