Toward a Sociology of Conflict of Interest in Medical Research Content Type Journal Article Category Case Studies Pages 389-391 DOI 10.1007/s11673-011-9332-0 Authors Sarah Winch, School of Medicine, The University of Queensland, Queensland, Australia 4072 Michael Sinnott, School of Medicine, The University of Queensland, Queensland, Australia 4072 Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 8 Journal Issue Volume 8, Number 4.

Increased technological and pharmacological interventions in patient care when patient outcomes are uncertain have been linked to the escalation in moral and ethical dilemmas experienced by health care providers in acute care settings. Health care research has shown that facilities that are able to attract and retain nursing staff in a competitive environment and provide high quality care have the capacity for nurses to process and resolve moral and ethical dilemmas. This article reports on the findings of a systematic review (...) of the empirical literature (1980 — February 2007) on the effects of unresolved moral distress and poor ethical climate on nurse turnover. Articles were sought to answer the review question: Does unresolved moral distress and a poor organizational ethical climate increase nurse turnover? Nine articles met the criteria of the review process. Although the prevailing sentiment was that poor ethical climate and moral distress caused staff turnover, definitive answers to the review question remain elusive because there are limited data that confidently support this statement. (shrink)

Governing nursing conduct: the rise of evidence‐based practice Drawing on the Foucauldian concept of ‘governmentality’ to analyse the evidence‐based movement in nursing, we argue that it is possible to identify the governance of nursing practice and hence nurses across two distinct axes; that of the political (governance through political and economic means) and the personal (governance of the self through the cultivation of the practices required by nurses to put evidence into practice). The evaluation of nursing work through evidence‐based reviews (...) provides detailed information that may enable governments to target and instruct nurses regarding their work in the interest of preserving the health of the population as a whole. Political governance of the nursing population becomes possible through centralised discursive mechanisms, such as evidence‐based reviews that present nursing practice as an intelligible field whose elements are connected in a more or less systematic manner. The identity of the evidence‐based nurse requires the modern nurse to develop new skills and attitudes. Evidence‐based nursing is an emerging technology of government that judges nursing research and knowledge and has the capacity to direct nursing practice at both the political and personal level. (shrink)

The work of Michel Foucault, the French philosopher who was interested in power relationships, has resonated with many nurses who seek a radically analytical view of nursing practice. The purpose of this article is to explore ‘ethics’ through a Foucauldian lens, in a conceptual and methodological sense. The intention is to provide a useful framework that will help researchers critically to explore aspects of nursing practice that relate to the construction of the self, morality and identity, be that nurse or (...) patient related. The fundamentals of the research method of genealogy and the methods of ethics are reviewed. Using an example taken from the sexual health practice area, advice is given on how to structure data collection, incorporate interview data, avoid discourse determinism and measure resistance. (shrink)

In this analysis I apply a Foucauldian approach to ethics to examine the politically prescribed moral and ethical character required of carers of aged persons at home in Australia and the role of nurses in shaping these behaviours. The work that spousal carers provide, although often founded on love and/or obligation, has been formalized through a variety of policy initiatives and technologies that serve to construct the moral approach they must adopt. This shaping of conduct at the most personal level (...) takes place through the application of codes of behaviour policed largely by nurses. These codes redefine the mode of coexistence between an aged husband and wife and propose a new form of relationship that is derived from and supports policies of the deinstitutionalization of care services for elderly persons. In this way modern carer policy has drawn on knowledge and governance of the self to produce a morality of caring that is both authoritative and scientific. (shrink)

No Chance, No Value, or No Way: Reassessing the Place of Futility in Health Care and Bioethics Content Type Journal Article Pages 121-122 DOI 10.1007/s11673-011-9303-5 Authors Sarah Winch, School of Medicine, The University of Queensland, Brisbane, Australia Ian Kerridge, Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 8 Journal Issue Volume 8, Number 2.

The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants’ experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place’s moral climate as well as by two aspects of the mental health staff’s moral sensitivity. The (...) nurses’ experience of ‘moral burden’ or ‘moral support’ increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency. Copyright © 2011 by SAGE Publications. (shrink)

Objective Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment that they consider to be futile is sometimes provided at the end of a patient9s life. Design Semistructured in-depth interviews. Setting Three large tertiary public hospitals in Brisbane, Australia. Participants 96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration departments. Participants were recruited using purposive maximum variation sampling. (...) Results Doctors attributed the provision of futile treatment to a wide range of inter-related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk and poor communication skills. Second, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty and lack of information about patient wishes. Third, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the _main_ reasons for futile care. Conclusions Doctors believe that a range of factors contribute to the provision of futile treatment. A combination of strategies is necessary to reduce futile treatment, including better training for doctors who treat patients at the end of life, educating the community about the limits of medicine and the need to plan for death and dying, and structural reform at the hospital level. (shrink)

