BackgroundThe advent of learning healthcare systems (LHSs) raises an important implementation challenge concerning how to request and manage consent to support secondary use of data in learning cycles, particularly research activities. Current consent models in Quebec were not established with the context of LHSs in mind and do not support the agility and transparency required to obtain consent from all involved, especially the citizens. Therefore, a new approach to consent is needed. Previous work identified the meta-consent model as a promising (...) alternative to fulfill the requirements of LHSs, particularly large-scale deployments. We elicited the public’s attitude toward the meta-consent model to evaluate if the model could be understood by the citizens and would be deemed acceptable to prepare for its possible implementation in Quebec.MethodsEight focus groups, with a total of 63 members of the general public from various backgrounds were conducted in Quebec, Canada, in 2019. Explicit attention was given to literacy levels, language spoken at home and rural vs urban settings. We assessed attitudes, concerns and facilitators regarding key components of the meta-consent model: predefined categories to personalized consent requests, a dynamic web-based infrastructure to record meta-consent, and default settings. To analyse the discussions, a thematic content analysis was performed using a qualitative software.ResultsOur findings showed that participants were supportive of this new approach of consent as it promotes transparency and offers autonomy for the management of their health data. Key facilitators were identified to be considered in the implementation of a meta-consent model in the Quebec LHSs: information and transparency, awareness campaigns, development of educational tools, collaboration of front-line healthcare professionals, default settings deemed acceptable by the society as well as close partnerships with recognized and trusted institutions.ConclusionsThis qualitative study reveals the openness of a sample of the Quebec population regarding the meta-consent model for secondary use of health data for research. This first exploratory study conducted with the public is an important step in guiding decision-makers in the next phases of implementing the various strategies to support access and use of health data in Quebec. (shrink)

Although there are notable exceptions, examination of nursing's participation in colonizing processes and practices has not taken hold in nursing's consciousness or political agenda. Critical analyses, based on the examination of politics and power of the structural determinants of health, continue to be marginalized in the profession. The goals of this discussion article are to underscore the urgent need to further articulate postcolonial theory in nursing and to contribute to nursing knowledge about paths to work toward decolonizing the profession. The (...) authors begin with a description of unifying themes in postcolonial theory, with an emphasis on colonized subjectivities and imperialism; the application of a critical social science perspective, including postcolonial feminist theory; and the project of working toward decolonization. Processes involved in the colonization of nursing are described in detail, including colonization of nursing's intellectual development and the white privilege and racism that sustain colonizing thinking and action in nursing. The authors conclude with strategies to increase the counter‐narrative to continued colonization, with a focus on critical social justice, human rights and the structural determinants of health. (shrink)

Pedro Almodóvar is one of the most renowned film directors of recent years. Talk to Her is one of the most discussed and controversial of all his films. Dealing principally with the issue of rape, it also offers profound insights into the nature of love and friendship whilst raising important philosophical and moral questions in unsettling and often paradoxical ways. This is the first book to explore and address the philosophical aspects of Almodóvar’s film. Opening with a helpful introduction by (...) Noël Carroll that places the film in context, specially commissioned chapters examine the following topics: The relationship between art and morality and the problem of 'immoralism' Moral injury and its role in the way we form moral judgments, including the ethics of love and friendship The nature of dialogue, sexual objectification and what 'listening to' means in the context of gender Almodóvar's use of allusion and the unmasking of appearances to explore hidden themes in human nature. Including a biography of Almodóvar, Talk to Her is essential reading for students interested in philosophy and film as well as ethics and gender. It is also provides an accessible and informative insight into philosophy for those in related disciplines such as film studies, literature and religion. Contributors: Noël Carroll, A. W. Eaton, Cynthia Freeland, Robert B. Pippin, C.D.C. Reeve, and George M. Wilson. (shrink)

