Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. (...) A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom -based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician’s duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to. (shrink)

This paper considers how Cato's status as a "new man" in the competitive social and political arena he entered at Rome shaped his self-representation in the sphere of his historical writing. At the heart of the argument is the question of how Cato's insertion of his own speeches into the fabric of the Origines modulated the tenor of his self-commemoration in that work. After briefly considering how previous historiography may have helped determine Cato's choices, the argument looks to Roman discursive (...) practices that appear to have taken shape around the 4th- and early 3rd-century rise of the nobilitas. Especially in focus are the functions of the ancestor mask and the use of voice in honorific epigraphy. (shrink)

We recorded participants' eye movements while they read sentences containing verb‐phrase coordination. Results showed evidence of immediate processing disruption when a reflexive pronoun embedded in the conjoined verb phrase mismatched the sentence subject. We argue that this result is incompatible with models of human parsing that employ only bottom‐up parsing procedures, even when flexible constituency is employed. Models need to incorporate a mechanism similar to the adjoining operation in Tree‐Adjoining Grammar, in which one structure is inserted into another.

Argument schemes are abstractions substantiating the inferential connection between premise(s) and conclusion in argumentative communication. Identifying such conventional patterns of reasoning is essential to the interpretation and evaluation of argumentation. Whether studying argumentation from a theory-driven or data-driven perspective, insight into the actual use of argumentation in communicative practice is essential. Large and reliably annotated corpora of argumentative discourse to quantitatively provide such insight are few and far between. This is all the more true for argument scheme corpora, which tend (...) to suffer from a combination of limited size, poor validation, and the use of ad hoc restricted typologies. In the current paper, we describe the annotation of schemes on the basis of two distinct classifications: Walton’s taxonomy of argument schemes, and Wagemans’ Periodic Table of Arguments. We describe the annotation procedure for each, and the quantitative characteristics of the resulting annotated text corpora. In doing so, we extend the annotation of the preexisting US2016 corpus of televised election debates, resulting in, to the best of our knowledge, the two largest consistently annotated corpora of schemes in argumentative dialogue publicly available. Based on evaluation in terms of inter-annotator agreement, we propose further improvements to the guidelines for annotating schemes: the argument scheme key, and the Argument Type Identification Procedure. (shrink)

Pandemics such as COVID-19 place everyone at risk, but certain kinds of risk are differentially severe for groups already made vulnerable by pre-existing forms of social injustice and discrimination. For people with disability, persisting and ubiquitous disablism is played out in a variety of ways in clinical and public health contexts. This paper examines the impact of disablism on pandemic triage guidance for allocation of critical care. It identifies three underlying disablist assumptions about disability and health status, quality of life, (...) and social utility, that unjustly and potentially catastrophically disadvantage people with disability in COVID-19 and other global health emergencies. (shrink)

ABSTRACT The part played by time in ethics is often taken for granted, yet time is essential to moral decision making. This paper looks at time in ethical decisions about having a genetic test. We use a patient‐centred approach, combining empirical research methods with normative ethical analysis to investigate the patients' experience of time in (i) prenatal testing of a foetus for a genetic condition, (ii) predictive or diagnostic testing for breast and colon cancer, or (iii) testing for Huntington's disease (...) (HD). We found that participants often manipulated their experience of time, either using a stepwise process of microdecisions to extend it or, under the time pressure of pregnancy, changing their temporal ‘depth of field’. We discuss the implications of these strategies for normative concepts of moral agency, and for clinical ethics. (shrink)

This note is in part a response to Alastair Hannay's review discussion, ?A Kind of Philosopher: Comments in Connection with Some Recent Books on Kierkegaard? (Inquiry, Vol. 18 [1975], No. 3). In his review, Hannay states that Kierkegaard and philosophy appear to be on the road to a reconciliation, and asks What is behind this get?together if it is one??. I suggest that in some remarks touching on Kierkegaard's theory of Truth, Hannay has touched on the ground for that ?get?together?, (...) a Pyrrhonian scepticism. (shrink)

St. Stephen's Society, Hang Fook Camp, Kowloon, Hong Kong was formally registered in 1981, but its origins go back to 1966. It is a member of the Hong Kong Council of Social Services and the central Registry of Drug Abuse. The Society works in cooperation with the courts, doctors and social workers to provide a spiritual, physical, emotional, educational and social rehabilitation programme. St. Stephen's houses about 300 people on any given day. It meets in Hang Fook Camp which is (...) leased to them by the Hong Kong Government where a regular meeting is held for Christian Fellowship, the Hang Fook Christian Fellowship. (shrink)

This book reconceives disability as a set of social relations and practices, as experienced embodiment, and as an emancipatory movement, as well as a biomedical phenomenon. The author brings new attention to complex ethical questions surrounding disability, looking at not only the biomedical understanding of impairment, but also its cultural representations and social organization.