ObjectiveTo increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility.SettingThree tertiary hospitals in metropolitan Brisbane, Australia.DesignQualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic (...) analysis.ResultsDoctors’ perceptions of whether resource limitations were relevant to their practice varied, and doctors were more comfortable with explicit rather than implicit rationing. Several doctors incorporated resource limitations into their definition of futility. For some, availability of resources was one factor of many in assessing futility, secondary to patient considerations, but a few doctors indicated that the concept of futility concealed rationing. Doctors experienced moral distress due to the resource implications of providing futile treatment and the lack of administrative supports for bedside rationing.ConclusionsDoctors’ ability to distinguish between futility and rationing would be enhanced through regulatory support for explicit rationing and strategies to support doctors’ role in rationing at the bedside. Medical policies should address the distinction between resource limitations and futility to promote legitimacy in end-of-life decision making. (shrink)

SummaryMalaria is a major cause of under-five mortality in Mali and many other developing countries. Malaria control programmes rely on households to identify sick children and either care for them in the home or seek treatment at a health facility in the case of severe illness. This study examines the involvement of mothers and other household members in identifying and treating severely ill children through case studies of 25 rural Malian households. A wide range of intra-household responses to severe illness (...) were observed among household members, both exemplifying and contravening stated social norms about household roles. Given their close contact with children, mothers were frequently the first to identify illness symptoms. However, decisions about care-seeking were often taken by fathers and senior members of the household. As stewards of the family resources, fathers usually paid for care and thus significantly determined when and where treatment was sought. Grandparents were frequently involved in diagnosing illnesses and directing care towards traditional healers or health facilities. Relationships between household members during the illness episode were found to vary from highly collaborative to highly conflictive, with critical effects on how quickly and from where treatment for sick children was sought. These findings have implications for the design and targeting of malaria and child survival programming in the greater West African region. (shrink)

This volume unites Peter Winch's previously unpublished work on Baruch de Spinoza. The primary source for the text is a series of seminars on Spinoza that Winch gave, first at the University of Swansea in 1982 and then at King's College London in 1989. What emerges is an original interpretation of Spinoza's work that demonstrates his continued relevance to contemporary issues in metaphysics, epistemology and ethics, and establishes connections to other philosophers - not only Spinoza's predecessors such as (...) René Descartes, but also important 20th Century philosophers such as Ludwig Wittgenstein and Simone Weil. Alongside Winch's lectures, the volume contains an interpretive essay by David Cockburn, and an introduction by the editors. (shrink)

The case study presented by Winch and Sinnott (2011) shows not only how difficult it is for clinicians and researchers to identify conflicts of interest (COI), but also how damaging it can be when there are unin- formed and uncoordinated policy responses by senior administrators.

In Whose Interest? Content Type Journal Article Category Case Studies Pages 1-2 DOI 10.1007/s11673-012-9357-z Authors Linda Shields, School of Medicine, The University of Queensland, Brisbane, Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529.

Toward a Postmodernist View of Conflict of Interest Content Type Journal Article Category Case Studies Pages 1-2 DOI 10.1007/s11673-012-9359-x Authors Elise Smith, Doctorat en sciences humaines appliquées, option bioéthique, Programmes de bioéthique, Département de médecine sociale et préventive, Université de Montréal, C.P. 6128, succ. Centre-ville, Montréal, Québec, Canada H3C 3J7 Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529.

The Strange Case of Dr. B and Mr. Hide: Ethical Sensitivity as a Means to Reflect Upon One’s Actions in Managing Conflict of Interest Content Type Journal Article Category Case Studies Pages 1-3 DOI 10.1007/s11673-012-9360-4 Authors Marie-Josée Potvin, Programmes de bioéthique, Department of Social and Preventive Medicine, Université de Montréal, C.P. 6128, succ. Centre-ville, Montréal, Québec, Canada H3C 3J7 Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529.

Philosophical Investigations, Volume 45, Issue 4, Page 540-543, October 2022.

Two years ago, I was on a boat in the middle of the river that runs through Brisbane, Australia, with Sarah Winch, a medical ethicist at the University of Queensland. We were talking about the intersection of our professional work and our personal experiences of caregiving. Sarah's husband, Lincoln, had died at the age of forty‐eight, four months after a late‐stage diagnosis of kidney cancer. My friend Julia was the same age when she died, on November 18, (...) 2010, after living with breast cancer for seven years. Sarah asked me, “What was it like to write guidelines on end‐of‐life care while your best friend was dying?”. (shrink)

