Breastfeeding remains an understudied topic in research and theorizing about reproductive experience and women's bodies. This article reports on women's experiences of breastfeeding in public as revealed through in-depth interviews with 51 women. The current construction of the good maternal body requires women to carefully manage the performance of breastfeeding in specific ways and with particular attention to the dominant notion of a sexualized rather than nurturing breast. Women accommodate to, and resist, the perceived boundaries of the good maternal body (...) through their breastfeeding behaviors. (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.

High-profile corporate scandals earlier in this decade provoked outrage and legislative action; however, corporate executive-level ethical lapses continue to come to light. This article examines the work of Professor Dunfee and his coauthors on corruption, ethical leadership, and social contracts theory, and relates that literature to corrupt activities by corporate executives. Corruption is defined broadly to encompass executive self-dealing, which harms their firms. The specific example of stock options backdating is used to show the harmful impact on shareholders and the (...) lack of managerial integrity though consequentialist, deontological, and legal analysis, as well as a critique of the practice using social contracts principles. Ultimately, this article utilizes the insights of Dunfee and his coauthors, and the lessons from the backdating example, to propose a framework aimed at improving corporate governance and preventing future executive corruption. The framework includes a strategy of identification and prevention, employing detection and eradication mechanisms, and institutional learning from past instances of corporate corruption. (shrink)

Recent research has focused on business as a mediating institution that can influence society while engaging in the traditional profit-making and value generation functions. This work includes Professors Fort's and Schipani's arguments about how business may be able to play a role in promoting more peaceful societies, and other research addressing how businesses might serve a role in reducing violence in society and the workplace. Although there is a significant body of scholarship on the role of business in reducing violence (...) in society, there is little research on concrete steps for businesses to take to achieve this goal. This article attempts to begin to fill that void. As identified by Fort and Schipani, business may promote more peaceful societies by encouraging a sense of community. We argue that one way to reach that goal is for business to provide what we denote as complementary alternative benefits (CABs), to its workforce. In this article, we advocate for businesses to offer CABs which focus on sustaining the health, reducing the stress, and improving the camaraderie of its workforce. We argue that business can use these benefits to promote a healthy, less-stressed, and collegial workforce that is less prone to resolve conflicts by violence. Further, we examine the role business plays in promoting more peaceful societies and how employer-initiated stress reduction programs are consistent with both business ethics and peace-building principles. Finally, using case studies we demonstrate how CABs may also reduce costs related to absenteeism and turnover, and thus improve the bottom line. (shrink)

Maintaining academic integrity is a growing concern for higher education, increasingly so due to the pivot to remote learning in 2020 caused by the COVID-19 pandemic. We canvassed students, faculty, and tutors at an online Canadian university about their perspectives on academic integrity and misconduct. The survey asked how the university could improve policies concerning issues of academic integrity, how faculty and tutors handled cases of misconduct, about satisfaction with how academic violations were treated, and about the role of students, (...) faculty, and tutors in encouraging academic integrity. As well, we collected suggestions from respondents for reducing cheating, addressing academic misconduct, and general ideas about academic integrity. The distinction between misconduct and integrity was not always clear in their comments. We received responses from 228 students and 73 faculty and tutors, generating hundreds of comments. In this paper we focus only on the answers to open-ended questions. Using content analysis, we categorized the replies into similar threads. After multiple iterations of analysis, we extracted three general recommendation groupings: Policy and Procedures, Compliance and Commitment, and Resources. Based on respondents’ views, we propose a balanced approach to supporting academic integrity. Although we conducted the study pre-COVID-19, the recommendations apply to current and future academic integrity practices in our context and beyond. (shrink)

