Clinical ethics committees aim to resolve conflict, facilitate communication and ease moral distress in health care. Dialogue in committee discussions is complex and involves a balance between implicitly and explicitly expressed values of patients, families and professionals. Evaluating effectiveness and concrete outcomes is challenging and most studies focus on broad benefits such as quality of care and reduction of unnecessary or unwanted treatments. In this paper we propose ‘physician satisfaction’ as a valuable outcome. We refer to the clinical ethics approach (...) followed at one large paediatric hospital in Australia, propose reasons for the often-expressed feeling of satisfaction and discuss why this feeling matters. We conclude that physician satisfaction is a valid measure of an effective ethics consultation because it implies the person has been listened to and respected by others, and has perhaps developed greater understanding of and insights into their own work and values, and those of others. (shrink)

_The Consulting Room and Beyond _is not a typical example of clinical writing in the field of psychoanalysis. Therese Ragen, pushing the boundaries of the genre, thoughtfully explores in a very immediate way the intersubjective nature of psychoanalysis, particularly looking at the role of the psychoanalyst’s subjectivity, both how it influences and is influenced by the psychoanalytic relationship. The profound ways in which analyst and patient affect each other are captured as the author moves from a moment with a patient, (...) to one of her own memories, to a dream, to a professional consultation and back to the session with the patient. Ragen’s detailed descriptions of her subjective experiences and clinical skill help to weave the anecdotes into a compelling narrative, worthy of the attention of theorists, academics and clinicians alike. (shrink)

The primary objective of The Health Care Ethics Con sultant is to focus attention on an immediate practical problem: the role and responsibilities, the education and training, and the certification and accreditation of health care ethics consultants. The principal questions addressed in this book include: Who should be considered health care ethics consultants? Whom should they advise? What should be their responsi bilities and what kind of training should they have? Should there be some kind of accreditation or certification program (...) to ensure that those who call themselves ethics consultants are in fact qualified to advise, consult, research, and write in health care ethics? The distinguished authors ofthese articles are persons with diverse backgrounds, interests, presumptions, and val ues. Not surprisingly, therefore, diverse responses have emerged to the questions posed. Though the book's chapters are individually authored, they are informed by the group discussions that went on during active workshop sessions, and by knowledge of the contributions of others. All of the chapters meaningfully represent their consensus. This is not to say that there were no disagreements regarding specific details, but rather that there were no fundamental objections on the book's basic content among a panel of authors who share basic premises regarding the role, responsibilities, education, and certifica tion of health care ethics consultants. (shrink)

We first heard about this case from nurses in one of our intensive care units while we were conducting an inservice. When the session was over, we discussed it between ourselves, and decided that it must have been misrepresented. The case had been presented as one of a teenager who was brain dead, had been so for six months, yet had been brought into the ICU for treatment. We have run into this before, we thought: medical professionals confusing brain death (...) with persistent vegetative state. But, of course, we reasoned, no one can be brain dead for six months. To us, as it would to many, the case sounded like a clinical and ethical impossibility.A week later, we were called by an attending physician from another ICU, at the urging of that unit's nursing staff. They had a patient who was brain dead, whose presence was causing distress among the staff. Ronald Chamberlain, a fifteen-year-old boy, had been a patient at a nearby longterm rehabilitation facility that is equipped to care for ventilator-dependent patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Womanist-Buddhist Consultation as a Reading CommunityCarolyn M. Jones MedineIn Breaking the Fall, the late Robert Detweiler (1932-2008) imagines what a reading community, "a contemporary version of the old storytelling cultures,"1 might look like. He suggests that in such a community, "The accent on community itself would offer a balance to our excessively privatizing tendencies; the communal interaction could counter our relentless drive to interpret... with attitudes of (...) play and Gelassenheit (abandonment, chance, and relaxation); the writing and reading community especially as a liminal entity, could nurture a respect for the incomprehensibility of form and a reverence for mystery."2 This description offers an entry to the work of the Womanist-Buddhist Consultations. To reach a provisional understanding of the meaning of that work, I shall reflect on first what we mean when we say that we want to read something. Second, I turn to a conversation with Robert Detweiler, who was one of my mentors, as a way to address the form of reading that we do and the form of community that we make in the Womanist-Buddhist Consultations. Third, I want to draw on the thought of the consultations themselves, using Emmanuel Levinas's work on reading and ethics, to examine the capacity the consultations have to hold tensions creatively and to allow multiple meanings to be part of them. Finally, I want to address the goals for the consultations. I am thinking specifically of Melanie Harris's desire to see the consultations as generating practices that promote peace, compassion, and justice, and Charlie Hallisey's desire to generate a more complex reading of Buddhist texts in and of themselves.The Womanist-Buddhist Consultations have met three times between 2009 and 2011. We met at Harvard Divinity School and at Texas Christian University for sessions of four days each, and for an evening at the University of Georgia between the two longer meetings. The Texas Christian meeting included some previous members from the Harvard meeting, and added new ones. The University of Georgia meeting consisted primarily of students who participated in the reading practice.In the meeting at the University of Georgia, Charles Hallisey looked askance at me when I said that Buddhism offers an entry into peace and compassion; yet Melanie Harris, when she constructed the later session at Texas Christian University, deployed the terms "peace" and "justice" as descriptors for the work of the group. Hallisey's ironic glance occurred right before we read, at the University of Georgia, a text that contained magic and murder. His glance and the content of that text have prompted [End Page 47] me to think through Harris's claims and to see how our group achieves both a reading of Buddhism and an ethical practice that generates peace and points to justice.The instructions that Hallisey gives for the reading process describe a practice of "being and reading together" as we encounter a variety of Buddhist texts.3 The group's guide is the bodhisattva Manjushri, who has overseen our work through an image gracing the wall at all our meetings. Manjushri has a sword to cut through obstacles, and holds a book, signifying wisdom. The practice of reading with friends, Hallisey told us, comes from Jewish tradition: we need a friend to help us overcome what we can and to begin to see what we cannot. The work involves three steps:1. To read passages individually.2. To read the same passages together in small groups.3. To gather again as a large group and discuss what we have discovered.The major goal of reading is to encounter levels of ourselves to which we ordinarily have no access, by examining a text that becomes "generous" to us. Reading together, Hallisey asserts, makes the generosity of the text visible to us.This process of reading, I would argue, is different from what we usually do when we read and different from what we mean when we tell students to read. Patricia O'Connell Killen, an AAR Teaching Award winner, has delineated some of what we mean when we say to our students: "Read chapter 2 of 'X' and come to class prepared."4... (shrink)

The Ethics Consultation Quality Assessment Tool (ECQAT) establishes standards by which the quality of ethics consultation records (ECRs) can be assessed. These standards relate to the ethics question, consultation-specific information, ethical analysis, and recommendations and/or conclusions, and result in a score associated with one of four levels of ethics consultation quality. For the ECQAT to be useful in assessing and improving the quality of healthcare ethics consultations, individuals who rate the quality of ECRs need to be (...) able to reliably use the tool.We developed a short course to train ethics consultants in using the ECQAT, and evaluated whether the participants (1) achieved an acceptable level of calibration in matching expert-established quality scores for a set of ethics consultations, and (2) were satisfied with the course. We recruited 28 ethics consultants to participate in a virtual, six-session course. At each session participants and faculty reviewed, rated, and discussed one to two ECRs. The participants’ calibration in matching expert-established quality scores improved with repeated exposure at all levels of ethics consultation quality. Participants were generally more accurate when assessing consultation quality at the dichotomous level of “acceptable” (scores of three or four) versus “unacceptable” (scores of one or two) than they were with a more specific score. Participants had higher rates of accuracy with the extreme ratings of “strong” (level four) or “poor” (level one). Although participants were highly satisfied with the course, only a minority of participants achieved the prespecified acceptable level of calibration (that is, 80 percent or greater accuracy between their score and expert-established scores). These results suggest that ECQAT training may require more sessions or need modification in the protocol to achieve higher reliability in scoring. Such trainings are an important next step in ensuring that the ECQAT is a tool that can be used to promote improvement in ethics consultation quality. (shrink)

The conference entitled ‘Best Practices in Clinical Ethics Consultation and Decision-Making’, held in London 8–9 July 2010, was the first of its kind dedicated to identifying best practices in clinical ethics consultation and decision-making. Academics, health and social care professionals, clinical ethics committee members, lawyers, service users and carers from the UK, USA, Europe, Canada, Australia and Asia attended lectures, workshops, parallel paper sessions and clinical ethics case discussions across adult, maternity, children's, older persons, mental health and (...) learning disabilities settings. Seventy-eight best-practice points impacting on the quality of clinical ethics consultations and subsequent decisions were identified and grouped into eight themes: who tells the story; how the story is told; how the analysis, discussion and subsequent decisions are made; how values are weighted and balanced against one another; who decides; how the decision is made; how group dynamics and conflict are handled; how decisions are recorded. (shrink)

Demonstrating value is an ongoing process and requirement for institutional survival for ethics programs. Although our ethics program has significantly increased our ethics consultation volume and maintains a robust database that tracks ethics consultation data, these data regarding ethics consultations alone do not accurately represent the program’s overall activities and value to the institution. The roles and responsibilities of clinical ethicists extend beyond clinical ethics consultation, and there are many other ways that clinical ethicists contribute and add (...) value to their institutions. This article describes our ethics program’s early efforts to systematically track ethics program activities outside of ethics consultations as a way to demonstrate additional value to the institution that goes beyond ethics consultation. By systematically tracking activities such as internal ethics education sessions, conference presentations, publications, grants, committee/policy work, and other activities, our ethics program has been able to gather substantial quantitative data that highlight our program’s numerous activities and outreach, both within and outside the institution, that provide additional value to the institution beyond our ethical consultation activities. (shrink)

ate program and identified the ethical commitments and threats living kidney donors perceive throughout the donation process. Method: This quality improvement project reflects a mixed-methods methodology. Qualitative as well as quantitative data were generated through the donor-advocate consultation sessions and the written Living Donor Satisfaction Survey. Thirteen living donors participated. Results: No threats to donor rights were identified by either the donor or the advocate. Nonrelated donors were motivated by altruism, whereas related donors were motivated by a sense (...) of family. A majority of donors reported being changed emotionally and spiritually by the act of serving as a living donor. The living kidney donors were overwhelmingly extremely satisfied with their decision to donate and perceived the living donor advocacy program as being very good. Discussion: Questions have been raised about what role the donor’s spouse should have during the informed consent process. Further research is needed to better understand the role and power of an advocate when threats to the donor’s rights are noted.... (shrink)

In May 2011, the clinical ethics group of the Center for Ethics at Washington Hospital Center launched a 40-hour, three and one-half day Clinical Ethics Immersion Course. Created to address gaps in training in the practice of clinical ethics, the course is for those who now practice clinical ethics and for those who teach bioethics but who do not, or who rarely, have the opportunity to be in a clinical setting. “Immersion” refers to a high-intensity clinical ethics experience in a (...) busy, urban, acute care hospital. During the Immersion Course, participants join clinical ethicists on working rounds in intensive care units and trauma service. Participants engage in a videotaped role-play conversation with an actor. Each simulated session reflects a practical, realistic clinical ethics case consultation scenario. Participants also review patients’ charts, and have small group discussions on selected clinical ethics topics. As ethics consultation requests come into the center, Immersion Course participants accompany clinical ethicists on consultations. Specific to this pilot, because participants’ evaluations and course faculty impressions were positive, the Center for Ethics will conduct the course twice each year. We look forward to improving the pilot and establishing the Immersion Course as one step towards addressing the gap in training opportunities in clinical ethics. (shrink)

