Contemporary reasoning about health is infused with the work products of experts, and expert reasoning about health itself is an active site for invention and design. Building on Toulmin’s largely undeveloped ideas on field-dependence, we argue that expert fields can develop new inference rules that, together with the backing they require, become accepted ways of drawing and defending conclusions. The new inference rules themselves function as warrants, and we introduce the term “warranting device” to refer to an assembly of the (...) rule plus whatever material, procedural, and institutional resources are required to assure its dependability. We present a case study on the Cochrane Review, a new method for synthesizing evidence across large numbers of scientific studies. After reviewing the evolution and current structure of the device, we discuss the distinctive kinds of critical questions that may be raised around Cochrane Reviews, both within the expert field and beyond. Although Toulmin’s theory of field-dependence is often criticized for its relativism, we find that, as a matter of practical fact, field-specific warrants do not enjoy immunity from external critique. On the contrary, they can be opened to evaluation and critique from any interested perspective. (shrink)

Background Providing understandable information to patients is necessary to achieve the aims of the Informed Consent process: respecting and promoting patients’ autonomy and protecting patients from harm. In recent decades, new, primarily digital technologies have been used to apply and test innovative formats of Informed Consent. We conducted a systematic review to explore the impact of using digital tools for Informed Consent in both clinical research and in clinical practice. Understanding, satisfaction and participation were compared for digital tools versus the (...) non-digital Informed Consent process. Methods We searched for studies on available electronic databases, including Pubmed, EMBASE, and Cochrane. Studies were identified using specific Mesh-terms/keywords. We included studies, published from January 2012 to October 2020, that focused on the use of digital Informed Consent tools for clinical research, or clinical procedures. Digital interventions were defined as interventions that used multimedia or audio–video to provide information to patients. We classified the interventions into 3 different categories: video only, non-interactive multimedia, and interactive multimedia. Results Our search yielded 19,579 publications. After title and abstract screening 100 studies were retained for full-text analysis, of which 73 publications were included. Studies examined interactive multimedia, non-interactive multimedia, and videos, and most studies were conducted on adults. Innovations in consent were tested for clinical/surgical procedures and clinical research. For research IC, 21 outcomes were explored, with a positive effect on at least one of the studied outcomes being observed in 8/12 studies. For clinical/surgical procedures 49 outcomes were explored, and 21/26 studies reported a positive effect on at least one of the studied outcomes. Conclusions Digital technologies for informed consent were not found to negatively affect any of the outcomes, and overall, multimedia tools seem desirable. Multimedia tools indicated a higher impact than videos only. Presence of a researcher may potentially enhance efficacy of different outcomes in research IC processes. Studies were heterogeneous in design, making evaluation of impact challenging. Robust study design including standardization is needed to conclusively assess impact. (shrink)

“Female sexual dysfunction” is the type of contested disease that has sparked concern about the role of the pharmaceutical industry in medical science. Many policies have been proposed to manage industry influence without carefully evaluating whether the proposed policies would be successful. We consider a proposal for incorporating citizen stakeholders into scientific research and show, via a detailed case study of the pharmaceutical regulation of flibanserin, that such programs can be co-opted. In closing, we use Holman’s asymmetric arms race framework (...) as a tool for evaluating policies in industry-funded science. (shrink)

Using relations of solidarity in global contexts, this article explores some of the debates about what constitutes solidarity. Three primary forms of solidarity are discussed, with particular attention to the different nature of the solidaristic relations and their moral obligations.

Customarily patient advocacy is argued to be an essential part of nursing, and this is reinforced in contemporary nursing codes of conduct, as well as codes of ethics and competency standards governing practice. However, the role of the nurse as an advocate is not clearly understood. Autonomy is a key concept in understanding advocacy, but traditional views of individual autonomy can be argued as being outdated and misguided in nursing. Instead, the feminist perspective of relational autonomy is arguably more relevant (...) within the context of advocacy and nurses’ work in clinical healthcare settings. This article serves to highlight and problematise some of the assumptions and influences around the perceived role of the nurse as an advocate for patients in contemporary Western healthcare systems by focusing on key assumptions concerning autonomy inherent in the role of the advocate. (shrink)

Causal modelling provides a powerful set of tools for identifying causal structure from observed correlations. It is well known that such techniques fail for quantum systems, unless one introduces 'spooky' hidden mechanisms. Whether one can produce a genuinely quantum framework in order to discover causal structure remains an open question. Here we introduce a new framework for quantum causal modelling that allows for the discovery of causal structure. We define quantum analogues for core features of classical causal modelling techniques, including (...) the causal Markov condition and faithfulness. Based on the process matrix formalism, this framework naturally extends to generalised structures with indefinite causal order. (shrink)

