Volume 20, Issue 4, May 2020, Page 35-37.

BackgroundSarcomas are a diverse group of neoplasms that vary greatly in clinical presentation and responsiveness to treatment. Given the differences in the sites of involvement, rarity, and treatment modality, a multidisciplinary approach is required. Previous literature suggests patients with sarcoma suffer from poorer quality of life especially physical and functional wellbeing. Adolescent and young adult patients are an underrepresented population in cancer research and have differing factors influencing QoL.MethodsRetrospective analysis of Young Adult patients enrolled in the Sarcoma Tissue Repository at (...) University of Iowa. QoL was assessed using the self-report FACT-G questionnaire at enrollment and 12 months post-diagnosis; overall scores and the 4 wellbeing subscales were calculated. Linear mixed effects models were used to measure the association between the rate of change in FACT-G subscale scores and baseline clinical, comorbidity, and treatment characteristics.Results49 patients were identified. 57.1% of patients had a malignancy involving an extremity. Mean FACT-G scores of overall wellbeing improved from baseline to 12 months. Social and emotional wellbeing did not differ significantly between baseline and 12 months. Physical wellbeing and functional wellbeing scores improved from baseline to 12 months. No difference was seen for FACT-G overall scores for age, sex, laterality, marital status, performance status, having children, clinical stage, limb surgery, chemotherapy, or tumor size. A difference was demonstrated in physical wellbeing scores for patients with baseline limitation compared to those with no baseline limitation. A difference was demonstrated in social wellbeing based on anatomical site.ConclusionYoung adults with sarcoma treated at a tertiary center had improvements in overall reported QoL at 12 months from diagnosis. Overall baseline QoL scores on FACT-G were lower than the general adult population for YA patients with sarcoma but at 12 months became in line with general population norms. The improvements seen merit further investigation to evaluate how these change over the continuum of care. Quality of life changes may be useful outcomes of interest in sarcoma trials. (shrink)

Background: Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic. Objective: To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency. Research design: A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 (...) nurses caring for Covid-19 patients in the acute care units within large academic medical systems in Maryland and New York City during April to June 2020. Ethical considerations: We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore. Results: We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies. Discussion/Conclusion: Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences. (shrink)

At the end of World War II, Congress terminated the only national day care policy ever enacted to that point in the United States. It was nearly 20 years later, with the 1962 Public Welfare Amendments, that the American state launched the next national experiment in day care. This policy was constructed not in response to the needs of working women but rather to address rising concerns over the Aid to Dependent Children program. In this article, the author (...) examines archival data from the U.S. Women's Bureau, the U.S. Children's Bureau, and other agencies to explain the transformation of day care from an employment policy to an adjunct of ADC. She argues that maternalists within the state were able to redefine the content of maternalist ideology to occupy the discursive space produced by the emergent political crisis in the ADC program. This new maternalism provided the grounds for a new national commitment to day care provision but also created the institutional structures of its marginalization. (shrink)

This insightful book uniquely charts the events, experiences and challenges faced by teachers during and beyond the COVID-19 pandemic including periods of national lockdowns and school closures. Research-based and evidence informed, this key title explores the multiple media outputs created by teachers in a variety of different socio-economic contexts. The authors reflect on their stories through a series of themed analyses, as well as describe and discuss key issues related to the enactment of teacher professionalism in challenging times. With fascinating (...) vignettes and interview extracts that reinforce the idea that teachers can manage rather than survive, this book unveils a strong sense of moral purpose, professional identity, commitment, care, and resilience. It will be of interest to teachers, headteachers and teacher educators internationally. (shrink)

From the perspective of gender theory, the intersections among gender, class, and race make it difficult, if not impossible, to assign political issues and identities to just one social movement. Instead, the negotiation of movement ownership of issues and identities occurs through interaction among social movements, including interactions that create denial and distance. This article takes the interaction of labor organizing and feminism as the lens for studying movement interaction at three levels: opportunity structure, organizing practices, and framing ideas. Using (...) a case study of a strike of day care workers in West Berlin in the winter of 1989-90, it contrasts inclusive and exclusive forms of solidarity and their consequences for organizational practices. This particular strike received little support from either feminists or the labor movement and eventually failed, an outcome that can be seen as reflecting the weakness of structural and organizational supports for frames favoring inclusive solidarity. (shrink)

Many parents are hesitant about, or face motivational barriers to, vaccinating their children. In this paper, we propose a type of vaccination policy that could be implemented either in addition to coercive vaccination or as an alternative to it in order to increase paediatric vaccination uptake in a non-coercive way. We propose the use of vaccination nudges that exploit the very same decision biases that often undermine vaccination uptake. In particular, we propose a policy under which children would be vaccinated (...) at school or day-care by default, without requiring parental authorization, but with parents retaining the right to opt their children out of vaccination. We show that such a policy is likely to be effective, at least in cases in which non-vaccination is due to practical obstacles, rather than to strong beliefs about vaccines, ethically acceptable and less controversial than some alternatives because it is not coercive and affects individual autonomy only in a morally unproblematic way, and likely to receive support from the UK public, on the basis of original empirical research we have conducted on the lay public. (shrink)

