(No abstract is available for this citation).

Recently, several states in the US have made it more difficult to receive nonmedical exemptions to school vaccine mandates in the hope of better orienting parents towards vaccination. However, little is known about how public-facing school staff implement and enforce mandate policies, including why or how often they steer parents towards nonmedical exemptions. This study focused on Michigan, which has recently added an additional burden for families seeking nonmedical exemptions. We used an anonymous online survey to assess Michigan public-school (...) employees (n = 157) about their knowledge, attitudes, and behaviors regarding Michigan's school enrollment vaccine mandate policy. Our main conclusions are that frontline school staff are generally knowledgeable about vaccines and immunization policy, but are at best ambivalent about their role in immunization governance, believing that other agents should be responsible for ensuring that children are vaccinated. Furthermore, some respondents indicated low vaccine confidence, which was associated with increased ambivalence about, or opposition to, their role in immunization governance. As more jurisdictions within and beyond the US consider introducing or tightening childhood vaccine mandates, it is increasingly important to understand how these policies can be improved by attending to the attitudes and roles of relevant frontline actors. (shrink)

In this presentation, our goals are to identify some of the ways in which information technology poses a threat to librarians' professional identity and to develop a theory about the role that it should play. In the process of doing that we will identify organizational processes which may help librarians negotiate technological change, both within their profession and with their patrons. (For simplicity, we will use the phrase "information technology" to refer to contemporary trends in electronic or cybernetic information technology. (...) Obviously, print books are also a form of information technology.). (shrink)

Background The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit (...) staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. Methods A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. Results All 178 respondents (response rate: 25–32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to ‘team cooperation’, ‘team solidarity’ and ‘work ethic’. Lessons learned were mostly related to ‘quality of care’ and ‘professional qualities’. Conclusions Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals’ dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. Trial registration The trial was registered on The Netherlands Trial Register, number NL9177. (shrink)

As the COVID-19 pandemic impacts on health service delivery, health providers are modifying care pathways and staffing models in ways that require health professionals to be reallocated to work in critical care settings. Many of the roles that staff are being allocated to in the intensive care unit and emergency department pose additional risks to themselves, and new policies for staff reallocation are causing distress and uncertainty to the professionals concerned. In this paper, we analyse a range of (...) ethical issues associated with changes to staff allocation processes in the face of COVID-19. In line with a dominant view in the medical ethics literature, we claim, first, that no individual health professional has a specific, positive obligation to treat a patient when doing so places that professional at risk of harm, and so there is a clear ethical tension in any reallocation process in this context. Next, we argue that the changing asymmetries of health needs in hospitals means that careful consideration needs to be given to a stepwise process for deallocating staff from their usual duties. We conclude by considering how a justifiable process of reallocating professionals to high-risk clinical roles should be configured once those who are ‘fit for reallocation’ have been identified. We claim that this process needs to attend to three questions that we consider in detail: (1) how the choice to make reallocation decisions is made, (2) what justifiable models for reallocation might look like and (3) what is owed to those who are reallocated. (shrink)

In the clinical setting, questions of medical ethics raise a host of perplexing problems, often complicated by conflicting perspectives and the need to make immediate decisions. In this volume, bioethicists and physicians provide a nuanced, in-depth approach to the difficult issues involved in bioethics consultation. Addressing the needs of researchers, clinicians, and other health professionals on the front lines of bioethics practice, the contributors focus primarily on practical concerns -- whether ethics consultation is best done by individuals, teams, or committees (...) how an ethics consult service should be structured the need for institutional support and techniques and programs for educating and training staff -- without neglecting more theoretical considerations, such as the importance of character or the viability of organizational ethics. (shrink)

Background In May 2020, England moved to an opt-out organ donation system, meaning adults are presumed to be an organ donor unless within an excluded group or have opted-out. This change aims to improve organ donation rates following brain or circulatory death. Healthcare staff in the UK are supportive of organ donation, however, both healthcare staff and the public have raised concerns and ethical issues regarding the change. The #options survey was completed by NHS organisations with the aim (...) of understanding awareness and support of the change. This paper analyses the free-text responses from the survey. Methods The #options survey was registered as a National Institute of Health Research (NIHR) portfolio trial [IRAS 275992] 14 February 2020, and was completed between July and December 2020 across NHS organisations in the North-East and North Cumbria, and North Thames. The survey contained 16 questions of which three were free-text, covering reasons against, additional information required and family discussions. The responses to these questions were thematically analysed. Results The #options survey received 5789 responses from NHS staff with 1404 individuals leaving 1657 free-text responses for analysis. The family discussion question elicited the largest number of responses (66%), followed by those against the legislation (19%), and those requiring more information (15%). Analysis revealed six main themes with 22 sub-themes. Conclusions The overall #options survey indicated NHS staff are supportive of the legislative change. Analysis of the free-text responses indicates that the views of the NHS staff who are against the change reflect the reasons, misconceptions, and misunderstandings of the public. Additional concerns included the rationale for the change, informed decision making, easy access to information and information regarding organ donation processes. Educational materials and interventions need to be developed for NHS staff to address the concepts of autonomy and consent, organ donation processes, and promote family conversations. Wider public awareness campaigns should continue to promote the positives and refute the negatives thus reducing misconceptions and misunderstandings. Trial registration National Institute of Health Research (NIHR) [IRAS 275992]. (shrink)

Background Since 2015, Michigan has required parents who request nonmedical exemptions (NMEs) from school or daycare immunization mandates to receive education from local public health staff (usually nurses). This is unlike most other US states that have implemented mandatory immunization counseling, which require physicians to document immunization education, or which provide online instruction. -/- Purpose To attend to the activity and dispositions of the public health staff who provide “waiver education”. -/- Method This study reports results of focus (...) group interviews with 39 of Michigan's vaccine waiver educators (37 nurses), conducted during 2016 and 2017, and analyzed in 2018. -/- Findings Four themes emerged from analysis of the transcripts of these interviews: Participants had (1) complex and nuanced observations and evaluations of parents' judgments and feelings about vaccines and vaccine education; (2) sympathetic attitudes about alternative vaccine schedules; (3) critical and supportive evaluations of institutional policies and the background political context of immunization education; and (4) consistent commitments to respect parents, affirm their values, and protect their rights. Discussion These results show that public health nurses are sensitive to the burdens mandatory immunization education places on families, the motivations for parents' requests for nonmedical exemptions, and the values implicated by personal immunization decisions and government immunization policies. In light of the unique training, experiences, and public reputation of nurses, there is good reason for additional investigation into the roles that nurses can play in immunization education and in vaccine mandate policies, more generally. (shrink)

