BackgroundDealing with end of life is challenging for patients and health professionals alike. The situation becomes even more challenging when a patient requests a legally permitted medical service that a health professional is unable to provide due to a conflict of conscience. Such a scenario arises when Victorian health professionals, with a conscientious objection (CO) to voluntary assisted dying (VAD), are presented with patients who request VAD or merely ask about VAD. The Voluntary Assisted Dying Act 2017 (Vic) recognizes the (...) inherent conflict of conscience that may arise for some health professionals when asked to provide VAD and responds by affording broad protection to conscientious objectors who wish to refuse to take part in the VAD process.MethodsSeventeen semi-structured qualitative interviews were conducted with Victorian health professionals with a self-identified CO to VAD in the lead-up to the implementation of VAD in Victoria. Interviews explored how participants anticipated they would manage their CO in practice. Interviews were transcribed verbatim and analyzed thematically.ResultsOur results reveal that the way in which health professionals claimed they would approach CO conversations is variable and was dependant on the strength of their opposition to VAD. We categorized conscientious objectors according to their approach as either dissuasive non-referrers, passive non-referrers, facilitators or negotiators. Our study also explores the perceived difficulties of exercising one’s CO as identified by our participants.ConclusionThe broad protection offered by the Voluntary Assisted Dying Act 2017 (Vic) encourages a range of behaviors from conscientious objectors, due to the minimal obligations imposed. In order to assist conscientious objectors, more policy, institutional guidance, and education needs to be available to conscientious objectors explicitly addressing how to effectively manage one’s CO. Such guidance is imperative to ensuring that their moral integrity is preserved and that they are exercising their CO appropriately. (shrink)

In Victoria, Australia, the law regulating abortion was reformed in 2008, and a clause was introduced requiring doctors with a conscientious objection to abortion to refer women to another provid...

Whilst care imperatives have arisen across the breadth of Western societies, within the education sector they appear both prolific and urgent. This paper explores the deployment of care discourses within education generally and draws upon the case of Australian Health and Physical Education (HPE) more specifically, to undertake a Foucauldian interrogation of care. In so doing I demonstrate the usefulness of Foucault's pastoral power lens and its capacity to provide insight into the moral and ethical work conducted by caring teachers (...) on behalf of the state (Acker, 1995). Following a brief overview of the advocacy, challenges and debates surrounding the issue of caring teaching within education, I draw on the work of Hunter (1994) and three case studies from a genealogical interrogation of HPE that employed Foucualt's ethical fourfold as a heuristic device to reveal the ethical practices and objectives of the good HPE teacher. Drawing on this genealogical work, I argue that HPE teachers and their colleagues have been purposefully incited to constitute themselves as agents of pastoral power. From this Foucauldian perspective, I conclude with an exploration of the unintended and possibly ‘dangerous’ practices of caring teaching that may emerge within the complex and messy nexus of contemporary self‐constitution. (shrink)

Much attention has been devoted to ethical issues related to randomized controlled trials for HIV treatment and prevention. However, there has been less discussion of ethical issues surrounding families involved in observational studies of HIV transmission. This paper describes the process of ethical deliberation about how best to obtain informed consent from sex partners of injection drug users (IDUs) tested for HIV, within a recent HIV study in Eastern Europe. The study aimed to assess the amount of HIV serodiscordance among (...) IDUs and their sexual partners, identify barriers to harm reduction, and explore ways to optimize intervention programs. Including IDUs, either HIV-positive or at high risk for HIV, and their sexual partners would help to gain a more complete understanding of barriers to and opportunities for intervention. (shrink)

