The notion of harm has been a recurring and a significant notion in the characterization of mental disorder. It is present in eminent diagnostic manuals such as DSM and ICD, as well as in the discussion on mental disorders in philosophy of psychiatry. Recent demotion of harm in the definition of mental disorders in DSM-5 shows a general trend towards reducing the significance of harm when thinking about the nature of mental disorders. In this paper, we defend the relevance of (...) the notion of harm in the characterization of mental disorder against some of these attacks. We approach this issue by using the method of conceptual explication pioneered by Rudolf Carnap. Within this framework, we argue that keeping the notion of harm not only helps to discriminate what is pathological from the nonpathological but also prevents potential misuses of psychiatric authority. (shrink)

Background: Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral (...) Case Deliberation should contain. Objective: To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces. Methods: A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority. Ethical considerations: No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation. Findings: Other than ‘moral reasoning’ (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of ‘reflections on the psychosocial work environment’ to a varying extent (md: 29%). Additional content comprised ‘assumptions about the patient’s psychosocial situation’ (md: 6%), ‘facts about the patient’s situation’ (md: 5%), ‘concrete problem-solving’ (md: 6%) and ‘process’ (md: 3%). Conclusion: The findings suggest that a restorative function of staff’s wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants’ own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation. (shrink)

Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. The (...) aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers’ experiences and perceived importance of outcomes of Moral Case Deliberation. (shrink)

Based on a case study of a large multinational group, this paper addresses the way in which social and environmental reporting systems were changed and the consequences and controversies associated with this change. Drawing on Power’s work on the processes by which things are made auditable via underlying systems, we focus on how and why a specific programme with auditability as its ultimate aim changed the basis on which the external social and environmental report was prepared. Our analysis demonstrates that (...) the perceived alignment with the financial report preparation and the explicit pursuit of auditability legitimized SER and paved the way for data systems to be changed. The programme borrowed authority from financial accounting technologies not only to make a system change but also to push SER internally, as we suggest that an intraorganizational group used the programme to ensure the existence and organizational status of SER. However, we also illustrate some of the practical challenges associated with this change, which include issues related to internal control and the establishment of organizational boundaries. (shrink)

Cognitive models of social anxiety disorder suggest that memory biases for negative social information contribute to symptoms of social anxiety. However, it remains unclear whether memory bias...

In inclusive dance settings, where people with different abilities and talents come together, the role of facilitators is essential in guiding the process of inclusion. Their behavior gives sensitive information to the individual about one’s status within the own-group affiliation. Even today, very little research on the motivation for facilitating inclusivity in dance contexts exists. This case study will examine the facilitator’s motivation by juxtaposing current theory next to experiences of seven experts of contemporary dance facilitation in Europe. Good opportunities (...) for meaningful interactions can be created in a dance setting: it promotes a deeper sense of community, gives us the feeling of belonging, generates respect and inclusion, and helps to prevent the feeling of loneliness. This research report sheds light on the motivation of being the facilitator of dance for heterogeneous groups and reveals three factors from the data. First, to be led by an artistic motivation, second, to have a vision in terms of changing the society, and third, to have another personal motivation. The motivation of the facilitator is regarded as highly important for inclusive work, as the person who facilitates plays a key role in these successful processes of inclusion. (shrink)

BackgroundBesides balancing burdens and benefits of intensive care, ethical conflicts in the process of decision-making should also be recognised. This calls for an ethical analysis relevant to clinicians. The aim was to analyse ethically difficult situations in the process of deciding whether a patient is admitted to intensive care unit.MethodsAnalysis using the ‘Dilemma method’ and ‘wide reflective equilibrium’, on ethnographic data of 45 patient cases and 96 stakeholder interviews in six UK hospitals.Ethical analysisFour moral questions and associated value conflicts were (...) identified. Who should have the right to decide whether a patient needs to be reviewed? Conflicting perspectives on safety/security. Does the benefit to the patient of getting the decision right justify the cost to the patient of a delay in making the decision? Preventing longer-term suffering and understanding patient’s values conflicted with preventing short-term suffering and provision of security. To what extent should the intensivist gain others’ input? Professional independence versus a holistic approach to decision-making. Should the intensivist have an ongoing duty of care to patients not admitted to ICU? Short-term versus longer-term duty to protect patient safety. Safety and security were key values at stake in the ethical conflicts identified. The life-threatening nature of the situation meant that the principle of autonomy was overshadowed by the duty to protect patients from harm. The need to fairly balance obligations to the referred patient and to other patients was also recognised.ConclusionProactive decision-making including advance care planning and escalation of treatment decisions may support the inclusion of patient autonomy. However, our analysis invites binary choices, which may not sufficiently reflect reality. This calls for a complementary relational ethics analysis. (shrink)

