Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. (...) A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom -based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician’s duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to. (shrink)

Book reviewed in this article: The Man Who Mistook His Wife for a Hat and Other Clinical Tales. By Oliver Sacks.

Many scientists believe that there is a uniform, interdisciplinary method for the prac- tice of good science. The paradigmatic examples, however, are drawn from classical ex- perimental science. Insofar as historical hypotheses cannot be tested in controlled labo- ratory settings, historical research is sometimes said to be inferior to experimental research. Using examples from diverse historical disciplines, this paper demonstrates that such claims are misguided. First, the reputed superiority of experimental research is based upon accounts of scientific methodology (Baconian inductivism (...) or falsificationism) that are deeply flawed, both logically and as accounts of the actual practices of scientists. Second, although there are fundamental differences in methodology between experimental scien- tists and historical scientists, they are keyed to a pervasive feature of nature, a time asymmetry of causation. As a consequence, the claim that historical science is methodo- logically inferior to experimental science cannot be sustained. (shrink)

Two years ago, the US National Academy of Sciences and the National Academy of Medicine released a report drafted by an international committee regarding the use of gene editing in humans. Once a tedious and expensive process, gene editing has now become more accessible and cheaper using the new CRISPR technology, making the issue of its use more urgent and pressing. The committee cites general support for somatic nonheritable gene editing to correct for a serious disease already present in a (...) human being, but more controversial is germline gene editing for heritable conditions. Performing gene editing that affects an individual's descendants is at present tightly controlled in the US, but around the... (shrink)

_Material Feminisms: New Directions for Education_ provides a range of powerful theoretical and innovative methodological examples to illuminate how new material feminism can be put to work in education to open up new avenues of research design and practice. It poses challenging questions about the nature of knowledge production, the role of the researcher, and the critical endeavour arising from inter- and post-disciplinarity. Working with diffractive methodologies and new materialist ecological epistemologies, the book offers resources for hope which widen the (...) scope for how educational problems are interrogated, and provides a political counter-movement to neo-positivist, outcomes-based approaches within education. Inspired by writers such as Barad, Bennett, and Deleuze and Guattari, the book makes a radical break with cognitive, dualist, and universal conceptions of human subjectivity and intelligence in education. By taking its starting point as the co-consitutiveness of discourse, materiality, corporeality, and place, the book foregrounds educational practices as material enactments of multiple, non-linear, entangled, affective, and relational forces. It offers new insights into how gender, class, and ethnicity are constituted in, and by, material assemblages that are often submerged or ‘unseen’. This book is an essential starting place for those intrigued by what new theoretical accounts of materiality, posthumanism, and affect can offer educational research. Diffractive methodologies challenge readers to take a fuller range of actors into account than in ‘objective’ humanist methodologies, and in so doing to pay closer attention to what data is. It invites researchers to engage with long-standing feminist concerns about power and knowledge production in research processes. This book was originally published as a special issue of _Gender and Education. _. (shrink)

The authors of the concept Health-Related Digital Autonomy have laid the first building block to examine the interactions between artificial intelligence, social media, and depression f...

Recent research into climate shocks and what this means for the on-farm production of food revealed mixed and unanticipated results. Whilst the research was triggered by a series of catastrophic, climate related disruptions, Australian beef producers interviewed for the study downplayed the immediate and direct impacts of climate shocks. When considering the changing nature of production under shifting climatic conditions, producers offered a commentary on the digital technology and data which interconnected with climate solutions deriving from both on and off (...) the farm. Perceptions of digital technologies were mixed. Some viewpoints outlined how data driven climate solutions supported on farm planning and decision making, helping to manage climate risks and shocks. However, alongside these narratives, concerns were raised about satellite-based sustainability surveillance and their implications for producer agency. These concerns include the data-informed actions of non-farming third parties, such as bank loan call-ins for properties perceived to be a climate risk, remote surveillance of ground cover, and the commercial re-appraisal of pastoral lands as carbon sinks. Digital solutions to climate shocks thus emerge as inherently ambivalent, a response to shocks and a potential catalyst for renewed crisis. Drawing upon the theoretical lens of relationality, we argue that digital data are increasingly entangled with other material and non-material elements that may disrupt and/or reconfigure the management of farming and with that, the future security of food production. In some instances, data-based solutions to climate risks and shocks present even greater risks to producer agency than climate risks and shocks themselves. (shrink)