Der zweite Band der Reihe Philosophische Forschung spannt zwei Kerngebiete der Analytischen Philosophie zusammen: die Semantik und die Ontologie. Was sind die Grundbausteine unserer Ontologie? Wie beziehen wir uns sprachlich bzw. geistig auf sie? Diese und weitere Fragen werden von international renommierten Philosophen aus historischer und systematischer Perspektivediskutiert. Die Beiträge sind in Deutsch und English verfasst. Sie stammen von Christian Beyer, Johannes Brandl, Dagfinn Føllesdal, Dorothea Frede, Rolf George, Gerd Graßhoff, Peter Hacker, Andreas Kemmerling, Edgar Morscher, Kevin Mulligan, Rolf (...) Puster, Richard Schantz, Benjamin Schnieder, Oliver Scholz, Severin Schröder, Peter Simons, Thomas Spitzley, Markus Stepanians, Ralf Stoecker und Daniel von Wachter. (shrink)

Across Tibet during the 1940s, young Han Chinese weather observers became stranded at their weather stations, where they faced illness, poverty and isolation as they pleaded with their superiors for relief. Building on the premise that China exercised ‘imperial nationalism’ in Tibet, and in light of scholarship that emphasizes the desirous ‘gaze’ of imperial observers toward the frontier, this essay considers how the meteorological archive might disrupt our understanding of the relationship between observation and empire. Meteorology presented a new way (...) of viewing the landscape that deliberately disregarded the embodied experience of the observer in favour of instrument-mediated readings. The process produced a bifurcated archive, in which stations disseminated quantitative weather charts as a matter of public interest while privately recording the embodied and often miserable experiences of observational staff on the frontier. Unpublished letters between observers and supervisors offer a rare glimpse into the frontier as experienced by reluctant or unwilling agents of the state. (shrink)

Although the role of imagination in moral reasoning is often neglected, recent literature, mostly of pragmatist signature, points to imagination as one of its central elements. In this article we develop some of their arguments by looking at the moral role of imagination in practice, in particular the practice of neonatal intensive care. Drawing on empirical research, we analyze a decision-making process in various stages: delivery, staff meeting, and reflection afterwards. We show how imagination aids medical practitioners demarcating moral (...) categories, tuning their actions, and exploring long-range consequences of decisions. We argue that imagination helps to bring about at least four kinds of integration in the moral decision-making process: personal integration by creating a moral self-image in moments of reflection; social integration by aiding the conciliation of the diverging perspectives of the people involved; temporal integration by facilitating the parties to transcend the present moment and connect past, present, and future; and epistemological integration by helping to combine the various forms of knowledge and experience needed to make moral decisions. Furthermore, we argue that the role of imagination in these moral decision-processes is limited in several significant ways. Rather than being a solution itself, it is merely an aid and cannot replace the decision itself. Finally, there are also limits to the practical relevance of this theoretical reflection. In the end, it is up to care professionals as reflective practitioners to re-imagine the practice of intensive care and make the right decisions with hope and imagination. (shrink)

The COVID-19 pandemic has introduced new ethical challenges in the care of patients with serious psychiatric illness who require inpatient treatment and who may have beeen exposed to COVID-19 or have mild to moderate COVID-19 but refuse testing and adherence to infection prevention protocols. Such situations increase the risk of infection to other patients and staff on psychiatric inpatient units. We discuss medical and ethical considerations for navigating this dilemma and offer a set of policy recommendations.

The patient was a 19-year-old female who was transferred to this children's hospital from a community hospital in a neighboring state. She is well known to the hospital staff because she had a kidney transplanted and retransplanted several times there. Her first transplant as at age 8 and she was retransplanted most recently approximately 3 years ago. She immediately rejected her second kidney and received a third. She is currently admitted because she is again rejecting her kidney, probably due (...) to not taking her medication. The ethics consultant was called because the attending physician wanted to know if it was ethical to retransplant a patient. (shrink)

These are not the words of a harsh critic of the Food and Drug Administration. They were penned by the agency’s deputy commissioner for food. That this is an insider’s view makes it all the more troubling. Recent studies suggest that roughly half the products on supermarket shelves proclaim their purported health benefits.2 But a trip to the supermarket suggests that this is a conservative estimate. The FDA is not powerless to regulate these claims, but it operates in a regulatory (...) framework that is the product of piecemeal reform and compromise, not intelligent design. And its limited staff resources and budget further constrain what it can do. The food industry is required to seek prior .. (shrink)

After recent tragedies involving mass murders on a college campus in Virginia, an Army base in Texas, a congressional constituent event at a shopping center in Arizona, and a movie theater in Colorado, one might have assumed the public had become numb to horrendous and senseless acts of killing. If so, one would have been wrong. The public was not prepared for the brutal and cold-blooded murder of 20 first-grade school children and six teachers and staff at Sandy Hook (...) Elementary School in Newtown, Connecticut, on December 14, 2012.Following the all-too-familiar emotional stages of shock, grief, and anger, many members of the public and elected officials turned to the issue of how to prevent such tragedies in the future. Two main questions quickly became the focus of policy makers. (shrink)

