Objective Cluster randomised trial (CRT) investigators face challenges in seeking informed consent from individual patients (cluster members). This study examined associations between reporting of patient consent in healthcare CRTs and characteristics of these trials. Study design Consent practices and study characteristics were abstracted from a random sample of 160 CRTs performed in primary or hospital care settings that were published from 2000 to 2008. Multivariable logistic regression was used to examine associations between reporting of patient consent and methodological characteristics, as (...) well as publication features such as date and journal of publication. Results 82 (53.8%) of 160 studies reported obtaining informed consent from individual patients. Reporting of patient consent was independently and positively associated with: smaller cluster size, the evaluation of experimental interventions targeted at patients, data collection from individual patients, publication later than 2004 and publication in higher-impact journals. Conclusions Reporting of consent practices in published CRTs should be improved. Consent practices in published CRTs appear to be related to the type of interventions under study, as well as journal impact and trends in research ethics practices. These findings will inform best practices in trial conduct and ethics review, remediation of errors in consent practices and ethics review and the development of regulatory guidance for CRTs. (shrink)

Although in modern times and clinical settings, we rarely see the old characteristics of tribal shamanism such as deep trances, out-of-body experiences, and soul retrieval, the archetypal dreams, waking visions and active imagination of modern depth psychology represents a liminal zone where ancient and modern shamanism overlaps with analytical psychology. These essays explore the contributors' excursions as healers and therapists into this zone. The contributors describe the many facets shamanism and depth psychology have in common: animal symbolism; recognition of the (...) reality of the collective unconscious; and healing rituals that put therapist and patient in touch with transpersonal powers. By reintroducing the core of shamanism in contemporary form, these essays shape a powerful means of healing that combines the direct contact with the inner psyche one finds in shamanism with the self-reflection and critical awareness of modern consciousness. The essays draw from the contributors' experiences both inside and outside the consulting room, and with cultures that include the Lakota Sioux, and those of the Peruvian Andes and the Hawaiian Islands. The focus is on those aspects of shamanism most useful and relevant to the modern practice of depth psychology. As a result, these explorations bring the young practice of analytical psychology into perspective as part of a much more ancient heritage of shamanistic healing. Contributors: Margaret Laurel Allen, Norma Churchill, Arthur Colman, Lori Cromer, Patricia Damery, C. Jess Groesbeck, Pansy Hawk Wing, June Kounin, Carol McRae, Pilar Montero, Jeffrey A. Raff, Janet S. Robinson, Meredith Sabini, Dyane N. Sherwood, Sara Spaulding-Phillips, Bradley A. Te Paske and Louis M. Vuksinick. (shrink)

Marie-Anne Boivin a été en son temps une des sages-femmes françaises les plus célèbres. Son parcours professionnel et scientifique est présenté ici, illustrant l’espace laissé aux femmes dans les professions médicales. Reconnue d’abord pour ses ouvrages techniques concernant l’obstétrique, elle sort de son champ traditionnel de compétence pour aborder de façon novatrice la gynécologie naissante, à l’instar des médecins, avec son Traité pratique des maladies de l’utérus (1833), devenu un classique. Cette œuvre scientifique lui vaut un succès d’estime, mais ne (...) lui permet pas d’atteindre une véritable reconnaissance institutionnelle dans son pays. (shrink)

Behavioral weight loss interventions that promote healthy eating as a way to achieve and maintain healthy weights do not work for most people. Most participants encounter significant challenges to behavior change and do not lose weight or maintain meaningful weight loss. For some, there may be negative consequences of participating in a BWLI, including social, psychological and economic costs. The literature is largely silent on these negative unintended consequences, but they are important for both practical and ethical reasons. If efforts (...) to eat healthier have too many negative consequences for individuals and groups, then these efforts are unlikely to be effective, and promoting them may not always be ethical; this would boost the case for moving away from individual-focused efforts as part of healthy eating efforts. Alternatively, if we can make BWLI interventions more effective and more ethical by mitigating these unintended consequences, then it may be too soon to give up on individual-focused efforts. We make a case for systematic assessment and reporting of the unintended consequences of BWLI. This could contribute to more effective and ethical BWLI and inform obesity interventions and policies more broadly. (shrink)

