De manière générale, la référence à l’âge dans notre société est à la fois admise et sujette au débat. A l’instar d’autres pays, la pandémie COVID-19 en France a ébranlé la cohérence de notre système de santé. La peur engendrée a modifié les repères : la notion de triage est apparue et a succédé à celle de priorisation commune en médecine. Dans cette situation de crise sanitaire, est-ce que le recours éventuel au critère de l’âge est pertinent et peut-il remettre (...) en cause le principe de justice entre les générations? Nous tenterons d’y répondre grâce aux éléments apportés par Axel Gosseries et Véronique Fournier lors d’une discussion organisée par l’association EthicA durant le congrès, les « Questions d’éthiques » à Nantes en novembre 2020. (shrink)

To commemorate 40 years since the founding of the Journal of Business Ethics, the editors in chief of the journal have invited the editors to provide commentaries on the future of business ethics. This essay comprises a selection of commentaries aimed at creating dialogue around the theme Ethics at the centre of global and local challenges. For much of the history of the Journal of Business Ethics, ethics was seen within the academy as a peripheral aspect of business. However, in (...) recent years, the stakes have risen dramatically, with global and local worlds destabilized by financial crisis, climate change, internet technologies and artificial intelligence, and global health crises. The authors of these commentaries address these grand challenges by placing business ethics at their centre. What if all grand challenges were framed as grand ethical challenges? Tanusree Jain, Arno Kourula and Suhaib Riaz posit that an ethical lens allows for a humble response, in which those with greater capacity take greater responsibility but remain inclusive and cognizant of different voices and experiences. Focussing on business ethics in connection to the grand challenge of environmental emergencies, Steffen Böhm introduces the deceptively simple yet radical position that business is nature, and nature is business. His quick but profound side-step from arguments against human–nature dualism to an ontological undoing of the business–nature dichotomy should have all business ethics scholars rethinking their “business and society” assumptions. Also, singularly concerned with the climate emergency, Boudewijn de Bruin posits a scenario where, 40 years from now, our field will be evaluated by its ability to have helped humanity emerge from this emergency. He contends that Milieudefensie v. Royal Dutch Shell illustrates how human rights take centre stage in climate change litigation, and how business ethics enters the courtroom. From a consumer ethics perspective, Deirdre Shaw, Michal Carrington and Louise Hassan argue that ecologically sustainable and socially just marketplace systems demand cultural change, a reconsideration of future interpretations of “consumer society”, a challenge to the dominant “growth logic” and stimulation of alternative ways to address our consumption needs. Still concerned with global issues, but turning attention to social inequalities, Nelarine Cornelius links the capability approach to global and corporate governance, arguing that CA will continue to lie at the foundation of human development policy, and, increasingly, CSR and corporate governance. Continuing debate on the grand challenges associated with justice and equality, Laurence Romani identifies a significant shift in the centrality of business ethics in debates on managing differences, positing that dialogue between diversity management and international management can ground future debate in business ethics. Finally, the essay concludes with a commentary by Charlotte Karam and Michelle Greenwood on the possibilities of feminist-inspired theories, methods, and positionality for many spheres of business ethics, not least stakeholder theory, to broaden and deepen its capacity for nuance, responsiveness, and transformation. In the words of our commentators, grand challenges must be addressed urgently, and the Journal of Business Ethics should be at the forefront of tackling them. (shrink)

Scholarship flourishes in inclusive environments where open deliberations and generative feedback expand both individual and collective thinking. Many researchers, however, have limited access to such settings, and most conventional academic conferences fall short of promises to provide them. We have written this Field Report to share our methods for cultivating a vibrant intellectual community within the Science and Technology Studies Food and Agriculture Network (STSFAN). This is paired with insights from 21 network members on aspects that have allowed STSFAN to (...) thrive, even amid a global pandemic. Our hope is that these insights will encourage others to cultivate their own intellectual communities, where they too can receive the support they need to deepen their scholarship and strengthen their intellectual relationships. (shrink)

This is the first of three parts of an introduction to the philosophy of climate science. In this first part about observing climate change, the topics of definitions of climate and climate change, data sets and data models, detection of climate change, and attribution of climate change will be discussed.