Der zweite Band der Reihe Philosophische Forschung spannt zwei Kerngebiete der Analytischen Philosophie zusammen: die Semantik und die Ontologie. Was sind die Grundbausteine unserer Ontologie? Wie beziehen wir uns sprachlich bzw. geistig auf sie? Diese und weitere Fragen werden von international renommierten Philosophen aus historischer und systematischer Perspektive diskutiert. Die Beiträge sind in Deutsch und English verfasst. Sie stammen von Christian Beyer, Johannes Brandl, Dagfinn Føllesdal, Dorothea Frede, Rolf George, Gerd Graßhoff, Peter Hacker, Andreas Kemmerling, Edgar Morscher, Kevin Mulligan, (...) Rolf Puster, Richard Schantz, Benjamin Schnieder, Oliver Scholz, Severin Schröder, Peter Simons, Thomas Spitzley, Markus Stepanians, Ralf Stoecker und Daniel von Wachter. (shrink)

In this digital age the use of video in social science research has become commonplace. As sophistication has increased along with usability, as spiralling staff costs push out direct observation, the researchers training today are grasping video as a means of coming to terms with the continued pressure to produce accessible research. However, the ‘fit’ of technology with research is far from simple. Ideally placed to offer guidance to developing researchers, this new text draws together the theoretical, methodological and (...) practical issues of effectively using video across the social sciences. This book concentrates on how researchers can benefit from the use of video in their own research, whether it is: Video as representation Video as an aid to reflection Video that generates participation Video, voice and articulation, or Video that acts as a provocation. In turn each of these five central functions is discussed in relation to different stages of the research process, consisting of: Research design Fieldwork and data collection Analysis of data and findings Dissemination. As a practical research tool this book shows how, why and when video should be used, representing an invaluable guide for postgraduate and doctoral students conducting research in the social sciences, as well as any researchers, academics or professionals interested in developing technologically informed research. (shrink)

This paper provides a series of reflections on making the case to senior leaders for the introduction of clinical ethics support services within a UK hospital Trust at a time when clinical ethics committees are dwindling in the UK. The paper provides key considerations for those building a case for clinical ethics support within hospitals by drawing upon published academic literature, and key reports from governmental and professional bodies. We also include extracts from documents relating to, and annual reports of, (...) existing clinical ethics support within UK hospitals, as well as extracts from our own proposal submitted to the Trust Board. We aim for this paper to support other ethicists and/or health care staff contemplating introducing clinical ethics support into hospitals, to facilitate the process of making the case for clinical ethics support, and to contribute to the key debates in the literature around clinical ethics support. We conclude that there is a real need for investment in clinical ethics in the UK in order to build the evidence base required to support the wider introduction of clinical ethics support into UK hospitals. Furthermore, our perceptions of the purpose of, and perceived needs met through, clinical ethics support needs to shift to one of hospitals investing in their staff. Finally, we raise concerns over the optional nature of clinical ethics support available to practitioners within UK hospitals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Transactions of the Charles S. Peirce Society 42.3 (2006) 459-461 MuseSearchJournalsThis JournalContents[Access article in PDF]Minutes of the Business Meeting Charles Sanders Peirce Society 28 December 2006Following the annual scholarly meeting, with papers by President Vincent Colapietro, "Reflective Acknowledgment and Practical Identity: Kant and Peirce on the Reflexive Stance" and Essay Contest winner Shannon Dea, "'Merely a Veil over the Living Thought': Math and Logic in Peirce's Forgotten Spinoza Review," (...) President Colapietro called the meeting to order shortly after 7 o'clock in Concourse B of the New York Hilton.The minutes of the 2003 and 2004 meetings, published in the Fall, 2004, and Summer 2005 Transactions respectively, were approved.Vincent Colapietro delivered the following report from the President and Executive Committee:André De Tienne's proposal to adopt the address of the Institute for American Thought at IUPUI as the official address of the Peirce Society was accepted.It was agreed that announcements for the Peirce Essay Contest should be placed in the Transactions and in other appropriate publications (e.g. The Journal of Speculative Philosophy and the S.A.A.P. newsletter) by mid-year if possible. It was also agreed that some length limits should be set for submitted essays and that there should be a requirement that essays meet the general standard of a submission for publication in a journal.There was discussion of the desirability of separating the collection of membership dues from subscription to the Transactions. The chief reasons for thinking that this separation might be called for are 1) the increasing availability of the Transactions through university library electronic subscriptions and 2) the higher cost of foreign subscriptions (making membership in the Society far most costly for foreign members). It was decided to revisit this issue in a year or two (after the new arrangement with IU Press has become more settled).Vincent Colapietro, Mark Migotti, and Nathan Houser were appointed to serve as a "meta" committee to form, with the approval of the Executive Committee, a "regular" committee to organize the 2014 Peirce World Congress. They will also recommend a chair for the committee and a location for the congress. Indianapolis was favored by members present.It was agreed that a list of rules and procedures for conducting Society business should be drawn up for the guidance of new Society office holders. These lists will include the rules and procedures for fulfilling the functions of the various offices, for running meetings, time-tables for making decisions, and so on. N. Houser will work on this with André Tienne and Mark Migotti to draft these lists. [End Page 459]It was agreed that the outgoing Chair of the Nominating Committee should communicate with the incoming Chair a list of the candidates who were considered but not nominated, along with the basis for consideration.Peter Hare delivered the following report on the Transactions:Starting with the fall issue, the Transactions is being published by Indiana University Press. Editorial arrangements are unchanged. Although the transition has been time-consuming in the short run, the new publishing arrangements promise in the long run to increase greatly the journal's impact on the world of scholarship. This year has also been difficult because a key staff member in our previous publishing arrangements failed us. In 2005 we had 499 member/subscribers (406 domestic and 93 foreign). The bank balance is $4008.Vincent Colapietro delivered for Mark Migotti a preliminary version of the following financial report :2005 income was $1,713.05 ($1,497 in membership dues and $216.05 in interest). 2005 expenditures were c. $1,987.40: ($500 for the essay contest prize, $550 for travel subvention and dinner for the contest winner; 674.40 for mailings; $128.40 for web-site fees; $75 dues to the Logic and Methodology section of the International Society for the Philosophy of Science, and $60.00 for a subsidized membership for CISPEC).As of December 31, 2005, the Society's assets were: $10,625.92, a decrease of $.274... (shrink)

