Background: Cardio-pulmonary resuscitation is the default procedure during cardio-pulmonary arrest. If a patient does not want cardio-pulmonary resuscitation, then a do not attempt resuscitation order must be documented. Often, this order is not given; even if thought to be appropriate. This situation can lead to a slow code, defined as an ineffective resuscitation, where all resuscitation procedures are not performed or done slowly. Research objectives: To describe the perceptions of nurses working on internal medicine wards of slow codes, including the (...) factors associated with its implementation. Research design: This was a cross-sectional, descriptive study. Participants completed a personal characteristics questionnaire and the Perceptions and Factors of Slow Codes questionnaire designed for this study. Participants and research context: The sample was a convenience sample of nurses working on internal medicine wards in two Israeli hospitals. Ethical considerations: The study received ethical approval from both institutions, where data were collected and stored according to institutional policy. Findings: Most reported that resuscitations were conducted according to protocol (n = 90, 76.2%). Some took their time calling the code (n = 22, 18.3%), or waited by the bedside and did not perform cardio-pulmonary resuscitation (n = 45, 37.5%). Factors most associated with slow codes were poor patient prognosis (mean = 3.52/5, standard deviation = 1.27) and a low chance of patient survival (mean = 3.37/5, standard deviation = 1.21). Two-thirds (n = 76, 66.8%) reported that slow codes were done on their unit and the majority (n = 80, 69%) perceived slow codes as ethical. Discussion: This study confirms that slow codes are part of medical care on internal medicine wards, where most nurses perceive them as an ethical alternative. These perceptions are in contrast to most legal and ethical opinions expressed in the literature. Conclusion: Nurses should be educated about the legal and ethical implications of slow codes, and qualitative and quantitative studies should be conducted that further investigate its implementation. (shrink)

Patients with advanced dementia are less likely than those with other terminal illnesses to receive palliative care. Due to the nature and course of dementia, there may be a failure to recognize the terminal stage of the disease. A possible and under-investigated explanation for this healthcare disparity is the healthcare practitioner who plays a primary role in end-of-life decision-making. Two potential areas that might impact provider decision-making are cognitive biases and moral considerations. In this analysis, we demonstrate how the cognitive (...) biases and moral considerations of practitioners related to clinical decision-making are inherent in clinical practice and may impact on providers’ accuracy related to diagnostic and treatment related decision-making associated with patients with advanced dementia. Anchoring, default, availability, representativeness and framing biases are cognitive biases based on the "Two System Model" that relate to decision-making in end-of-life care. In patients with advanced dementia, those biases may result in a tendency to adhere to traditional mandatory care, involving an aggressive approach to care, which values saving lives at all costs, without taking into account the possible suffering and long-term consequences. Aspects such as moral sensitivity and moral courage play an important role in ethical decision-making related to advanced dementia. Investigations of clinical decision-making that include the cognitive biases and ethical considerations of practitioners might advance the comprehensive understanding of the clinical decision-making process related to care of patients with advanced dementia and promote the quality of care given to this population. (shrink)

Background: Nurse managers are placed in a unique position within the healthcare system where they greatly impact upon the nursing work environment. Ethical dilemmas and moral distress have been reported for staff nurses but not for nurse middle managers. Objective: To describe ethical dilemmas and moral distress among nurse middle managers arising from situations of ethical conflict. Methods: The Ethical Dilemmas in Nursing–Middle Manager Questionnaire and a personal characteristics questionnaire were administered to a convenience sample of middle managers from four (...) hospitals in Israel. Results: Middle managers report low to moderate levels of frequency and intensity of ethical dilemmas and moral distress. Highest scores were for administrative dilemmas. Conclusion: Middle managers experience lower levels of ethical dilemmas and moral distress than staff nurses, which are irrespective of their personal characteristics. Interventions should be developed, studied, and then incorporated into institutional frameworks in order to improve this situation. (shrink)

In this interview with Thomas Dekeyser, Eugene Thacker elaborates on the central themes of his work. Addressing themes including extinction, futility, human universalism, network euphoria, political indecision and scientific nihilism, the interview positions Thacker’s work within the contemporary theoretical conjuncture, specifically through its relation to genres of thought his work is often grouped with or cast against: vitalism, speculative realism and accelerationism. More broadly, however, the interview offers a unique insight into Thacker’s approach to the thinking, doing and writing (...) of ‘philosophy’. (shrink)