Throughout March and April 2020, debate raged about how best to allocate limited intensive care unit (ICU) resources in the face of a growing COVID-19 pandemic. The debate was dominated by utility-based arguments for saving the most lives or life-years. These arguments were tempered by equity-based concerns that triage based solely on prognosis would exacerbate existing health inequities, leaving disadvantaged patients worse off. Central to this debate was the assumption that ICU admission is a valuable but scarce resource in the (...) pandemic context.In this paper, we argue that the concern about achieving equity in ICU triage is problematic for two reasons. First, ICU can be futile and prolong or exacerbate suffering rather than ameliorate it. This may be especially true in patients with COVID-19 with emerging data showing that most who receive access to a ventilator will still die. There is no value in admitting patients with poor prognostic indicators to ICU to meet an equity target when intensive critical care is contrary to their best interests. Second, the focus on ICU admission shifts focus away from important aspects of COVID-19 care where there is greater opportunity for mitigating suffering and enhancing equitable care.We propose that the focus on equity concerns during the pandemic should broaden to include providing all people who need it with access to the highest possible standard of end-of-life care. This requires attention to culturally safe care in the following interlinked areas: palliative care, communication and decision support and advanced care planning. (shrink)

In this study, I surveyed students' evaluative perceptions of instructor behavior and their possible influence on academic dishonesty. Slightly over 20% of 1,369 student respondents admitted to academic dishonesty in at least 1 class during 1 term at college. Students who admitted to acts of academic dishonesty had lower overall evaluations of instructor behavior than students who reported not committing academic dishonesty. Implications for student learning and the enhancement of academic integrity in the classroom are discussed.

Cultural narratives shape how we think about the world, including how we decide when the end of life begins. Hospice care has become an integral part of the end‐of‐life care in the United States, but as it has grown, its policies and practices have also imposed cultural narratives, like those associated with the “six‐month rule” that the majority of the end of life takes place in the final six months of life. This idea is embedded in policies for a range (...) of care practices and reimbursement processes, even though six months is not always a meaningful marker. In the case of people living with advanced dementia, six months is both too early in the trajectory to facilitate conversations and too late in the trajectory to ensure decision‐making capacity. This essay encourages scholars and policy‐makers to consider how cultural narratives may limit what they think is possible in care for people living with dementia. (shrink)

ABSTRACT:Regulatory focus theory is proposed as offering an explanation for the influence of ethical leadership on organizational citizenship behaviors and employee commitments. The prevention focus mindset of an employee is argued to be the mechanism by which an ethical leader influences extra-role compliance behavior as well as normative commitment, whereas the promotion focus mindset of an employee is argued to be the mechanism by which an ethical leader influences extra-role voice behavior as well as affective commitment. Moreover, leader-member exchange is (...) proposed as a moderator of the relationship of ethical leadership to regulatory focus mindsets and employee behavior and commitments. Using the data collected in two waves from 250 working adults, we tested the proposed relationships with moderated mediation bootstrap procedures. The findings generally support the hypothesized relationships and point toward important implications for ethical leadership in work settings. (shrink)

Broadening participation in early science, technology, engineering and math learning outside of school is important for families experiencing poverty. We evaluated variations of the Teaching Together STEM pre-kindergarten program for increasing parent involvement in STEM learning. This informal STEM, family engagement program was offered in 20 schools where 92% of students received free/reduced lunch. The core treatment included a series of family education workshops, text messages, and family museum passes. The workshops were delivered at school sites by museum outreach educators. (...) We randomly assigned schools to business-as-usual control or one of three additive treatment groups. Using an additive treatment design, we provided the core program in Treatment A, we added take-home STEM materials in Treatment B, and added materials + parent monetary rewards in Treatment C. The primary outcome was parent involvement in STEM. There were no significant impacts of any treatment on parent involvement; however, the groups that added take-home materials had larger effect sizes on parent involvement at posttest and later, kindergarten follow-up. Adding parent monetary rewards only produced short-term improvements in parent involvement that faded at follow-up. We discuss implications for other community-sponsored family engagement programs focused on informal STEM learning, including considering characteristics of families who were more versus less likely to attend. These null findings suggest that alternatives to in-person family education workshops should be considered when parents are experiencing poverty and have competing demands on their time. (shrink)

