This study aimed to explore the enabling context of the HIV care continuum as perceived by people living with HIV and healthcare professionals. This qualitative study involved in‐depth individual interviews with eight people living with HIV and group interviews with seven nurses and physicians. These interviews took place between March 5, 2021, and July 13, 2022. Thematic analysis was conducted. The main themes that emerged included “network of support and systems,” “personal gains from the care continuum,” (...) “continuity and practicality of healthcare services,” “presence of significant other(s),” and “social belonging.” These themes were structured within the five levels of the socio‐ecological model (system, individual, organizational, interpersonal, and community levels), and 10 subthemes were identified. With the integration of themes, the enabling context was compared to a “care orbit,” indicating that people diagnosed with HIV start treatment at the system level and continue HIV care at other levels. In addition to primary support at the system level, the enabling context also includes individual commitment to care and regular health habits, hospital services, support from significant others, and community culture. Together, the context helps guide people living with HIV into the “orbit” of the care system. (shrink)

The purpose of this research was to explore the concept of collaboration within a specific healthcare context and to include the perspectives of healthcare users, a position largely lacking in previous studies. In applying a critical theoretical approach, the focus was on, as an exemplar, mothers with newborn babies who had spent more than 48 hr in a special care nursery. Semistructured interviews were undertaken with child health nurses, midwives and mothers. The three key theoretical findings on collaboration generated (...) in the study point to layers of meanings around identity, knowledge and institutions of care. Findings from the interview data analysis were further examined through the lens of key policy documents. The research outcomes indicate that the concept of collaboration serves an important function in healthcare in obscuring the complexities and ambiguities that characterise the care continuum. The study concludes the need for a more critical approach to the assumptions that underlie the language of collaboration and the implications for practice in healthcare. (shrink)

The practice around informed consent in clinical medicine is both inconsistent and inadequate. Indeed, in busy, contemporary health care settings, getting informed consent looks little like the formal process developed over the past sixty years and presented in medical textbooks, journal articles, and academic lectures. In this article, members of the Society of Teachers of Family Medicine (STFM) Collaborative on Ethics and Humanities review the conventional process of informed consent and its limitations, explore complementary and alternative approaches to doctor‐patient (...) interactions, and propose a new model of consent that integrates these approaches with each other and with clinical practice. The model assigns medical interventions to a consent continuum defined by the discrete categories of traditional informed consent, assent, and nondissent. Narrative descriptions and clinical exemplars are offered for each category. The authors invite colleagues from other disciplines and from the academic ethics community to provide feedback and commentary. (shrink)

Self‐care, or self‐management, is presented in healthcare policy as a precursor to patient empowerment and improved patient outcomes. Alternatively, critiques of the self‐care agenda suggest that it represents an over‐reliance on individual autonomy and responsibility, without adequate support, whereby ‘self‐care’ is potentially unachievable and becomes ‘care left undone’. In this sense, self‐care contributes to a blame culture where ill‐health is attributed to personal behaviours or lack thereof. Furthermore, self‐care may represent a covert form of (...) rationing, as the fiscal means to enable effective self‐care and supplement, or replace, self‐care capacities, is not provided. This paper explores these arguments through a contemporary ethical analysis of the self‐care agenda. The terms self‐care and self‐management are used interchangeably throughout whereby self‐management is understood as a point in the wider self‐care continuum. (shrink)

The expressions ‘high quality care’ and ‘low quality care’ are cognitive and linguistic artefacts that help to structure people’s lives and thinking; for example, moves are now afoot internationally to pay bonuses to health professionals for delivering high quality care. United States programmes, most conspicuously, are assuming that high quality care can be validly distinguished from low quality care, and incentivised through bonuses. This distinction is always at least implicit, for high quality care has (...) no meaning without low quality care. Through a ‘deconstructionist reading,’ this article discusses limitations of categorising the quality of care as either high or low. The limitations of this ‘binary opposition’ can include a lack of defining attributes; vagueness and fuzziness at the ‘boundaries’ between high quality care and low quality care; concealment of quality as a continuum; and use of the binary opposition to effect social order and control. Health policy implications of our analysis are discussed. Drawing upon the general medical services contract in the United Kingdom, we suggest an approach to overcoming the oversimplification and imprecision that categorisation tends to produce. (shrink)

The article presents two gestures corresponding to two profound new understandings of Peirce's Continuum and Peirce's Existential Graphs. Vargas and Oostra have revolutionized Peirce's mathematical studies, thanks to a first complete model for Peirce's continuum provided by Vargas, and thanks to the emergence of intuitionistic existential graphs provided by Oostra. The article aims at showing how these careful mathematical constructions can be encrypted in very simple gestures.