Documentary film, in the words of Bill Nichols, is one of the "discourses of sobriety" that include science, economics, politics, and history-discourses that claim to describe the "real," to tell the truth. Yet documentary film, in more obvious ways than does history, straddles the categories of fact and fiction, art and document, entertainment and knowledge. And the visual languages with which it operates have quite different effects than does the written text. In the following interview conducted during the winter of (...) 1997, historian Ann-Louise Shapiro raises questions about genre-the relationship of form to content and meaning-with documentary filmmaker Jill Godmilow.In order to explore the possibilities and constraints of non-fiction film as a medium for representing history, Godmilow was asked: What are the strategies and techniques by which documentary films make meaning? In representing historical events, how does a non-fiction filmmaker think about accuracy? authenticity? invention? What are the criteria you have in mind when you call a film like The Wonderful, Horrible Life of Leni Riefenstahl "dishonest"? How does the tension between making art and making history affect documentary filmmaking? Should documentary filmmakers think of themselves, in the phrase of Ken Burns, as "tribal storytellers"? What kind of historical consciousness is produced by documentary film? (shrink)

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations (...) and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts. (shrink)

For nearly a century, the French have entertained an unshakable conviction that their ability to recognize themselves-to know and transmit the essence of Frenchness-depended on the teaching of the history of France. In effect, history was a discourse on France, and the teaching of history-"la pédagogie centrale du citoyen"-the means by which children were constituted as heirs and carriers of a common collective memory that made them not only citizens, but family. In this essay, I examine the rhetorical and conceptual (...) effects on history writing that emerge out of this preoccupation with the elaboration of a continuous, coherent national identity. Focusing on schoolbooks, I begin by looking at the dominant, nearly hegemonic model of French history created by Ernest Lavisse in the 1890s-a model informed by the dream of a unified, unitary French nation, embodied in and articulated through the history of France-and at the disruption of this paradigm in the aftermath of the Great War. I then consider a text written in the 1990s specifically to repudiate the kind of nationalist narratives that prevailed for most of this century-a new supranational history of Europe. I argue that, in their different experiments with fixing history, both Lavisse and the contemporary textbook authors did not so much repair a deficient history as produce a historical fixation, creating mythicized histories that are complete, closed, predictable, and at bottom ahistorical. Finally, I turn to a recent World War I novel, A Very Long Engagement by Sébastien Japrisot, in order to suggest ways in which the narrative strategies of a fiction writer may be useful to historians in thinking about a different kind of historical project. (shrink)

This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could ‘see’ neither their (...) role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for ‘things’ such as cost‐effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice. (shrink)

This article presents a three-stage model of how isomorphic mechanisms have shaped corporate social responsibility reporting practices over time. In the first stage, defensive reporting, companies fail to meet stakeholder expectations due to a deficiency in firm performance. In this stage, the decision to report is driven by coercive isomorphism as firms sense pressure to close the expectational gap. In the second stage, proactive reporting, knowledge of CSR reporting spreads and the practice of CSR reporting becomes normatively sanctioned. In this (...) stage, normative isomorphism leads other organizations to look to CSR reporting as a potential new opportunity for achieving the firm’s goals. In the third stage, imitative diffusion, the defensive reporters together with the proactive reporters create a critical mass of CSR reporters that reaches a threshold at which the benefits of CSR reporting begin to outweigh any costs due to mimetic isomorphism. The study finds support for the model in an examination of Fortune 500 firms from 1997 to 2006. (shrink)

This paper explores the application of ethical thinking from the perspective of someone with the dual role of social worker and PhD researcher. The focus of the research was family secrets and their influence upon child-to-parent violence and abuse (CPVA). The participants were children and their parents, who, at the time of the research, were experiencing family violence and abuse.This paper was developed from a conversation between Lee-Ann and Louise. Lee-Ann was Louise’s PhD supervisor and was therefore involved (...) in supporting Louise in gaining ethics approval, as well as holding continued reflexive conversations about the ethical questions and dilemmas that arose throughout this study.This paper has shown the importance of hearing the voices of children within research about CPVA. Children can offer a rich layer of information that is seldom heard. It also shows that there may be a different lens through which ethics can be considered during research, not only the purely objective or academic, but also from a practitioner-researcher in a social care setting position. (shrink)

