Language tests for overseas registered nurses (ORN) working outside their home country are essential for patient safety, as communication competency needs to be established in any workforce. We argue that the current employment of existing language tests is structurally and institutionally racist and disadvantages ORNs from non‐European Union (EU) and non‐White countries seeking to work in the United Kingdom. Using Critical Race Theory (CRT), we argue that existing English language tests for ORNs seeking registration in the United Kingdom are discriminatory (...) due to the UK's racist migration policies and a regulatory body for nursing and midwifery that fails to acknowledge and understand its own institutionally racist practices. (shrink)

Much of the literature on clinical ethical conflict has been specific to a specialty area or a particular patient group, as well as to a single profession. This study identifies themes of hospital nurses’ and physicians’ clinical ethical conflicts that cut across the spectrum of clinical specialty areas, and compares the themes identified by nurses with those identified by physicians. We interviewed 34 clinical nurses, 10 nurse managers and 31 physicians working at four different Canadian hospitals as part of a (...) larger study on clinical ethics committees and nurses’ and physicians’ use of these committees. We describe nine themes of clinical ethical conflict that were common to both hospital nurses and physicians, and three themes that were specific to physicians. Following this, we suggest reasons for differences in nurses’ and physicians’ ethical conflicts and discuss implications for practice and research. (shrink)

It has been argued that infants possess a rich, sophisticated theory of mind that is only revealed with tasks based on spontaneous responses. A mature theory of mind implies the understanding that mental states are person-specific. Previous studies on infants’ understanding of motivational mental states such as goals and preferences have revealed that, by 9 months of age, infants do not generalize these motivational mental states across agents. However, it remains to be determined if infants also perceive epistemic states as (...) person-specific. Therefore, the goal of the present study was to use a switch agent paradigm with the classic false belief violation-of-expectation task. Results revealed that 16-month-old infants attributed true and false beliefs to a naïve agent—they did not perceive beliefs as person-specific. These findings indicate that infants’ understanding of beliefs is not as sophisticated as the rich mentalistic view suggests. (shrink)

The focus of this article is perceptions of elderly patients and nurses regarding patients’ autonomy in nursing practice. Autonomy is empirically defined as having two components: information received/given as a prerequisite and decision making as the action. The results indicated differences between staff and patient perceptions of patient autonomy for both components in all five countries in which this survey was conducted. There were also differences between countries in the perceptions of patients and nurses regarding the frequency with which patients (...) received information from nursing staff or were offered opportunities to make decisions. This is the second of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented. (shrink)

The focus of this article is on elderly patients’ and nursing staff perceptions of privacy in the care of elderly patients/residents in five European countries. Privacy includes physical, social and informational elements. The results show that perceptions of privacy were strongest in the UK (Scotland) and weakest in Greece. Country comparisons revealed statistically significant differences between the perceptions of elderly patients and also between those of nurses working in the same ward or long-term care facility. Perceptions of privacy by patients (...) and their nursing staff were quite similar in Finland, Germany and the UK. In contrast, in Greece and Spain these perceptions were different: nurses believed that they took account of their patients’ privacy needs more often than the patients themselves felt this was the case. Among Spanish and UK patients, an association was found between lower levels of independence and comparatively less positive perceptions of privacy. No associations were established between nurses’ perceptions and their demographic factors. This is the third of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented. (shrink)

A key challenge when learning language in naturalistic circumstances is to extract linguistic information from a continuous stream of speech. This study investigates the predictors of such implicit learning among adults exposed to a new language in a new modality. Sign-naïve participants were shown a 4-min weather forecast in Swedish Sign Language. Subsequently, we tested their ability to recognise 22 target sign forms that had been viewed in the forecast, amongst 44 distractor signs that had not been viewed. The target (...) items differed in their occurrence frequency in the forecast and in their degree of iconicity. The results revealed that both frequency and iconicity facilitated recognition of target signs cumulatively. The adult mechanism for language learning thus operates similarly on sign and spoken languages as regards frequency, but also exploits modality-salient properties, for example iconicity for sign languages. Individual differences in cognitive skills and language learning background did not predict recognition. The properties of the input thus influenced adults’ language learning abilities at first exposure more than individual differences. (shrink)