This article provides a history of private sector tracking technologies, examining how the advent of commercial surveillance centered around a logic of data capitalism. Data capitalism is a system in which the commoditization of our data enables an asymmetric redistribution of power that is weighted toward the actors who have access and the capability to make sense of information. It is enacted through capitalism and justified by the association of networked technologies with the political and social benefits of online community, (...) drawing upon narratives that foreground the social and political benefits of networked technologies. I examine its origins in the wake of the dotcom bubble, when technology makers sought to develop a new business model to support online commerce. By leveraging user data for advertising purposes, they contributed to an information environment in which every action leaves behind traces collected by companies for commercial purposes. Through analysis of primary source materials produced by technology makers, journalists, and business analysts, I examine the emergence of data capitalism between the mid-1990s and mid-2000s and its central role in the contemporary information economy. (shrink)

This article asks whether being a child is, all things considered, good or bad for children. I defend a predicament view of childhood, which regards childhood as bad overall for children. I argue that four features of childhood make it regrettable: impaired capacity for practical reasoning, lack of an established practical identity, a need to be dominated, and profound and asymmetric vulnerability. I consider recent claims in the literature that childhood is good for children since it allows them to enjoy (...) special goods that aren't available in adulthood, or which are harder to access in adulthood. I raise some difficulties for these claims. Then I argue that whatever version of these views survives my criticism will not establish that childhood is overall good for children. This is because the goods of childhood aren't significant enough to outweigh the bad features associated with being a child. I conclude by suggesting that the badness of childhood for children means that we are likely to owe more to children than to adults. (shrink)

Concerns that people would be disinclined to voluntarily undergo moral enhancement have led to suggestions that an incentivised programme should be introduced to encourage participation. This paper argues that, while such measures do not necessarily result in coercion or undue inducement (issues with which one may typically associate the use of incentives in general), the use of incentives for this purpose may present a taboo tradeoff. This is due to empirical research suggesting that those characteristics likely to be affected by (...) moral enhancement are often perceived as fundamental to the self; therefore, any attempt to put a price on such traits would likely be deemed morally unacceptable by those who hold this view. A better approach to address the possible lack of participation may be to instead invest in alternative marketing strategies and remove incentives altogether. (shrink)

Volume 20, Issue 7, July 2020, Page 86-88.

This article argues, contra-Derrida, that Foucault does not essentialize or precomprehend the meaning of life or bio- in his writings on biopolitics. Instead, Foucault problematizes life and provokes genealogical questions about the meaning of modernity more broadly. In The Order of Things, the 1974-75 lecture course at the Collège de France, and Herculine Barbin, the monster is an important figure of the uncertain shape of modernity and its entangled problems (life, sex, madness, criminality, etc). Engaging Foucault’s monsters, I show that (...) the problematization of life is far from a “desire for a threshold,” à la Derrida. It is a spur to interrogating and critiquing thresholds, a fraught question mark where we have “something to do.” As Foucault puts it in “The Lives of Infamous Men,” it an ambiguous frontier where beings lived and died and they appear to us “because of an encounter with power which, in striking down a life and turning it to ashes, makes it emerge, like a flash [...]. (shrink)

In this article I set out to trace some of the implications of recharging the political potency of nature in more-than-human terms. This shifts attention from a biopolitical focus on the inventiveness of the life sciences and what this means in terms of the emergence of ‘cyborg’ political subjects to an onto-political focus on the inventiveness of knowledge controversies and what these mean for techno-political practices. Specifically, the article examines the onto-politics of ‘natural’ hazard events and their capacity to force (...) thought in those affected by them, and so to place new demands on research practices in terms of rendering such events affective and amenable to political interrogation. I work these arguments through the demanding experimental ethos of the philosopher Isabelle Stengers, for whom scientific practices produce reliable knowledge claims only in so far as the questions they address are at risk of being redefined by the phenomena mobilized in them, and who extends this ethos to elaborate an understanding of, even a test for, an adequate political theory and practice. I do so with reference to a recent research experiment in which I collaborated with social and natural scientists and people affected by flooding in the UK. (shrink)

What is the best model of epistemic agency for virtue epistemology? Insofar as the intellectual and moral virtues are similar, it is desirable to develop models of agency that are similar across the two realms. Unlike Aristotle, the Stoics present a model of the virtues on which the moral and intellectual virtues are unified. The Stoics’ materialism and determinism also help to explain how we can be responsible for our beliefs even when we cannot believe otherwise. In this paper I (...) show how a neo-Stoic model of epistemic agency can address common objections to treating epistemic and moral agency similarly and allow a robust explanatory role for character in determining our actions and beliefs. The picture of epistemic responsibility that flows from this model also explains why we often deserve credit for our knowledge, while demonstrating that the truth of our beliefs is not something for which we are epistemically responsible. (shrink)