Traditional theistic proofs are often understood as evidence intended to compel belief in a divinity. John Clayton explores the surprisingly varied applications of such proofs in the work of philosophers and theologians from several periods and traditions, thinkers as varied as Ramanuja, al-Ghazali, Anselm, and Jefferson. He shows how the gradual disembedding of theistic proofs from their diverse and local religious contexts is concurrent with the development of natural theologies and atheism as social and intellectual options in early modern Europe (...) and America. Clayton offers a fresh reading of the early modern history of philosophy and theology, arguing that awareness of such history, and the local uses of theistic argument, offer important ways of managing religious and cultural difference in the public sphere. He argues for the importance of historically grounded philosophy of religion to the field of religious studies and public debate on religious pluralism and cultural diversity. (shrink)

Since the turn of the millennium, a new phenomenon has arisen on the global stage, as girls have increasingly begun to raise their voices. In an effort to achieve new philosophical understandings of contemporary childhoods in a post-truth era, the present article examines this Girl Rising movement from an existential perspective. In doing so, the article aims to problematise children’s right to be heard and listened to, as enshrined in Article 12 of the Convention on the Rights of the Child. (...) More specifically, the article explores children as rights-holders and their rights-subject position and how these positions are supported (or not) by adults in different ways. Throughout the analysis, Greta Thunberg is used as a case study to illustrate the phenomenon under study. This new movement highlights children’s right to be heard as a valuable right. The defence of this view relies on the claim that at the heart of adult’s acknowledgement lies the uniqueness of each child and the implications of this uniqueness. Taking into consideration the realisation of children’s rights, powerful stakeholders who seek to silence children’s voices are also identified, as are worldwide adult acknowledgements intended to empower girls to exist ‘in’ and ‘with’ the world in a ‘grown-up’ way. (shrink)

There are wide individual differences in the ability to detect a stimulus contingency embedded in a complex paradigm. The present study used a cognitive masking paradigm to better understand individual differences related to contingency learning. Participants were assessed on measures of electrodermal arousal and on working memory capacity before engaging in the contingency learning task. Contingency awareness was assessed both by trial-by-trial verbal reports obtained during the task and by a short post-task recognition questionnaire. Participants who became aware had fewer (...) non-specific skin conductance responses and tended to score higher on a digit span assessment. Skin conductance level was not significantly lower in the aware group than in the unaware group. These findings are consistent with studies showing that lower arousal and greater cognitive processing capacity facilitate conscious perception of a greater breadth of information within a scene or a task. (shrink)

An initial distinction is made between two ways of referring in thought to a particular object. One can think of an object in virtue of having a descriptive condition in mind which uniquely denotes that object. Alternatively, one can think about a particular in a more direct way. It is with the nature of this more direct sort of reference that the subsequent discussion is primarily concerned. ;It has been argued that the relation of direct reference is purely causal in (...) nature. A number of difficulties are raised for this causal view. A diagnosis of these difficulties suggests that the causal view ignores the cognitive aspects of direct reference. ;The idea that direct reference is a cognitive relation is not new. Bertrand Russell's notion of knowledge by acquaintance can be thought of as involving the idea of a relation of reference which is direct and cognitive. A good place to begin an exploration of the cognitive dimensions of direct reference is with Russell's notion of acquaintance. Thus this notion is analysed in some depth. ;An objection to the effect that acquaintance is a relation incapable in principle of playing a role in an account of reference is shown to be unfounded. This clears the way for an extended discussion of the nature of acquaintance. This discussion suggests that we should posit a special demonstrative way in which objects can be presented to us. This demonstrative way of being presented with an object is in turn explored by way of an extended metaphor, in which it is suggested that becoming acquainted with an object should be thought of as the opening of a mental file of a special sort for that object. ;Some indirect support for this account of demonstrative modes of presentation and the associated account of direct reference comes from the fact that these notions can help solve the problem of cognitive significance that has been thought to pose a serious threat to theories that somehow treat reference as direct. ;Finally, some potential counterexamples are examined and shown not to seriously threaten the acquaintance theory of direct reference. (shrink)