Photo by Hannah Busing on Unsplash INTRODUCTION Religion has long provided guidance that has led to standards reflected in some aspects of medical practices and traditions. The recent bioethical literature addresses numerous new problems posed by advancing medical technology and demonstrates an erosion of standards rooted in religion and long widely accepted as almost axiomatic. In the deep soul-searching that pervades the publications on bioethics, several disturbing and dangerous trends neglect some basic lessons of philosophy, logic, and history. The bioethics (...) discourse on medical aid in dying emphasizes similarity over previously recognized important distinguishing features. For example, it overplays a likeness between assistance in dying and the withdrawal of life-saving technology. In many bioethics’ topics, arguments based on a logical continuum are used to question the lines demarcating important moral differences. l. The Line Between Ethical and Not: Logic Based on Continuum Careful case selection, often either end of a continuum, allows the tearing down or ridiculing of many rules and codes across most professions and fields of interest. This situation holds true for traffic laws as well as medical ethics guidelines. It is relatively simple for those who desire to attack a particular viewpoint by selecting a case that makes that position seem untenable. In the ethics realm, good and bad medicine exist at opposite ends of an ethical continuum, with many practices lying in between. For example, much of medical ethics exists between the Nazi criminal physicians and the most sainted nurse or physician. A gradual progression occurred over less than two decades from a utilitarian position that supported limited euthanasia for those with certain mental illnesses to genocide. German society embraced a utilitarian ethic in which the value of human life no longer was intrinsic but instrumental.[1] Many morally significant points on a continuum were then ignored as the misguided utilitarian policy rampantly continued. A point in the continuum to distinguish between ethically justifiable and that which is not can be difficult to identify compared to the two extremes. This continuum is not unique to ethics but can be applied to almost any other aspect of human life and endeavor. Between a severely ill schizophrenic person and a superbly well-adjusted individual, there is a continuum of mental and psychological function. The existence of a continuum should not paralyze thinking and prevent us from drawing lines and identifying moral differences based on objective criteria as well as moral philosophy. Yet, by focusing on a continuum, many bioethicists use logic to disregard dividing lines between an "ethical" and an "unethical" act. Unfortunately, sometimes bioethicists draw revolutionary conclusions that would change the scope of medical practices which is accepted as ethical. There are many examples of similar shifts on the continuum. Many authors argue for the ethical permissibility of abortion by pointing out that the human fetus is no different in various characteristics, one arguing it is as like an ape or chick as it is like a person,[2] and does not achieve unique human and individual characteristics until well into the first year of life.[3] While human fetuses arguably do not have certain distinctive qualities of personhood, most people shy away from the logical next conclusion: permitting infanticide. For example, Joshua Lederberg condemns infanticide, in the face of biological illogic, because of our emotional commitment to infants, to me, a relatively weak explanation. Sir Francis Crick suggests we might consider birth at two days of life in order to decide whether an infant is a "suitable" member of society.[4] Giublini and Minerva suggest that infanticide should be permissible since late pregnancy abortions are permissible, arguing there is no significant difference between a fetus just before birth and an infant just after birth.[5] Clearly the continuum approach would allow for subjective arguments in favor of later infanticide at other points many days post-birth. Years ago, with a cynical tone, I mentioned infanticide as a further step on the continuum beyond abortion, and I was rightly shouted down as being deliberately provocative to assert the logic would ever stretch so far. While it is not an accepted mainstream position, the movement in academic settings from widespread condemnation to limited possible acceptance of infanticide has taken place in an incredibly short time. Public opinion and medical opinion in these areas have shifted dramatically in a short time. In another area, from a biological and chemical point of view, there is a continuum from man down to a single carbon atom. Yet, it would not seem logical to ignore the emotional differences, the meaning of personhood, or the moral distinction between killing an insect and killing a person. ll. A False Continuum: Medical Aid in Dying I assert that there has been an erosion of ethical guidelines in recent years attributable to using continuums to camouflage important distinctions. James Rachels’ work on active and passive euthanasia, which contends that the two are ethically identical, exemplifies that logic.[6] He illustrates this thesis, using a continuum to compare different scenarios with like consequences as morally equivalent, by comparing the deliberate drowning of a child with a deliberate failure to rescue a drowning child when easily able to do so. The author's comparison proposes that since much of the medical profession has already made peace with withholding treatment in order to hasten death, consistency inexorably demands that we permit active euthanasia as well.[7] When permission for active euthanasia was first introduced, it was limited exclusively to patients suffering severely from an intractable, incurable, and irreversible disease. These guidelines have been continuously eroded. There is now a substantial serious consideration for permitting active euthanasia of healthy elderly individuals who feel that they have completed their lives and are "tired of living."[8] There are many moral and factual differences along the ethical continuum. In human life, there is a difference between a live baby and a fetus, between a viable fetus and one that is not, between a fetus and a zygote, and between a zygote and a sperm cell. Similarly, there is a difference between pulling a trigger to kill someone and not interfering in preventing his death, which is reprehensible though both may be. There is a difference between not resuscitating an 80-year-old man with cancer when his heart stops and injecting him with a fatal dose of potassium chloride. I argue that an overt act of taking life repels civilized human beings is to be commended and encouraged as the reverence for human life or even for just a moment of human life is one of the great contributions of our civilization. CONCLUSION As an orthodox Jew, I feel that divinely inspired guidelines that have stood the test of centuries shape my beliefs, and such guidelines contradict medical aid in dying. I cannot speak to the viewpoint of those who do not access religion in defining their moral stance, nor do I implicate them in the current bioethics' trends, as I am not aware of the personal role of religion in the lives of most such authors. While many nonreligious people have a firm philosophical grounding and oppose medical aid in dying, I suggest that in the absence of any religious or other absolute standards, developing logically defensible ethical guidelines may be challenging. At the least, religion may play a role in defining the points on the continuums that are ethically meaningful and refuting the trending beliefs that if the endpoint is the same, allowing different methods of arriving at that end are somehow ethically equal. The continuum of ways death may result does not negate analysis of whether death is brought about in ways that recognize the importance of life. The German philosopher Hans Jonas said, "It is a question whether without restoring the category of the sacred, the category most thoroughly destroyed by the scientific enlightenment, we can have an ethics able to cope with the extreme powers that we possess today and constantly increase and are compelled to use."[9] While countries vary on the role of religion in policy, with many emphasizing freedoms of religion, a recent position paper released by a group of Jewish, Christian, and Moslem leaders suggested the need for agreement on the unique sanctity of human life.[10] I would recommend that such a document serve as an example of consensus on critical foundational bioethical guidelines for democratic secular societies. - [1] Alexander L Medical science under dictatorship. New England Journal of Medicine, 241, p39-47 DOI10.1056/NEJM194907142410201 [2] Lederberg J. A geneticist looks at contraception and abortion, Annals of Internal Medicine 67, sup 2, 25-27. https:/doi.org/10.7326/0003-4819-67-3-25 [3] Ibid. [4] Editorial, Sociology: Logic of biology. Nature 220, 429 https://www.nature.com/articles/220429b0 [5] Giublini A Minerva F After-birth abortion: why should the baby live. J Med Ethics 39, 261- [6] Rachels J Active and passive euthanasia. New England Journal of Medicine 292, 78-80 [7] Ibid. [8] Cohen-Almagor R Euthanizing people who are "tired of life". in Euthanasia and Assisted Suicide-Lessons from Belgium. Ch 11 of Euthanasia and Assisted Suicide, Cambridge University Press pp173-187. 2017 and DOI; https://doi.org/10.1017/9781108182799.012 [9] Hans Jonas, Technology and Responsibility: Reflections on the New Tasks of Ethics, 1972, found as Chapter IX, Philosophical Essays, 1980. https://inters.org/jonas-technology-responsability [10] A position paper of the Abrahamic Monotheistic religions on matters concerning the end-of-life. Vatican Press 28 October 2019 https://press.vatican.va/content/salastampa/en/bollettino/pubblico/2019/10/28/191028f.html. (shrink)

Pediatric palliative care is specialized medical care for children who live with serious and life-limiting illnesses, with the central goal to improve quality of life for both children and their families. Presently, a majority of pediatric palliative care referrals are based on the traditional consultative model, in which primary providers serve as the gatekeepers to palliative care access. It is well-known that racial and ethnic healthcare disparities exist across the continuum of care, fraught with (...) healthcare providers’ biases that impact the care delivered. This includes the referral practices, allocation and utilization of palliative care services, and leaving vulnerable children and families with potentially unmet palliative care needs. We make the moral argument that the establishment of standard referral criteria for pediatric palliative care services is one simple step that must be taken to begin to address and hopefully ameliorate the impact of providers’ biases and disparities that exist within pediatric palliative care. (shrink)

This chapter suggests that the state of nature is a continuum notion that lies in a segment along a larger continuum of the scope of private judgment, as does the continuum notion of civil authority. Jean Hampton saw Thomas Hobbes's state of nature as a “presocietal” condition of “isolated asocial individuals,” “stripped of their social connections.” There is plentiful evidence against Hampton's interpretation of the state of nature as an “asocial” condition in Hobbes's insistence across all his (...) political writings that men care deeply about their relative social standing and reputations, and that this is a major source of conflict in a state of nature. A potentially more promising way of understanding the state of nature is as a lawless condition. Societies exhibiting a high degree of consensus among private judgments may be able to tolerate incomplete removal from the mere state of nature, without threat to their stability. (shrink)

The paediatric intensive care unit (PICU) is a high-stress environment for parents, families and health care professionals (HCPs) alike. Family members experiencing stress or grief related to the admission of their sick child may at times exhibit challenging behaviours; these exist on a continuum from those that are anticipated in context, through to unacceptable aggression. Rare, extreme behaviours include threats, verbal or even physical abuse. Both extreme and recurrent ‘subthreshold’ behaviours can cause significant staff distress, impede optimal (...) clinical care and compromise patient outcomes. The unique PICU environment and model of care may magnify stressors for both families and staff and the family-centred approach to care (FCC) central to paediatric practice, may also contribute to contextual challenges. Pervasive conflict in paediatric healthcare is harmful for patients, families, PICU staff and the institution more broadly. We propose that caring for children and caring for staff are inseparable goals and the latter has been inadvertently but detrimentally deprioritised as FCC has become a primary focus. A transparent and graded hierarchy of responses to variable levels of challenging behaviour is necessary to ensure that families are supported, while HCPs remain protected in the workplace. This requires establishing firm limits supported by all teams and levels of the institution. As such, we aim to identify and clarify the context and impact of challenging parent and family behaviour in the PICU and to offer potential, proactive mitigation strategies, based on reflections and stakeholder discussion following recent clinical challenges and experiences in our unit. (shrink)

