Chaplains often describe their work in health care as “translation” between the world of the patient and the world of hospital medicine. Translators usually work with texts, interpreters with words. However, when chaplains use this metaphor, it describes something other than a discrete task associated with the meaning of words. While medical professionals focus on patients' medical conditions, chaplains seek to read the whole person, asking questions about what people's lives are like outside of the hospital, what they (...) class='Hi'>care about most, and where they find joy and support in the world. Chaplains offer a supportive presence that serves to remind patients and caregivers that people are more than just their medical conditions or their current collection of concerns. Some chaplains are skilled at translating patients' experiences and sources of meaning in real time, allowing medical teams to better understand the person they are treating. “Translation” is also defined as metamorphosis. Chaplains provide this sort of translation when they are alone with patients, listening to their deepest concerns, helping them redefine their lives. (shrink)

The field of psychiatry has long struggled with developing models of practice; most underemphasize the interpersonal aspects of clinical practice. This essay is unique in putting intersubjectivity front and centre. It is an attempt to provide a clinical method to re-establish the fragile dialogue of the soul with oneself and with others.

Drawing on previous empirical research, we provide an exemplary narrative to illustrate how patients have experienced hospital care organized according to evidence‐based fast‐track programmes. The aim of this paper was to analyse and discuss if and how it is possible to include patients’ individual perspectives in an evidence‐based practice as seen from the point of view of nursing theory. The paper highlights two conflicting courses of development. One is a course of standardization founded on evidence‐based recommendations, which specify a (...) set of rules that the patient must follow rigorously. The other is a course of democratization based on patients’ involvement in care. Referring to the analysis of the narrative, we argue that, in the current implementation of evidence‐based practice, the proposed involvement of patients resembles empty rhetoric. We argue that the principles and values from evidence‐based medicine are being lost in the transformation into the current evidence‐based hospital culture which potentially leads to a McDonaldization of nursing practice reflected as ‘one best way’. We argue for reviving ethics of care perspectives in today's evidence practice as the fundamental values of nursing may potentially bridge conflicts between evidence‐based practice and the ideals of patient participation thus preventing a practice of ‘McNursing’. (shrink)

This article analyzes the contribution Christian ethics might be able to make to the ethical debate on policy and caregiving in health and social care in the United Kingdom. The article deals particularly with the concepts of solidarity and subsidiarity which are essential in Christian social ethics and health care ethics, and which may be relevant for the ethical debate on health and social caregiving in the United Kingdom. An important argument in the article is that utilitarian and (...) market-driven policies in the National Health Service (NHS) and the social care system have marginalized the position of the elderly and have seriously impoverished the quality of care for the elderly. The neglect of the elderly and other vulnerable groups is also the result of widespread consumerist attitudes among patients and of libertarian models of noninterference which are affirmed by a public ethos of self-sufficiency and counter-dependency. Those who need care dare not make their need known to others and ask for help, while simultaneously those who could help are so intimidated by the public affirmation of privacy and negative rights that they do not dare to offer help except if this is explicitly demanded. This distant and standoffish attitude is in an important way responsible for the fact that the voice of those in need is altogether lost to the public forum. Christian ethics puts much emphasis on responsibility and solidarity with the needy other but is not able to have much impact on the delivery of care in a secularized society and health care system like the NHS. Nonetheless, Christianity still has a powerful and respected voice, by speaking up for those who cannot speak for themselves, such as the elderly and the handicapped. Christians can find allies in the ethics of care and other relational approaches in health care ethics in order to combat libertarianism, consumerism, and utilitarianism. (shrink)

This paper involves a case study of physicians working in an urban Midwestern region. It raises questions surrounding how physicians adapted to, encouraged and resisted the increasing presence of managed care in their work lives. The patterning of physician accommodation to managed care and the failure of physicians to mount any effective organized resistance in Metro has some important implications for theories about professional dominance and decline.

_Lost Lullaby_ makes one think the unthinkable: how a loving parent can pray for the death of her child. It is Deborah Alecson's story of her daughter, Andrea, who was born after a full-term, uneventful pregnancy, weighing 7 pounds 11 ounces, perfectly formed and exquisitely featured. But an inexplicable accident at birth left her with massive and irreversible brain damage. On a vitality scale of one to ten, her initial reading was one. And so begins Deborah Alecson's heart-rending struggle to (...) come to terms with two desperately conflicting and powerful emotions: her desire to nurture and love Andrea, and her desire to do everything in her power to bring about her death. Told in a mother's voice, with a simplicity and directness that heighten the intensity of the drama that unfolds, _Lost Lullaby_ reaffirms the human dimension of what is too often an abstract and purely theoretical discussion. During the two months that Andrea spent in the Infant Intensive Care Unit, Ms. Alecson spoke with lawyers, doctors, and ethicists in an effort to understand the legal, medical and ethical implications of her plight. She recounts those discussions and describes legal cases that have a direct bearing on her own situation. Her battle—both in coming to the agonizing decision to let her child die and in convincing the medical and legal establishments to respect that decision—will engender empathy for the plight of many families, and an awareness of the need to use medical technology with restraint. It is a must-read for everyone who cares about how we make life-and-death decisions on these new medical, legal, and moral frontiers. (shrink)

“Doctors cure and nurses care” was a phrase used to differentiate between medicine and nursing. Even though rhetorically we may well agree that doctors and nurses have their equal share in caring, literature on caring so far has been produced mainly from the perspective of nursing. Now there is a book containing 11 essays on caring written or coauthored by seven medical doctors, two nurses, four social scientists, and two philosophers. The impressive list of authors is headed by the (...) editors of the volume, Leighton Cluff (medical doctor and gerontologist) and Robert Binstock (political scientist and gerontologist). The volume includes authors who are well known scholars active in the field of medical ethics as well as clinicians and educators in various areas of health care facilities. The foreword by Rosalynn Carter, wife of ex President Jimmy Carter, gives the book its …. (shrink)

In this classic work by one of America's most distinguished historians, Daniel Boorstin enters into Thomas Jefferson's world of ideas. By analysing writings of 'the Jeffersonian Circle,' Boorstin explores concepts of God, nature, equality, toleration, education and government in order to illuminate their underlying world view. The Lost World of Thomas Jefferson demonstrates why on the 250th anniversary of his birth, this American leader's message has remained relevant to our national crises and grand concerns. "The volume is too subtle, (...) too rich in ideas for anyone to do justice to it in brief summary, too heavily documented and too carefully wrought for anyone to dismiss its thesis. . . . It is a major contribution not only to Jefferson studies but to American intellectual history. . . . All who work in the history of ideas will find themselves in Mr. Boorstin's debt."—Richard Hofstadter, South Atlantic Monthly. (shrink)

A Yale physician's fascinating and wise exploration of why so many people die poorly and how a medieval bestseller on the art of dying well holds important lessons for today.