Charlotte Wolff was born in Riesenburg, West Prussia into a middle-class Jewish family. She studied philosophy and then medicine at several German universities, completing her doctorate in Berlin in 1926. Working in various institutions over the next few years, she was also interested in psychotherapy and had a small private medical and psychotherapeutic practice. In 1933 she was forced to leave Germany because of the Nazi regime, and settled for a few years in Paris. As a German refugee she (...) was unable to practice medicine, so she began her research into the correlation between hand traits and personality. In 1936 she went to London to continue her research work and lived there until her death. An active lesbian from an early age, her later research turned to sexology and her writing on lesbianism and bisexuality were influential early works in the field. This is a great opportunity to rediscover her early work, including her first autobiography. (shrink)

IntroductionEspecially in the chronic phase, individuals with traumatic brain injury may still have impairments at the discourse level, even if these remain undetected by conventional aphasia tests. As a consequence, IwTBI may be impaired in conversational behavior and disadvantaged in their socio-communicative participation. Even though handling discourse is thought to be a basic requirement for participation and quality of life, only a handful of test procedures assessing discourse disorders have been developed so far. The MAKRO Screening is a recently developed (...) screening tool designed to assess discourse impairments. The test construction is based on psycholinguistic frameworks and the concept of macro-rules, which refer to cognitive functions responsible for organizing and reducing complex information in discourse.AimThe aim of our study was to investigate discourse processing in IwTBI in different tasks and to assess problems in communicative participation in the post-acute and chronic phase. In this context, we also aimed to analyze the influence of the severity of the initial impairment and the verbal executive abilities on the discourse performance. Additionally, the impact of macrolinguistic discourse impairments and verbal fluency on perceived communicative participation was targeted in our analysis.MethodsData from 23 IwTBI and 23 healthy control subjects have been analyzed. They completed two subtests of the MAKRO screening: Text production and Inferences. Discourse performance was examined in relation to measures of semantic fluency and verbal task-switching. Socio-communicative problems were evaluated with the German version of the La Trobe Communication Questionnaire.ResultsIwTBI showed lower test results than the control group in the two subtests of the MAKRO-Screening. Difficulties in picture-based narrative text production also indicated greater perceived difficulties in communicative participation. We also found that the subject’s performance on the MAKRO-Screening subtests can partly be explained by underlying dysexecutive symptoms and the severity of their injury. The preliminary results of our study show that cognitive-linguistic symptoms in IwTBI are also evident in the chronic phase. These can be detected with procedures referring to the discourse level, such as the MAKRO-Screening. The assessment of discourse performance should be an integral part in the rehabilitation of IwTBI in order to detect cognitive-linguistic communication disorders and to evaluate their impact on socio-communicative participation. (shrink)

Several quantitative studies (e.g. Kidd & Castano, 2013a; Djikic et al., 2013) have shown a positive correlation between literary reading and empathy. However, the literary nature of the stimuli used in these studies has not been defined at a more detailed, stylistic level. In order to explore the stylistic underpinnings of the hypothesized link between literariness and empathy, we conducted a qualitative experiment in which the degree of stylistic foregrounding was manipulated. Subjects (N = 37) read versions of Katherine Mansfield's (...) 'The Fly', a short story rich in foregrounding, while marking striking and evocative passages of their choosing. Afterwards, they were asked to select three markings and elaborate on their experiences in writing. One group read the original story, while the other read a 'non-literary' version, produced by an established author of suspense fiction for young adults, where stylistic foregrounding was reduced. We found that the non-literary version elicited significantly more (p < 0.05) explicitly empathic responses than the original story. This finding stands in contradiction to widely accepted assumptions in recent research, but can be assimilated in alternative models of literariness and affect in literary reading (e.g. Cupchik et al., 1998). We present an analysis of the data with a view to offering more than one interpretation of the observed effects of stylistic foregrounding. (shrink)

Reorienting the Political examines the reception of two controversial German philosophers, Carl Schmitt and Leo Strauss, in the Chinese-speaking world. This volume explores the powerful resonance of both thinkers in Chinese political thought from a cross-cultural and interdisciplinary perspective.