Background Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses’ experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. Research aim To analyze frontline U.S. nurses’ experiences of ethics during the COVID-19 pandemic. Research design Qualitative analysis using a directed content (...) methodology. Participants and research context The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. Ethical considerations Participant privacy and data confidentiality were addressed. Findings Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. Discussion This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. Conclusions Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

The practice of placing men and women in the same hospital room (mixed gender rooms) has been prohibited in the UK National Health Service for over a decade. However, recent research demonstrates that the practice is common and increasing in a major New Zealand public hospital. Reports and complaints show that the practice also occurs in Australia. We argue that mixed gender rooms violate the fundamental human rights of personal security and dignity. The high rates of cognitive impairment, sensory impairment (...) and frailty in hospital wards exacerbates the risk for these violations and subsequent harm. We argue for the adoption of specific national policies prohibiting mixed gender rooms and public reporting of breaches. Importantly, these guidelines can be adopted without compromising the rights of gender minorities. In the long term, hospitals should be built with single occupancy rooms. (shrink)

The child protection system in France has gradually changed along the lines of the laws enacted in 2002 and 2007 that reasserted the importance of the role played by the parents. Far from condemning the family, it henceforth seeks to provide it with accompaniment so as to ensure the child’s future reintegration. Grounded in psychoanalytical group and family theories, the article investigates the psychic function of the institution and (with case studies to support it) discusses what has to be done (...) to make arrangements within the therapeutic framework for families to make progress and maintain ties despite the absence of direct relations. For it is only after a real period of separation that work on the young person’s psychic group experience will enable the family to move forward. (shrink)

In Singapore’s multicultural society, a sizable proportion of the population subscribes to complementary and alternative medicine. In this article, we discuss the impact this has on medical practice in the context of the four principles of medical ethics. To uphold the principle of autonomy, we propose a non-judgmental approach towards patients who use CAM. Nevertheless, in order to promote health and prevent harm, the safety profiles of CAM must be studied through systematic research. In addition, the principle of justice is (...) one concerned with the fair distribution of scarce healthcare resources, while granting equal access to healthcare regardless of beliefs. Understanding CAM from an ethical perspective allows for the provision of safe, holistic, and culturally relevant care. (shrink)

This roundtable brings together contributions from nine senior, mid-career and junior scholars who work on the history of science in pre-1800 Islamicate societies. The contributions reflect upon some of the challenges that have historically constrained the subfield, how they have sought to overcome them, and what they see as some of the more productive and fruitful turns the field has taken and/or should take in the future. A central trend in all contributions is how they seek to confront the combined (...) weight of colonialism, Orientalism, and the teleological history of science that continues to haunt contemporary discussions in both academia and the general public with regards to science in pre-1800 Islamicate societies. Without diminishing the pioneering achievements of the generations of historians who have preceded us, and upon whose work we continue to rely, this combined weight has tended a) to marginalize the study of occult sciences in Islamicate societies; b) to emphasize investigations of content from an etic perspective of how we got to the present, which is primarily seen as how the scientific content is connected to the rise of modern science in Europe; and c) to concomitantly marginalize the study of science in post-1200 Islamicate societies, particularly those with little to no connection to the rise of “Western” science. The contributions build upon conversations that took place among participants in December 2019 at a workshop at New York University (NYU), Abu Dhabi Institute in New York City, funded by a grant from NYU Abu Dhabi. (shrink)

American parents greatly value children’s happiness, citing it well above other possible priorities. This commitment to happiness, shared with parents in other Western societies but not elsewhere, is an important feature of popular emotional culture. But the commitment is also the product of modern history, emerging clearly only in the 19th century. This article explains the contrast between more traditional and modern views, and explains the origins but also the evolution of the idea of a happy childhood. Early outcomes, for (...) example, included the novel practice of hosting parties for children’s birthdays, another mid-19th-century innovation that has expanded over time. Explaining the intensification of the happiness commitment also reveals some of the downsides of this aspect of popular emotional culture, for example in measurably complicating reactions to childish unhappiness. The basic goal of the essay is to use this important facet of modern emotional history to evaluate a commitment that many modern parents assume is simply natural. (shrink)