Attention to care in modern society has fallen out of view as an ethos of personal responsibility, free markets, and individualism has been in the ascendant. The Liberalism of Care argues that contemporary liberalism is suffering from a crisis of care, manifest in a decaying sense of collective political responsibility for citizens' well- being and for the most vulnerable members of our communities. The book maintains that this practical crisis stems from a theoretical one. We have (...) class='Hi'>lost the political language of care, which, prior the 19th century, was commonly used to express these dimensions of political life. To recover that language, Shawn C. Fraistat turns to three prominent philosophers-Plato, Jean-Jacques Rousseau, and William Godwin-who illuminate the varied ways caring language and caring values have structured core debates in the history of Western political thought about the proper role of government, as well as the rights and responsibilities of citizens. The Liberalism of Care presents a distinctive vision for our liberal politics where political communities and citizens can utilize the ethic and practices of care to face practical challenges. (shrink)

An eleventh-century manuscript in the Biblioteca Laurenziana in Florence preserves a short excerpt of a calendar outlining stages in the development of the foetus. It is headed Δαμναστού έκ τού Περί κυουσών καί βρεΦών θεραπείας, ‘Damnastes, from On the Care of Pregnant Women and of Infants’. Though its existence has long been noted, it has not been previously edited or published.

Our lives are such that moral wrongdoing is sometimes inescapable for us. We have moral responsibilities to persons which may conflict and which it is wrong to violate even when they do conflict. Christopher W. Gowans argues that we must accept this conclusion if we are to make sense of our moral experience and the way in which persons are valuable to us. In defending this position, he critically examines the recent moral dilemmas debate. He maintains that what is important (...) in this debate is not whether there are irresolvable moral conflicts, but whether there are moral conflicts in which wrongdoing is unavoidable. Though it would be incoherent to conclude moral deliberation by deciding to perform incompatible actions, he argues that there is nothing incoherent in supposing that we have conflicting moral responsibilities. In this way, he shows that it is possible to capture the intuitions of those who have defended the idea of moral dilemmas while meeting the objections of those who have rejected this idea. Gowans carefully evaluates utilitarian and Kantian analyses of moral dilemmas. He argues that these approaches eliminate genuine moral conflict only by displacing persons as direct objects of moral concern. As an alternative, he develops a more concrete account in which moral responsibilities to persons are central. The book also includes discussions of Melville's Billy Budd, methodology in moral philosophy, moral pluralism, moral tragedy, and "dirty hands" in politics. (shrink)

The conventional wisdom about advance care planning holds that the normative force of my prior wishes is simply that they are mine. It is their connection to me that matters. This paper challenges conventional thinking. I propose that the normative force of prior wishes does not depend exclusively on personal identity. Instead, it sometimes depends on a special relationship that exists between a prior, capacitated person and a now incapacitated person. I consider what normative guidance governs persons who stand (...) in a special relationship, and contrast these with the standard model of respect for autonomy. My conclusion is that advance care planning for individuals who have lost decision-making capacity should incorporate the virtues of prudence and integrity, even when one and the same person ceases to exist, and respect for personal autonomy is no longer relevant. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Lost Italian Renaissance: Humanists, Historians, and Latin’s LegacyPaul Richard BlumChristopher S. Celenza. The Lost Italian Renaissance: Humanists, Historians, and Latin’s Legacy. Baltimore: The Johns Hopkins University Press, 2004. Pp. xx + 210. Cloth, $45.00This is a programmatic book about why and how philosophy should care about Renaissance texts. Celenza starts with an assessment of the neglect of the wealth of Latin Renaissance [End Page (...) 485] sources by nineteenth-century historiography, followed by portraits of two prototypal twentieth-century historians and their philosophical approach. He proposes a method of study for Renaissance thinkers and exemplifies it with two key figures and with the concept of honor. A survey of the field of study and an appendix concerning Renaissance research in the US conclude the book."The Renaissance" as a field of research between the Middle Ages and what is now cowardly called "Early Modern" became legitimate through the awakening of national consciousness in the nineteenth century. Consequently, the emphasis lay on vernacular language works in Italy and elsewhere. Latin Renaissance literature never was worthy of Grossforschung, i.e., of national projects like the academy enterprises concerning world history or classical studies, even though classical philology originated in the humanists' emulation of the ancients. This however would be absorbed by the nineteenth-century idea of national character (12).Italian Hegelianism of the nineteenth and early-twentieth century included Renaissance philosophy in the evolution of national spirit, and the late Eugenio Garin as its pupil spent his scholarly life portraying with astounding precision and detail Italian Humanism and Renaissance as a dialectic and rational development. Equally diligent was the German born Paul Oskar Kristeller, clinging, however, to a very different understanding of philosophy, which Celenza describes as rationalist in the Kantian and metaphysical in the Platonico-Aristotelian tradition (41). Here the author underestimates the influence of Heidegger on Kristeller: his dissertation was clearly an interpretation of Plotinus in the light of existentialism, which still transpires in his famous Ficino book and many later philosophical statements. The problem with both approaches, that of Garin and that of Kristeller, is that those philosophers who ignore history (deliberately or incidentally) and those who lost an understanding of metaphysics do not know how to read Renaissance thinkers.'Microhistory' is the formula Celenza proposes: Richard Rorty's abolishing the notion of 'representing' reality in favor of evocation and conversation—both for the interpretation of the past and the past itself—and Pierre Bourdieux's notions of 'field' and 'relational thinking' open the possibility of locating past thinkers in their community and, consequently, the meaning of their philosophical endeavor. What Celenza exercised with Garin and Kristeller applies also to Renaissance authors. Under the heading 'Orthodoxy,' Celenza shows that it is unfortunate to censure Lorenzo Valla (+ 1457) or Marsilio Ficino (+ 1499) as being unorthodox or as precursors to the Reformation, because this perspective misses the point of their lives' work—namely, to find out what makes Christian beliefs and their sources Christian. Valla's discoveries in Greek and Latin philology and Ficino's experiments with magic are part of their scrutiny of orthopraxy (my term), the right way of Christian life, and are embedded in their conversations with friend and foe, who in some cases still await discovery. The far-reaching message of these two samples is: reading their work and studying their conversations is the way to study philosophy in the fifteenth century.The same is proven by engaging in social concepts such as 'honor.' Starting with a surprising appreciation of gender studies, Celenza suggests taking a look at intellectual masculinity among courtiers and writers. Then it turns out that Machiavelli bequeathed to modernity—perhaps as a caricature—the structure of struggle for power, ideas, and provision in which humanists were engaged, being the first large generation of intellectuals outside the safe haven of cathedrals and convents."What is really there?" is the concluding question. A new canon, the prelude to early modern sociology of scholarship, and models of—presently highly acclaimed—contextualization of intellectual productivity. Returning to the Latinity of Renaissance sources Celenza shows that even the emergence of vernacular literature, which bewitched nationalist historiography, was by itself a fruit... (shrink)

