BackgroundCountries are increasingly devoting significant resources to creating or strengthening research ethics committees, but there has been insufficient attention to assessing whether these committees are actually improving the protection of human research participants.DiscussionResearch ethics committees face numerous obstacles to achieving their goal of improving research participant protection. These include the inherently amorphous nature of ethics review, the tendency of regulatory systems to encourage a focus on form over substance, financial and resource constraints, and conflicts of interest. Auditing and accreditation programs (...) can improve the quality of ethics review by encouraging the development of standardized policies and procedures, promoting a common base of knowledge, and enhancing the status of research ethics committees within their own institutions. However, these mechanisms focus largely on questions of structure and process and are therefore incapable of answering many critical questions about ethics committees' actual impact on research practices.The first step in determining whether research ethics committees are achieving their intended function is to identify what prospective research participants and their communities hope to get out of the ethics review process. Answers to this question can help guide the development of effective outcomes assessment measures. It is also important to determine whether research ethics committees' guidance to investigators is actually being followed. Finally, the information developed through outcomes assessment must be disseminated to key decision-makers and incorporated into practice. This article offers concrete suggestions for achieving these goals.ConclusionOutcomes assessment of research ethics committees should address the following questions: First, does research ethics committee review improve participants' understanding of the risks and potential benefits of studies? Second, does the process affect prospective participants' decisions about whether to participate in research? Third, does it change participants' subjective experiences in studies or their attitudes about research? Fourth, does it reduce the riskiness of research? Fifth, does it result in more research responsive to the local community's self-identified needs? Sixth, is research ethics committees' guidance to researchers actually being followed? (shrink)

My paper challenges an influential distinction between pain and suffering put forward by physician-ethicist, Eric Cassell. I argue that Cassell’s distinction is philosophically untenable because he contrasts suffering with an outdated theory of pain. In particular, Cassell focuses on one type of pain, the interpretation of nociception induced by noxious stimuli such as heat or sharp objects; yet since the late 1970s, pain scientists have rendered both nociception and noxious stimuli unnecessary for pain. I argue that this discrepancy between Cassell’s (...) distinction and pain science produces three philosophical problems for his distinction: first, he frames his distinction too generally, concentrating on only one type of pain (interpreted nociception) to the neglect of others, such as neuropathy; second, it is possible that Cassell’s understanding of pain may include suffering; and third, Cassell gives examples of pain and suffering manifesting independently of each other, but it is possible that these cases may instead exemplify differences between nociceptive and non-nociceptive types of pain. Due to these problems, I conclude that Cassell’s distinction currently lacks a difference. I call for new efforts to articulate the differences, if any, between pain and suffering. (shrink)

Background In 2001 a report on the provision of clinical ethics support in UK healthcare institutions identified 20 clinical ethics committees. Since then there has been no systematic evaluation or documentation of their work at a national level. Recent national surveys of clinical ethics services in other countries have identified wide variation in practice and scope of activities. Objective To describe the current provision of ethics support in the UK and its development since 2001. Method A postal/electronic questionnaire survey administered (...) to the chairs of all 82 clinical ethics services registered with the UK Clinical Ethics Network in July 2010. Results Response rate was 62% with the majority of responding services situated in acute trusts. All services included a clinical ethics committee with one service also having a clinical ethicist. Lay members were present in 72% of responding committees. Individual case consultation has increased since 2001 with 29% of chairs spending more than 50% of their time on this. Access to and involvement in the process of case consultation is less for patients and families than for clinical staff. There is wide variation in committee processes and levels of institutional support. Over half of the responding committees undertook some form of evaluation. Conclusion Clinical ethics services in the UK are increasing as is their involvement in case consultation. However, the significant variation in committee processes suggests that further qualitative research is needed to understand how these committees function and the role they play in their institution. (shrink)