For the inaugural session of the Consultation on Mysticism and Politics at the 1995 convention of the College Theology Society, the consultation’s conveners, David Hammond and Kris Willumsen (both of Wheeling Jesuit College) organized a panel presentation on John Milbank’s Theology and Social Theory: Beyond Secular Reason. The panelists were John Berkman (then of Sacred Heart University, now of the Catholic University of America), Anthony Godzieba (VillanovaUniversity), Paul Lakeland (Fairfield University), and William Loewe (Catholic University of America).The choice (...) of text was a fortunate one as panelists and audience members alike recognized something emphasized by previous reviewers of the book: no matter how one evaluates Milbank’s proposal, he makes a major contribution to contemporary theology by plunging theology into the thick of the contemporary debates over the status of modernity and postmodernity. In doing so, Milbank avoids employing any of the means normally used in these debates, such as the correlationmethod. Rather, his deeply reflective analysis reaches back into the Christian theological tradition in order to retrieve its Augustinian moment for the post-Nietzschean present. From his dialogue with contemporary Western culture and the social and political theories which undergird it, Milbank pointedly proposes a provocation: not only an alternative theological reading of the history and status of modernity/postmodernity, but also nothing less than a truly theological reconstruction of the contemporary.This review symposium presents the panelists’ contributions, which have been revised for this publication. (shrink)

Un examen attentif des sources montre que la théorie la plus largement répandue fixant la session d'Automne de l'Amphictionie de Delphes au mois delphique Boukatios (mois des Pythia tous les quatre ans) et la session de Printemps en Bysios (mois privilégié pour la consultation de l'oracle) ne peut se fonder que sur la seule vraisemblance. Les seuls mois attestés dans les Actes Amphictioniques sont Héraios/Boathoos pour l'Automne et Endyspoïtropios pour le Printemps. En réalité, ces noms importent peu : les (...) membres de l'Amphictionie, dans le désordre causé par la diversité de leurs calendriers respectifs, ne pouvaient sans doute s'entendre que sur un rendez-vous fixé par des repères astronomiques. προγόνων» είναι πιθανόν οι ημερομηνίες ενός ημερολογίου «κατά θεόν» κοινού σε όλους. Είναι λοιπόν περιττό να ζητάμε την καταχρηστική συστηματοποίηση χρονολογικών αναφορών που είναι πολύ σπάνιες και συχνά αντιφατικές. Με αυτό το δεδομένο, η διάκριση του G. Roux μεταξύ Πυλαίας-συνεδρίασης και Πυλαίας-λογαριασμών, δεν επιβεβαιώνεται από τα επιγραφικά δεδομένα, καθώς επίσης και η υπόθεση για την ύπαρξη μιας «μόνιμης αντιπροσωπείας» απαρτιζόμενης από μερικούς ιερομνήμονες. (shrink)

Giving Voice to Values is a very important tool that has helped many professionals better align what they do with what they value and believe. This book introduces the methodology of Socratic Dialogue as a complementary set of tools for creating spaces of joint reflection in which one can gain clarity about one's values and gain the confidence to voice them effectively. Socrates' main concern was to progressively reach a higher alignment between ideas and actions: that is, to achieve a (...) harmony between what we think, what we say and what we do. The first step to giving voice to our values involves introspection and dialogue with others - which is how we can become aware of what we really think and value. An examined life, Socrates reminds us, is a fulfilled one. Based on more than 10 years' experience teaching Socratic Dialogue to business and law students, executives and professionals, faculty, incarcerated people and other vulnerable groups, the book provides teachers and practitioners with a roadmap to conceive, design and conduct Socratic Dialogue courses and sessions. It provides context for the method and its adaptation to the challenges of the 21st century. The book also offers guidance on how to structure a Socratic Dialogue classroom, as well as a series of tried-and-true activities and exercises, practical recommendations, and testimonies of the transformative impact that dialogue courses have had on participants. The book is of prime interest to professors and educators of business ethics, as well as professional consultants working to help organizations become more responsible and introduce ethical reasoning in their decisions. It also serves as a valuable resource for social educators and practitioners in prisons and rehabilitation units, as well as teachers in primary and secondary education. (shrink)

Background: People with traumatic brain injury face a range of mental health challenges during the adjustment process post-injury, but access to treatment can be difficult, particularly for those who live in regional and remote regions. eHealth provides the potential to improve access to evidence-based psychological therapy for people with a severe TBI. The aim of the current study is to assess the efficacy of a psychological intervention delivered via video consulting to reduce psychological distress in people with TBI.Methods: This paper (...) outlines the protocol for a multi-center, three-arm, parallel, non-inferiority randomized controlled trial of an evidence-based manualized psychological intervention, ACT-Adjust. ACT-Adjust provides nine sessions for adults with a moderate to severe TBI experiencing clinical levels of psychological distress. Fifty-six participants referred from Brain Injury Rehabilitation Units across New South Wales and the NSW icare scheme will be randomly allocated to three conditions; video consulting, face-to-face and, a waitlist control.Discussion: This is the first RCT to evaluate the efficacy of a psychological therapy delivered via video consulting for individuals with a moderate to severe TBI.Trial Registration:www.anzctr.org.au, Australian New Zealand Clinical Trials Registry ANZCTRN2619001602112. (shrink)

In this profound and subtle study, a practising psychoanalyst explores the dynamics of the interaction between the patient and the analyst. Michael Feldman draws the reader into experiencing how the clinical interaction unfolds within a session. In doing so, he develops some of the implications of the important pioneering work of such analysts as Klein, Rosenfeld and Joseph, showing in fine detail some of the ways in which the patient feels driven to communicate to the analyst, not only in order (...) to be understood by him, but also in order to affect him. The author's detailed descriptions of the clinical process allow the reader to follow the actual process that enables the patient to get into contact with thoughts and feelings of which he or she was previously unconscious or only vaguely aware. Feldman makes the reader aware of the constant dynamic interaction between the patient and the analyst, each affecting the other. He shows how the analyst has to find a balance between doubt, uncertainty and confusion in himself and through this process may arrive at an understanding of what is happening, and by formulating this understanding the analyst can make a significant contribution to the process of psychic change. This collection of essays not only throws light on fascinating questions of technique, but also reflects on elements that are fundamental to psychoanalytic work. It is essential reading for practising psychoanalysts and those in training, as well as anyone with a general interest in the psychoanalytic relationship between the client and the therapist in the consulting room. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 33.3 (2000) 259-285 [Access article in PDF] The Personal, the Political, and Others: Audre Lorde Denouncing "The Second Sex Conference" 1 Lester C. Olsen Those of us who stand outside the circle of this society's definition of acceptable women; those of us who have been forged in the crucibles of difference--those of us who are poor, who are lesbians, who are Black, who are older--know that (...) survival is not an academic skill. It is learning how to stand alone, unpopular and sometimes reviled, and how to make common cause with those others identified as outside the structures in order to define and seek a world in which we can all flourish.--Audre Lorde, Sister Outsider 112Fifty years ago, in 1949, Simone de Beauvoir's book entitled The Second Sex was published in France. She did not consider herself a philosopher because, to her, a philosopher was "someone who has built a great system" (Simons and Benjamin 1979, 338). Her book, nonetheless, became a milestone in feminist philosophy, for it synthesizes elements of existentialism, phenomenology, and socialism in an account of women's situation in society. Central to this account is Beauvoir's concentration upon representations of "self" and "other." For example, Beauvoir affirmed, "The category of the Other is as primordial as consciousness itself. In most primitive societies, in the most ancient mythologies, one finds the expression of a duality--that of the Self and the Other. This duality was not originally attached to the division of the sexes; it was not dependent upon any empirical facts" (1993, xl). In an interview, Beauvoir stressed, "I believe that the Other is not simply an idealist relationship, it is a materialist relationship" (Simons and Benjamin 1979, 345). To develop her analysis, Beauvoir drew upon another binary, "master" and "slave." However, she concentrated on how women, as a category, had been subordinated as men's "other."Twenty years ago, in 1979, Audre Lorde delivered her best-known speech, "The Master's Tools Will Never Dismantle the Master's House," at an international conference held in honor of the thirtieth anniversary of [End Page 259] Beauvoir's book. According to conference organizer Jessica Benjamin and reporter Lilly Rivlin, writing together in Ms. magazine, "[M]ore than 800 women from all over the world gathered at a conference on feminist theory, 'The Second Sex--Thirty Years Later,' sponsored by the New York Institute for the Humanities" (1980, 48). Like most of the conference participants, Lorde was a woman, a feminist, a socialist, a public intellectual, and an activist scholar. Lorde may have participated in the conference as a "consultant," a poet at a public reading, and a speaker at a plenary session 2 because her feminist philosophy is of resonance to Beauvoir's. Both women rejected biology as the basis for women's situation, believing instead that material conditions are most fundamental. Both commented upon the power of symbolism, especially myths about others, in perpetuating social inequalities and failing to differentiate categories for others. Both saw the relationship between "self" and "other" as a vital and creative tension.To understand this tension, Beauvoir drew explicitly on Hegel's ideas as they were treated in Sartre's oeuvre (Lloyd 1983). In contrast, Lorde may have drawn upon conceptions of double consciousness among black public intellectuals in the United States (Henderson 1989, 17-21). Unlike Beauvoir, Lorde was a lesbian, a mother, and a black woman for whom Beauvoir's analogies between the status of women and the status of "Negroes" were problematic. Confronting the conference participants on the last day, during the last panel entitled "The Personal and the Political," Lorde condemned the conference for its limited range of speakers, its substance, its very structure. Lorde examined the ramifications of failing to include others as equals. For in failing to do so, the conference had employed the same tools of oppression over others that the participants deplored in the politics of patriarchy. Lorde challenged the conference participants, who presumably understood that Beauvoir had represented woman as... (shrink)

Treatments for students with problematic levels of music performance anxiety commonly rely on approaches in which students are referred to psychotherapists or other clinical professionals for individual care that falls outside of their music training experience. However, a more transdisciplinary approach in which MPA treatment is effectively integrated into students’ training in music/performing arts colleges by teachers who work in consultation with clinical psychologists may prove more beneficial, given the resistance students often experience toward psychotherapy. Training singing teachers, and (...) perhaps music teachers at large, to use an evidence-based coaching strategy like Acceptance and Commitment Coaching to directly manage students’ MPA is one such approach. Building on the work of a previous study in which ACC was administered by a singing teacher to a musical theatre student with problematic MPA, we piloted the effectiveness of a six-session, group ACC course for a sample of performing arts students with MPA related to vocal performances, using a mixed-methods design. The coach here was also a singing teacher without a clinical background, and her training in ACC by a clinical psychologist was of a similar duration as the previous teacher’s. Similar to the musical theatre student, the students reported being significantly less fused with their MPA-related cognitions, more accepting of their MPA-related physiological symptoms, and more psychologically flexible while performing in general, and these improvements were maintained after 3 months. Furthermore, they appeared to lower their shame over having MPA and change how they thought in relation to one another. Of note, these improvements were similar to those shown by seven vocal students with MPA after they received Acceptance and Commitment Therapy from a clinical psychologist, but with larger reductions in shame and better acceptance of MPA, which suggests a non-clinical, group ACC intervention that includes supportive discussions to normalize MPA and challenges attempts to control it may be more helpful than individual psychotherapy. These results are promising and indicate a brief training in ACC may be sufficient for singing teachers to provide significant benefit for students with problematic MPA. (shrink)