Although Chinese law imposes informed consent for medical treatments, the Chinese understanding of this requirement is very different from the European one, mostly due to the influence of Confucianism. Chinese doctors and relatives are primarily interested in protecting the patient, even from the truth; thus, patients are commonly uninformed of their medical conditions, often at the family’s request. The family plays an important role in health care decisions, even substituting their decisions for the patient’s. Accordingly, instead of personal informed (...) consent, what actually exists is ‘family informed consent’. From a Western perspective, these features of Chinese law and Chinese culture might seem strange, contradicting our understanding of doctor-patient relationship and even the very essence of self-determination and fundamental rights. However, we cannot forget the huge influence of cultural factors in these domains, and that ‘Western’ informed consent is grounded on the individualistic nature of Western culture. This article will underline the differences between the Western and the Chinese perspectives, clarifying how each of them must be understood in its own cultural environment. But, while still respecting Chinese particularities, this paper advocates that China adopt patient individual informed consent because this is the only solution compatible with human dignity and human rights. (shrink)

Is positive thinking really so healthy that, as Martin Seligman (2000) and Mihaly Csikszentmihalyi passionately thus argued, "we believe that a psychology of positive human functioning will arise, which achieves a scientific understanding and effective interventions to build thriving individuals, families, and communities"? This optimistic view on positive thinking for health can be contrasted with an opposing view by Barbara Ehrenreich (2009), who "extensively critiqued 'positive psychology'" and showed "how obsessive positive thinking impedes productive action, causes delusional assessments of situations, (...) and people are then blamed for not visualising hard enough and thus 'attracting' failure even in situations when 'masses of lives were lost'." (WK 2013; R Byrne 2006) Contrary to these opposing views (and other ones as will be discussed in the book), health care (in relation to mental health and physical health in the context of mind and body) are neither possible (or impossible) nor desirable (or undesirable) to the extent that the respective ideologues (on different sides) would like us to believe. Surely, this questioning of the opposing views on health care does not suggest that the study of health care is worthless, or that those fields (related to health care) like medicine, chiropractic, health system, dentistry, health info tech, nursing, psychiatrics, clinical psychology, occupational therapy, pharmacy, allied health, and so on are unimportant. Needless to say, neither of these extreme views is reasonable. Instead, this book offers an alternative (better) way to understand the future of health care, especially in the dialectic relationships between mental health and physical health in the context of mind and body -- while learning from different approaches in the literature but without favouring any one of them (nor integrating them, since they are not necessarily compatible with each other). More specifically, this book offers a new theory (that is, the interconnected theory of health care) to go beyond the existing approaches in a novel way and is organised in four chapters. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Caring for Landscapes of Justice in Perilous Settler EnvironmentsMishuana Goemanindians are the "singing remnants" or "graffiti," in the words of Leanne Betasamosake Simpson ("i am graffiti"). The forms this graffiti takes, our inscriptions on the landscape, are as numerous as our Nations, abundant as our ancestors who loved, lived, and passed down knowledge of our lands and histories. "You are the result of the love of thousands," writes Linda (...) Hogan, who beseeches us to listen to the environment surrounding us (159). Deborah Miranda (Coastal Esselen and Chumash) reminds us that we are also the result of violent histories, in her tribal memoir Bad Indians, a book that relishes the tales of her ancestors who resist and act out to survive. This harm, genocide, and settler mapping of worlds also must be attuned to in our surroundings and in "our bodies [that are] bridges over which our descendants cross, spanning unimaginable landscapes of loss" (Miranda 74). Visual cartographic mapping has been part and parcel of the erasure of California Indians, relegated to the small, contained, and past temporal space of a romanticized mission.This paper centers on the NDN Collective's work and the photography of Cara Romero's project Tongvaland and the works of Gabrielino Tongva artist Mercedes Dorame. The setting of these projects is in the sprawling landscape of Los Angeles, or the homelands of the Gabrielino Tongva people, who call it Tovaangar. I will examine the anti-colonial aesthetics and care practices mapped out in the work rather than presenting a "true" Indigenous map or alternative map. Mapping a history of the landscape by creating a "new" narrative or "true" narrative is not enough. As Maori scholar Linda Tuhwi Smith states, "[w]e believe that history is also about justice, that understanding history will enlighten our decisions about the future. Wrong. History is also about power. In fact, history is mostly about power. … [A] thousand accounts of the truth will not alter the fact that indigenous peoples are still marginal [End Page 50] and do not possess the power to transform history into justice" (34). The Gabrielino Tongva, who comprise an estimated 2,300 people, do not possess the population power and cannot access the form of voting or democracy to make the changes needed just by telling their truth. Across California, people know about the raw deal, the embezzlement, the genocide, and the so-called lost treaties. In fact, under Eisenhower, recompense was paid out in small amounts to Tongva families of the dispossessed. Instead, to continue with the words of Smith, "[i]t is also about reconciling and reprioritizing what is really important about the past with what is important about the present" (111). What Romero and the NDN Collective—made up of numerous tribal leaders, scholars, and other artists—did was relay and prioritize how they wanted to be seen in their homelands. These billboards invite us in, in a gift of sharing, or what tribal cultural leader Craig Torres related to me as a spirit of Maxxa, a sharing, gifting, or swapping of knowledge. Dorame's beautiful and critical installations in public art spaces reflect Maxxa—they invite the viewers to think through land from her curious arrangements. As artists, part of their practice is not that of a Western version of a tortured genius but instead is energized by pulling in community and creating a collective practice. They undo settler space together and with us. The cartographic practices of these California Indians' creative arts exemplify communities of care that must be considered when we think through the unmapping of settler terrains. This question requires an approach of radical care. As Hi'ilei Hobart and Tamara Kneese make clear, the notion of care is "inseparable from systemic inequalities and power systems" (Hobart and Kneese 1).The work of the NDN Collective and Dorame counters a settler-based, commercial map of Los Angeles. Indigenous people, relegated by the settler state as expendable and erasable graffiti, confront capitalist and state ordinances at various scales. Rather than understand this as a subjugated positionality, I posit that graffiti is the critique necessary and valuable to understanding interlocking structures of oppression. In the following words of Leanne... (shrink)