Is there something special about group rights? Many would say "yes". For some, only certain kinds of groups---ones that are oppressed, or play a special role in well-being---may have rights. For others, the kind of group is not as important as the group's culture and internal structure. At the very least, many argue, group rights ought to be more restricted than individualistic ones. For these reasons, arguing the merits of a group right is often thought to require a theory of (...) groups or of group identity. If only certain kinds of groups may have rights then one has to identify the roles that various groups and/or identities play in personal well-being. If a group's culture or internal structure must meet certain standards then one must develop a theory of how culture or the internal organization of a minority influences people. ;I argue that it is a mistake to think that arguing a group right requires a theory of groups. This mistake reflects a tendency to think about group membership as a kind of good and to focus on its internal, psychological significance. But if one thinks about group membership as a vehicle of action, and focuses on the concrete effects it may have, it becomes apparent that arguing for a group right does not require a theory of groups, group identity or culture. For in the end, the issues that one must address in arguing a group rights are issues about groups. Rather, they are issues about political and moral authority, and about the extent to which moral and political norms ought to recognize and reinforce the ways that people depend upon one another. These are important issues and they raise pressing questions for political philosophy. But they are not about groups. (shrink)

Carbon offsetting remains contentious within, at least, philosophy. By posing and then answering a general question about an aspect of the morality of carbon offsetting—Does carbon offsetting make luxury emissions morally permissible?—this essay helps to lessen some of the topic’s contentiousness. Its central question is answered by arguing and defending the view that carbon offsetting makes luxury emissions morally permissible by counteracting potential harm. This essay then shows how this argument links to and offers a common starting point for further (...) examination of offsetting across various disciplines and domains, such as policy and other branches of philosophy like the ethics of risk. (shrink)

Background Current requirements for ethical research in Canada, specifically the standard of active or signed parental consent, can leave Indigenous children and youth with inequitable access to research opportunities or health screening. Our objective was to examine the literature to identify culturally safe research consent processes that respect the rights of Indigenous children, the rights and responsibilities of parents or caregivers, and community protocols. Methods We followed PRISMA guidelines and Arksey and O’Malley’s approach for charting and synthesizing evidence. We searched (...) MEDLINE, PsycINFO, ERIC, CINAHL, Google Scholar, Web of Science, Informit Indigenous Collection, Bibliography of Native North Americans, and Sociological Abstracts. We included peer-reviewed primary and theoretical research articles written in English from January 1, 2000, to March 31, 2022, examining Indigenous approaches for obtaining informed consent from parents, families, children, or youth. Eligible records were uploaded to Covidence for title and abstract screening. We appraised the findings using a Two-Eyed Seeing approach. These findings were inductively coded using NVivo 12 and analyzed thematically. Results We identified 2,984 records and 11 eligible studies were included after screening. Three key recommendations emerged: addressing tensions in the ethics of consent, embracing wise practices, and using relational approaches to consent. Tensions in consent concerned Research Ethics Board consent requirements that fall short of protecting Indigenous children and communities when culturally incongruent. Wise practices included allowing parents and children to consent together, land-based consenting, and involving communities in decision-making. Using relational approaches to consent embodied community engagement and relationship building while acknowledging consent for Indigenous children cannot be obtained in isolation from family and community. Conclusions Very few studies discussed obtaining child consent in Indigenous communities. While Indigenous communities are not a monolith, the literature identified a need for community-driven, decolonized consent processes prioritizing Indigenous values and protocols. Further research is needed to examine nuances of Indigenized consent processes and determine how to operationalize them, enabling culturally appropriate, equitable access to research and services for all Indigenous children. (shrink)