Moral distress forms a major threat to the well-being of healthcare professionals, and is argued to negatively impact patient care. It is associated with emotions such as anger, frustration, guilt, and anxiety. In order to effectively deal with moral distress, the concept of moral resilience is introduced as the positive capacity of an individual to sustain or restore their integrity in response to moral adversity. Interventions are needed that foster moral resilience among healthcare professionals. Ethics consultation has been proposed (...) as such an intervention. In this paper, we add to this proposition by discussing Moral Case Deliberation (MCD) as a specific form of clinical ethics support that promotes moral resilience. We argue that MCD in general may contribute to the moral resilience of healthcare professionals as it promotes moral agency. In addition, we focus on three specific MCD reflection methods: the Dilemma Method, the Aristotelian moral inquiry into emotions, and CURA, a method consisting of four main steps: Concentrate, Unrush, Reflect, and Act. In practice, all three methods are used by nurse ethicists or by nurses who received training to facilitate reflection sessions with these methods. We maintain that these methods also have specific elements that promote moral resilience. However, the Dilemma Method fosters dealing well with tragedy, the latter two promote moral resilience by including attention to emotions as part of the reflection process. We will end with discussing the importance of future empirical research on the impact of MCD on moral resilience, and of comparing MCD with other interventions that seek to mitigate moral distress and promote moral resilience. (shrink)

Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario’s protocols were presented to the public in a democratic deliberation during the summer of 2022. Objectives (1) To explore the perspectives of Quebec and Ontario (...) citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. Methods This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. Results A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value – a less acceptable tiebreaker. Conclusion Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria. (shrink)

The Hannover qualifying programme ‘ethics consultation in hospitals’, conducted by a four-institution cooperation partnership, is an interdisciplinary, scientifically based programme for healthcare professionals interested in ethics consultation services and is widely acknowledged by hospital managements and healthcare professionals. It is unique concerning its content, scope and teaching format. With its basic and advanced modules it has provided training and education for 367 healthcare professionals with 570 participations since 2003 (until February 2010). One characteristic feature is its attractiveness for (...) health professionals from different backgrounds. Internationally, the Hannover programme is one of the few schedules with both academics and non-academics as target groups and a high participation rate of physicians. The concept of the Hannover programme is in great demand, and its schedule is continuously optimised through evaluation. The goals of enabling healthcare professionals from different professional backgrounds to define and reflect ethical problems, to facilitate and support the process of decision-making and to work out structures for their own institutions seem to have been achieved. However, in order to obtain effective and sustainable results, participation in the programme should be supplemented regularly by in-house training sessions or individual expert consultations. Future challenges include new thematic courses and providing a network for former participants, especially when they come from non-academic hospitals. The network is a reasonable platform to discuss participants' experiences, successes and pitfalls. A further task will be research on how the programme's concept can support the sustainability of ethics structures in the various institutions. (shrink)

BackgroundEven though research integrity (RI) training programs have been developed in the last decades, it is argued that current training practices are not always able to increase RI-related awareness within the scientific community. Defining and understanding the capacities and lacunas of existing RI training are becoming extremely important for developing up-to-date educational practices to tackle present-day challenges. Recommendations on how to implement RI education have been primarily made by selected people with specific RI-related expertise. Those recommendations were developed mainly without (...) consulting a broader audience with no specific RI expertise. Moreover, the academic literature lacks qualitative studies on RI training practices. For these reasons, performing in-depth focus groups with non-RI expert stakeholders are of a primary necessity to understand and outline how RI education should be implemented.MethodsIn this qualitative analysis, different focus groups were conducted to examine stakeholders’ perspectives on RI training practices. Five stakeholders' groups, namely publishers and peer reviewers, researchers on RI, RI trainers, PhDs and postdoctoral researchers, and research administrators working within academia, have been identified to have a broader overview of state of the art.ResultsA total of 39 participants participated in five focus group sessions. Eight training-related themes were highlighted during the focus group discussions. The training goals, timing and frequency, customisation, format and teaching approach, mentoring, compulsoriness, certification and evaluation, and RI-related responsibilities were discussed. Although confirming what was already proposed by research integrity experts in terms of timing, frequency, duration, and target audience in organising RI education, participants proposed other possible implementations strategies concerning the teaching approach, researchers' obligations, and development an evaluation-certification system.ConclusionsThis research aims to be a starting point for a better understanding of necessary, definitive, and consistent ways of structuring RI education. The research gives an overview of what has to be considered needed in planning RI training sessions regarding objectives, organisation, and teaching approach. (shrink)

Ce texte résume la présentation et les commentaires des parties prenantes recueillis lors de l’atelier de la Société canadienne de bioéthique et du forum communautaire de mai 2023, lors d’une session intitulée « Clinical Ethics Fellowship in Canada: Making the Move Towards Standardization ». Ce résumé donne un aperçu du paysage des bourses en éthique clinique au Canada, y compris les lacunes actuelles dans la formation des éthiciens des soins de santé canadiens et les possibilités de progresser vers la normalisation.

Talk therapy is, by definition, difficult, if not impossible, to represent materially. Whereas other scholars have sought to do so by referencing Sigmund Freud’s drawings or the setting of his consulting room, this article looks instead to the use of cloth in Joanne Greenberg’s 1964 semiautobiographical novel I Never Promised You a Rose Garden. The two main treatments given to protagonist Deborah Blau were therapy sessions with Dr. Clara Fried, based on Frieda Fromm-Reichmann, and the “cold pack,” in which (...) the patient was restrained and wrapped in sheets drenched with ice water. The two treatments, this article argues, can be considered in parallel, and through analysis of the material descriptions of the cold pack, one can learn more about the talking cure. Namely, this article analyzes the care in both cases as one of constraint, giving material form to the metaphorical “holding environment” of psychoanalyst D. W. Winnicott. Deborah uses the cold pack to endure her psychosis and return to reality. Similarly, Winnicott describes the ideal therapeutic space as one that, by its reliability, allows regression in service of finding a new self and distinguishing between fantasy and the outside world. The aim of this article is thus twofold: one, to further elucidate the role of cloth in treating mental distress, and two, to understand more fully the therapeutic relationship via the literal and figurative constraint of treatment. (shrink)

Rendre compte des processus psychologiques qui sous-tendent les stratégies de consultation conçues comme des actions de rassemblement d'informations, de sélection d'un corpus d'images de télévision dans les fonds, corpus à transformer pour procéder à des traitements analytiques ou illustratifs , supposés pertinents pour l'identification et/ou la compréhension des phénomènes étudiés. Les observations et les reconstitutions de séance, donnent accès aux difficultés cognitives de manipulation et d'appropriation des outils et logiciels disponibles. Les jugements métacognitifs qui régulent les clôtures « acceptables (...) » de corpus et la « représentativité typique » des éléments iconiques et linguistiques sélectionnés, sont évoqués pour expliquer la gestion de ces recherches.A study of the psychological processes that underlie the consulting strategies conceived as actions of assembling data, of selecting a corpus of television images from the collections of Inathèque de France, a corpus requring transformation to carry out analytical processing, that are supposed to be relevant to identify or to understand investigated phenomena. The session observations and reconstitutions give access to the cognitive difficulties in handling and adapting available tools and software. The metacognitive assessments that control the "acceptable closures" of corpus and the "typical representativeness" of the iconic and linguistic elements selected, are discussed with a view to explaining how the researchers managed their work. (shrink)

Background Pharmacists are often faced with scenarios in practice that require application of ethical reasoning and decision-making skills. There is limited research on the ethical decision-making processes of hospital pharmacists. Pharmacists who are compassionate and put the interests of their patients first are thought to positively impact on patient care, but there are often complex health-care system pressures in the hospital setting that cause pharmacists to behave in ways that may conflict with professional values and behaviours. This multisite study aimed (...) to evaluate an interactive education workshop on hospital pharmacists’ ethical reasoning skills and explore the need for ongoing training and support. Methods This mixed-methods study was carried out across two health services including three hospitals. It incorporated a pre-workshop survey, a feedback survey immediately post-workshop and a third survey four weeks after the workshop. Semi-structured interviews were conducted with hospital pharmacists at least four weeks after the ethics workshop. Results In total, 32 participants completed the pre-workshop survey, nominating peers/colleagues as the most common source of support they would consult to inform ethical decision-making (17/118 sources of support). Almost all (n = 31/33; 94%) strongly agreed/agreed that the education session provided them with ethical reasoning skills and a process/framework which they could use when faced with an ethical issue. Pre- and post-survey responses showed increased self-confidence in identifying the regulatory frameworks applicable to pharmacy privacy requirements (p = 0.011) and ethical issues applicable to pharmacy privacy requirements (p = 0.002), as well as applying ethical reasoning to scenarios that involve pharmacy privacy dilemmas/issues (p = 0.004). Participants’ self confidence in knowing where to find support when faced with clinical and non-clinical ethics questions was improved (p = 0.002 and p = 0.003 respectively). Participants supported the introduction of quarterly ethics cafes after the workshop, compared to before the workshop (p = 0.001). Conclusion Hospital pharmacists rely on discussions with colleagues to brainstorm how to address ethical issues. This study showed that a targeted interactive education workshop facilitated familiarity with ethics resources and decision-making processes. It also demonstrated that this approach could be used to enhance hospital pharmacists’ readiness, confidence, and capabilities to recognise and respond to challenging ethical issues. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:News from the President’s Council on BioethicsF. Daniel Davis (bio) and Diane M. Gianelli (bio)As most readers of this column already know, the President's Council on Bioethics went through a major transition during the past year when Leon Kass—in October 2005—handed the chairman's gavel over to Georgetown University's Edmund Pellegrino. Dr. Kass has remained on the Council as a member.1When the gavel change took place, the Council's phone started (...) ringing. Everyone wanted to know the same thing: What topics would the Council take up this term? Dr. Pellegrino's answer was always the same: The Council's agenda would be established through a consultative process with the members themselves and with an eye to those problems and controversies in bioethics to which we, as a body, can make a contribution.Taking its cue from the list of potential topics suggested by members, the Council—over the course of the next several meetings—listened to experts on such topics as children and bioethics (with a focus on children in clinical research), organ transplantation, and that oft-cited-but-hard-to-define concept, "human dignity."The latter topic entered the arena of discussion because it is a concept that is cited frequently in the bioethics literature, and it is also one that has figured prominently in Council discussions and documents. Although the concept is widely invoked, there is no universal understanding of what it means, and it is not easy to encapsulate into a one-size-fits-all definition. Indeed, some critics maintain that appeals to human dignity are fig leaves used to camouflage unconvincing arguments. So between December 2005 and April 2006, the Council devoted several sessions to various perspectives on "human dignity: its meaning, its foundations, and its relevance to bioethics." After hearing from James Childress, Patricia Churchland, Daniel Sulmasy, and Paul Weithman2 on the topic, the Council decided to issue a volume of approximately 20 essays, some by Council members and others by scholars from a variety of relevant disciplines.3 The volume is expected to encompass a broad array of opinion on the topic of human dignity and is scheduled to be published next spring."Children" were also the focus of several sessions during the past year. The Council's last report addressed care giving for the elderly.4 After it was issued, several members suggested it was time to focus on the youngest members of [End Page 375] society. The challenge, of course, was to find a topic that was both timely and relevant—and one about which the Council was uniquely qualified to make a contribution. A number of experts in a variety of related fields testified before the Council about possible issues it could explore: newborn screening for genetic disorders; decision-making standards for those who lack capacity; ethical issues in neonatal and pediatric intensive care; pharmacology and psychiatric disorders in children; and children and clinical research. In addition, a number of groups and individuals involved in related topics met with staff to discuss their interests and concerns.This exploratory engagement with facets of the broad topic of children and bioethics led the Council to focus, more narrowly, on a cluster of issues concerning newborn screening for genetic disorders—a topic on which it is likely that the Council will issue a white paper, possibly by next summer. The stimulus for this particular focus has been the American College of Medical Genetics's recommendation that all newborns in the U.S. be screened for a panel of 29 disorders.5 Currently, each state decides for its residents which conditions are subject to mandated screening, so it is possible to get early diagnoses of treatable disorders in one geographical area but not in another. Proponents of screening find the federal approach to mandated screening more equitable. Potential ethical problems, however, exist with the proposal. Some want to ensure that newborns are screened only for treatable conditions on grounds that it would be too burdensome to discover one is carrying the gene for a late-onset disease that cannot be prevented. Others want to make sure that insurance coverage for individuals and their families is... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Tacitus, Germanicus, Piso, and the Tabula SiarensisJulián GonzálezTacitus describes the funerary honors that were decreed for Germanicus in a dense narrative covering the whole of chapter 83 of book 2 of his Annals. Modern critics consider that this extensive chapter was taken from the acta senatus, from which not only the senatus consulta would have been taken but also various items from the debate, especially the sententiae of the (...) senators and the interventions of the emperor himself. 1 In the introductory phrase honores ut quis amore in Germanicum aut ingenio ualidus reperti decretique the word decreti clearly indicates that we are dealing with a decision of the Senate, but I also believe that reperti, “found after a search,” ties in perfectly with the result of a senatorial deliberation. This initial supposition is supported by Ann. 2.83.3, where Tacitus records the proposal of the Senate to dedicate to Germanicus a golden imago clipeata among the portraits of the classical orators (cum censeretur clipeus auro et magnitudine insignis inter auctores), a proposal rejected by Tiberius. The use of the technical term censeretur, “vote,” and the fact that Tacitus records the intervention of the emperor verbatim can only be explained in terms of direct consultation of the acta senatus.The Tabula Siarensis, discovered in 1982 in the province of Sevilla, preserves on two large bronze fragments much of the Senatus Consultum de Honoribus Germanici Decernendis that was decreed at the end of A.D. 19. We know this from fr. IIb, lines 20–21, in which it is decreed that the senatus consultum be inscribed together with another, earlier, senatus consultum, which was passed on 16 December (Itemque hoc s(enatus) c(onsultum) in aere incideretur cum eo s(enatus) c(onsulto) quod factum est A.D. XVII kal. Ian.... figeretur). The text of fr. IIb, lines 18–19, placere uti libellus, quem is (Drusus) proxumo senatu recitasset, in aere incideretur, mentions, in turn, another session of the Senate different from that of 16 December. [End Page 123]As we compare Tacitus’ narrative with the official documents, then, we have to reckon with two (or three) senatus consulta and one comitial law, the lex Valeria Aurelia (found on the Tabula Hebana), through which we have at our disposal an unrivaled wealth of information on the funerary honors of Germanicus. This will allow us to ascertain not only to what extent Tacitus uses the acta senatus and in what way he adapts his narrative to the content of these sources, but also to what extent his signature statement sine ira et studio is valid. Thanks to these discoveries, we now have another example to add to the speech of Claudius in support of the admission to the Senate of the leading men of the Three Gauls. Although it is certain that Tacitus used the acta senatus, our first observation in comparing his narrative to the contents of the Tabula Siarensis and the Tabula Hebana is in some ways surprising, since Tacitus only mentions a dozen honors, while the Tabula Siarensis records a total of twenty-seven, to which one must add others to be found in the Tabula Hebana that are equally ignored by Tacitus.Tacitus divides Germanicus’ funerary honors into four sections:1. In the first of these he mentions the following: (a) that his name be sung in the carmen Saliare; (b) that the curule chairs, decorated with laurel crowns, be positioned in the places usually occupied by the sacerdotes Augustales; (c) that an ivory statue of him precede the pompa circensis; and (d) that no flamen or augur be elected in his place unless he belong to the gens Iulia. These measures do not feature in the extant portions of the Tabula Siarensis, although the Tabula Hebana mentions some of them, specifically the inclusion of Germanicus’ name in the carmen Saliare (Tab. Heb. lines 4–5), and the positioning of the curule chairs, decorated with laurel crowns, in places usually occupied by the sodales Augustales (Tab. Heb. lines 50–52), and probably also the ivory statue carried in front of the pompa circensis. 2This would indicate, in the opinion of some scholars, that Tacitus... (shrink)

