This article explores how ethics and religion interface in everyday life by drawing on a study examining the negotiation of religious and spiritual plurality in health care. Employing methods of critical ethnography, namely, interviews and participant observation, data were collected from patients, health care providers, administrators and spiritual care providers. The findings revealed the degree to which `lived religion' was intertwined with `lived ethics' for many participants; particularly for people from the Sikh faith. For these participants, religion was woven into (...) everyday life, making distinctions between public and private, secular and sacred spaces improbable. Individual interactions, institutional resource allocation, and social discourses are all embedded in social relationships of power that prevent religion from being a solely personal or private matter. Strategies for the reintegration of religion into nursing ethics are: adjusting professional codes and theories of ethics to reflect the influence of religion; and the contribution of critical perspectives, such as postcolonial feminism, to the understanding of lived ethics. (shrink)

Nursing, with its socially embedded theory and practice, inevitably operates in the realm of power and politics. One of these political sites is that of religion, which to varying degrees continues to shape beliefs about health and illness, the delivery of healthcare services and the nurse–patient encounter. In this paper, I attempt to complicate nursing's views on religion and politics in healthcare, with the intent of thinking critically and philosophically about questions that arise at the intersection of religion, politics and (...) nursing/healthcare. These questions include the following: What is the domain of religion and politics? How (non)religious are the contemporary societies in which nurses practice? What are the variations and implications of secularism? How is religion entangled with other intersecting social relations of power? How does a political reading of religion and politics matter to the concerns of nursing? (shrink)

Although spiritual practices such as prayer are engaged by many to support well‐being and coping, little research has addressed nurses and prayer, whether for themselves or facilitating patients' use of prayer. We conducted a qualitative study to explore how prayer (as a proxy for spirituality and religion) is manifest—whether embraced, tolerated, or resisted—in healthcare, and how institutional and social contexts shape how prayer is understood and enacted. This paper analyzes interviews with 21 nurses in Vancouver and London as a subset (...) of the larger study. Findings show that nurses' kindness can buffer the loneliness and exclusion of ill health and in this way support the “spirit” of those in their care. Spiritual support for patients rarely incorporated prayer, in part because of ambiguities about permission and professional boundaries. Nurses' engagement with prayer and spiritual support could become a politicized site of religious accommodation, where imposition, religious illiteracy, and racism could derail person‐centered care and consequently enact social exclusion. Spiritual support (including prayer) sustained nurses themselves. We propose that nursing's equity‐oriented knowledge encompass spirituality and religion as sites of exclusion and inclusion. Nurses must be supported to move past religious illiteracy to provide culturally and spiritually sensitive care with clarity about professional boundaries and collaborative models of spiritual care. (shrink)

In many parts of sub-Saharan Africa, mothers impacted by the genetic condition of albinism, whether as mothers of children with albinism or themselves with albinism, are disproportionately impacted by a constellation of health-related stigma, social determinants of health, and human rights violations. In a critical ethnographic study in Tanzania, we engaged with the voices of mothers impacted by albinism and key stakeholders to elucidate experiences of stigma. Their narratives revealed internalized subjective stigma, social stigma such as being ostracized by family (...) and community, and structural stigma on account of lack of access to SDH. An analysis of health systems as SDH revealed stigmatizing attitudes and behaviours of healthcare providers, especially at the time of birth; a lack of access to timely quality health services, in particular skin and eye care; and a lack of health-related education about the cause and care of albinism. Gender inequality as another SDH featured prominently as an amplifier of stigma. The findings pose implications for research, policy, and practice. A concrete avenue to de-stigmatization of mothers impacted by albinism exists by the application of principles of human rights, particularly equality and non-discrimination; contextual analysis of cultural dynamics including relevant ontology; meaningful participation of rights-claimants, such as peer groups of mothers; and accountability of governments and their obligation to ensure access to health information as a key social determinant of the right to health. (shrink)

