Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the (...) responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

Social enterprises are seen as innovative towards solving societal problems, but little research exists on possible negative aspects, the so‐called dark sides. In this study, the emphasis is on dark sides of social entrepreneurship, how they are managed, and how systems thinking can contribute towards managing these effects. Dark sides of social entrepreneurship can take many forms, like unethical or insincere motives and unintended outcomes like the negative impact on the well‐being of founders and employees, but they are also a (...) call for a critical reflection on the role of the government in society and the economic system social enterprises have to operate in. This paper aims to contribute to the dark side theory of social entrepreneurship by linking system archetypes to themes of dark side thereby stressing how management strategies act as balancing feedback loops to mitigate or prevent dark sides. A qualitative research was conducted by interviewing 21 respondents who play an important role in the world of social entrepreneurship in Belgium. The results show that dark sides of social enterprises manifest itself mostly in the form of trade‐offs and financial, business, and management related issues. Taking over the habits of profit‐oriented companies emerged as a new dark side element. Management strategies include anchoring goals, transparency, obtaining external views, changing the system, and above all reflection. The latter is an important first step to become aware of these issues to be able to change the negative dynamism of these dark sides. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:You Can't Say "No" to That!(A "Difficult Patient" Story)Ingrid BergAs a sequela of COVID-19, my rural Wisconsin hospital has been jam-packed for months with patients for whom we routinely provide care and many for whom we do not. An exodus of health care workers and other constraints have made the transfer of critically ill patients very difficult. In this disquieting "new-normal" of our work life, we routinely must (...) call bigger cities throughout our state to find beds for complex patients.So, it was not surprising when a young patient, an IV drug user in sepsis from a heart infection, was admitted to me in the middle of the night. In less disheartening times, before the pandemic, this patient would have been transferred promptly to the big-city hospital. Now, though, the possibility of finding an open bed is next to impossible. Resigned, I placed admission orders, continued antibiotics and fluids, and crossed my fingers. Then the unexpected happened: a bed opened up, and we could send her at once!The patient had a harsh heart murmur. It was likely that a "vegetation" was clinging to the valve, between the right upper and lower chambers of her heart. A vegetation is a clump of debris, such as platelets, clotting proteins, and bacteria that is a menace to the body. Her chest imaging looked like her infection had already spread to her lungs.A definitive diagnosis for endocarditis requires a special ultrasound with a probe that goes down through the esophagus, a procedure performed by cardiologists. It's a serious infection, one that requires weeks of IV antibiotics and is best monitored by infectious disease specialists. Sometimes, cardiothoracic surgeons are called upon to strip away the infection at the site, depending on how badly the valve has been slayed or the size of the vegetation. My only recommendation for a young, otherwise healthy patient in this scenario, is transfer.All of these reasons for transfer were lolling around in my tired head when the night-time [End Page 14] nursing supervisor approached me and said, "We have a problem." When the patient was updated about the transfer, she balked: "She says she is tired and refusing to go," the supervisor began. "She doesn't feel like getting into an ambulance in the middle of the night and she doesn't care if her condition is life-threatening. She knows we can't force her to go and she will only talk about it again in the morning."The cartoon version of myself at that moment had bugged-out eyes, a dropped jaw, fists tight and clenched at my sides, and steam coming out of my head. I can look past a patient's self-neglect, poor medication adherence, abysmal communication, alcohol and drug addiction, and other crimes. But saying no to a bed at a tertiary care facility? Unacceptable!I marched down the quiet hallway and into her room. She was lying on her side, facing the door, one IV in a thin arm. I was confident I could reason with her once I explained the scarcity of beds and the medical necessity of transfer. But she was having none of it. I was calm until I could no longer maintain my cool: "You can't give up this bed!""Maybe in the morning," she insisted, yawning. "But not now. I am tired and want to rest!""But there might not be a bed in the morning," I countered. "And your infection can be life-threatening." (This is true, but we both knew she wasn't dying at this very moment.)"I am not going anywhere!" She raised her voice and then closed her eyes.And she was right. I had no choice but to keep her. I could not kick her out of the hospital because she was making a poor choice, and I was frustrated for having to manage the fallout of that decision. Giving her antibiotics and fluid boluses to bolster her blood pressure was certainly within my scope of practice. And fretting. Fretting is always within my scope of practice; not that my scope of practice matters when all the big... (shrink)

Graphical AbstractEnvironmental oxygen might have been the key for the evolution of novel developmental mechanisms, such as the interdigital cell death of amniotes. Increased amount of oxygen can also induce cell death in interdigital regions of an amphibian that typically lacks it. To learn more about the role of environmental oxygen in the evolution of new traits, see the article number 2000025 by Ingrid Rosenburg Cordeiro and Mikiko Tanaka. Cover image by Itoko Tanaka and Mikiko Tanaka.