IntroductionFew studies have examined psychological distress in healthcare workers across the care continuum. This study describes distress levels reported by HCWs across care settings and factors associated with distress.MethodsA cross-sectional survey of HCWs from Windsor, Ontario, was conducted between May 30th, 2020, and June 30th, 2020. The survey included the Kessler Psychological Distress Scale, sociodemographic, frontline status, perceptions of training, protection, support, respect among teams, and professional and personal stressors. Univariate analyses were used to compare across settings (...) and multivariate logistic regression assessed factors associated with distress.ResultsFour hundred and three HCWs from the hospital, community health and social service, first responder, primary care, home, and long-term care participated in the survey. Common concerns included fear of transmitting COVID-19 to family, safety on the job, and balancing personal care with work demands. LTC and home-care HCWs reported greater concern about workload and staffing levels, whereas community health workers were more anxious about their financial security. Overall, 228 HCWs who completed the K10 reported high distress, with greater rates among hospital and LTC HCWs. Distress was more likely in HCWs who identified as female, younger than 55, perceived lower respect among team, and experienced greater worry about physical and mental health and managing high workloads.ConclusionResults showed a high degree of distress experienced by HCWs across care settings and the impact of the COVID-19 pandemic on personal and work-related stress. Promoting self-care and supportive and collaborative healthcare teams are promising avenues for mitigating symptoms of distress. (shrink)

This article aims to explore the relations between equality of opportunity and early childhood. By referring to the work of contemporary philosophers, i.e. Rawls, Sen, Dworkin, Cohen and Roemer, we argue for different possible interpretations, based on political discussions, concerning how to operationalize equality of opportunities. We represent these diverging options on a continuum, ranging from Responsibility-oriented Equality of Opportunity and Circumstances-oriented Equality of Opportunity. We then analyse how early childhood care and education policies can be constructed in (...) relation to these conceptualisations and argue that the CEOp is a more plausible interpretative framework to operationalize equality of opportunity in early childhood. (shrink)

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their (...) understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy. (shrink)

The question of how to improve the quality of nursing care is quite properly perceived to be at the heart of the contemporary nursing debate. Yet it is not clear what quality in health care is; nor is it clear what quality nursing care is. This article will explore why quality issues are such a matter of concern in public and political debate and how different concepts of quality determine different definitions of nursing. The former definitions constitute (...) a developmental continuum of nursing from minimally acceptable levels of competence to excellence. It is argued that the quality of nursing cannot be assessed in terms of performance referenced criteria, but only in terms of the personal qualities displayed in the performance. The key to improvement in practice may be the improvement of emotional and motivational tendencies. In essence, professional development implies personal development. (shrink)

Objectives: The present study questioned the moral orientation between males and females. It was hypothesized that males will score high on justice and social exchange, whilst females high on care and kin reciprocity. High scores on justice and care were found in a respective continuum with social exchange and kin reciprocity.Design: A between-participant independent t-test design of differences was carried out to search for the moral orientation of males and females. The dependent variable (DV) was the scores (...) participants rated on justice and social exchange, and care and kin reciprocity, whilst sex was the independent variable (IV).Method: Three moral vignettes were given to participants followed by questions/state-ments (Appendix C). Participants were asked to respond to those vignettes by using a Likert Scale scoring system rated 1 to 5.Results: The results have shown that males score high on justice and social exchange, whereas females high on care and kin reciprocity. Through the t-test were found significant differences between the sexes on moral reasoning orientations, and the hypothesis was supported.Conclusions: It was concluded that males demonstrate a just moral reasoning, whereas females a caring moral orientation. The continuum between justice and care with social exchange and kin reciprocity portrayed interpersonal relations in view to group dynamics as well as a maintenance of balance through cooperation. (shrink)

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. Macro-duties of (...) this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally.In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values—liberty and equity—can be evaluated and assessed. (shrink)

Alcohol use has been recognized as a challenge in eldercare and social care, and some anticipate that problems related to alcohol use will increase in the future as the current adult generation has high alcohol consumption rates. Accordingly, it is suggested that care workers are at risk of becoming passive bystanders to the destructive lifestyles of vulnerable older adults and even facilitating these lifestyles. In the present paper, we suggest that alcohol exacerbates and underscores inherent difficulties in eldercare, (...) such as finding an appropriate balance between the personal freedom of the older adult and the responsibility of the care worker to provide care. The specific focus in the paper regard the communication and interaction involving values between people in eldercare in cases of problematic alcohol‐related situations to uncover the difficulties. We found it noteworthy that the objectives and perspectives of older adults, care workers, managers and relatives have implications regarding their interactions and communications because their varying experiences involve values that are not necessarily aligned. Sometimes, care workers have no choice but to act against what, in the public sphere and to the other care workers, is ruled out by virtue of their professional ethics. It is suggested that care workers describe and judge situations where alcohol is present paradoxically by virtue of their professional ethics, yet regulate their care to preserve the dignity of older adults, even when they find the situation to be an apparent dilemma. (shrink)

Bioartists Oron Catts and Ionat Zurr define many of their tissue-based artworks as semi-living, and use an ethical framework to contextualize their care for these semi-living creations, claiming that their work inspires reflection on our responsibilities toward the continuum of life. There are ways in which Catts and Zurr’s relation to the semi-living does meet the standards of an ethics of care, as defined in particular by political scientist Joan Tronto, but only within certain constraints—namely, the performative (...) and participatory spaces of their installations. When their claims, as they frequently do, extend beyond these circumstances, their statements become mired in contradictions and inconsistencies, even as their work points to an original artistic practice that provokes thought about the nature of the body, of life, and of the living. (shrink)

In this case study, we describe an approach to dealing with a complicated, systemic, and multi-faceted organizational issue: the continuum of maternal care from antepartum care, birthing, to post-natal care.