Much work on intellectual humility has focused on its epistemic benefits. We suggest that displaying (or failing to display) intellectual humility also has effects on how others perceive us and that, as a result, intellectual humility can serve reputation management purposes, in at least four ways: (i) Intellectual humility can be used to signal we are a good source of information; (ii) Intellectual humility can be used to signal we are competent through countersignaling; (iii) Intellectual humility can be used to (...) make sure others do not believe we are overclaiming superiority; (iv) lack of intellectual humility (or intellectual arrogance) can be used to signal dominance. The evidence suggests that intellectual humility (or lack thereof) can have each of these effects. Seeing intellectual humility as (inter alia) a reputation management tool predicts that people will be more or less likely to display intellectual humility in some contexts. For instance, people in a position of power might stand to lose less if they fail to be intellectual humble; accordingly, evidence suggests that they tend to display less intellectual humility. In conclusion, we speculate that understanding intellectual humility as reputation management could help construct environments more conducive to displays of intellectual humility. (shrink)

Developing countries need to reform legislation to ensure the global supply firms in ready-made garment industry is adequately addressing obligations of social responsibility. Literature typically focuses on strategies for raising responsible standards in global buying firms within the RMG industry, but fails to focus on implementing strategies for suppliers in developing countries. This article addresses this gap by specifically focusing on the RMG industry in Bangladesh, the home of the third largest RMG supplier in the world. It concentrates on analysing (...) how and to what extent the law can assist in developing social responsibility performance of the RMG manufacturing firms in developing countries. It ultimately concludes that a new governance approach in laws can effectively increase the social responsibility practice standards of an industry where global buying firms are profit-driven and governmental agencies are either inadequate or corrupt. (shrink)

This chapter investigates medieval Sweden and its iconography of justice. The Swedish lay judges were without university education, and especially the commoners had few opportunities of seeing images of justice on artefacts or in secular buildings. Yet, the ecclesiastical imagery in churches was seen and understood by all, thanks to the Church’s teaching. Based on surveys of justice-related iconography in medieval Swedish and Finnish churches, the chapter argues that the scope of these motifs was very limited. Images of the Last (...) Judgment and Saint Michael weighing souls predominate, while some churches had murals with Moses receiving the Tables of the Law, Solomon’s justice, or truth- or justice-related Biblical verses in Latin. No images of Lady Justice or other justice-related representations came up. Even only a fraction of the Finnish churches had a Last Judgment or Saint Michael to adorn them. However, these two images together, with images of devils tempting people to sin and perdition, were visualisations that had practical meaning in the Swedish legal culture. The practices of justice and judging were popular and daily reiterated, making each sworn oath a step towards either heaven or hell. (shrink)

Mandalas in the Making: The Visual Culture of Esoteric Buddhism at Dunhuang, by Michelle C. Wang. Leiden: Brill, 2018. xviii + 318 pages. Hb. $147.00, ISBN-13: 9789004357655; Ebook $25.00, ISBN-13: 9789004360402.

