Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

This article reports the findings of a qualitative study that explored the organizational influences on moral distress for health professionals working in pediatric intensive care units across Canada. Participants were recruited to the study from PICUs across Canada. The PICU is a high-tech, fast-paced, high-pressure environment where caregivers frequently face conflict and ethical tension in the care of critically ill children. A number of themes including relationships with management, organizational structure and processes, workload and resources, and team dynamics were identified. (...) This study provides a rare and important multi-disciplinary perspective on this topic and the findings have implications for administrators and leaders who seek to improve the moral climate of healthcare delivery. (shrink)

Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue (...) that ‘disease’ should be considered a vague concept with a non-classical structure. On this view, overdiagnosed cases are ‘borderline’ cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a pre ́cising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)

A substantial portion of the developed world's population is increasingly dependent on machines to make their way in the everyday world. For certain privileged groups, computers, cell phones, PDAs, Blackberries, and IPODs, all permitting the faster processing of information, are commonplace. In these populations, even exercise can be automated as persons try to achieve good physical fitness by riding stationary bikes, running on treadmills, and working out on cross-trainers that send information about performance and heart rate.

An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve (...) ‘mismatches’ between one’s beliefs about one’s health status on the one hand, and bodily sensations or past experience on the other. Patients’ attempts to integrate these diagnoses into their self-narratives often involve either forming inaccurate beliefs about bodily sensations and/or past experience, or coming to believe that feelings and experience do not necessarily track or predict health status, leading to an ongoing sense of vulnerability to ill health. These resulting alterations in self-understanding can sometimes be considered harmful, in view of their implications for ascriptions of responsibility and ongoing anxiety. (shrink)

Although health and disease occupy opposite ends of a spectrum, distinguishing between them can be difficult. This is the “line-drawing” problem. The papers in this special issue engage with this challenge of delineating the boundaries of disease. The authors explore different views as to where the boundary between disease and nondisease lies, and related questions, such as how we can identify, or decide, what counts as a disease and what does not; the nature of the boundary between the two categories; (...) and what sorts of considerations could justify the location of that boundary. In exploring these questions, the papers draw on detailed clinical examples, provide theoretical critiques of existing approaches to disease definition, and offer new ways to conceptualize key features in debates about disease, including harm and biological dysfunction. (shrink)

Nursing faces an uncertain future as technological developments, structural changes within health systems and rapidly evolving health needs create new and challenging possibilities. This article draws on the results of a qualitative study undertaken with a range of Queensland nurse leaders to explore their perceptions of these changes. The study re‐surfaced, and allows for a re‐examination of, four issues that have long created tension within nursing and which continue to have a negative impact on the profession as a whole. These (...) are as follows: professionalisation; preparation of graduates; myths and narratives of nursing; and leadership. We provide a metaphor that imagines all of these tensions operating in dynamic interplay. The image is that of a Newton's Cradle – a model for energy and momentum. The metaphor allows one to see the wide context of changes affecting nursing and the significance of the interconnections. If tensions within nursing maintain their own integrity through containment, understanding and development, they remain in alignment, and energy is conserved rather than wasted or misdirected. It suggests that with increased awareness and attention paid to internal challenges, and by taking a broad‐based approach to systemic improvements, nursing could become more effective, progressive and proactive in shaping its own future. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 39.1 (2006) 45-71 [Access article in PDF] Presencing "Communion" in Chaïm Perelman's New Rhetoric Richard Graff Wendy Winn Department of RhetoricUniversity of MinnesotaOver the second half of his long and distinguished career, Chaïm Perelman reiterated the central themes of his theory of rhetoric many times. As the audience for his work expanded, Perelman was repeatedly invited to summarize the principles presented in La nouvelle rhétorique, (...) his magnum opus authored in collaboration with Lucie Olbrechts-Tyteca, which appeared in 1958. On these occasions, he would often attempt to clarify or refine the major concepts presented in that treatise. Nevertheless, even today many aspects of Perelman's work remain enigmatic. In outline, The New Rhetoric itself conveys a sense of structural and theoretical clarity, but for many readers this first impression evaporates when they confront the complexity and detail of the work's exposition. In the preface to their new study of Perelman, Alan Gross and Ray Dearin observe:The New Rhetoric is difficult to read, a task made even more difficult for American audiences because virtually all its examples and illustrations are from a literature in a foreign language.... Moreover, Perelman's later attempts to achieve clarity, in The Realm of Rhetoric, and numerous shorter articles, are equally puzzling. Consequently, some of Perelman's best ideas are virtually buried in a very long work, and therefore largely lost even to the most careful readers. In addition, on such central issues as the relationship between rhetoric and philosophy Perelman remains maddeningly obscure. (2003, ix) While Perelman's status as a pioneering figure in the rejuvenation of rhetorical study in Continental Europe is secure, as is his placement among the canonical twentieth-century theorists by American scholars, such difficulties constitute an impediment to contemporary understanding and future appreciation of his achievement; and the sprawling character of The New Rhetoric certainly has not helped to counteract the less [End Page 45] sympathetic reception his work has received in some corners of rhetorical and argumentation studies.1Gross and Dearin's volume joins several other recent studies that have contributed to the untangling of Perelman's thought and to the profitable application of his ideas.2 Still, some of Perelman's "best ideas" remain buried and sorely in need of excavation. Chief among these are considerations prompted by Perelman's use of the evocative yet mysterious term "communion." Although communion appears repeatedly among the panoply of concepts and argumentative techniques described in The New Rhetoric, explicit discussion of it there is brief and scattered, and the subject receives only glancing mention in Perelman's subsequent publications. In turn, communion has been all but ignored in the scholarship responding to or extending Perelman's work.3 This is even the case in studies where one would expect to see more serious engagement with Perelman's ideas on the subject—notably, in those that consider the status of values in argumentation and the role of rhetoric in the constitution and maintenance of community.4In this essay, we offer a detailed analysis of Perelman's conception of communion and, in the course of endowing the concept with greater "presence," aim to show its rich implications for these areas of inquiry. We argue that the idea of communion is a vital, if understated, component of Perelman's proposed "new rhetoric." Like other aspects of Perelman's theory, however, it is an expansive and somewhat slippery notion. In The New Rhetoric, communion is used in a very general sense as the term denoting a community's agreement on questions of value, but also, more narrowly, as an objective sought in certain forms of discourse and as an effect of specific linguistic-stylistic devices. The exegesis needed to indicate the subtle links between these senses will enable us to describe the manner in which Perelman endeavored to integrate the technical lore inherited from the classical tradition of rhetoric with a broadly social and determinedly pluralisticconception of argumentation.We begin by examining communion in relation to Perelman and Olbrechts-Tyteca's ideas... (shrink)

Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence-based medicine (EBM) methods within surgical research and among practitioners has been slow compared with other areas of medicine. Although this is often viewed as arising from practical and cultural barriers, it also reflects a lack of epistemic fit between EBM research methods and surgical practice. In this paper we discuss some epistemic challenges in surgery relating to this lack (...) of fit, and investigate how resources from feminist epistemology can help to characterize them. We point to ways in which these epistemic challenges may be addressed by gathering and disseminating evidence about what works in surgery using methods that are contextual, pluralistic, and sensitive to hierarchies. (shrink)

Our social role/biosocial theory provides a more adequate account of aggression sex differences than does Archer's sexual selection theory. In our theory, these sex differences arise flexibly from sociocultural and ecological forces in interaction with humans' biology, as defined by female and male physical attributes and reproductive activities. Our comments elaborate our theory's explanations for the varied phenomena that Archer presents.

While Sarah Hoagland's conception of a lesbian ethic offers a promising route toward articulating an ethics of resistance, her notion of self in community does not provide a conception of "subject" capable of both embracing political action as fundamental to personal life and explicitly recognizing cultural, ethnic, and sexual multiplicity as central to ethical decision-making. Such a notion can be found, however, in the remarks of later Wittgenstein concerning the "language games" of describing.

The aim of the following paper is, firstly, to provide the reader with a brief exposition of the critical response offered by some current french feminists of the largely American, compensatory approach to feminist historiography. Secondly, I wish to show why the french feminist alternative itself provides an inadequate methodology for the resolution of the problems that it raises in its critique. Lastly, I shall suggest that the Wittgensteinian concept of ‘family resemblance’ contains the seeds of a plausible alternative to (...) either the compensatory or the french structuralist approach to feminist historiography. The upshot of this latter claim is that the historical subject may be most fruitfully conceived genealogically, that is, as the dynamic product of an inexhaustible complex of historical and contextual resemblances constructed on the behalf of a specific interpretational task. (shrink)