REIMER‐KIRKHAM S, SHARMA S, PESUT B, SAWATZKY R, MEYERHOFF H and COCHRANE M. Nursing Inquiry 2012; 19: 202–212 Sacred spaces in public places: religious and spiritual plurality in health careSeveral intriguing developments mark the role and expression of religion and spirituality in society in recent years. In what were deemed secular societies, flows of increased sacralization (variously referred to as ‘new’, ‘alternative’, ‘emergent’ and ‘progressive’ spiritualities) and resurgent globalizing religions (sometimes with fundamentalist expressions) are resulting in unprecedented plurality. (...) These shifts are occurring in conjunction with increasing ethnic diversity associated with global migration, as well as other axes of difference within contemporary society. Democratic secular nations such as Canada are challenged to achieve social cohesion in the face of growing religious, spiritual and ethnic diversity. These challenges are evident in the high‐paced, demanding arena of Health care. Here, religious and spiritual plurality enter in, sometimes resulting in conflict between medical services and patients’ beliefs, other times provoking uncertainties on the part of healthcare professionals about what to do with their own religiously or spiritually grounded values and beliefs. In this paper, we present selected findings from a 3‐year study that examined the negotiation of religious and spiritual pluralism in Health care. Our focus is on the themes of ‘sacred’ and ‘place’, exploring how the sacred – that which is attributed as special and set apart as it pertains to the divine, transcendence, God or higher power – takes form in social and material spaces in hospitals. (shrink)

The tremendous growth in nursing literature about spirituality has garnered proportionately little critique. Part of the reason may be that the broad generalizing claims typical of this literature have not been sufficiently explicated so that their particular implications for a practice discipline could be evaluated. Further, conceptualizations that attempt to encompass all possible views are difficult to challenge outside of a particular location. However, once one assumes a particular location in relation to spirituality, then the question becomes how one resolves (...) the tension between what are essentially theological or philosophical commitments and professional commitments. In this study, we discuss the tension between these perspectives using the idea of a responsible nursing response to spiritual pluralism. We then problematize three claims about spirituality in nursing discourse based upon our location as scholars influenced by Christian theological understandings: (i) the claim that all individuals are spiritual; (ii) the claim that human spirituality can be assessed and evaluated; and (iii) the claim that spirituality is a proper domain of nursing’s concern and intervention. We conclude by suggesting that the widely shared values of social justice, compassion and human dignity may well serve as a grounding for the critique of spiritual discourses in nursing across particularized positions. (shrink)

While for decades nursing has advocated for theory‐informed practice, more recent attention has tended to focus on mid‐range theory rather than the earlier focus on developing grand theory to encompass all of nursing practice. However, there has been continued interest in the holistic nursing community on grand theory and, in particular, on Integral Theory. Although Integral Theory's four‐quadrant (AQAL) perspective is familiar in nursing, little is known about how it is being used by nurses in direct practice. The purpose of (...) this interpretive descriptive study was to provide a practice‐based perspective on Ken Wilber's Integral Theory in professional nursing practice. The following research question was investigated: How does Integral Theory assist nurses in describing and understanding their professional work? Nurses participating in this study used Integral Theory as a map or heuristic that gave structure to an inquiry process in professional nursing practice and in nursing education in a manner that was holonic, multiperspectival, and self‐reflective. Challenges constraining nurses’ use of Integral Theory included its intricacy, as well as contextual factors in practice environments. Implications for nursing practice and education for the use of Integral Theory's meta‐framework are described. (shrink)

Our intention is to contribute to the development of Canadian Nursing and Medical Education (NursMed) and efforts to redress deepening, intersecting health and social inequities. This paper addresses the following two research questions: (1) What are the ways in which Decolonial, Intersectional Pedagogies can inform Canadian NursMed Education with a focus on critically examining settler‐colonialism, health equity, and social justice? (2) What are the potential struggles and adaptations required to integrate Decolonial, Intersectional Pedagogies within Canadian NursMed Education in service of (...) redressing intersecting health and social inequities? Briefly, Decolonial, Intersectional Pedagogies are philosophies of learning that encourage teachers and students to reflect on health through the lenses of settler‐colonialism, health equity, and social justice. Drawing on critical ethnographic research methods, we conducted in‐depth interviews with 25 faculty members and engaged in participant observation of classrooms in university‐based Canadian NursMed Education. The research findings are organized into three major themes, beginning with common institutional features influencing pedagogical approaches. The next set of findings addresses the complex strategies participants apply to integrate Decolonial, Intersectional Pedagogies. Lastly, the findings illustrate the emotional and spiritual toll some faculty members face when attempting to deliver Decolonial, Intersectional Pedagogies. We conclude that through the application of Decolonial, Intersectional Pedagogies teachers and students can support movements towards health equity, social justice, and unlearning/undoing settler‐colonialism. This study contributes new knowledge to stimulate dialog and action regarding the role of health professions education, specifically Nursing and Medicine as an upstream determinant of health in settler‐colonial nations such as Canada, United States, Australia, and New Zealand. (shrink)

Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical perspectives that foster (...) a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)

The ethical theories employed in health care today assume, in the main, a modern Western philosophical framework. Yet the diversity of cultural and religious assumptions regarding human nature, health and illness, life and death, and the status of the individual suggest that a cross-cultural study of health care ethics is needed. A Cross-Cultural Dialogue on Health Care Ethics provides this study. It shows that ethical questions can be resolved by examining the ethical principles present in each culture, critically assessing each (...) value, and identifying common values found within all traditions, It encourages the development of global awareness and sensitivity to and respect for the diversity of peoples and their values and will advance understanding as well as help to foster a greater balance and a fuller truth in consideration of the human condition and what makes for health and wholeness. (shrink)

Continuing the dialogue: postcolonial feminist scholarship and Bourdieu — discourses of culture and points of connection Postcolonial feminist theories provide the analytic tools to address issues of structural inequities in groups that historically have been socially and economically disadvantaged. In this paper we question what value might be added to postcolonial feminist theories on culture by drawing on Bourdieu. Are there points of connection? Like postcolonial feminists, he puts forward a position that aims to unmask oppressive structures. We argue that, (...) while there are points of connection, there are also epistemologic and methodologic differences between postcolonial feminist perspectives and Bourdieu's work. Nonetheless, engagement with different theoretical perspectives carries the promise of new insights — new ways of ‘seeing’ and ‘understanding’ that might enhance a praxis‐oriented theoretical perspective in healthcare delivery. (shrink)

In this paper we continue an ongoing dialogue that has as its goal the critical appraisal of theoretical perspectives on culture and health, in an effort to move forward scholarship on culture and health. We draw upon a programme of scholarship to explicate theoretical tensions and challenges that are manifest in the discourses on culture and health and to explore the possibilities Bourdieu's theoretical perspective offers for reconciling them. That is, we hope to demonstrate the need to move beyond descriptions (...) ‘of’ culture to an understanding of cultures as dynamic, and to show ways cultural practices create contexts that have the potential to foster or impede health.In our early research, largely undertaken in Canada's multicultural context, we sought to make visible the ways in which culture shaped conceptions of health and influenced health practices of immigrant groups. In recent years this focus has expanded to include populations that reflect the cultural and social diversity of our region. From the outset we attempted to move towards a conception of culture as negotiated, unifying, transformative and dynamic. While this position continues to hold appeal we are continually reminded that, despite our leanings towards constructivism, there is salience to the notion of culture as having enduring elements. It is this tension between the view of culture as embodied and enduring and culture as constructed and dynamic that we seek to examine.We explore whether Bourdieu's theoretical perspective offers promise for reconciling these apparently competing views. Using exemplars from our research we share insights that Bourdieu's work has offered to our analyses, thereby enabling us to move towards a view of culture that holds in tension these apparently contradictory positions of culture as both essence (albeit unstable, negotiated) and constructed. (shrink)

Socrates, Sports, and Students involves a philosophical justification for the inclusion of physical education in the school system. This book will appeal to physical educators and administrators interested in justifying their activity, as well as philosophers and professors in the areas of education and sport.

Theories of Truth provides a clear, critical introduction to one of the most difficult areas of philosophy. It surveys all of the major philosophical theories of truth, presenting the crux of the issues involved at a level accessible to nonexperts yet in a manner sufficiently detailed and original to be of value to professional scholars. Kirkham's systematic treatment and meticulous explanations of terminology ensure that readers will come away from this book with a comprehensive general understanding of one of (...) philosophy's thorniest set of topics. -/- Included are discussions of the correspondence, coherence, pragmatic, semantic, performative, redundancy, appraisal, and truth-as-justification theories. There are also chapters or sections of chapters on the liar paradox, three-valued logic, Field's critique of Tarski, Davidson's program, Dummett's theory of linguistic competence, satisfaction, recursion, the extension/intension distinction, and an explanation of how theories of justification, properly understood, differ from theories of truth. -/- A persistent theme is that philosophers have too often failed to recognize that not all theories of truth are intended to answer the same question. When the various questions are made distinct, it is apparent that many of the "debates" in this field are really cases of philosophers talking past one another. There is much less disagreement within the field than has commonly been thought. (shrink)