Background and aims. In pediatrics receiving a diagnosis of a chronic condition is a matter that involves caregivers at first. Beyond the basic issues of caring for the physical body of the ill child, caregivers’ manners of facing and making sense of the disease orient and co-construct their children’s sensemaking processes of the disease itself. The aim of this article is to explore the experience of a rare chronic illness, Hereditary Angioedema (HAE), in pediatrics, from the caregivers’ perspective. Hereditary Angioedema (...) is characterized by subcutaneous swellings that can involve the mucosal tissues of external as well as internal parts of the body, manifesting in a highly variable and unpredictable way in terms of localization, severity, and frequency. Materials and methods. Within a qualitatively-driven research design, we conducted a qualitative narrative semiotic analysis of n.28 mothers’ narratives on their children’s disease experience. Narratives were collected by an ad hoc interview on three domains of the disease experience: A. interpretation of the disease variability; B. dialogical processes; C. management of the disease. Subsequently, we executed a TwoStep cluster analysis for categorical data to detect cross-sectional profiles of the maternal sensemaking processes of the disease. Results. The coding grid was built analyzing the characteristic of the narrative links that orient the connection between the elements of the experience within each domain: A. the connection among events, for the domain of the interpretation of the disease variability; B. the connection between self and other, for the domain of the dialogue; C. the connection among sensemaking and actions, for the domain of the management of the disease. Results from cluster analysis show three narrative profiles: 1. adempitive; 2. reactive; 3. dynamic. Discussion. Profiles will be discussed in the light of the general conceptual framework of the Sense of Grip on the Disease (SoGoD) highlighting the importance of those sensemaking processes which, instead of relying on a coherent and close interpretation of the disease, are characterized by a degree of tolerance for the uncertainty and the unknowingly. (shrink)

This paper centres the colonial pre-histories of ‘the digital’ to complicate posthumanist theorisations of subjectivity. Posthumanism helpfully undercuts human exceptionalism by presenting subjectivity as always-already co-constituted by technology. However, this paper argues that it insufficiently engages the human as the historico-political effect of negating the assumed non-technological colonial Other. Focusing on liberal humanism between the 16th and 19th centuries, the paper theorises the modern human as bound up in ‘technological onticide’. The presumed absence of technology became a (theo-centric, ratio-centric, bio-centric) (...) measure of the Other’s sub-humanity, at the same time as this Other was expected to be humanised through its technologisation. An emphasis on technological onticide complicates universalist theories of subjectivity that take it as always a matter of human-technology co-constitution. The paper argues that, to confront the legacies of ontological murder, conceptual room needs to be made for inhuman, counterhuman or unhuman theories of subjectivity. (shrink)

In this acticle I want to introduce the work of the painter Marlene Dumas. The human condition and religion are important themes in her work. I explore the question if she is a feminist, religious or neither but an artist with just provoking ideas? In my opinion she is in her provoking ideas at the edge of both feminism and religion.

The authoress questions the historiographic dogma that, tracing back to F.W. Maitland, gave the pure «Englishry» of English law for granted, thus building its history on its exceptionality with respect to European tradition, from which it would not have been contaminated at all. The Anglo-Saxon historiographical analysis of the most important English constitutional document aims at answering to the provocative question: how English is Magna Carta? What role did jus commune play in its drafting? What is its relationship with contemporary (...) Roman Canon law? Through the examination of its cultural roots, the essay shows not only the substantial influence of Roman Canon law on Magna Carta, but also, more generally, the affinities and the common elements that characterize in principle the relationship between English juridical tradition and the continental one. (shrink)

The international network of submarine cables plays a crucial role in facilitating global telecommunications connectivity, carrying over 99% of all internet traffic. However, submarine cables challenge digital sovereignty due to their ownership structure, cross-jurisdictional nature, and vulnerabilities to malicious actors. In this article, we assess these challenges, current policy initiatives designed to mitigate them, and the limitations of these initiatives. The nature of submarine cables curtails a state’s ability to regulate the infrastructure on which it relies, reduces its data security, (...) and threatens its ability to provide telecommunication services. States currently address these challenges through regulatory controls over submarine cables and associated companies, investing in the development of additional cable infrastructure, and implementing physical protection measures for the cables themselves. Despite these efforts, the effectiveness of current mechanisms is hindered by significant obstacles arising from technical limitations and a lack of international coordination on regulation. We conclude by noting how these obstacles lead to gaps in states’ policies and point towards how they could be improved to create a proactive approach to submarine cable governance that defends states’ digital sovereignty. (shrink)

Background: Decisions of patients, families, and health care providers about medical care at the end of life depend on many factors, including the societal culture. A pan-European study was conducted to determine the frequency and types of end of life practices in European intensive care units , including those in Israel. Several results of the Israeli subsample were different to those of the overall sample.Objective: The objective of this article was to explore these differences and provide a possible explanation based (...) on the impact of culture on end of life decision making.Method: All adult patients admitted consecutively to three Israeli ICUs who died or underwent any limitation of life saving interventions between 1 January 1999 and 30 June 2000 were studied prospectively . These patients were compared with a similar sample taken from the larger study carried out in 37 European ICUs. Patients were followed until discharge, death, or 2 months from the decision to limit therapy. End of life decisions were prospectively organised into one of five mutually exclusive categories: cardiopulmonary resuscitation , brain death, withholding treatment, withdrawing treatment, and active shortening of the dying process . The data also included patient characteristics , specific therapies limited, and the method of SDP.Results: The majority of patients had treatment withheld, none underwent SDP, 62 received CPR , 31 had brain death , and 18 underwent withdrawal of treatment . The primary reason given for limiting treatment was that the patient was unresponsive to therapy . End of life discussions were held with 132 families , the vast majority of which revolved around withholding treatment and the remainder concerned withdrawing treatment .There was a statistically significant association between the type of end of life decision and region—that is, the northern region of Europe, the central region, the southern region, and Israel.Conclusions: Regional culture plays an important part in end of life decision making. Differences relating to end of life decision making exist between regions and these differences can often be attributed to cultural factors. Such cultures not only affect patients and their families but also the health care workers who make and carry out such decisions. (shrink)