This contribution focuses on a physiotherapy consultation in which the first author of the contribution is the patient and the second author is the physiotherapist. It features analysis of video excerpts in which (1) the physiotherapist instructs the patient how to do an exercise and (2) the patient turns the physiotherapist's instructions into a course of action while (3) the physiotherapist monitors, assesses, guides, and corrects the patient's instructed actions by deploying touch. The investigation draws on video-recordings and transcriptions (...) of the physiotherapist’s and the patient’s interaction during the exercise instructions, the authors’ experience of touching/being touched during these instructions, and their shared understandings as discussed during data-sessions devoted to select video-clips of exercise instructions. In a learning process, the instructor’s instructional corrections are critical: they provide learners with relevant specifications and explanations as to how instructed actions and/or remedial actions are to be accomplished. Whereas monitoring and touching the patient allows the physiotherapist to feel, assess, correct, and guide the patient’s instructed actions, being touched permits the patient to feel how the physiotherapist’s touch resonates beyond locally circumscribed body contact and adapt her movements accordingly. Our contribution thus reveals touching/being touched configurations that establish joint attention and action on extended sensoriality as forming constitutive parts of a dynamic sensorimotor process of inter- and intrabodily resonance, which is challenging to investigate. (shrink)

This article introduces the Bishri Hafi Effect, a distinctive psycho-spiritual phenomenon that appears to hinder the recovery journey of individuals struggling with alcohol and substance addiction. This effect is characterized by the belief held by addicts that their recovery is contingent upon an external (supernatural) force, rather than their own agency, thereby creating a significant hurdle in their path to overcoming addiction. The phenomenon emerged as a byproduct of a larger study involving 10 individuals undergoing treatment for alcohol and substance (...) addiction at various Green Crescent (Yeşilay) Consultancy Center branches in Istanbul between 2019 and 2021. Employing phenomenological analysis, this effect was identified and examined within the broader context of the study. During spiritual counseling sessions that incorporates Islamic tradition, it became apparent that some individuals, when presented with the recovery story of Bishri Hafi—a key figure in Islamic tradition symbolizing alcohol addiction—tended to idealize his narrative, often to the point of overlooking their own personal progress. The story of Bishri Hafi triggered an outlook wherein recovery was anticipated as a miraculous event. This article aims to introduce and shed light on this unique phenomenon, highlighting its unexpected impact within the realm of spirituality in addiction treatment. (shrink)

Previous work has shown that concerns of breast cancer patients after finishing radiotherapy are responsive to conversations with radiographers during the treatment period. This study seeks to further understand radiographer and patient experiences, determine shared priorities for improvement in clinical interaction and develop communication guidelines and training to help radiographers support patients.Methods: Using the principles of Experience-Based Co-Design, semi-structured interviews were held with N = 4 patients and N = 4 radiographers, followed by feedback events to validate findings. Patients and (...) radiographers exchanged experiences in a joint co-design session, agreed with shared priorities and generated ideas for further support. A survey was conducted for process evaluation. To scale up findings, UK-wide representatives from patient networks and radiographers and managerial staff provided consultative input utilizing an iterative, adaptive procedure.Results: Radiographers expressed a need for support with “difficult conversations,” especially those on Fear of Cancer Recurrence, and their appropriate management. Important pointers for reassuring communication were identified, including: being treated like a person, knowing what to expect, and space to ask questions. The co-design process was rated positively by both staff and patients. Thematic collation of findings and mapping these on literature evidence resulted in the “KEW” communication guidelines for radiographers: Know, Encourage, Warmth. National stakeholder consultations validated and helped fine-tune the training model. The resulting training package, included: trigger videos, a simulated patient scenario and interactive handouts on fears of cancer recurrence and the patient pathway.Conclusions: The co-design process captured good practice to help standardize quality in empathic communication in the radiotherapy service. The resulting KEW: Know, Encourage, Warmth guidelines, and training package are user-centered as well as evidence-based. Supplementing single-site co-design with national consultative feedback allows for the development of interventions that are relevant to the clinical practice, even in detail, and helps to generate appropriate buy-in for roll out on a wider scale after evaluation.Trial Registration:www.ClinicalTrials.gov ID: NCT03468881. (shrink)

