Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.

A few weeks ago, a rural hospital administrator phoned with a question posed by his management team. “If you were going to give us some ethics resources,” he queried, “just exactly what would they...

Hospital ethics committees have evolved as a response to complicated legal, ethical, and social dilemmas that accompany modern medicine. In the United States, their growth has been augmented by Joint Commission for the Accreditation of Healthcare Organizations standards and the Patient Self-Determination Act. There appears to be an implicit presumption that all clinical ethics consultation practices are relatively similar. Finally, there is heightened awareness of the needs for quality standards and assessment of the outcomes of ethics consultations.

Clinical research is increasingly conducted in settings that include private physicians’ offices, clinics, community hospitals, local institutes, and independent research centers. The migration of such research into this new, non–academic environment has brought new cadres of researchers into the clinical research enterprise and also broadened the pool of potential research participants. Regulatory approaches for protecting human subjects who participate in research have also evolved. Some institutions retain their own Institutional Review Boards (IRBs), but Independent IRBs, community hospital IRBs and community–based (...) IRBs also fulfill oversight responsibilities. This article sheds light on this evolving world by discussing the findings gleaned from two studies: a study of the decision making processes used by members who serve on different kinds of IRBs and a study of the decision making processes employed by research participants. The article then discusses how the key findings may inform proposed revisions to the Common Rule. (shrink)

The ramifications of including genetic components in the clinical studies conducted in non-academic settings create unique ethical challenges. We used a qualitative research design consisting of semi-structured interviews that took place between October 2010 and September 2012. The sample consisted of 80 participants − 38 physicians and 42 coordinators − who worked across a number of different settings, including clinics, private practices, small hospitals, free standing research centers, and blended hospital-institutes in both rural and urban communities in 13 states across (...) the United States. The respondents primarily conducted industry sponsored trials and recruited their own patients as research participants. A majority of the respondents (65%) reported that most of the studies they conducted included an additional genetics component, and so participants were asked to donate specimens for genomics or biobanking. While genomics association studies were perceived as being of benefit, awareness of ethical implications associated with such studies was limited. The rapid advances in genetic technologies make it hard for clinicians and coordinators to help patients make informed decisions about participating in clinical research, and underscore the need to ensure that the regulations governing research on human subjects keep pace with the social and technological changes. It seems essential to discern legitimate ethical concerns and find ways to convey what is going on, what is possible and what might not be possible in terms of protecting privacy, anonymity, and confidentiality. (shrink)

Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.

Over the past 20 years, clinical research has migrated from academic medical centers to community-based settings, including rural settings. This evolving research environment may present some moral hazards or challenges that could undermine traditionally accepted standards for the protection of human subjects. The study described in this article was designed to explore the influence of motives driving the decisions to conduct clinical trial research in rural community settings. The researchers conducted semi-structured interviews with 80 participants who conducted clinical trials with (...) rural subjects. The interviews provided a way to examine the influence of budgetary factors when deciding to conduct a clinical study, how information about the budget and the purpose of the study is conveyed to research participants, and the potential willingness of clinicians and coordinators to enroll in the kinds of studies they offer. The findings suggest that clinical trial research in rural communities may challenge clinicians’ abilities to balance the needs of the patient with the needs of the research enterprise. Few respondents seemed to recognize the traditionally recognized hazards of a dual relationship, specifically the moral risks of trying to attend to the interests of both patient and industry. It seems important to re-examine how we protect human subjects and what such protection should look like as research becomes part of the way medical care is provided, even in very rural areas. (shrink)

To better understand the available publications addressing ethical issues in rural health care we sought to identify the ethics literature that specifically focuses on rural America. We wanted to determine the extent to which the rural ethics literature was distributed between general commentaries, descriptive summaries of research, and original research publications. We identified 55 publications that specifically and substantively addressed rural health care ethics, published between 1966 and 2004. Only 7 (13%) of these publications were original research articles while (12) (...) 22% were descriptive summaries of research and 36 (65%) were general commentaries. The majority of publications examined (55%) were clinically focused while 27% addressed organizational ethics and 18% addressed ethical ramifications of rural health care policy at a national or community level. Our findings indicate that there are a limited number of publications focusing on rural health care ethics, suggesting a need for scholars and researchers to more rigorously address rural ethics issues. (shrink)