Journal of Political Philosophy, Volume 30, Issue 2, Page 249-270, June 2022.

Background: The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction. Aim: Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway. Research design: A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020. Ethical considerations: Ethical approval granted (...) by the Regional Research Ethics Committee in Western Norway (131421). Findings: Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful. Discussion: By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority. Conclusion: Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

A philosopher‐poet‐theologian ponders the implications of the multimillion‐year biogenetic process that produced Homo sapiensand is beginning to reveal itself ever more clearly as evolution of the mind and consciousness. As meaning trappers and makers, called to actualize the divine image imprinted upon us, we are now facing biological and cultural evolution with deliberate human input as well as the evolution of evolution. As communicating animals that are becoming ever more aware of our adaptive behavior, we have the potential of affecting (...) our own destiny by listening to the spirit within and nurturing the genes and memes that give rise to physical, intellectual, creative, and moral excellence. In the matrix of cyberspace we have the opportunity to heal the two‐culture split, to reinvent ourselves, to incubate/weave the emergent religions of the future, and to create our multiple “Ways” appropriate to the dawning Age of Global Dialogue. (shrink)

This monograph on the capability approach does two things. First, it provides an advanced introduction to the capability approach, as an account used in philosophy, as well as other disciplines. Second, it provides an account of the capability approach which is able to encompass all existing views and theories on the capability approach, including the writings on the capability approach by Martha Nussbaum and Amartya Sen.

This paper offers a critique of Martha Nussbaum’s description of the capability approach, and offers an alternative. I will argue that Nussbaum’s characterization of the capability approach is flawed, in two ways. First, she unduly limits the capability to two strands of work, thereby ignoring important other capabilitarian scholarship. Second, she argues that there are five essential elements that all capability theories meet; yet upon closer analysis three of them are not really essential to the capability approach. I also offer (...) an alternative description of the capability approach, which is called the cartwheel view of the capability approach. This view is at the same time radically multidisciplinary yet also contains a foundationally robust core among its various usages, and is therefore much better able to make the case that the capability approach can be developed in a very wide range of more specific normative theories. Finally, the cartwheel view is used to argue against Nussbaum's claim that all capabilitarian political theory needs to be politically liberal. (shrink)

Human embryos produced in labs since the 1970s have generated layers of uncertainty for law and policy: ontological, moral, and administrative. Ontologically, these lab-made entities fall into a gray zone between life and not-yet-life. Should in vitro embryos be treated as inanimate matter, like abandoned postsurgical tissue, or as private property? Morally, should they exist largely outside of state control in the zone of free reproductive choice or should they be regarded as autonomous human lives and thus entitled to constitutional (...) protection like full-fledged citizens? Administratively, if they deserve protection, what institutional and policy mechanisms are best suited to carrying out the necessary oversight? Using a method termed comparative problematization, this article traces divergent answers to these questions produced in three countries—the United States, United Kingdom, and Germany—across the last twenty-five years. Comparison reveals distinct bioconstitutional foundations that give rise to systematically different understandings of each state’s responsibilities toward human life and hence its particular treatment of claims on behalf of embryonic lives. (shrink)

The category of “former friend” is familiar, yet the nature of this relationship type remains underexplored. Aristotle, for example, poses but does not answer the question of what constitute appropriate relations between former friends. To elucidate post-friendship expectations, I promote an account of friendship according to which some of our most significant friendships participate in a type of intimacy characterized by having normative standing to interpret each other in a constitutive manner, which I call the “co-interpretation view” of friendship. Unchecked (...) powers of co-interpretation, however, invite and allow for violations of each friend’s personhood, so I draw on Kantian resources to guide the co-interpretation view and render it more plausible. These Kantian resources help to establish relevant expectations for co-interpretation between friends. This positions me to provide an account of appropriate expectations between former friends, which I analyze in three types of post-friendship circumstance: when the friendship has faded but the parties still share a general outlook; when the friendship has become damaging for the friends but not due to viciousness; and, when the friendship ruptures due to vicious behaviors. (shrink)

