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)

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)

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)

Neal Berlin, Ann Arbor City Administrator, Tom Blessing, Assistant City Attorney, plus some Cable Communications Commission (CCC) members are trying to put free speech restrictions into Community Television Network�s policies and remove City Council from the debate. CTN, Ann Arbor�s community access cable TV station, is run by the city but not paid for by tax dollars. It is one of the first public access cable stations in the U.S., founded in 1973.

Recent events concerning Žižek at the Left Forum in New York have revealed much about the state of the Left. It appears that the Left is weaker than ever before and Žižek’s appeal to return to radical roots, yet also break some Leftist taboos, situates the liberal Left as anxious, insecure and reactionary. It also appears that Žižek is deliberately and steadily undertaking what many have accused him of failing to attain – of not going far enough. Here, Žižek is (...) breaking away from being the poster boy for the liberal Left and refining his commitment to communism through critiquing postmodern representations concerning tolerance, hyper-relativism and culturation. (shrink)

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)

This chapter contains sections titled: Character of Claus Christmas Crowd Civic Claus Symbol of Supremacy? Common Claus.

Over the past decade AIDS research has turned toward the use of pharmacology in HIV prevention, including pre-exposure prophylaxis (PrEP): the use of HIV medication as a means of preventing HIV acquisition in those who do not have it. This paper explores the contradictory reasons offered in support of PrEP—to empower women, to provide another risk-reduction option for gay men—as the context for understanding the social meaning of the experimental trials that appear to show that PrEP works in gay men (...) and heterosexual couples but not single women. The PrEP debates reveal the different ideas about “demedicalization” in the earlier gay health and women’s health movements and highlight the relationship between health activism and critique of research ethics in the context of a global pharmaceutical market. (shrink)

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)

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)

[P]layers line up in a long line and hold hands. The player at the front of the line is the ‘head’ and the player at the end of the line is the ‘tail’.… The game begins when the head begins to run wildly in any direction, making sharp turns and quick double-backs.… The force created by the twists and turns will often send the tail of the whip flying.… It may be best for the tail to hold on with both (...) hands to keep from flying off the end. Sometimes, however, the tail will go flying no matter how hard they hold on... Be prepared to get dirty if you play this game!--"Crack the Whip: Party Game CentralIf the evolution of American health policy is compared to the children’s game of Crack the Whip, then there is no question that the Medicaid program is the tail of the line. When those at the head of the line start to move. Medicaid receives whatever shocks and unintended consequences result, and when the line “begins to run wildly in any direction,” it receives them faster and harder than the players at the center.Shocks also come from other sources. When the economy slumps, an epidemic arises, or a path in another part of the system becomes a cul-de-sac, new twists and turns occur, with Medicaid absorbing much of the change. (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)

La conceptualización del saber artesanal es compleja y requiere del reconocimiento epistemológico dentro del contexto sociocultural y económico en el que opera lo artesanal, donde es necesario resaltar el valor ancestral, pues, dentro del aprendizaje hay una transferencia de conocimiento tradicional cuando no hay una ruptura en la producción de sentido que se constituye.Por ello, esta investigación busca, por medio de un documental, visibilizar la labor que cumplen los artesanos y cesteros del municipio de Tocaima, Cundinamarca, logrando construir un espacio (...) de integración y capacitación donde sean los cesteros quienes se beneficien y logren transmitir los saberes de la cestería. (shrink)

Throughout the 1980s, the American right wing attempted to control the field of social politics and social policy through a rhetoric of `family'. In response, the left, including much of the lesbian and gay movement, abandoned an early, theorized antipathy to family, attempting to recapture the political field with ideas like `alternative families' and `families we chose'. These moves do not sufficiently account for the hidden glue that binds bodies to politics, national or anti-national. The glue, or, as Benedict Anderson (...) calls it, `political love' is no longer an affect to be rejected but a `feeling' to be embraced. Examining the case of sexual abstinence in early right-wing AIDS discourse and in current websites, this article suggests that micro-politics of love are inextricable from macro-politics of nationalism. (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)

At the turn of the nineteenth century when anatomy and hands-on dissection became the prerequisite for a medical career, the medical community in England and France increasingly relied upon visual representations as part of a complex system of reinforcement of their professional goals. The production of novel illustrated textbooks that disseminated arguments through systematizing illustrations were thus integral to their professional status. Through an examination of a series of realistic diagrams that outlined the new methods of surgical and preservation techniques, (...) this paper argues that visual diagrams were instrumental in supporting the systematic codification and prestige on which nineteenth-century medical knowledge was to depend. It analyses the visual rhetoric and the complex representational languages of these intricate and equally precise illustrations by asking how these illustrations embraced new representational strategies as well as embodied idealizing aesthetic techniques. (shrink)