Background Ethical climate refers to the shared perception of ethical norms and sets the scope for what is ethical and acceptable behaviour within teams. Aim This paper sought to explore perceptions of ethical climate amongst healthcare workers as measured by the Ethical Climate Questionnaire (ECQ), the Hospital Ethical Climate Survey (HECS) and the Ethics Environment Questionnaire (EEQ). Methods A systematic review and meta-analysis was utilised. PSYCINFO, CINAHL, WEB OF SCIENCE, MEDLINE and EMBASE were searched, and papers were included if they (...) sampled healthcare workers and used the ECQ, HECS or EEQ. Ethical consideration Ethical approval was not required. Results The search returned 1020 results. After screening, 61 papers were included ( n = 43 HECS, n = 15 ECQ, n = 3 EEQ). The overall sample size was over 17,000. The pooled mean score for the HECS was 3.60. Mean scores of individual studies ranged from 2.97 to 4.5. For the HECS studies, meta-regression was carried out. No relationship was found between the country of the studies, the study setting (ICU v non-ICU settings) or the mean years of experience that the sample had. For the ECQ, sub-scales had mean scores ranging from 3.41 (instrumental) to 4.34 (law) and were all observed to have significant and substantial heterogeneity. Three studies utilised the EEQ so further analysis was not carried out. Conclusions The above results provide insight into the variability of scores as measured by the HECS, ECQ and EEQ. To some extent, this variability is not surprising with studies carried out across 21 countries and in a range of healthcare systems. Results also suggest that it may be that more local and context specific factors are more important when it comes to predicting ethical climate. (shrink)

Earp and colleagues make a strong case for the complete decriminalization and even the legalization of recreational drug use based on the negative impact of the “War on drugs” on racialized...

This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral and psychological considerations to support (...) the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy. (shrink)

ABSTRACTThe massive influx of refugees into Europe in the past few years has given rise to different kinds of challenges among which is the challenge to successfully communicate with newly arrived immigrants. In this article, we will focus on the public service provision sector where quality of service is to a large extent determined by the capability of a service provider and his or her “client” to understand one another. The article centres on a study involving public organisations providing asylum (...) services or healthcare services in the multilingual and multicultural city of Brussels. Several interviews were conducted to gain insight into the communication problems such organisations face, as well as their communication requirements and solutions when providing services to people of different linguistic and cultural backgrounds. We will focus on the types of bridging functions commonly deployed by these organisations in multilingual service encounters and on the motivations for using them. In a... (shrink)

Biomedical research policy in recent years has often tried to make such research more ‘translational’, aiming to facilitate the transfer of insights from research and development to health care for the benefit of future users. Involving patients in deliberations about and design of biomedical research may increase the quality of R&D and of resulting innovations and thus contribute to translation. However, patient involvement in biomedical research is not an easy feat. This paper discusses the development of a method for involving (...) patients in biomedical research aiming to address its main challenges. (shrink)

As part of a multifactorial approach to address weak incentives for innovative antimicrobial drug development, market entry rewards are an emerging solution. Recently, the Duke-Margolis Center for Health Policy released the Priority Antimicrobial Value and Entry Award proposal, which combines a MER with payment reforms, transitioning from volume-based to “value-based” payments for antimicrobials. Here, the PAVE Award and similar MERs are reviewed, focusing on further refinement and avenues for implementation.

We explore the various ethical challenges that arise during the practical implementation of an emergency resource allocation protocol. We argue that to implement an allocation plan in a crisis, a hospital system must complete five tasks: (1) formulate a set of general principles for allocation, (2) apply those principles to the disease at hand to create a concrete protocol, (3) collect the data required to apply the protocol, (4) construct a system to implement triage decisions with those data, and (5) (...) create a system for managing the consequences of implementing the protocol, including the effects on those who must carry out the plan, the medical staff, and the general public. Here we illustrate the complexities of each task and provide tentative solutions, by describing the experiences of the Coronavirus Ethics Response Group, an interdisciplinary team formed to address the ethical issues in pandemic resource planning at the University of Rochester Medical Center. While the plan was never put into operation, the process of preparing for emergency implementation exposed ethical issues that require attention. (shrink)

Religious and Ethical Perspectives on Global Migration examines the complicated social ethics of migration in today's world. Editors Elizabeth W. Collier and Charles R. Strain bring the perspectives of an international group of scholars toward a theory of justice and ethical understanding for the nearly two hundred million migrants who have left their homes seeking asylum from political persecution, greater freedom and safety, economic opportunity, or reunion with family members.

Do the rich descriptions and narrative shapings of literature provide a valuable resource for readers, writers, philosophers, and everyday people to imagine and confront the ultimate questions of life? Do the human activities of storytelling and complex moral decision-making have a deep connection? What are the moral responsibilities of the artist, critic, and reader? What can religious perspectives—from Catholic to Protestant to Mormon—contribute to literary criticism? Thirty well known contributors reflect on these questions, including iterary theorists Marshall Gregory, James Phelan, (...) and Wayne Booth; philosophers Martha Nussbaum, Richard Hart, and Nina Rosenstand; and authors John Updike, Charles Johnson, Flannery O'Connor, and Bernard Malamud. Divided into four sections, with introductory matter and questions for discussion, this accessible anthology represents the most crucial work today exploring the interdisciplinary connections between literature, religion and philosophy. (shrink)

The aim of this work is to revisit the proposal made by Dag Westerståhl a decade ago when he provided a modern reading of the traditional square of opposition and of related structures. We propose a formalization of this modern view and contrast it with the classical one. We discuss what may be a modern hexagon of opposition and a modern cube, and show their interest in particular for relating quantitative expressions.