The aim of this literature study was to suggest a value ground for nursing anchored in two ethical principles: the principle of human value and the right to experience a meaningful life. Previous nursing research between the years 2000 and 2009 was analysed. Presented values suggested in this value ground are thus in line with the nursing context and science of today. Statements within ethical literature have been used in order to formulate arguments aimed at supporting the values that were (...) found in the study. In the literature study six values were found: trust, nearness, sympathy, support, knowledge and responsibility. These values hold equal status and are not presented in hierarchical order. They vary due to the persons involved, nursing situations and cultural surroundings, but have the common requirement of being non-excluding. In order to implement the values within the value ground, two prerequisites are discussed and claimed as essential: ethical dialogue and a caring encounter between care provider and patients. (shrink)

ABSTRACT:Increasing research attention to the ways that firms seek to influence the emotions of employees, consumers, and other stakeholders has not been accompanied by systematic attention to the ethical dimensions of emotion management. In this article we review and discuss research that informs the morality of influencing and regulating the emotions of others. What are the moral limits of the use of emotion as a management tool for shaping workplace behavior and influencing the thoughts and actions of consumers? Do the (...) ethics of emotional labor and emotional appeals (e.g., in consumer advertising) depart from moral rules that apply in “non-emotional” contexts? To explore these questions we examine research on the means by which individuals’ emotions are shaped and on the organizationally relevant consequences of individual emotional experience. We then discuss a number of potential ethical issues that are implicit or explicit in the organizationally sanctioned use of emotion management, incorporating existing literature in management and business ethics that has addressed the moral obligations of organizations in this context, and highlighting areas where there is yet work to be done. We conclude by discussing the implications of our analysis. (shrink)

This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in (...) the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection. (shrink)

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and (...) nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care. (shrink)

En quoi le corps participe-t-il de l'entente que l'homme a du monde? Que signifie dès lors écouter? Comment établir un rapport juste à l'animal? Quel sens prêter aux couleurs? Pourquoi la tonalité décisive de notre rapport au monde peut-elle advenir à la faveur d'expériences olfactives et gustatives? En quoi la tactilité incite-t-elle à considérer le corps vif comme une donnée originaire et à reconnaître qu'il est bien une vulnérabilité dotée d'aptitudes qui nous dispose au monde? Comment l'angoisse, révélée et cachée (...) tout à la fois par la maladie, est-elle chevillée au corps de l'être-au-monde, le Dasein? Qu'en est-il du corps dans la nostalgie, dans la mélancolie, dans l'ennui et dans la joie? Pourquoi la coexistence, supposant relations et rencontres, implique-t-elle l'articulation des corporéités vives comme dans le tact sensitif ou dans la jalousie amoureuse et dans l'amour pensé en terme de tonalité érotique? Comment comprendre la mobilité et parvenir ainsi jusqu'à l'éminente dignité ontologique du mouvement? De quoi la pensée est-elle redevable au corps? Telles sont les questions qui jalonnent cet ouvrage. Par son orientation résolument phénoménologique, l'Intelligence du corps entend renouveler l'entente du phénomène le plus proprement humain et, cependant, le plus malmené par la métaphysique. Prenant librement appui sur les vues inouïes de Martin Heidegger, consciente de l'actuelle soumission du corps de l'homme à l'arraisonnement technique, Ingrid Auriol ouvre une voie d'accès à l'intelligence du corps libérée de cette violence. (shrink)

Paradoxically, the practical necessity of love seems to combine the personal character of psychological necessity with the inescapable and authoritative quality of moral necessity. Traditionally, philosophers have avoided this paradox by treating love as an amalgam of impersonal evaluative judgments and affective responses. On my account, love participates in a different form of practical necessity, one characterized by a non-moral yet normative type of expectation. This expectation is best understood as a kind of second-personal address that does not support derivative (...) third-personal demands. It is revealed when we react with hurt feelings instead of resentment upon its disappointment. (shrink)

In this paper, we show that non-well-founded sets can be defined constructively by formalizing Hallnäs' limit definition of these within Martin-Löf's theory of types. A system is a type W together with an assignment of ᾱ ∈ U and α̃ ∈ ᾱ → W to each α ∈ W. We show that for any system W we can define an equivalence relation = w such that α = w β ∈ U and = w is the maximal bisimulation. Aczel's proof (...) that CZF can be interpreted in the type V of iterative sets shows that if the system W satisfies an additional condition (*), then we can interpret CZF minus the set induction scheme in W. W is then extended to a complete system W * by taking limits of approximation chains. We show that in W * the antifoundation axiom AFA holds as well as the axioms of CFZ -. (shrink)