IntroductionA symptom cluster is very common among oncological patients: cancer-related fatigue, emotional distress, sleep difficulties, pain, and cognitive difficulties. Clinical applications of interventions based on non-ordinary states of consciousness, mostly hypnosis and meditation, are starting to be investigated in oncology settings. They revealed encouraging results in terms of improvements of these symptoms. However, these studies often focused on breast cancer patients, with methodological limitations. Another non-ordinary state of consciousness may also have therapeutic applications in oncology: self-induced cognitive trance. It seems (...) to differ from hypnosis and meditation, as it involves the body more directly. Thus, investigating its clinical applications, along with hypnosis and meditation interventions, could improve available therapeutic options in oncology. This article details the study protocol of a preference-based longitudinal controlled superiority trial aiming to assess the effectiveness of 3 group interventions to improve oncological patients’ quality of life, and more specifically CRF, emotional distress, sleep, pain, and cognitive difficulties.Methods and analysisA power analysis required a total sample of 160 patients. Main inclusion criteria are: cancer diagnosis, active treatments completed for less than a year, no practice of hypnosis, meditation, or SICT, and presence of at least one of these four symptoms: fatigue, sleep difficulties, depression, or anxiety. Each participant will choose the intervention in which they want to participate. To test the effectiveness of the interventions, data will be collected by questionnaires and neurobiological measures and directly from the medical record at four time points: before inclusion in the study ; immediately after the intervention; and at 3- and 12-month follow-up. The longitudinal data in each group will then be measured.DiscussionIn addition to standard cancer therapies, there is a growing interest from patients in complementary approaches, such as hypnosis, meditation, and SICT. The results of this study will be useful to increase knowledge about short- and long-term effectiveness of 3 group interventions for CRF, emotional distress, sleep, pain, and cognitive difficulties in patients with different cancers.Clinical Trial RegistrationClinicalTrials.gov/. Retrospectively registered on the 29th of April 2021. url: https://clinicaltrials.gov/ct2/show/NCT04873661. (shrink)

My paper challenges an influential distinction between pain and suffering put forward by physician-ethicist, Eric Cassell. I argue that Cassell’s distinction is philosophically untenable because he contrasts suffering with an outdated theory of pain. In particular, Cassell focuses on one type of pain, the interpretation of nociception induced by noxious stimuli such as heat or sharp objects; yet since the late 1970s, pain scientists have rendered both nociception and noxious stimuli unnecessary for pain. I argue that this discrepancy between Cassell’s (...) distinction and pain science produces three philosophical problems for his distinction: first, he frames his distinction too generally, concentrating on only one type of pain (interpreted nociception) to the neglect of others, such as neuropathy; second, it is possible that Cassell’s understanding of pain may include suffering; and third, Cassell gives examples of pain and suffering manifesting independently of each other, but it is possible that these cases may instead exemplify differences between nociceptive and non-nociceptive types of pain. Due to these problems, I conclude that Cassell’s distinction currently lacks a difference. I call for new efforts to articulate the differences, if any, between pain and suffering. (shrink)

The provision of informed consent is a prerequisite for inclusion of a patient in a clinical research project. In some countries, the legislation on clinical research authorizes a third person to provide informed consent if the patient is unable to do so directly . This is the case during acute stroke, when the symptoms may prevent the patient from providing informed consent and thus require a third party to be approached. Identification of factors associated with the medical team’s decision to (...) resort to surrogate consent may help the care team during the inclusion process and enable the patient’s family circle to be better informed about providing surrogate consent. (shrink)

We reflect, using a vignette, on conceptual tensions and the value judgements that lie behind difficult decisions about whether or not the older person with dementia should return home or move into long-term care following hospital admission. The paper seeks, first, to expose some of the difficulties arising from the assessment of residence capacity, particularly around the nature of evaluative judgements and conceptual tensions inherent in the legal approach to capacity. Secondly, we consider the assessment of best interests around place (...) of residence, which demonstrates significant conceptual tensions. In addition, ‘best interests’ raise issues around the perception of risk and the perceptions of the family and crucially involve the notions of autonomy and trust. Finally, we not only gesture at some practical considerations based on insights from values-based medicine, but also make the suggestion that we require tighter functional assessments of residence capacity coupled with broader judgements about best interests. (shrink)