Books reviewed:John Barton, Joel and Obadiah: A Commentary John P. Meier, A Marginal Jew, Volume III: Companions and CompetitorsWilliam E. Arnal, Jesus and the Village Scribes: Galilean Conflicts and the Setting of QRichard A. Horsley, Hearing the Whole Story: The Politics of Plot in Mark's GospelMaurice Casey, Aramaic Sources of Mark's GospelPhilip Jenkins, Hidden Gospels: How the Search for Jesus Lost its WayChristopher M. Tuckett, Christology and the New Testament: Jesus and His Earliest FollowersMarkus Bockmuehl, The Cambridge Companion to (...) JesusShelly Matthews, First Converts: Rich Pagan Women and the Rhetoric of Mission in Early Judaism and ChristianityStephen J. Davis, The Cult of Saint Thecla: A Tradition of Women's Piety in Late AntiquityJ. Nimmo Smith, A Christian's Guide to Greek Culture. The Pseudo‐Nonnus Commentaries on Sermons 4, 5, 39 and 43 by Gregory of Nazianzus: Introduction, Translation and Notes.David Thomas, Early Moslem Polemic Against Christianity: Abu Isa al‐Warraq's ‘Against the Incarnation’Thomas O'Loughlin, Celtic Theology: Humanity, World and God in Early Irish WritingsCaroline M. Baron and Jenny Stratford, The Church and Learning in Later Medieval Society: Essays in Honour of R. B. Dobson Owen Chadwick, The Early Reformation on the Continent Benson Bobrick, The Making of the English BiblePeter Marhall and Alec Ryrie, The Beginnings of English ProtestantismRobert Tittler, The Reformation and the Towns in England. Politics and Political Culture, c. 1540–1640Peter Marshall, Beliefs and the Dead in Reformation EnglandNicholas Tyacke, Aspects of English Protestantism, c.1530–1700John Coffey, Persecution and Toleration in Protestant England, 1558–1689William Gibson, The Church of England 1688–1832: Unity and AccordWarwick Gould and Marjorie Reeves, Joachim of Fiore and the Myth of the Eternal Evangel in the Nineteenth and Twentieth CenturiesJames M. Byrne, God: Thoughts in an Age of Uncertainty Michael Palmer, The Question of God: An Introduction and SourcebookMichel René Barnes, The Power of God: ΔYNAMIΣ in Gregory of Nyssa's Trinitarian TheologyThomas Aquinas, Disputed Questions on VirtueStanley M. Hauerwas, Wilderness Wanderings: Probing Twentieth‐Century Theology and PhilosophyDavid Toole, Waiting for Godot in Sarajevo: Theological Reflections on Nihilism, Tragedy, and ApocalypseJohn Sullivan, Catholic Education: Distinctive and InclusiveGeorge Dennis O'Brien, The Idea of a Catholic UniversityGunnar Skirbekk and Nils Gilje, A History of Western ThoughtEllen Wagner, Essays on Plato's PsychologyAnthony Kenny, Aquinas on BeingJame Daly, Deals and Ideals: Two Concepts of EnlightenmentManfred Kuehn, Kant: A BiographyP. Travis Kroeker and Bruce K. Ward, Remembering the End: Dostoevsky as Prophet to ModernityStephen Mulhall, Inheritance and Originality: Wittgenstein, Heidegger, KierkegaardDavid Braybrooke, Natural Law ModernizedMaría Pía Lara, Rethinking EvilW. W. Meisner, Freud and PsychoanalysisJennifer Jackson, Truth, Trust and MedicineJeremy Sugarman and Daniel P. Sulmasy, Methods in Medical EthicsH. Tristram Engelhardt, Jr. and Mark J. Cherry, Allocating Scarce Medical Resources: Roman Catholic PerspectivesMaura A. Ryan, The Ethics and Economics of Assisted Reproduction: The Cost of LongingMichael Walsh, Dictionary of Christian Biography. (shrink)

Table of Contents: Illustrations Acknowledgments Conventions Introduction 3 Ch. 1 Kinds of Natural Philosophy 14 Ch. 2 Methods of Bookishness 49 Ch. 3 Modes of Argument 82 Ch. 4 Bodin’s Philosophy of Nature 116 Ch. 5 Theatrical Metaphors 153 Ch. 6 The Reception of the Theatrum 180 Epilogue: The Legacies of the Theatrum 225 Notes 233 Bibliography 331 Index 369.

Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.

Does the sense of smell involve the perception of odor objects? General discussion of perceptual objecthood centers on three criteria: stimulus representation; perceptual constancy; and figure-ground segregation. These criteria, derived from theories of vision, have been applied to olfaction in recent philosophical debates about psychology. An inherent problem with such framing of olfactory objecthood is that philosophers explicitly ignore the constitutive factors of the sensory systems that underpin the implementation of these criteria. The biological basis of odor coding is fundamentally (...) different from the coding principles of the visual system. This article analyzes the three measures of perceptual objecthood against the biological background of the olfactory system. It contrasts the coding principles in olfaction with the visual system to show why these criteria of objecthood fail to be instantiated in odor perception. The argument demonstrates that olfaction affords perceptual categorization without the need to form odor objects. (shrink)