What follows is one piece of a series of conversations that I conducted with a small group of young children in a day care center where I was working in 1983. The children were between the ages of 3 and 6, and we had been together long enough to speak frankly and comfortably with each other. I used small group time to ask six questions, all of them about the ultimate issues - the origins, ends, and limits of things, (...) death, dreams, soul, spirit, self, God, evil. Taken together, the conversations we had make for a transcript of 65 manuscript pages. The issues raised there are many, and provoke questions not only about how young children think, but how adults influence them to think. The issues taken up below - the origins of things - was continued past this conversation, and its sequel will appear in the next issue of Analytic Teaching. Although the text tends to speak for itself, a few comments on the pattern of the conversation follow the transcript. (shrink)

The practice around informed consent in clinical medicine is both inconsistent and inadequate. Indeed, in busy, contemporary health care settings, getting informed consent looks little like the formal process developed over the past sixty years and presented in medical textbooks, journal articles, and academic lectures. In this article, members of the Society of Teachers of Family Medicine (STFM) Collaborative on Ethics and Humanities review the conventional process of informed consent and its limitations, explore complementary and alternative approaches to doctor‐patient (...) interactions, and propose a new model of consent that integrates these approaches with each other and with clinical practice. The model assigns medical interventions to a consent continuum defined by the discrete categories of traditional informed consent, assent, and nondissent. Narrative descriptions and clinical exemplars are offered for each category. The authors invite colleagues from other disciplines and from the academic ethics community to provide feedback and commentary. (shrink)

Erik Wielenberg recently invoked the parent-child analogy in an argument against Christian theism. The argument relies on the claim that a loving parent would never allow her child to feel abandoned in the midst of what feels like gratuitous suffering. In this paper, I offer three clear counterexamples to Wielenberg’s central premise. At the same time, a successful counterexample does not a robust theology of suffering make. To that end, and with a careful eye towards anti-theodical concerns, I defend the (...) need for a more proactive Christian philosophical examination of the role of suffering in a meaningful life. (shrink)

This chapter is a substantially expanded version of (and so substantially supersedes) “Words Fail Me. (Stanley Cavell’s Life Out of Music)” that appeared in Inheriting Stanley Cavell: Memories, Dreams, Reflections (Bloomsbury, 2020). It offers to read Cavell’s claim that “philosophy, of a certain ambition, tends perpetually to intersect the autobiographical.” Its guiding thought is that a life that finds a home in philosophy from out of its devotion to music (as is true of, among others, Rousseau, Nietzsche, and Wittgenstein, all (...) philosophers Cavell wrote about and cared about) will take on a certain character. In Cavell’s case, his distinctive orientation in philosophy—call this his lifelong coming to terms with his abandoning a life in music—is guided in part by (1) an interest in those moments in experience where words seem to run out, or veer toward nonsense, leaving in their wake touchstones of ecstasy; and (2) an interest in the education of the senses, without which interest we risk their starvation. These twin claims are illustrated through an interweaving of remarks and reminiscences of Cavell on music that culminate in a reading of his last published pieces devoted to music, primarily “Impressions of Revolution.”. (shrink)

The present paper illustrates an autobiographical writing experience carried out in a therapeutic day care center involving nine preadolescents and adolescents with moderate to severe mental distress. According to the literature, autobiographical writing is an useful tool to improve educational work with teenagers, because it can accommodate the need to express themselves that characterizes the adolescence and can prevent or reduce feelings of distress. Autobiographical practice is particularly suitable to work with teenagers because it is focused on the question (...) “Who am I?”, which is typical of adolescence. This question was the central theme of the autobiographical writing workshop. During the workshop, was proposed an introspective journey in search of one’s identity between past (who was I?), present (who am I?) and a possible future (who do I want to become?). This article will describe the themes and various stimuli that were proposed during the meetings and will present and discuss the results achieved. (shrink)