Families have a right to privacy, but we know little about how the public–private boundary is negotiated at the micro level in educational settings. Adopting ethnomethodology, the paper examines how talk about the home situation was occasioned and managed in ten parent–teacher conferences in early childhood education and care (ECEC), with a special focus on the ECEC teacher’s strategies for eliciting family information. The paper demonstrates a continuum of interactional practices which, in various degrees, make parents accountable for (...) providing family information. The analysis shows that parents both volunteer and provide the pursued information, thus actively orienting to the norm of visibility in child rearing. However, although both parties orient to questioning and fishing as business as usual, the parents’ accounts sometimes had an excusing quality or they adopted a reserved communication style, suggesting a certain ambivalence as well. The paper outlines different ways of understanding the present partnership ideal in parent–teacher teacher cooperation with implications for the negotiation of privacy. The paper also addresses training, which can contribute to staff and student reflections on the management of the public–private boundary. (shrink)

BackgroundSarcomas are a diverse group of neoplasms that vary greatly in clinical presentation and responsiveness to treatment. Given the differences in the sites of involvement, rarity, and treatment modality, a multidisciplinary approach is required. Previous literature suggests patients with sarcoma suffer from poorer quality of life especially physical and functional wellbeing. Adolescent and young adult patients are an underrepresented population in cancer research and have differing factors influencing QoL.MethodsRetrospective analysis of Young Adult patients enrolled in the Sarcoma Tissue Repository at (...) University of Iowa. QoL was assessed using the self-report FACT-G questionnaire at enrollment and 12 months post-diagnosis; overall scores and the 4 wellbeing subscales were calculated. Linear mixed effects models were used to measure the association between the rate of change in FACT-G subscale scores and baseline clinical, comorbidity, and treatment characteristics.Results49 patients were identified. 57.1% of patients had a malignancy involving an extremity. Mean FACT-G scores of overall wellbeing improved from baseline to 12 months. Social and emotional wellbeing did not differ significantly between baseline and 12 months. Physical wellbeing and functional wellbeing scores improved from baseline to 12 months. No difference was seen for FACT-G overall scores for age, sex, laterality, marital status, performance status, having children, clinical stage, limb surgery, chemotherapy, or tumor size. A difference was demonstrated in physical wellbeing scores for patients with baseline limitation compared to those with no baseline limitation. A difference was demonstrated in social wellbeing based on anatomical site.ConclusionYoung adults with sarcoma treated at a tertiary center had improvements in overall reported QoL at 12 months from diagnosis. Overall baseline QoL scores on FACT-G were lower than the general adult population for YA patients with sarcoma but at 12 months became in line with general population norms. The improvements seen merit further investigation to evaluate how these change over the continuum of care. Quality of life changes may be useful outcomes of interest in sarcoma trials. (shrink)

The idea of narrative has been widely discussed in the recent health care literature, including nursing, and has been portrayed as a resource for both clinical work and research studies. However, the use of the term 'narrative' is inconsistent, and various assumptions are made about the nature (and functions) of narrative: narrative as a naive account of events; narrative as the source of 'subjective truth'; narrative as intrinsically fictional; and narrative as a mode of explanation. All these assumptions have (...) left their mark on the nursing literature, and all of them (in our view) are misconceived. Here, we argue that a failure to distinguish between 'narrative' and 'story' is partly responsible for these misconceptions, and we offer an analysis that shows why the distinction between them is essential. In doing so, we borrow the concept of 'narrativity' from literary criticism. Narrativity is something that a text has degrees of, and our proposal is that the elements of narrativity can be 'sorted' roughly into a continuum, at the 'high narrativity' end of which we find 'story'. On our account, 'story' is an interweaving of plot and character, whose organization is designed to elicit a certain emotional response from the reader, while 'narrative' refers to the sequence of events and the (claimed) causal connections between them. We suggest that it is important not to confuse the emotional persuasiveness of the 'story' with the objective accuracy of the 'narrative', and to this end we recommend what might be called 'narrative vigilance'. There is nothing intrinsically authentic, or sacrosanct, or emancipatory, or paradigmatic about narrative itself, even though the recent health care literature has had a marked tendency to romanticize it. (shrink)

An anthropologist describes how he found himself at the vortex of a “clash of medical civilizations:” neoliberalism and the international primary health care movement. His involvement in a $6 million social change initiative in medical education became a basis to unlock the hidden tensions, contradictions and movements within the “primary care” phenomenon. The essay is structured on five ethnographic stories, situated on a continuum from “natural” species-level primary care to “unnatural” neoliberal primary care. Food is (...) an element of all tales. Taking the long view of history/prehistory permits us to better recognize ideological distortions in order to more capably transform medicine. (shrink)

Truly transforming the healthcare delivery and payment system turns on the ability to engage in the interoperable electronic exchange of patient health information across and beyond the care continuum. Achieving transformation requires a legal framework that supports information sharing with appropriate privacy and security protections and a trusted governance structure.

Context: Since 2015, physicians are the only health professionals who have the legal authority to administer medical aid in dying (MAID) in Quebec. A new legislative context is bringing major changes to their end-of-life care practice. Objective: Explore the meaning-making factors that emerge from the experience of physicians administering MAID in order to shed light on what leads them to integrate this practice into their professional continuum. Methodology: Semi-structured interviews were conducted with ten physicians who had performed at (...) least one MAID throughout the territory of the CIUSSS de l’Estrie. Analysis: Conducted using Pierre Paillé’s (1994) grounded theorization, it showed that MAID is a human approach requiring time and social skills, and where life skills are paramount. The results suggest that MAID is located at the boundaries of the physician’s personal and professional identity. In short, what motivates a physician to participate in the MAID process is their narrative identity, including the values and meaning that they give to their experiential journey. Conclusion: MAID is an existential form of care, and the process is experienced differently by each physician; therefore, it is important to respect the meaning and values of each physician, whether or not they incorporate MAID into their medical practice. (shrink)

Some argue that the concept of medical need is inadequate to inform the design of a universal health care system—particularly an institutional rather than a residual system. They argue that the concept contradicts the idea of comprehensiveness; leads to unsustainable expenditures; is too indeterminate for policy; and supports only a prioritarian distribution. I argue that ‘comprehensive’ understood as ‘including the full continuum of care’ and ‘medically necessary’ understood as ‘prioritized by medical criteria’ are not contradictory, and that (...) UHC is a solution to the problem of sustainability, not its cause. Those who criticize ‘medical need’ for indeterminacy are not transparent about the source of their commitment to their standards of determinacy: they promote standards that are higher than is necessary for legitimate policy, ignoring opportunity costs. Furthermore, the indeterminacy of concepts affects all risk-sharing systems and all systems that rely on medical standard of care. I then argue that the concept of need in itself does not imply a minimal sufficientist standard or a prioritarian distribution; neither does the idea of legitimate public policy dictate that public services be minimalist. The policy choice for a system of health care that is comprehensive and offers as good care as can be achieved when delivered on equal terms and conditions for all is a coherent option. (shrink)

The purpose of this study was to assess the presence of ethics committees in rural critical access hospitals across the United States. Several studies have investigated the presence of ethics committees in rural health care facilities. The limitation of these studies is in the definition of ‘rural hospital’ and a regional or state focus. These limitations have created large variations in the study findings. In this nation-wide study we used the criteria of a critical access hospital (CAH), as defined (...) by the Medicare Rural Hospital Flexibility Program (Flex Program, 2007), to bring consistency and clarity to the assessment of the presence of ethics committees in rural hospitals. The Flex Monitoring Team conducted a national telephone survey of 381 CAH administrators throughout the United States. The survey covered a wide variety of questions concerning hospitals’ community benefit, impact activities, and whether the hospital had a formally established an ethics committee. About 230 (60%) of the respondents indicated they had a formally established ethics committee or ethics consultation program at their CAH. The prevalence of ethics committees declined as the CAH location became increasingly rural along a rural–urban continuum. Unlike CAHs, all rural Department of Veterans Affairs Medical Centers have ethics committees. The results of this study provide an understanding of the limited presence of ethics committee in rural America and the need to consider new approaches for providing ethics assistance. A virtual ethics committee network may be the most efficient and effective way of providing rural hospitals access to a knowledgeable ethics committee or consultant. (shrink)