Background/ObjectiveSeveral studies have examined the impact of Parkinson’s disease on the quality of couples’ relationships. To date, few studies have explored how couples experience their relationship dynamic by taking into account the disease stage. The objectives of this study were to understand the experience of each partner and to study the mechanisms that underlie their couple organization in the advanced stage of PD.MethodsSemistructured individual interviews conducted with fifteen patients and their partners were the subject of a dyadic interpretative phenomenological analysis.ResultsThree (...) themes were identified from the analysis: the first, “A Closeness That Separates,” allows the identification of different patterns of interactions that lead to emotional distancing between the partners; the second, “The Adversity Is Not Unbearable, But Going It Alone Would Be,” emphasizes the importance of how the assisting partner provides support; and the third, “Be Prepared for Anything and Facing an Uncertain Future,” reveals the extent and modes of the dyadic regulation of the emotions linked to what the future may hold.ConclusionPsychological support is important to help couples express both their feelings and their respective needs in the evolving context of PD. (shrink)

Charlotte Sabourin | : Cet article se penche sur la contribution de Gabrielle Suchon à la célèbre « querelle des femmes ». J’y démontre que, quoique Suchon défende l’égalité des deux sexes en ce qui a trait à leurs capacités à la liberté, à la science et à l’autorité, elle vise ultimement à montrer que les femmes peuvent se rendre supérieures aux hommes. Je montrerai que son projet d’élévation des femmes ne peut être accompli qu’en soustrayant les femmes à (...) l’influence des hommes, les relations entre les deux sexes étant foncièrement préjudiciables aux premières. | : This paper examines Gabrielle Suchon’s contribution to the famous “querelle des femmes”. I argue that although Suchon is a proponent of the equality of the sexes with respect to their capacities for freedom, science and authority, she ultimately suggests that there is a way in which women can make themselves superior to men. I will show that her project for the elevation of women can be accomplished only by isolating women from men, given that the relationships between the sexes will always be detrimental to women. (shrink)

Emotion differentiation has generally been viewed as a trait that is related to emotion regulation and well-being. There are theoretical considerations that state that the beneficial effect on well...

We are all immersed in a sea of social norms, but they are sometimes tricky to observe with any clarity. They are often invisible to us and emerge only when they are not observed. Social norms are important to understand because they are both limiting of our freedom, such as gendered and racialized norms, and at the same time the very conditions of our agency. Social Goodness presents an original, externalist answer to the question of the source or origin of (...) social role normativity. Rather than grounding social normativity in the attitudes of persons, the book argues for an externalism that roots social role normativity in the social world itself: in its positions, institutions, and larger architecture. The core insight of externalism is that the function or structural feature of an enterprise or activity can bring with it normative demands quite independently of the attitudes of those who engage with it. According to the artisanal model, just as a carpenter, ceramicist, or chef is responsive to and evaluable under a set of artisanal norms or techniques, so too is a mother and or an academic or a President. The source of normativity is this technique or expertise, independent of the preferences, endorsements, or recognitive attitudes of individuals. The artisanal model for social role normativity has resources to explain both the "stickiness" or persistence of social norms and our ability to criticize existing norms and to engage in normative self-creation--to create new normative selves. The artisanal model also has resources to capture and express the social situatedness, locality, and materiality of social roles. The relational ontology of social roles, implicit in the artisanal model, provides a useful frame to consider both hierarchical and oppressive social relations. (shrink)

