Burnout syndrome and obesity are two growing conditions that affect employees’ health and company productivity. Recently, several studies have pointed to a possible relationship between both phenomena. However, such a relationship has not been clearly defined. This research analyzes the relationship between BS dimensions and body mass index, the latter being treated as a moderator variable among obese senior and middle managers in the Mexican maquiladora industry through a structural equation model. A total of 361 senior and middle managers completed (...) both the Maslach Burnout Inventory-General Survey [with emotional exhaustion, cynicism, and professional efficacy as subscale dimensions] and a sociodemographic questionnaire. The results showed a statistically significant relationship between EE and PE, with BMI acting as a moderator variable. The results showed that when BMI increases as a moderator variable, the strength of the relationship between EE and PE also changes. For example, although PE had a negative value of 0.14 before the moderator effect, the value increased up to 0.32 when the BMI was factored into the relationship. Therefore, maquiladora industries are being advised to increase their investments on the identification and prevention of employees’ EE and obesity. Such interventions would promote a better quality of life and could prevent economic losses resulting from poor employee performance. (shrink)

The recent push to extend physician-aid-in-dying (PAD) to psychiatric conditions has significantly altered the ethical landscape surrounding psychiatric judgments concerning treatment-refractory il...

Visual aids can improve comprehension of risks associated with medical treatments, screenings, and lifestyles. Do visual aids also help decision makers accurately assess their risk comprehension? That is, do visual aids help them become well calibrated? To address these questions, we investigated the benefits of visual aids displaying numerical information and measured accuracy of self-assessment of diagnostic inferences (i.e., metacognitive judgment calibration) controlling for individual differences in numeracy. Participants included 108 patients who made diagnostic inferences about three medical tests on (...) the basis of information about the sensitivity and false-positive rate of the tests and disease prevalence. Half of the patients received the information in numbers without a visual aid, while the other half received numbers along with a grid representing the numerical information. In the numerical condition, many patients --especially those with low numeracy-- misinterpreted the predictive value of the tests and profoundly overestimated the accuracy of their inferences. Metacognitive judgment calibration mediated the relationship between numeracy and accuracy of diagnostic inferences. In contrast, in the visual aid condition, patients at all levels of numeracy showed high-levels of inferential accuracy and metacognitive judgment calibration. Results indicate that accurate metacognitive assessment may explain the beneficial effects of visual aids and numeracy --a result that accords with theory suggesting that metacognition is an essential part of risk literacy. We conclude that well-designed risk communications can inform patients about health-relevant numerical information while helping them assess the quality of their own risk comprehension. (shrink)

ABSTRACT AIDS raises the moral problem of confidentiality because those in sexual contact with the patient may contract a life‐threatening and incurable disease. Medicine has a tradition in which a patient's condition is regarded as confidential information held by the doctor alone. In this case there is a clear moral inclination to inform those at risk from the disease. In most cases no problem will arise but when it does the moral justification for a violation of confidentiality comes into question. (...) Confidentiality is important because of our respect for certain human values and their importance to our patient. Where that patient acts so as to disregard the welfare of others with whom they are in close relationship, those values are lacking. This lack warrants a departure from our normal canons and provokes a suspension of normal moral privileges. The contention that any transgression, however slight, could be held to justify such a response posits a slope down which we, in fact, have no tendency to slide. (shrink)

Altered Conditions provides a bold new intervention into existing theories of the human body and its meanings in a variety of cultural contexts. By exploring the history of medical narratives, especially medical case histories, as well as the exciting work that has been done in feminist and lesbian and gay studies, Julia Epstein poses a number of provocative questions about the relations between bodies, selves, and identities. Epstein focuses on a number of diagnoses that shed light on what is at (...) stake when cultures regulate human bodies, including hermaphroditism, birth malformations, and AIDS. She pays special attention to the regulation of sexual minorities and women and looks carefully at the ways in which cultures attempt to define and control behaviors seen as threatening or subversive. (shrink)