Traditional conceptions of informed consent seem difficult or even impossible to apply to new technologies like biobanks, big data, or GMOs, where vast numbers of people are potentially affected, and where consequences and risks are indeterminate or even unforeseeable. Likewise, the principle has come under strain with the appropriation and monetisation of personal information on digital platforms. Over time, it has largely been reduced to bare assent to formalistic legal agreements. To address the current ineffectiveness of the norm of informed (...) consent, I suggest that we need a notion of structural injustice (on a distinctive interpretation, elaborated here, which takes account of unequal power and property relations). I then argue that in order to protect and enhance people's freedom, we have to go beyond traditional applied ethics and introduce perspectives from democratic theory and social philosophy. I attempt to show how applications of the ‘all‐affected principle’, together with new forms of democratic participation, deliberation, and representation can helpfully frame the narrower principle of informed consent. There is an important role for what we could call collective consent, and informed consent can only succeed in increasing individual agency if it is situated within enhanced forms of democratic decision‐making. (shrink)

The stability of each of the theories of separably closed fields is proved, in the manner of Shelah's proof of the corresponding result for differentially closed fields. These are at present the only known stable but not superstable theories of fields. We indicate in § 3 how each of the theories of separably closed fields can be associated with a model complete theory in the language of differential algebra. We assume familiarity with some basic facts about model completeness [4], stability (...) [7], separably closed fields [2] or [3], and (for § 3 only) differential fields [8]. (shrink)

Recent research into climate shocks and what this means for the on-farm production of food revealed mixed and unanticipated results. Whilst the research was triggered by a series of catastrophic, climate related disruptions, Australian beef producers interviewed for the study downplayed the immediate and direct impacts of climate shocks. When considering the changing nature of production under shifting climatic conditions, producers offered a commentary on the digital technology and data which interconnected with climate solutions deriving from both on and off (...) the farm. Perceptions of digital technologies were mixed. Some viewpoints outlined how data driven climate solutions supported on farm planning and decision making, helping to manage climate risks and shocks. However, alongside these narratives, concerns were raised about satellite-based sustainability surveillance and their implications for producer agency. These concerns include the data-informed actions of non-farming third parties, such as bank loan call-ins for properties perceived to be a climate risk, remote surveillance of ground cover, and the commercial re-appraisal of pastoral lands as carbon sinks. Digital solutions to climate shocks thus emerge as inherently ambivalent, a response to shocks and a potential catalyst for renewed crisis. Drawing upon the theoretical lens of relationality, we argue that digital data are increasingly entangled with other material and non-material elements that may disrupt and/or reconfigure the management of farming and with that, the future security of food production. In some instances, data-based solutions to climate risks and shocks present even greater risks to producer agency than climate risks and shocks themselves. (shrink)

Abstract: The emergence of cross-border communities and transnational associations requires new ways of thinking about the norms involved in democracy in a globalized world. Given the significance of human rights fulfillment, including social and economic rights, I argue here for giving weight to the claims of political communities while also recognizing the need for input by distant others into the decisions of global governance institutions that affect them. I develop two criteria for addressing the scope of democratization in transnational contexts— (...) common activities and impact on basic human rights —and argue for their compatibility. I then consider some practical implications for institutional transformation and design, including new forms of transnational representation. (shrink)

Arguments in favor of legalized assisted suicide often center on issues of personal privacy and freedom of choice over one's body. Many disability advocates assert, however, that autonomy arguments neglect the complex sociopolitical determinants of despair for people with disabilities. Specifically, they argue that social approval of suicide for individuals with irreversible conditions is discriminatory and that relaxing restrictions on assisted suicide would jeopardize, not advance, the freedom of persons with disabilities to direct the lives they choose. This paper examines (...) the idea promoted by some proponents of assisted suicide that it is reasonable to be depressed about one's diminished quality of life in cases of irreversible illness or disability and, therefore, such depression should not call into question the individual's competence to request assistance in dying. The concept of rational depression is defined and examined in the context of: four real-life cases involving individuals with disabilities who requested assistance in dying; a set of criteria commonly applied to decision-making to determine rationality; and research bearing on the emotional status of people with disabilities. It is concluded that although disability is associated with particular socially mediated stressors, there is no theoretical or empirical evidence to indicate that depression and its role in the right to die is dynamically different, more natural, or more reasonable for disabled people than for non-disabled people. (shrink)