"William Day is . . . concerned to explore the dynamics of what Cavell calls 'a theology of reading' through a careful examination of a fragment of the philosopher's autobiography first published as 'Excerpts from Memory' (2006) and subsequently revised for Little Did I Know (2010). If, as Cavell suggests, 'the underlying subject' of both criticism and philosophy is 'the subject of examples', in which our interest lies in their emblematic aptness or richness as exemplars, exemplarity becomes central to the (...) aim of our reading. . . . Day considers how autobiography as a genre is preoccupied with the question of the author's exemplarity (Augustine or Rousseau), and in Cavell's retelling in 'Excerpts from Memory' he discusses how an event that Cavell would have us read allegorically - his move at the age of seven to a new apartment, his coming upon a familiar bowl containing nonpareils, his remark upon this to his father and his father's violent reaction - recasts a scene of paternal hatred as the child's offer of communion. Day suggests that this retelling proves to be redemptive: first, of the incident itself, and second, of the reader's own experience. Seeing how to read this autobiographical life as exemplary helps us to transfigure our own moments of deprivation into so many possibilities for freedom." --James Loxley and Andrew Taylor, introductory chapter to Stanley Cavell: Philosophy, Literature and Criticism, 15-16. (shrink)

This is an abridged, paperback edition of Peter le Huray and James Day's invaluable anthology of writings concerned with the role of music in eighteenth- and early-nineteenth-century aesthetics. This volume retains all the most important and significant items from the original hardcover edition. Over fifty writers are represented here, including such major figures as Rousseau, Kant, Schlegel, Schopenhauer and Hegel, and the useful introductions and biographical details of the original are also retained. The aesthetic literature of the period is profuse (...) but this carefully edited volume offers a balanced selection which illuminates the ways people experienced music and how they came to an understanding in particular of the new music of their day. (shrink)

"William Day is . . . concerned to explore the dynamics of what Cavell calls 'a theology of reading' through a careful examination of a fragment of the philosopher's autobiography first published as 'Excerpts from Memory' (2006) and subsequently revised for Little Did I Know (2010). If, as Cavell suggests, 'the underlying subject' of both criticism and philosophy is 'the subject of examples', in which our interest lies in their emblematic aptness or richness as exemplars, exemplarity becomes central to the (...) aim of our reading. . . . Day considers how autobiography as a genre is preoccupied with the question of the author's exemplarity (Augustine or Rousseau), and in Cavell's retelling in 'Excerpts from Memory' he discusses how an event that Cavell would have us read allegorically - his move at the age of seven to a new apartment, his coming upon a familiar bowl containing nonpareils, his remark upon this to his father and his father's violent reaction - recasts a scene of paternal hatred as the child's offer of communion. Day suggests that this retelling proves to be redemptive: first, of the incident itself, and second, of the reader's own experience. Seeing how to read this autobiographical life as exemplary helps us to transfigure our own moments of deprivation into so many possibilities for freedom." --James Loxley and Andrew Taylor, introductory chapter to Stanley Cavell: Philosophy, Literature and Criticism, 15-16. (shrink)

Patient’s decision making competence is a widely discussed subject. Issues of competence, autonomy, well-being and protection of the patient come up every day. In this article we analyse what role PDMC plays in Dutch legislation and what dilemmas healthcare professionals may experience, notably in patients suffering from Korsakoff’s syndrome. Dilemmas emerge if professionals want to meet the requirements mentioned in Dutch law and the desires of their patients. The autonomy of the patient and the healthcare professionals’ duty to take (...) class='Hi'>care of their patient’s best interests, create a tension and lead to uncomfortable situations. Healthcare professionals describe difficulty finding a balance between these issues and assessing the degree of mental competence still present. In long term care situations, quality of the relationship between healthcare professionals and their patients seems to be of much more importance in decision making on minor issues of competence than simply relying on legal or house rules. In being committed to their cases, professionals will be more sensitive to individuals habits, abilities, welfare and dignity, which will make it easier to decide on issues of competence, and to find creative solutions to their dilemmas. (shrink)

BackgroundCommunity engagement is increasingly promoted as a marker of good, ethical practice in the context of international collaborative research in low-income countries. There is, however, no widely agreed definition of community engagement or of approaches adopted. Justifications given for its use also vary. Community engagement is, for example, variously seen to be of value in: the development of more effective and appropriate consent processes; improved understanding of the aims and forms of research; higher recruitment rates; the identification of important ethical (...) issues; the building of better relationships between the community and researchers; the obtaining of community permission to approach potential research participants; and, the provision of better health care. Despite these diverse and potentially competing claims made for the importance of community engagement, there is very little published evidence on effective models of engagement or their evaluation.MethodsIn this paper, drawing upon interviews with the members of a Community Advisory Board on the Thai-Myanmar border, we describe and critically reflect upon an approach to community engagement which was developed in the context of international collaborative research in the border region.Results and conclusionsDrawing on our analysis, we identify a number of considerations relevant to the development of an approach to evaluating community engagement in this complex research setting. The paper also identifies a range of important ways in which the Community Advisory Board is in practice understood by its members to have morally significant roles and responsibilities beyond those usually associated with the successful and appropriate conduct of research. (shrink)