A growing literature examines the organizational factors that promote women’s access to positions of organizational power. Fewer studies, however, explore the implications of women in leadership positions for the opportunities and experiences of subordinates. Do women leaders serve to undo the gendered organization? In other words, is women’s greater representation in leadership positions associated with less gender segregation at lower organizational levels? We explore this question by drawing on Cohen and Huffman’s conceptual framework of women leaders as either “change agents” (...) or “cogs in the machine” and analyze a unique multilevel data set of workplaces nested within Fortune 1000 firms. Our findings generally support the “agents of change” perspective. Women’s representation among corporate boards of directors, corporate executives, and workplace managers is associated with less workplace gender segregation. Hence, it appears that women’s access to organizational power helps to undo the gendered organization. (shrink)

The urgent need for solutions to critical environmental challenges is well attested, but often environmental problems are understood as fundamentally collective action problems. However, to solve to these problems, there is also a need to change individual behavior. Hence, there is a pressing need to inculcate in individuals the environmental virtues — virtues of character that relate to our environmental place in the world. We propose a way of meeting this need, by the judicious, safe, and controlled administration of “classic” (...) psychedelic drugs as a way to catalyze the development of environmental virtues – a form of moral bio-enhancement. Recent evidence shows that psychedelics can be given safely in controlled environments, and can induce vivid experiences of unity and connectedness. These experiences, in turn, can durably increase feelings of nature-relatedness and pro-environmental behaviors. Therefore, we argue that responsible psychedelic use can reliably catalyze the development of a key environmental virtue known as living in place. This is a “master environmental virtue” that subsumes the qualities of respect for nature, proper humility, and aesthetic wonder and awe. Our account advances the environmental virtues debate by introducing a relevant practical proposal, and advances the psychedelic moral enhancement debate by providing a much-needed conceptual framework. (shrink)

In this paper, we discuss several problems with current Big data practices which, we claim, seriously erode the role of informed consent as it pertains to the use of personal information. To illustrate these problems, we consider how the notion of informed consent has been understood and operationalised in the ethical regulation of biomedical research (and medical practices, more broadly) and compare this with current Big data practices. We do so by first discussing three types of problems that can impede (...) informed consent with respect to Big data use. First, we discuss the transparency (or explanation) problem. Second, we discuss the re-repurposed data problem. Third, we discuss the meaningful alternatives problem. In the final section of the paper, we suggest some solutions to these problems. In particular, we propose that the use of personal data for commercial and administrative objectives could be subject to a ‘soft governance’ ethical regulation, akin to the way that all projects involving human participants (e.g., social science projects, human medical data and tissue use) are regulated in Australia through the Human Research Ethics Committees (HRECs). We also consider alternatives to the standard consent forms, and privacy policies, that could make use of some of the latest research focussed on the usability of pictorial legal contracts. (shrink)

Patients with psychosis often have poor insight into their illness. Poor insight into illness is, at least among patients with psychosis, a good predictor of treatment non-adherence. This is no mystery, for as Xavier Amador asks, "Who would want to take medicine for an illness they did not believe they had?" What is curious is that some patients with psychosis do adhere to treatment despite a lack of insight. Why do these patients adhere to treatment, given that they do not (...) believe they are ill to begin with? In this paper, I attempt to answer this question. I do so by first considering cases of non-psychotic patients who adhere to treatment despite a lack of insight. I point out that these sorts of cases are commonplace, and attempt to explain why they arise. The explanation is given in terms of anticipated treatment benefits. However, these benefits are not conceptualized by the patient in terms of pathology. The patient does not, in other words, think of such benefits in terms of illness, symptoms, treatment, and so forth. I then argue that the proposed explanation can be extended to account for why psychotic patients without insight sometimes adhere to treatment. I conclude by drawing out some of the practical implications of the proposed view. I first argue, on practical as well as ethical grounds, that improving insight for purposes of treatment adherence is misguided. I then suggest that such adherence might be increased simply by explaining treatment benefits in language that does not presuppose that the patient is, in any sense, "ill," "diseased," "sick," "unwell," and so on. (shrink)