The principle of individual medical confidentiality is one of the moral principles that Africa inherited unquestioningly from the West as part of Western medicine. The HIV/AIDS pandemic in Southern Africa has reduced the relevance of the principle of individual medical confidentiality. Individual medical confidentiality has especially presented challenges for practitioners among the Bantu communities that are well known for their social inter-connectedness and the way they value their extended family relations. Individual confidentiality has raised several unforeseen problems for persons living (...) with HIV/AIDS, ranging from stigma and isolation to feelings of dejection as it drives them away from their families as a way of trying to keep information about their conditions confidential. The involvement of family members in treatment decisions is in line with the philosophy of Ubuntu and serves to respect patients’ and families’ autonomy while at the same time benefiting the individual patient. (shrink)

Peter Singer and Peter Unger argue that moral decency requires giving away all one's “surplus” for the relief or prevention of “absolute poverty,” because not doing so is analogous to refusing to save a drowning child to avoid making one's clothes muddy. I argue that there is a crucial disanalogy between the two cases and, moreover, that there are four independent moral objections to their thesis: it is monomaniacal in ignoring the variety of morally worthy ideals and elevating self-sacrificial aid (...) to the global poor into the sole ideal; it is misanthropic in its indifference to the happiness of those it adjures to give; it is incompatible with integrity; it would have disastrous effects for the poor if it were generally adopted. I argue that genuine beneficence aims at creating or restoring the conditions that enable its beneficiaries to become self-sufficient creators themselves — creators of wealth and of meaningful and enjoyable lives. Small-scale beneficence is necessary for moral goodness, but large-scale beneficence is optional, so long as its absence is not due to a lack of regard for those in need. The uncharitable person violates the neo-Lockean non-waste proviso that we acquire or keep for ourselves and those we love as much, but only as much, as we can use or invest meaningfully or enjoyably, now or in the long run. But someone who invests all his resources in creating something of worth leads a morally worthy life even if he reserves nothing for large-scale charity. Both our capacity for beneficence, which bids us stretch out a hand to those in need, and our capacity for creation, which bids us reach for the stars, are important aspects of our humanity. The Singer-Unger ideal advocates not genuine beneficence but the profligate giving away of wealth to prolong lives, while failing to appreciate what makes life worth living. a Footnotesa I am grateful for helpful comments on this paper from Ellen Frankel Paul, Larry White (who commented on the paper at the 2005 conference of the Association for Private Enterprise Education), David Blumenfeld, and Garrett Cullity (whose comments from Australia were a wonderful example of voluntary international aid to a stranger). I would also like to thank Georgia State University, Bowling Green State University, and the Association for Private Enterprise Education for inviting me to present this paper, and the audiences at these presentations for their helpful discussion. Finally, I would like to thank Harry Dolan for his expert copyediting, which saved me from some embarrassing mistakes and infelicities. (shrink)

In the discussion of the responsibilities of society to the HIV infected and uninfected, a serious question seems to have been left out of the picture: To what extent are people who are not infected, have no special relationship to the infected and have no professional responsibilities for the care of AIDS patients under an obligation to come to the aid of people with the HIV? In this paper, I shall examine our responsibilities, as members of society, for the welfare (...) of others to whom we may or may not have a special relationship. I shall argue that those responsibilities flow from the conditions that structure our transactions with others; conditions that make such transactions possible. (shrink)

Recent publications by Pogge ( Global ethics: seminal essays. St. Paul: Paragon House 2008 ) and by Singer ( The life you can save: acting now to end world poverty. New York: Random House 2009 ) have resuscitated a debate over the justifiability of famine relief between Singer and ecologist Garrett Hardin in the 1970s. Yet that debate concluded with a general recognition that (a) general considerations of development ethics presented more compelling ethical problems than famine relief; and (b) some (...) form of development would be essential to avoiding the problems of growth noted by Hardin. Better than renewing the debate, we should recognize two points. First, food needs do indeed evoke a moral response that is more direct and compelling than the philosophical positions often generated to rationalize a duty to bring aid. As such the argument for feeding hungry people cannot be generalized into a paradigm for development ethics without distortions that undercut the morally valid elements in Singer’s original argument. Second, contrary to prevailing assumptions in present day development ethics, food aid and famine relief continue to be important priorities for international agencies, notably the World Food Program. Emergency food assistance, the nominal topic of Singer’s original article, thus is an important issue for agricultural as well as development ethics, though one that should indeed be seen as distinct from more complex duties to address the conditions of chronic poverty and underdevelopment. (shrink)