This essay provides a comprehensive overview of Charles Darwin's evolutionary theorizing about the natural origins of religion. More specifically, it argues that Darwin's commitment to locating elementary forms of the religious life in non-human animals was informed by his desire to sever the connection between the moral status of being human and the anthropological status of having a religion. The essay concludes that when we carefully examine the Darwinian solution to the evolutionary puzzle of religion, we discover how his naturalist (...) project was structured in quite fundamental ways by his normative commitments. (shrink)

Whilst the nature of human illness is not determined by time of day or day of week, we currently structure health service delivery around a five-day delivery model. At least one country is endeavouring to develop a systems-based approach to planning a transition from five- to seven-day healthcare delivery models, and some services are independently instituting program reorganization to achieve these ends as research, amongst other things, highlights increased mortality and morbidity for weekend and after-hours admissions to hospitals. In this (...) article, we argue that this issue does not merely raise instrumental concerns but also opens up a normative ethical dimension, recognizing that clinical ethical dilemmas are impacted on and created by systems of care. Using health policy ethics, we critically examine whether our health services, as currently structured, are at odds with ethical obligations for patient care and broader collective goals associated with the provision of publicly funded health services. We conclude by arguing that a critical health policy ethics perspective applying relevant ethical values and principles needs to be included when considering whether and how to transition from five-day to seven-day models for health delivery. (shrink)

Although the theological elements of Robert Boyle’s mechanical philosophy have received careful scrutiny, his reflections on economic issues have largely been overlooked. This article takes a small step towards redressing this state of affairs. Rather than argue that Boyle – like John Locke or David Hume – was as interested in political economy as he was in discovering the nature of Nature, the article treats him as a point of entry for considering how early-modern England negotiated the revolutionary cultural and (...) economic changes that emerged as capitalism took command. More specifically, it uses one of Boyle’s less-famous inventions – a hydrostatic device for discriminating between real, degraded and counterfeit coinage – in order to explore how economic exchange began to acquire a patina of ‘objectivity’ in the 17th-century imagination. (shrink)

There has been considerable recent debate about prostitution in Europe that reflects concerns about health, employment and human rights. Legal changes are being introduced in many countries. We focus on two examples in order to discuss the likely implications. A new law in The Netherlands is normalizing aspects of the sex industry through decriminalizing both workers and businesses. In Sweden, on the other hand, prostitution is considered to be a social problem, and a new law criminalizes the purchasers of sexual (...) services in an attempt to reduce demand. Both reforms appear to have had their desired effect at one level; in The Netherlands, health and safety regulations will be introduced as in any other job, and EU sex workers gain full social, legal and employment rights; in Sweden there was initially a tenfold decrease in the numbers of women working visibly on the streets, and some workers have left the industry. However, in both countries, the new legislation has also driven some sex work underground. Many sex workers are excluded by the Dutch system and move underground to become effectively invisible to the authorities. In Sweden sex workers and their clients also become less visible in order that the latter can avoid sanction. Social and economic changes, such as increased migration and the growing use of the Internet will also render the sex industry less visible both to state regulation and to health care workers. The major problems of prostitution for the workers remain exploitation, stigma, abuse and criminalization. These are not unique to the industry, and can only be tackled effectively by the self-organization of sex workers into unions and rights groups, along with full decriminalization. An alternative vision is promised through self-organization and anti-racist actions by sex workers in Germany; normalization and workers’ rights are tackled alongside training programmes for those seeking alternatives. Policy makers throughout Europe would do well to look at their experience and not simply at the clash of legal reforms. (shrink)

Although primary source work is a major component of undergraduate history degrees in many countries, the topic of how best to support this work has been relatively unexplored. This article addresses the pedagogical support of primary source work by reviewing relevant literature to identify the challenges undergraduates face in interpreting sources, and examining how in two courses carefully articulated course design and supportive teaching activities assisted students to meet these challenges. This fine-grained examination of the courses is framed within a (...) socio-cultural account of learning. The findings show how a skilful drawing of students into the interpretive/discursive practices of source analysis was associated with an epistemological reframing of historical knowledge and dialogical forms of teaching that helped the students to take forward a dialectical engagement with sources. The benefits of an ‘integrated’ approach to source work that fosters students’ affective and intellectual engagement with historical interpretive practices are highlighted. (shrink)

Those who find their work meaningful often need to be more committed. Over-commitment, in turn, frequently results in stress, personal conflicts, and burnout. Such over-commitment, in other words, leads to employees needing to take more care of themselves. This paper considers the prospects for meaningful self-care in the context of working time reduction. For this, we consider the case of the four-day workweek, asking employees of such organizations to explain how they make meaning out of their newly found (...) time off. Conceptually, we rely upon the work of Michel Foucault, particularly his analysis of the care of the self. On its basis, we coded five self-care practices: (1) rest and recuperation, (2) professional and personal development, (3) domestic work, (4) balancing work, and (5) additional work. We conclude by highlighting the theoretical and practical implications of work reduction for the analytical, ethical, and practical pursuit of meaningful work. (shrink)

