In this article I offer a map of recent UK and US lesbian feminist literary theory which highlights the shifting and often paradoxical interpretations of lesbian sexuality as both real and as metaphorical. I focus on two key texts which offer overviews and analysis of the field from different sides of the Atlantic, which are both accessible, in the sense of being written from the perspective of ‘ordinary’ lesbians, rather than structuring lesbian feminist literary criticism around traditional critical concepts, and (...) which also, unusually, offer some (small) comment on bisexuality. These two works are Bonnie Zimmerman's Safe Sea of Women (1992), and Palmer's Contemporary Lesbian Writing (1993). I argue that lesbian/feminist literary theory offers particular constructions of sexuality which, while challenging many of the assumptions of heterosexual feminist literary theory, largely ignores the bisexual content of much lesbian fiction, and consequently glosses over some of the tricky areas of gender and sexuality difference. Through this ‘les/bi’ reading I hope to encourage the figure of the bisexual woman to question both constructions and deconstructions of lesbian sexuality. (shrink)

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)

Examines how violence has been conceptually and rhetorically put to use in continental social theory.

Is the sense of smell a source of aesthetic perception? Traditional philosophical aesthetics has centered on vision and audition but eliminated smell for its subjective and inherently affective character. This article dismantles the myth that olfaction is an unsophisticated sense. It makes a case for olfactory aesthetics by integrating recent insights in neuroscience with traditional expertise about flavor and fragrance assessment in perfumery and wine tasting. My analysis concerns the importance of observational refinement in aesthetic experience. I argue that the (...) active engagement with stimulus features in perceptual processing shapes the phenomenological content, so much so that the perceptual structure of trained smelling varies significantly from naive smelling. In a second step, I interpret the processes that determine such perceptual refinement in the context of neural decision-making processes, and I end with a positive outlook on how research in neuroscience can be used to benefit philosophical aesthetics. (shrink)

The essence of religion was once widely thought to be a unique form of experience that could not be explained in neurological, psychological, or sociological terms. In recent decades scholars have questioned the privileging of the idea of religious experience in the study of religion, an approach that effectively isolated the study of religion from the social and natural sciences. Religious Experience Reconsidered lays out a framework for research into religious phenomena that reclaims experience as a central concept while bridging (...) the divide between religious studies and the sciences. Ann Taves shifts the focus from "religious experience," conceived as a fixed and stable thing, to an examination of the processes by which people attribute meaning to their experiences. She proposes a new approach that unites the study of religion with fields as diverse as neuroscience, anthropology, sociology, and psychology to better understand how these processes are incorporated into the broader cultural formations we think of as religious or spiritual. Taves addresses a series of key questions: how can we set up studies without obscuring contestations over meaning and value? What is the relationship between experience and consciousness? How can research into consciousness help us access and interpret the experiences of others? Why do people individually or collectively explain their experiences in religious terms? How can we set up studies that allow us to compare experiences across times and cultures? Religious Experience Reconsidered demonstrates how methods from the sciences can be combined with those from the humanities to advance a naturalistic understanding of the experiences that people deem religious. (shrink)

Prior studies have advanced our knowledge of the individual determinants of corporate philanthropy; however, little empirical research has been conducted on how these determinants combine to influence giving. In this study, the authors develop and test an integrated model of the relationship between firm resources and corporate philanthropy as mediated by managerial discretion and managerial values. In addition, the authors offer organizational slack as an alternative measure of organizational resources. As predicted, the results show that firm resources have a positive (...) effect on corporate philanthropy. This effect is fully mediated by managerial discretion and partially mediated by managerial values. (shrink)