We conducted a narrative review of existing literature to identify the knowledge, skills, and abilities necessary for officers who police in democratic societies to successfully manage potentially volatile police–public interactions. This review revealed 10 such KSAs that are frequently discussed in the literature. These KSAs include: knowledge of policies and laws; an understanding of mental health-related issues; an ability to interact effectively with, and show respect for, individuals from diverse community groups; awareness and management of stress effects; communication skills; decision-making (...) and problem-solving skills; perceptual skills; motor skills related to use-of-force; emotion and behavior regulation; and an ability to treat people in a procedurally just manner. Following our review, we conducted semi-structured interviews with researchers who specialize in police training and adult education, interactions with individuals in crisis, and racialized policing, as well as two police trainers with expertise in de-escalation and use-of-force training. These interviews confirmed the importance of the 10 KSAs and highlighted two additional KSAs that are likely to be critical: understanding the role of policing in a free and democratic society and tactical knowledge and skills. To ensure that police–public interactions are managed effectively, police trainers may want to focus on the development and evaluation of these KSAs—something that is not always done currently. (shrink)

This article examines the current use of Jesus language in a convenience sample of twenty-five mission statements from Roman Catholic hospitals and health care systems in the United States. Only twelve statements specifically use the words “Jesus” or “Christ” in their mission statements. The author advocates the use of explicit Jesus language and modeling. While the witness of Jesus in the Gospel healing narratives is not the only corrective to current abuses in the health care delivery system, it is foundational (...) to the integrity of Roman Catholic health care identity and mission. An analysis of Gospel healing narratives is used to illustrate the prophetic dimension of Jesus' wisdom, word, and witness. (shrink)

This paper investigates the import for a conception of democratic socialism of Marx’s well-known principle “From each according to their abilities, to each according to their needs,” arguing that it is best taken together with another of his principles: “The free development of each is the condition for the free development of all.” It considers their implications for the near term rather than some possible ultimate form of communal society, and also brings in a principle that I have developed previously—equal (...) positive freedom—which in some ways synthesizes the other two. In analyzing the abilities and needs principle, the notion and extent of needs are explicated, seeing them as including not only material needs, but needs for recognition and for relationships. Marx’s crucial insight that distribution largely depends on the organization of the production process also comes into play. On these bases, the paper proposes that a system of democratically managed firms forms the centerpiece for democratic socialism, supplemented by some other institutions that would work to meet basic needs. The paper also proposes a role for the norms of reciprocity and solidarity, in addition to those of freedom and equality that are most evident in the three principles. Finally, the relative inattention to social reproduction in the early Marxist tradition is addressed with an interpretation of the notion of socializing care and a consideration of its import for institutional design, including cooperative ways of providing such care. Throughout, Marx’s distinctive notions of social individuality, socialized wealth, and the free development of individuals are appealed to for the guidance they can provide for interpreting the abilities/needs principle for the period ahead. (shrink)

The purpose of this paper is to explore job performance, mergers and acquisitions (M&A) from an ethical perceptive. A great number of studies have extensively discussed the link between M&A and performance; however, most focused on the financial functions and strategy selections. Although ethical issues emerge in the M&A process, it is a less studied area. This study adopted the structural equation modeling approach to empirically test our hypotheses. Based on 264 samples from financial companies, data analyses indicated that ethical (...) conduct in M&A is significantly correlated with employee job performance. Ensuring employment security and caring practices can significantly explain organizational commitment. Organizational commitment also plays a significant mediating role between a company’s ethical conduct and employee job performance. Managerial implications are also provided. (shrink)

: Advances in medical technology now permit children who need ventilator assistance to live at home rather than in hospitals or institutions. What does this ventilator-dependent life mean to children and their families? The impetus for this essay comes from a study of the moral experience of 12 Canadian families—parents, ventilator-dependent child, and well siblings. These families express great love for their children, take on enormous responsibilities for care, live with uncertainty, and attempt to create "normal" home environments. Nevertheless, they (...) experience social isolation, sometimes even from their extended families and health care providers. Their lives are constrained in many ways. The challenges faced by parents of technology-dependent children raise questions of justice within society and within families. (shrink)

: This response to the preceding article by Gastmans, Dierckx de Casterle, and Schotsmans challenges the notion of "good care" as the ultimate goal of nursing practice, explores further the possible goals of nursing and how they may be identified, and presents six elements of professional caring along with their related virtues and moral obligations.