Dateline NBC’s “To Catch a Predator”(2006-08) involved NBC staff working with police and a watchdog group called “Perverted Justice” to televise “special intensity” arrests of men who were lured into meeting adult decoys posing as young children, presumably for a sexual encounter. As reality television, “To Catch a Predator” facilitates public shaming of those caught in front of the cameras, which distinguishes it from fictional representations. In one case, a Texas District Attorney, Louis Conradt, shot himself on film, unable (...) to bear the public humiliation of cameras airing his arrest. The show engenders conflicting responses: Did the show fulfill a public service by informing the public about real dangers and deterring potential predators, or was it an insensitive effort to garner ratings by taking advantage of human weaknesses? Is the sort of public shaming it imposes an appropriate form of punishment given the legitimate purposes of punishment? Did the show portray justice, or did it entrap victims? How did NBC’s working relationship with local police bear on the answer to that question? This paper addresses these questions and develops three objections to the show: that NBC in effect metes out unjust punishment; that it invades privacy; and that it entraps. (shrink)

This paper explores the conduct of performance appraisals of nurses in a New Zealand hospital, and how fairness is perceived in such appraisals. In the health sector, performance appraisals of medical staff play a key role in implementing clinical governance, which, in turn, is critical to containing health care costs and ensuring quality patient care. Effective appraisals depend on employees perceiving their own appraisals to be fair both in terms of procedure and interaction with their respective appraiser. We examine (...) qualitative data from interviews and focus groups, involving 22 nurses in a single department, to determine whether perceived injustices impact on the effective implementation of the appraisal system. Our results suggest that particular issues had been causing some sense of injustice, and most of these were procedural. Potential solutions focus on greater formalisation of the performance appraisal process, and more training for appraisers and appraisees. (shrink)

Listening for the sounds of silence: a nursing consideration of caring for the politically tortured In 1997 Amnesty International reported that 115 out of 251 countries surveyed practised torture on their citizens. Many of these victims have been forced to flee their country of origin and become refugees in the West, in countries such as Australia, Canada, the UK and the United States. However, torture itself remains an unspoken and covert problem. In addition to the obvious traumatic effects, it may (...) induce shame and dread on the part of the victim. It may be too terrifying and too painful to talk about, and yet may affect every aspect of a person’s life (Forrest 1996). All too commonly a victim of torture may pass unnoticed or unrecognised because health care providers do not know how, or may be unwilling to engage with the issue. This paper will examine the implications for nurses of caring for the tortured. It will explore the nature of torture itself, who might be the perpetrators and who might be the victims (always acknowledging that nurses and other health care staff are often both), how victims of torture may present for health care, and the possible subjective perceptions of a torture victim when faced with a Western health care process and understanding. Finally, it will argue for an increase in awareness and sensitivity on the part of all nurses in all health care settings to the needs and sensibilities of victims of torture, and suggest that caring for them is the distillation of everything good nursing practice should be. (shrink)

Background The existing literature on sexuality and intimacy in residential care tends to focus on either the question of rights, or the value of autonomy. Where the literature does reference values other than autonomy, such values are considered in the context of being a guide to whether or not a resident is autonomous, rather than being important values in their own right. Objective This paper draws on qualitative data gathered as part of a larger study in order to inform practice (...) on how care workers respond to intimacy issues that arise with residents with dementia and to inform a general ethics of sex and sexuality, demonstrating that an approach which permits value pluralism can be appropriate in certain contexts. Research Design The qualitative data referred to in this paper was gathered from semi-structured interviews undertaken as part of a larger mixed-method research project. The interview text was analysed using Thorne’s methodological approach, interpretive description. Participants and research context The qualitative arm of the project consisted of semi-structured interviews conducted between October 2018 and October 2019 with participants (staff, residents and family members) recruited from 35 residential care homes in Aotearoa New Zealand. Ethical Considerations Participation was informed, voluntary and written consent was gained before interviews. The project was approved by the Massey University Human Ethics Committee (Northern), number NOR 18/25. Findings Analysis of the scenarios presented in this paper shows that decision-making around sexual intimacy involving people with dementia in a residential care setting is complex and requires recognizing and weighing the different values that may be a in play. Conclusion A focus on safety and consent to the exclusion of other values which matter morally in this context is a mistake which prevents care workers from providing appropriately person-centred care to residents, as policies which focus on the goal of care allow space for critical examination of issues which are likely to be highly context-sensitive. (shrink)

The harmful impact of an adverse event ripples beyond injured patients and their families to affect physicians, nurses, and other health care staff that are involved. These “Second Victims” may experience intense feelings of anxiety, guilt, and fear. They may doubt their clinical competence or ability to continue working at all. Some go on to suffer post-traumatic stress disorder and depression.Medical institutions long ignored this problem, preferring to believe that adverse events, or “errors,” occur due to incompetence — the (...) unfortunate work of a few “bad” practitioners who deserve, if anything, a reprimand for their negligence. Study after study has rejected this attribution and shown that adverse events in health care stem primarily from systemic flaws, not “bad apples.” Devastating errors, in other words, can, do, and always will happen in the care of competent, well-trained, and caring practitioners. (shrink)

Background: There is an international trend for frail older adults to move to residential care homes, rather than ageing at home. Residential facilities typically espouse a person-centred philosophy, yet evidence points to restrictive policies and surveillance resulting in increased loneliness and diminished opportunities for intimacy and sexual expression. Residents may experience what has been termed social death, rather than perceive they are related to by others as socially alive. Aim: To consider how the loss of intimacy and sexuality in residents’ (...) lives contributes to iatrogenic loneliness experienced in residential care, and the importance of considering these issues together. Research design: The study utilised a constructionist methodology, investigating the meanings associated with intimacy, loneliness, and ageing. Participants and research context: Qualitative data used in this study are drawn from a larger dataset of a mixed-methods study. Interviews were completed as follows: staff, 21 individual interviews, and two groups with a total of 13 additional people; residents, 26 interviews with 28 people; and family members, 12 interviews with 13 people. Findings: Five key themes were identified in the data analysis: loneliness and relational identity, loneliness and functional relationships, loneliness and disrupted intimacy, loneliness and liminality, and loneliness and the built environment. Ethical considerations: The study was approved by a University Human Ethics Committee. Participation was voluntary. Consent was gained and confidentiality upheld. Discussion: Residents’ expression of intimacy and sexuality can be compromised through paternalism, ageism, restrictive policies, care-rationing and functional care, alienating residents from sustaining and developing significant relationships. Attitudes and cultural beliefs of staff and family members about ageing and intimacy, compounded by architectural design, may intensify loneliness. Conclusions: Nurses have a pivotal role in ensuring policies and practice enhance social citizenship. (shrink)