Detecting contract cheating in written submissions can be difficult beyond direct plagiarism detectable via technology. Successfully identifying potential cases of contract cheating in written work such as essays and reports is largely dependent on the experience of assessors and knowledge of student. It is further dependent on their familiarity with the patterns and clues evident in sections of body text and reference materials to identify irregularities. Consequently, some knowledge of what the patterns and clues look like is required. This paper (...) documents how to identify some of the patterns and clues observed in essay and report submissions. Effective assessment design with specific contextual requirements make irregularities easier to detect and interpret. The irregularities identified were confirmed as instances of contract cheating through conversations held with postgraduate students. An essential element of the conversations was the evidence presented for discussion. Irregularities were noted on a pro-forma specifically developed for this purpose. Patterns identified include misrepresented bibliographic data, inappropriate references, irrelevant material and generalised text that did not address the assessment question or grading criteria. The validated patterns formed the basis of identifying potential instances of contract cheating in later submissions. Timely conversations with students before the end of semester are essential to determining whether the patterns and clues link to poor knowledge of academic writing conventions or classified as contract cheating necessitating the application of appropriate penalties under institutional policies and procedures. (shrink)

While there is an extensive subfield in sociology studying the sources, content, and consequences of collective memory, the study of future projections has been much more fragmentary. In part, this has to do with the challenge of measurement; how do you measure something that has not happened yet? In this article, I argue that future projections can be studied via their externalizations in attitudes, narratives, performance, and material forms. They are particularly evident in what I call “sites of hyperprojectivity,” that (...) is, sites of heightened, future-oriented public debate about possible futures. As a pilot project, I examine contending narratives about possible futures in the online documents of the United Nations Conference on Sustainable Development and the accompanying “People’s Summit,” held in Rio de Janeiro in June 2012. I propose a framework for studying how public interventions into debates about “sustainable futures” and the “green economy” differ on various dimensions of projectivity, including their temporal reach, attention to contingency and causality, and network mapping of future actors. I present a preliminary analysis at the level of narrative and grammar, by analyzing the use of predictive, imperative, and subjunctive verb forms in both programmatic and oppositional texts. I close with a discussion of how different genres of future projection might be put to analytical use in studying processes of interest to social scientists, such as coalition formation, institution building, political mobilization, and policy change. (shrink)

“Humanism” is a term that has designated a remarkably disparate set of ideologies. Nonetheless, strains of religious, secular, existential, and Marxist humanism have tended to circumscribe the category of the human with reference to the themes of reason, autonomy, judgment, and freedom. This essay examines the emergence of a new humanistic discourse in feminist theory, one that instead finds its provocation in the unwilled passivity and vulnerability of the human body, and in the vulnerability of the human body to suffering (...) and violence. Grounded in a descriptive ontology that privileges figures such as exposure, dispossession, vulnerability, and “precariousness,” this new humanism is a corporeal humanism. This essay probes both the promise and the limitations of this emergent humanism with particular reference to recent work by feminist philosophers Judith Butler and Adriana Cavarero. (shrink)

'The church in danger' : latitudinarians, Socinians, and Hobbists -- Animal spirits and living fibres -- Mortalists and materialists -- Journalism, exile, and clandestinity -- Mid-eighteenth-century materialism -- Epilogue : some consequences.

Rape, claims Ann J. Cahill, affects not only those women who are raped, but all women who experience their bodies as rapable and adjust their actions and self-images accordingly. Rethinking Rape counters legal and feminist definitions of rape as mere assault and decisively emphasizes the centrality of the body and sexuality in a crime which plays a crucial role in the continuing oppression of women.

This paper tells the story of G-protein coupled receptors, one of the most important scientific objects in contemporary biochemistry and molecular biology. By looking at how cell membrane receptors turned from a speculative concept into a central element in modern biochemistry over the past 40 years, we revisit the role of manipulability as a criterion for entity realism in wet-lab research. The central argument is that manipulability as a condition for reality becomes meaningful only once scientists have decided how to (...) conceptually coordinate measurable effects distinctly to a specific object. We show that a scientific entity, such as GPCRs, is assigned varying degrees of reality throughout different stages of its discovery. The criteria of its reality, we further claim, cannot be made independently of the question about how this object becomes a standard by which the reality of neighbouring elements of enquiry is evaluated. (shrink)

Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective (...) ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings. (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)

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)