Scholars and practitioners alike indicate a movement in corporate philanthropy toward “strategic” giving, for example, giving that improves the firm's strategic position (ultimately the “bottom line”) while it benefits the recipient of the philanthropic act. Although the existence of this trend is widely accepted, it is represented in the literature most often by anecdotal evidence. This article presents the findings of a survey of corporate giving managers of U.S. firms that have had an established giving program of at least 5 (...) years, with annual giving totaling at least $200,000 each year. The data show that corporate giving managers believe their firms are becoming increasingly strategic in their philanthropic activities. The findings also indicate that institutional-, firm-, and individual-level influences combine to precipitate strategic philanthropy. These findings lend support to the belief that the nature of corporate philanthropy is evolving to fit a more competitive marketplace. (shrink)

Name der Zeitschrift: Kierkegaard Studies Yearbook Jahrgang: 2016 Heft: 1 Seiten: 39-50.

The pressure for publication is ever present in academe. Rules for submission are elucidated by conferences, proceedings and journals for the benefit of authors; however, the rules for reviewers and editors are not so well established or consistent. This treatise examines examples of abuse of the editorial process and points to a need for formal recognition of rules for review. The manuscript culminates with proposed Codes of Ethics for researchers, referees and editors and suggestions for improvement of the peer review (...) process. (shrink)

This article focuses on a crucial development in genetic research that occurred in the 1990s: the identification of the first two of the genes responsible for hereditary breast and ovarian cancer. Issues addressed touch on the evolution of the subfield, its potential impact on cancer treatment, and industry involvement. The article follows the activities of the various research groups competing in the race to identify the genes and depicts the frequent conflicts between them. Data are derived chiefly from a bibliometric (...) database. The results show a diversity of research practices. Industrial researchers interacted within far more tightly knit networks than their counterparts working in public organizations. The patenting and commercial exploitation of results led to fierce battles, with one group capturing most of the benefits. (shrink)

A substantial body of theoretical literature testifies to the evolutionary functions of emotions. Relatively little has been written about their developmental functions. This article discusses the developmental functions of emotions from the perspective of differential emotions theory (DET; Izard, 1977, 1991). According to DET, although all the emotions retain their adaptive and motivational functions across the lifespan, different sets of emotions may become relatively more prominent in the different stages of life as they serve stage-related developmental processes. In the first (...) section, we present a brief overview of relevant aspects of the theory. In the second section, we discuss how emotions play a central role in helping the individual achieve developmental milestones and tasks during four major periods of life: Infancy, toddler through preschool years, middle to late childhood, and adolescence. The underlying thesis of this article is that emotions play a central role in stimulating social cognitive attainments at each stage of development. (shrink)

Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses’ assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The (...) results showed six dimensions, found also in theory and empirical health care studies. Conscience was perceived as authority, a warning signal, demanding sensitivity, an asset, a burden and depending on culture. We conclude that the Perceptions of Conscience Questionnaire is valid for assessing some perceptions of conscience relevant to health care providers. (shrink)

Actor‐Network Theory is a research lens that has gained popularity in the nursing and health sciences domains. The perspective allows a researcher to describe the interaction of actors (both human and non‐human) within networked sociomaterial contexts, including complex practice environments where nurses and health technology operate. This study will describe Actor‐Network Theory and provide methodological considerations for researchers who are interested in using this sociotechnical lens within nursing and informatics‐related research. Considerations related to technology conceptualization, levels of analysis, and sampling (...) procedures in Actor‐Network Theory based research are addressed. Finally, implications for future nursing research within complex environments are highlighted. (shrink)

Pour les Dormeuses et les Méditateurs, l’anachronisme est placé au centre de leur discours artistique et de leur pratique vitale. En s’habillant en Grecs et en vivant en communauté à la périphérie de la ville, ils tentent d’incarner leur vision idéalisée de l’Antiquité. Par leur absence de fidélité historique, ils ouvraient également un espace d’expérimentation sociale. Ce texte soulève donc la possibilité d’utiliser l’anachronisme comme outil pour débloquer l’imagination politique et imaginer de nouveaux horizons collectifs.