People who make graveside promises consider themselves bound by them, which raises the question of whether a promise can morally obligate a promisor directly to a promisee who cannot acknowledge the promise. I show that it can by using the theoretical framework provided by “transaction accounts” of promising. Paradigmatically, these accounts maintain that the creation of a promissory obligation requires that the promisee consent to the promise. I extend these accounts to capture promises made by proxy and self-promises, and conclude (...) that we can make promises to absent promisees when we bear responsibility for their moral and personal development. (shrink)

Background: According to ethical guidelines, healthcare professionals should be able to provide care that allows for the patients’ values, customs and beliefs, and the existential issues that are communicated through them. One widely discussed issue is existential loneliness. However, much of the debate dealing with existential loneliness concludes that both the phenomenon and the concept are quite vague. Aim: To clarify what constitutes existential loneliness, and to describe its lived experiences. A further aim was to provide a definition of existential (...) loneliness that can function as a tool for identifying the phenomenon and for differentiating it from other kinds of loneliness. Method: A literature review including theoretical and empirical studies. Different search strategies were used to gather the articles included in the study. The analysis of the empirical studies had an interpretative approach. The articles were also analysed with the aim of providing a definition of existential loneliness. This was done by means of criteria such as language, uniqueness, theory and usefulness. This study is not empirical and does therefore not require an ethics review. Results: The analysis resulted in two main characteristics. The first one was perceiving oneself as inherently separated (disconnected) from others and from the universe. The second one brings out emotional aspects of EL, such as isolation, alienation, emptiness and a feeling of being abandoned. The empirical findings were divided into two categories: experiences of EL and circumstances in which EL arises. A definition of EL is also suggested, based on the two main characteristics identified. Conclusion: In order to meet patients’ needs, it is an ethical duty for healthcare staff to be able to recognise experiences of EL, that is, to communicate with the patients about these experiences in an appropriate manner. This in turn demands knowledge about existential issues and skills to deal with them. (shrink)

Abstract.Klaus Günther's (1988) book developed the distinction between two kinds of discourse, the foundation discourse and the application discourse. In an article (Günther 1989a) following the publication of the book, he used this basic distinction as the starting point for a criticism of the special case‐thesis as defended by Robert Alexy (1978, 32ff., 263ff.; Alexy 1989, 16ff., 213ff.). The aim of this article is to criticize this criticism in its turn and to show that the special case‐thesis does not need (...) the reformulation which Günther proposes. It should be clear from the outset that this concerns an internal discussion in the field of discourse theory; certain discourse‐theoretical premises are taken for granted. In order to understand Giinther's criticism I will first give a brief account of the distinction he has made. (shrink)

In the philosophy of well-being, there is hardly anything written on the lives of people with autism or on the question whether existing philosophical theories of well-being are suited for understanding how well the lives of autistic persons are going. This paper tries to make some progress towards filling this gap. I start by giving a concise account of autism, which highlights the huge heterogeneity among autistics. I discuss some basic features of autism, ask whether there are good reasons why (...) we would need an account of well-being specifically for autistics and what philosophical well-being research could learn from being informed by autistic experiences and phenomenology. I then investigate to what extent the capability approach gives us a helpful theory of well-being for autistics, and what looking through an autism-lens can contribute to the further development of the capabilitarian well-being. In particular, I show that some capabilities that are crucially relevant for autistics are also relevant for the lives of non-autistic people. The final part of the paper looks at an important difficulty in using the capabilitarian account of well-being for autistics, namely: should the normative focus be on achievements (functionings) or real opportunities (capabilities)? (shrink)

Having Too Much is the first academic volume devoted to limitarianism: the idea that the use of economic or ecosystem resources should not exceed certain limits. This concept has deep roots in economic and political thought. One can find similar statements of such limits in thinkers such as Plato, Aquinas, and Spinoza. But Having Too Much is the first time in contemporary political philosophy that limitarianism is explored at length and in detail. Bringing together in one place the best writing (...) from key theorists of limitarianism, this book is an essential contribution to political philosophy in general, and theories of distributive justice in particular. Including some of the key published articles as well as new chapters, Having Too Much is necessary reading for scholars and students of political theory and philosophy, as well as anyone interested in questions of distributive justice. (shrink)