Researchers have begun to use response times to emotion items as an indirect measure of emotional clarity. Our first aim was to scrutinise the properties of this RT measure in more detail than previously. To be able to provide recommendations as to whether emotional intensity – as a possible confound – should be controlled for, we investigated the specific form of the relation between emotional intensity and RTs to emotion items. In particular, we assumed an inverted U-shaped relation at the (...) item level. Moreover, we analysed the RT measure’s convergent validity with respect to individuals’ confidence in their emotion ratings. As a second aim, we compared the predictive validity of emotional clarity measures with respect to daily emotion regulation. The results of three experience sampling studies showed that the association between emotional intensity and RT followed an inverted U shape. RT was in part related to confidence. Emotional clarity measures were unrelated to reappraisal. There was some evidence that lower emotional clarity was related to a greater use of suppression. The findings highlight that emotional intensity and squared emotional intensity should be controlled for when using the RT measure of emotional clarity in future research. (shrink)

ABSTRACT:This paper explores how corporations, through their Corporate Social Responsibility (CSR) activities, can help to effect positive developmental change. We use research on institutional change, deinstitutionalization, and institutional work to develop our central theoretical framework. This framework allows us to suggest more explicitly how CSR can potentially be mobilized as a purposive form of institutional work aimed at disrupting existing institutions in favor of positive change. We take the gender institution in the Arab Middle East as a case in point. (...) Our suggestion is that the current context of the Arab Spring, which combined with increasingly obvious endogenous institutional contradictions, has created a fertile ground for shaping change processes within the gender institution. Finally, we provide concrete examples of CSR initiatives that regional corporate actors can engage in for positive developmental change supporting women. (shrink)

The doctor-patient relationship is built on an implicit covenant of trust, yet it was not until the post-World War Two era that respect for patient autonomy emerged as an article of mainstream medical ethics. Unlike their medical forebears, physicians today are expected to furnish patients with adequate information about diagnoses, prognoses and treatments. Against these dicta there has been ongoing debate over whether placebos pose a threat to patient autonomy. A key premise underlying medical ethics discussion is the notion that (...) the placebo effect necessitates patient deception. Indeed, the American Medical Association guidelines imply that placebo treatment necessary entails a form of deception. As a consequence of this assumption, the fulcrum of debate on the use of placebo treatment has hinged on whether that deception is ever justified. Recently performed experiments with open-label transparently prescribed placebos have begun to challenge the notion that deception is necessary in eliciting the placebo effect and such effects necessarily involve a binary distinction between autonomy and beneficence. In this article we focus on the content of disclosures in distinctive open-label, transparently disclosed placebo studies and inquire whether they might be said to invoke deception in clinical contexts, and if so, whether the deception is unethical. We find that open placebos may be said to involve equivocation over how placebos work. However, drawing on surveys of patient attitudes we suggest that this equivocation appears to be acceptable to patients. We conclude that open placebos fulfil current American Medical Association guidelines for placebo use, and propose future research directions for harnessing the placebo effect ethically. (shrink)

The Metaphysics of Gender is a book about gender essentialism: what it is and why it might be true.

In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians (‘open notes’). However, even in countries that (...) have implemented the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to (oftentimes, non-intentional) epistemic injustice. Nonetheless, we conclude that the marginalisation of patients’ access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety. (shrink)

* INTRODUCTION This book seeks to add dimension to our understanding of Greek Skepticism by concentrating attention on a particular area that is of ...