Environmental changes such as extreme weather events become increasingly noticeable worldwide. Earth observation (EO) data provide information about such changes, but little is known about citizens’ perceptions of and responses to such changes. Across three studies, we assess whether people’s place attachment on different regional levels predicts interest in EO data, and whether perceived environmental change affects emotional responses and place attachment. Two survey studies ( N = 118 students and N = 197 citizens from the Palatinate in Southern Germany) (...) revealed that place attachment predicts interest in EO data, especially when people felt strongly attached to the region or place in question. A third experimental study ( N = 600) with repeated measures ( N = 203) revealed that visualized environmental change – using satellite images of local vs. non-local environmental change – did not affect place attachment but elicited stronger emotional responses than visualizing no change. Policy support measures across Studies 2 and 3 suggest that place attachment and emotional responses are important predictors for action to mitigate consequences of environmental change. (shrink)

The purpose of the article is to elaborate on the scholarly debate on affect. We consider the site of affect to be the activities of embodied, socioculturally and spatially situated participants: “Affective activity is a form of social practice” (Wetherell, 2015, p. 147). By studying affect as a social phenomenon, we treat affect as a social ontology. Social practices are constituted through participation in social interaction, which makes it possible to study affect empirically. Moreover, we suggest that to consider affect (...) a social ontology connects affect to agency. We regard affect as a participants’ phenomenon where emotions and knowledge are not separated, i.e. as a social epistemology. To capture the complexity of affective activity, the study of situated participation requires video data. We collected data at a centre for persons with acquired brain injury (ABI), which highlights research ethics. The International Classification of Functioning, Disability and Health (ICF) framework defines participation as involvement in life situations. ICF focuses on two broader perspectives: the body and the individual in society. We turn ICF’s abstract societal perspective on participation to meaningful local accomplishments in lived social practices. Our focus is, in line with a critical social ontology in disability studies, on how-ability, the communicative abilities of the residents (Hughes, 2007). To get closer to life situations as they unfold, we analyse participation in its details as embodied actions during activities in the material environment of the centre. To conclude, we demonstrate a resident’s competent participation in an occupational therapy session through a fine-grained analysis of affective activity. Interaction, practices and phenomena are complex theoretical and practical issues. In the analysis of the encounters as complex multimodal and -sensorial situations, we use an extended version of Ethnomethodological Conversation Analysis (EMCA) that incorporates the body and material environment with the interconnectedness of interactional episodes. To do this, we enlarge the scope of analysis from the complexity of local occasions of affective activity to connections between consecutive affective entanglements. In the indicated work we draw on theoretical (lamination) and methodological (nexus analysis) suggestions in order to best pursue the sociocultural nature of situated interactions. (shrink)

Background The first COVID-19 wave started in February 2020 in France. The influx of patients requiring emergency care and high-level technicity led healthcare professionals to fear saturation of available care. In that context, the multidisciplinary Ethics- Support Cell (EST) was created to help medical teams consider the decisions that could potentially be sources of ethical dilemmas. Objectives The primary objective was to prospectively collect information on requests for EST assistance from 23 March to 9 May 2020. The secondary aim was (...) to describe the Cell’s functions during that period. Research design This observational, real-time study of requests for Cell consultations concerned ethical dilemmas arising during a public health crisis. The EST created a grid to collect relevant information (clinical, patient’s/designated representative’s preferences and ethical principles strained by the situation), thereby assuring that each EST asked the same questions, in the same order. Participants and research context Only our university hospital’s clinicians could request EST intervention. Ethical considerations The hospital Research Ethics Committee approved this study (no. CER-2020-107). The patient, his/her family, or designated representative was informed of this ethics consultation and most met with EST members, which enabled them to express their preferences and/or opposition. Findings/results 33 requests (patients’ mean age: 80.8 years; 29 had COVID-19: 24 with dyspnea, 30 with comorbidities). 17 Emergency Department solicitations concerned ICU admission, without reference to resource constraints; others addressed therapeutic proportionality dilemmas. Discussion Intervention-request motives concerned limited resources and treatment intensity. Management revolved around three axes: the treatment option most appropriate for the patient, the feasibility of implementation, and dignified care for the patient. Conclusions COVID-19 crisis forced hospitals to envisage prioritization of ICU access. Established decision-making criteria and protocols do not enable healthcare professionals to escape ethical dilemmas. That acknowledgement highlights ethical risks, enhances the added-value of nursing and encourages all players to be vigilant to pursue collective deliberations to achieve clear and transparent decisions. (shrink)

