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 article reports the findings of a qualitative study that explored the organizational influences on moral distress for health professionals working in pediatric intensive care units across Canada. Participants were recruited to the study from PICUs across Canada. The PICU is a high-tech, fast-paced, high-pressure environment where caregivers frequently face conflict and ethical tension in the care of critically ill children. A number of themes including relationships with management, organizational structure and processes, workload and resources, and team dynamics were identified. (...) This study provides a rare and important multi-disciplinary perspective on this topic and the findings have implications for administrators and leaders who seek to improve the moral climate of healthcare delivery. (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)

Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in (...) the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH. (shrink)

This book explores the complex nexus of discourses, principles and practices within which educators mobilise school-based health education. Through an interrogation of the ideas informing particular models and approaches to health education, the authors provide critical insights into the principles and practices underpinning approaches to health education policy, curriculum, pedagogy and assessment. Drawing on extensive literature and research, the book explores and considers what health education can and should do. Chapters examine the extent to which health education, past and present, (...) has attended to the needs and interests of young people in school environments, as well as assess common pedagogical approaches and whether the outcomes tally with expectations. By considering the problems in teaching health education, curriculum making, health education pedagogies and porous classrooms, the book offers a knowledge base from which educators can consider how theories and models can sit together to shape curriculum and influence practice. School Health Education in Changing Times will be of key interest to postgraduate students, researchers and academics in the field of health education. It will also be a valuable resource for teacher educators, current teachers, and those on professional development courses who want to navigate the moral minefield surrounding health education. (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)

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)

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)

Drawing on insights from conversation analysis, discursive psychology and social psychology, this article describes some interactional features of two celebrity TV confessionals and the resources used by the TV interviewers and celebrity guests to attribute, accept or deny responsibility for their transgressions. The analytic interest lies in how confessions are locally and interactionally managed, that is, how ‘doing confessing’ is achieved in the television interview context. We show how the host’s opening turn constrains the celebrity guest’s contribution and secures overt (...) admission of guilt, while simultaneously inviting the celebrity guest to tell their side of the story. We also show how celebrity guests produce descriptions which minimize the extent and severity of their transgressions, reduce agency and transform the character of their transgression. In doing so, we argue that celebrity interviewees can convey mitigations and extenuations which diminish the extent of their responsibility – calling into question the very nature of their confession. We propose that our findings demonstrate the hybrid nature of interviewing in the celebrity TV confessional and contribute to our understanding of how ‘doing confessing’ in the public eye is discursively and interactionally negotiated. (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)

Slippery slope arguments appear regularly whenever morally contested social change is proposed. Such arguments assume that all or some consequences which could possibly flow from permitting a particular practice are morally unacceptable.Typically, “slippery slope” arguments claim that endorsing some premise, doing some action or adopting some policy will lead to some definite outcome that is generally judged to be wrong or bad. The “slope” is “slippery” because there are claimed to be no plausible halting points between the initial commitment to (...) a premise, action, or policy and the resultant bad outcome. The desire to avoid such projected future consequences provides adequate reasons for not taking the first step.Thus the legalization of abortion in limited circumstances is asserted to lead down the slippery slope towards abortion on demand and even infanticide; and the legalization of assisted suicide to lead inexorably to the acceptance of voluntary euthanasia and subsequently to the sanctioning of the practice of nonvoluntary euthanasia – even involuntary euthanasia of “undesirable” individuals. (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)

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)

Procedures such as organ or tissue donation, elective ventilation and non‐therapeutic research can be said to be against the medical interests of the participant. Competent adults can consent to procedures such as these that are against their medical interests, but when, if ever, should incompetent persons participate in such procedures? Legal approaches to decision‐making in the area of the medical care of incompetent persons are generally based on respect for the patient's autonomy, or protection of her welfare, or some combination (...) of the two. The limitations of these approaches become apparent upon examination of their application in this context. Societal interests are also used to justify the participation of the incompetent in procedures which are against their medical interests, for example, the societal interest in pursuing non‐therapeutic research on incompetents in order to benefit future incompetents. These types of approaches are implicit in much current policy and reform proposals on non‐therapeutic research, contributing to the disrespect for incompetent persons that is implicit in many research projects and much argument on the categorization of risks, and the repeated failure to consider the burdens imposed on incompetent persons in the interests of society. (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.

Reframes the terms of cultural analysis with a fresh take on transference theory in Freud and Lacan and a critical engagement with the philosophy of Alain Badiou.