There has been increasing attention to financial conflicts of interest (COI) in public health research and policy making, with concerns that some decisions are not in the public interest. One notable problematic area is expert advisory committee (EAC). While COI management has focused on disclosure, it could go further and assess experts’ degree of (in)dependence with commercial interests. We analyzed COI disclosures of members of Québec’s immunization EAC (in Canada) using (In)DepScale, a tool we developed for assessing experts’ level of (...) (in)dependence. We found great variability of independence with industry and that companies with the highest vaccine sales were predominantly associated with disclosed COIs. We argue that EACs can use the (In)DepScale to better assess and disclose the COIs that affect their experts. Going forward our scale could help manage risk and select members who are less conflicted to foster a culture of transparency and trust in advisors and policy-makers. (shrink)

Publics are key stakeholders in population genomic screening and their perspectives on ethical considerations are relevant to programme design and policy making. Using semi-structured interviews, we explored social views and attitudes towards possible future provision of personalised genomic risk information to populations to inform prevention and/or early detection of relevant conditions. Participants were members of the public who had received information on their personal genomic risk of melanoma as part of a research project. The focus of the analysis presented here (...) is participants’ views regarding ethical considerations relevant to population genomic screening more generally. Data were analysed thematically and four key themes related to ethical considerations were identified: personal responsibility for health: ‘forewarned is forearmed’; perceptions of, and responses to, genetic fatalism; implications for parenting and reproduction; divided views on choosing to receive genomic risk information. Ethical considerations underlying these themes include the valorisation of information and choice, paternalism, non-directiveness and increasing responsibilisation of individuals in health and healthcare. These findings arguably indicate a thin public conceptualisation of population genomic testing, which draws heavily on how these themes tend to be described in existing social discourses. Findings suggest that further public engagement is required to increase complexity of debate, to consider the appropriate place of individual and social interests in population genomic testing. Further discernment of relevant ethical approaches, drawing on ethical frameworks from both public health and clinical settings, will also assist in determining the appropriate implementation of population genomic screening for complex conditions. (shrink)

AimWhite matter changes in individuals at ultra-high risk for psychosis (UHR) may be involved in the transition to psychosis. Sleep-wake disturbances commonly precede the first psychotic episode and predict development of psychosis. We examined associations between white matter microstructure and sleep-wake disturbances in UHR individuals compared to healthy controls (HC), as well as explored the confounding effect of medication, substance use, and level of psychopathology.MethodsSixty-four UHR individuals and 35 HC underwent clinical interviews and diffusion weighted imaging. Group differences on global (...) and callosal mean fractional anisotropy (FA) was tested using general linear modeling. Sleep-wake disturbances were evaluated using the subjective measures disturbed sleep index (DSI) and disturbed awakening index (AWI) from the Karolinska Sleep Questionnaire, supported by objective sleep measures from one-night actigraphy. The primary analyses comprised partial correlation analyses between global FA/callosal FA and sleep-wake measures. Secondary analyses investigated multivariate patterns of covariance between measures of sleep-wake disturbances and FA in 48 white matter regions of interest using partial least square correlations.ResultsUltra-high risk for psychosis individuals displayed lower global FA (F = 14.56, p < 0.001) and lower callosal FA (F = 11.34, p = 0.001) compared to HC. Subjective sleep-wake disturbances were significantly higher among the UHR individuals (DSI: F = 27.59, p < 0.001, AWI: F = 36.42, p < 0.001). Lower callosal FA was correlated with increased wake after sleep onset (r = −0.34, p = 0.011) and increased sleep fragmentation index (r = −0.31, p = 0.019) in UHR individuals. Multivariate analyses identified a pattern of covariance in regional FA which were associated with DSI and AWI in UHR individuals (p = 0.028), but not in HC. Substance use, sleep medication and antipsychotic medication did not significantly confound these associations. The association with objective sleep-wake measures was sustained when controlling for level of depressive and UHR symptoms, but symptom level confounded the covariation between FA and subjective sleep-wake measures in the multivariate analyses.ConclusionCompromised callosal microstructure in UHR individuals was related to objectively observed disruptions in sleep-wake functioning. Lower FA in ventrally located regions was associated with subjectively measured sleep-wake disturbances and was partly explained by psychopathology. These findings call for further investigation of sleep disturbances as a potential treatment target. (shrink)