How should we explore the relationship between race and educational opportunity? One approach to the Black-White achievement gap explores how race and class cause disparities in access and opportunity. In this paper, I consider how education contributes to the creation of race. Considering examples of classroom micropolitics, I argue that breakdowns of trust and trustworthiness between teachers and students can cause substantial disadvantages and, in the contemporary United States, this happens along racial lines. Some of the disadvantages are academic: high (...) achievement is more difficult when one faces mistrust, ego depletion, effort pessimism, and insult. And within a knowledge economy, exclusion from knowledge work makes one vulnerable to injustice. But the problem goes deeper than achievement, for schools are contexts in which we develop self-understandings and identities that situate us as members of society. If students of color are systematically denied full participation in trusting conversations that create shared knowledge—especially, knowledge that holds power within the dominant culture—they are unjustly deprived resources to form flourishing selves that are suited to the positions of power and authority. The argument suggests that knowledge is not best understood simply as a commodity to be distributed, and opportunity is not just a matter of access. Moreover, even if access is granted, those who are motivated and talented can fail: they drain their willpower by coping with insults, or reasonably lose optimism about their efficacy. Over time, motivation may shift away from achievement, and under the circumstances this can be a rational response. The barriers to achievement are many, but true opportunity is impossible without trust and trustworthiness. (shrink)

Recent ideological positioning on the world stage has born a startling resemblance to a form of positioning within nursing theory – that of taking complex ideas, reducing them to a simplistic binary form, and uncritically adopting one half of that form. In some cases, this adoption of a binary position has led to a passionately held form of ‘othering’ that prohibits a healthy and critical engagement with ideas. As alluring as settling for the binary form may be – we argue (...) for holding binaries in tension as a catalyst for stimulating dialogue – reasoning and exploration of new ways of wrestling with the social and moral complexity of nursing. (shrink)

ABSTRACT‘Solidarity’ is a key concept in political movements and usually bears on matters of labour, health and social justice. As such, it is essential in the reproduction and transformation of communities that support their members and protect their interests. It is sometimes overlooked that interspecies solidarity already pertains with a number of domesticated animals, and that people are willing to carry substantial emotional, financial and social burdens to benefit them. There has been even more reluctance to acknowledge wild animals as (...) fellow members of our political communities with whom we might stand in solidarity. The purpose of this paper is to propose that solidaristic relations with certain wild animals are not only possible, but also already exist in some contexts. It explores three different understandings of solidarity, and in probing to what extent they can be applied to wild animals, it identifies some important different roles they can play in ‘animal politics’, and shows how they can help us reconceive our communities in less anthropocentric terms. (shrink)

We recognize a paradox of power and promise in the context of legislative and organizational changes in nurse regulation which poses constraints on nursing's capacity to bring voice and influence to pressing matters of healthcare and public policy. The profession is at an important crossroads wherein leaders must be well informed in political, economic and legislative trends to harness the profession's power while also navigating forces that may put at risk its central mission to serve society. We present a critical (...) policy analysis of the impact of recent regulatory trends on what the International Council of Nurses considers nursing's three ‘pillars’ – the profession of nursing, socioeconomic welfare of nurses and nurse regulation. Themes surfacing from this analysis include regulatory discontinuity, a tightening of regulatory control, and an increasingly managerial governance culture. These themes illuminate insights and strategies required to renew and revitalize the social mandate of our profession amidst a climate of urgency in the questioning of nurse scholars with respect to the future of the profession. At this historic juncture, nurses must clearly understand the implications of legislative and organizational regulatory changes to ensure the profession contributes to full capacity in achieving health and health equity globally. (shrink)

Self-reported data are regarded by medical researchers as invalid and less reliable than data produced by experts in clinical settings, yet individuals can increasingly contribute personal information to medical research through a variety of online platforms. In this article we examine this ‘participatory turn’ in healthcare research, which claims to challenge conventional delineations of what is valid and reliable for medical practice, by using aggregated self-reported experiences from patients and ‘pre-patients’ via the internet. We focus on 23andMe, a genetic testing (...) company that collects genetic material and self-reported information about disease from its customers. Integral to this research method are relations of trust embedded in the information exchange: trust in customers’ data; trust between researchers/company and research subjects; trust in genetics; trust in the machine. We examine the performative dimension of these trust relations, drawing on Shapin and Schaffer’s (1985) discussion of how material, literary and social technologies are used in research in order to establish trust. Our scepticism of the company’s motives for building trust with the self-reporting consumer forces us to consider our own motives. How does the use of customer data for research purposes by 23andMe differ from the research practices of social scientists, especially those who also study digital traces? By interrogating the use of self-reported data in the genetic testing context, we examine our ethical responsibilities in studying the digital selves of others using internet methods. How researchers trust data, how participants trust researchers, and how technologies are trusted are all important considerations in studying the social life of digital data. (shrink)