This article discusses the [development and] use of a video life-world schema to explore alternative orientations to the shared health consultation. It is anticipated that this schema can be used by practitioners and consumers alike to understand the dynamics of videoed health consultations, the role of the participants within it and the potential to consciously alter the outcome by altering behaviour during the process of interaction. The study examines health consultation participation and develops an interpretative method of analysis that includes (...) image elicitation (via videos), phenomenology (to identify the components of the analytic framework), narrative (to depict the stories of interactions) and a reflexive mode (to develop shared meaning through a conceptual framework for analysis). The analytic framework is derived from a life-world conception of human mutual shared interaction which is presented here as a novel approach to understanding patient-centred care. The video materials used in this study were derived from consultations in a Walk-in Centre (WiC) in East London. The conceptual framework produced through the process of video analysis is comprised of different combinations of movement, knowledge and emotional conversations that are used to classify objective or engaged WiC health care interactions. The videoed interactions organise along an active or passive, facilitative or directive typical situation continuum illustrating different kinds of textual approaches to practice that are in tension or harmony. The schema demonstrates how practitioners and consumers interact to produce these outcomes and indicates the potential for both consumers and practitioners to be educated to develop practice dynamics that support patient-centred care and impact on health outcomes. (shrink)

This collection of thirty-one cases and commentaries addresses ethical problems commonly encountered by the average health care professional, not just those working on such high-tech specialties as organ transplants or genetic engineering. It deals with familiar issues that are rarely considered in ethics casebooks, including such fundamental matters as informed consent, patient decision-making capacity, the role of the family, and end-of-life decisions. It also provides resources for basic but neglected ethical issues involving placement decisions for elderly or technologically dependent (...) patients, rehabilitation care, confidentiality regarding AIDS, professional responsibility, and organizational and institutional ethics. The authors describe in detail the perspectives of each party to the case, the kind of language that ethicists use to discuss the issues, and the outcome of the case. A short bibliography suggests useful articles for further reading or curriculum development. Easily understood by readers with no prior training in ethics, this book offers guidance on everyday problems from across the broad continuum of care. It will be valuable for health-care professionals, hospital ethics committees, and for students preparing for careers in health-care professions. (shrink)

Supervision is widely acknowledged as influencing the quality of postgraduate theses, and thus, by implication, of postgraduates. Despite this, the literature on conducting research offers little guidance in respect of managing the supervision relationship. This paper opens a window onto the relationship - and particularly the power relationship - between a particular supervisor of postgraduate research, Howard, and his Master's student, Ray. It draws on research that explores how contemporary influences in the university domain intersect with individual agency and with (...) power relations to produce knowledge on two levels: the thesis as an extrinsic product of processes of education, and the person as an intrinsic product of processes of learning.Selections of Michel Foucault's insights are used to explore the notion of power and how it operates through rules of discourse to construct knowledge and identity. Accordingly, the research describes and tracks the functioning of two discourses pivotal to Howard and Ray's experience of supervision: anarchic educational leadership discourse, and humanistic discourse. The research on which the paper is based is constructivist, and as such it is underpinned by the assumption, or rather belief, that the discursive construction of reality is mediated by individual agency. In order to analyse how power operates between individuals, and between them and their broader educational contexts, a conceptual tool capable of accommodating manifest strategic processes - identified along a positional continuum as ‘push',' allow' and ‘pull' - was devised.The case study yields several thematic correlations in interpersonal and institutional power. These are: the significance of supervisor-student matching; links between expectations, abilities, the way participants negotiate power, and the quality of professional and pastoral care they experience; the impact of personal affinity on supervision; and the influence of ontology on thesis-as-product and person-as-product. (shrink)

Medicaid coverage matters for millions of low-income Americans, and especially for those with ongoing and serious health challenges. A source of comprehensive and affordable coverage, Medicaid has long been a cornerstone of federal and state efforts to improve access and health outcomes for very poor and medically vulnerable populations. The Affordable Care Act leveraged Medicaid's role in serving the poor to broaden the program's reach to millions of low-income uninsured adults, and positioned the program as a fundamental component of (...) the newly established continuum of public and private coverage. Looking ahead, if more states embrace the Medicaid expansion, there is the potential to build on this progress to significantly reduce the number of uninsured Americans. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Art of Teaching MusicBetty Anne YounkerEstelle R. Jorgensen, The Art of Teaching Music(Bloomington, IN: Indiana University Press, 2008)I have had the pleasure of reading the book manuscript, The Art of Teaching Music, by Estelle Jorgensen. The content explores a variety of ideas that are covered in the myriad of courses experienced by undergraduate students and introduces new ones that are critical to the development of musicians and (...) prospective teachers. Some of these ideas might be alluded to or briefly discussed in methods classes, but not at the level of thoughtful detail as they are entertained and examined in the book. This level of depth would require students and teachers to discuss, dialogue, debate, and reflect over time within and across semesters and courses. I dare to suggest that some of the ideas might not be brought to students’ attention at all throughout the undergraduate experience, which is of a concern and suggests an even greater need for such a book.My overall impression of the book is that the content and the depth of writing would serve the undergraduate students throughout their undergraduate experience and the graduate population for similar and yet different reasons. In terms of the undergraduates, there are parts of the book that would be relevant during their first year in a foundations class, second year in technique classes, third year in methods (for lack of a better word) classes, and student teaching [End Page 109] seminar experiences as they prepare to enter the profession. Utilizing a book across an undergraduate’s experience could generate interesting conversation amongst faculty members as discussions about why, how, what, and when parts of the book would be relevant would need to evolve. Some chapters could be revisited while others visited for the first time at differing places and spaces across the four years. I cannot think of another book that could be utilized in this way and thus serve the undergraduate student throughout her four-year experience and this prospect I find exciting.The book is organized around fourteen chapters, all of which are followed by an afterward. The flow of the chapters invites the reader to examine aspects of becoming and being a music educator at various levels of growth and understanding.The first chapter is titled “Teacher” and requires the reader to think at broader and deeper levels when discussing the notions of role and identity, self-awareness, motivation to enter the profession, and reflective practice. While reading the text, I imagined conversations that would include a comparative analysis of students’ experiences, which could in turn provide larger contexts for the topics. Such a discussion is necessary when examining aspects of being and becoming a teacher in various contexts. The notion of situatedness is highlighted when individual cases are heard and examined and compared across other cases, carefully noting what might or might not be comparable and taking that bit of analysis into consideration. Having such discussions across the four years of undergraduate life allows students to re-visit what was and is, and to speculate about what is to come. Such reflection can be just as fruitful at the graduate level. Students enter graduate school with a variety of teaching experiences and time is needed to reflect on the transition from being a teacher to being a student again. Realization of the continuum on which they travel between learner and teacher becomes apparent in that the place on the continuum shifts regardless of their present position; that is, as a student or teacher. For doctoral students, this reflection is rich as they begin to engage with undergraduate students and forge a new path as budding teachers of teachers and researchers and continue to be musicians.Chapter Two took me to the writings of Dewey1 particularly as I read about a student-centered focus and the experience-based approach. So much of our profession has been driven by content and theories that the student has been removed from the center of the focus and thought of as peripheral. I welcome the idea of placing the students at the center of our thinking and conversations. These ideas have been articulated in... (shrink)