As the number of people affected by dementia increases rapidly, dementia has been transformed into an epidemic which endangers global health and wealth, and many populations are now living in what Jain terms a time of prognosis, in fear of the disease. Through its strong association with ageing and memory loss, dementia is conceived of as a linear decline into loss of self and death, and those with dementia as other. More significantly, imagined as a threat that signifies both a (...) loss of able-bodied workforce and a large population dependent on care and support, dementia inevitably feeds into the ‘crisis-of-care’ narrative that is prominent in many ageing societies. With one of the fastest ageing populations in the world, and an extremely low birth rate, the dementia prognosis is particularly acute in Japan and dementia is strongly linked to the idea of a ‘care crisis’. This situation has produced an increasing number of cultural representations of dementia and care and this paper considers three of these cultural texts, all rooted in the historical and cultural contexts in which they were produced: the novel The Twilight Years; the film Memories of Tomorrow; and the comic book Pecoross’ Mother and Her Days. The analysis concentrates upon their representations of care, seeing this as a space where the ethical relationship between self and other can be negotiated and where time with dementia can be imagined and re-imagined. The analysis of these texts from a feminist ethics perspective demonstrates the potential of popular and creative representations to interrogate and potentially expand the meanings of dementia, ageing and living in prognosis. (shrink)

Community engagement is increasingly promoted as a marker of good, ethical practice in the context of international collaborative research in low-income countries. There is, however, no widely agreed definition of community engagement or of approaches adopted. Justifications given for its use also vary. Community engagement is, for example, variously seen to be of value in: the development of more effective and appropriate consent processes; improved understanding of the aims and forms of research; higher recruitment rates; the identification of important ethical (...) issues; the building of better relationships between the community and researchers; the obtaining of community permission to approach potential research participants; and, the provision of better health care. Despite these diverse and potentially competing claims made for the importance of community engagement, there is very little published evidence on effective models of engagement or their evaluation. (shrink)

Decisions related to births in the “gray zone” of periviability are particularly challenging. Despite published management guidelines, clinicians and families struggle to negotiate care management plans. Stakeholders must reconcile conflicting values in the context of evolving circumstances with a high degree of uncertainty within a short time period. Even skilled clinicians may struggle to guide the patient in making value–laden decisions without imposing their own values. Exploring the experiences of one pregnant woman and her caregivers, this case study highlights (...) how bias may undermine caregivers’ ability to meet their obligation to enhance patient autonomy and the moral distress they may experience when a patient’s values do not align with their own. Management strategies to mitigate the potential impact of bias and related moral distress are identified. The authors then describe one management strategy used in this case, facilitated ethics consultation, which is focused on thoughtful consideration of the patient’s perspective. (shrink)

BackgroundImportant sex and gender differences have been found in research on diabetes complications and treatment. Reporting on whether and how sex and gender impact research findings is crucial for developing tailored diabetes care strategies. To analyze the extent to which this information is available in current diabetes research, we examined original investigations on diabetes for the integration of sex and gender in study reporting.MethodsWe examined original investigations on diabetes published between January 1 and December 31, 2015, in the top (...) five general medicine journals and top five diabetes-specific journals (by 2015 impact factor). Data were extracted on sex and gender integration across seven article sections: title, abstract, introduction, methods, results, discussion, and limitations.ResultsWe identified 155 original investigations on diabetes, including 115 randomized controlled trials (RCTs) and 40 observational studies. Sex and gender were rarely incorporated in article titles, abstracts and introductions. Most methods sections did not describe plans for sex/gender analyses; 47 (30.3%) articles described plans to control for sex/gender in the analysis and 12 (7.7%) described plans to stratify results by sex/gender. While most articles (151, 97.4%) reported the sex/gender of study participants, only 10 (6.5%) of all articles reported all study outcomes separately by sex/gender. Discussion of sex-related issues was incorporated into 21 (13.5%) original investigations; however, just 1 (0.6%) discussed gender-related issues. Comparison by journal type (general medicine vs. diabetes specific) yielded only minor differences from the overall integration results. In contrast, RCTs performed more poorly on multiple sex/gender assessment metrics compared to observational studies.ConclusionsSex and gender are poorly integrated in current diabetes original investigations, suggesting that substantial improvements in sex and gender data reporting are needed to inform the evidence to support sex- and gender-specific diabetes care. (shrink)

This article reviews the primary avenues of judicial challenge to the ACA, focusing on those that have reached, or have the potential to reach, the Supreme Court. The review demonstrates how deep-seated public policy opposition can be expressed through litigation.