Since 2008 I have been closely following the conceptual/performance/video work of Daniel Peltz. Gently rendered through media installation, ethnographic, and performance strategies, Peltz’s work reverently and warmly engages the inner workings of social systems, leaving elegant rips and tears in any given socio/cultural quilt. He engages readymades (of social and media constructions) and uses what are identified as interruptionist/interventionist strategies to disrupt parts of an existing social system, thus allowing for something other to emerge. Like the stereoscope that requires two (...) identical images to create an illusion of a three-dimensional image, Peltz sometimes visualizes two separate elements to create an object or moment that requires space and depth to focus on its varied layers. They say your brain has to process and make meaningful sense out of all that visual information before it can accept the illusion. I say your brain has to do a similar thing when looking and seeing the divine, magical, and faithful (social) art making of Daniel Peltz. Daniel Peltz is Associate Professor of Film/Animation/Video at RISD. He divides his time between Rhode Island and Sweden and is currently at work on an exhibition at Botkyrka Konsthall, Stockholm opening February 2013 and a new project to be included in the IASKA: Spaced Biennial (Australia) in 2014. This interview took place on Skype and is part one of a two-part interview. Feliz Lucia Molina: Are you in Providence, RI? Daniel Peltz: I’m at my house in Providence. I’ve been back for six days teaching winter session at RISD and doing this workshop series—these investors’ drum circles with a group of wealth managers. a client of the firm, 2013, photo Shirin Adhami FLM: The wealth managers were all drumming together? DP: They were all drumming in response to the performance of their retirement portfolios. FLM: Is this part of the “Unrealized Gain/Loss” piece? DP: Yes, it’s part of a show I’m working on in Sweden. I can show you because it was just today. I’ll show you some of this. Lets see—share screen [click, click, click]. This is the room. I’ve been using the camera system that’s already installed in the conference rooms to record them. So the video is being recorded directly by the wealth management office’s tech staff. These are the people I worked with in the last workshop. This conference table is less wondrous. They’ve been learning to drum in response to their retirement portfolios. I started by bringing in my little bit of wealth for them to propose a management strategy, I came to the follow-up meeting with a counter proposal, which was this workshop. So they agreed to do this series of workshops instead of managing my wealth. FLM: Does everybody in the room manage your wealth? That’s kind of a lot of people. DP: That woman in the back there and Craig —they handle new client business. So when you come there with your wealth, they sit down with you and suggest to you how they would manage it. They’re very nice, responsible people. FLM: And where is this? DP: This is in Providence and the one I was showing you is in Waltham, where I was today. Then I’m going to Newport for the last one on Friday. So I will have done four of them. This is the group in Waltham that I just played with today. I played directly with the two groups in Providence and I’m working with an ethnomusicologist at Brown, Asha Tamarisa, who is facilitating the last two. She’s helped develop the workshop in terms of figuring out how to train a group to do this and thinking about the compositional challenges of working in response to retirement portfolio data. FLM: Screensharing helps me to figure out tiny bits here and there about the project. DP: I might even be able to play you a little of the audio I’ve also been working with a group of professional percussionists on what will become a quarterly public investors’ drum circle event. Their stuff was really nice, but I want you to hear what we sounded like in the workshops. They’ve all been recorded by the a/v system in the offices. We use a simple structure where the drummer investors interpret the sensation of gain or loss as embellishments to a base heartbeat rhythm. The group holds the heartbeat and, as each person experiences gain or loss, they embellish that rhythm. "Screensharing helps me to figure out tiny bits here and there about the project" FLM: Is the process all very spontaneous? DP: Its actually quite structured. We produce a custom stock ticker that shows the performance of their collective portfolios. In advance of the workshop each participant submits assets in their retirement portfolio. Then we make a stock ticker that shows the real-time performance of their assets so that they can respond to almost live data. FLM: Are they reading the stock ticker projected up on the screen in the room? Do people drum in correspondence to the visual live data of the performance of their assets? DP: Exactly. They’re looking at the stock ticker as opposed to each other, so it’s a slightly shifted drum circle. They’re looking at the ticker but they’re listening to each other—that’s what we’re practicing. For example, NVO—the price is 172.08 but it’s down -1.16 and as that moves across the screen, the person who’s retirement is invested in that asset starts to embellish when that arrow first appears, based on their experience of loss. They stop when it exits the screen and return to the heartbeat. You could have one ticker for each retirement portfolio, but the way the workshop is constructed is that we just isolate one asset from each person’s portfolio so that everyone in the group is represented in a single ticker. So they’re drumming and looking at the ticker, but they’re hearing each other experience gain and loss. We’ve removed direct visual engagement from the social structure of a drum circle but the oral engagement is still there. FLM: So they had their own sound interpretation of gain and loss? DP: Yeah and that part is quite spontaneous as you were saying. In some of the preparatory exercises we’ve been working to give the participants more strategies for interpreting the sensations of gain and loss. We’re trying to develop their capacity to embellish a heartbeat or base rhythm but I’m not invested in having a melodious result. I’m quite curious about what this kind of structure will result in without any desire for a particular result. FLM: For context, can you talk about the project you did a couple years ago in Bali, “Unrealized Gain/Loss” in relation to this current wealth management project? DP: The workshops I’ve been doing use a similar strategy to the other components in this project. It started in Indonesia on my sabbatical and I was really trying to understand where I was physically and where I was being on sabbatical—this kind of strange jubilee structure where every seventh year you’re supposed to renew your self. And it was around the time of the global financial crisis. I was on sabbatical for the global financial crisis. I remember watching my father, in particular, respond to the financial crisis by monitoring his retirement portfolio and trying to make sense of it. I realized on a visit to their home that he checked his retirement portfolio every single day and I was really struck by that because in some way our parents are mysteries to us as children, especially their moods. We know how important their moods are but we don’t know what governs them. And somehow it was like I’d figured it out, it’s the performance of the DOW! So I think there was something in that. Then I was in Indonesia and I had been drawn there by an interest in their highly ritualized Hindu culture, where so much of life is driven by a ceremonial calendar. I was interested in Bali as this predominantly Hindu pocket within a predominantly Islamic country and life there being organized by this ritual calendar functioning as a kind of resistance to the dominant global religion of free-market capitalism. So I started to explore that correlation between the ways in which this culture that I was living in was sort of “living for the afterlife” and this idea within certain segments of American society of “living for the afterwork life”. The idea that your wellbeing in the “afterwork life” is tied to forces that are unseen and largely beyond your control has strong similarities to many religious understandings of the universe. So I started to explore that and the crafts and materials that were around me were primarily Batik and percussion. Percussion is a huge part of daily life in Bali. These gamelan troupes were everywhere. And I also happened to be there for Nyepi, the day of silence, which is preceded by a very elaborate procession and construction of demonic statues. These were the things that were around me and I started studying Batik with one of the Batik artists there and also started a conversation with two master Batik artists, one who is American and her Indonesian husband. I developed these patterns that were based on symbols from the performance of my retirement portfolio and worked with the batik artists to produce two sarongs. d. peltz - 2012 In producing the designs, I treated the performance of my retirement portfolio since my arrival at RISD [7 years] as a significant interval and then I looked at the ways in which decisions are made within retirement portfolios as having an extension outwards from the individual assets that underlie the retirement portfolio, which are kind of like the base elements of the retirement world. Then there’s the allocation of your assets, which is a global way of understanding an individual according to typologies, which are often referred to in terms of risk—this notion of a ‘risk profile’. What type of ‘person’ you are is determined by your attitude towards risk, or potentiality, and I found that to be a really fascinating way of understanding the universe. I remember looking at the tabs in my retirement portfolio and finding this one for viewing ‘Unrealized Gain/Loss’ and that’s often how I work—is just going through the Cambridge Parking Code, for example, and finding this section of the code that was called ‘Crossing Non-Signalized Locations’ and just feeling “I can’t do any better than that,” you know? That’s what I was talking about in terms of ready-mades that exist in the social sphere. So I found that tab, actually, a long time ago, and I pulled it out of a journal when I was there [in Bali] working on these pieces and I wound up making these two sarongs and later on a series of porcelain vessels for holding one’s unrealized gains and losses. At the time, I knew that I wanted a performance to come out of them, but I wasn’t sure what it was. I was inspired very much by this sort of thing: Pulls out a TIAA-CREF brochure with a man in a suit seated at a table. This guy is probably an actor, and [the brochure] says “TIAA-Cref announces “Individual counseling sessions at the Rhode Island School of Design. Individual counseling sessions at no additional cost to you. You can discuss your personal financial situation with an experienced TIAA consultant on a confidential basis. We are available to help you discuss how to achieve your financial goals by investing in financial solutions such as mutual funds, brokerage, life insurance, and annuities...etc....What retirement benefits best fits your situation?” Often I encounter this and I think O.K., this is one way to prepare for the after-work life and it seems inadequate to me. But, I also find it really inspiring. I really like the visual language of it. I kind of want to be that man. I’d like to see if I could maybe buy his clothes. FLM: What it is about the man on the brochure that interests you? DP: He’s offering personalized objective advice and a detailed evaluation of everything you need to know and do. Who wouldn’t want that? But he’s also something of a contemporary priest or priestess, mediating between the unseen all-powerful universe of global capitalism and the common worker. So I started off developing Unrealized Gain/Loss directly from the charts that represent the performance of my retirement portfolio. Then I came home and I wanted to use those. I had this word in my journal “unrealized gain/loss vessel.” I had this notion of vessels that would contain unrealized gains and losses. That felt really important to me that they would have somewhere to go. I had been thinking a lot about altars and making offerings—that somehow this really fickle, massive, difficult-to-comprehend-universe of the financial world—that somehow it might be nice if you could making an offering to it. [In Bali] they made such beautiful elaborate offerings. So I studied offering making as well with one of the women there and she taught me some of the standard forms created by folding leaves and the significance of the floral arrangements. I started working in clay and then moved to porcelain and I made these unrealized gain/loss vessels. I made a few of them, they have holes on either side that you can’t get your fingers in. But something can go in there and something can go out of there. It’s a nice size for putting on an altar. Then I got this commission from Artists in Context who was interested in my doing something for this project “Artists Perspectives for the Nation” project. I proposed initiating these investors’ drum circles as a new public performance form. I’m interested in bringing together those two symbols—the symbol of the djembe and the drum circle. unrealized gain/loss vessel - d.peltz - 2012 FLM: I can imagine the public digital stock ticker performing like a soft fleeting stream of information, a kind of (meaningless) illusory comfort blanket. DP: In some way you have to understand its relevance outside of the obvious, right? Because the obvious is illogical. Nobody is actually using that data to day trade, for example. People aren’t sitting there with their computers watching the market data in Times Square or setting up an outdoor office and being like “OK it’s up 3 points or it’s up 1.56, trade! Ok now buy, Ok now sell!” That would be a kind of a nice performance, actually. But actual day traders would want more up to date data than that. To understand what that data is doing is really important. And that’s something I’ve realized—that I’m interested in a particular kind of data visualization, which is not about what data can tell people, but what data can tell people who are visualizing it. For example, in the Cambridge Project “Crossing Non-Signalized Locations” I was interested in the 10,000 excuses archive of data recording five years worth of excuses for why people thought they shouldn’t have received their parking ticket. I was not interested in making that excuse wall so that the public could see and understand this data. Inevitably the data will be seen by others but I was really interested in what the action of visualizing the data told those who were visualizing it. The parking attendants themselves were writing those excuses on the wall—I was interested in what that kind action of writing the excuses on the wall told them about the data. Similarly, I’m interested in designing a way to allow people to pass this data from the unseen universe of the market, through their own bodies, which happens through the merging of the drum and the stock ticker. I’m interested in those two also as symbols; the drum as this symbol of the earth, the body and a pagan counterculture, and the stock ticker referring to the ethereal world of global markets—bringing those two together and making them dependent. I’m often drawn to conceptual propositions that I become invested in testing in a sincere way—at first they often they sound humorous to others, but I have to remember that there is humor in them. I don’t sit around and laugh about these things. I stop finding them funny at all. I’m interested in the proposition that we could know something about the after-work life by drumming in response to our retirement portfolio. So then I become really interested in how to craft that into a viable performance form for myself and others. FLM: The aspect of using sound in “Unrealized Gain/Loss” as a way of embodying the information to the asset holder is really intriguing—using sound as a means of embodying the asset data. Was sound a medium that made sense to use immediately or were you considering other means of attempting to embody it? DP: Well I do use other mediums within the project like textile, ceramic, and batik patterns. I was first drawn to the history of Batik patterns as a socio-economic stratification system and the vessels as a way of embodying or manifesting this data of unrealized gain and loss. My first approach was to work with meditation actually—a meditation workshop with my colleagues. I was going to offer this “Unrealized Gain/Loss” workshop where you would explore the sensations of gain and loss by adapting the way yogi-nidra brings you into contact with your physical surroundings and stretches your perception. FLM: At Naropa University there are/were business & compassion workshops—a sort of mash-up of business and compassion and how compassion could be incorporated into a business model. This process and engagement of “embodying data” also has to do with “Participatory Democracy and the Future of Karaoke” you created at the DNC in Denver in 2008. DP: That kind of appropriation and instrumentalization of spiritual practice could be disturbing and thus compelling as a strategy. For various reasons, I’ve come to be drawn to both the form of a quarterly public performance and the established performance form of a drum circle. Its something I’ve seen myself do before, that is to mess up a really good functional social system like a drum circle or karaoke. I remember I was developing language for the karaoke project and started calling it “Participatory Democracy and the Future of Karaoke” and one of my assistants on the project, who’s an incredible artist, said, “but don’t you think the future of karaoke is guitar hero?” and I realized that maybe he thought I was trying to improve the form. I’m just trying to get people to have this shifted embodied experience, I need to craft the performance context so that they can do that. In the case of the karaoke project, for example, what did I need in order to be able to do this [a person to stand up in front of a bar and deliver a karaoke speech]? I realized that the body is very vulnerable so I built a podium so that the speaker can feel secure enough to do this, otherwise you couldn’t get to this state achieved by passing these speeches through the body. Then I was, like, well you need to be able to practice the lyrics because you don’t know all the “songs” by heart, which became an insert to the massive track books carried by most karaoke VJs. And then sometimes the crowd in the bar isn’t there with me, so I needed to extract the voice of the crowd cheering from the original venue and I needed the local audience to cheer if they wanted to. I’m interested in both where the form succeeds and fails. In particular, one of the most interesting things is this auditory gap between the space where you are, the reduced scale of applause in your own little bar, and this grand scale of applause at the convention center where the speech was originally delivered. FLM: How did the concept of “Participatory Democracy Karaoke” come about and why did you use karaoke as a means of engaging what was happening at the DNC in 2008? DP: I was looking at a lot of different readymade media infrastructures within the city at the time. I was interested in the emergency broadcast systems and I developed a proposal to repurpose that system and karaoke became an important symbol because it was this populist form that was already engaged in exploring the sensation of celebrity but also visualizing the gap between ourselves and those with more power and influence. So it had this readymade capacity to play with power and celebrity and I felt like the Obama presidential campaign, the first one in particular, had some very curious overlaps with this culture of celebrity. Obama of course rose to power partly based on his oratory abilities and I was interested in how karaoke as a vehicle was so adept at offering people all that was left of authentic expression in a political speech. Managing a politician and constructing their identity is such a developed practice that it becomes, kind of automatically, a metaphor for the way that our own identities are constructed. Of course the Obama campaign was very hip and savvy and deploying this notion of grassroots. It was really pioneering in its use of social media and this deployment of notions of populism. I was interested at that time in the capacity of karaoke to track speech patterns, precise tempos of anyone’s delivery, and that to me was a way of thinking about what might be left of the authentic self. I was interested in karaoke’s capacity to extract that authentic component and offer it to others. So not just to stand up and be them, but to [literally] pass their speech patterns through your own body. A long time ago, it started to strike me as odd that one would make media at all. It struck me as a kind of un-contemporary way of going about making art in an age of media overflow. That logic extended into my thinking on delivery devices and installation as well. Why would one buy a screen or even set one up when there are so many out there? And the way in which these media displays function in karaoke bars and bars in general is very interesting to me. I’m drawn to this passive consumption of media where your primary social interaction is with the bartender or a few other individuals but these screens are around you and your attention is shifting back and forth between these spaces. So much political rhetoric is spoken to a half-listening audience. I was interested in what was happening in the slippage and that karaoke was a kind of slippage amplifier. So if you put people in a bar and they are delivering a Kucinich speech and Kucinich comes up on a screen then your getting a sound bite of Kucinich and an image of Kucinich and your friend is talking to you— FLM: A kind of magic takes place in that incongruency between sound and image and the karaoke participant who’s relaying the speech-text at the same time. DP: Exactly and there’s some kind of truth in that experience of reality. FLM: Yeah, there’s something uncanny about seeing the body close-up like that as though it can’t lie to you in that moment or context. It’s a weird moment of luminous clarity. The work you’ve done and all of what you’re saying about karaoke is so very interesting to me. Growing up, my dad and uncles sang karaoke a lot (and still do) and being first-generation Filipino American is a different cultural subtext entirely. I’m also seeing it from the position of witnessing family members who are carriers of these stories and songs. And seeing them cherish these Tony Bennett, Frank Sinatra, Elvis Presley songs so much, I also see how their bodies are literal vessels of popular music that signifies something greater—it signifies their cultural and socioeconomic place in the world. The way that they cherish these American 1950s and 1960s pop songs is similar to having a certain kind of reverence for their spiritual faith or Catholicism. It’s a similar kind of care, focus, and attention exerted in karaoke and Catholicism—that these two structures and systems give something to focus on. Setsuko, Seiji and Hitoshi in Obama, Japan as Obama in Indiana — d. peltz — 2008 DP: Sure there something about the relationship we have to our candidate or the way we go about choosing a candidate, which is very similar to a deity or idol. I learned a lot about karaoke culture through this project. I’d never done karaoke. I’d never been interested in it as a form and then I travelled to Japan as part of the project when I made “Setsuko, Seiji and Hitoshi in Obama, Japan as Barack Obama in Indiana” and it was quite fascinating because my image of karaoke had always been this very public forum in a karaoke bar and then I discovered there’s this whole other world of karaoke where people even go on their own, they go and rent a room or cubicle and sing, or they go on a date—just the two of them go and sit in a room and do karaoke together. FLM: I’m interested in issues that take place within or as a result of specific karaoke culture(s). In the Philippines within the last several years there’s been occurring the “My Way Killings” phenomenon. Apparently baklas or gay men are employed by karaoke establishments to help “smooth over conflicts over karaoke singing”—these social forms of conduct, or lack thereof that arise out of the infrastructures of this social sport. In this one rural part of the Philippines there’s a village karaoke machine that the whole village shares—the Aeta indigenous people have an appointed “keeper” of the karaoke machine. I also see karaoke as a proxy to the confessional box in Catholicism where one goes to pour out their sins (minus the penance and redemption). The karaoke machine enables one to literally sing out whatever’s going on internally, but through highly saturated popular song lyrics. While karaoke is a public and social sport, it can also be a private one. Karaoke is a means of communion with each other. DP: Right, this preference for this kind of mediated communication. In Japan I was trying to organize people to work on this project and I was talking about throwing a party and they were like, well, we have to rent a karaoke machine because what else are we going to do? And I think its kind of serving that function of surrogacy—emotional surrogacy. FLM: And karaoke tools can be read as ritual tools—the magic mic that holds everything. There’s got to be some overlap at some point—between religious ceremony and devotion to the karaoke machine. DP: The way I designed the piece was so that it could slip right on top of the ready-made karaoke infrastructure. There was a flat-packed podium and it was made of a single sheet of plywood with no fasteners that slotted into itself. Those were sent out to a network of karaoke bars that I invited to become “karaoke convention centers.” The local VJs downloaded our custom-made, speech-extracted tracks that were designed to play on their existing equipment. In this sense the piece is a permanent installation. If you go to Denver today, some of the VJs still have the tracks in their library of offerings, the Ramones and Romney. It was this notion of re-purposing readymade infrastructure to create a distributable populist form. Obama was coming and the convention was in the Pepsi Center and 30,000 people were coming including 10,000 journalists. The impetus behind the larger art project that commissioned international artists to make works in Denver, was that local people weren’t going to have much access to this convention. It was like an invasion, the city was being descended upon, but if you lived a block away from the site, you had the same access as people in Zimbabwe&mash;30 second media bits excerpted from the speeches. So it seemed to me that the fundamental gesture was how do I take that signal, which was travelling out of the convention center, and create a local interruption? FLM: Is that what you mean by ‘intervention’? The term is frequently used to help describe your work. DP: It depends on the day. Around that karaoke project I had a conversation with Krzysztof Wodiczko and he was proposing that maybe rather than intervention, we should consider the word interruption. Because intervention is kind of an overused term in the field of art and it has militaristic and therapeutic associations outside of the art context. Fundamentally, the idea of intervening speaks to the readymade social world as your primary material. So it’s basically suggesting a kind of subtractive process, which gets back to this question: what is the role of the contemporary media artist in a world that’s so saturated with media? You can’t work additively in a saturated field. If you want to make a visible mark you have to work subtractively. That’s what intervention is about to me, just another way of saying “to work subtractively.” FLM: So the interventions or interruptions aren’t necessarily adding or subtracting, but are they putting orange cones there? What are they doing exactly? DP: I think you’re right about that, they’re not really subtracting. They’re adding to the scope of possibility. I’ve been thinking (with this exhibition I’m mounting next month) about the work as explorations and expansions of social possibility. Maybe it’s more insertion. I started calling the pieces ‘insertions’ that I was making in Rejmyre—a small town in Sweden where I’ve been working for six years now. My favorite site to install there is the tourist bureau. I started calling the video pieces that I made for the tourist bureau, video insertions. This idea that you’re inserting something into the readymade media infrastructure of the world resonates with me. Insertion leverages a context, creating a possibility that the inserted object might be naturalized in the process — that someone can encounter my video in Rejmyre as tourist information. And then all of a sudden tourist information can include some American guy prostrating through town and it can include really bad relationship advice. Maybe insertion is a better word. tourist information – d. peltz 2009-present  . (shrink)