This paper examines the social and organizational innovation processes undertaken by small-scale producers engaged in short food supply chains in the North Swedish region of Västerbotten. The study uses the notion of proximity to empirically analyse and conceptually explore these phenomena. The paper illustrates the ‘new associationalism’ mobilized by producers in order to promote knowledge exchange and learning and highlights the role of translocal practices in sustaining this transition. The study found that open and trusted interactions with consumers are central (...) to the development of ‘quasi-organic’ practices, and that producers belong to numerous motley associations of food professionals facilitating the creation of collective meanings about near-produced quality food. The paper contributes to the rapprochement between agri-food studies and human geography to understand the formation of local food systems from an evolutionary and relational perspective. (shrink)

Expressing doubts about death criteria can serve healthy purposes, but can also cause a number of harms, including decreased organ donation rates and distress for donor families and health care staff. This paper explores the various causes of doubts about death criteria—including religious beliefs, misinformation, mistrust, and intellectual questions—and recommends responses to each of these. Some recommended responses are relatively simple and noncontroversial, such as providing accurate information. However, other responses would require significant changes to the way we currently do (...) business. Policymakers should establish minimum national standards for determining death to foster a trustworthy system; academics and publishers have a duty to publish only materials that substantially engage and advance the debate to minimize the harm caused by divided expert opinion; and opposition to the dead donor rule should be conceptually separated from doubts about death criteria. (shrink)

During the last decades several tools have been developed to anticipate the future impact of new and emerging technologies. Many of these focus on ‘hard,’ quantifiable impacts, investigating how novel technologies may affect health, environment and safety. Much less attention is paid to what might be called ‘soft’ impacts: the way technology influences, for example, the distribution of social roles and responsibilities, moral norms and values, or identities. Several types of technology assessment and of scenario studies can be used to (...) anticipate such soft impacts. We argue, however, that these methods do not recognize the dynamic character of morality and its interaction with technology. As a result, they miss an important opportunity to broaden the scope of social and political deliberation on new and emerging technologies.In this paper we outline a framework for building scenarios that enhance the techno-moral imagination by anticipating how technology, morality and their interaction might evolve. To show what kind of product might result from this framework, a scenario is presented as an exemplar. This scenario focuses on developments in biomedical nanotechnology and the moral regime of experimenting with human beings. Finally, the merits and limitations of our framework and the resulting type of scenarios are discussed. (shrink)

First published in 1991, this book -- through the examination of ancient Greek literary, philosophical and legal texts -- analyses how the Athenian torture of slaves emerged from and reinforced the concept of truth as something hidden in the human body. It discusses the tradition of understanding truth as something that is generally concealed and the ideas of 'secret space' in both the female body and the Greek temple. This philosophy and practice is related to Greek views of the 'Other' (...) (women and outsiders) and considers the role of torture in distinguishing slave and free in ancient Athens. A wide range of perspectives -- from Plato to Sartre -- are employed to examine the subject. (shrink)

Between the last decades of the 18th century and the middle of the 19th century, something of paramount importance happened in the history of anthropology. This was the advent of a physical anthropology that was about the classification of ‘human races’ through comparative measurement. A central tool of the new trade was diagrams. Being inherently about relations in and between objects, diagrams became the means of defining human groups and their relations to each other – the last point being disputed (...) between the monogenists and the polygenists. James Cowles Prichard, a proponent of the comparative historical approach, was able to do without images in his pioneering Researches Into the Physical History of Man of 1813, but the third edition, which appeared in five volumes between 1836 and 1847, was richly illustrated with ‘ethnic types’ and skulls, including diagrams. What was happening is a process I engage with in detail for Samuel George Morton, who collected and distributed human skulls as lithographs in Crania americana (1839) and Crania aegyptiaca (1844). Along with the paper skulls travelled detailed instructions of how to look at them through a set of lines and to set their individual parts in relation to each other as well as to those of other types. Drawing on Johann Friedrich Blumenbach and Peter Camper, the Crania thus played a pivotal role in establishing what I call a diagrammatics of race – a diagrammatics that became overtly political with Types of Mankind (1854), which was written in Morton's honour by Josiah Nott and George Gliddon. (shrink)

In this book, Marianne Moyaert develops a new interreligious appropriation of Paul Ricoeur’s hermeneutical philosophy. Viewed in context of his philosophical, anthropological, and ethical work, Ricoeur’s fragmentary reflections on the encounters between religions provide insights on global cooperation practices and religious identity concerns.