The work of a bioethicist carries distinctive responsibilities. Alongside those of any worker, there are responsibilities associated with giving guidance to practitioners, policy makers and the public. In addition, bioethicists are professionally exposed to and required to identify situations of moral trouble, and as a result may find themselves choosing to work as advocates or activists, with responsibilities that are distinct from those generally acknowledged within academia. The requirement for bioethics to make normative judgements entails taking a stance, which means (...) there cannot be a sharp line between ‘academic’ or ‘objective’ bioethics, and advocacy/activism, but a continuum of bioethicists’ engagement and an associated continuum of responsibilities. (shrink)

In this paper a dialogue game for critical discussion is developed. The dialogue game is a formalisation of the ideal discussion model that is central to the pragma-dialectical theory of argumentation. The formalisation is intended as a preparatory step to facilitate the development of computational tools to support the pragma-dialectical study of argumentation. An important dimension of the pragma-dialectical discussion model is the role played by speech acts. The central issue addressed in this paper is how the speech act perspective (...) can be accommodated in the formalisation as a dialogue game. The starting point is an existing ‘basic’ dialogue game for critical discussion, in which speech acts are not addressed. The speech act perspective is introduced into the dialogue game by changing the rules that govern the moves that can be made and the commitments that these result in, while the rules for the beginning, for the end, and for the structure of the dialogue game remain unchanged. The revision of the move rules is based on the distribution of speech acts in the pragma-dialectical discussion model. The revision of the commitment rules is based on the felicity conditions that are associated with those speech acts. (shrink)

La maladie de l'ame... la belle expression platonicienne n'a de cesse d'etre d'actualite. Non seulement elle est prompte a revenir d'epoque en epoque, mais elle semble particulierement friande de la notre. Que cette maladie designe une vague tristesse, un taedium vitae, ou, plus grave, une depression, elle implique tout a la fois la souffrance morale et la souffrance physique. L'ame et le corps sont divises mais se retrouvent dans la douleur si bien que la maladie de l'ame vient de ce (...) que nous avons un corps. De ce constat paradoxal Jackie Pigeaud tire une histoire, celle du triomphe du dualisme, du fardeau de l'ame et du corps contraints a etre separes et ensemble a perpetuite. Cette histoire trouve son origine dans le monde grec, et plus exactement dans sa philosophie. La division entre maladies de l'ame et autres maladies, c'est-a-dire maladies du corps, appartient a la philosophie. La medecine aurait ete bien soulagee de cette partition. Est-ce a dire qu'elle n'entendait pas etre philosophique? Sans doute: Hippocrate en offre un bon exemple. L'accord, tacite, est le suivant: l'ame appartient au philosophe et le corps au medecin. Ciceron s'occupe des passions et Galien suspend son jugement des qu'il approche la psyche. Chacun y trouve son compte mais les consequences sont importantes: la partition du champ des maladies, la place du malade dans la societe, les traitements a apporter, notamment a la folie, dependent de ce dualisme initial. Si le legs de la medecine greco-romaine est riche, il est aussi fort lourd et trouve des developpements tout au long de l'histoire de la medecine, jusqu'a la constitution au XVIIIe siecle de la psychiatrie. D'une ecriture et d'une pensee personnelles et profondes, ce livre est un essai sur l'histoire de la pensee medicale, depuis l'Antiquite jusqu'a nos jours. La Maladie de l'ame a ete un succes des sa parution, et ce succes n'a pas ete dementi depuis. L'ouvrage n'etait malheureusement plus disponible: les livres ont leur destin commentait l'auteur. Avec cette edition revue et augmentee, accompagnee d'une preface nouvelle, le livre connait enfin le sort qu'il merite.Jackie Pigeaud est professeur emerite de litterature latine a l'Universite de Nantes et membre de l'Institut universitaire de France. On lui doit egalement, aux Belles Lettres, Folie et cures de la folie chez les medecins de l'Antiquite greco-romaine. La manie. (shrink)