The genre of fiction portraying worlds without men is over a century old – and growing. It reaches back to Charlotte Perkins Gilman’s 1910 Herland, through scores of utopias from second wave feminist writers like Joanna Russ and Suzy McKee Charnas to contemporary examples from Lauren Beukes and Sandra Newman. This article asks: if it were in fact possible to create a world without men, for what reasons should we pursue or forgo such a world? Those who have endured (...) patriarchy’s cruelty have good reasons to want to institute such a world. However, I present a biblical warrant for rejecting that utopian vision derived from 1 Corinthians 11, where Paul writes that there is “no woman without man” (χωρὶς ἀνδρὸς, choris andros), and “no man without woman.” At the crux of a text that emphasizes the interdependence of God’s creatures, Paul reminds us that interdependence obtains across lines of sexual difference. (shrink)

Mary Taylor, Charlotte Bront"e's closest and lifelong friend, did indeed fulfill Bront"'s prediction in both her life and her writings. Recently, however, the authenticity of Taylor's feminist classic, Miss Miles, has been put into question. A controversy is now raging among experts and scholars of Victorian fiction over the true authorship of Miss Miles. Did Mary Taylor labor over this novel from her early womanhood until the end of her life, and offer it as her last great act of (...) friendship to women? Or is it the last work of Charlotte Bront"e, taken from her home to prevent its destruction, then published posthumously under Taylor's name? Regardless of its authorship, Miss Miles is a passionate and compelling novel, well deserving of its literary status on its own terms, and fascinating as a part of the Bront"e world. In this, the only edition of Miss Miles available, Taylor breaks with tradition by creating a profoundly feminist and morally intense novel which depicts female friendships as sustaining life and samity through the vicissitudes of Victorian womanhood. Set in the small Yorkshire village of Repton against the backdrop of starvation in the wool districts and the rise of Chartism in the 1830s, this extraordinary work chronicles the lives of four socially disparate women as they learn to find their own voices and support one another. Taylor's own courage and allegiance to her friends is wonderfully reflected in each of these individually ambitious women, while the novel's emphasis on the healing power of women's friendships echoes the relationship between Bront"e and Taylor herself. Originally published in 1890, Miss Miles continues to stand as an eloquent polemic in favor of a women's personal obligation to support herself. It is a classic that will delight all lovers of fine literature. (shrink)

Germaine de Staël (1766–1817), despite having published a considerable body of work, is seldom regarded as a feminist philosopher. Unlike, for instance, Mary Wollstonecraft of the same period, Staël is not directly arguing for the equality of the sexes. She even, at times, makes surprisingly derogatory remarks about women's nature. I argue that she is nevertheless putting forward a brand of difference feminism, which deserves our attention as a contribution to feminist reflections on gender norms in the early modern era. (...) Staël's contribution takes the form of a plea for the improvement of women's lives that engages with the combined action of nature and society. I clarify the meaning that we should ascribe to Staël's frequent appeals to nature and argue that, for her, society and education should be used to correct (alleged) natural weaknesses instead of reinforcing them. I also give an overview of Staël's political proposals toward the improvement of women's lives, which call for a better form of political regime than the one she lived in, as well as a better access to education and a more egalitarian conception of marriage. (shrink)

