Antimicrobial Resistance is a threat to individual and to population health and to future generations, requiring “collective sacrifices” in order to preserve antibiotic efficacy. ‘Who should make the sacrifices?’ and ‘Who will most likely make them?’ are ethical concerns posited as potentially manageable through Antimicrobial Stewardship. Antimicrobial stewardship almost inevitably involves a form of clinical cost-benefit analysis that assesses the possible effects of antibiotics to treat a diagnosed infection in a particular patient. However, this process rarely accounts properly for patients (...) – above and beyond assessments of potential (non)compliance or adherence to care regimes. Drawing on a vignette of a pregnant woman of colour and migrant diagnosed with Mycoplasma genitalium, a sexually transmissible bacterium, this article draws out some of the ethical, speculative, and practical tensions and complexities involved in Antimicrobial Stewardship. We argue that patients also engage in a form of cost-benefit analysis influenced by experiences of reproductive and social (in)justice and comprising speculative variables - to anticipate future possibilities. These processes have the potential to have effects above and beyond the specific infection antimicrobial stewardship was activated to address. We contend that efforts to practice and research antimicrobial stewardship should accommodate and incorporate these variables and acknowledge the structures they emerge with(in), even if their components remain unknown. This would involve recognising that antimicrobial stewardship is intricately connected to other social justice issues such as immigration policy, economic justice, access to appropriate medical care, racism, etc. (shrink)

In this article we investigate the way in which viral load assays are used to assess the viruses of Human Immunodeficiency Virus (HIV)-positive pregnant women who are cared for in an HIV-specialist antenatal clinic in London. One of the viral load assays has been made more sensitive to subtypes of the virus that are considered to be local, possibly reading the viruses of those who have ‘foreign’ subtypes as undetectable. Consequently, the patient might not be offered the kind of care (...) needed to prevent transmission of HIV, as her body is not recognised as sufficiently debilitated. Thus, being identified as a debilitated body in this setting facilitates the prevention of vertical transmission of HIV and the management of the HIV-positive pregnant patient's virus. Further to this, we argue that in our example, having a debilitated body as constructed by the viral load assay is thus a ‘privilege’ that is accorded to HIV-positive persons depending on the geographic origin of their virus. Using Karen Barad's agential realism, we argue that the manner in which HIV is read through the viral load assay constructs a specific woman/foetus/hiv phenomenon. The specificity of this phenomenon directly impacts on the course of care, opening up or foreclosing the possibility of her child having a future free from HIV. (shrink)

W B Gallie’s notion of essentially contested concepts remains of philosophical interest. I argue that medicine is one such concept and look at the consequences of this as regards the inappropriateness of looking for definitions and necessary and sufficient conditions to settle debates about what medicine is and is not.

Respect for autonomy and self-determination is a central principle in nursing ethics. Autonomy and quality of life are strongly connected, and, at the same time, autonomy is an important quality indicator on how older persons' housing functions. In this study, autonomy was conceived as self-determination. The aim of the study was to describe how older people living in sheltered housing experience self-determination and how they are valued as human beings. Eleven persons living in five different housing facilities for older people (...) in southern Sweden were interviewed. The data were analysed by manifest and latent qualitative content analysis. The overall theme expressing the latent content in the interviews emerged as disempowerment, which implied an environment that does not strengthen individual self-determination. The results showed a negative experience of how these older people thought they were valued in the sheltered housing where they lived. In sheltered housing, more attention should be paid to residents' self-determination and sense of value. (shrink)

As a preliminary to the modern theory of measurement with which this paper is chiefly concerned, it is desirable to review a few of the characteristics and implications of classical physics to illustrate the far reaching changes that have taken place in our conception of nature as the result of the development of quantum mechanics.

ABSTRACT In his paper ‘The Survival Lottery’John Harris suggested that there could be situations where the rational thing to do would be to kill a healthy person and harvest his organs for transplantation, thereby saving several lives at the cost of one. Anne Maclean claims that such a proposal, far from being rational, does not qualify as a moral proposal at all since what it suggests is ‘plain murder’. I argue that she is correct to claim that the proposal is (...) not uniquely rational and that doctors could quite rationally reject it, but that she overreaches herself when she holds it not to be a moral proposal at all. (shrink)

Name der Zeitschrift: Paragrana Jahrgang: 23 Heft: 2 Seiten: 185-193.