In light of the ramifications for Spenserian hermeneutics in the Proems to Books Two (“unseen” reality) and Three (“living art”) of The Faerie Queene, this essay reads Prince Arthur’s account of his dream-vision of Gloriana (1.9) as an allegory for how the reader ideally should encounter and make meaning from the poet’s text. Spenser’s concept of “living art” echoes Dante’s “living language,” and both show the influence of Augustine, especially as regards the readerly agency called for in the Christian Doctrine (...) and the Confessions. Places of textual obscurity (the “unseen”) mark opportunities for the reader to exercise and develop the capacity to generate interpretations, a process both the effect and the cause of virtue. This process is figured in Arthur’s memory of his dream of the Faerie Queen and how it inspires him to pursue her. (shrink)

Background: While sustainability is a key concept in many different domains today, it has not yet been sufficiently emphasized in the healthcare sector. Earlier research shows that ethical values and evidence-based care models create sustainability in care practice. Objective: The aim of this study was to gain further understanding of the ethical values central to the realization of sustainability in care and to create an ethical practice model whereby these basic values can be made perceptible and active (...) in care practice. Research design: Part of the ongoing “Ethical Sustainable Caring Cultures” research project, a hermeneutical application research design was employed in this study. Participants: Dialogues were used, where scientific researchers and co-researchers were given the opportunity to reflect on ethical values in relation to sustainability in care. Findings: An ethical practice model with ethos as its core was created from the results of the dialogues. In the model, ethos is encircled by the ethical values central to sustainability: dignity, responsibility, respect, invitation, and vows. Discussion: The model can be used as a starting point for ethical conversations that support carers’ reflections on the ethical issues seen in day-to-day care work and the work community, allowing ethical values to become visible throughout the entire care culture. Conclusion: It is intended as a tool whereby carers can more deeply understand an organization’s common basic values and what they entail in regard to sustainability in care. (shrink)

“Only about 25 percent of the employees in child-care operations around the country have had professional training in dealing with children.”—_Newsweek_ This book is a proven, practical approach to providing that training at a minimum of expense and disruption of services. Written for trainers, it may profitably be used by any individual who wants to know more about positive methods for working with children. The information provided here has been used extensively to train child-care providers throughout Illinois. Covered (...) in detail are discipline, professionalism, child and adult communication, child development, observation, assessment, play, nutrition, health and safety, parent involvement and education, child abuse, developmental care, and organization of the environment. Illinois Governor James Thompson, former DCFS Director Gregory Coler, and DCFS Director Gordon Johnson have all endorsed these materials by continuing to recommend them for day-care training in Illinois. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Care of the terminal patient:Are we on the same page?Lauren WancataIn surgical training a “service” or care team consists of sick patients admitted to the hospital and the medical team caring for the patient. Each service consists of an attending physician, a chief resident, a senior resident and junior residents structured as a hierarchy. The chief was gone for the week. As a senior trainee I would (...) be the acting chief—a role I had assumed many times before this month. To prepare for the week of his absence, I read through each patient’s chart, and the chief and I discussed each patient—diagnosis, procedures, and plans.One was a 41–year–old male with cancer—he was young, but a patient like him was not uncommon at my institution. He originally came in through the emergency department with abdominal pain and difficulty with urination. His admitting medical team started the work–up for his symptoms—blood tests, a CAT scan, and consults to other physician services with specialized knowledge. He eventually underwent endoscopy with biopsies of his stomach and placement of stents into his ureter and kidney for his urinary issues. With return of the biopsies, he had a diagnosis—cancer. He required additional procedures, including the placement of stents into his bile ducts, as they, like his ureter, had become affected by the cancer. The next step was staging the cancer to determine his treatment options. Our surgical service was consulted for a diagnostic laparoscopy with washing—we would take a look inside his abdomen with a camera and obtain a fluid sample to be sent to the pathologist for review, the standard of care for this type of cancer. When the camera was placed nodules were seen—a sample of the nodules and the fluid were sent to a pathologist and determined to be positive for cancer: metastatic disease, stage IV. A special feeding tube was placed into his small intestine to aid in nutritional support, as he had already lost a significant amount of weight, and improving his nutrition would be imperative for any further treatments. Following this operation, oversight of his day–to–day care was taken on by our surgical service, and he had been under our care for a period of time before I rotated onto the service for the month.What was the plan for his care in the hospital, and what was his–long–term plan? His cancer could not be surgically removed due to the extent of its spread within his body. He had recently undergone another CAT scan due to an elevation in his white blood cell count (this elevation was a sign of possible infection) and a thoracentesis, a procedure to remove some of the fluid that was collecting around his lungs. Nephrologists (kidney specialist) had been consulted due to his declining kidney function. Throughout the days, his tube feeds, his source of nutrition, would often be turned off due to bloating and feeling full.Each morning, I rounded with our team, and we would see how he was doing. We would discuss how his night went, and make a plan for the day. He was a man of few words, but his wife was always at his bedside, to support him, listen to updates and keep tract of his progress. She had worked at the hospital and had seen a wide range of patients. She would ask about his kidney function, his tube feeds, and his labs. But, she never asked about his prognosis. I would leave his room each day with the unnerving feeling that the patient, family members and care team were not on the same page. Yes, we all wanted him to get better and to leave the hospital. [End Page 28] But, was he really going to get better? What defined better? Did the patient and his family really know the extent of his disease and his prognosis?Towards the end of my week as chief, I started to ask if they had any other questions. It had been a few weeks since his operation. Was there anything that they wanted to discuss or ask me about? At the... (shrink)