A decade ago, conventional wisdom in the medical establishment was that physicians treating chronic pain with opioid analgesics were at a substantial risk of being sanctioned for overprescribing by state medical regulatory boards. Dozens of articles written since have alluded to this risk as an obstacle to effective pain re1ief. In the early 1990s, a number of high profile cases in which physicians were disciplined by regulatory boards for overprescribing to patients with chronic pain were reported in the press. Although (...) the board actions in many of these cases were eventually overturned by state judiciaries, the publicity heightened practitioners’. sensitivity to the regulatory risks associated with prescribing opioids.A review of the available data on state medical board actions nationwide for the period from 1990 to 1996 reveals that the perception of regulatory risk far exceeds the reality. Indeed, relatively few of the disciplinary actions taken for overprescribing by state medical boards in any given year directly concern the treatment of chronic pain—malignant or nonmalignant—in patients. (shrink)

This book gives a socialist-feminist theory of the origins, persistence and reproduction of male dominance in systems of parenting/motherhood and sexuality. I create the concept of "modes of sex/affective production" which I see as analogous to and intertwined with modes of economic production to reproduce historically different systems of male dominance. I compare my Multi-system socialist-feminist theory to those of Liberal Feminism, Radical feminism, Marxist-feminism, Freudian feminism, and various types of lesbian-feminism. The concluding chapter presents a socialist-feminist vision of a (...) liberated society where class, gender and racial dominance have been eliminated. Historical, political and personal examples are discussed. (shrink)

In this article I will revisit the question of what I term the continuum of heteronormative sexual interactions, that is, the idea that purportedly ethically acceptable heterosexual interactions are conceptually, ethically, and politically associated with instances of sexual violence. Spurred by recent work by psychologist Nicola , I conclude that some of my earlier critiques of Catharine MacKinnon's theoretical linkages between sexual violence and normative heterosex are wanting. In addition, neither MacKinnon's theory nor my critique of it seem up to (...) the task of providing an ethical account of the examples of “unjust sex” that Gavey has described. I come to the conclusion that an ethical analysis of sexual interactions requires a focus on sexual desire, but that desire cannot take on the by now heavily criticized role of consent. Rather than looking for the presence or absence of sexual desire prior to sexual encounters as a kind of ethical certification of them, we ought instead to focus on the efficacy of that sexual desire, that is, its ability (or lack thereof) to shape an encounter in substantial and meaningful ways. (shrink)

Political philosophy and feminist theory have rarely examined in detail how capitalism affects the lives of women. Ann Cudd and Nancy Holmstrom take up opposing sides of the issue, debating whether capitalism is valuable as an ideal and whether as an actually existing economic system it is good for women. In a discussion covering a broad range of social and economic issues, including unequal pay, industrial reforms and sweatshops, they examine how these and other issues relate to women and how (...) effectively to analyze what constitutes 'capitalism' and 'women's interests'. Each author also responds to the opposing arguments, providing a thorough debate of the topics covered. The resulting volume will interest a wide range of readers in philosophy, political theory, women's studies and global affairs. (shrink)

Despite the fact that ethics consultations are an accepted practice in most healthcare organizations, many clinical ethicists continue to feel marginalized by their institutions. They are often not paid for their time, their programs often have no budget, and institutional leaders are frequently unaware of their activities. One consequence has been their search for concrete ways to evaluate their work in order to prove the importance of their activities to their institutions through demonstrating their efficiency and effectiveness.

Imagery is one of the new, exciting frontiers in cognitive therapy. From the outset of cognitive therapy, its founder Dr. Aaron T. Beck recognised the importance of imagery in the understanding and treatment of patient's problems. However, despite Beck's prescience, clinical research on imagery, and the integration of imagery interventions into clinical practice, developed slowly. It is only in the past 10 years that most writing and research on imagery in cognitive therapy has been conducted. The Oxford Guide to Imagery (...) in Cognitive Therapy is a landmark book, which will play an important role in the next phase of cognitive therapy's development. Clinicians and researchers are starting to recognise the centrality of imagery in the development, maintenance and treatment of psychological disorders - for example, in social phobia, agoraphobia, depression, PTSD, eating disorders, childhood trauma, and personality disorder. In the fields of cognitive psychology and cognitive neuroscience, researchers are identifying the key role that imagery plays in emotion, cognition and psychopathology.The Oxford Guide to Imagery in Cognitive Therapy has been written both for clinicians and researchers. For clinicians, it is a user-friendly, practical guide to imagery, which will enable therapists to understand imagery phenomenology, and to integrate imagery-based interventions into their cognitive therapy practice. For researchers, it provides a state-of-the-art summary of imagery research, and points the way to future studies. Written by three well-respected CBT researcher-clinicians, it is essential reading for all cognitive therapists, who have recognised the limitations of purely 'verbal' CBT techniques, and want to find new ways to work with clients with psychological disorders. Readership: CBT therapists. (shrink)