Background To investigate attitudes of staff, residents and family members in long-term care towards sex and intimacy among older adults, specifically the extent to which they conceptualise sex and intimacy as a need, a right, a privilege or as a component of overall well-being. Methods The present study was a part of a two-arm mixed-methods cross-sectional study using a concurrent triangulation design. A validated survey tool was developed; 433 staff surveys were collected from 35 facilities across the country. (...) Interviews were conducted with 75 staff, residents and family members. Results It was common for staff, residents and family members to talk about intimacy and sexuality in terms of rights and needs. As well as using the language of needs and rights, it was common for participants to use terms related to well-being, such as fun, happiness or being miserable. One participant in particular described receiving intimate touch as a ‘kind of care’—a particularly useful way of framing the conversation. Conclusion While staff, residents and family frequently used the familiar language of needs and rights to discuss access to intimate touch, they also used the language of well-being and care. Reframing the conversation in this way serves a useful purpose: it shifts the focus from simply meeting minimum obligations to a salutogenic approach—one that focuses on caring for the whole person in order to improve overall well-being and quality of life. No data are available. (shrink)

BackgroundLimited research has been conducted on explanations and understandings of biobanking for future genomic research in African contexts with low literacy and limited healthcare access. We report on the findings of a sub-study on participant understanding embedded in a multi-disease community health screening and biobank platform study known as ‘Vukuzazi’ in rural KwaZulu-Natal, South Africa.MethodsSemi-structured interviews were conducted with research participants who had been invited to take part in the Vukuzazi study, including both participants and non-participants, and research staff (...) that worked on the study. The interviews were transcribed, and themes were identified from the interview transcripts, manually coded, and thematically analysed.ResultsThirty-nine individuals were interviewed. We found that the research team explained biobanking and future genomic research by describing how hereditary characteristics create similarities among individuals. However, recollection and understanding of this explanation seven months after participation was variable. The large volume of information about the Vukuzazi study objectives and procedures presented a challenge to participant recall. By the time of interviews, some participants recalled rudimentary facts about the genetic aspects of the study, but many expressed little to no interest in genetics and biobanking.ConclusionParticipant’s understanding of information related to genetics and biobanking provided during the consent process is affected by the volume of information as well as participant’s interest in the subject matter being discussed. We recommend that future studies undertaking biobanking and genomic research treat explanations of this kind of research to participants as an on-going process of communication between researchers, participants and the community and that explanatory imagery and video graphic storytelling should be incorporated into theses explanations as these have previously been found to facilitate understanding among those with low literacy levels. Studies should also avoid having broader research objectives as this can divert participant’s interest and therefore understanding of why their samples are being collected. (shrink)

Introduction: Dignified care is one of the moral responsibilities of professional caregivers. However, in many cases the dignity of hospitalized patients, especially women in the delivery room, is not maintained. Dignity is an abstract concept and there has been no previous research exploring the dignity of pregnant women in the delivery room in Iran. Objectives: The objective of this study is to define and explain the concept of dignity for pregnant women in the delivery room from the perspectives of professional (...) caregivers. Research design: This is qualitative research. The data were collected through in-depth semi-structured individual interviews. The conventional content analysis method was used to analyze the data. In qualitative content analysis, participant narrative is examined in-depth and sorted into categories and themes. Participants and research context: Potential participants who met the entrance criteria for this study were approached between July 2016 and February 2017. In all, 20 professional caregivers working in the delivery room setting within Iranian general hospitals were invited to participate in the study. The sampling was done through targeted sampling until saturation was achieved. Ethical considerations: The research ethics committee of the Shiraz University of Medical Sciences has approved the study’s protocol and all commonly recognized ethical principles were followed throughout the study. Findings: The findings of this study were presented in three main themes, including “privacy,” “respecting patients’ preferences,” and “comprehensive attention” and eight categories. Discussions and conclusion: Women in the delivery room need to be taken care of in an environment where healthcare staff promote the preservation of dignity through maintaining privacy, by providing attentive care and through ensuring that patient preferences regarding care and treatment are respected. In such an environment, the dignity of these women would be maintained and desirable outcomes achieved. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Parenting Children With Autism Spectrum Disorders Through the Transition to AdulthoodAnonymous One, Anonymous Two, Lorri Centineo, Anonymous Three, Virginia Clapp, Catherine Cornell, Nancy Coughlin, David McDonald, Mark Osteen, Laura Shumaker, Julie Van der Poel, Anonymous FourMy Son's Life with Autistic Spectrum DisorderAnonymous OneThis is the story of how my son, David, has tried to become independent. David is now 25–years–old. His immediate family is his dad, a brother (...) (age 22) and myself (his mother). He was diagnosed with an autism spectrum disorder (ASD) when he was 13. We looked up all the information and decided not to make a big deal of it. Looking back, he displayed all the classic signs of a high functioning autistic disorder. Would he have been diagnosed with the new DSM 5 guidelines? He probably would have. His life would be much, much different if he had been diagnosed at an early age.I'll start with David at age 13 when he was able to harness his big interest in computer science into a career for himself. He was expelled from middle school for threatening some kid that had been picking on him all year. He had a meltdown and wasn't able to communicate his side of the story and that was it.During the summer of that year he took classes in computer engineering (Microsoft) and became an engineer when he was 13. At that time it was quite an accomplishment because he was the youngest person in the United States to do so at such a young age. (By the way, the administration of the school that expelled him sent him a congratulatory card when he was written up in the paper).His father and uncle are in business running a computer company so David had a ready–made job waiting for him when he graduated from high school and was able to keep it during difficult times. David finished high school (mainstreamed special education as emotionally disturbed) and he also received another engineering certification (Cisco).I have to mention here that I truly did not understand what it was like for my son until one day when he was in high school, as I was lecturing him again for some stupid reason, he said, "You don't know how hard it is for me to not sit in a corner and rock every day." Think about that. ASD individuals get up and keep going every day when they know they are going to be misunderstood and picked on. They all deserve a medal for bravery.David became really upset that he had never had a date and that girls were not even interested in talking to him. He started cutting himself and shaving his head. That got him some attention from the stoner group. He had someone to sit with at lunch anyhow. Parents, I think it's better to have no friends than the wrong friends. They introduced him to drugs.We did not mention any trouble David was having to any relatives. We had lived 800 miles from our families in a very unspoiled part of northern America. In hindsight this was not good either. [End Page 151]Another thing, and I think every parent will agree with this—teachers, school staff, health care industry staff, doctors and every one that comes into contact with an ASD individual—take the time to get to know them. It may be difficult and some may appear non–caring and rude. You must overlook this and look to the person underneath. They are great people. They have been through stuff and it means so much to them. Like I said—parents, you know this. Please remember it when times get tough.During David's senior year he started work release so he could start earning money to buy a car and move out as soon as he turned 18. Things were made easy for David since the company was owned by his father and his uncle and I worked there also. David enjoyed the work but had the occasional meltdown and had difficulties fitting in with other employees. He wasn't able to communicate... (shrink)