Virginia Woolf, in A Room of One’s Own, asked why there were no women writers before 1800. If she had been thinking about philosophers instead of writers in the traditional women’s areas of plays and fiction, she might have asked why there were no women philosophers at all, for I suspect that most people would find it very hard to name a woman philosopher before the present day. To help her in answering her question, she invented a fictional character, Judith (...) Shakespeare, a sister to William Shakespeare. The conditions of Judith’s life made it impossible for her to write, and so Woolf speculated that the women who would have been writers did not lead the kinds of lives that permitted them to realize their talents. Woolf’s image of Judith Shakespeare is a very powerful one but her speculation is only half right. There undoubtedly were many women in the past who would have been talented writers or philosophers if their lives had been different, but Judith Shakespeare’s image can also blot out our knowledge of women who, contrary to Woolf’s speculation, did exist and did write. Indeed, we know now there were even women who wrote philosophy. These women were in many ways exceptional, for Woolf is quite right that most women did not live either with enough privacy or with enough income to allow them to write. Often, they were members of the aristocracy, whose position enabled them to behave eccentrically, sometimes to be able to demand privacy, and sometimes to be able to invite contacts with leading intellectuals. Quite often, these women were childless, which in an age before birth control made them exceptions to the general rule, and at a time when many women were bearing their last child in their forties, was the only thing that could have given them private time. Nevertheless, research in the last ten or fifteen years has uncovered the work of quite a number of these women: for example, Princess Elizabeth of Bohemia, the Electress Sophie, Queen Christina of Sweden, Queen Sophie Charlotte of Prussia, Anne, Lady Conway, Mary Astell, Damaris, Lady Masham, Catharine Trotter Cockburn, Emilie du Chatelet, Catherine Macaulay, Lady Mary Shepherd, and many more. Woolf’s question then comes up again in a slightly different form. Why is it that the work of these women was for so long unknown? Why do so many people even today remain ignorant of the existence of women philosophers before the present day? I am not going to answer this question directly; in fact, I suspect it has multiple answers. Instead, I am going to present a case study from amongst all the cases of all of these women. I hope by considering the history of this woman, and, in particular, considering the way in which she was read, it will be possible to gain some insights into the ways in which women have failed to be incorporated into philosophical history. The woman I am going to discuss is Lady Mary Shepherd. Mary Shepherd actually falls outside of Woolf’s target date of 1800, since she flourished in the first half of the nineteenth century, but this merely reflects my point about the greater ignorance that prevails about women in philosophy. (shrink)

‘Writing Pain’ argues that Anna Seward‘s Letters and Mary Robinson‘s letters create alternative models of sensibility from the suffering poet of Charlotte Smith‘s Elegiac Sonnets. Immensely popular, Smith‘s sonnets made feminine suffering a source of poetic agency by aestheticizing and privatizing it. However, despite their sincerity, her sonnets effaced the physical, nervous body of sensibility on which Seward‘s and Robinsons early poetic reputations had depended and for which they had been mocked. The popularity of Smith‘s model made it an (...) important model for women poets, but, by the end of the eighteenth century, sensibility was also associated with sickness and artifice. For Seward and Robinson, who wanted to build their literary reputations but were living with disabled bodies, Smiths example needed to be reimagined to account for the reciprocity of body and mind as they struggled to write through pain. (shrink)

Examines the theories of Plato, Rousseau, Mary Wollstonecraft, Catherine Beecher, and Charlotte Perkins Gilman concerning the education of women.

Maurice Blondel’s philosophy has had a decisive influence on the theology of Henri de Lubac, but more than an influence, it goes of an encounter and a dialogue between two great Catholic thinkers. This article proposes, over the course of successive encounters and collaborations between Blondel and Lubac, a presentation of Lubac’s reflection in that it extends Blondel’s critique of extrinsicity to the field of theology. This friendship between Lubac and Blondel testifies to the inherent character of the mystical question (...) to both philosophy and theology. This anchoring signifies the Mystery of Christ at work in the gesture of reason and in the understanding of faith. At the same time, Lubac promotes, in philosophy itself, an intelligence through faith. Friendship has not been an empty word with Lubac who openly defended Maurice Blondel on several occasions, and even after Blondel’s death, when Lubac continued to make the philosopher’s thought known by publishing and annotating a large part of his correspondence. (shrink)

La correspondance de Pline le Jeune, publiée au II e siècle de notre ère, regorge de références à la mission de l’avocat. Bien que l’activité d’avocat ne soit pas la seule exercée par l’auteur, elle occupe une partie très importante de son temps, comme il le reconnaît lui-même, et remplit une fonction essentielle au sein de la société romaine. En assurant la défense des droits des femmes et des hommes qui le sollicitent, l’avocat s’assure de placer la justice et le (...) droit au cœur de la société et participe ainsi au renforcement du lien social. Une telle mission ne peut, selon Pline le Jeune, être confiée qu’à des hommes dont les qualités humaines sont supérieures et qui appartiennent de facto à la noblesse romaine. L’avocat plinien s’illustre par une noblesse de rang et d’âme. (shrink)

Collection of previously published material, 1975-1993.