In the field of placebo studies residual disagreement about the terminology ‘placebo’ and ‘placebo effect’ still persists. We differentiate between the conceptualization of placebos in clinical trials; and placebo effects understood as a psychobiological phenomenon. With respect to the latter, we argue that a scientific ‘placebo paradigm’ has emerged, indicating that—at least among placebo scientists—there exists relatively stable consensus about how to conceive of placebo effects. We claim that existence of a placebo paradigm does not protect concepts from revision; nonetheless, (...) we argue that scientific progress is dependent on, and guided by relative conceptual stability. Therefore, to mount persuasive arguments for conceptual revision in respect of ‘placebo effects’ we argue, critics either need to defend the claim that a placebo paradigm is not underway, or that there are major scientific failings in respect of it. With these considerations in mind we examine three alternative proposals for conceptual reform: Grünbaum/Howick’s relativity models of placebo concepts; Moerman/Brody’s meaning response; and Nunn/Turner’s proposal for conceptual eliminativism. We derive two conclusions from this evaluation. First, we conclude that no convincing arguments have so far been presented for conceptual overhaul of ‘placebo effects.’ Notwithstanding this analysis, we conclude that refinement of this concept is likely. Second, we agree with Turner and Nunn that the term ‘placebo’ in the context of randomized controlled trials remains a source of confusion for many researchers, risking the design and scientific integrity of clinical findings. Therefore, in these contexts, replacing the term ‘placebo’ with ‘control’ is justified. (shrink)

InThe Second Sex, Simone de Beauvoir argues that women are often complicit in reinforcing their own unfreedom. But why women become complicit remains an open question. The aim of this article is to offer a systematic analysis of complicity by focusing on the Heideggerian strands of Beauvoir's account. I begin by evaluating Susan James's interpretation of complicity qua republican freedom, which emphasizes the dependent situation of women as the primary cause of their complicity. I argue that James's analysis is compelling (...) as far as it goes, but that it implies complicity is the inevitable outcome of women's current existence and fails to adequately account for Beauvoir's claim that women actively embrace their own unfreedom. I then draw out the Heideggerian strands of Beauvoir's analysis, demonstrating how this enables us to systematize Beauvoir's account of women's oppressive situation with her claims regarding the active role women can play in reinforcing their own unfreedom. I argue that this approach preserves the strengths of the republican interpretation, but provides a better account of cases where complicity may not be inevitable and yet some women still act to reinforce rather than resist their own unfreedom. (shrink)

Behavioral evidence for the COVIS dual‐process model of category learning has been widely reported in over a hundred publications (Ashby & Valentin, ). It is generally accepted that the validity of such evidence depends on the accurate identification of individual participants' categorization strategies, a task that usually falls to Decision Bound analysis (Maddox & Ashby, ). Here, we examine the accuracy of this analysis in a series of model‐recovery simulations. In Simulation 1, over a third of simulated participants using an (...) Explicit (conjunctive) strategy were misidentified as using a Procedural strategy. In Simulation 2, nearly all simulated participants using a Procedural strategy were misidentified as using an Explicit strategy. In Simulation 3, we re‐examined a recently reported COVIS‐supporting dissociation (Smith et al., ) and found that these misidentification errors permit an alternative, single‐process, explanation of the results. Implications for due process in the future evaluation of dual‐process theories, including recommendations for future practice, are discussed. (shrink)

Hume is committed, By one of his criticisms of reason as the route to moral knowledge, To an internalist position. In the argument from motivation, Hume starts by observing that morality is practical--That morals excite passions and produce or prevent actions. But, Hume argues, Rationalist moral theories cannot explain how moral considerations motivate. This is because reason alone is incapable of motivating us. The premise that morality is practical, However, May be interpreted in two ways--Either in an externalist or internalist (...) manner. Charity requires us to adopt the internalist reading because only then is the argument valid. An internalist reading of the argument, However, Commits hume, In his constructive phase, To construing the moral sentiments of approval and disapproval as possessing motivational influence by themselves. But an examination of what hume has to say about the motives that prompt us to do what is right shows that he fails to provide such an account himself. This points to an inconsistency in hume's moral theory. (shrink)