This essay reviews recent feminist scholarship, autobiographical narrative and fiction which explores nurses' engagement with empire in Africa and elsewhere in this century. Such literature suggests that while nursing work may have improved native health in colonized regions, it also contributed significantly to the establishment and stabilization of the racialized order of colonial rule. Of particular significance was colonial nursing's intervention into the reproductive practices of native women, resulting in the loss of local knowledges and autonomy, the disruption of complex (...) social links and indigenous health strategies, and the expansion of markets for western capitalism. (shrink)

This article outlines the emergence of ABA (Applied Behaviour Analysis) in the mid-20th century, and the current popularity of ABA in the anglophone world. I draw on the work of earlier historians to highlight the role of Ole Ivar Lovaas, the most influential practitioner of ABA. I argue that reception of his initial work was mainly positive, despite concerns regarding its efficacy and use of physical aversives. Lovaas’ work, however, was only cautiously accepted by medical practitioners until he published results (...) in 1987. Many accepted the results as validation of Lovaas’ research, though both his methods and broader understanding of autism had shifted considerably since his early work in the 1960s. The article analyses the controversies surrounding ABA since the early 1990s, considering in particular criticisms made by autistic people in the ‘neurodiversity movement’. As with earlier critics, some condemn the use of painful aversives, exemplified in the campaign against the use of shock therapy at the Judge Rotenberg Center. Unlike earlier, non-autistic critics, however, many in this movement reject the ideological goals of ABA, considering autism a harmless neurological difference rather than a pathology. They argue that eliminating benign autistic behaviour through ABA is impermissible, owing to the individual psychological harm and the wider societal impact. Finally, I compare the claims made by the neurodiversity movement with those made by similar 20th- and 21st-century social movements. (shrink)

Socrates, Sports, and Students involves a philosophical justification for the inclusion of physical education in the school system. This book will appeal to physical educators and administrators interested in justifying their activity, as well as philosophers and professors in the areas of education and sport.

We address the question whether there is an explanation for the fact that as Fodor put it the micro-level “converges on stable macro-level properties”, and whether there are lessons from this explanation for other issues in the vicinity. We argue that stability in large systems can be understood in terms of statistical limit theorems. In the thermodynamic limit of infinite system size N → ∞ systems will have strictly stable macroscopic properties in the sense that transitions between different macroscopic phases (...) of matter (if there are any) will not occur in finite time. Indeed stability in this sense is a consequence of the absence of fluctuations, as (large) fluctuations would be required to induce such macroscopic transformations. These properties can be understood in terms of coarse-grained descriptions, and the statistical limit theorems for independent or weakly dependent random variable describing the behaviour averages and the statistics of fluctuations in the large system limit. We argue that RNG analyses applied to off-critical systems can provide a rationalization for the applicability of these limit theorems. Furthermore we discuss some related issues as, for example, the role of the infinite-system idealization. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reflections on InsightDilemmas, Paradoxes, and PuzzlesMarga Reimer (bio)Keywordsinsight, psychosis, treatment adherence, medical model, autonomy, open placebos, rationalityThe Practitioner's DilemmaThe psychiatrist aware of the potential intractability of what Jennifer Radden calls "insightlessness," faces a dilemma. Should she encourage her patient to embrace a medical model of his "troubles," a model whose adoption is likely to motivate treatment adherence? She might then be trying to do the impossible; she might (...) also alienate her patient in the process. Should she instead encourage her insightless patient to embrace his own non-medical model, according to which treatment adherence makes no medical sense whatsoever? She might then see herself as encouraging a kind of uninformed consent: Her insightless patient might be taking powerful, potentially harmful, medication for reasons (such as sound sleep and "peace of mind") that would never medically justify adherence.In my original paper, I suggested that the way out of this dilemma might be to embrace the latter option, while characterizing the very real (and medically based) benefits of treatment adherence in non-medical terms. I now realize that my proposed resolution reflects an oversimplified understanding of what might be called the "practitioner's dilemma." As Michaela Amering (2010) makes clear, the situation for those with mental illness is improving dramatically. With "recovery orientation" as the "guiding principle of mental health policy," the emphasis is on "health promotion, individual strengths, and resilience." The question becomes: Can the practitioner encourage her insightless patient to partake in this "recovery" movement if she does not simultaneously encourage him to embrace a medicalized understanding of his "troubles"?Not obviously. For although a "recovery" model might eschew notions like illness1 and disease, pathology and dysfunction, and even schizophrenia, it will inevitably involve some medical notions. The patient who partakes in the "recovery movement" described by Amering, would seem to have no choice but to accept a model that is essentially medical. Consider the language used by Amering in characterizing that movement. She talks of mental health problems, therapeutic relations, patient self-determination, diagnosis and, of course, recovery. The concepts underlying such language are intrinsic to the patient-oriented movement Amering describes. The question becomes:How can the insightless patient rationally partake in such a movement without embracing some version of the medical model of mental illness? [End Page 85]This question suggests the importance of promoting some kind of insight, even if not insight "into psychosis." At the close of these comments, I consider briefly what such "revisionary" insight might involve.Paradoxes of Conditional and Relinquished AutonomyAutonomy among patients with psychosis presupposes the sort of clear-headedness that arguably comes only with treatment adherence. This may provide some justification for the "coercive treatments" that Anthony (2006) finds so offensive. For patients with psychosis, genuine autonomy is conditional, requiring some degree of insight: Recognition that their "troubles" are at least amenable to medical treatment. Once the patient recognizes this, he can choose freely to decline such treatment (regardless of whether that choice is ultimately respected). Call this the "paradox of conditional autonomy." The conditional nature of autonomy is a familiar point in philosophical discussions regarding free will. There is no genuine freedom without the sort of knowledge required for informed choices. What distinguishes the patient with psychosis from persons more generally is that his autonomy is further conditioned: The knowledge required for autonomous decision making arguably requires some degree of treatment adherence.However, the mentally ill patient has the right, as do all patients, to relinquish autonomy. He may opt for deference to, and dependency on, the relevant experts: Mental health care professionals (Campbell 1994). We are led once again to paradox. To respect the patient's autonomy, the mental health care professional must respect his right to forego autonomy in favor of deference and dependency. This paradoxical situation, involving a kind of deferred autonomy, is not unique to psychiatry but applies to medicine across the board. Indeed, it applies to the human service industry more generally where, as McGorry (1992) suggests, there is an implicit assumption that the service user is to defer to the expertise of the service provider.This assumption is rightly challenged. Suppose Justin and... (shrink)