Atmospheres are affective, sensory realms, where mood is palpable. Memory landscapes intensify affectivity, amplifying emotion. The senses, especially smell and taste, trigger and heighten memory. There is therefore a potent intersection between landscape, atmospheres, memory, and the senses. These connections present the compelling prospect that atmospheres could be designed, with the intention of enhancing memory landscapes through sensory means. This paper is written from the perspective of landscape architecture, a discipline which designs and shapes landscapes. Landscape architects work within the (...) spatially and temporally fluid context of the landscape, and aligned with this is the prospect of generating and tuning atmospheres. Past traumatic events, losses of people and places, float in atmospheres of melancholy. Two projects are explored here to probe the possibilities of intentionally invoking atmospheres, exploring how the landscape could be sensorially tonalised. The memorial landscape of Pike River where 29 men died in a mine explosion, and Laura Daly’s augmented reality artwork, The Storm Cone, offer insights into the possibilities of atmospheric design. (shrink)

This research provides a look at men doing gender in the highly feminized context of temporary clerical employment. Male clerical temporaries, as with other men who cross over into “women's work,” face institutionalized challenges to their sense of masculinity. In particular, male clerical temporary workers face gender assessment—highlighting their failure to live up to the ideals of hegemonic masculinity. The resulting gender strategies these men adopt reveal how male clerical temporary workers “do masculinity”—often in a collaborative performance shaped by the (...) gendered expectations of their agencies, their clients, and even themselves—to reassert the feminine identification of the job while at the same time rejecting its application to them. Paradoxically, rather than disrupting the gender order, the gender strategies used by these male clerical temporaries help to reproduce and naturalize the gendered organization of work and reinvigorate hegemonic masculinity and its domination over women and subaltern men. (shrink)

This paper is based on linked qualitative studies of the donation of human embryos to stem cell research carried out in the United Kingdom, Switzerland, and China. All three studies used semi-structured interview protocols to allow an in-depth examination of donors’ and non-donors’ rationales for their donation decisions, with the aim of gaining information on contextual and other factors that play a role in donor decisions and identifying how these relate to factors that are more usually included in evaluations made (...) by theoretical ethics. Our findings have implications for one factor that has previously been suggested as being of ethical concern: the role of gratitude. Our empirical work shows no evidence that interpersonal gratitude is an important factor, but it does support the existence of a solidarity-based desire to “give something back” to medical research. Thus, we use empirical data to expand and refine the conceptual basis of bioethically theorizing the IVF–stem cell interface. (shrink)

Bioethics traditionally focuses on establishing moral limits between different types of acts. However, boundaries are established by communities and individuals who differ in the constraints shaping their moral world. Phase boundaries, the sites of transition between two physical phases such as a liquid and a gas, provide a metaphor for ‘drawing a line’ in bioethics discourse. Phase boundaries occur where the physical constraints allow both phases to coexist in stable equilibrium. This relationship can also be considered in reverse, using the (...) known position of the phase boundary to disclose the physical constraints. By analogy, instead of trying to locate the ‘correct’ moral boundary, the alternative perspective of ‘reverse ethics’ works from a commonly accepted boundary to examine the constraints of the moral world that are being used to establish it. Genetic interventions into the human body provide interesting examples of boundary establishment. In gene therapy, focusing on boundaries has resulted in a model of moral permissibility that ignores some alternative standpoints and increases the potential for conflict between them. Reverse ethics examines such conflicts in terms of the nature of the moral worlds that have come into contact with each other, taking seriously the diversity of factors governing the location of a boundary, in ways that might help shift some entrenched lines of conflict. (shrink)

Susan has been profoundly deaf since childhood. She is a hearing aid wearer, and likes to use the induction loops built into some public spaces, such as theaters and cinemas, to help cut down the background noise that can make hearing speech very difficult. But this depends on the building having an induction loop fitted and properly maintained. Like many other induction loop users, Susan frequently finds that the advertised loop system is either working poorly or not working at all. (...) Almost as often, she then has the experience of making a complaint about it only to have the problem denied. If she persists, she is often then met... (shrink)