I am leading a debriefing session—the second part of a three-part model we have started for ethics consultations at our rehabilitation hospital. The debriefing is loosely organized. We begin with follow-up from a recent ethics consultation. For some team members, this is a time to learn how ethics was involved and how things got resolved. I then ask for their responses to the case: what went right, what went wrong.One team member remarks, "I was angry at Maria's daughter. She (...) never let anyone get a word in edgewise, including her mother." Another says, "I was emotionally exhausted. Her daughter was manipulative. She was good at splitting the team and playing us against each other." Respecting the patient's .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 33.3 (2000) 259-285 [Access article in PDF] The Personal, the Political, and Others: Audre Lorde Denouncing "The Second Sex Conference" 1 Lester C. Olsen Those of us who stand outside the circle of this society's definition of acceptable women; those of us who have been forged in the crucibles of difference--those of us who are poor, who are lesbians, who are Black, who are older--know that (...) survival is not an academic skill. It is learning how to stand alone, unpopular and sometimes reviled, and how to make common cause with those others identified as outside the structures in order to define and seek a world in which we can all flourish.--Audre Lorde, Sister Outsider 112Fifty years ago, in 1949, Simone de Beauvoir's book entitled The Second Sex was published in France. She did not consider herself a philosopher because, to her, a philosopher was "someone who has built a great system" (Simons and Benjamin 1979, 338). Her book, nonetheless, became a milestone in feminist philosophy, for it synthesizes elements of existentialism, phenomenology, and socialism in an account of women's situation in society. Central to this account is Beauvoir's concentration upon representations of "self" and "other." For example, Beauvoir affirmed, "The category of the Other is as primordial as consciousness itself. In most primitive societies, in the most ancient mythologies, one finds the expression of a duality--that of the Self and the Other. This duality was not originally attached to the division of the sexes; it was not dependent upon any empirical facts" (1993, xl). In an interview, Beauvoir stressed, "I believe that the Other is not simply an idealist relationship, it is a materialist relationship" (Simons and Benjamin 1979, 345). To develop her analysis, Beauvoir drew upon another binary, "master" and "slave." However, she concentrated on how women, as a category, had been subordinated as men's "other."Twenty years ago, in 1979, Audre Lorde delivered her best-known speech, "The Master's Tools Will Never Dismantle the Master's House," at an international conference held in honor of the thirtieth anniversary of [End Page 259] Beauvoir's book. According to conference organizer Jessica Benjamin and reporter Lilly Rivlin, writing together in Ms. magazine, "[M]ore than 800 women from all over the world gathered at a conference on feminist theory, 'The Second Sex--Thirty Years Later,' sponsored by the New York Institute for the Humanities" (1980, 48). Like most of the conference participants, Lorde was a woman, a feminist, a socialist, a public intellectual, and an activist scholar. Lorde may have participated in the conference as a "consultant," a poet at a public reading, and a speaker at a plenary session 2 because her feminist philosophy is of resonance to Beauvoir's. Both women rejected biology as the basis for women's situation, believing instead that material conditions are most fundamental. Both commented upon the power of symbolism, especially myths about others, in perpetuating social inequalities and failing to differentiate categories for others. Both saw the relationship between "self" and "other" as a vital and creative tension.To understand this tension, Beauvoir drew explicitly on Hegel's ideas as they were treated in Sartre's oeuvre (Lloyd 1983). In contrast, Lorde may have drawn upon conceptions of double consciousness among black public intellectuals in the United States (Henderson 1989, 17-21). Unlike Beauvoir, Lorde was a lesbian, a mother, and a black woman for whom Beauvoir's analogies between the status of women and the status of "Negroes" were problematic. Confronting the conference participants on the last day, during the last panel entitled "The Personal and the Political," Lorde condemned the conference for its limited range of speakers, its substance, its very structure. Lorde examined the ramifications of failing to include others as equals. For in failing to do so, the conference had employed the same tools of oppression over others that the participants deplored in the politics of patriarchy. Lorde challenged the conference participants, who presumably understood that Beauvoir had represented woman as... (shrink)