In this article, the authors, as researchers, are part of a clinical approach to psychoanalytic orientation in education sciences, questioning their research approach during an investigation on the expulsion from classrooms in secondary school in France. Trying to compare themselves to different types of collaborative research, they analyse the modalities of relationship they tried to implement during this research ‘with’ subjects, including teenagers students they have interviewed.

Is the Miranda warning, which lets an accused know of the right to remain silent, more about procedural fairness or about the conventions of speech acts and silences? Do U.S. laws about Native Americans violate the preferred or traditional "silence" of the peoples whose religions and languages they aim to "protect" and "preserve"? In Just Silences, Marianne Constable draws on such examples to explore what is at stake in modern law: a potentially new silence as to justice.Grounding her claims (...) about modern law in rhetorical analyses of U.S. law and legal texts and locating those claims within the tradition of Nietzsche, Heidegger, and Foucault, Constable asks what we are to make of silences in modern law and justice. She shows how what she calls "sociolegal positivism" is more important than the natural law/positive law distinction for understanding modern law. Modern law is a social and sociological phenomenon, whose instrumental, power-oriented, sometimes violent nature raises serious doubts about the continued possibility of justice. She shows how particular views of language and speech are implicated in such law.But law--like language--has not always been positivist, empirical, or sociological, nor need it be. Constable examines possibilities of silence and proposes an alternative understanding of law--one that emerges in the calling, however silently, of words to justice. Profoundly insightful and fluently written, Just Silences suggests that justice today lies precariously in the silences of modern positive law. (shrink)

Adolf Reinach was one of the leading figures of the Munich and Göttingen circles of phenomenology, and Husserl's first real co-worker. Although his writings are highly original and remarkably clear, Reinach's tragic death in the First World War prevented him from formulating a definitive statement of his phenomenology, leaving his name virtually unknown to all but a small circle. In his ground-breaking study, Judgment and Sachverhalt, DuBois shows how Reinach succeeds in developing a realist ontology and epistemology based on (...) rigorous argumentation and phenomenological elucidation. Drawing from numerous texts and the developments of Reinach's students and colleagues - Roman Ingarden, Alexander Pfänder and Dietrich von Hildebrand above all - DuBois presents, refines and defends Reinach's `phenomenological realism'. Confrontations of Reinach's theories of states of affairs, concepts and speech acts with the work of contemporary authors like Chisholm and Searle allow readers to evaluate Reinach's philosophy, not only in the light of the later developments of Husserl, but also in the light of certain Anglo-American developments. (shrink)

In this article, I am concerned with the public engagements of Julian Huxley, Lancelot Hogben, and J. B. S. Haldane. I analyze how they used the new insights into the genetics of heredity to argue against any biological foundations for antidemocratic ideologies, be it Nazism, Stalinism, or the British laissez-faire and class system. The most striking fact—considering the abuse of biological knowledge they contested—is that these biologists presented genetics itself as inherently democratic. Arguing from genetics, they developed an understanding of (...) diversity that cuts across divisions of race, class, or gender. Human diversity rightly understood was advantageous for societal progress. Huxley, Hogben, and Haldane did not hold identical political ideals, but they all argued for democratic reforms and increased planning geared toward greater social equality, and they did so under the label of scientific humanism. Huxley took issue with the notion that evolutionary history does not carry any moral lessons for human societies. Rather than being its antithesis, evolution was the basis of human sociality. In fact, the entire future progress of individuals and communities toward a democratic world order needed to be founded on the cosmic principles of evolution—a process that had to be guided by the biological expert with a strong sense of social responsibility. (shrink)

An in-depth reform of the asylum system took place in Great Britain from the 1830s onwards, under the influence of Dr John Conolly, who succeeded in imposing a new model at Hanwell pauper lunatic asylum, near London, a model that was more respectful of the patients and based on the abandonment of mechanical restraint (non-restraint) combined with occupational therapy. The success of this system at Hanwell, the largest asylum in the country with over a thousand inmates, contributed to the spread (...) of what became a form of psychiatric orthodoxy for the next thirty years. Far from being a strictly medical measure, this reform was anchored in a general reform of poor relief. In this respect, it was in line with the Poor Law of 1834 (inspired by Jeremy Bentham, notably under the aegis of Edwin Chadwick, secretary of the Poor Law Commission). This reform was also part of a more political reflection on the extension of civil and social rights for the working classes, in particular under the... (shrink)