Background The impact of healthcare ethics educational interventions on participants’ ethical development is rarely reported on and assessed; even less attention is paid to educational interventions that focus on end-of-life ethical issues. Aim To evaluate the impact of the Ethical Framework for End-of-Life Care Study Sessions Programme ( EOLCSS) on the moral development of healthcare staff who are delivering end-of-life care. Methods The EOLCSS was delivered to 20 multi-disciplinary health care staff in Ireland in May 2013. Effect on (...) moral reasoning was measured pre and post education using the Defining Issues Test 2 (DIT2). Inferential statistics were used to examine the relationships between change in DIT2 scores and demographic variables. Results Participants experienced moral reasoning development following receipt of EOLCSS. Age and previous ethics education contributed to the observed changes in moral reasoning. Conclusions Receipt of the EOLCSS may contribute to moral reasoning development in practicing healthcare professionals. (shrink)

For all humans, sexual orientation and gender identity are essential elements of identity, informing how we plan and live our lives. The historic invisibility of sexual minorities in medicine has meant that these important aspects of their identities as patients have been ignored, with the result that these patients have been denied respect, culturally competent services, and proper treatment. Likely due to historic rejection and mistreatment, there is evidence of reluctance on the part of LGBT patients to disclose their sexual (...) orientation (SO) or gender identity (GI) to their health care providers. There is some perception of risk in sharing SO and GI for many patients who have had bad prior experiences. Despite these risks, we argue that we can improve the quality of care provided this population only by encouraging them to self‐identify and then using that information to improve quality of care.One strategy both to prompt patient self‐identification and to store and use SO and GI data to improve care centers on the use of electronic health records. However, gathering SO and GI data in the EHR requires a workforce that knows both how to obtain and how to use that information. To develop these competencies, educational programs for health professionals must prepare students and educators to elicit and to use sexual orientation and gender identity information to improve care while simultaneously ensuring the safety of patients, trainees, and staff and faculty members as SO and GI become openly discussed and integral parts of ongoing medical discussion and care. As determination of SO and GI demographics becomes more common in health research, we will more fully understand the health risks for all the LGBTIQQ populations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:On PartnershipRyan Schwarz, Duncan Smith-Rohrberg Maru, Dan Schwarz, Bibhav Acharya, Bijay Acharya, Ruma Rajbhandari, Jason Andrews, Gregory Karelas, Ranju Sharma, and Mark ArnoldyRecently, Bayalpata Hospital, in the rural district of Achham, Nepal almost collapsed under the weight of its own staff's discontent. The hospital had been largely abandoned until 2009 when our organization, Nyaya Health, renovated and opened it in partnership with the Nepali government. Since then, (...) the hospital has seen great progress and has experienced widespread community support. Nonetheless, earlier this year, a broad-based staff revolt occurred, led primarily by our senior clinical staff members, raising concerns that Nyaya's management policies were ineffective, and wages and benefits were too low. The unrest included everything from a strike, limiting services to our patients, to aggression against non-strikers and slander and racist comments in public media against the Nyaya Health Board of Directors. Ultimately, the conflict was resolved, though not without the departure of our three most senior clinicians. The incident deeply damaged staff morale [End Page 101] and impeded basic services to our patients, and from our perspective as a leadership and management team, it was deeply troubling and spiritually challenging. We have learned much in the wake of the strike, but here we focus more narrowly on the concept of partnerships in our work by examining the recent strike and the two key issues that lead to it: wages and benefits, and management policies at Bayalpata Hospital.In grappling with the recent staff crisis, some of our leadership team expressed concerns that we would never be able to develop a true partnership in Achham if our senior-level employees led strikes against the organization. The leaders of the strike were our most well-educated and high-ranking staff. They were also individuals who had come to work for us specifically citing the moral imperative of our work, and their pride in helping to serve the poorest of the poor. One leadership team member asked, "What is 'partnership' then? We came into this work with the premise that we would work together, with our partnership built around the right to health—but who are our partners if they lead strikes damaging the very services our collective mission aims to offer?"Another leadership team member commented, "The first time I visited Achham I was invited for tea at Meena's* house (one of Nyaya's midwives). We arrived at her house and Meena greeted us warmly. She showed us in to a small room: there was no furniture, but there was an immaculately swept mat which we joined her on. We drank tea, seated on her rug, and listened to her tell us how she had come to live in the house, how she had come to work for Nyaya, and her pride in now being able to provide both for her own children, as well as, the children of her relatives. As the only employed family member, she now had the challenge of providing for all of them. When we question our partnership, I'm taken back to Meena's warm, but extremely poor, home. She has worked for Nyaya for almost four years. She has helped our organization provide free care to over 75,000 people. Is this not a type of 'partnership'?"Allow us to offer some background on the issue of wages—Meena has been with our team since 2008, and has been paid about $2,500 per year—a generous wage compared to other employers in the region. Meena was one of the striking staff members. Among other concerns about the way the hospital was being run, she and other staff asked indignantly why we couldn't provide them with higher wages, better benefits, and more resources, both for her and the hospital. Notably, Meena's salary (and the rest of our staff's) was well above her equivalent in other, more urban hospitals (to compensate for the extremely remote area in which we work), and in a district where most families are farmers, our staff's salaries occupy the highest income bracket in the region. Nonetheless, as is common throughout the world in both rich and poor areas... (shrink)