Motivated by the increasing economic significance of investment advisory industries and the prevalence of wrongdoing in financial planning services, we examine whether, and to what extent, employee misconduct is shaped by their local corruption culture. Using novel data of more than 4.7 million adviser-year observations of financial advisers and the Department of Justice’s data on corruption, we find that financial advisers and advisory firms located in areas with higher levels of corruption are more likely to commit misconduct. These results hold (...) for both individual advisor and firm level analyses and are robust to the use of various fixed effects, model specifications, proxies for corruption and misconduct, and an instrumental variable approach. Using the passage of the Dodd-Frank Whistleblower Provision, which provides incentives for reporting corruption incidences and thereby reduces the incentives for fraud, we find that the relation between local corruption culture and adviser misconduct is attenuated after the provision enacted by the SEC. Overall, our study highlights the externalities of corruption culture on individual ethics and the essential role of whistleblowing laws in reducing corruption-prone norms. (shrink)

Une nouvelle écrite pour l’anthologie Octavia’s Brood: Science Fiction Stories from Social Justice Movements [enfants d’Octavia: des histoires SF tirées des mouvements de justice sociale], éditée par adrienne maree brown et Walidah Imarisha. L’histoire parle d’un futur dans lequel toutes les personnes handicapées (appelées I. P. ou ImParfait·es) ont été envoyées sur une autre planète où, débarrassées des soldats envoyés pour les surveiller, ielles se sont créé une vie faite d’entraide. Cette vie est menacée par les Parfait·es, qui s’apprêtent à (...) revenir prendre le contrôle et créer une nouvelle dystopie pour eux. (shrink)

This book evaluates the Western conception of man. After having examined primitive thought in which Nature comprises everything that exists, including man, the author explains why in Western thought man is usually not only different from Nature, but opposed to it, which may have grave consequences to Nature’s fate.

When immigrant children are separated from their parents, inexorable medical and legal harms result. Family separation violates a fundamental right of parents to participate in medical decisions involving their children. This paper reviews and contributes to evolving analyses of the public health, legal, and ethical consequences of immigration policy.

The convergence of corporate social responsibility (CSR) and corporate governance (CG) has changed the corporate accountability mechanism. This has developed a socially responsible ‘corporate self-regulation’, a synthesis of governance and responsibility in the companies of strong economies. However, unlike in the strong economies, this convergence has not been visible in the companies of weak economies, where the civil society groups are unorganised, regulatory agencies are either ineffective or corrupt and the media and non-governmental organisations do not mirror the corporate conscience. (...) Using the case of Bangladesh, this article investigates the convergence between CSR and CG in the self-regulation of companies in a less vigilant environment. (shrink)

BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation (MCD). Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument (Euro-MCD) instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA North European (...) field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such asmoralreflexivity andmoralattitude outcomes, should still be included. In the future, a combination of empirical findings (practice) and normative reflection (theories) will contribute to the revision of the instrument. (shrink)

Background: Ethics rounds are one way to support healthcare personnel in handling ethically difficult situations. A previous study in the present project showed that ethics rounds did not result in significant changes in perceptions of how ethical issues were handled, that is, in the ethical climate. However, there was anecdotal evidence that the ethics rounds were viewed as a positive experience and that they stimulated ethical reflection. Aim: The aim of this study was to gain a deeper understanding of how (...) the ethics rounds were experienced and why the intervention in the form of ethics rounds did not succeed in improving the ethical climate for the staff. Research design: An exploratory and descriptive design with a qualitative approach was adopted, using individual interviews. Participants and research context: A total of 11 healthcare personnel, working in two different psychiatry outpatient clinics and with experience of participating in ethics rounds, were interviewed. Ethical considerations: The study was based on informed consent and was approved by one of the Swedish Regional Ethical Review Boards. Findings: The participants were generally positive about the ethics rounds. They had experienced changes by participating in the ethics rounds in the form of being able to see things from different perspectives as well as by gaining insight into ethical issues. However, these changes had not affected daily work. Discussion: A crucial question is whether or not increased reflection ability among the participants is a good enough outcome of ethics rounds and whether this result could have been measured in patient-related outcomes. Ethics rounds might foster cooperation among the staff and this, in turn, could influence patient care. Conclusion: By listening to others during ethics rounds, a person can learn to see things from a new angle. Participation in ethics rounds can also lead to better insight concerning ethical issues. (shrink)