In a recent paper, Michael Levin argues that both statements reporting causal relations and causal explanatory statements are extensional. We show that his argument for the extensionality of causal explanatory statements fails to establish that conclusion. His claim that certain 'because' statements are elliptical for statements of what he terms the 'causal explanatory' form is unsubstantiated. The argument for the referential transparency of the allegedly explanatory form, regardless of whether it is a distinct explanatory form, fails because of scope problems. (...) Finally, we argue that the apparent referential opacity of explanations, the attribution of certain kinds of properties to explanations, and our satisfaction with explanations in what appear to be disparate forms are best accounted for, not by the assumption of ellipticality of statements in various forms for statements in some inherently explanatory form, but rather by an account of explanation as a speech act, the success or failure of which may be affected by which of several co-referring expressions is employed. (shrink)

A dominant belief in political philosophy is that states must be entitled to authorize the use of coercion in order to justifiably coerce its subjects. Call this view the entitlement view. On this view, for a state to justifiably coerce its subjects, a necessary condition is that it is entitled to authorize the use of coercion. Sceptics hold the entitlement view. However, they deny that states are entitled to authorize the use of coercion. This denial informs their views regarding the (...) permissible use of political power. Skeptics believe that nearly all uses of political power is impermissible. In this paper, I present a challenge to the skeptical view that nearly all uses of political power is impermissible. I also present a view on the justification of certain uses of political power that is an alternate to the entitlement view. My alternate view allows me to demonstrate that a state can engage in permissible uses of political power over a broad range of domains without possessing any entitlements. (shrink)

Conventional wisdom suggests that promoting self-determination for peoples and protecting the human rights of individuals are competing priorities. By this is meant that securing individuals in their human rights requires limits on the rights of their peoples, and vice versa. In contrast, the Draft UN Declaration on the Rights of Indigenous Peoples (the Draft Declaration) treats the two as not only mutually supporting but mutually necessary. In the Draft Declaration, the right of peoples to self-determination is more than a principle (...) that constrains states in their behavior towards other states and territories “outre-mer”; it also constrains states within their domestic realm. This view of self-determination reflects the experience of many indigenous groups, for whom refusal to respect the integrity of their group and failure to respect the integrity of their persons have gone hand in hand. In this chapter, I argue that the Draft Declaration’s treatment of self-determination is right: self-determination is a human right and this human right is the same right that underpins the rights of states. Treating an interest of peoples like self-determination as a constitutive element of human dignity raises practical worries about the stability of the international system, and philosophical worries about potential conflicts between individuals and peoples. But it also casts state sovereignty itself in a different light. This new light has interesting consequences both for international law and for philosophical debates about minorities within minorities. In particular, it allows one to think about questions about internal minorities as ultimately questions about legitimacy and representation. (shrink)

Music can answer questions that often confound more discursive modes of thought. Music takes concepts that are all too familiar, reframes these concepts, and returns them to us with incisive clarity and renewed vision. Unity is one of these "all too familiar concepts," thrown around by politicians, journalists, and pastors as if we all know what it means. By turning to music, especially musical space, the relational structure of unity becomes less abstract and more tangible within our philosophy. Arnold Schoenberg, (...) as an inherently musical thinker, is our guide in this study of unity. His reworking of musical structure, dissonance, and metaphysics transformed the tonal language and aesthetic landscape of twentieth century music. His philosophy of compositional unity helps us to deconstruct and reconceive how unity can be understood and worked with both aesthetically and theologically. This project also critiques Schoenberg's often monadic musical metaphysic by turning to Colin Gunton's conviction that the particularity and unity at the heart of God's triune being should guide all of our theological endeavors. Throughout, music accompanies our thinking, demonstrating not only how theology can benefit the philosophy of music but also how the philosophy of music can enrich and augment theological discourse. (shrink)