Background: Nurse managers have responsibilities relating to the quality of care, the welfare of the staff and running of the organization. Ethics plays significant role in these responsibilities. Ethical problems are part of daily management, but research in this area is limited. Objective: The aim of this study was to identify and describe ethical problems nurse managers encounter in their work to get more detailed and extensive view of these problems. Methods: The data consisted of nine interviews with nurse managers (...) at different management levels in primary healthcare and specialized healthcare organizations, and it was analysed by inductive content analysis. Ethical considerations: Permission to conduct the interviews including ethical approval was given at all participating organizations according to national standards. The respondents were informed about the aim of the study, and voluntary participation, anonymous response and confidentiality were explained to them. Findings: Four main categories were found: conflicts in practical situations, lack of appreciation, disregard of problems and experienced inadequacy. Problems could also be divided to patient-related, staff-related, organization-related and other problems. Discussion: The findings correspond with results from earlier studies but add knowledge of the nature and details of nurse managers’ ethical problems. New information is produced related to the ethical problems with nurse managers’ own courage, motivation and values. Conclusion: Nurse managers identified a variety of different ethical problems in their work. This information is useful in the development of ethics in nursing management. Further research about the frequency and intensity of nurse managers’ ethical problems is needed as well as possible differences in different levels of management. (shrink)

This open access book provides original, up-to-date case studies of “ethics dumping” that were largely facilitated by loopholes in the ethics governance of low and middle-income countries. It is instructive even to experienced researchers since it provides a voice to vulnerable populations from the fore mentioned countries. Ensuring the ethical conduct of North-South collaborations in research is a process fraught with difficulties. The background conditions under which such collaborations take place include extreme differentials in available income and power, as well (...) as a past history of colonialism, while differences in culture can add a new layer of complications. In this context, up-to-date case studies of unethical conduct are essential for research ethics training. (shrink)

Details the intellectual development of George Herbert Mead as a thinker of great originality and as a practitioner of social reform.

RESUMO O objetivo deste artigo é analisar e avaliar um conjunto de textos aqui denominados textos-moldura presentes nas obras de Bakhtin e do Círculo traduzidas no Brasil desde 1979, com vistas a traçar um panorama nacional crítico do contexto de recepção da obra bakhtiniana e evidenciar algumas de suas especificidades, indiciadas nos diálogos que empreendem com os aspectos sociais, históricos e culturais. Pretende-se, ainda, contribuir para o aprofundamento dos estudos dialógicos e sua incontestável dimensão interdisciplinar. Além da perspectiva dialógica, as (...) reflexões apoiam-se, também, em teorias da tradução, caso específico da que discute a “relação entre um texto de partida e um contexto de chegada”, ou ainda “um modo de ler um texto em dado contexto”. Parte de uma pesquisa maior, os resultados aqui apresentados dizem respeito unicamente a uma das obras do Círculo: Marxismo e filosofia da linguagem. Problemas fundamentais do método sociológico na Ciência da linguagem e suas duas traduções brasileiras. ABSTRACT This article aims to analyze and evaluate a number of texts called frame-texts found in the works of Bakhtin and the Circle, which have been translated in Brazil since 1979. Our objective is to offer a critical overview of the context of the reception of their work nationwide and highlight some of its specific features, apprehended in the dialogues established with social, historical and cultural aspects. We also intend to contribute to deepening the dialogical studies and its undeniable interdisciplinary dimension. In addition to the dialogic perspective, these reflections rely on theories of translation, especially those that discuss the “relationship between a text and its context of reception” or “a certain way of reading a text in a given context.” This discussion is part of a larger research study, and the results presented herein are related to one of the works of the Circle, namely, Marxism and the Philosophy of Language and its two translations into Brazilian Portuguese. (shrink)

The rise of managerialism within healthcare systems has been noted globally. This paper uses the findings of a scoping study to investigate the management of poor performance among nurses and midwives in the United Kingdom within this context. The management of poor performance among clinicians in the NHS has been seen as a significant policy problem. There has been a profound shift in the distribution of power between professional and managerial groups in many health systems globally. We examined literature published (...) between 2000 and 10 to explore aspects of poor performance and its management. We used Web of Science, CINAHL, MEDLINE, British Nursing Index, HMIC, Cochrane Library and PubMed. Empirical data are limited but indicate that nurses and midwives are the clinical groups most likely to be suspended and that poor performance is often represented as an individual deficit. A focus on the individual as a source of trouble can serve as a distraction from more complex systematic problems. (shrink)

This chapter examines the debate between advocates of classical logic and advocates of intuitionistic logic. It examines the semantic and epistemic issues on which this debate is usually conducted. After introducing the idea that logic is a model of correct reasoning, the chapter explores the viability of a logic intermediate between classical and intuitionistic.