This essay confronts Ray Brassier’s vindication of nihilism with other two important but frequently underexamined philosophical attempts to overcome nihilism: Hans Jonas’ and Keiji Nishitani’s. By putting these different takes on nihilism into dialogue, it explores some blind spots in Brassier’s position, as well as some of the practical consequences, for our current planetary situation, of undertaking a radical divorce between the normative and the natural that results from his radical nihilism. The article opts for a more moderate acceptance and (...) eventual self-overcoming of nihilism, according to which, even if natural entities are indifferent to human reasons and meanings, this does not entail that nature is bereft of a human-independent normative dimension. In other words, the essay argues that care must be taken not to confuse criticisms of an anthropocentric conception of reasons and meanings with the belief that meaning is completely absent from the natural world. Thus, the central contention of the article is that, given our current climate and ecological catastrophe, one of the most pressing tasks of contemporary philosophy is to understand normativity in non-anthropocentric ways, so that humans are no longer considered as the only entities that respond to normativity. Such an attitude conceives humans as estranged normative creatures amidst a meaningless, indifferent natural world, toward which they would have no ethical responsibilities. The essay finishes by suggesting ways in which to develop an account that does not fall into this ethical vacuum. (shrink)

A prolific discourse on the sexualisation of girls has developed in the Anglophone west. Since 2006, at least six governmental policy papers, four think tank reports, ten parenting manuals as well as over a thousand newspaper articles have been published on the topic. Deconstructing popular feminist narratives, one finds that beneath calls for protection there often resides a deeply ambivalent construction of the middle-class white girl. I argue that these narratives are beset by a melancholic subtext, one that is fuelled (...) by care and a desire for the future as well as an undercurrent of suspicion, anger and resentment. (shrink)

AAL encompasses smart home technologies that are installed in the personal living environment in order to support older, disabled, as well as chronically ill people with the goal of delaying or reducing their need for nursing care in a care facility. Artificial intelligence (AI) is seen as an important tool for assisting the target group in their daily lives. A literature search and qualitative content analysis of 255 articles from computer science and engineering was conducted to explore the (...) usage of ethical concepts. From an ethical point of view, the concept of independence and self-determination on the one hand and the possible loss of privacy on the other hand are widely discussed in the context of AAL. These concepts are adopted by the technical discourse in the sense that independence, self-determination and privacy are recognized as important values. Nevertheless, our research shows that these concepts have different usages and meanings in the ethical and the technical discourses. In the paper, we aim to map the different meanings of independence, self-determination and privacy as they can be found in the context of technological research on AI-based AAL systems. It investigates the interpretation of these ethical and social concepts which technicians try to build into AAL systems. In a second step, these interpretations are contextualized with concepts from the ethical discourse on AI-based assistive technologies. (shrink)

Restructured health care reimbursement systems and new requirements for nonprofit hospitals are transforming the U.S. health system, creating opportunities for enhanced integration of public health and health care goals. This article explores the role of public health practitioners and lawyers in this moment of transformation. We argue that the population perspective and structural strategies that characterize public health can add value to the health care system but could get lost in translation as changes to tax requirements (...) and payment systems are rapidly implemented. We urge public health leaders to take a more active role in hospital assessments of community health needs and evaluation of the patient outcomes for which providers are accountable. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Care of the terminal patient:Are we on the same page?Lauren WancataIn surgical training a “service” or care team consists of sick patients admitted to the hospital and the medical team caring for the patient. Each service consists of an attending physician, a chief resident, a senior resident and junior residents structured as a hierarchy. The chief was gone for the week. As a senior trainee I would (...) be the acting chief—a role I had assumed many times before this month. To prepare for the week of his absence, I read through each patient’s chart, and the chief and I discussed each patient—diagnosis, procedures, and plans.One was a 41–year–old male with cancer—he was young, but a patient like him was not uncommon at my institution. He originally came in through the emergency department with abdominal pain and difficulty with urination. His admitting medical team started the work–up for his symptoms—blood tests, a CAT scan, and consults to other physician services with specialized knowledge. He eventually underwent endoscopy with biopsies of his stomach and placement of stents into his ureter and kidney for his urinary issues. With return of the biopsies, he had a diagnosis—cancer. He required additional procedures, including the placement of stents into his bile ducts, as they, like his ureter, had become affected by the cancer. The next step was staging the cancer to determine his treatment options. Our surgical service was consulted for a diagnostic laparoscopy with washing—we would take a look inside his abdomen with a camera and obtain a fluid sample to be sent to the pathologist for review, the standard of care for this type of cancer. When the camera was placed nodules were seen—a sample of the nodules and the fluid were sent to a pathologist and determined to be positive for cancer: metastatic disease, stage IV. A special feeding tube was placed into his small intestine to aid in nutritional support, as he had already lost a significant amount of weight, and improving his nutrition would be imperative for any further treatments. Following this operation, oversight of his day–to–day care was taken on by our surgical service, and he had been under our care for a period of time before I rotated onto the service for the month.What was the plan for his care in the hospital, and what was his–long–term plan? His cancer could not be surgically removed due to the extent of its spread within his body. He had recently undergone another CAT scan due to an elevation in his white blood cell count (this elevation was a sign of possible infection) and a thoracentesis, a procedure to remove some of the fluid that was collecting around his lungs. Nephrologists (kidney specialist) had been consulted due to his declining kidney function. Throughout the days, his tube feeds, his source of nutrition, would often be turned off due to bloating and feeling full.Each morning, I rounded with our team, and we would see how he was doing. We would discuss how his night went, and make a plan for the day. He was a man of few words, but his wife was always at his bedside, to support him, listen to updates and keep tract of his progress. She had worked at the hospital and had seen a wide range of patients. She would ask about his kidney function, his tube feeds, and his labs. But, she never asked about his prognosis. I would leave his room each day with the unnerving feeling that the patient, family members and care team were not on the same page. Yes, we all wanted him to get better and to leave the hospital. [End Page 28] But, was he really going to get better? What defined better? Did the patient and his family really know the extent of his disease and his prognosis?Towards the end of my week as chief, I started to ask if they had any other questions. It had been a few weeks since his operation. Was there anything that they wanted to discuss or ask me about? At the... (shrink)

In this article, caring, remembering and sharing memory are presented as moral responses, the case study being Alzheimer’s disease (AD). Memory connects memories and images, while care connects individuals, which is an ethical issue. When a person’s memory is lost, the care of others becomes the only thread connecting them to the world. AD deprives a person of memories, body control, makes it impossible to remember, communicate, move, recognize the environment, and disrupts consciousness. Caring for a patient (...) with a neurodegenerative brain disease requires constant reminding and reiteration; the presence of a caring person reminds of what the patient themselves can no longer remember. Lost memories do not mean that life or relational values have also lost their meaning. The description of the memory movement emphasizes the importance of repetition in the moral act. Highlighting the matter of care, also in scientific work, is the aim of this text. To care is to remember, on behalf of the AD patient, about the patient’s life. Within bioethical research, moral responses are an important point for projects which seek to improve the condition of patients—not only the condition of health but also the comfort of life. This improvement will not be possible without attentive, committed caregivers and their responsible attitude in the face of the phenomenon of memory loss. (shrink)