Medically unexplained symptoms (MUS) are common and costly in both primary and secondary health care. It is gradually being acknowledged that there needs to be a variety of interventions for patients with medically unexplained symptoms to meet the needs of different groups of patients with such chronic long-term symptoms. The proposed intervention described herewith is called The BodyMind Approach (TBMA) and promotes learning for self-management through establishing a dynamic and continuous process of emotional self-regulation. The problem is the mismatch (...) between the patient’s mind-set and profile and current interventions. This theoretical article, based on practice-based evidence, takes forward the idea that different approaches (other than cognitive behaviour therapy) are required for people with MUS. The mind-set and characteristics of patents with MUS are reflected upon to shape the rationale and design of this novel approach. Improving services for this population in primary care is crucial to prevent the iterative spiralling downwards of frequent GP visits, hospital appointments, and Accident and Emergency attendance, all of which are common for these patients. The approach derives from embodied psychotherapy (authentic movement in dance movement psychotherapy) and adult models of learning for self-management. It has been developed from research and practice-based evidence. In this article the problem of MUS in primary care is introduced and the importance of the reluctance of patients to accept a psychological/mental health referral in the first instance is drawn out. A description of the theoretical underpinnings and philosophy of the proposed alternative to current interventions is then presented related to the design, delivery, facilitation and educational content of the programme. The unique intervention is also described to give the reader a flavour. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Alzheimer's Disease, Aging, Chance, and RaceAtwood D. Gaines (bio)KeywordsAlzheimer’s disease, chance, mild cognitive impairment, racism, social constructionsThomas Kirkwood's comments are a welcome, articulate detailing of how and why we age with special reference to the brain. As well, his paper indicates clearly that processes reified as pathology and disease, such as Alzheimer's disease (AD), are in fact common and inevitable as the human brain ages. Doubtless, this is the (...) reason that aging is by far the greatest risk factor for the development of AD. A key notion, briefly mentioned by Kirkwood, is that of chance. He points out that, "cells (will be) burdened with protein aggregates and similar materials that will increase with aging. Once again, which cells will experience this fate and which will continue to function healthily is strongly influenced by chance" (Kirkwood 2006, 80–81). This mention of chance is most important for our paper, "Building a Mystery," and for an understanding of science as well. In "Building a Mystery," Peter Whitehouse and I sought to show that the history of AD was not inevitable and demonstrates a variety of chance and singular decisive occurrences of encounters, interpretations, social movements, government initiatives, and technological developments. Such decisive moments do not occur by virtue of some (natural) lawful process that is unfolding, but rather, these are chance events that could have happened in other ways. Indeed, science has been viewed as human attempts to "tame chance" (Hacking 1990). However, it often does so by sleight of hand, misinterpretation, and the biomedical discourse of hope. Increasingly, we are learning that chance is a commonality, not a rarity, in social and biological domains. The biomedical approach assumes the opposite. For example, it seeks to tame the chance appearance of AD in the case of Auguste D, and does so in part by reifying differences that exist, as Kirkwood notes, along a continuum rather than as the discrete entities implied by the labels Alzheimer's disease or mild cognitive impairment (MCI).We thus stand with Kirkwood's bold recognition of chance (see also Kirkwood 2003) in the biological domain and have applied the same idea to the social domain in which we consider the practice of biomedical science. We have elsewhere emphasized consensus statements in the making of AD (Gaines and Whitehouse 1998). In the present article, we add a number of other chance, decisive sociocultural moments to the mix of social processes producing AD and MCI. We have not considered in detail here a host of cultural features in the theory and practice of biomedicine with respect to AD. These include implicit, yet highly [End Page 83] implicative, cultural notions of bilateral kinship employed in genetic research on AD considered elsewhere (Gaines 1998).Bavidge's comments are cogent as well. With respect to the notion of my concept of the local biology of "race" (Gaines 2005), it is germane to point out here that such culturally constructed biologies are relevant to a discussion of AD and other dementias. Such constructions represent culture in science. We used the dramatic example of "race" in US biomedicine because it is experiencing a resurgence as an explanatory tool. For example, recently Haiman et al. (2006) presented research that suggests that "Among cigarette smokers, African Americans and native Hawaiians are more susceptible to lung cancer than whites, Japanese Americans and Latinos." The authors assert, as have many US studies, that their findings show differences relate to the alleged biology of the social groups concerned. Their problem and that of others, is that the groups are social, not biological, and most have mixed ancestry and do not stem from distinct groups. This is particularly true of African Americans and Latinos; both groups are substantially composed of individuals with European, West African, and Native American ancestry in widely varying proportions (Gaines 2005). Thus, they are different only in terms of their classification. Such work regularly overlooks influences, such as environmental racism, discrimination, poverty, and a lack of medical care, as well as other practices. These might include, in a study of smoking, pakalolo smoking (local marijuana) among Hawaiians, who themselves are usually part Portuguese, Japanese, Chinese, and or European... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 23 (2003) 155-157 [Access article in PDF] Religious Feminism and the Future of the Planet: A Buddhist-Christian Conversation. By Rita M.Gross and Rosemary Radford Ruether. New York: Continuum, 2001. 229 pp. Is feminism indigenous to Buddhism and Christianity? Or must feminists reinvent their religious traditions? The probing autobiographical reflections by Rita Gross and Rosemary Ruether expose the tensions of feminist reform. Like many religious feminists, they (...) claim to preserve continuity with tradition despite their innovations. But upon reading Religious Feminism and the Future of the Planet, the similarities between feminist Buddhism and feminist Christianity lead me to wonder whether feminism plays a more formative role than tradition in shaping their visions of the future.The ingenious structure of the book allows the opportunity for maximum dialogue. [End Page 155] Authors write chapters paired on the same topic, and each chapter has a short response attached. This organization mirrors the real-life dialogue between Gross and Ruether that occurred at a workshop in Grailville, Ohio, in 1999. The back-and-forth movement allows for meta-reflection on feminist interpretation, on the self-understandings of scholars who practice the traditions that they study.The first two chapters are autobiographical. There is an especially detailed account of Gross's journey toward Tibetan Buddhism and a shorter chapter on the evolution of Ruether's Catholic identity. The second pair of chapters responds to patriarchal religious origins. Ruether's critique of Christian sexism is theological, dealing with Christology, anthropology, and ecclesiology. In contrast, Gross asserts that the Buddhist "view" or theology is nonsexist and even feminist, thus she considers male leadership as the main obstacle to women. The difficulty of defending such large claims in a short space is compensated by the fact that their conclusions have already been developed in previous publications.Striking parallels emerge when the authors identify what is most liberating in their tradition and most inspiring in the other tradition. In both cases, mindfulness practice in Buddhism and the prophetic voice in Christianity are singled out. The overarching message is that Christians can learn about prayer from Buddhists, and Buddhists can learn about social critique from Christians. Another crucial parallel occurs when the authors choose one key social problem to address religiously—they both focus on environmental ethics. They agree that loving care for the earth is the key to both ecological and human flourishing.One asymmetry, however, concerns sensitivity to departure from tradition. In particular, Gross questions whether by utilizing "prophetic" critique she is applying an extrinsic Hebrew and Christian viewpoint to Tibetan Buddhist reflection. I greatly admire how she faces up to the problem of discontinuity between feminist critique and Buddhist institutions rather than insist that the tradition is inchoately feminist. Ruether, on the other hand, does not take the discontinuity between traditional and feminist Christian viewpoints as seriously, although she undoubtedly reshapes Christianity, particularly theological doctrines, into new forms.From a Christian perspective, I notice striking omissions in Ruether's presentation concerning the subject of prayer and the theme of suffering. When Ruether experimented with lay monastic practice early on in her career, she became impatient with silence and intensive prayer as isolating and unproductive. In her autobiographical chapter, she speaks of turning away from prayer toward social engagement. Yet she also mentions admiration for certain contemporary monks and nuns who are on the vanguard of creative worship and ethical engagement. Although she admires Buddhist mindfulness, she does not take seriously analogous Christian meditative practices and their capacity to sustain social activism. She leaves the impression that prayer and action are separate paths, whereas Christian prayer and resistance may be closely associated.The nature of suffering and its overcoming are topics central to Christianity and Buddhism, as well as to feminist thought. For feminists, reflection on suffering tends [End Page 156] to concentrate on exposing and removing its causes, such as abuse, oppression, or violence. Buddhists also focus on cessation of suffering, but "suffering" is centrally an individual barrier to overcome before social issues can be corrected. In contrast, Christians think about... (shrink)