This study investigated attitudes toward the use of deception in negotiation, with particular attention to the distinction between deception regarding the informational elements of the interaction (e.g., lying about or misrepresenting needs or preferences) and deception about emotional elements (e.g., misrepresenting one's emotional state). We examined how individuals judge the relative ethical appropriateness of these alternative forms of deception, and how these judgments relate to negotiator performance and long-run reputation. Individuals viewed emotionally misleading tactics as more ethically appropriate to use (...) in negotiation than informational deception. Approval of deception predicted negotiator performance in a negotiation simulation and also general reputation as a negotiator, but the nature of these relationships depended on the kind of deception involved. (shrink)

In this article, Ingrid Andersson discusses the decolonial philosophy of Sylvia Wynter, with a special focus on addressing her concepts of the hybrid human and origin stories. Andersson shows how Wynter's philosophizing about the being of being human is premised on an entanglement of nature and culture that is on par with the posthuman understanding of the ontological inseparability of matter and discourse. She goes on to interrogate some productive tensions between Wynter's decolonial philosophy and posthumanism by pointing out (...) how Wynter's hybrid human formulates an understanding of human nature that is different in itself and not solely in relation to other nonhuman entities. In the final part of the article, she proposes how we, with Wynter, can devise a pedagogical approach that seeks to counteract harmful taxonomizing practices. (shrink)

This article is based on an empirical study regarding ethical challenges in intercultural nursing. The focus is on autonomy and disclosure. Autonomy is a human capacity that has become an important ethical principle in nursing. Although the relationship between autonomy and patients’ possibly harmful choices is discussed, the focus is on ‘forced’ autonomy. Nurses seem to equate respect with autonomy; it seems to be hard to cope with the fact that there are patients who voluntarily undergo treatment but who actively (...) participate neither in the treatment offered nor in making choices regarding that treatment. Nurses’ demand for patients to be autonomous may in some cases jeopardize the respect, integrity and human worth that the ethical principle of autonomy is meant to ensure. Even though respect for a person’s autonomy is also respect for the person, one’s respect for the person in question should not depend on his or her capacity or aptitude to act autonomously. Is autonomy necessarily a universal ethical principle? This article negates this question and, through the issues of culture, individualism versus collectivism, first- and second- order autonomy, communication and the use of family interpreters, and respect, an attempt is made to explain why. (shrink)