Walter Conn's theory of Christian Conversion (1986) provides an illuminating lens for understanding Dorothy Day's conversion experience. Day's story, conversely, offers an opportunity to test selected features of Conn's theory, specifically the affective, cognitive, moral, and religious categories of analysis. The dialectic is a fruitful one, yielding insight into both Day's story and Conn's theory, while at the same time raising provocative questions about and contributing to the current debate regarding an "ethic of care" as distinct from an "ethic (...) of justice.". (shrink)

Objective: This main aim of the study is to explore COVID-19 pandemic problems from the perspective of public health-clinical care ethics through online mediareports in Turkey. Method: This research was designed as a descriptive and qualitative study that assesses COVID-19 through online media reports on critics between the periods of March 11, 2020 and April 2 2020 as a quantitative as number of reports and qualitative study, across Turkey. Reports were from Turkish Medical Association websites which included newspaper reports. (...) Study data were presented as statistically and qualitative data case and headlines. No ethical or ofTicial permission was sought as the study was conducted through open access internet news sites. Results: This online reports analysis retrieved about 6723 articles about the COVID-19. According to study data, information about COVID-19 were themed as follows: general deTiciencies in taking action and isolation, lack of isolation, passengers and transport vehicles not quarantined ; insufTicient diagnostic tests, decision to test after healthcare professionals become infected, lack of equipment, lack of evaluation outbreak countries [Table 2]. Conclusion and Suggestions: COVID-19 is a pandemic and is a global public health problem that concerns every individual and needs to be handled carefully. This requires a multi-faceted preparation and education. In this context, healthcare professionals should be well trained in this aspect and have all the necessary equipment throughout the process. Additionally, it should work systematically with the cooperation of all health organizations, the Ministry of Health, local governments and of course the media, in order to inform society, fairly distribute the resources and to implement the safety measures effectively. BrieTly, lack of transparency, insufTicient information, limited resources, lack of public health protection measures such as partial quarantine decision, partial implementation of the scientiTic board's re c ommenda ti on s fo r e c on omi c rea s on s, and contradiction of the explanations are revealed as serious ethical problems. (shrink)

Managed care has brought wide-ranging changes to the health care system. Some of these changes have been well publicized. Among them are the financial pressures that have resulted in numerous mergers of health care institutions, the restriction on the ability of patients to select their physician of choice, and the ever diminishing number of days that patients are permitted to stay in the hospital. Individual physicians, too, have been affected. For example, they are under pressure to see (...) more patients per unit time and to use fewer resources. Utilization review and payment methods may make them reluctant to undertake the full set of diagnostic tests and therapeutic interventions when they might otherwise have done so. (shrink)

Collections of living organisms are reservoirs of biological knowledge that operate across times and places. From the mid-20th century, scientific institutions dedicated to the cultivation of such collections have routinized and professionalized their care. But “care,” for these collections, is focused not just on individual organisms—instead, a principal aim of a curator is to maintain the integrity of a reproducing “strain,” “variety,” “line,” or “stock,” and the composition of a collection as a whole. This paper explores the forms, (...) the material dimensions, the temporalities, and the values of that care, to recover the conditions under which scientist-custodians maintain continuity of research over many decades. This paper does so by focusing on two rather different kinds of scientific collection: that of Drosophila fruit flies on the one hand, and plant seeds on the other. Their comparison is valuable because their vastly different needs and life cycles engender very different practices of care. Comparing the materialities, life cycles, needs, and values of these divergent collections helps to draw attention to the routine and the apparently mundane. First, the paper asks: what kinds of work go into managing such collections—that is, the day-to-day management and cultivation, surveillance, and administration of information? Second, it asks: how do these practices maintain the integrity of the strains and stocks, and the collections themselves? What kinds of value does this work create? Third, what are the future imaginaries that are rhetorically drawn into the funding strategies of these collections, and how do they envision future use, ownership, and control? (shrink)