Infants, children, adolescents, and pregnant and lactating women have been described as groups with special needs. Regardless of diet chosen, these groups are at higher risk for nutritional deficiencies than adult males. Vegan diets can be safely used by these groups if foods, and in some instances supplements, are selected which provide a healthful and nutritionally adequate diet. Guidelines have been developed for those choosing to follow vegan diets. In many instances vegan diets offer health benefits. Studies of vegans are (...) limited by factors such as heterogeneity of diets, the size and extent of this type of study, and difficulty in subject identification. There is a scarcity of studies of newer vegetarians who are often more mainstream than the vegetarians of the 1960s and 1970s. In some instances this has led to assumptions about today's vegans which are based on out-dated information. Thorough scientific studies of today's vegetarians, especially of those in groups with special needs, are needed. (shrink)

This paper investigates the spatial dimensions of olfactory perception, challenging philosophical views that marginalize smell in spatial navigation and cognition compared to visual phenomenology. I argue that both olfactory and visual perceptions—despite smell often being considered non-spatial or minimally spatial—involve intricate spatial structuring when processed through unconscious cognitive processes. An information-theoretical approach shows that cognitive inferences turn spatially deficient sensory data into spatialized perceptual content to generate spatial perception across sensory modalities. This challenges the idea that spatial perception is tied (...) to external features. My argument is supported by two lines of evidence: (i) figure-ground segregation across sensory modalities, suggesting a general mechanism in perceptual processing; (ii) recent neuroscientific evidence demonstrating how spatial information is processed in olfaction for navigation and environmental mapping. My analysis calls for a reevaluation of assumptions about the non-spatial nature of smell, highlighting significant cognitive and spatial capabilities in olfaction. (shrink)

The feminist philosopher and social scientist shows how "gendering" has affected the social and natural sciences as she reconciles the long-standing dichotomy between the quantitative and qualitative methods and demonstrates the tandem use of both experimental and intuitive approaches.

This collection presents stimulating and diverse essays by scholars from several different fields; the contributors have made important contributions to the ...

Neurobiology studies mechanisms of cell signalling. A key question is how cells recognise specific signals. In this context, olfaction has become an important experimental system over the past 25 years. The olfactory system responds to an array of structurally diverse stimuli. The discovery of the olfactory receptors (ORs), recognising these stimuli, established the olfactory pathway as part of a greater group of signalling mechanisms mediated by G-protein-coupled receptors (GPCRs). GPCRs are the largest protein family in the mammalian genome and involved (...) in numerous fundamental physiological processes. The OR family exhibits two characteristics that make them an excellent model system to understand GPCRs: its size and the structural diversity of its members. Research on the OR binding site investigates what amino acid sequences determine the receptor-binding capacity. This promises a better understanding of how the basic genetic makeup of GPCRs relates to their diversification in ligand-binding capacities. (shrink)

A virtue centred approach to ethics has been criticized for being vague owing to the nature of its central concept, the paradigm person. From the perspective of the practitioner the most damaging charge is that virtue ethics fails to be action guiding and, in addition to this, it does not offer any means of act appraisal. These criticisms leave virtue ethics in a weak position vis-à-vis traditional approaches to ethics. The criticism is, however, challenged by Hursthouse in her analysis of (...) the accounts of right action offered by deontology, utilitarianism and virtue ethics. It is possible to defend the action guiding nature of virtue ethics: there are virtue rules and exemplars to guide action. Insights from Aristotle’s practical approach to ethics are considered alongside Hursthouse’s analysis and it is suggested that virtue ethics is also capable of facilitating action appraisal. It is at the same time acknowledged that approaches to virtue ethics vary widely and that the challenges offered here would be rejected by those who embrace a radical replacement virtue approach. (shrink)