In the mid-nineteenth century, healthcare delivery began transitioning from an individual, private payment model to a third-party payment model, dominated by the insurance industry. During the same time, productivity shifted from a transformational model, centered on the provider-patient relationship, to a transactional model, based on the distribution of services. The emergence of medical insurance and other third-party payers removed providers and patients from discussions about treatment plans, payment, and risk. This resulted in a weakening, if not fracturing, of the provider-patient (...) relationship. All healthcare providers enter their profession to care for people, yet what has most frequently been lost in the transformed relationship over the past century is context, communication, and trust—all elements of a relational ethic, or what ethicist and psychologist Carol Gilligan first described as, “the ethics of care.” This loss of relationality has led to a model of healthcare delivery that is fractured, isolated, and uncoordinated, with an epidemic of medical errors that by some estimates results in the death of approximately 400,000 individuals per year. Thus far, isolated foci on patient quality, outcomes, and safety have been feckless and unimpressive. However, new advanced payment models, such as value-based purchasing and patient-centered medical homes, have the potential to reduce medical error by addressing its root cause. In linking payment to factors such as context, communication, and trust, they bring relationality back into the healthcare system. This essay traces the historic devolution of the provider-patient relationship and the promise of new payment models to restore it. (shrink)

It is argued by Lie et al in the current issue of the Journal of Medical Ethics that an international consensus opinion has formed on the issue of standards of care in clinical trials undertaken in developing countries. This opinion, so they argue, rejects the Declaration of Helsinki’s traditional view on this matter. They propose furthermore that the Declaration of Helsinki has lost its moral authority in the controversy in research ethics. Although the latter conclusion is supported by (...) this author, it will be demonstrated in this paper that there is not such a thing as an international consensus opinion, and that the authorities used by Lie et al as evidence in support of their claim should not be relied upon as authorities or final arbiters in this debate. Furthermore, it will be shown that arguments advanced substantively to show that lower standards of care are ethically acceptable in the developing world, conflate scientific with economic reasons, and ultimately fail to bolster the case they are designed to support. (shrink)

In 1889, the German philologist Friedrich Blass isolated a section of Chapter 20 from Iamblichus’ Exhortation to Philosophy (mid- or late 3rd Century CE) as an extract from a lost sophistic or philosophical treatise from the late 5th Century BCE. In this article, I introduce the text, which is now known as 'Anonymus Iamblichi' (or 'the anonymous work preserved in Iamblichus') by appeal to its two main contexts (source preservation and original historical composition), translate and discuss all eight surviving (...) fragments in their entirety, and provide some closing remarks about its importance to this history of democratic thought. The text itself presents a series of very carefully interwoven arguments concerning the three “parts” of excellence (ἀρετή) – wisdom, courage, and eloquence – and their successful application in society. In the course of presenting this case, Anonymus Iamblichi comments on the conditions under which one should learn to be excellent (Fragments 1-2) and the ends to which one should direct one’s excellence (Fragments 3-4); he provides an anthropological discussion of the weaknesses of human psychology and its effects on the good man (Fragments 5-6) and an hypothetical thought experiment concerning the “Superman” (which naturally solicits comparison with Nietzsche’s übermensch) and his inability to overcome the multitude in a lawless state (Fragments 6 and 8); and a positive defense of law and justice, reflecting a pro-democratic philosophical perspective (Fragments 7-8) – a rara avis indeed in ancient philosophy. (shrink)

I examine the concept of granting for the sake of the argument in the context of explanatory reasoning. I discuss a situation where S wishes to argue for H1 as a true explanation of evidence E and also decides to grant, for the sake of the argument, that H2 is an explanation of E. S must then argue that H1 and H2 jointly explain E. When H1 and H2 compete for the force of E, it is usually a bad idea (...) for S to grant H2 for the sake of the argument. If H1 and H2 are not positively dependent otherwise, there is a key argumentative move that he will have to make anyway in order to retain a place at the table for H1 at all—namely, arguing that the probability of E given H2 alone is low. Some philosophers of religion have suggested that S can grant that science has successfully provided natural explanations for entities previously ascribed to God, while not admitting that theism has lost any probability. This move involves saying that the scientific explanations themselves are dependent on God. I argue that this “granting” move is not an obvious success and that the theist who grants these scientific successes may have to grant that theism has lost probability. (shrink)

This paper tracks the development of Merleau-Ponty's inquiries into language through the themes of institution, symbolism, and nature in his Collège de France lectures of 1953-1960. It seeks to show the continuity of Merleau-Ponty's inquiries over this period. The Problem of Speech course (1953-1954) constitutes his last extended treatment of speech, language, and expression, and it leaves many questions unanswered. Nonetheless, a careful study of the course reveals that the inquiries that follow into institution and symbolism, and later into nature, (...) do not mark a sharp rupture with his earlier thought. Rather, the later investigations are required by those into language and expression to clarify the underlying functions that support them. Ultimately, the themes of language and nature will be deeply interwoven in Merleau-Ponty's late thought, with institution and symbolism serving as important mediating concepts. (shrink)

The global COVID‐19 pandemic challenged the world—how it functions, how people move in the social worlds and how government/government services and people interact. Health services, operating under the principles of new public management, have undertaken rapid changes to service delivery and models of care. What has become apparent is the mechanisms within which contemporary health services operate and how services are not prioritising the person at the centre of care. Person‐centred care (PCC) is the philosophical premise upon (...) which models of health care are developed and implemented. Given the strain that COVID‐19 has placed on the health services and the people who deliver the care, it is essential to explore the tensions that exist in this space. This article suggests that before the pandemic, PCC was largely rhetoric, and rendered invisible during the pandemic. The paper presents an investigation into the role of PCC in these challenging times, adopting a Foucauldian lens, specifically governmentality and biopolitics, to examine the policies, priorities and practical implications as health services pivoted and adapted to changing and acute demands. Specifically, this paper draws on the Australian experience, including shifting nursing workforce priorities and additional challenges resulting from public health directives such as lockdowns and limitations. The findings from this exploration open a space for discussion around the rhetoric of PCC, the status of nurses and that which has been lost to the pandemic. (shrink)