This paper aims to confront two notions that have acquired a particular importance in contemporary reflections on the law: the notion of “un-law” (“Unrecht” or “non-droit”), that was constructed after the second WW in order to think about the specific nature of “Nazi law”; and the notion of “state of exception” (“Ausnahmezustand” or “état d’exception”), which is now commonly tied up with the idea of juridical anomie. This confrontation extends the analysis that is especially exposed by the very concept of (...) “un-law”, in order to think about the possibility of a “monstrous law” in a functional way, and not in a substantial one. In return, this new light will help to think of the discontinuities between a “state of exception” and a “state of un-law”. (shrink)

The number of depressed people has been increasing regularly. This increase is clearly aggravated by psycho-pharmacological factors. Psychoanalysts have encountered difficulties with a new type of patient for whom neurotic solutions do not work. For this reason, a new evaluation of the psycho-conception of the subject, melancholy and distress, and the social link is needed: this new evaluation allows us to define the nature of the relation between depression and society, and to plan a more effective clinical response.

S’inscrivant dans un courant qui reconsidère aujourd’hui la place des femmes dans l’histoire, Mélanie Fabre publie une édifiante biographie de Dick May, une intellectuelle largement oubliée de la Belle Époque, fondatrice notamment du Collège libre des sciences sociales en 1895, de la première École supérieure de journalisme française en 1899 et de l’École libre des hautes études sociales en 1900. Elle a été aussi active dans la fondation du Musée social en 1894, dans la formation de l’univers...

Introduction -- From natural philosophy to theories of method -- Explanations, laws, and theories -- Change and the effect on scientific realism -- Science, society, and values -- Conclusion -- Glossary.

Personality disorders: illegitimate subject positions The diagnosis of personality disorder is common in mental health nurse settings and is a term often used without critical consideration. In clinical practice, the term personality disorder has pejorative connotations, which arise out of the way in which these behaviours are constructed as behavioural rather than psychiatric. The discursive construction of categories of personality disorder are inculcated into clinical practice and become taken‐for‐granted by those in practice culture. The construction of some personalities as disordered (...) and, therefore, illegitimate becomes natural. This paper provides a critical analysis of the diagnosis and suggests an approach to mental health nursing care that is more legitimising for those people who receive psychiatric diagnoses. (shrink)

This paper describes a discourse analysis of the process of interpersonal psychotherapy (IPT) in the recovery from depression. It demonstrates how IPT is an effective treatment strategy for mental health nurses to utilise in the treatment of depression. The discourse analysis highlights how the development of more meaningful subject positions enables one woman to recover from her depression. The process of recovery is underpinned by an understanding of women's depression as promoted by contemporary social and cultural expectations for detachment and (...) reflexivity. This paper shows how IPT provides an opportunity for recovery from depression for one woman by facilitating a reconstruction of her subject positions in relation to others. The discourse analysis revealed that the therapist facilitated this through the use of a range of techniques: seeking information, exploring beliefs/values/assumptions, exploring communication patterns, exploring affective responses and exploring alternative subject positions. (shrink)

This paper deals with the 24-line mythological epyllion Progne et Philomela, an anonymous Virgilian cento of presumed North African origin, which is usually dated to the fourth or fifth century and is marked by considerable obscurity. The aim is to shed some light on the most intriguing parts of this elliptical retelling of the given myth, in particular the puzzling network of family relationships and the extended talking-blood metaphor. Offering a new perspective on the text, the author claims that its (...) general ambiguity is, to some extent, a purposefully adopted authorial strategy rather than a by-product of the cento technique. For this reason, it is proposed that the poem might have been written as a sort of mythological riddle to be solved by its readers. (shrink)