The notion of virtue in general, and courage in particular, has had a hard time integrating itself into the everyday lexicon of bioethics. Following the lead of enlightenment moral philosophy, which concentrates on the theory of right action as opposed to the ancient Greeks' emphasis on the development of good character, bioethics, with some notable exceptions, has tended to relegate consideration of the virtues to the sidelines of moral argument. Recently, however, there have been calls for the necessity of “moral (...) courage” in the context of clinical ethics. As nurses, physicians, and other health care professionals confront a variety of moral contexts in which the virtue of courage is invoked to "do the right thing," stand up for patients' rights, and uphold the ethical standards of their professions, they are increasingly reminded of their moral duty to exhibit courage in the face of institutional obstacles to the proper care of their patients. For example, a nurse's hesitation to approach a physician to request increased sedation for an agitated patient out of fear of retaliation is represented in one article as a lack of courage.In this paper we offer a critical assessment of such invocations of courage. While we find courage to be an indispensable virtue in some challenging contexts, in other settings we find invocations of courage to be both an unfortunate endorsement of an oppressive status quo that can divert attention from the real problems and an undesirable and potentially destructive strategy within health care institutions whose goal is medically excellent and morally good clinical practice. As we shall argue, a call to virtuousness is not always virtuous. (shrink)

Background: Intensive care unit nurses are providing care to COVID-19 patients in a stressful environment. Understanding intensive care unit nurses’ sources of distress is important when planning interventions to support them. Purpose: To describe Canadian intensive care unit nurse experiences providing care to COVID-19 patients during the second wave of the pandemic. Design: Qualitative descriptive component within a larger mixed-methods study. Participants and research context: Participants were invited to write down their experiences of a critical incident, which distressed them when (...) providing nursing care. Thematic analysis was used to analyze the data. Ethical considerations: The study was approved by the ethics committee at the researchers’ university in eastern Canada. Results: A total of 111 critical incidents were written by 108 nurses. Four themes were found: (1) managing the pandemic, (2) witness to families’ grief, (3) our safety, and (4) futility of care. Many nurses’ stories also focused on the organizational preparedness of their institutions and concerns over their own safety. Discussion: Nurses experienced moral distress in relation to family and patient issues. Situations related to insufficient institutional support, patient, and family traumas, as well as safety issues have left nurses deeply distressed. Conclusion: Identifying situations that distress intensive care unit nurses can lead to targeted interventions mitigating their negative consequences by providing a safe work environment and improving nurses’ well-being. (shrink)

Education has long been charged with the taskof forming and shaping subjectivity andidentity. However, the prevailing view ofeducation as a project of producing rationalautonomous subjects has been challenged bypostmodern and poststructuralist critiques ofsubstantial subjectivity. In a similar vein,Emmanuel Levinas inverts the traditionalconception of subjectivity, claiming that weare constituted as subjects only in respondingto the other. In other words, subjectivity isderivative of an existentially priorresponsibility to and for the other. Hisconception of ethical responsibility is thusalso a radical departure from the prevailingview (...) of what it means to be a responsible moralagent. In this paper, I use jazz improvisationas a metaphor to focus on three interrelatedaspects of ethical responsibility on Levinas'saccount: passivity, heteronomy, andinescapability. I then point toward some waysin which reframing responsibility andsubjectivity along this line might offer newpossibilities for conceiving subjectivity andmoral agency in education. (shrink)

Virginia Held argues that feminism has a distinct contribution to make to morality, one that will transform theory and society by beginning from the experiences of women and children. Her main thesis is that the mother-child relation should be taken as the primary moral relation and the model, at least initially, for all other relations in society. She spends the first four of the ten chapters of this book arguing for the distinctness of feminist moral theory; then chapters 5-7, chapter (...) 10, and the epilogue discussing the difference that taking the mother-child relationship as the paradigm for morality would make to theory and society; chapters 8 and 9 criticizing what she takes to be her major nonfeminist competitors, especially contractualist liberal theory. Regrettably, none of these projects are, I think, particularly successful or enlightening in their failure. (shrink)

The causal theory of properties is standardly combined with a realist's ontology of universals or tropes. In this paper, I consider an uncharted alternative – a nominalist causal theory of properties. I discuss advantages and disadvantages of the resulting theory of properties, and explore the Rylean understanding of causal powers that emerges.