I claim that the revisions John Rawls made to his theory of justice—as seen in his political conception of justice as fairness in the revised edition of Political Liberalism and Justice as Fairness: A Restatement—result in him being able to secure justice for all persons even in their private lives. Thus, I defend his theory against common communitarian and feminist criticisms, viz the lack of moral community and inability to secure justice for individuals in the private domain. I demonstrate that (...) justice is secured from the categorical requirement that all associational life and moral doctrines must adhere to the constraints of justice, by (what Rawls terms) the indirect application of the first principle of justice. The implications of and necessity for this indirect application are precisely what I interrogate in this thesis. I suggest that this indirect application requires unconditional acknowledgement and internalisation of the values of liberty and equality (political values of the first principle) into all aspects of civil society. I claim that Rawls realised this necessity for the congruence between the moral powers of persons, the spheres of society, and the right and the good and, as such, developed a complementary relation between these three features. Coherence between these three aspects is essential; without coherence, citizens would have a split moral personality, the public and the non-public spheres would be in conflict, and the political values and the moral doctrines of individuals would undermine one another. The significance of this strict coherence is that it can ensure the adequate development of individuals’ capacity for citizenship during the three stages of moral development. This results in citizens being able to form bonds of civic friendship necessary for justice as reciprocity to be realised. Thus, in this thesis, I position my argument against theorists such as Nancy Rosenblum, who argue for a more relaxed congruence between political institutions and civil society, as according to her illiberal forms of associational life can help form the necessary bonds of love and care needed for mutual cooperation in a liberal society. In opposition to this, I claim that strict congruence is necessary; without it, a stable liberal society is not possible as the citizens would not be able to able to respect one another on free, equal, and mutually beneficial terms. I rely on Hochschild’s sociological evidence to demonstrate that civic friendship has not been developed, due to a lack of reciprocity, impacting the negative development of one’s sense of justice. I then illustrate how this lack of reciprocity is amplified by digital and artificial intelligence (AI) technologies. The significance of this thesis is that I claim, firstly, Rawls’s last revisions and works before his death demonstrate that justice is a collective non-comprehensive good that results by constraining individuals’ associational life and their partial comprehensive doctrines to Rawlsian demands of justice. Thus, Rawls takes seriously the feminist and communitarian critiques he received. Secondly, I claim that this interpretation of Rawls’s theory of justice cannot be conceptualised in terms of a binary presentation of the priority of the right versus the good debate and, instead, I argue for a reconceptualisation of the priority of the right versus the good as ranges on a continuum of structural relations between the right and the good. (shrink)

Usually a novel’s subject is the individual in action. That individual must confront a set of social expectations and norms which define and limit him. In such novels the revelation of social expectations constitutes a central element in the artist’s depiction. The degree to which society limits the hero’s action, of course, varies widely. We can imagine a continuum along which the influence of society is arranged. Sociological/naturalistic novels, in which a social order is depicted as destructive, define one (...) extreme of that continuum. The protagonists in their suffering reveal this society’s destructive force. At the opposite extreme, society’s values and norms may be important in guiding and evaluating a protagonist’s movement toward his fate without society itself becoming an obstacle to his progress. We think, for instance, of Jane Austen’s novels. In the broad middle range of the continuum, protagonists struggle to realize their potential within social limitations, and their successes are usually partial. In assessing their triumphs, we must evaluate the obstacles they have encountered both in their own natures and in the natures of their social milieu.To make society the protagonist of a novel upsets the expectations of readers, first because the novel as a genre usually depicts the growth or change of protagonists moving from complications to stability, and second because the novel customarily concludes in some alteration of the protagonist’s external state and in some expansion of his understanding. With society as his protagonist, a writer commits himself to engaging our primary interest in the life of an abstraction or set of principles. Here, too, action is crucial. This kind of novel differs from a utopian novel, however, which focuses on ideas about society and whose principal end is to criticize or espouse a particular social order, not to engage us in working out instabilities through action. In novels in which society is protagonist, we are involved with the fate of an entire social order, and it is one about which we are made to care. The principal purpose is to present a society moving from a state of instability toward a qualitatively defined fate analogous to the movement of an individual hero.To achieve this end, characters become agents through which a social order realizes its fate. This function of character entails no simple inversion of the usual relationships between individuals and society, because characters can never be reduced to a backdrop the way society can, and society cannot easily achieve the particularity of definition and identity the way a character can. In attempting to discover narrative terms for realizing the fate of a society, a novelist faces an enormous technical challenge. He must make us care as much about a social order as he would about a particular individual, and yet he cannot write directly about ideas—he must record the actions of humans. Because his plot will focus on no single individual but on abstract processes and social hopes, he must constantly minimize individual fates and aspirations and make them clearly a function of society’s larger turmoil. Our empathy must rest firmly with the social principles being threatened rather than with any single character. With this end in view, a clearly defined, circumscribed arena for action becomes necessary. Literal battles, or scenes in which battles operate as a principal metaphor, frequently appear in such novels. By bringing many of the major characters together, defining and creating allegiances, and pitting opposing social principles, such battles provide an important context for measuring the progress of those values with which we empathize. (shrink)