Severe Traumatic Brain Injury (TBI) remains a major cause of death and disability afflicting mostly young adult males and elderly people, resulting in high economic costs to society. Therapeutic approaches focus on reducing the risk on secondary brain injury. Specific ethical issues pertaining in clinical testing of pharmacological neuroprotective agents in TBI include the emergency nature of the research, the incapacity of the patients to informed consent before inclusion, short therapeutic time windows, and a risk-benefit ratio based on concept that (...) in relation to the severity of the trauma, significant adverse side effects may be acceptable for possible beneficial treatments. Randomized controlled phase III trials investigating the safety and efficacy of agents in TBI with promising benefit, conducted in acute emergency situations with short therapeutic time windows, should allow randomization under deferred consent or waiver of consent. Making progress in knowledge of treatment in acute neurological and other intensive care conditions is only possible if national regulations and legislations allow waiver of consent or deferred consent for clinical trials. (shrink)

Following the seemingly endless debate over managed care liability, I cannot suppress thoughts of Yeats’s poem, “The Second Coming.” It is not the wellknown phrase, “Things fall apart; the centre cannot hold,” that comes to mind; although that could describe the feeling of a health-care system unraveling. The poem’s depiction of lost innocence — “The best lack all conviction, while the worst/Are full of passionate intensity” — does not allude to the legislature, the industry, the public, or (...) the medical or legal profession. What resonates is the poem’s evocation of humanity’s cyclical history of expectation and disappointment, with ideas as grand as justice and occupations as pedestrian as managed care. Writing in 1919, Yeats described the end of an era with images of war’s destructive forces. The poem expresses a universal desire for some miraculous rebirth or resolution of all problems: “Surely some revelation is at hand.” But instead, the brutish Sphinx-like creature emerges, possibly the Antichrist. New gods displace old gods in the cycle of civilization, and man must muddle on. (shrink)

Patients with end-stage renal disease experience significant mortality and morbidity, including cognitive decline. Advance care planning has been emphasized as a responsibility and priority of physicians caring for patients with chronic kidney disease in order to align with patient values before decision-making capacity is lost and to avoid suffering. This emphasis has proven ineffective, as illustrated in the case of a patient treated in our hospital. Is this ineffectiveness a consequence of failure in the courtroom or the clinic? (...) Through our own experience we affirm what has been written before: that legal precedent favors intensive treatment in virtually all cases without ‘clear and convincing evidence’ of a patient’s previously declared wishes to the contrary. Equally clear is that more than 20 years of support in the clinical literature suggesting advance care planning early in the course of disease can address challenges in the legal system for those lacking capacity. However, many physicians fail t... (shrink)

Comparisons have frequently been made between the works of Dante and Milton, more often than not by critics with a definite predilection one or the other poet. The author of this systematic comparison has approached the task without partisanship, but with a warm admiration for both poets. It is her contention that, although Dante was generally out of favor during the seventeenth century, even in Italy, Milton had read the Divina Commedia sympathetically and with care by the time he (...) came to write Paradise Lost. In substantiation Professor Samuel cites many parallel uses of language, imagery, theme, and method, while also taking note of divergences. Source materials are given in the appendixes, including Milton's references to Dante and a list of previously published comparisons. (shrink)

Background: Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy. Objective: To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy. Setting: Two long-term residential care facilities: a nursing home for people with dementia and a care facility (...) for people with intellectual disabilities. Methods: Ethnographic field study. Ethical considerations: The boards representing clients and relatives/proxies of the clients were informed of the study and gave their written consent. The clients’ assent was sought through a special information leaflet. At any time clients and/or proxy were given the option to withdraw from the study. The research protocol was also reviewed by a medical ethics committee. Findings: Our findings show a pattern of two themes: (1) coping with new spaces which entailed clients: wandering around, getting lost, being triggered, and retreating to new spaces and (2) resisting the surveillance technology measure because clients feel stigmatized, missed the company, and do not like being “watched.” Conclusion: Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices’ presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach. (shrink)