My aim … is to show that the celestial machine is likened not to a kind of divine living being but rather to a clockwork. I consider the human body to be a machine … Although it may exaggerate to say that Descartes fathered the mechanization of biology, it is true that his Treatise of Man provided the first systematic development of the idea that a complete understanding of all the phenomena of life, including all abilities and behaviour of animals, (...) can be achieved by viewing living things as machines. To make this out, Decartes had to learn to think about living things in a new way. My first aim here is to identify the fundamental conceptual innovations at work in Descartes’ attempt to extend the new mechanics to include biology. My second aim is to locate the point at which Descartes’ mechanical imagination runs out. This requires study of Descartes’ scientific work on sense. (shrink)

Despite establishing the gendered construction of infertility, most research on the subject has not examined how individuals with such reproductive difficulty negotiate their own sense of gender. I explore this gap through 58 interviews with women who are medically infertile and involuntarily childless. In studying how women achieve their gender, I reveal the importance of the body to such construction. For the participants, there is not just a motherhood mandate in the United States, but a fertility mandate—women are not just (...) supposed to mother, they are supposed to procreate. Given this understanding, participants maintain their gender by denying their infertile status. They do so through reliance on essentialist notions, using their bodies as a means of constructing a gendered sense of self. Using the tenets of transgender theory, this study not only informs our understanding of infertility, but also our broader understanding of the relationship between gender, identity, and the body, exposing how individuals negotiate their gender through physical as well as institutional and social constraints. (shrink)

Two significant, apparently unrelated, trends have emerged in American society and medicine. First, American medicine is reexamining its approach to dying. The Institute of Medicine, the American Medical Association and private funding organizations have recognized that too many dying people suffer from pain and other distress that clinicians can prevent or relieve. Second, this past decade has marked a sharp increase in the number of physicians prosecuted for criminal negligence based on arguably negligent patient care. The case often cited as (...) a watershed is People u. Einaugfer, which involved a New York nursing home patient whose physician was convicted in 1993 of two criminal misdemeanors after he ordered an elderly dialysis patient to be tube fed through a peritoneal dialysis Catheter.How is the growing awareness of dying patients’ pain and the increasing willingness of prosecutors to charge physicians with crimes connected? Pain at the end of life is frequently treated with narcotics, prescription drugs that are closely regulated by state and federal law. That complex web of laws—and a growing fear of legal sanctions—has deterred physicians from prescribing controlled substances. As those legal sanctions move from disciplinary actions to criminal charges, physicians’ fears may expand. (shrink)

Agrifood scholars commonly adopt “a matter of fact way of speaking” to talk about the extent of neoliberal rollout in the food sector and the viability of “alternatives” to capitalist food initiatives. Over the past few decades this matter of fact stance has resulted in heated debate in agrifood scholarship on two distinct battlegrounds namely, the corporate food regime and the alternative food regime. In this paper I identify some of the limitations of speaking in a matter of fact way (...) and of focusing on capitalist and neoliberal economies as the yardstick by which to assess all food economy initiatives. Using stories of bananas in Australia and the Philippines I advocate for a new mode of critical inquiry in food scholarship that focuses on matters of concern. Following Bruno Latour I use the term critical inquiry to refer to research methods and thinking practices that multiply possible ways of being and acting in the world. The new mode of critical inquiry I propose centers on enacting three broad research matters of concern. These are gathering and assembling economic diversity human actancy and nonhuman actancy. I argue that through becoming critical minds in the Latourian sense researchers can play a key role in enacting economic food futures in the Anthropocene. (shrink)

Background: Person-centred care is often described as an ideal way of preserving vulnerable persons’ wellbeing and dignity and an essential component of quality-care delivery. However, the staff find that making the care dignified is the most challenging issue, often because of effectivity, everyday stress and overload. In the interests of making the care more person-centred, systematic intervention involving ‘one-to-one contact’ (resident – carer) was trialled for 30 min twice a week over 12 months in two units in a nursing home (...) in Eastern Norway. Objectives: The aim of the study was to elicit healthcare staff’s experiences of implementing ‘one-to-one contact’ between residents and carers in nursing homes. Methods: The study has a grounded-theory inspired design. Two groups of health care staff were each interviewed three times. Data were collected over an 18-month period. Ethical considerations: The study was approved by the Data Protection Official for Research under the auspices of the Norwegian Social Science Data Services. Findings: The core category is ‘One-to-one contact’ at a nursing home is possible, but requires open-mindedness. The core category indicates that open-mindedness is required, since it does not take much for scepticism to take over and cause reversion to habitual practices. The category Expectant but Sceptical describes staff thoughts and experiences before the implementation phase got underway. The category Positive but Undecided describes staff experiences 6 months into the intervention and after 12 months. Conclusions: This study has revealed that systematic ‘one-to-one contact’ between resident and carer in nursing home is achievable, and that such a simple action might be an important step towards achieving more person-centred care as the resident is seen more as a person. However, in order to make a more person-centred and dignified approach to care constant attentiveness and awareness is required, as there were ongoing factors counteracting it. (shrink)