Governments now recognise the potential for ICTs to improve the way in which they can engage with the population, whether conducting online consultations to elicit the people’s views on proposed policy, or disseminating information via websites. However, much of the information remains in text format, leaving the task of extracting data the viewer’s responsibility. This can be a daunting prospect, especially in the case of reports of parliamentary proceedings. In the past, Argument Visualisation techniques were used in training law students (...) to render legal cases easier to comprehend; now, enhanced by all the advantages ICT has to offer, these techniques are employed to help make sense of thorny problems in academia and business. The possibility exists that such methods might also serve to clarify complex political issues of interest to the public. This paper describes an investigation into such a possibility. Two debates taken from the Scottish Parliament 2003 Autumn session were converted into argument visualisations and presented for comparison with the ‘Official Report’ to assess whether the visualisations offered any advantages over the textual alternative. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Managing the Transition from Patient-Centered Care to ProtocolDavid SlakterI learned that I would need a kidney transplant in the summer of 2015. This was not a complete surprise to me, as I had been subjected to a number of tests and invasive procedures to investigate nephritis since I was a child. I had heard similar stories of clinicians performing repeated tests on my father for similar reasons without any (...) conclusions. Following my recommendation for transplant and consultation with genomics specialists, the cause of my kidney failure was determined to be Alport syndrome. What made Alport syndrome so difficult to diagnose in my case was that the associated mutation is a rare, autosomal-dominant one that has only recently been associated with the condition.After reviewing the data on survival rates for transitioning to dialysis versus a transplant, my family and I then considered the success rates for living versus cadaver donors, and the success rates at various transplant centers. The current data favor the long-term outcomes of transplant over dialysis and living over cadaver donors. Since we had decided to focus on searching for a live donor, my nephrologist recommended contacting Renewal, an organization that specializes in connecting those in need of a kidney transplant with live donors and providing support for donors to make the donation process less burdensome.On Renewal’s recommendation, my family and friends reached out across their social networks to search for potential donors. Many of those tested for compatibility were eliminated on basic matching criteria, others due to previously undiagnosed medical problems. Finally, the wife of a childhood friend came forward as an eligible donor and was also an incredibly close match on the antigens tested for kidney transplants.Having a living donor who was also a friend made the transplant experience somewhat less intimidating than it might have been. It meant the transformation of an existing relationship with someone already close to me, with fewer open questions about what may have motivated them to be so generous than if the donor had been someone I did not know. It also meant our families could be together in the waiting room, and that we shared in each other’s recoveries.Life post-transplant has been a significant improvement from what it was like immediately beforehand. Before my transplant, I regularly weighed food and consulted nutrition charts to gauge how much potassium I was consuming. To prevent too much potassium from building up in my bloodstream, I had to take sodium polystyrene [End Page 111] regularly. As one might guess from the name, it tastes much like burnt Styrofoam, and I could only ingest it with copious amounts of fruit-flavored syrup (strawberry covered up the awful flavor the best). There are other potassium binders on the market now, so fewer people with kidney failure will likely need to engage in such gustatory experimentation.I was also able to engage in more activities than what was possible even years before my transplant. I had long experienced difficulty with aerobic exercises, but assumed the reason was merely being out of shape. Though I have always walked regularly, even the one-mile walk from my office to my apartment had become a chore by the end. Within a few months after my transplant, I was riding a bicycle all over NYC, from Harlem to Brooklyn and back regularly, and hiking trails in nearby state parks. I began sessions with a personal trainer and attained a level of fitness I had not reached since I played soccer as a child.The transition from personalized care to one more driven by protocol has been a surprising and challenging aspect of the transplant process. While my previous experience with medical treatment has been individual meetings with physicians, my post-transplant care is managed by a team of nephrologists and other specialists in transplant care. My initial transplant nephrologist was automatically assigned to me. Because the standard of care for transplant patients is often driven by protocol, my assigned nephrologist recommended a biopsy on my transplanted kidney due to results in my recent lab tests. When pressed on the necessity of a biopsy in my case versus... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:St. John Henry Newman's Theory of Doctrinal Development and the Synodal Process:A Survey and Concrete ApplicationWilliam B. GoldinGood afternoon, Your Excellencies, Most Reverend bishops, and my brother priests. Firstly, please permit me to say that, while it is certainly an honor to have been invited to speak to you, for which I would like to express my gratitude to my own bishop and our host for this reunion, His (...) Excellency, Bishop Kevin W. Vann, it is also not a little bit daunting. To speak to such an erudite group of clerics, all of whom have a connection to our common alma mater and to the various celebrated universities in the Eternal City, brings back fond memories of my three years at the Casa Santa Maria. During that time, while I would occasionally have the opportunity to preach at Sunday Masses at the Casa, I was always keenly aware that I was not nearly as qualified to do so as many of my listeners. As such, I beg your pardon if I should fail to explain adequately any aspect of this lecture, and I would be grateful for any questions and/or corrections, theological or otherwise, that you may have afterwards.Let us begin with a prayer:In the Name of the Father, and of the Son, and of the Holy Spirit. Amen. [End Page 21]Come, Holy Spirit, fill the hearts of thy faithful, and enkindle in them the fire of thy love. Send forth thy Spirit and they shall be created, and thou shalt renew the face of the earth.Let us pray.O God, who didst inspire thy faithful by the light of thy Holy Spirit, grant that, in the same Spirit we may be truly wise and ever more rejoice in His holy consolation.Through Christ our Lord.Amen.Vergine Immacolata... Aiutateci.Introduction: The Synod on Synodality and Speculation on Doctrinal ChangeIn the late autumn of 2021, Bishop Vann appointed me and my colleague, Mrs. Katie Dawson, our diocesan director of parish faith formation, as the coordinators for the Synod on Synodality in the Diocese of Orange. In this role, we were tasked with bringing to fruition the diocesan phase of the synodal consultation of the faithful here in Orange County. Since last autumn, we have labored to carry out the bishop's synodal plan for this diocese, and I must say that I have been pleasantly surprised with the manner in which the consultation took place, and in its results, notwithstanding my initial reservations both as to the scope of this particular synod and as to the potential risks inherent in such a universal survey. As we all know from diocesan and parochial life, "listening sessions" have a tendency to become "shouting sessions"; and as a thoroughgoing introvert myself, such sessions do not exactly bring joy to my heart. Thankfully, though, my fears were not realized, and the actual experience of our synodal process was almost altogether pleasant.Perhaps surprisingly, one of the fruits of our consultation, which we heard from the majority of the faithful, is their clear desire for doctrinal clarity in their faith journeys. The majority of the People of God in Orange County whom we surveyed do not want to see any doctrinal changes emerge from this synod that could be critiqued for being in serious discontinuity with the [End Page 22] solemnly defined magisterial teaching of the past. Regularly, they expressed to us that, if our "journeying together" is to be authentic and credible, then the continuity of our doctrinal teaching is a matter of no small importance. Indeed, the ability of many to take the Church's faith seriously depends on whether the doctrinal content of that faith seems solid and unshakeable. If the content of our faith can shift substantially in ways that mirror modern shifts in secular thinking, then people can easily critique our faith as being blown about by the winds of change, with no certitude whatsoever. If something taught by the Catholic Church can be true today and false tomorrow, then why is the Catholic Church's message worth listening to at all? What we heard from the overwhelming majority of... (shrink)

El propósito de este artículo es analizar las estrategias de descortesía verbal en una muestra de discurso parlamentario chileno. Para tal propósito se estudiaron las secuencias de discurso que manifestaban dichas estrategias en un corpus de 28 sesiones de la honorable Cámara de Diputados de Chile realizadas entre 2005 y 2007, en las que se discutieron diferentes asuntos polémicos de interés público. Para el análisis de la descortesía en el discurso político aquí realizado se consultaron los trabajos de Chilton y (...) Schäffner (1999), Blas Arroyo (2001 y 2003) y Bolívar (2005), entre otros. Una vez analizados los textos de las transcripciones de las sesiones de la muestra se identificaron las siguientes estrategias de descortesía: atacar la imagen pública del oponente y resguardar la propia imagen pública. Asimismo, la primera de dichas estrategias se subclasificó en las siguientes tácticas: desacreditaciones, ridiculizaciones y amedrentamientos. The purpose of this article is to analyze impoliteness strategies in a sample of Chilean parliamentary discourse. To that effect, this study puts forward an analysis of the discourse sequences manifesting these strategies in a corpus constituted by 28 sessions held between 2005 and 2007 by the honorable Chamber of Representatives of Chile, in which different and controversial issues of public interest were discussed. For the analysis of impoliteness in political discourse carried out in this study, the works of Chilton y Schäffner (1999), Blas Arroyo’s (2001 and 2003) and Bolívar’s (2005) were consulted, among others. Once the transcriptions of the sessions under analysis were processed, the following impoliteness strategies expressing the representatives’ political goals were identified: attacking the opponent’s public image and protecting the own public image. Likewise, the first of these strategies was sub-classified into the following tactics: discrediting, ridiculizing, and intimidating. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:1 & 2 Thessalonians by Douglas FarrowAnna Silvas1 & 2 Thessalonians by Douglas Farrow (Grand Rapids, MI: Brazos, 2020), xx + 336 pp.1 and 2 Thessalonians are probably the very first written testimonies of early Christianity. When Paul wrote 1 Thessalonians in AD 50, Our Lord Jesus Christ had "accomplished his exodus in Jerusalem" (see Luke 9:31) not twenty years before. Here we find the paradosis of the (...) Mystery of Christ among the Gentiles, the first articulations of Trinitarian faith (see 1 Thess 1:2-5), expressions of longing for the coming Parousia of Christ, warnings of a strange lawlessness already at work ripening towards a great apostasy and the coming of the "man of lawlessness."Douglas Farrow has pondered 1 and 2 Thessalonians for many years, attested by his numerous expositions and essays over three decades. He brings to his task a ready command of Greek, Hebrew, and Latin, and a vast reading of historical commentary and controversy, an intense personal and ecclesial faith, and a sense of historical, prophetic, and pastoral urgency.Throughout the book are excurses on themes opened up by the words and phrases of St Paul's text: Satan (82-86); the sexual body and virtue in sex, divorce, and remarriage (95-114); the remedial pains of purgatory (beginning in this life); the reality of final retribution, the finality of hell; the untenability of so-called "universalism" (131-41,178-84,192-96); the imminency and the delay of the Parousia (199-204); the apostasy / man of lawlessness / Antichrist; the temple in which the Antichrist seats himself (205-42); the mystery of lawlessness at work, especially in undermining the Church (245-61).In studying Paul's eschatological themes, Farrow necessarily ponders other scriptural texts leading in the same direction: Dani 7-12; Jesus's Olivet Discourse in its most extensive form at Matt 24:1-25:46 (though it really begins at 23:23); 2 Pet 2:1-5, 3:3-15; much of the Rev 6:1 through 19:21; [End Page 398] Deut 32:1-43 (Farrow says the Song of Moses encapsulates the whole of human history); Psalms 97 (LXX 96); 110 (LXX 109); Wis 4-5, 10-19; Sirach 50; Joel; Zech 8-14; Mai 3-4; 2 Mace 5-9; Isa 66:5,14-16; and so on. Farrow holds that Paul worked from knowledge of Jesus's apocalyptic teachings in aversion closest to Matthew's (138,142,184, 189, 205).Farrow takes companions in his exegesis: Irenaeus, Hippolytus, Cyril of Jerusalem, John Chrysostom, Augustine, Haimo, Anselm, Aquinas, and others. He knows Luther's hermeneutics and Calvinist disputes about supra- and infra-sessionism and double predestinationism. He consults more recent prophets, quoting at length from Newman's amazingly prescient 1838 discourses on the last times, Solovyovin 1899, and Fulton Sheen in 1948 and 1958. Another exegete is an artist: Luca Signorelli, whose Disputation of the Antichrist in Orvieto Cathedral Farrow refers to several times.Farrow shows his affinity with Irenaeus. That means cleaving to the visible and invisible truths of the Incarnation of God the Word, respecting concrete and embodied realities, keeping in view the transcendent goal ("The glory of God is a living man—and the life of man is in the vision of God"), instinctively flinching at gnosticizing tendencies—sophisticated re-interpretations of Scripture that elide the rule of faith and dissolve truth. It means a ruling sense of the Kingdom of God as an intervention from heaven rather than generating from man or from the earth. It means a spirit of obedience to the commandments, to the paradosis that descends to us from above in Christ, effected by the Spirit in the ecclesia, the company of brethren destined to "gather to Christ" at his coming (1 Thess 2:1), who practice that final gathering to Christ by participating in the Eucharist on the "Eighth Day," the Lord's Day.Farrow deplores the patchy reading of 1 and 2 Thessalonians in the lectionaries: "While 1 Thessalonians fares a little better, barely half of 2 Thessalonians is read in the Churches" (11). Missing is the eschatologically pivotal 2 Thess 2:3-15, where Paul, distinguishing... (shrink)