In her 2004 book Carol Gould addresses the fundamental issue of democratizing globalization, that is to say of finding ways to open transnational institutions and communities to democratic participation by those widely affected by their decisions. The book develops a framework for expanding participation in crossborder decisions, arguing for a broader understanding of human rights and introducing a new role for the ideas of care and solidarity at a distance. Reinterpreting the idea of universality to accommodate a multiplicity of (...) cultural perspectives, the author takes up a number of applied issues, including the persistence of racism, cultural rights, women's human rights, the democratic management of firms, the use of the Internet to enhance political participation, and the importance of empathy and genuine democracy in understanding terrorism and responding to it. Accessibly written with a minimum of technical jargon this is a major contribution to political philosophy. (shrink)

How to formulate the doctrine of relativism -- Evaluating the doctrine of relativism.

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)

Pettit and List argue for realism about group agency, while at the same time try to retain a form of metaphysical and normative individualism on which human beings qualify as natural persons. This is an unstable and untenable combination of views. A corrective is offered here, on which realism about group agency leads us to the following related conclusions: in cases of group agency, the sort of rational unity that defines individual rational unity is realized at the level of a (...) whole group; rational unity is never a metaphysical given but always a product of effort and will; just as it can be realized within groups of human beings it can also be realized within parts of human beings, as well as within whole human lives; in cases of group agency, the rational unity that is achieved at the level of the group typically precludes rational unity at the level of its human constituents within their whole lives, though it can be realized within parts of those human lives. Along the way, a contrast is drawn between cases of genuine group agency and the cases of political agency envisaged by Rousseau and Rawls (and by Pettit and List) which leave individual human beings intact as separate agents in their own rights. (shrink)

In behavioral ethics today, there is debate as to which theory of moral development is the best for understanding ethical decision making, thereby facilitating ethical behavior. This debate between behavioral ethicists has been profoundly influenced by the field of moral psychology. Unfortunately, in the course of this marriage between moral psychology and business ethics and subsequent internal debate, a simple but critical understanding of human being in the field of management has been obscured; i.e., that morality is not a secondary (...) phenomenon arising out of something else. Therefore, in this paper, we will argue that there is a need in behavioral ethics to shift our understanding away from the influence of contemporary moral psychology and back to management theorist Ghoshal’s :75–91, 2005) view of what it means to be human in which the moral is fundamental. To assist in this labor, we will build on the philosophical work of Emmanuel Levinas who sees ethics, regardless of the setting, as a metaphysical concern. What this means is that Levinas sees the essential moral character of human life and the reality of human agency as ontologically fundamental, or constitutive of human nature itself. In other words, the ethical is the “first cause” in regard to understanding the nature and action of the individual, including within organizations. Thus, morality in any sphere of human endeavor, including in business, is not merely epiphenomenal to some more fundamental reality. (shrink)

The existential analysis -- The death of dasein -- The timeliness of dasein -- The derivation of time -- The time of being.

In the technical literature of computer science, the concept of an effective procedure is closely associated with the notion of an instruction that precisely specifies an action. Turing machine instructions are held up as providing paragons of instructions that "precisely describe" or "well define" the actions they prescribe. Numerical algorithms and computer programs are judged effective just insofar as they are thought to be translatable into Turing machine programs. Nontechnical procedures (e.g., recipes, methods) are summarily dismissed as ineffective on the (...) grounds that their instructions lack the requisite precision. But despite the pivotal role played by the notion of a precisely specified instruction in classifying procedures as effective and ineffective, little attention has been paid to the manner in which instructions "precisely specify" the actions they prescribe. It is the purpose of this paper to remedy this defect. The results are startling. The reputed exemplary precision of Turing machine instructions turns out to be a myth. Indeed, the most precise specifications of action are provided not by the procedures of theoretical computer science and mathematics (algorithms) but rather by the nontechnical procedures of everyday life. I close with a discussion of some of the rumifications of these conclusions for understanding and designing concrete computers and their programming languages. (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.