This paper applies concepts Deleuze developed in his ‘Postscript on the Societies of Control’, especially those relating to modulatory power, dividuation and control, to aspects of Australian schooling to explore how this transition is manifesting itself. Two modulatory machines of assessment, NAPLAN and My Schools, are examined as a means to better understand how the disciplinary institution is changing as a result of modulation. This transition from discipline to modulation is visible in the declining importance of the disciplinary teacher–student relationship (...) as a measure of the success of the educative process. The transition occurs through seduction because that which purports to measure classroom quality is in fact a serpent of modulation that produces simulacra of the disciplinary classroom. The effect is to sever what happens in the disciplinary space from its representations in a luminiferous ether that overlays the classroom. (shrink)

On the Dummettian understanding, anti-realism regarding a particular discourse amounts to (or at the very least, involves) a refusal to accept the determinacy of the subject matter of that discourse and a corresponding refusal to assert at least some instances of excluded middle (which can be understood as expressing this determinacy of subject matter). In short: one is an anti-realist about a discourse if and only if one accepts intuitionistic logic as correct for that discourse. On careful examination, the strongest (...) Dummettian arguments for anti-realism of this sort fail to secure intuitionistic logic as the single, correct logic for anti-realist discourses. Instead, antirealists are placed in a situation where they fail to be justified in asserting monism (that intuitionistic logic is the unique correct logic). Thus, antirealists seem forced either to accept pluralism (i.e. one or more intermediate logic is at least as `correct’ as intuitionistic logic–an option I take to be unattractive from the anti-realist perspective), or they must be anti-realists about the realism/anti-realism debate (and, in particular, must refuse to assert the instance of excluded middle equivalent to logical monism or logical pluralism). (shrink)

Which famous twentieth-century philosopher instigated a revolution in philosophy, arguing that the philosopher’s business is not to advance general theories about reality, but rather to help release our thinking from the intellectual cramps produced by a misunderstanding of the forms of language? Wittgenstein? Wrong! according to John W. Cook. This revolution in philosophy actually had no author. Apparently, it arose through a misinterpretation of Wittgenstein’s later writings. In fact, Cook implies, Wittgenstein himself was not genuinely engaged in a (...) struggle with philosophical puzzles, but rather had an ontological theory up his sleeve: he was a conventional empiricist in the tradition of Berkeley, Ernst Mach, and Russell, though he happened to express himself so obscurely that some philosophers, believing themselves inspired by his writings, dreamed up the whole revolution by mistake, as it were. However, Cook is not arguing that the revolution should be canceled; rather he looks at Wittgenstein’s work from the standpoint of that accidental revolution, berating Wittgenstein, as it were, for not having thought to be a Wittgensteinian himself. (shrink)

The paper highlights shortcomings in the public consultation practices on the deliberate release and placing on the market of GMOs in the European Union and in one of its member countries, Finland. It is argued that current GMO consultation practices do not meet the aims and objectives on which their introduction is typically justified. Specifically, they do not serve democracy, increase consensus, enable better decisions to be made, or establish trust. We conclude that there is a clear need for the (...) active development of the GMO consultation practices and for a further critical discussion on the ethical and socio-political foundation of public engagement. (shrink)

The posthumanist project proposes directing the evolution of human beings by promoting their improvement through technological means to create a variety of entities that will have few or no common...

This paper uses Deleuze and Guattari’s concept of faciality to analyse the teacher’s face. According to Deleuze and Guattari, the teacher-face is a special type of face because it is an ’overcoded’ face produced in specific landscapes. This paper suggests four limit-faces for teacher faciality that actualise different mixes of signifiance and subjectification in a classroom in which individualisation and massifications are affected. Understanding these limit-faces suggests new ways to conceive the affects actualised in the classroom that are subjected to (...) increasing levels of surveillance from education policy makers. Through this ‘partial mapping’ new possibilities emerge to “escape the face”. (shrink)

This article reports the findings of a one-year project examining British press coverage of the genetically modified food debate during the first half of 2003, and both expert and non-expert reactions to that coverage. Two pro-GM newspapers and two anti-GM newspapers were selected for analysis, and all articles mentioning GM during the period in question were stored in a machine readable database. This was then analyzed using corpus linguistic and discourse analytic techniques to reveal recurrent wording, themes and content. This (...) text analysis was complemented by 12 interviews with experts involved in the communication of GM issues, and 12 focus-group sessions in which members of the public reacted to selected newspaper texts and other GM material. Both in the press and in public reaction, the issue of GM was found to be intimately associated with other political events of the time, notably the invasion of Iraq. Except among experts, there was little awareness of the official national debate and issues were approached in more general terms. Pro-GM characterization of the issues as primarily scientific, both by newspapers and experts, was rejected by the anti-GM press and campaigners, and by the focus-group participants. They assessed the issues in a more global frame, rejecting scientists and companies as unreliable. In addition, they linked both US and British GM policy to the invasion of Iraq, and, by analogy, rejected pro-GM arguments as untrustworthy. (shrink)