This article draws on data from a qualitative research study undertaken in an old UK university with the main aim of investigating the issue of the gender dimension of academic careers. It examines the idea of an individualistic academic career that demands self-promotion, which is still used as a measure of achievement by those in senior positions. However, there is a basic contradiction. While this idea is upheld, men simultaneously gain by an in-built patriarchal support system. They do not have (...) to make a conscious effort to be helped by it, thereby perpetuating the cultural hegemony of individualism. Women are not admitted to this support system, and if they are seen as needing or wanting to set up their own system, this is viewed as a weakness. The answer appears to be for women to strategically harness feminist ways of working in a collaborative and supportive way. (shrink)

Literature relating to gender and discourse has shown that the features and structure of women's talk are highly cooperative. The implicature taken from this research has led to a binary opposition of gender stereotyping that allows for the inference that if women's talk is stylistically cooperative then it follows that cooperativity is a characteristic feature of women's social lives. Further, in opposition to this, men are seen as competitive and, as Cameron has rightly noted, analysis that focuses on the `style (...) rather than the substance of what is said' obscures the complex nature of talk and results in unhelpful `competitive/cooperative oppositions'. This article explores the genre of gossip and suggests two main sub-genres `bitching' and `peer group news-giving'. Analysis of instances of women's `bitching' reveals that while women's conversations may rely on interlocutor cooperativity and a collaborative floor, the conversations are underpinned by a need to discursively claim symbolic capital through competition for socially acceptable images of femininity which reproduce a hegemonic ideology of gender. (shrink)

Mitochondrial replacement techniques are intended to avoid the transmission of mitochondrial diseases from mother to child. MRT represent a potentially powerful new biomedical technology with ethical, policy, economic and social implications. Among other ethical questions raised are concerns about the possible effects on the identity of children born from MRT, their families, and the providers or donors of mitochondria. It has been suggested that MRT can influence identity directly, through altering the genetic makeup and physical characteristics of the child, or (...) indirectly through changing the child's experience of disease, and by generating novel intrafamilial relationships that shape the sense of self. In this article I consider the plausibility and ethical implications of these proposed identity effects, but I focus instead on a third way in which identity may be affected, through the mediating influence of the wider social world on MRT effects on identity. By taking a narrative approach, and examining the nature and availability of identity narratives, I conclude that while neither direct genetic nor indirect experiential effects can be excluded, social responses to MRT are more likely to have a significant and potentially damaging influence on the generation of MRT children's narratives of identity. This conclusion carries some implications for the collective moral responsibility we hold to ensure that MRT, if implemented, are practised in ethically justifiable ways. (shrink)

This paper discusses the ways in which anesthetic agents can be used to investigate the role of awareness in learning and memory. It reviews research into learning during light, subclinical anesthesia, termedhypesthesia.This research suggests that the effects of anesthetics on implicit and explicit memory are roughly comparable, although implicit memory for simple stimuli may resist the effects of very low doses of anesthetic. In addition, this paper reports experimental data demonstrating that long-term retention of information is prevented by doses of (...) anesthetic that are low enough to permit awareness and even short-term memory of auditory stimuli. Overall, these findings are consistent with the hypothesis that frontal lobe function is particularly sensitive to anesthetics. They raise theoretical and practical questions about the necessity of consciousness for learning and about interpretation of the evidence for learning during surgery under general anesthesia. (shrink)

This paper identifies and discusses ethical issues associated with the increasingly common use of multiple reminders in postal survey research. When undertaking postal surveys, it is common to improve response rates by contacting survey recipients multiple times encouraging them to complete the questionnaire. The ethical implications of the use of multiple reminders are rarely discussed in the literature advocating their use. The paper briefly reviews the arguments encouraging use of multiple reminders, and identifies and discusses the potential ethical issues raised (...) by their use in postal surveys. A set of principles is then proposed for using multiple reminders in an ethically responsible way. It is argued that by following these principles, the use of multiple reminders should present no increased potential for harassment or coercion of survey recipients compared to alternative survey techniques. The use of these principles in a recent postal survey is then presented and discussed; a 60% response rate was achieved utilising multiple survey reminders in a way consistent with this set of principles. (shrink)

Philosophically grounded, methodologically sound, and theoretically rigorous, this paradigm-challenging collection ponders the most dynamic areas of feminist inquiry into bioethical thought and practice and sketches future directions for this rapidly growing field.