:This article considers recent ethical topics relating to medical AI. After a general discussion of recent medical AI innovations, and a more analytic look at related ethical issues such as data privacy, physician dependency on poorly understood AI helpware, bias in data used to create algorithms post-GDPR, and changes to the patient–physician relationship, the article examines the issue of so-called robot doctors. Whereas the so-called democratization of healthcare due to health wearables and increased access to medical information might suggest a (...) positive shift in the patient-physician relationship, the physician’s ‘need to care’ might be irreplaceable, and robot healthcare workers might be seen as contributing to dehumanized healthcare practices. (shrink)

The purpose of this qualitative case study is to understand and critique the gendered political processes in the search for an athletic director following a merger between men’s and women’s intercollegiate athletic departments in a U.S. university. Semi-structured interviews were used to ask 55 athletic department stakeholders their perceptions of the search process and associated politics. Findings indicated gendered political activities occurred along gender-affiliated departmental lines. Political strategies contributed to gendered processes favoring certain masculinities and male candidates in the search (...) for an athletic director. While gender equity was an important consideration in the search process, because of the controversial nature of the merger and the politics expressed, the belief that hiring a man was essential to the merger’s success was widely accepted by many stakeholder groups. The findings are positioned in the critical management and sport literature. This research contributes to our understanding of the complexity of gender relations and provides insight into the gendered political processes that inform leadership searches. (shrink)

With some notable exceptions, feminist epistemologists have not focused (like many contemporary analytic epistemologists) on the the semantics of claims to know: What are the truth conditions of claims of the form S knows that p? My goal in this paper is to suggest a way of approaching the task of specifying the truth conditions for knowledge while (hopefully) making clear how a broad range of feminist work that is often deemed irrelevant to the philosophical inquiry into knowledge is, in (...) fact, highly relevant. My discussion may also show (though I’m not going to take this up explicitly) that there are reasons why the search for truth conditions for knowledge could have a legitimate place in feminist epistemological inquiry. (shrink)

This paper attends to the question of how to effectively teach ethics in universities. The author challenges the accepted skepticism amongst other disciplines that philosophers are no longer equipped to teach ethics courses to accommodate the moral demands of the contemporary world. Philosophers are believed to merely focus on abstract issues concerning moral attitudes and behavior. Currently, ethics courses in universities have replaced abstract moral issues of moral theory with concrete issues such as, homosexuality, the green house effect, pornography, and (...) gender and race issues. This paper seeks to offer an alternative way to think about the abstractness of moral theories that focus on moral attitudes, which will alleviate concerns about their validity and application to concrete ethical concerns. (shrink)

Post–dualist philosophies of nursing acknowledge embodiment as a condition of human existence. Philosophical writing, however, remains abstract and disembodied. A philosophical framework that embraces embodiment needs to recover the materiality of language; its text needs to include language that is not only rational and clear but sensuous and ambiguous. I describe three cultural narratives of women's embodiment and compare them with an imaginative narrative, a nurse's poem about women in labour. I propose, not that philosophers become poets, but that they (...) abandon a dualist position in which language is either literal or metaphorical, adopting instead the poet's approach in which any word or object has unlimited meanings. I argue that, without fixed reference points, language embodies rather than escapes contingency. Finally, I discuss two forms of philosophical writing – irony and motet – that savour contingency, illustrating philosophy as endless redescription, aiming not for finality but for the grace of a dancer's deliberate fall. (shrink)

This is the review of a book by Paula Byrne on Lord Mansfield's great-niece, Dido, whom he raised as his own daughter. Lord Mansfield was the Lord Chief Justice of England in the Eighteenth Century. The child was brought to him as an infant and grew up to become what we would today term his paralegal clerk in his Library at Kenwood House. His great-niece was the child of a black slave and his sister's son, Sir John Lindsay. This is (...) also a narrative of the British Slave trade including some of Lord Mansfield's judgements at the King's Bench Division, Royal Courts of Justice. (shrink)

Attentional scanning was studied in anxious and non-anxious participants, using a modified change detection paradigm. Participants detected changes in pairs of emotional scenes separated by two task irrelevant slides, which contained an emotionally valenced scene and a visual mask. In agreement with attentional control theory, change detection latencies were slower overall for anxious participants. Change detection in anxious, but not non-anxious, participants was influenced by the emotional valence and exposure duration of distractor scenes. When negative distractor scenes were presented at (...) subliminal exposure durations, anxious participants detected changes more rapidly than when supraliminal negative scenes or subliminal positive scenes were presented. We propose that for anxious participants, subliminal presentation of emotionally negative distractor scenes stimulated attention into a dynamic state in the absence of attentional engagement. Presentation of the same scenes at longer exposure times was accompanied by conscious awareness, attentional engagement, and slower change detection. (shrink)