The public funding of early years education and care in England has been transformed. Historically, local councils had the main responsibility for decisions regarding nursery education and child day care, but in 1996 the Conservative government introduced a nursery education voucher scheme. Parents of four-year-olds could exchange the voucher for three terms of part-time ‘preschool provision’ in a state maintained nursery or primary school, or in a private, voluntary or independent (PVI) provider of child day care; in (...) 1998, the Labour government replaced the voucher with an entitlement to free part-time ‘early education’. The entitlement was expanded progressively and in 2017 the Conservative government introduced 30 h per week free ‘childcare’ for some children, together with an Early Years National Funding Formula. Funding goals and policy have shifted over time, underpinned by the idea of ‘a level playing field’ between providers in maintained and PVI sectors. However, there is no statutory requirement for PVI settings to employ qualified teachers, militating against a genuine ‘level playing field’ and the integration of education and care. (shrink)

Background: Neonatal nurses report a great deal of ethical challenges in their everyday work. Seemingly trivial everyday choices nurses make are no more value-neutral than life-and-death choices. Everyday ethical challenges should also be recognized as ethical dilemmas in clinical practice. Research objective: The purpose of this study is to investigate which types of ethical challenges neonatal nurses experience in their day-to-day care for critically ill newborns. Research design: Data were collected through semi-structured qualitative in-depth interviews. Phenomenological-hermeneutic analysis was applied (...) to interpret the data. Participants and research context: Six nurses from neonatal intensive care units at two Norwegian hospitals were interviewed on-site. Ethical considerations: The study is designed to comply with Ethical Guidelines for Nursing Research in the Nordic Countries and the Helsinki declaration. Findings: Findings suggest that nurses experience a diverse range of everyday ethical challenges related to challenging interactions with parents and colleagues, emotional strain, protecting the vulnerable infant, finding the balance between sensitivity and authority, ensuring continuity of treatment, and miscommunication and professional disagreement. Discussion: A major finding in this study is how different agents involved in caring for the newborn experience their realities differently. When these realities collide, ethical challenges arise. Findings suggest that acting in the best interests of the child becomes more difficult in situations involving many agents with different perceptions of reality. Conclusion: The study presents new aspects which increases knowledge and understanding of the reality of nursing in a neonatal intensive care unit, while also demanding increased research in this field of care. (shrink)

The argument for children's rights in health care has been long in the making. The success of this position is reflected in the 1995 American Academy of Pediatrics recommendations for the role of children in health care decisionmaking, which suggest that children be given greater voice as they mature. But there are good moral and practical reasons for exercising caution in these health care situations, especially when the child and parents disagree. Parents need the moral and legal (...) space within which to make decisions that will facilitate their child's long‐term autonomy, not only her present‐day autonomy. Moreover, third‐party intrusion, by physicians or the state, should be resisted unless negligent and abusive decisions are in the making. (shrink)

Hong Kong is undergoing a public debate on the need to reform and future directions of reforming its health care system. This paper highlights the debates and considerations brought up by the Hospital Authority, the largest provider of public health care in Hong Kong, on the ethical principles and societal values underlying the upcoming reform. It is recognized that the exact meanings behind each ethical principle and value must be debated and clarified during the reform process. In a (...) modern day society like Hong Kong, societal values are likely to be diversified. A health care system also has to fulfil different and often conflicting objectives of equity, efficiency, quality and choice. It would be difficult for a health care system to satisfy these different values and objectives based on a single value parameter. The Hong Kong experience shows that a society may prefer a combination of strategies in addressing different societal values. The re-structuring of the health care system in Hong Kong should therefore be based on a balanced and optimum combination of various financing and delivery strategies. (shrink)

Following a boom in investment and overinflated expectations in the 1980s, artificial intelligence entered a period of retrenchment known as the “AI winter.” With advances in the field of machine learning and the availability of large datasets for training various types of artificial neural networks, AI is in another cycle of halcyon days. Although medicine is particularly recalcitrant to change, applications of AI in health care have professionals in fields like radiology worried about the future of their careers and (...) have the public tittering about the prospect of soulless machines making life‐and‐death decisions. Medicine thus appears to be at an inflection point—a kind of Groundhog Day on which either AI will bring a springtime of improved diagnostic and predictive practices or the shadow of public and professional fear will lead to six more metaphorical weeks of winter in medical AI. (shrink)

Normal 0 21 false false false MicrosoftInternetExplorer4 One of the most important questions of moral philosophy is what makes a life a good life. A good way of approaching this issue is to watch the film Groundhog Day which can teach us a lot about what a good life consists in - and what not. While currently there are subjective and objective theories contending against each other about what a good life is, namely hedonism and desire satisfaction theories on the (...) one hand and objective list theories on the other, the film illustrates that at least one constituent of the good life can only be understood if we see it as having both an objective and a subjective side to it. Thus, the film shows that, in contrast to the beginning of the film, at the end the protagonist Phil has a good life insofar as that he finds something to do that suits him (the objective element), and comes to care deeply about it (the subjective element). (shrink)