Conventional wisdom suggests that promoting self-determination for peoples and protecting the human rights of individuals are competing priorities. However, many recent international human rights documents include rights of peoples in their lists of basic human rights. In this paper, I defend including at least one people’s right, the right to self-determination, in the list of basic rights. Recognizing that self-determination is a constitutive element of human dignity casts state sovereignty in a different light, with interesting consequences both for international law (...) and for philosophical debates about the rights of minorities. (shrink)

In Global Justice: A Cosmopolitan Account Gillian Brock makes three important claims: that we have duties of justice to all human beings and not only those with whom we share a state; that our duties to those outside our states are of the same scope and normative weight as our duties to those with whom we share a state; and that the existing framework of international institutions affords us a number of straightforward and accessible means to act on our duties (...) to persons outside our states that we ought to pursue. These claims are important in themselves, but the real interest of Brock’s book lies with the argumentative strategy she uses in support of them. This strategy, which includes emphasizing the compellingness of specific institutional and policy prescriptions and distancing her arguments from debates about the structure and plausibility of Rawlsian internationalism, bears interesting fruit in a number of respects. However, it also raises difficult questions about the coherence of the distinction between cosmopolitanism and nationalism on which Brock relies, and about the value of institutionalist approaches to justice more generally. (shrink)

The concern people are now expressing about the human environment, ecology, pollution, and overpopulation, though admittedly legitimate from a moral point of view, has not attracted much attention from philosophers. This is notable particularly inasmuch as the United States civil rights struggle, the Vietnam War, and various responses of civil disobedience and violence to social problems have all aroused philosophers to careful thought on rights and obligations. I do not want to suggest that a social problem is interesting only if (...) it is philosophically interesting; nor do I want to make light of the way in which the problems of waste, noise, and overcrowding have captured the popular imagination. Yes, we must protect and use wisely the human environment and natural resources. But still, saying it seems banal, and philosophers do not feed on banalities. Here we have a modern moral commandment which speaks to an urgent and serious matter but which, like “Do not steal,” seems so obvious as to be trite. Yes, we must plan the world’s population in a rational way. Even that commandment, though disputed by some, seems trite. (shrink)