Wales uses languages with both regular (Welsh) and irregular (English) counting systems. Three groups of 6- and 8-year-old Welsh children with varying degrees of exposure to the Welsh language—those who spoke Welsh at both home and school; those who spoke Welsh only at home; and those who spoke only English—were given standardized tests of arithmetic and a test of understanding representations of two-digit numbers. Groups did not differ on the arithmetic tests, but both groups of Welsh speakers read and compared (...) 2-digit numbers more accurately than monolingual English children. A similar study was carried out with Tamil/English bilingual children in England. The Tamil counting system is more transparent than English but less so than Welsh or Chinese. Tamil-speaking children performed better than monolingual English-speaking children on one of the standardized arithmetic tests but did not differ in their comparison of two-digit numbers. Reasons for the findings are discussed. (shrink)

What if depression, in the Americas at least, could be traced to histories of colonialism, genocide, slavery, exclusion, and everyday segregation and isolation that haunt all of our lives, rather than to biochemical imbalances? This article seeks alternatives to the medical model found in most depression memoirs by considering how the epistemological and methodological struggles faced by a scholar of the African diaspora confronted by the absent archive of slavery are relevant to discussions of political depression. Combining scholarly investigation and (...) personal memoir, Saidiya Hartman’s Lose Your Mother exemplifies feminism’s affective turn not only by bringing personal narrative into scholarship, but by seeking reparation for the past in the affective dynamics of cultural memory rather than in legal reform or state recognition. Stubbornly refusing to find solace in an African past before slavery, though, Hartman provides a model of emotional reparation in which feelings of loss and alienation persist. Her work suggests the relevance of political depression to both the ordinary life of racism and to what gets called clinical depression. (shrink)

The aim of this essay is to rethink classic issues of freedom and moral responsibility in the context of feminist and antiracist theories of male and white domination. If personal identities are socially constructed by gender, race and ethnicity, class and sexual orientation, how are social change and moral responsibility possible? An aspects theory of selfhood and three reinterpretations of identity politics show how individuals are morally responsible and nonessentialist ways to resist social oppression.

I consider a grand, yet neglected proposal put forward by Shoemaker—a functionalist theory of all properties. I argue that two possible ways of developing this proposal meet with substantial objections. However, if we are prepared to endorse an ontology of tropes, one of these functionalist analyses can be developed into an original and informative theory of properties.

This collection challenges the traditional divide between the investigation of ethics is a private concern and politics as a public, group concern.

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)

Short piece for The Philosophers' Magazine on why philosophers should pay attention to olfaction.

Background: The foundation of all nursing practice is respect for human rights, ethical value and human dignity. In perioperative practice, challenging situations appear quickly and operating theatre nurses must be able to make different ethical judgements. Sometimes they must choose against their own professional principles, and this creates ethical conflicts in themselves. Objectives: This study describes operating theatre nurses’ experiences of ethical value conflicts in perioperative practice. Research design: Qualitative design, narratives from 15 operating theatre nurses and hermeneutic text interpretation. (...) Ethical consideration: The study followed ethical principles in accordance with the Helsinki Declaration and approval was granted by the local university ethics committee. Findings: The result showed that value conflicts arose in perioperative practice when operating theatre nurses were prevented from being present in the perioperative nursing process, because of current habits in perioperative practice. The patient’s care became uncaring when health professionals did not see and listen to each other and when collaboration in the surgical team was not available for the patient’s best. This occurred when operating theatre nurses’ competence was not taken seriously and was ignored in patient care. Conclusion: Value conflicts arose when operating theatre nurses experienced that continuity of patient care was lacking. They experienced compassion with the patient but still had the will and ability to be there and take responsibility for the patient. This led to feelings of despair, powerlessness and of having a bad conscience which could lead to dissatisfaction, and even resignations. (shrink)