Merchants in late medieval Antwerp worked with a number of different representatives: They appointed proxies to trade on their behalf, to collect debts in their name or to represent them in court. If a merchant wanted to authorize another person to act on his behalf, he went to a notary who issued a letter of procuration. The article discusses the role of Roman law in these procurations. It contrasts the procurations issued by the notaries with other models for procurations found (...) in a form book for notaries in Antwerp. The analysis comes to the conclusion that the basic idea of installing a proxy did not rely on Roman law. However, knowledge of Roman law was crucial if someone wanted to be represented in a Roman law court. Furthermore, concepts derived from Roman law were applied when complicated problems or phenomena had to be shortened to a few words. In sum, the practice of including phrases and concepts of Roman law wherever they proved useful can be regarded as a part of the lex mercatoria, the customary law of merchants. (shrink)

As a means to challenge and diminish the hold of mainstream curriculum's claim of being a colorblind, politically neutral text, we will address two particular features that partially, though significantly, constitute the hidden curriculum in the United States—race and class—historically studied as separate social issues. Race and class have been embedded within the institutional curriculum from the beginning in the US; though rarely acknowledged as intertwined issues. We illustrate how the theoretical and interpretive structure of French philosopher and sociologist Pierre (...) Bourdieu can productively subsume the insights of critical race theory into its framework in a way that provides a more robust understanding of how race and class continue to be socially reproduced in schools. To perform this task we examine, through Bourdieu's constructs of habitus, field, capital, symbolic violence and misrecognition, the ways in which race, in general, and whiteness, specifically, influences pedagogical and curricular existence within the institutional superstructure of school. (shrink)

The first extensive examination of Stein's notebooks, manuscripts and letters, prepared over a period of twenty years, _Gertrude Stein: The Language That Rises_ asks new questions and explores new ways of reading Stein. This definitive study give us a finely detailed, deeply felt understanding of Stein, the great modernist, throughout one of her most productive periods. From "An Elucidation" in 1923 to _Lectures In America_ in 1934, Ulla E. Dydo examines the process of the making and remaking of Stein's (...) texts as they move from notepad to notebook to manuscript, from an idea to the ultimate refinement of the author's intentions. The result is an unprecedented view of the development of Stein's work, word by word, text by text, and over time. (shrink)

Value pluralism does not imply relativism or subjectivism about values. What it does is allow respect for an at least limited toleration of values with which one may profoundly disagree. Thus a doctor can respect the autonomy of a patient whose values he does not share.

In lieu of an abstract, here is a brief excerpt of the content:The Case of the Disappearing EnigmaDeborah Knight and George McKnightAsked to give examples of detection narratives, one might first mention paradigms of the detective genre from either the classical or hard-boiled traditions. But the study of detection need not be restricted to the generic as familiarly construed. 1 Our interest in detection is transgeneric, which is why we speak in terms of “detection narratives” rather than the detective genre. (...) We are as interested in detection narratives that exploit the generic tendencies of suspense or comedy as we are in nongeneric narratives that feature an investigation of some mystery or crime. While what we have to say about detection, interpretation, and narrative explanation is generally applicable to both literary and non-literary detection narratives, our five main examples are all unapologetically taken from cinema. We have selected these five just because they are unlikely to strike anyone as an intuitively obvious group of films. They are The Thin Man (W. S. Van Dyke, 1934), a mystery/comedy; The Maltese Falcon (John Huston, 1941), standardly cited as the earliest film noir and a paradigm of the cinematic hard-boiled detective genre; All The President’s Men (Alan J. Pakula, 1976), a political thriller based on Bernstein and Woodward’s nonfictional investigation of the Watergate break-in; Nicholas Roeg’s 1980 Bad Timing, a nongeneric film about sensual obsession; and Woody Allen’s 1993 comedy of manners, Manhattan Murder Mystery.Whether focusing on the investigation of a crime, the unraveling of a puzzle, or the solution of a mystery, detection narratives exhibit what Frank Kermode calls “a specialized ‘hermeneutic’ organization.” 2 As such, they call for a particular sort of investigation: namely, a hermeneutical one. Often we think about hermeneutical investigations as [End Page 123] interpretations and assume that the proper object of such interpretations is a text. Thinking primarily about literary texts, David Novitz argues that the function of such explanations is to “solve certain puzzles, answer certain questions, dispel confusions, or eliminate doubts about... the theme of a work or its plot, [or] about the actions, motives, or machinations of fictional characters....” 3Of course, interpretation is not restricted to literary texts, nor to answering specific questions about such matters as theme or plot or character motivation, nor does Novitz suggest it is. But when the object of interpretation is a text—literary, cinematic, legal, or other—it is arguable that interpretation is not restricted to those localized aspects of the text which we take to be puzzling. Novitz’s position is that interpretation only occurs when one confronts a specific puzzle or problem. What we understand directly is not, on this account, interpreted; interpretation is required only where we do not understand. The consideration of detection narratives suggests that understanding and interpretation are more closely related than Novitz seems to allow.In our attempts to make sense of the course of action of any detection narrative, there is always the question whether we have understood a given situation, event, action or statement correctly. It is always a question whether we have correctly distinguished between clues and red herrings. Detection narratives operate on the basis of a continual questioning—both for the detective and for the reader or viewer—as to whether we do, in fact, understand what is happening.This questioning attitude is keyed to the uncertainty as to whether we have correctly recognized what information is salient, which characters’ testimony is trustworthy. At various moments in any detection narrative, the detective (or reader/viewer) will have reason to question the reliability of their own assessment of what is going on. There is the risk of being mistaken, but also the risk of being deceived. So the appropriate attitude to detection narratives is an interpretive one, an attitude that asks questions about what is presented.Of course, particular questions cannot even be sensibly asked in the absence of a larger interpretive framework which gives the particular question its point. Not only the detective, but the reader or viewer, is well advised to contextualize any particular event or action as a (potential) part of what we call, adapting a notion of David Carr’s, an action of large... (shrink)