This paper is not about the medical condition of AIDS. Nor is it about the history of the condition since it was first reported in Atlanta, Georgia in 1981. It looks rather, at the catalogue of legislative and other legal responses to the spread of AIDS. The paper analyses the AIDS condition in its historical context. The hysteria accompanying the outbreak of AIDS is contrasted with the similar hysteria associated with other previous epidemics experienced in Australia over the past two (...) centuries. The paper categorises the responses of lawmakers to the condition, according to the approach taken; from 'full blast', through 'moderate heat' to 'low key' or an attempt to avoid or minimise legal intervention. It is suggested that the appropriate response should depend upon such factors as the present magnitude of the condition, its likely future course, the availability of cures and protections against its spread and objectives being sought by intervention. Unless these factors are taken into account gross over-reaction can occur, causing social disruption and much personal injustice. (shrink)

« Je t’aime moi non plus », le titre de la fameuse chanson de Gainsbourg reflète de manière exquise ce que la vie a de beau et d’amer à la fois. A défaut de traiter d’amour, cet ouvrage analyse les méandres de l’aide à sens unique. L’altruisme, ce comportement de don sans attente de retour de service, est abordé ici de manière scientifique et philosophique plutôt que poétique et littéraire. Un objectif est d’en traquer les mécanismes sous-jacents, ceux qui échappent (...) à tout romantisme et se traduisent souvent en calculs de coûts et bénéfices. Il s’agit également d’approfondir les diverses manières de comprendre et de pratiquer l’altruisme. Souvent considéré comme une des plus grandes vertus humaines, l’objet de nombreux écrits philosophiques et psychologiques, l’altruisme peut-il se trouver chez les abeilles et les marmottes ? Posez la question à un biologiste de l’évolution et il vous répondra « Mais oui, évidemment ! ». A première vue, une telle réponse est consternante mais nous verrons qu’à y regarder de plus près, les philosophes et les biologistes ne parlent pas exactement de la même chose en utilisant le même terme. L’hétérogénéité des disciplines intéressées à l’altruisme et des contextes théoriques dans lesquels il est utilisé en ont fait une notion extrêmement complexe et difficile à saisir. Au sein des différentes sciences sociales et du vivant, l’altruisme est un élément pivot dans trois débats dont cet ouvrage prend le temps de retracer les contours. Tantôt, l’altruisme se profile en danger (apparent) pour la théorie de l’évolution darwinienne (chap. 1), tantôt, il sert de cheval de bataille dans la croisade contre l’idéal de l’homo economicus si souvent prôné en économie (chap. 2 et 3), tantôt il est une énigme à découvrir dans les méandres de nos motivations intimes (chap. 3). Dans le cadre de ces différents débats, la notion d’altruisme prend des significations sensiblement différentes. Pour en rendre compte, l’ensemble de l’ouvrage s’articule autour d’une triple distinction fondamentale : l’altruisme peut être compris au sens biologique, comportemental ou psychologique. Chacune de ces notions est utilisée dans un contexte spécifique au sein de sciences qui ont leurs propres traditions et leurs propres débats internes. La structure de l’ouvrage est organisée en fonction de cette triple distinction. Le premier chapitre est consacré à l’altruisme biologique, définit en termes de valeur de survie et de reproduction (fitness) : un comportement est altruiste s’il a pour effet d’augmenter la fitness d’autrui aux dépens de sa propre fitness. L’observation de comportements altruistes au sein du monde animal a posé un des plus grands défis à la théorie de l’évolution depuis la publication de l’Origine des espèces. Des générations de biologistes se sont attelés à la tâche d’expliquer comment un comportement qui augmente la fitness biologique d’autres organismes aux dépends de la fitness de l’agent a pu être sélectionnée au fil de l’évolution. Nous verrons que c’est grâce aux travaux de William Hamilton et d’autres que cette