Nursing is a complicated and multifaceted profession that sets high demands in preparing nursing students for the profession. In today's education, the emphasis is often on knowledge and skills, that is, epistemology. In caring science another approach is sought, an approach based on human sciences in which knowledge will serve a more profound understanding, that is, the ontology. Consequently, the question of what this ‘understanding’ in clinical education is and how it is promoted in clinical nursing education becomes important to (...) clarify. Therefore, the aim here is to explicate the phenomenon of understanding in clinical education as experienced by third‐year undergraduate nursing students ready for graduation. This study, with a hermeneutic approach, is based on a secondary analysis of focus group interviews with undergraduate nursing students. The analytical expansion of the original material suggests three interrelated themes that illuminate the phenomenon of understanding in clinical education. These findings are deepened and enriched through philosophical abstraction. In the process of understanding, episteme, techne and phronesis can be viewed as inherent parts of the structure of thought in nursing. The perspective advanced in this study adds new aspects to the phenomenon of understanding and its meaning and significance in the dynamic process of formation and becoming in clinical education. The focus in clinical nursing education should be on learning reflective, critical thinking and the ways of being a nurse, rather than drilling students on particular skills. In the rapidly changing world of the 21st century, an understanding‐based education is needed as a more meaningful and authentic approach. Therefore, an ontological turn in nursing education, through which the main focus shifts from a traditional epistemology to an epistemology in the service of ontology, is suggested. Further studies are needed in the development and implementation of an understanding‐based, interpretative education in nursing. (shrink)

Feminist analysis of cultural mythology surrounding organ donation offers a critical perspective on current U.S. transplant policy. My argument is three-pronged. First, I argue that organ donation is appropriately understood as a sacrifice. Structurally, donation accords both to general and to specifically Christian archetypes of sacrifice. The characterization of donation as sacrifice resonates in the cultural psyche even though it is absent in public rhetoric. Second, I characterize widespread feminist concerns about the over-glorification of sacrifice. These concerns provide a helpful (...) framework for considering whether the sacrifice of organ donation is over-glorified in our culture. Third, I consider several specific aspects of organ recruitment and organ allocation. Each demonstrates an over-glorification of sacrifice that leads to a dangerous "routinization" of sacrifice. None of these excesses are addressable without due attention to the symbolic import of organ donation and transplantation. I close by suggesting lessons my analysis offers to Christian churches who support donation, to the discourse of bioethics, and to the general public. (shrink)

BackgroundWhen rationing health care, a commonly held view among ethicists is that there is no ethical difference between withdrawing or withholding medical treatments. In reality, this view does not generally seem to be supported by practicians nor in legislation practices, by for example adding a ‘grandfather clause’ when rejecting a new treatment for lacking cost-effectiveness. Due to this discrepancy, our objective was to explore physicians’ and patient organization representatives’ experiences- and perceptions of withdrawing and withholding treatments in rationing situations of (...) relative scarcity.MethodsFourteen semi-structured interviews were conducted in Sweden with physicians and patient organization representatives, thematic analysis was used.ResultsParticipants commonly express internally inconsistent views regarding if withdrawing or withholding medical treatments should be deemed as ethically equivalent. Participants express that in terms of patients’ need for treatment withholding and withdrawing should be deemed ethically equivalent. However, in terms of prognostic differences, and the patient-physician relation and communication, there is a clear discrepancy which carry a moral significance and ultimately makes withdrawing psychologically difficult for both physicians and patients, and politically difficult for policy makers.ConclusionsWe conclude that the distinction between withdrawing and withholding treatment as unified concepts is a simplification of a more complex situation, where different factors related differently to these two concepts. Following this, possible policy solutions are discussed for how to resolve this experienced moral difference by practitioners and ease withdrawing treatments due to health care rationing. Such solutions could be to have agreements between the physician and patient about potential future treatment withdrawals, to evaluate the treatment’s effect, and to provide guidelines on a national level. (shrink)

Three periods in the development of Whitehead's thought are generally recognized : ()-: The period of the writing of Universal Algebra, ...

Hospital ethics committees have evolved as a response to complicated legal, ethical, and social dilemmas that accompany modern medicine. In the United States, their growth has been augmented by Joint Commission for the Accreditation of Healthcare Organizations standards and the Patient Self-Determination Act. There appears to be an implicit presumption that all clinical ethics consultation practices are relatively similar. Finally, there is heightened awareness of the needs for quality standards and assessment of the outcomes of ethics consultations.