The "public sphere" -- an idea with deep roots in the European enlightenment -- has always been a contested concept in American culture and society. American intellectuals, artists, politicians, and activists have stressed the non-unitary, diversified, and oppositional dynamics of all things public. From the early days of the American republic, competing interest groups and commercial mass media (first newspapers, novels, and the theater, then radio, television, and the internet) have worked to pluralize public speech and public action -- and (...) ultimately the notion of "publicness" itself. This essay collection explores the public sphere in North America as a multi-agential, commercially embattled, highly mediated, and ultimately trans-nationalized aggregate of publics and counterpublics. The contributors present innovative theoretical and historical assessments of American counter/publics across an array of fields including social activism, political communication, literary discourse, and contemporary mass media. (shrink)

In a world where economies have no moral conscience, biblical theologians can challenge local cultures with ancient wisdom about generosity and equity. Systemic solutions require changes in the habits of virtue, and this study focuses on the habit of generosity. Building on the work of Stephan Joubert’s Paul as Benefactor, this study concentrates on Paul’s collection in one notable instance: what he says about generosity in 2 Corinthians 8-9 and, in particular, what he means by isotēs in 2 Cor 8:13–15. (...) Does it mean “equality” or “equity”? Beginning with a reinvigorated interest in the economic vision of the apostle Paul about what is meant by “weak” and “good works” and what the Pastoral Epistles communicate with eusebeia (not “godliness” but “social respectability and civility”), we reconsider the collection as an act on the part of the Pauline mission churches to express more than ecclesial unity. This act embodied a theology of grace in mutual reciprocity and in equitable provision on the part of the wealthy for the poor, not least and not limited to those in their own Christian assemblies. The term isotēs is too easily glossed over when translated as “fair balance”, “fairness”, and so the translation of the term with “equity” or “equality” comes closest to the vision of the apostle. Too few studies on this term baptize it sufficiently in the economics of the ancient world and the early Christian radical vision of siblingship and family. Contribution: From the perspective of the Historical Thought and Source Interpretation of the work of Paul, the question of systemic equality or equity is as crucial to navigating the current economic climate as it has ever been. Equality or equity is not limited to Christian communities but following the early church in embodying a theology of grace. (shrink)

The use of the term "experience" is rarely explained in sufficient detail to allow researchers to fully appreciate the complexity of the experience-performance relationship. The findings research in this area are difficult to interpret and often lead to unwarranted or exaggerated claims. The interpretation of the results is made difficult from problems stemming from a poorly defined and measured construct and an inadequate conceptualization of the relationship of experience to several specific dependent variables. Additionally, exposure is often misconstrued as experience. (...) This paper aims to develop a conceptual framework of experience that will be helpful in promoting consistency in the use of the term by researchers, theorists, and professionals and that will facilitate understanding of what are now confusing findings concerning the effects of experience. (shrink)