Tolerance is generally regarded as an unqualified achievement of the modern West. Emerging in early modern Europe to defuse violent religious conflict and reduce persecution, tolerance today is hailed as a key to decreasing conflict across a wide range of other dividing lines-- cultural, racial, ethnic, and sexual. But, as political theorist Wendy Brown argues in Regulating Aversion, tolerance also has dark and troubling undercurrents. Dislike, disapproval, and regulation lurk at the heart of tolerance. To tolerate is not to (...) affirm but to conditionally allow what is unwanted or deviant. And, although presented as an alternative to violence, tolerance can play a part in justifying violence--dramatically so in the war in Iraq and the War on Terror. Wielded, especially since 9/11, as a way of distinguishing a civilized West from a barbaric Islam, tolerance is paradoxically underwriting Western imperialism. Brown's analysis of the history and contemporary life of tolerance reveals it in a startlingly unfamiliar guise. Heavy with norms and consolidating the dominance of the powerful, tolerance sustains the abjection of the tolerated and equates the intolerant with the barbaric. Examining the operation of tolerance in contexts as different as the War on Terror, campaigns for gay rights, and the Los Angeles Museum of Tolerance, Brown traces the operation of tolerance in contemporary struggles over identity, citizenship, and civilization. (shrink)

Understanding Computers and Cognition presents an important and controversial new approach to understanding what computers do and how their functioning is related to human language, thought, and action. While it is a book about computers, Understanding Computers and Cognition goes beyond the specific issues of what computers can or can't do. It is a broad-ranging discussion exploring the background of understanding in which the discourse about computers and technology takes place. Understanding Computers and Cognition is written for a wide audience, (...) not just those professionals involved in computer design or artificial intelligence. It represents an important contribution to the ongoing discussion about what it means to be a machine, and what it means to be human. Book jacket. (shrink)

Lloyd (2009) contends that climate models are confirmed by various instances of fit between their output and observational data. The present paper argues that what these instances of fit might confirm are not climate models themselves, but rather hypotheses about the adequacy of climate models for particular purposes. This required shift in thinking—from confirming climate models to confirming their adequacy-for-purpose—may sound trivial, but it is shown to complicate the evaluation of climate models considerably, both in principle and in practice.

'Is politics gendered? Wendy Brown things so, and argues for this point with elegance, imagination and pungent phrases. Brown's book is challenging, provocative and...original; it does force us to question the degree to which gender controls our politics.'-THE REVIEW OF POLITICS.

Wendy Donner contends here that recent commentators on John Stuart Mill's thought have focused on his notions of right and obligation and have not paid as much attention to his notion of the good. Mill, she maintains, rejects the quantitative hedonism of Bentham's philosophy in favor of an expanded qualitative version. In this book she provides an account of his complex views of the good and the ways in which these views unify his moral and political thought.

In Sleeping with Extra-Terrestrials , Wendy Kaminer argues that we are a society intoxicated by the irrational: religion, spirituality, and popular therapies threaten to replace rational thought with supernaturalism and impassioned but unexamined personal testimony. Ranging from our fascination with angels, aliens, and near- death experiences to the rise of junk science, the recovery movement, and the digital culture, Kaminer points out the amusing and ominous effects of our deference to spiritual authorities and resistance to critical thinking. She questions (...) conventional wisdom about the association of religious belief with virtue, identifying the sectarianism of efforts to establish religion in the public square. With both wit and empathy, Kaminer takes on what many people hold sacred. Kaminer is an eloquent and incisive critic and rationalist living in a superstitious, evangelical age. In Sleeping with Extra-Terrestrials she challenges us to exercise skepticism, reason, and irreverence and to appreciate the pleasures of free inquiry. (shrink)

DIVA reader aimed at revitalizing left legal and political critique./div.

Increasingly there are calls for climate services to be “co-produced” with users, taking into account not only the basic information needs of users but also their value systems and decision contexts. What does this mean in practice? One way that user values can be incorporated into climate services is in the management of inductive risk. This involves understanding which errors in climate service products would have particularly negative consequences from the users’ perspective (e.g., underestimating rather than overestimating the change in (...) an impact variable) and then prioritizing the avoidance of those errors. This essay shows how inductive risk could be managed in climate services in ways that serve user values and argues that there are both ethical and practical reasons in favor of doing so. (shrink)

The Supreme Court ended its last term by making unconstitutional a choice Brown v. Board of Education once required - the voluntary, and race conscious, pursuit of integration - to little public outcry. As a society, we continue to find comfort in segregation. This Article argues that this acceptance is wrong, both educationally and constitutionally. It does so through the lens of teacher segregation, a topic all but ignored in the current literature. The first step of this argument is demonstrating, (...) by an original empirical study, the segregation of teachers, thereby proving a more profound school segregation than is generally recognized. The second step establishes, through an extensive review of the existing social science literature, that the typical minority student benefits from integration because it ensures a fundamental resource - experienced teachers. Lastly, the inherent inequality of segregation should have constitutional implications. While the Rehnquist Court utilized an interest balancing approach to the Equal Protection clause and recognized the constitutional harms of segregation, the Roberts Court has begun to minimize the Equal Protection to concern only capitalizing individual treatment and has erred in creating a "constitutional chill" toward the value of integration. (shrink)