Background: Providing information to patients is an essential aspect of care. The way in which such information is transmitted is also important and is affected by different variables. The perceptions of dishonest nursing staff have not been sufficiently discussed to date. Aim: The purpose is to explore the reasons for dishonesty in transmitting information to patients. Design and Method: In this qualitative content analysis study, data were collected using semi-structured interviews with Twelve Iranian Critical Care Nurses from January 2020 (...) till August 2020. Data were analyzed according to Graneheim and Lundman approach. Ethical consideration: The research protocol was authorized by the Ethics Committee of the Medical Sciences University of Tehran (Register number: 95-04-99-33485). Results: The findings indicated that dishonesty in giving information to the patients has many reasons. Although lying is not compatible with ethical care, working conditions sometimes forced nurses to hide the truth. Discussion and conclusion: Nurses believed honesty was an integral aspect of professional practice, but situational specifics have an effect on whether the truth is told or withheld. Finally, the nurses noticed a big gap between what they want to tell and what they were doing in practice. (shrink)

This article examines the problem of agency in resident–staff interaction in a Japanese eldercare facility. Data were collected during the morning care routines and analysed within the framework of Conversation Analysis. Focusing on the openings and closings, I show that the interactions in the setting under observation are marked by a clear dominance of the care workers. This becomes most obvious at the level of the turn-taking system, where the first pair part of a new sequence is commonly delivered (...) by a care worker, thus assigning a mainly reactive role to the residents. However, the data also contain instances where this pattern is broken up by a reversal of the turn structure. I show how this sequential re-organisation enables a resident to take a more proactive role in determining the relevant next action, arguing that there is much potential for higher resident agency even in routine interactions such as the morning care activities. I also discuss the practical implications of these findings for care communication in general. (shrink)

To mark International Women’s Day the Research Group for Law, Gender and Sexuality at Westminster Law School held an evening conversation on 10 March 2016 on Women and Asylum. Speakers working in different areas of the asylum system shared their insights and experiences with an audience of staff, students, activists and other visitors. Harriet Samuels chaired the conversation and the speakers were Princess Chine Onyeukwu, Debora Singer, Priya Solanki and Zoe Harper. This article is an edited extract from (...) the transcript of the presentations and wide-ranging discussion, including the question and answer session. The discussion focused on the different steps in the refugee determination process and considered, in particular, the gendering of credibility and how women’s perceived lack of credibility has a significant impact on determinations and processes. (shrink)

*I am very pleased to be able to contribute this paper to a festschrift for Andrea Bonomi. This is not however, the paper I really wanted to write; I would have much rather have contributed a paper comparing the pianistic styles of Lennie Tristano and Bill Evans, which I think Andrea would have found much more fascinating than an essay devoted to an understanding of Frege’s thinking. But I do not totally despair. Andrea’s first paper published in English was entitled (...) “On the Concept of Logical Form in Frege,” so perhaps I can maintain some hope that this paper will appeal to lingering interests that Andrea wrote of in the past. I would like to thank Johannes Brandl, Ben Caplan, Bill Demopoulos, Bob Fiengo, Mark Kalderon, Patricia Marino, Gila Sher, Michael Thau, Dan Vest and especially Aldo Antonelli for very helpful discussion. (shrink)

This book offers a systematic framework for thinking about the relationship between language and technology and an argument for interweaving thinking about technology with thinking about language. The main claim of philosophy of technology—that technologies are not mere tools and artefacts not mere things, but crucially and significantly shape what we perceive, do, and are—is re-thought in a way that accounts for the role of language in human technological experiences and practices. Engaging with work by Wittgenstein, Heidegger, McLuhan, Searle, Ihde, (...) Latour, Ricoeur, and many others, the author critically responds to, and constructs a synthesis of, three "extreme", idealtype, untenable positions: only humans speak and neither language nor technologies speak, only language speaks and neither humans nor technologies speak, and only technology speaks and neither humans nor language speak. The construction of this synthesis goes hand in hand with a narrative about subjects and objects that become entangled and constitute one another. Using Words and Things thus draws in central discussions from other subdisciplines in philosophy, such as philosophy of language, epistemology, and metaphysics, to offer an original theory of the relationship between language and technology centered on use, performance, and narrative, and taking a transcendental turn. (shrink)

August 2006 marked the 10th anniversary of landmark legislation when Israel’s parliament passed the unique Patient’s Rights Law. This law underscores the importance of medical ethics in Israeli society. During a seminar at the Shaare Zedek School of Nursing, third-year students performed a qualitative research study investigating ethical issues arising in the field of nursing, and how nursing staff dealt with these issues in relation to the law. The research was conducted using semistructured questionnaires. The results showed that the (...) staff participants knew the law, but did not differentiate between legal and ethical problems. The establishment of a framework for dealing with these issues would help to promote professional ethics, encourage broad-based agreements related to ethical decisions, reduce ethical conflict, and increase implementation of the law on patients’ rights. (shrink)