It is generally assumed that group agency must be a social phenomenon because it involves interactions among many human beings. This assumption overlooks the real metaphysical nature of agency, which is both normative and voluntarist. Construed as a normative phenomenon, individual agency arises wherever there is a point of view from which deliberation and action proceed in accord with the requirements that define individual rationality. Such a point of view is never a metaphysical given, but is always a product of (...) rational activities that aim to satisfy the requirements that define individual rationality. When such a deliberative point of view is forged within a whole human life, there is a single agent of human size. But such points of view can also be forged within parts of human lives so as to constitute multiple agents within them; and they can also be achieved within groups of human lives so as to constitute group agents that literally deliberate and act as one. If such a group agent were a social phenomenon, then its agency would simultaneously be the agency of many even as it was also the agency of one. In that case, its deliberations and actions would have to proceed from many separate deliberative points of view, at the same time that they also proceeded from a single deliberative point of view. A correct account of rational agency shows that this is not necessarily so, and indeed, not typically so. Moreover, if it were so much as possible for this to be so, it would require special conditions of the sort that Rousseau identified in his account of the general will. But this special case is not a good model on which to understand the cases of group agency that are most often discussed in the philosophical literature. They are more appropriately viewed as cases in which the condition of individual agency is realized at the level of a group, than as cases of social agency per se. (shrink)

Since the mid-twentieth century, the concept of the Turing machine has dominated thought about effective procedures. This paper presents an alternative to Turing's analysis; it unifies, refines, and extends my earlier work on this topic. I show that Turing machines cannot live up to their billing as paragons of effective procedure; at best, they may be said to provide us with mere procedure schemas. I argue that the concept of an effective procedure crucially depends upon distinguishing procedures as definite courses (...) of action(- types) from the particular courses of action(-tokens) that actually instantiate them and the causal processes and/or interpretations that ultimately make them effective. On my analysis, effectiveness is not just a matter of logical form; `content' matters. The analysis I provide has the advantage of applying to ordinary, everyday procedures such as recipes and methods, as well as the more refined procedures of mathematics and computer science. It also has the virtue of making better sense of the physical possibilities for hypercomputation than the received view and its extensions, e.g. Turing's o-machines, accelerating machines. (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)

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)

The pluralism of methodologies and severe time constraints pose important challenges to pedagogy in clinical ethics. We designed a step-by-step student handbook to operate within such constraints and to respect the methodological pluralism of bioethics and clinical ethics. The handbook comprises six steps: Step 1: What are the facts of the case?; Step 2: What are your obligations to your patient?; Step 3: What are your obligations to third parties to your relationship with the patient?; Step 4: Do your obligations (...) converge or conflict?; Step 5: What is the strongest objection that could be made to the identification of convergence in step 4 or the arguments in step 4? How can this objection be effectively countered?; and Step 6: How could the ethical conflict, or perceived ethical conflict, have been prevented? (shrink)

It is easy to say that the analysis by Kendler and Schaffner of the status of the dopamine hypothesis of schizophrenia (DHS) is, at the very least, a scholarly read. It includes an exhaustive review of the DHS literature accompanied by a demanding critique. The authors' bar for hypothesis verification is high, and their conclusion is negative—that scientific support is insufficient to retain the hypothesis as such. They proceed to evaluate the reasons they see for both (1) the extensive testing (...) of the hypothesis extending over decades and (2) the failure of the field to falsify in a timely fashion. In a very interesting section, they review philosophical positions about how and in what context scientific advances .. (shrink)

This paper draws on a phenomenological study of students’ experience of the demands of a module, Reading and Writing Academic Texts, designed with the specific aim of developing students’ academic literacy. This module is a core, compulsory component of the mixed-mode Bachelor of Education Honours programme offered by the School of Education and Development at the University of Kwa-Zulu Natal in Pietermaritzburg, South Africa. The study thus foregrounds issues of language and literacy, and is contextualized within a “distance” model of (...) teacher education.The paper proceeds with a brief focus on teacher education through “distance” and the role and nature of this form of pedagogical delivery. It then engages directly with phenomenology and the relevance of a phenomenological sensitivity to pedagogical contexts. In order to demonstrate the type of process that can nudge phenomenological sensitivity into being, two aspects of the phenomenological research process that shaped this study – namely, identifying the phenomenon under study, and the phenomenological interview – are presented. The paper concludes with an explanation of the type of data analysis used, and examples of its application in this study. (shrink)

An affectionate and thoughtful look at the history of county fairs and their tradition and persistence today reveals the county fair as an important institution that helped define America as a nation of free-thinking, self-reliant, and ...