This paper carried out bibliographical and documentary investigation on exploratory research with a qualitative approach in collect and analysis of data by consulting the sites and documents of various religious groups, systematizing liturgical and spirituality understanding, checking divergences and convergences and producing key considerations about liturgical and theological aspects and pastoral practice, to contribute with integral mission practice. Cults and religious celebrations in different churches and denominations have certain rites and actions that give them specific characteristics in order to allow (...) its members to experience their faith in the celebrative space, at churches or in open spaces, this set takes the name liturgy. The so called Tridentine liturgy, while celebrative practices, is eminently clergy centered. The assumed liturgical language has become far from full understanding of most of the faithful. The great mass of Catholics could not deeply connect them with what was celebrated in its temples. With the opening of Vatican Council II and the discussions held under its auspices, on its subsequent sessions, there was a rethink that also intends to answer for the claims of local churches about various aspects of a liturgy that is more participatory. There is a set of tensions between those who remained in favor of the former rite, called Tridentine rite, and those according to the following rite set at the Second Vatican Council, both with allowed use by the Holy See. Differences between the rites, and theological and spiritual understandings alleged, the differences are not in the foundation of matter itself, since if we takes not the letter but the lex orandi spirit, both one and the other has the same requirements for the mystery celebration that is full of sacrifice dimensions, this deeply catechetical nature, and Passover, when Christ becomes present as sacrificial gift and scatological hope. It is found that on stir core is a necessary liturgical studies which influences on effective participation, in any of the rites, when used in the celebrations. (shrink)

The last 20 years have seen the development of a new form of therapy, compassion focused therapy. Although CFT has a growing evidence base, there have been few studies of CFT outside of an Anglo-European cultural context. In this paper, we ask: Might a CFT-based approach be of value for Indigenous Australians? If so, what kind of cultural adaptations might be needed? We report the findings from a pilot study of an arts-based compassion skills training group, in which usual CFT (...) group processes were significantly adapted to meet the needs of Indigenous Australians. At face value, CFT appeared to be a promising approach to enhancing the social and emotional wellbeing of Australia’s Indigenous peoples. However, despite initial consultations with Indigenous health professionals, the first attempts to offer a more conventional group-based CFT to Indigenous clients were largely unsuccessful. Following a review and advice from two Indigenous clients, we combined elements of CFT with visual arts to develop a new approach, “arts-based compassion skills training”. This paper reports an evaluation of this pilot ABCST group. The group had 6 × 4 h sessions of ABCST, facilitated by two psychologists and two artists. There were 10 participants, who attended between 2 and 6 sessions: five were clients, five were health professionals. Between 1 and 3 months later, six of the participants were interviewed. Qualitative analysis of interview data identified that two key processes—creating a positive group atmosphere and channeling compassion skills training through the medium of visual arts—led to four positive outcomes for participants: planting the seeds of new understandings, embodying the skills of compassion, strengthening relationships with others, and evolving a more self-compassionate relationship. We suggest that the preliminary results are sufficiently encouraging to warrant further development of ABCST in Indigenous communities. (shrink)

Before COVID-19, dementia singing groups and choirs flourished, providing activity, cognitive stimulation, and social support for thousands of people with dementia in the UK. Interactive music provides one of the most effective psychosocial interventions for people with dementia; it can allay agitation and promote wellbeing. Since COVID-19 has halted the delivery of in-person musical activities, it is important for the welfare of people with dementia and their carers to investigate what alternatives to live music making exist, how these alternatives are (...) delivered and how their accessibility can be expanded. This community case study examines recent practice in online music-making in response to COVID-19 restrictions for people with dementia and their supporters, focusing on a UK context. It documents current opportunities for digital music making, and assesses the barriers and facilitators to their delivery and accessibility. Online searches of video streaming sites and social media documented what music activities were available. Expert practitioners and providers collaborated on this study and supplied input about the sessions they had been delivering, the technological challenges and solutions they had found, and the responses of the participants. Recommendations for best practice were developed and refined in consultation with these collaborators. Over 50 examples of online music activities were identified. In addition to the challenges of digital inclusion and accessibility for some older people, delivering live music online has unique challenges due to audio latency and sound quality. It is necessary to adapt the session to the technology's limitations rather than expect to overcome these challenges. The recommendations highlight the importance of accessibility, digital safety and wellbeing of participants. They also suggest ways to optimize the quality of their musical experience. The pandemic has prompted innovative approaches to deliver activities and interventions in a digital format, and people with dementia and their carers have adapted rapidly. While online music is meeting a clear current need for social connection and cognitive stimulation, it also offers some advantages which remain relevant after COVID-19 restrictions are relaxed. The recommendations of this study are intended to be useful to musicians, dementia care practitioners, and researchers during the pandemic and beyond. (shrink)

Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires (...) researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)

Lack of guidance and regulation for authorizing medical cannabis for conditions involving the health and neurodevelopment of children is ethically problematic as it promulgates access inequities, risk-benefit inconsistencies, and inadequate consent mechanisms. In two virtual sessions using participatory action research and consensus-building methods, we obtained perspectives of stakeholders on ethics and medical cannabis for children and youth. The sessions focused on the scientific and regulatory landscape of medical cannabis, surrogate decision-making and assent, and the social and political culture (...) of medical cannabis. We found that evidence-gathering and data dissemination, pressures on clinical relationships, and the lack of integration of culturally diverse perspectives and Indigenous knowledges were key areas of concern. Participants emphasized the importance of utilizing adaptive study designs, highlighted the importance of trust-building between clinicians, patients and caregivers, and discussed barriers including historical and ongoing stigmatization of medical cannabis. We conclude that continued public consultation and strength-based research that integrate diverse perspectives are critical steps forward. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Dialogic Interpretation of Hume's Dialogues William Lad Sessions For all ofits prominence in contemporary Anglo-American philosophy of religion, Hume's Dialogues Concerning Natural Religion continues to provoke divergent readings, especially as regards its author's intentions and beliefs. Most writers today, following Norman Kemp Smith's masterful analysis, accept some version ofwhat I will call "the standard interpretation": Hume aimed to discredit religion—natural and revealed religion alike, but especially the (...) "experimental theism" represented by Cleanthes' so-called "design argument." Hence, the sceptic "Philo represents Hume's views onreligiousbelief,"even though Cleanthes (occasionally) and Demea(rarely) also speakfor Hume.1 But a significant minority have given divergentinterpretations: some have held that Pamphilus, the narrator of the Dialogues, is Hume;2 some have given credence to Hume's remark in a letter that "I make Cleanthes the Hero of the Dialogue";3 others think that none of the characters represent Hume, at least not consistently, either because the characters represent types, not individuals,4 or because none are "wholly consistent, completely clear-headed, and unmuddled throughout,"5 or because "it is the whole of the dialogue which represents Hume."6 One interpreter has even gone so far as to declare that "I shall take it that Hume in the Dialogues is any speaker who appears tobe makingagood philosophical point,"7 whichis tantamount to identifying Hume with any self-assured philosophical reader of the Dialogues] My chief purpose in this essay is not to take issue with these interpretations, nor to propose a novel interpretation of the text—though I will do both—but rather to promote a different kind of interpretation altogether: what I will call a "dialogic" interpretation, since it views the literary form as contributory and indeed essential to the philosophical message.8 Still, the particular dialogic interpretation I propose may be of interest. On it, the Dialogues are not chiefly a diatribe against theism, much less a polemic against all (theistic or Christian) religion. Rather, the book at its most searching level is a careful rational examination of"true" vs. "false" religion, with the virtues ofthe former commended even as the vices ofthe latter are condemned. In short, Hume gives us an eighteenth century discussion ofreligiousfaith in relation to human Volume XVII Number 1 15 WILLIAM LAD SESSIONS reason, a discussion wherein reason is not automatically the enemy of faith (in all its guises). More specifically, Philo's and Cleanthes' apparent disagreements on the results and utility ofnatural theology mask a more fundamental and considerably more important harmony in their views concerning "the proper office ofreligion."9 Contrary to the standardinterpretation, they fundamentally agree on the nature and value of natural piety, which is the other component of natural religion besides natural theology.10 In the end, then, Pamphilus is not wrong to judge that Cleanthes' principles "approach still nearer to the truth" than Philo's, and not merely for reasons of filial piety (he is, after all, Cleanthes' house-guest, his loyal student, and his "adopted son"). No doubt Philo does tend to "win" his skirmishes in natural theology with Cleanthes (not to mention those with Demea!), but though Philo triumphs tactically, Cleanthes is the victor in the wider war for Pamphilus' heart and mind: critical scepticism may be a useful safeguard for careful thinkers against the "superstition" endemic to "false" and harmful piety, butitsutilityislimited; Philo's prophylaxisis muchless effective than Cleanthes' empirical theism at the vitally important task of inculcating and nurturing "true" natural piety in a young person such as Pamphilus. However, before supporting this controversial view of the Dialogues, I need to make clearer the nature, limits and value of a dialogic interpretation, by way of contrast with the more common approaches. I. Standard Hermenéutica Most philosophical interpretations of the Dialogues share several assumptions—or perhaps one should say "presumptions." First, they all focus on the propositions, beliefs, and arguments expressed by characters in the Dialogues—their claims, assertions, speculations, suggestions, rejections, replies, reasons, rebuttals, and the like—and they seek to extract from the discussion those expressed or implied beliefs and arguments which current interpreters believe most worthy of continuing philosophical adherence, development, demolition, or at least discussion. Literary... (shrink)

This paper is concerned with autonomous learning of plans in probabilistic domains without a priori domain-specific knowledge. In contrast to existing reinforcement learning algorithms that generate only reactive plans and existing probabilistic planning algorithms that require a substantial amount of a priori knowledge in order to plan, a two-stage bottom-up process is devised, in which first reinforcement learning/dynamic programming is applied, without the use of a priori domain-specific knowledge, to acquire a reactive plan and then explicit plans are extracted from (...) the reactive plan. Several options for plan extraction are examined, each of which is based on a beam search that performs temporal projection in a restricted fashion, guided by the value functions resulting from reinforcement learning/dynamic programming. Some completeness and soundness results are given. Examples in several domains are discussed that together demonstrate the working of the proposed model. (shrink)

The paper presents an approach for developing multi-agent reinforcement learning systems that are made up of a coalition of modular agents. We focus on learning to segment sequences (sequential decision tasks) to create modular structures, through a bidding process that is based on reinforcements received during task execution. The approach segments sequences (and divides them up among agents) to facilitate the learning of the overall task. Notably, our approach does not rely on a priori knowledge or a priori structures. Initial (...) experiments demonstrated the basic promise of the approach. This work shows how bidding and reinforcement learning can be usefully combined, thus pointing to a new research direction. (shrink)