Megan1 is a young teenage patient who suffered a stillbirth at 28 weeks, leading to a year long police investigation dropped only after postmortem tests found that her pregnancy was lost due to natural causes. The stress of the investigation and her isolation from friends and support network following the seizure of her mobile and laptop compounded the trauma of the stillbirth, leaving her requiring emergency psychiatric care. Aisha1 is a vulnerable patient who suffered a premature delivery, having (...) experienced similar problems in earlier pregnancies. Things happened so quickly that Aisha delivered on her own at home, only then seeking medical care. She told hospital staff that earlier in her pregnancy she had considered an abortion. As a result, she found herself interviewed under police caution and was required to surrender her phone and tablet, limiting access to friend and family support just when most needed. Aisha was denied unsupervised access to her baby in the intensive care unit, needing to hand over expressed breast milk to a receptionist. These stories, which were reported in a recent meeting in Parliament,1 are sadly far from unusual. They reflect the collateral damage of a growing trend towards more enthusiastic enforcement of the archaic abortion laws of England and Wales.2–5 In such cases, women who present with miscarriage, stillbirth or a premature delivery have aroused the suspicion of health professionals, sometimes because—like Aisha—they speak honestly about having considered abortion earlier in their pregnancies. They then find themselves reported to the police, required to surrender electronic devices and sometimes advised by duty solicitors to speak to no one about events leading to their investigation, thus being denied emotional and full clinical support at a time of significant trauma. These women are not the only victims of British abortion laws: so …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bringing Cancer Care to Those who Don't Have ItLawrence N. ShulmanI have been treating cancer patients in the Harvard Medical School hospitals since 1977, and in those 35 years we have made tremendous progress. Though work still needs to be done, and far too many patients still die of cancer, many are cured. In particular, children and young adults have a high rate of cure from such diseases (...) as Hodgkin's lymphoma, non-Hodgkin's lymphoma, acute lymphoblastic leukemia, and childhood sarcoma. Patients with breast cancer in the US have a greater than 80% chance for long-term survival. The death rate from cervical cancer in the US is very low. These results have been achieved by making diagnoses earlier, in many cases surgical excision, and often systemic therapies such as chemotherapy, hormonal therapy, radiation therapy, and more recently by using so-called "targeted" therapies—those directed at particular molecular characteristics of the cancer cells.Princess Dina Mired has said that the opportunity to survive cancer should not be an accident of geography. In cases where we already have effective and inexpensive tools to cure cancer, these treatments should be considered a basic human right, a life-saving medical service.I met Patty, a young woman living in the U.S. during November of her senior year in high school, after she discovered a small lump above her left collar bone. Though she felt entirely well, she called her primary care doctor who saw her the next day, felt the enlarged lymph node, and referred her to a surgeon, who did a biopsy later that week. Her primary care doctor also called me, and we scheduled a visit when the pathology results were available. The following week the pathologist notified Patty's pediatrician that the biopsy showed Hodgkin's lymphoma. When I met Patty, she was a bright and focused young woman, waiting to hear about her college applications and enjoying her senior year. Her cancer diagnosis was completely out of context with her life as she planned it, but with the support of her family and boyfriend, she seemed prepared to take things one step at a time. A PET CT scan demonstrated a modest mass in the mediastinum (chest), but no other disease. She was in an early stage of the disease with an excellent prognosis. We recommended and administered six months of chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine—four chemotherapy agents that are off-patent, and relatively inexpensive. She lost her hair, not a trivial issue for her, but otherwise felt reasonably well during the treatment. She was determined to graduate with her classmates, and was able continue to attend school and keep up with her work. In June, seven months into her cancer diagnosis and treatment, she graduated with honors, and was on track to enroll in college in September.Like other 18-year-old women with Hodgkin's lymphoma, Patty had an over 80% chance for cure with the potential for a long and productive life ahead of her because we could perform a biopsy, make a diagnosis, and safely and effectively treat her with four inexpensive, off-patent, chemotherapy drugs. She had nearly the same likelihood of living a long and fruitful life as her classmates, and had the same chances for childbearing. In my line of work, with the knowledge we now possess, to allow someone like Patty to die without a chance of curative care is simply unacceptable. Treatment of curable cancers should be considered on par with the right to clean water, adequate nutrition, treatment for infectious disease, and access to maternal and child healthcare services.But in many places in the world, people with cancers we could easily eradicate in Boston have no access to cancer services, and do die unnecessarily. The local healthcare infrastructure has no [End Page E10] capacity to evaluate a patient, perform or process a biopsy, make a diagnosis, or treat the patient with potentially curative surgery, chemotherapy and radiation. I have rounded on the wards of hospitals in developing countries, stopping to talk with numerous patients like Patty: young women, some of whom might have had Hodgkin's lymphoma, but no... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Natural Philosophy: On Retrieving a Lost Disciplinary Imaginary by Alister E. McGRATHJack ZupkoMcGRATH, Alister E. Natural Philosophy: On Retrieving a Lost Disciplinary Imaginary. Oxford: Oxford University Press, 2023. viii + 248 pp. Cloth, $39.95This book attempts to retrieve and reimagine the tradition of natural philosophy as an antidote for what the author sees as the fragmented, instrumentalized, and ethically disengaged understanding of the natural world most (...) of us have today. The idea is not to reinstate the older vision of Aristotle and Thomas Aquinas, with its final causes and animated spheres, or even the early modern culmination of natural philosophy in Newton’s universe of mathematically fixed natural laws; rather, the author hopes to engender a newer and deeper understanding of nature that is at once scientific, ethical, and poetic, which he explains in terms of the conceptual framework of Popper’s “Three Worlds”: objective, subjective, and theoretical. What is recovered thereby is said to be a “lost conceptual space” wherein human beings learn both about and from nature, modes of knowing rendered obsolete by disciplinary specialization in the sciences as well as our commitment to objective methods that leave no room for ethical or spiritual approaches to understanding the natural world and our place in it.The author covers quite a bit of ground on the historical side, from the ancient Greeks through the Middle Ages, moving on to the idea of natural philosophy as it was gradually transformed during the early modern period by Copernicus, Kepler, Galileo, Bacon, Boyle, and Newton—a picture finally eclipsed by the objective, empirical concept of natural science familiar to us today. Curiously, the book says very little about the Platonic tradition of natural philosophy that grew up around the Timaeus. Because it was available in Latin (or the first half of it, anyway, in a Latin translation by the Roman Neoplatonist Calcidius, who also wrote an influential commentary on the work), the Timaeus was, for almost a millennium, the authoritative text in natural philosophy in the West, at least until Aristotle’s nonlogical and scientific writings were recovered in the twelfth century. The Timaeus was the subject of many commentaries and philosophical discussions, from Calcidius in the fourth century to Bernardus Silvestris, William of Conches, and Alan of Lille in the twelfth. It fell out of favor among philosophers with the rise of Aristotle’s Physics and Aristotelian natural philosophy, though it continued to shape the popular imagination of nature in other genres, such as art and literature—recall, for example, the well-known image of “God the Geometer” (c. 1230), measuring the cosmos with a compass. If the author’s project is about “retrieving” natural philosophy “as a lost disciplinary imaginary” (the book’s subtitle), then surely the Platonic vision of the universe deserves equal billing with the Aristotelian. [End Page 158]That said, there is much to like in the project sketched here. The author’s diagnosis of the epistemic malaise of modern-day science sounds right to anyone familiar with the history of philosophy and natural science. So, even though we can now correctly describe the velocity constant of earth’s gravity as 9.8 m/s2, among other scientific achievements, we take ourselves to be wearing a different hat when we wax poetic at the beauty of the sky and the stars. Early-and pre-modern authors were more adept at bringing together science and poetry, but that might be because their epistemic position was radically different from our own. Calcidius, for example, finds it easy to draw moral and aesthetic conclusions from the motions of the cosmos because he really believed heavenly bodies are, like us, animated by souls. Even a materialist like Lucretius accepts that the gods exist; his (still) very radical thesis is that they don’t care about us. (And why should they? The Pythagorean theorem is much more beautiful and edifying to consider than the troubles of ignorant and weak-willed mortals.) Enlightened moderns that we are, we no longer believe the heavens are populated by super-intelligent beings; yet we continue to marvel at Van Gogh’s Starry Night and feel it is wrong to cause gratuitous... (shrink)

This paper investigates the ascription of a passage in Isidore’s Differentiae to the jurist Modestinus. A collection of philological notes by the humanist scholar Barthius reports the existence of a (now lost) manuscript that credited lemma 1.434 Codoñer to one Orenius, which has ever since usually been emended into Herennius (sc. Modestinus). It is possible to place this witness in the stemma of the Differentiae. Careful study of Barthius’ reported readings from the manuscript not only indicates that it was (...) peripheral to the tradition, but it also allows us to point out the (skilful) hand of an editor/interpolator, who may have been responsible for the addition of the name Orenius. (shrink)

Background Nurse leaders increasingly need effective tools that facilitate the prioritisation of ethics and help staff navigate ethical challenges and prevent moral distress. This study examined experiences with a new digital tool for ethical reflection, tailored to improve the capabilities of both leaders and employees in the context of municipal long-term care. Aim The aim was to explore the experiences of nurse leaders and nurses in using Digital Ethical Reflection as a tool for ethics work in home nursing (...) class='Hi'>care. Research design The study employed a qualitative design, incorporating individual and focus group interviews for data collection. Qualitative content analysis was used to analyse the data. Participants and research context The participants comprised six nurse leaders and 13 nurses, representing six home care zones across two Norwegian municipalities. Ethical considerations The study involved informed, voluntary participation and was approved by the Norwegian Agency for Shared Services in Education and Research. Findings Four themes were developed: a constant walk on the edge between engagement and discouragement and lost in translation describe the process, while tuning in to the ethical dimension and navigating ethical uncertainties illuminate the experienced significance of Digital Ethical Reflection. Conclusion Success with Digital Ethical Reflection in home nursing care depends on clear leadership planning, nurses’ understanding of the tool’s purpose, and active use of digital registrations. Support from ethically interested nurses enhances overall engagement. Further research is needed to explore the potential of Digital Ethical Reflection as an additional tool in long-term care ethics work. (shrink)