This paper provides frameworks for understanding how ethics might be expressed in gameplay situations, and how we can study the ethical frameworks that games offer to players. There are many ways to delve into such topics, and this paper considers only a few approaches. It briefly surveys some of the important ques-tions and critiques arising from audience studies, theories of play and games, and work on cheating, and begins to build a framework for considering ethics in relation to games and (...) players that transcends the “place apart” that games are often constructed as. (shrink)

This paper investigates the relationship between the experiences of mass vaccinations against two pandemic viruses: the swine flu in 2009–2010 and COVID-19 in the early 2020s. We show how distressing memories from the swine flu vaccination, which led to the rare but severe adverse effect of narcolepsy in approximately 500 children in Sweden, were triggered by the COVID-19 pandemic. The narcolepsy illness story has rarely been told in academic contexts; therefore, we will provide space for this story. It is presented (...) through a dialogue with the aim of shedding light on the interrelationship between pandemics—and between mass vaccinations—to investigate what could be termed cultural wounds that influence societies because they are characterized by the difficulty of talking about them. The paper explores the multiple shocks of illness in life and what can be learned from them by sharing them. (shrink)

The problem of political apathy and poor representation of women in the Belgian parliament bas been focused and seriously challenged with the 1974 parliamentary elections. Two different strategies hereby have been developed: on the one hand a separate, exclusive feminist party ; on the other hand a strategy of female candidates on the more conventional ballots. The effects of both strategies are quite remarkable : whereas the newcoming feminist party was struggling with breakthrough problems, the female candidate strategy strongly effected (...) the amount of female candidates, elected women, as well as the votes given to women, compared to previous elections. The accurate relationship between the women's campaign and its election effect can hardly be determined for the election determinant is too complex. The propaganda however, was an attempt to change the traditional image of women and to increase the political participation and emancipation of women via the instrument of parliamentary elections. The 1977 results, however, hardly equated the optimistic prospects of 1974 : the feminist party didn't survive its second participation and the candidate strategyurgently needs permanent action and political sensibilisation. (shrink)

Even though Corporate Social Responsibility (CSR) has become a widely accepted concept promoted by different stakeholders, business corporations' internal strategies, known as corporate self-regulation in most of the weak economies, respond poorly to this responsibility. Major laws relating to corporate regulation and responsibilities of these economies do not possess adequate ongoing influence to insist on corporate self-regulation to create a socially responsible corporate culture. This book describes how the laws relating to CSR could contribute to the inclusion of CSR principles (...) at the core of the corporate self-regulation of these economies in general, without being intrusive in normal business practice. It formulates a meta-regulation approach to law, particularly by converging patterns of private ordering and state control in contemporary corporate law from the perspective of a weak economy. It proposes that this approach is suitable for alleviating regulators' limited access to information and expertise, inherent limitations of prescriptive rules, ensuring corporate commitment, and enhance the self-regulatory capacity of companies. This book describes various meta-regulation strategies for laws to link social values to economic incentives and disincentives, and to indirectly influence companies to incorporate CSR principles at the core of their self-regulation strategies. It investigates this phenomenon using Bangladesh as a case study. (shrink)

The aim of this study was to evaluate agreement between nurses’ and physicians’ opinions regarding aggressiveness of treatment and to investigate and compare the rationales on which their opinions were based. Structured interviews regarding 714 patients were performed on seven general wards of a university hospital. The data gathered were then subjected to qualitative and quantitative analyses. There was 86% agreement between nurses’ and physicians’ opinions regarding full or limited treatment when the answers given as ‘uncertain’ were excluded. Agreement was (...) less (77%) for patients with a life expectancy of less than one year. Disagreements were not associated with professional status because the physicians considered limiting life-sustaining treatment as often as the nurses. A broad spectrum of rationales was given but the results focus mostly on those for full treatment. The nurses and the physicians had similar bases for their opinions. For the majority of the patients, medical rationales were used, but age and quality of life were also expressed as important determinants. When considering full treatment, nurses used quality-of-life rationales for significantly more patients than the physicians. Respect for patients’ wishes had a minor influence. (shrink)

The European Legacy, Volume 17, Issue 5, Page 706-707, August 2012.