In this paper I examine the twin concepts of 'playing God', and its secular equivalent – that which I term for the purpose of this discussion 'vexing Nature' – as they relate to arguments against certain human technological actions and behaviours. While noting the popular subscription to the notion that certain acts constitute instances of 'playing God' or interfering in the natural order, philosophers often deny that such phrases have any application to the central ethical issues in the areas where (...) they are most commonly applied. I examine, in detail, the interpretations of these phrases put forward by bio-ethicists Ruth Chadwick and John Harris and argue that the concepts 'playing God' and 'vexing nature' are best understood as an expression of a moral intuition that is both significant and deserving of serious philosophical attention. My contention is that intuitions of this kind often express a concern for the virtue of, and doubt about the intentions of, the agent whose acts are described in these terms, and that these concepts are best understood as part of an historical and cultural continuum specific to the Western tradition. Understood as such, this indicates that debate continues over the purpose of art and technology, and the place of humanity within the natural environment, and that a kind of traditional teleological virtue ethics still exerts a significant influence on popular conceptions of the moral issues underlying this debate. (shrink)

KEY POINTS In Canada, commercial data brokers collect deidentified patient data from pharmacies, private drug insurers, the federal government and medical clinics without patient consent. Although pharmaceutical companies are the data brokers’ primary customers, academics and nonprofit and public entities also use commercial data sets, given the absence of a coordinated public approach to collecting these data across Canada. Risks of commercialized patient data include loss of anonymity, surveillance and marketing, discrimination and violation of Indigenous data sovereignty. Coordinated infrastructure for (...) the collection and coordination of health data across Canada and updated privacy legislation would protect individuals and communities and enable appropriate data uses. (shrink)

In maternity care, costly high-technology interventions that have never been shown to be clinically effective continue to be used in the United States, while inexpensive and effective low-technology interventions continue to be underused. Three high-technology approaches to risk reduction—electronic fetal monitoring, cesarean section, and home uterine activity monitoring are contrasted with three low-technology approaches—prenatal care, smoking cessation, and nutrition supplementation. These technologies are examined in terms of current controversies over their safety, efficacy, and cost-effectiveness. Examination of these controversies illustrates how (...) the medical technology industry, the regulatory process, and systems of social stratification contribute to social and cultural constructions of what are regarded as reducible birth risks. (shrink)