This article argues, contra-Derrida, that Foucault does not essentialize or pre-comprehend the meaning of life or bio- in his writings on biopolitics. Instead, Foucault problematizes life and provokes genealogical questions about the meaning of modernity more broadly. In The Order of Things, the 1974-75 lecture course at the Collège de France, and Herculine Barbin, the monster is an important figure of the uncertain shape of modernity and its entangled problems. Engaging Foucault’s monsters, I show that the problematization of life is (...) far from a “desire for a threshold,” à la Derrida. It is a spur to interrogating and critiquing thresholds, a fraught question mark where we have “something to do.” As Foucault puts it in “The Lives of Infamous Men,” it an ambiguous frontier where beings lived and died and they appear to us “because of an encounter with power which, in striking down a life and turning it to ashes, makes it emerge, like a flash [...].”. (shrink)

This volume contributes to the growing literature on the morality of procreation and parenting. About half of the chapters take up questions about the morality of bringing children into existence. The other half of the volume considers moral and political questions about adoption and parenting. This collection builds on existing literature by advancing novel perspectives on existing debates. It also raises new issues deserving of our attention.

Ecological weed management (EWM) is a scientifically established management approach that uses ecological patterns to reduce weed seedbanks. Such an approach can save organic farmers time and labor costs and reduce the need for repeated cultivation practices that may pose risks to soil and water quality. However, adoption of effective EWM in the organic farm community is perceived to be poor. In addition, communication and collaboration between the scientific community, extension services, and the organic farming community in the US is (...) historically weak. In order to uncover the most persistent obstacles to promoting effective weed management in organic agroecosystems, we use the mental models approach to generate an expert model based on interviews with experts (e.g., weed scientists, weed ecologists, and extension personnel) and theories from the behavioral sciences. The expert model provides two main insights: (1) EWM is a complex strategy that may cause farmers to use heuristics in management decisions and (2) the long-term benefits of EWM, rather than the risks, need to be emphasized in communication with and outreach to organic farmers. The basis for new research topics and outreach material that incorporates these insights from the expert model are discussed. We briefly explain how the expert model is an incomplete picture of on-farm practices, but provides the basis for the second step of our mental models research, the farmer interviews and farmer decision model development. (shrink)

This paper examines the pedagogical values inherent in various traditions of philosophy education, from the ancient Greeks to current practices in Ontario high schools, and asks whether our current educational practices are imparting the philosophical values we wish to bestow upon our learners. I compare the approaches of Socrates, Descartes, and Dewey on the nature of philosophy and the pedagogical frameworks they defend for transmitting the “spirit” of philosophy, and then examine the Ontario curriculum guidelines for the teaching of philosophy. (...) In past philosophical traditions, dynamic growth, free questioning, and social responsibility are considered essential to the practice of philosophy. Certain factors in today’s educational institutions limit students’ abilities to achieve those values, although the appeal to these values is the same. I end with recommendations for amendments to the Ontario curriculum expectations that would help put the philosophical development of the individual student more clearly at the centre of these guidelines. (shrink)

Cet article analyse le rôle des vêtements dans la métamorphose d’esclaves afro-américains en soldats de l’Union pendant la Guerre civile (1861-1865). Il explore la manière et la raison pour laquelle les uniformes militaires portent un tel poids narratif dans les portraits de ces hommes. Les textes, images, objets, gravures et photographies sont étudiés dans le contexte de la perception du corps au xixe siècle et des nouvelles théories de l’anthropologie physique et de la phrénologie. L’article souligne le rôle de ces (...) images dans la construction d’un discours cohérent sur la rédemption de l’esclavage et d’une catégorie « homme » plus inclusive, plus universelle, fondée sur le service militaire. (shrink)

Most learning models assume, either implicitly or explicitly, that the goal of learning is to acquire a complete and veridical representation of the world, but this view assumes away the possibility that pragmatic goals can play a central role in learning. We propose instead that people are relatively frugal learners, acquiring goal-relevant information while ignoring goal-irrelevant features of the environment. Experiment 1 provides evidence that learning is goal-dependent, and that people are relatively frugal when given a specific, practical goal. Experiment (...) 2 investigates possible mechanisms underlying this effect, and finds evidence that people exhibit goal-driven attention allocation, but not goaldriven reasoning. We conclude by examining how frugality can be integrated into Bayesian models of learning. (shrink)

Research on human causal learning has largely focused on strength learning, or on computational-level theories; there are few formal algorithmic models of how people learn causal structure from covariations. We introduce a model that learns causal structure in a local manner via prediction-error learning. This local learning is then integrated dynamically into a unified representation of causal structure. The model uses computationally plausible approximations of rational learning, and so represents a hybrid between the associationist and rational paradigms in causal learning (...) research. We conclude by showing that the model provides a good fit to data from a previous experiment. (shrink)

Escalating demands for limited food supplies at America’s food banks and pantries during the COVID-19 pandemic have raised ethical concerns underlying “first-come, first-served” distributions strategies. A series of model ethical principles are designed to guide ethical allocations of these resources to assure greater access among persons facing food insecurity.