Research on gender and antimicrobial resistance (AMR) beyond women’s biological susceptibility is limited. A gender and equity lens in AMR research is necessary to promote gender equality and support the effectiveness, uptake, and sustainability of real-world AMR solutions. We argue that it is an ethical and social justice imperative to include gender and related intersectional issues in AMR research and implementation. An intersectional exploration of the interplay between people’s diverse identities and experiences, including their gender, socio-economic status, race, disability, age, (...) and sexuality, may help us understand how these factors reinforce AMR risk and vulnerability and ensure that interventions to reduce the risk of AMR do not impact unevenly. This paper reports on the findings of a systematic scoping review on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. The review focused on peer-reviewed and grey literature published between 2017 and 2022. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours. Research that fails to account for gender and its intersections with other lines of disadvantage, such as race, class and ability, risks being irrelevant and will have little impact on the continued and dangerous spread of AMR. We provide recommendations for integrating an intersectional gender lens in AMR research, policy and practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Right HeartIngrid GouldI remarked to a friend, “We haven’t spoken since my arrest!” Alarm and confusion clouded his face, given my half-century of squeaky-clean living. “Cardiac arrest,” I clarified. “The fire department rebooted me.”An electrophysiologist diagnosed Arrhythmogenic Right Ventricular Dysplasia, prescribed medication, and implanted a defibrillator. For the next three-and-a-half years, he helped me live with a disease I didn’t know existed until he told me I had (...) it.The disease progressed—an ironic, disease-centric term since its advancement was to my detriment— prompting my cardiologist to recommend seeing someone who specialized in heart failure. I resisted the very idea of heart failure, a terrible term for a struggling organ, but took her advice and scheduled an appointment.The new cardiologist urged transplant testing, a lengthy process. I agreed, figuring that by the time I needed a new heart in 15–20 years, they’d be rolling off 3D printers.To record occasional transplant musings and inchoate fears and perhaps, over time, untangle them, I began journaling. I chronicled my passage through the echocardiogram, heart catheterization, 31 tubes of bloodwork, interviews with different clinical specialties, a pulmonary function test in a machine reminiscent of Star Trek’s Transporter, and more. Testing had barely begun when my medication stopped working—a Halloween shock.I began a harsher medication, underwent an ablation, and spent six weeks in a wearable defibrillator, a vest with abundant wires, and a purse-sized battery pack that made me resemble a character in [End Page 123] the Jetsons. This attire did not bring holiday comfort or joy to the TSA1 when I flew to visit my sister. As my R-waves faded to a whisper, I swapped the vest for a second implanted defibrillator, substantially more sensitive than the first.In early 2018, we learned I had qualified for transplant listing, though I wished to get as much mileage as possible from the original engine. My cardiologist warned, “There is no Plan B—no machine, device, or medication for the long-term. You will need a transplant.” He explained that since most cardiac patients have left-heart problems, companies develop products for the left side of the heart. My problem was on the right—a tiny market. He also cautioned that a patient needs to be sick enough to warrant transplant and well enough to remain a candidate, survive the surgery, and recover.Although clinically I was ready, I was not personally ready. I felt too good to trade an excellent quality of life for the promised miserable post-transplant year. The cardiologist wisely asked if I wanted to speak with another patient. When I requested someone beyond the dreaded first year, he put me in touch with two women who had received new hearts a few years earlier and befriended each other. They soon became my invaluable mentors and cherished friends. I will never forget seeing them stride into our first meeting and thinking, “They are beautiful! They look totally normal!”By May, climbing four flights of stairs took as much effort as five used to take. Tests confirmed further deterioration and suggested I had 7–13 months of declining health before my heart would give out completely. We chose a date for hospital admission, and I started telling people outside my immediate family. Most were flabbergasted, believing heart transplants were the last hope of the desperately ill. I did not look moribund, though, apparently, I was.The eight months after my first transplant appointment let me prepare psychologically to bid farewell to my heart—the metaphor for kindness, love, and bravery in our culture—and to welcome a new organ from a generous person less medically fortunate than I.In the hospital, I met others awaiting their hearts. A sudden intimacy arises when mortal choices catapult people into a medical realm suggestive of science fiction. Add the emotional intensity that accompanies knowing your extended life comes courtesy of a person who breathes no more on this earth and you wonder how an organ recipient integrates sorrow and gratitude.Two weeks after I was hospitalized, my cardiologist informed me the wait was over... (shrink)

During the past decade, screening tests using computed tomography have disseminated into practice and been marketed to patients despite neither conclusive evidence nor professional agreement about their efficacy and cost-effectiveness at the population level. This phenomenon raises questions about physicians' professional roles and responsibilities within the setting of medical innovation, as well as the appropriate scope of patient autonomy and access to unproven screening technology. This article explores how physicians ought to respond when new screening examinations that lack conclusive evidence (...) of overall population benefit emerge in the marketplace and are requested by individual patients. To this end, the article considers the nature of evidence and how it influences decision-making for screening at both the public policy and individual patient levels. We distinguish medical and ethical differences between screening recommended for a population and screening considered on an individual patient basis. Finally, we discuss specific cases to explore how evidence, patient risk factors and preferences, and physician judgment ought to balance when making individual patient screening decisions. (shrink)

Este trabalho tem por objetivo examinar possíveis contribuições de Lyotard e Jameson para pensar um dos obstáculos ao ensino de filosofia que, por falta de melhor denominação chamaremos "regime de atenção dos adolescentes contemporâneos".

Social-emotional competences are critical for positive development and significantly predict educational and occupational attainment, health, and well-being. There is however a lack of consensus about the number of core competences, and how these are defined and operationalized. This divergence in approach challenges future research as well as the scientific usefulness of the construct. In an effort to create an integrative framework, this focused review evaluates different approaches of conceptualizing and assessing social-emotional competences. Building on shared conceptions, an integrative taxonomy “DOMASEC” (...) is introduced, specifying core domains and manifestations of social-emotional competences that bridge across frameworks focusing on social and emotional learning, personality traits and self-determination theory. Core domains include intrapersonal, interpersonal and task-oriented competencies, differentiating between affective, cognitive, and behavioral manifestations of competences across these domains. It is argued that the integrative taxonomy facilitates the conceptual specification of key constructs, that it helps to better organize the multitude of terms and definitions used, and to guide the conceptualization and operationalization of social-emotional competences and their various facets. (shrink)

Journal of Economic Methodology, Volume 19, Issue 2, Page 159-163, June 2012.