In the theater the fictional Dr. Kelekian’s relief that he does not have to talk to family members about his patient’s cancer treatment draws uneasy laughter from the audience. Doctors, patients, and family members alike recognize the situation, even if hearing it so baldly expressed discomfits them.Why do physicians and other health care professionals, including lawyers and bioethicists, so often view families as “trouble”? And why do families so often see medical professionals as uncaring and uncommunicative? Presumably everyone wants the (...) same goal—recovery or the best possible outcome for the patient. And yet trouble clearly exists. We do not see the problem as one of “dysfunctional families” or “callous doctors,” although there are undoubtedly many of each. (shrink)

The main question examined is: How do nurses and other healthcare professionals ensure ethical interprofessional collaboration-in-practice as an everyday practice actuality? Ethical interprofessional collaboration becomes especially relevant and necessary when interprofessional practice decisions are contested. To illustrate, two healthcare scenarios are analyzed through three ethics lenses. Biomedical ethics, relational ethics, and virtue ethics provide different ways of knowing how to be ethical and to act ethically as healthcare professionals. Biomedical ethics focuses on situated, reflective, and nonabsolute principled justification, all things (...) considered; relational ethics on intersubjective, professional, and institutional relations; and virtue ethics on prephilosophical tradition and what it means to be good and to be human embedded in social and political community. Analysis suggests that interprofessional collaboration-in-practice may be more rhetoric than actuality. Key challenges of interprofessional collaboration-in-practice and specific conditions perpetuating dissension and conflict are outlined with specific education and policy recommendations included. (shrink)

The global food system has been subject to a multitude of shocks in recent years, drawing renewed attention to food insecurity vulnerabilities. Extreme weather events, economic crises, a global pandemic and wars have caused significant disruptions, compromising food security for significant portions of the population. Shocks impacting upon food systems bear additional adverse outcomes where populations are already vulnerable to poverty and other social inequalities, and increasingly, shocks are affecting populations not previously considered food insecure. This paper, and the Symposium (...) it introduces, articulates an emerging field of study that explores the dynamic interplay of food system shocks and food security through multiple disciplinary perspectives. The articles in this Symposium address the impacts of and responses to shocks such as weather events and the COVID-19 pandemic and consider these through the theoretical lenses of actor perspectives, governance, and transitions. This Symposium looks beyond the short-term acute event and contributes to a systemic understanding of ‘food shocks’ by reflecting on how enduring and persistent disruptions reverberate through multiple layers of food systems, how they are experienced and addressed across global and local scales, and how they may deeply transform food systems and impact people over time. (shrink)

In “Robots, Trust and War” Simpson claims that victory in counter-insurgency conflicts requires that military forces and their governing body win the ‘hearts and minds’ of civilians. Consequently, forces made up primarily of autonomous robots would be ineffective in these conflicts for two reasons. Firstly, because civilians cannot rationally trust them because they cannot act from a motive based on good character. If they ever did develop this capacity then the purpose of sending them to war in our stead would (...) be lost because there would be no moral saving. Secondly, because if robot forces did offer a moral saving then this would signal that the deploying government could not be trusted to be committed to the conflict. I disagree with both claims. I argue firstly that there are less demanding grounds that could allow robot forces to be trusted sufficiently to be effective whilst still achieving a moral saving over the deployment of human ones. Secondly, that this moral saving would not necessarily signal that the deploying body lacked commitment because its interpretation would be highly context-dependent. I conclude therefore, contra-Simpson, that robot forces could plausibly be effective in counter-insurgency engagements in the foreseeable future. I suggest therefore that there may be a case for developing a more finely grained understanding of the opportunities for, and challenges of, their use. (shrink)