This study focuses on how moral aspects of purpose shape collaborative processes. It does so by analyzing the unfolding of 21 relationships between four nonprofits and their funders using a framework based on French pragmatist sociology to help uncover the deeply held, ideological and moral beliefs that underscore assumptions about what the overarching purpose of a collaborative effort is or should be. This study contributes to the literature on single and cross-sectoral collaboration by showing that the way partners handle and (...) reconcile differences about purpose is related to the forms of agreement likely to be achieved. It also suggests that certain forms of agreement are inherently more enduring than others. Taken as a whole, this study provides some plausible explanations as to why so many collaborations fail despite their seeming benefits for all the parties involved. (shrink)

This study explored the perceptions of ethics among long-term care employees (N275) in order to test two hypotheses. A cohort cross-sectional survey examined employees’ perceptions of an ethics environment, racial-ethnic, and position disparities (HO1; ANOVA), and, secondarily, ethics in relationship to select, research-grounded work features measured as manage disagreements, effectiveness, work satisfaction, and opinions of care, the latter including intention to remain (HO2; Pearson Correlations). Established questionnaires with robust psychometrics were employed. Response rate was 51%. Non-significant differences between sample and (...) population on key variables supported extrapolation of results. Statistically significant differences between racial–ethnic (p < 0.03; F 2.42) and work positions (p <0.0001; F 6.24) were revealed on ethics (3.16; HO1). Statistically significant relationships (p <0.0001; r = 0.26–0.68; HO2) between ethics and employees’ work features also were found, confirming both hypotheses. Perceptions of ethics based on racial-ethnic and position disparities, as well as the robust links with employee work features, offered potential avenues for decreasing disparities at work and improving the quality of long-term care. Noted further on ethics item scoring were relatively low scores indicating less involvement in, and access to, ethics discussions and decisions. In contrast, the literature review substantiated the importance of empowerment and retention, which were enhanced by employee involvement in work, notably, discussions and decisions. Thus, implications of ethics committees in long-term care sites as ways to potentially enhance employees’ work and quality of care, especially work satisfaction and retention, were explored; relevant concerns raised by the Covid pandemic were, briefly, discussed. (shrink)

This interview study investigates the short- and long-term implications of incidental findings detected through brain imaging on research participants’ lives and their surroundings. For this study, nine participants of the Rotterdam Scan Study with an incidental finding were approached and interviewed. When examining research participants’ narratives on the impact of the disclosure of incidental findings, the authors identified five sets of tensions with regard to motivations for and expectations of research participation, preferences regarding disclosure, short- and long-term impacts and impacts (...) on self and others. The paper shows: that the impact of incidental findings may be greater than participants at first let on; incidental findings can have significant effects on participants’ social environment; and participants may not feel prepared for disclosure even if incidental findings have been discussed during the informed consent process. The authors call for investigators to be aware of research participants’ experiences and these short- and long-term impacts when designing suitable courses of action for the detection and management of incidental findings in research settings. (shrink)

On the observational equivalence of continuous-time deterministic and indeterministic descriptions Content Type Journal Article Pages 193-225 DOI 10.1007/s13194-010-0011-5 Authors Charlotte Werndl, Department of Philosophy, Logic and Scientific Method, London School of Economics, Houghton Street, London, WC2A 2AE UK Journal European Journal for Philosophy of Science Online ISSN 1879-4920 Print ISSN 1879-4912 Journal Volume Volume 1 Journal Issue Volume 1, Number 2.

The central question of this paper is: are deterministic and indeterministic descriptions observationally equivalent in the sense that they give the same predictions? I tackle this question for measure-theoretic deterministic systems and stochastic processes, both of which are ubiquitous in science. I first show that for many measure-theoretic deterministic systems there is a stochastic process which is observationally equivalent to the deterministic system. Conversely, I show that for all stochastic processes there is a measure-theoretic deterministic system which is observationally equivalent (...) to the stochastic process. Still, one might guess that the measure-theoretic deterministic systems which are observationally equivalent to stochastic processes used in science do not include any deterministic systems used in science. I argue that this is not so because deterministic systems used in science even give rise to Bernoulli processes. Despite this, one might guess that measure-theoretic deterministic systems used in science cannot give the same predictions at every observation level as stochastic processes used in science. By proving results in ergodic theory, I show that also this guess is misguided: there are several deterministic systems used in science which give the same predictions at every observation level as Markov processes. All these results show that measure-theoretic deterministic systems and stochastic processes are observationally equivalent more often than one might perhaps expect. Furthermore, I criticise the claims of the previous philosophy papers Suppes (1993, 1999), Suppes and de Barros (1996) and Winnie (1998) on observational equivalence. (shrink)