_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)

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)

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...

Este artículo profundiza en los debates históricos y actuales en Canadá sobre la historia nacional y la enseñanza de la historia en el complicado escenario de trece jurisdicciones educativas de Canadá. En este trabajo se analizan los debates sobre los contenidos en la enseñanza de la historia y en los libros de texto, así como los enfoques en la escuela. Se analizan las formas en que un enfoque de pensamiento histórico está consolidándose en todo el país en el período actual, (...) con una mayor atención a la investigación en la enseñanza de la historia y su difusión y su mayor presencia en los planes provinciales. Se considera el papel del gobierno federal en estos cambios, las organizaciones privadas sin fines de lucro, y los proyectos financiados por el gobierno nacional, tales como el Historical Thinking Project y The History Education Network. (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.

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)

In lieu of an abstract, here is a brief excerpt of the content:Diacritics 32.2 (2002) 3-19 [Access article in PDF] (Queer) Theory and the Universal Alternative James Penney Judith Butler. Antigone's Claim: Kinship Between Life and Death. New York: Columbia UP, 2000. Judith Butler, Ernesto Laclau, and Slavoj Žižek. Contingency, Hegemony, Universality: Contemporary Dialogues on the Left. London: Verso, 2000. In October 2000, just a few weeks before the US presidential election, a young, fashionable, handsome man handed me a (...) political leaflet while I crossed Christopher Street in Greenwich Village. I didn't give it much thought at the time (apart from noticing that the boy was kind of cute): I was in transit toward the 4th Street subway station and the Port Authority where I would catch the bus back to Cornell. When I decided to write a review essay on the current state of poststructuralism, Marxism, and queer theory through the lens of the two books listed above, I discovered I had lost the pamphlet, certain that my hostile reaction to what I considered its fundamental conservatism and trendy political correctness had unconsciously caused its mysterious disappearance.When I rediscovered the leaflet in the chaos of my move away from Ithaca, I realized that my relation to it had been hysterical: I was reluctant to address its traumatic content, unwilling to excavate my multiple frustrations at the apparent impossibility of being a homosexual and a socialist in America. And yet I couldn't really forget about it either: though not an American citizen and therefore unable to vote, I found myself equally unable simply to dismiss the leaflet as a mere inconsequential symptom of the pseudo-democracy that America has always been, or unequivocally to endorse the snooty CBC/Queen Street condescension of my fellow Canadian Lefties toward the primitive, superficial, liberal (in the worst psychologistic sense), irremediably ideological, and thoroughly depressing state of American political discourse. "Those poor Americans," the far-from-irrelevant logic goes. "They either unquestioningly submit to the individualistic fantasy of the American Dream in order to participate in the 'political process,' or they become hermetically imprisoned in their pseudo-political anti-statist minoritarianism, too cool and too radical to condescend to the public sphere." After six years in the United States, I've now become aware that my inability to swallow much of contemporary queer theory—authored overwhelmingly by young, elite-educated Americans with relatively narrow political horizons—is mostly due to the manner in which it articulates numerous political assumptions fundamentally alien to my own socialization in a country whose political differences from the US are insufficiently appreciated in that nation, and in which extremes of climate and geography have engendered a collectivist ethos in many ways fundamentally hostile to the American-style extreme individualism with which I had lived for so many years.But the interest of this sort of political autobiography is in this context undoubtedly limited. What—you might now find yourself impatiently wondering if you don't already [End Page 3] know—were the contents of this famous pamphlet? And what exactly was my problem with it? Published by a coalition of queer voters in New York called the Empire State Pride Agenda, the pamphlet presented extremely selective profiles of the main candidates, both Democrat and Republican, running for the offices of President, US Senator, State Senator, and Member of the State Assembly. Each profile summarized the history of a candidate's positions with respect to rights issues of concern to gay, lesbian, bisexual, and transgendered persons. The profiles made no concerted effort to represent the candidates' perspectives on any other issue: gun control, education, foreign policy, the death penalty, taxation, health care (generally speaking, that is to say above and beyond the issues related to AIDS-related illness and reproductive rights); only policies directly concerning civil rights for nonheterosexual citizens were thoroughly broached.I should confess that once I got the general idea I threw the pamphlet away in disgust: "Am I supposed to feel interpellated," I asked myself in full hysterical Althusserian mode, "by this utterly pseudo-political claptrap?" Is this what it means to be gay and political in America... (shrink)