Debates over health care have focused for so long on economics that the proper goals for medicine seem to be taken for granted; yet problems in health care stem as much from a lack of agreement about the goals and priorities of medicine as from the way systems function. This book asks basic questions about the purposes and ends of medicine and shows that the answers have practical implications for future health care delivery, medical research, and the education of medical (...) students. The Hastings Center coordinated teams of physicians, nurses, public health experts, philosophers, theologians, politicians, health care administrators, social workers, and lawyers in fourteen countries to explore these issues. In this volume, they articulate four basic goals of medicine — prevention of disease, relief of suffering, care of the ill, and avoidance of premature death — and examine them in light of the cultural, political, and economic pressures under which medicine functions. In reporting these findings, the contributors touch on a wide range of diverse issues such as genetic technology, Chinese medicine, care of the elderly, and prevention and public health. The Goals of Medicine clearly demonstrates the importance of clarifying the purposes of medicine before attempting to change the economic and organizational systems. It warns that without such examination, any reform efforts may be fruitless. (shrink)

This year marks The Hastings Center's fortieth anniversary. These essays examine the four core issues that the early Center identified as its domain. Cofounder Daniel Callahan takes up population control, noting that the concern has shifted from overpopulation to underpopulation, but that the central issue remains—respect for procreative freedom and recognition of its profound social effects. Writing on behavioral control, cofounder Willard Gaylin recalls that this issue arose alongside early discoveries about the brain‐behavior link and the desire to find ways (...) to modify undesirable behavior, causing a reassessment of what is “normal.” Robert Veatch, among the Center's first staff members, discusses death and dying—including the ongoing controversy over defining death. Thomas Murray, president, revisits the Center's work on ethical issues in human genetics. Though that work began in 1971, when genetic counseling was in its infancy and genetic engineering was unheard of, Murray finds it “remarkably prescient.”. (shrink)

This dissertation explores the reasons why structured graphics have been largely ignored in the representation and reasoning components of contemporary theories of axiomatic systems. In particular, it demonstrates that for the case of modern logic and geometry, there are systematic forces in the intellectual history of these disciplines which have driven the adoption of sentential representational styles over diagrammatic ones. These forces include: the changing views of the role of intuition in the procedures and formalisms of formal proof; the historical (...) contrast between the universalist subject matter of logic and the specific subject matter of geometry; and the ways in which both logic and geometry were affected by the changes that swept through mathematics during the nineteenth century. This dissertation traces the effects of each of these influences in the evolution of logic and geometry from antiquity to the early twentieth-century work of David Hilbert. For each discipline, it examines the historical factors impacting the creation and development of important diagrammatic systems, the reasons for the adoption or abandonment of these systems, and the philosophical context and debates surrounding the use of these systems. It concludes by arguing that the history of diagrammatic representations in logic and geometry cannot be adequately understood without essential reference to their philosophical background. (shrink)

The spectre of the repugnant conclusion and the search for a population axiology that avoids it has endured as a focus of population ethics. This is in part because the repugnant conclusion is often interpreted as a defining problem for totalism, while the implications of averagism and related views are taken to illustrate the theoretical cost of avoiding the repugnant conclusion. However, we show that this interpretation cannot be sustained unless one focuses only on a special case of the repugnant (...) conclusion: namely, the subset of instances of the repugnant conclusion where there is no portion of the population unaffected by the choice between population outcomes (as in Derek Parfit’s original illustration). To avoid an inappropriate focus on only this proper subset of instances of the repugnant conclusion, we formulate a general characterization of the repugnant conclusion. We then prove formally that all leading welfarist axiologies imply this conclusion, including averagism and Ng’s Theory X0 , including probabilistic and ‘very repugnant’ variants that involve the addition of negative lives. We then prove that the full range of axiologies considered by population ethics each imply an extended version of the repugnant conclusion, including axiologies that are incomplete, intransitive, rank-dependent, person-affecting, and/or pluralist. The upshot is that the repugnant conclusion does not ultimately tell against any approach to axiology, and the methodological requirement to avoid the repugnant conclusion should be dropped from population axiology. (shrink)

Geach's problem, the problem of accounting for the fact that judgements expressed using moral terms function logically like other judgements, stands in the way of most noncognitive analyses of moral judgements. The non-cognitivist must offer a plausible interpretation of such terms when they appear in conditionals that also explains their logical interaction with straightforward moral assertions. Blackburn and Gibbard have offered a series of accounts each of which interprets such conditionals as expressing higher order commitments. Each then invokes norms for (...) the coherent acceptance of attitudes to explain why we hold certain combinations inconsistent. Against these accounts the paper presses two related objections: (1) The norms needed to do the explanatory work cannot be strong enough to do that work without also ruling clearly consistent attitudes inconsistent. And (2), the norms of rational attitude acceptance do not neatly track the distinction between consistent and inconsistent attitudes. (shrink)

This second edition of the book contains a new chapter on the notions of natural-kind words and natural kinds.

In this chapter, I outline dynamic models of motivation and emotion. These turn out not to be autonomous subsystems, but, instead, are deeply integrated in the basic interactive dynamic character of living systems. Motivation is a crucial aspect of particular kinds of interactive systems -- systems for which representation is a sister aspect. Emotion is a special kind of partially reflective interaction process, and yields its own emergent motivational aspects. In addition, the overall model accounts for some of the crucial (...) properties of consciousness. (shrink)

This book scrutinizes recent work in phonological theory from the perspective of Chomskyan generative linguistics and argues that progress in the field depends on taking seriously the idea that phonology is best studied as a mental computational system derived from an innate base, phonological Universal Grammar. Two simple problems of phonological analysis provide a frame for a variety of topics throughout the book. The competence-performance distinction and markedness theory are both addressed in some detail, especially with reference to phonological acquisition. (...) Several aspects of Optimality Theory, including the use of Output-Output Correspondence, functionalist argumentation and dependence on typological justification are critiqued. The authors draw on their expertise in historical linguistics to argue that diachronic evidence is often mis-used to bolster phonological arguments, and they present a vision of the proper use of such evidence. Issues of general interest for cognitive scientists, such as whether categories are discrete and whether mental computation is probabilistic are also addressed. The book ends with concrete proposals to guide future phonological research.The breadth and depth of the discussion, ranging from details of current analyses to the philosophical underpinnings of linguistic science, is presented in a direct style with as little recourse to technical language as possible. (shrink)

This book outlines and evaluates the principal strands of critical legal studies, and achieves much more as well.