In this article, we present a newly developed undergraduate module that is taught in the Humanities Department of the University of Roehampton. Campus and university themselves are the topics of th...

Childhood cancers are life-threatening diseases that affect the whole family. During the treatment moral situations might arise. Research on how parents perceive moral challenges in childhood cancer care is sparse. The aim was to explore parents’ main concern, and how they deal with their main concern, when facing moral challenges in childhood cancer care. Data collection included focus group interviews with parents. The data analysis was carried out according to a classical theory and revealed the core category “Sheltering in chaos”. (...) The strategies to handle the main concern included “To bring the child through a life-saving trajectory” by “Balancing control” and “Deliberating of suffering. The consequences included feelings of being “Torn between roles”. “Familiarity” emerged as a facilitating factor to handle moral challenges. The results indicate that parents are torn between different roles, and that the care experience is improved through familiarity with the healthcare professionals. The following findings may inspire new ways of offering moral support to families in childhood cancer care. (shrink)

Problematic substance use (PSU) among nurses has wide‐ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature and (...) that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use. (shrink)

Background When anti-cancer treatments have been given market authorization, but are not (yet) reimbursed within a healthcare system, physicians are confronted with ethical dilemmas. Arranging access through other channels, e.g., hospital budgets or out-of-pocket payments by patients, may benefit patients, but leads to unequal access. Until now, little is known about the perspectives of physicians on access to non-reimbursed treatments. This interview study maps the experiences and moral views of Dutch oncologists and hematologists.Methods A diverse sample of oncologists and hematologists (...) (n = 22) were interviewed. Interviews were analyzed thematically using Nvivo 12 qualitative data software.Results This study reveals stark differences between physicians’ experiences and moral views on access to anti-cancer treatments that are not (yet) reimbursed: some physicians try to arrange other ways of access and some physicians do not. Some physicians inform patients about anti-cancer treatments that are not yet reimbursed, while others wait for reimbursement. Some physicians have principled moral objections to out-of-pocket payment, while others do not.Conclusion Oncologists and hematologists in the Netherlands differ greatly in their perspectives on access to expensive anti-cancer treatments that are not (yet) reimbursed. As a result, they may act differently when confronted with dilemmas in the consultation room. Physicians working in different healthcare systems may face similar dilemmas. (shrink)

I thank Julie Hersh for her thoughtful and valuable comments on the use of electroconvulsive therapy .1 Discussions with those who have experience of treatments is of the utmost importance when debating issues such as informed consent. I am therefore very pleased to be given this opportunity to respond. Hersh offers three main criticisms of my paper but I hope to show that the tenets of the paper are not undermined by her commentary.Hersh's first criticism stems from her personal experience: (...) she claims that, ‘The results of ECT for me were miraculous’. She argues that ECT ‘works’ and we have ‘70 years of remarkably positive experience’ to support this fact. In response, I agree that there are certainly patients who believe that ECT has been a highly effective intervention: but equally, there are others who have experienced intolerable side effects as a result.2 ECT is a controversial treatment precisely because of the serious long-term risk of memory loss.3 ,4 If we are to strive for the best healthcare possible, we cannot base our conclusions merely on positive cases: we need to consider all cases . Thus, I reject her conclusion that ECT is ‘remarkably positive’ for all patients: studies do not unequivocally support Hersh's fortunate experiences. In addition, I must also challenge the assumption that ECT ‘works’. Counterintuitive as …. (shrink)