We present the design of a secure and privacy preserving e-petition system that we have implemented as a proof-of-concept demonstrator. We use the Belgian e-ID card as source of authentication, and then proceed to issue an anonymous credential that is used to sign petitions. Our system ensures that duplicate signatures are detectable, while preserving the anonymity of petition signers. We analyze the privacy and security requirements of our application, present an overview of its architecture, and discuss the applicability of data (...) protection legislation to our system. (shrink)

Although generational differences have been studied in developed countires, not much information is available about generational cohorts and how they differ in terms of work ethics in developing countries. A cross-sectional study was conducted with a sample of 301 respondents from South Africa. Work ethics of three generational cohorts were measured, namely the Baby Boomers, Generation X, and Generation Y. The main finding of this research was that statistically significant differences and similarities were found between the various generational cohorts in (...) terms of work ethics facets. Statistically significant generational differences were indicated for hard work and delay of gratification. (shrink)

First Published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

In recent years, there has been a growing public discourse regarding the influence AI will have on the future of work. Simultaneously, considerable critical attention has been given to the implications of AI on gender equality. Far from making precise predictions about the future, this discourse demonstrates that new technologies are instances for renegotiating the relation of gender and work. This paper examines how gender is addressed in news media discourse on AI and the future of work, focusing on Germany. (...) We approach this question from a perspective of feminist technology studies and discourse analysis, exploring a corpus of 178 articles from 2015 to 2021 from German newspapers and newsmagazines. The findings indicate that critical AI and gender knowledge circulates in public discourse in the form of specific discursive frames, thematizing algorithmic bias, automatization and enhancement, and gender stereotypes. As a result, we show that, first, the discourse takes up feminist and scholarly discourse on gender and discusses AI in a way that is informed by social constructivism and standpoint theories. Second, gender appears as a—to some extent intersectional—diversity category which is critical to AI, while at the same time omitting important perspectives. Third, it can be shown that there is a renegotiating of the ideal worker norm taking place, and finally, we argue that the gendered frame of the powerful men developer responsible for AI’s risk is a concept to be challenged. (shrink)

Editors of scientific literature rely heavily on peer reviewers to evaluate the integrity of research conduct and validity of findings in manuscript submissions. The purpose of this study was to describe the ethical concerns of reviewers of nursing journals. This descriptive cross-sectional study was an anonymous online survey. The findings reported here were part of a larger investigation of experiences of reviewers. Fifty-two editors of nursing journals (six outside the USA) agreed to invite their review panels to participate. A 69-item (...) forced-choice and open-ended survey developed by the authors based on the literature was pilot tested with 18 reviewers before being entered into SurveyMonkeyTM. A total of 1675 reviewers responded with useable surveys. Six questions elicited responses about ethical issues, such as conflict of interest, protection of human research participants, plagiarism, duplicate publication, misrepresentation of data and ‘other’. The reviewers indicated whether they had experienced such a concern and notified the editor, and how satisfied they were with the outcome. They provided specific examples. Approximately 20% of the reviewers had experienced various ethical dilemmas. Although the majority reported their concerns to the editor, not all did so, and not all were satisfied with the outcomes. The most commonly reported concern perceived was inadequate protection of human participants. The least common was plagiarism, but this was most often reported to the editor and least often led to a satisfactory outcome. Qualitative responses at the end of the survey indicate this lack of satisfaction was most commonly related to feedback provided on resolution by the editor. The findings from this study suggest several areas that editors should note, including follow up with reviewers when they identify ethical concerns about a manuscript. (shrink)

The rise of unethical leadership practices suggests a need to emphasise value-based workplaces and leadership, encompassing workplace spirituality and spiritual leadership. Most previous research focusing on ethical behaviour in the work context has been conducted with larger organisations. This study examines the influence of workplace spirituality and spiritual leadership on ethical behaviour within the small business context. A quantitative survey research design was employed. The final sample consisted of 385 employees of small, medium, and micro enterprises (SMMEs) in various industries (...) in a central district of South Africa. Structural equation modelling was utilised during the data analysis process. The study revealed that workplace spirituality and spiritual leadership had a positive and statistically significant influence on ethical behaviour in SMMEs, and workplace spirituality mediates the relationship between spiritual leadership and ethical behaviour. The study extends on existing literature as this relationship has previously not been investigated in the African small business context. Also, the findings hold practical significance for small businesses struggling with unethical behaviours and leadership. The findings of the study imply that a culture of spirituality in the workplace enhances the impact of spiritual leadership in promoting ethical behaviour in the small business environment. (shrink)