difficulté a pu être résolue. Le deuxième chapitre retrace les attaques d’une frange d’économistes (supportés dans leur effort critique par des théoriciens des jeux et anthropologues évolutionnistes), contre le modèle classique de l’homo economicus. Leur objectif est de montrer que des personnes ordinaires ne se comportement souvent pas en maximisateurs rationnels de leurs gains propres, comme le prédirait la théorie économique néo-classique. Dans le cadre de ce débat, c’est du comportement social spécifiquement humain et plus particulièrement de l’altruisme humain dont il est question. Le terme d’altruisme est alors utilisé dans un sens plus lâche que ne le font les biologistes ; ce que l’on appellera l’altruisme comportemental comprend les actions coûteuses pour l’agent et avantageuses pour autrui. La particularité humaine fournira également l’occasion de traiter la délicate question des rapports entre l’évolution génétique et la culture. Nous verrons que l’étude du comportement animal fournit les premiers éléments d’explication de l’altruisme humain, mais ce dernier ne peut être pleinement compris qu’au terme d’une analyse qui tient compte des capacités qui nous sont propres. Cette analyse nous permettra de saisir pourquoi les êtes humains sont à la fois plus sociaux et plus opportunistes (la contradiction n’est qu’apparente) que les autres espèces animales. Malgré leurs différences, les versions biologique et comportementale de l’altruisme sont très proches au sens où elles traitent des conséquences de comportements. Ces notions ne reflètent qu’imparfaitement la conception ordinaire que nous nous faisons de l’altruisme. L’altruisme tel qu’il est utilisé dans le langage courant correspond davantage à l’image que s’en font les philosophes et les psychologues. Pour déceler les actions altruistes, ces derniers se demandent généralement si elles ont été causées par un motif dirigé vers le bien d’autrui. En ce sens, on parle d’altruisme psychologique qui réfère aux causes plutôt qu’aux effets des actions d’aide. Le troisième chapitre est consacré aux débats qui font rage autour de la question de savoir si les êtres humains sont capables d’agir de manière altruiste psychologique, c’est-à-dire en fonction de motifs exclusivement dirigés vers le bien-être d’autrui. Nous verrons à quel point cette tâche est ardue à moins d’accepter de reformuler la question en termes de motivation primaire à l’action. Au terme de l’analyse, il apparaitra que les trois notions d’altruisme se croisent sans se recouper dans un enchevêtrement de liens plus ou moins complexes. Nous verrons par exemple que l’altruisme biologique (voire comportemental) pourrait bien être une condition nécessaire à l’évolution de l’altruisme psychologique ; des liens tangibles peut ainsi être tissés entre ces différentes notions. Les diverses approches du phénomène de l’altruisme retracées dans cet ouvrage fournissent également des clefs de compréhension des méandres du comportement social animal et plus particulièrement humain. De manière générale, sans apporter de solutions toutes faites, cet écrit peut servir de guide sémantique et initie le lecteur à une littérature interdisciplinaire émergeante, foisonnante, passionnante quoique encore souvent parsemée de confusions et de contradictions. (shrink)

Courts and commentators are notoriously puzzled about the mens rea standards for complicity. Accomplices intend to aid, but what attitude need they have towards the crimes that they aid? This paper both criticizes extant accounts of the mens rea of complicity and offers a new account. The paper argues that an intention can commit one to an event’s occurrence without committing one to promoting the event, or making it more likely to take place. Under the proposed account of the mens (...) rea of complicity, an accomplice must have an intention that commits him to the crime’s occurrence, but need not commit him to making it more likely that the crime occurs. The paper traces the implications of this view both for several difficult complicity cases, and for ongoing debates among philosophers of action about the necessary and sufficient conditions of joint agency. (shrink)