The prevention, treatment and management of disease are closely linked to how the causes of a particular disease are explained. For multi-factorial conditions, the causal explanations are inevitably complex and competing models may exist to explain the same condition. Selecting one particular causal explanation over another will carry practical and ethical consequences that are acutely relevant for health policy. In this paper our focus is two-fold; the different models of causal explanation that are put forward within current scientific literature for (...) the high and rising prevalence of the common complex conditions of coronary artery disease and type 2 diabetes mellitus ; and how these explanations are taken up within national health policy guidelines. We examine the causal explanations for these two conditions through a systematic database search of current scientific literature. By identifying different causal explanations we propose a three-tier taxonomy of the most prominent models of explanations: evolutionary, lifecourse, and lifestyle and environment. We elaborate this taxonomy with a micro-level thematic analysis to illustrate how some explanations are semantically and rhetorically foregrounded over others. We then investigate the uptake of the scientific causal explanations in health policy documents with regard to the prevention and management recommendations of current National Service Frameworks for CAD and T2D. Our findings indicate a lack of congruence between the complexity and frequent overlap of causal explanations evident in the scientific literature and the predominant focus on lifestyle recommendations found in the mainstream health policy documents. (shrink)

Handlungen, mit denen wir mehr Gutes tun, als unsere Pflicht ist, heißen in der Ethik supererogatorisch. Die Autorin steckt einen Rahmen für Theorien der Supererogation ab. In jenem Rahmen dokumentiert sie die Geschichte dieses Begriffes und würdigt aktuelle Theorien - um deren Beschränkungen zu überwinden. Auch wenn wir über das Gebotene hinausgehen, so ihre These, können wir fehlen; wir können uns neue Pflichten einhandeln.

Formalizing shared ethical standards is an activity of scientific societies designed to achieve a collective goal of promoting ethical conduct. A scientist who is faced with the choice of becoming a “whistleblower” by exposing misconduct does so in the context of these ethical standards. Examination of ethics policies of scientific societies which are members of the Council of Scientific Society Presidents (CSSP) shows a breadth of purpose and scope in these policies. Among the CSSP member societies, some ethics policies chiefly (...) present the ethical culture of the community in an educational context and do not have enforcement procedures. Other policies are more comprehensive and include standards for certification, procedures for addressing ethical issues, and established sanctions. Of the 36 member societies of CSSP that have developed a code or adopted a code of another professional society, 18 specifically identified a responsibility to expose ethical misconduct, demonstrating an acknowledgment of the possible critical role of the whistleblower in addressing ethical issues. Scientific societies may revise their ethics codes based upon experience gained in addressing cases of ethical misconduct. In most cases, the action of a whistleblower is the initial step in addressing an ethics violation; the whistleblower may either be in the position of an observer or a victim, such as in the case of someone who discovers that his or her own work has been plagiarized. The ethics committee of a scientific society is one of several possible outlets through which the whistleblower can voice a complaint or concern. Ethical violations can include falsification, fabrication, plagiarism and other authorship disputes, conflict of interest and other serious violations. Commonly, some of these violations may involve publication in the scientific literature. Thus addressing ethical issues may be intertwined with a scientific society’s role in the dissemination of new scientific results. For a journal published by a scientific society, the editor can refer at some point to the ethics committee of the society. Whereas, in the case of a journal published by a commercial publisher, the editor may be without direct support of the associated scientific community in handling the case. The association of a journal with a scientific society may thus direct a whistleblower towards addressing the issue within the scientific community rather than involving the press or talking to colleagues who may gossip. A formal procedure for handling ethics cases may also discourage false accusers. Another advantage of handling complaints through ethics committees is that decisions to contact home institutions or funding agencies can be made by the ethics committee and are not the responsibility of the whistleblower or the editor of the journal. The general assessment is that the establishment of ethics policies, especially policies covering publication in society journals, will promote a culture supportive of whistleblowers and discouraging to false accusers. (shrink)

Today, coolness is a term most often used in advertising trendy commodities, or, more generally, in promoting urban lifestyles. The Cultural Career of Coolness explores the history of the term as a metaphor for affect control and aesthetic detachment, charts various cultural p...