In this survey, we discuss and analyze foundational issues of the problem of time and its asymmetry from a unified standpoint. Our aim is to discuss concisely the current theories and underlying notions, including interdisciplinary aspects, such as the role of time and temporality in quantum and statistical physics, biology, and cosmology. We compare some sophisticated ideas and approaches for the treatment of the problem of time and its asymmetry by thoroughly considering various aspects of the second law of thermodynamics, (...) nonequilibrium entropy, entropy production, and irreversibility. The concept of irreversibility is discussed carefully and reanalyzed in this connection to clarify the concept of entropy production, which is a marked characteristic of irreversibility. The role of boundary conditions in the distinction between past and future is discussed with attention in this context. The paper also includes a synthesis of past and present research and a survey of methodology. It also analyzes some open questions in the field from a critical perspective. (shrink)

Medicalization was the theme of the 29th European Conference on Philosophy of Medicine and Health Care that included a panel session on the DSM and mental health. Philosophical critiques of the medical model in psychiatry suffer from endemic assumptions that fail to acknowledge the real world challenges of psychiatric nosology. The descriptive model of classification of the DSM 3-5 serves a valid purpose in the absence of known etiologies for the majority of psychiatric conditions. However, a consequence of the (...) “atheoretical” approach of the DSM is rampant epistemological confusion, a shortcoming that can be ameliorated by importing perspectives from the work of Jaspers and McHugh. Finally, contemporary psychiatry’s over-reliance on neuroscience and pharmacotherapy has led to a reductionist agenda that is antagonistic to the inherently pluralistic nature of psychiatry. As a result, the field has suffered a loss of knowledge that may be difficult to recover. (shrink)

Historians play it safe. Complex issues are dissected while analytical distance keeps stakeholders at bay. But the relevance of historical research may be lost in caution and failure to engage with a wider audience. We can't afford that. We have too much to offer and too much at stake. We need to take the discussion of science and religion beyond our own professional circles. Peter Harrison's The Territories of Science and Religion gives us an opportunity to do so. We (...) can use his book to understand why people consistently get the relation wrong. However, we need to take the next step ourselves, involve historians in the common academic goal, across disciplines, to make sense of the world around us and make that combined knowledge truly useful. Evolution and natural history might help to that effect. (shrink)

Historians play it safe. Complex issues are dissected while analytical distance keeps stakeholders at bay. But the relevance of historical research may be lost in caution and failure to engage with a wider audience. We can't afford that. We have too much to offer and too much at stake. We need to take the discussion of science and religion beyond our own professional circles. Peter Harrison's The Territories of Science and Religion gives us an opportunity to do so. We (...) can use his book to understand why people consistently get the relation wrong. However, we need to take the next step ourselves, involve historians in the common academic goal, across disciplines, to make sense of the world around us and make that combined knowledge truly useful. Evolution and natural history might help to that effect. (shrink)

BackgroundEverybody has the right to decide whether to receive specific medical treatment or not and to provide their free, prior and informed consent to do so. As dementia progresses, people with Alzheimer’s dementia (PwAD) can lose their capacity to provide informed consent to complex medical treatment. When the capacity to consent is lost, the autonomy of the affected person can only be guaranteed when an interpretable and valid advance directive exists. Advance directives are not yet common in Germany, and (...) their validity is often questionable. Once the dementia diagnosis has been made, it is assumed to be too late to write an advance directive. One approach used to support the completion of advance directives is ‘Respecting Choices’®—an internationally recognised, evidence-based model of Advance Care Planning (ACP), which, until now, has not been evaluated for the target group of PwAD. This study’s aims include (a) to investigate the proportion of valid advance directives in a memory clinic population of persons with suspected AD, (b) to determine the predictors of valid advance directives, and (c) to examine whether the offer of ACP can increase the proportion of valid advance directives in PwAD.MethodWe intend to recruit at leastN = 250 participants from two memory clinics in 50 consecutive weeks. Of these, the first 25 weeks constitute the baseline phase (no offer of ACP), the following 25 weeks constitute the intervention phase (offer of ACP). The existence and validity of an advance directive will be assessed twice (before and after the memory clinic appointment). Moreover, potential predictors of valid advance directives are assessed.DiscussionThe results of this study will enhance the development of consent procedures for advance directives of PwAD based on the ACP/Respecting Choices (R) approach. Therefore, this project contributes towards increasing the autonomy and inclusion of PwAD and the widespread acceptance of valid advance directives in PwAD.Trial RegistrationDRKS, DRKS00026691, registered 15th of October 2021,https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00026691. (shrink)

Background Clinical Ethics Committees are well established at healthcare institutions in resource-rich countries. However, there is limited information on established CECs in resource poor countries, especially in Africa. This study aimed to establish baseline data regarding existing formal CECs in Africa to raise awareness of and to encourage the establishment of CECs or Clinical Ethics Consultation Services on the continent. Methods A descriptive study was undertaken using an online questionnaire via SunSurveys to survey healthcare professionals and bioethicists in Africa. Data (...) were subjected to descriptive analysis and Fischer's exact test was applied to determine associations. Texts from the open-ended questions were thematically analysed. Results In total 109 participants from 37 African countries completed the survey in December 2019. A significant association was found between participants’ bioethics qualification or training and involvement in clinical ethics. All participants were familiar with Research Ethics Committees, and initially conflated RECs with CECs. When CECs were explained in detail, approximately 85.3% reported that they had no formal CECs in their institutions. The constraints to developing CECs included lack of training, limited resources, and lack of awareness of CECs. However, the majority of participants were interested in establishing CECs. Participants listed assistance required in establishing CECs including funding, resources, capacity building and collaboration with other known CECs. The results do not reflect CECs established since the onset of COVID-19 in Africa. Conclusions This study provides a first look into CECs in Africa and found very few formal CECs on the continent indicating an urgent need for the establishment of CECs or CESs in Africa. While the majority of healthcare professionals and bioethicists are aware of ethical dilemmas in healthcare, the concept of formal CECs is foreign. This study served to raise awareness of CECs. Research ethics and RECs overshadow CECs in Africa because international funders from the global north support capacity development in research ethics and establish RECs to approve the research they fund in Africa. Raising awareness via educational opportunities, research and conferences about CECs and their role in improving the quality of health care in Africa is sorely needed. (shrink)