Recent scholarship has suggested that compassion can occur at the organizational level. The definition of “organizational compassion” is particularly problematic because organizations have multiple reasons for engaging in actions that then have effects on various stakeholders. A number of questions regarding organizational compassion thus merit theoretical attention: Are all organizations capable of demonstrating caring and compassion? What factors enable or constrain organizational compassion? In a move toward a more complete understanding of compassion at the organizational level, a continuum of (...) organizational compassion is developed, considering both positive and negative organizational deviance. As factors across multiple levels of analysis may influence where firms would fall on this compassion continuum, examples of enablers and constraints to organizational compassion are also considered. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:A Nietzschean Bestiary: Becoming Animal Beyond Docile and BrutalRobert N. MatuozziA Nietzschean Bestiary: Becoming Animal Beyond Docile and Brutal, edited by Christa Davis Acampora and Ralph R. Acampora ; xxxii & 371 pp. Lanham, MD: Rowman & Littlefield, 2004. $75.00 cloth, $29.95 paper.What if instead of re-reading Nietzsche's corpus, one imagines what it would be like to view his works on the "Nietzsche Network." Imagine a spectator situated (...) in the middle of a vast amphitheatre preparing to watch these simulacra. Gazing up and around a series of giant, flat-screen video monitors arrayed in layers around the interior wall of an amphitheatre, the spectator views and listens to Nietzsche's multi-media texts as, simultaneously, they seductively flash their provocative narratives in flickering streams of high-resolution sounds, words, and images.The Nietzsche Network is a roaring carnival. It consists of colorful, speculative historical dramatizations and equally enticing philosophical tableaux. Dark ambient musical motifs, laced with interludes of explosive, uncontrollable laughter, are a subliminal presence. Lurid detective stories and somber cultural narratives and slashing polemics implicate cultures and ideologies in festivals of cruelty and soul-murder. Poignant genealogical and aphoristic asides on joy [End Page 443] and work and suffering, weird psychological skits starring well-known ensemble casts are accompanied by hoarse oratory, soaring denunciations, and sober etymological digressions. Intermittently, the spectator is startled by abrupt, sometimes strident proclamations, like confessional bulletins shot from nowhere.Nietzsche's siren-like prose exhibits an extraordinary rhetorical range. This is particularly true of the polychromatic works originally published in the gloaming of his career in the period after 1886. Nietzsche's compelling, fluvial style is accounted for in this volume by the kinetic movements of lizards and the halcyon tones of birds, to his study of the ancient Greek and Roman classics (and to the lost musicality of Greek tragedy in particular), and to his emphatic embrace of a kind of plosive, Dionysian philosophical technics.The content of the Nietzsche Network spans thousands of years of human experience and thought. A prequel features a substantial bestiary of traditional animals and emergent biomorphic forms set in a variety of carefully animated zoological dioramas. Among the modernists, has there been another thinker as strangely original and subversive? Allowing for fundamental differences, only Valéry comes to mind. Like the silent, ruminating cow in his "untimely" essay on history, Nietzsche prevents the past from injecting noise into present and future philosophizing. He will be the exemplary philosopher of the other-than-human as he campaigns to re-inscribe human animality into the zoological text of nature. Through explicit pronouncements and in scattered philosophical sorties involving human animality and his (desperate) utopist vision of human perfectibility, Nietzsche attempted to attain—at least conceptually—what Richard Rorty aptly calls the "historical sublime, a future which has broken all relations with the past."This excellent collection of essays on Nietzsche's bestiary demonstrates the surprising persistence of the animal imaginary in his thought. The various pieces also illuminate the multiple thematic and linguistic transformations Nietzsche develops as he enlists animals in his feral, anti-essentialist dialectic on the obscure continuum between "humans," "animals," and "nature." It turns out that a degraded version of Nietzsche's strangest thought experiment on animalism, the übermensch, is perhaps only a few years away from being produced through emerging boutique bioengineering, a prospect that has some commentators on both the left and the right blinking with apprehension. These essays amply demonstrate that Nietzsche's bestial philosophy of human and animal alterity subverts, among other paradigms, the strange Cartesian notion that animals are mechanical automata while humans are transcendental rationalists. As one commentator in this book broadly puts it, Nietzsche shows that the various schemes concocted to put an illusory distance between humans and animals have ended up being an immensely corrupting "pretense" (p. 224).Precursor bestiaries are indicated in this volume, though the medieval tradition originating in the Physiologus is here mostly displaced by a different [End Page 444] menagerie of cultural affiliations. The fabulist Aesop is present, along with Aristotle and Montaigne, though La Fontaine is not, and Pico Mirandola's famous remarks in his Oration on... (shrink)

With the increasing number of people living with HIV/AIDS and the escalating costs of health care, there is an increasing demand for informal caregiving in the community. Currently, much emphasis is placed on individuals who are living with HIV/AIDS (in terms of the provision of social, psychological and economic support), but very little attention has been paid to the well-being and quality of life of informal caregivers. Lack of support and care for caregivers may have a negative impact (...) on the quality of care and effective services for individuals living with HIV/AIDS. This paper is based on findings from a qualitative study that explored major sources of stress associated with caregiving among informal caregivers in a village in the southern part of Botswana. The paper suggests that informal caregivers are an integral part of the continuum of care. As a result, they need to be nurtured and supported for the betterment of those both infected and affected by HIV/AIDS. The paper concludes by discussing the implications for further research, policy and programme development. (shrink)

Two articles in the March‐April 2021 issue of the Hastings Center Report consider alterations to traditional informed consent. In “The Consent Continuum: A New Model of Consent, Assent, and Nondissent for Primary Care,” Marc Tunzi and colleagues argue that, in primary care settings, patient consent should be understood as taking a range of forms depending on the procedure, the patient, and the patient‐care context. Traditional informed consent is at the ceremonious end; for many things done in (...) these settings, the authors assert, assent or even nondissent is fine. In the lead article, health policy scholars Stephanie Morain and Emily Largent consider another continuum for informed consent, this one occurring with pragmatic research, at the intersection of clinical care with research. (shrink)

In this study the awake patient's intraoperative situation and experiences during regional anaesthetics and surgery are reflected upon by using the work of the French philosopher Maurice Merleau‐Ponty. Merleau‐Ponty's phenomenological idea of the body as being at the centre of the world highlights the patient's embodied position and bestows significance onto the body as a whole, as a lived body. A case, based on the findings from a previous interview study, is presented as a contextual starting point where a patient (...) goes from having a familiar body recognized as her own to having a partially anaesthetized body experienced as an unknown object. The intraoperative caring space is described in this context as the mutual ground where the awake patient and the nurse anaesthetist (NA) can interact to create meaning. The NA can act as the patient's bodily extension to bridge the gap between the patient's experiences and the situation. This calls for the NA's proximity and genuine presence in order to meet and understand the patient's awake experiences. Learning from the patient's situatedness gives information that is valuable for NAs to share with patients who are less experienced with this contextual situation. The challenge for the NA is not to perform routine‐based care, but to acknowledge every patient's lifeworld and uniqueness thus enabling the patient to move easily along the mind–body–world continuum. The core of intraoperative care is to provide support and promote well‐being of awake patients in the intraoperative environment. The use of a philosophical perspective is relevant for nurses who work in an intraoperative setting where patients undergo regional anaesthetics. This study shows how nursing research using phenomenological philosophy can help uncover new meanings known only to the patients living the experience. (shrink)

Aim: Explore nurses’ values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses’ values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the institutional review board (#191046). (...) Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: “Honoring Patient Autonomy without Judgment,” “Honoring with Limitations,” “Not until...,” and “Adamantly against.” Some felt it was a duty to honor the patients’ wishes, set aside own beliefs, and respect patients’ choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse’s role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses’ values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed. (shrink)

Teaching and Learning as a Pedagogic Pilgrimage is premised on an argument that if higher education is to remain responsive to a public good, then teaching and learning must be in a perpetual state of reflection and change. It argues in defence of teaching and learning as constitutive of a pedagogic pilgrimage and draws on a range of scholars and theories to explore concepts such as transcendental journeys, belief, hope and imagination. The main objective of the book is to show (...) how teaching and learning ought to be reconsidered in relation to that which lies beyond the parameters of the encounters, as well as that which is intrinsic to the encounters. This book gives shape to rituals and routines of engagement and debate, before extending the limitations in deliberative pedagogic encounters to offer desirable outcomes in which both student and teacher can practice a spiritual take on teaching and learning along a continuum of ongoing action. Themes explored in the chapters include the following: Faith and deliberative encounters Post-human ethics of care in teaching and learning Diffracted teaching and learning This book will be of great interest to academics, researchers and post-graduate students in the fields of philosophy of education, and teaching and learning in the philosophy of education. It will also appeal to school and university educators, policymakers and prospective teachers. (shrink)