Este estudio buscó describir e interpretar las teorías subjetivas sobre la identidad profesional docente que se construyen y difunden noticiosamente durante la educación de emergencia por la pandemia de COVID 19. Se utilizó un estudio de análisis documental, metodología cualitativa y un diseño de estudio de casos. El muestreo intencionado y por conveniencia corresponde a 40 noticias de prensa escrita en español, sobre el profesor(a) en pandemia y publicadas en diferentes medios que fueron recolectadas a través de Google Noticias desde (...) el 11 de marzo de 2020 y hasta el 01 de noviembre de 2020. A partir de una codificación temática, los resultados evidenciaron teorías subjetivas asociadas a las exigentes características, roles, funciones y valores con los que se identifica al profesorado durante la pandemia. El análisis mostró los distintos sentidos del ejercicio profesional y las competencias asociadas a su desempeño en la prensa. En la discusión, se utilizaron estudios relativos a la práctica docente para interpretar estos resultados. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Who Tells the StoryCindy BitterThirty years later, I do not remember her name, but I definitely remember her face, and this is how I remember her story.She came into the office for her flu shot. She was in her 70s and had a mild case of COPD attributed [End Page 87] to years of exposure to pesticides on the family farm. She said she was trying to stay healthy, (...) as the grandkids were due for a visit, and everyone had gotten a cold after Thanksgiving the year before. I was a sub-intern doing a required rural medicine rotation and diligently did an exam, finding asymptomatic new-onset atrial fibrillation of uncertain duration. We admitted her to the hospital and started anticoagulation. My attending also ordered a calcium channel blocker to slow her pulse, which was running 90–100 while she was at rest. The attending insisted that it would convert her back to sinus rhythm. The nurses were not experienced with the medication and were uncomfortable giving it. I was pretty sure the calcium channel blocker was not indicated, and a quick check of my pocket manual confirmed the drug would lower her heart rate and maybe her blood pressure but that it would not fix the abnormal rhythm. I refused to administer it. The attending came in, pushed the medication, and returned home. A few minutes later, the patient was struggling to speak. Her pulse fell to in the 30s, and her blood pressure had dropped dangerously low. I asked for the crash cart and calcium, and my attending, then started CPR when she lost her pulse. Half an hour later, my attending called her time of death.Hers was not the first death I'd witnessed, but it was the first time I felt like my patient would have been better off without our interventions. As a medical student hundreds of miles from the main hospital campus, I felt powerless to contradict the attending, and did not know where to turn for support in the moment. I rationalized it by saying that I had not actively contributed to her death by pushing the medication, but I held myself morally culpable for doing the exam and finding an asymptomatic abnormality that started her down that path. I felt I should have known the pathophysiology and medication side effects better, or been more assertive, or called for help.One could argue whether I was suffering from a grief reaction or falling into depression, but I questioned my calling to medicine and seriously considered leaving the field. But I was quite certain that I did not want another patient to be put at risk, or a student to feel cornered into taking actions against their better judgment. After returning to the main hospital, I met with the clerkship director and helped develop a pathway for students to raise safety concerns in real-time. Now I recognize the feeling I experienced as moral injury, but we weren't using that term at the time, or talking about Six Sigma safety, or stopping the line.Ultimately, I continued through medical school and trained as an emergency physician. My prior reverence for my attendings moderated to a healthier respect that had to be earned. I read voraciously, trying to prepare myself for unexpected situations. I became an advocate for patient safety and was an early adopter of shared decision-making. I strive to be a physician who welcomes questions and respects the concerns of all team members. Many of the principles that ground my career in medicine grew out of my exposure to this patient.It was always my least favorite of the tropes common to television medical dramas—the circumstances of the patient-of-the-week illuminated some aspect of our main characters' lives, providing a very important life lesson. I felt it positioned patients to be in service of the physician's aims, using patients as a means to our ends, when we should be using our knowledge and experience to further the patient's goals. Very un-Kantian, in addition to transgressing against multiple other philosophers and medical ethicists. As medicine learns more about the power of... (shrink)

The present study shows that the Internet functions as a gratifying context for the exchange of knowledge and values related to religious matters among youngsters in the Netherlands; they are in the midst of constructing a religious identity. Systematic content analysis complemented by qualitative research was carried out on Maroc.nl, a discussion forum primarily aimed at Moroccan youth. Inspired by Kemper's definitions of experiencing Islam, the recurrence of six dimensions of religious experience was looked into in 1,354 online messages. The (...) purpose of this study is to gain insight into the nature and the relative visibility of each of these dimensions in the online discussions under study. In addition, a number of context-bound and issue-related characteristics of the message were assessed through qualitative analysis, in an effort to find out what key issues were mainly dealt with, what normative statements were made, and how the informants related to one another. (shrink)

Several commentators have expressed concern that the Durban Platform does not include more specific language about the need for equitable mitigation efforts. Meanwhile, other commentators have argued that the differentiated approach adopted by the Kyoto Protocol set up an opposition between the developed and developing nations; resulting in an impasse which has prevented the achievement of adequately ambitious, agreeable and binding mitigation commitments. In this commentary I propose that the political impasse is not due to the equity track per se, (...) but rather to the territorial and production-based accounting system upon which it was built. Under the UNFCCC, parties are required to provide inventories of GHG emissions within their national borders. There are several problems with this method, but most important given the argument here, is that the production-approach has resulted in a significant misrepresentation of the total climate impact of developed nations. Because GHG emissions are not confined by geopolitical borders, it is important to understand the climate impact of contemporary consumption and trade, regardless of where emissions are produced. I argue that supplementing production-based accounting with a consideration of the emissions embedded in trade has the potential to provide a more agreeable and politically viable path for closing the ambition gap and ensuring equity. (shrink)