The article examines the record of compliance with the UN Committee against Torture’s decisions in individual complaints cases. Theoretically, I expect that compliance will be the outcome of a combination of normative and rationalist factors: States committed to human rights protection will comply even in the absence of enforcement but only as long as compliance costs remain relatively low. Using a data set covering all adverse decisions issued until 2018 and information on their compliance status, I employ fuzzy-set qualitative comparative (...) analysis to identify necessary and sufficient conditions for the outcomes of compliance and noncompliance. The analysis reveals that the conditions tested—liberal democracy, nonuse of political terror, violation type, and strong civil society—are in part individually (near-)necessary and jointly sufficient for compliance, while the presence of their complements is consistent with noncompliance. The Committee against Torture thus appears to be able to elicit (some) state compliance with its decisions, if mostly only with respect to certain kinds of states and select types of violations. (shrink)

Arguments for the provision of foreign aid to help relieve the blight of developing countries have traditionally centred on obligations of benevolence and a duty to help those less fortunate.1 However, the War on Terror has resulted in a significant shift in how foreign aid is perceived. International prosperity and stability are now recognized as key elements in a fight to ameliorate the conditions that give rise to terrorism. Public support for foreign aid in general, normally unpopular, has increased since (...) 11 September 2001 due to greater public understanding of its role in combating terrorism.2 In particular, the need to address attitudes of foreign civilians toward the United States has become more widely recognized as a key component of efforts to reduce the ferment of the terrorist mindset. These strategies have assumed particular importance in light of the non-traditional nature of the threat posed by contemporary terrorism: a threat posed not by states or armies, but by individuals and groups who blend into, garner both the implicit and explicit support of, and are recruited from general civilian populations. (shrink)

Critics of medical aid in dying (MAID) often argue that it is impermissible because background social conditions are insufficiently good for some persons who would utilize it. I provide a critical evaluation of this view. I suggest that receiving MAID is a sort of “hard choice,” in that death is prima facie bad for the individual and only promotes that person’s interests in special circumstances. Those raising this objection to MAID are, I argue, concerned primarily about the effects of injustice (...) on hard choices. I show, however, that MAID and other hard choices are not always invalidated by injustice and that what matters is whether the injustice can be remediated given certain constraints. Injustice invalidates a hard choice when it can, reasonably, be remedied in a way that makes a person’s life go better. I consider the implications of this view for law and policy regarding MAID. (shrink)

Canada’s population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who (...) usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs’ experiences of ethically challenging situations is warranted.We conducted a phenomenological study to access the lived experience of HCAs (N=12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care. (shrink)

Why do some donor governments pursue international development through recipient governments, while others bypass such local authorities? Weaving together scholarship in political economy, public administration and historical institutionalism, Simone Dietrich argues that the bureaucratic institutions of donor countries shape donor–recipient interactions differently despite similar international and recipient country conditions. Donor nations employ institutional constraints that authorize, enable and justify particular aid delivery tactics while precluding others. Offering quantitative and qualitative analyses of donor decision-making, the book illuminates how donors with neoliberally (...) organized public sectors bypass recipient governments, while donors with more traditional public-sector-oriented institutions cooperate and engage recipient authorities on aid delivery. The book demonstrates how internal beliefs and practices about states and markets inform how donors see and set their objectives for foreign aid and international development itself. It informs debates about aid effectiveness and donor coordination and carries implications for the study of foreign policy, more broadly. (shrink)

This paper urges the importance of including conditional proof as an inference rule in the teaching of elementary symbolic logic. The paper explains how to make clear to students that conditional proof is valid. This is done by a little proof that shows that hypothetical syllogism (or the chain rule) is both intuitively valid yet redundant. Teaching conditional proof not only aids in a deeper understanding of the meaning of “if” but also provides a strong reminder to (...) the student that they have not proved that the conclusion is true but instead have shown that the conclusion follows from the premises. (shrink)

The psychosocial morbidity associated with HIV infection and responses to such infection may exceed morbidity associated with medical sequelae of such infection. This paper argues that negative judgements on those with HIV infection or in groups associated with such infection will cause avoidable psychological and social distress. Moral judgements made regarding HIV infection may also harm the common good by promoting conditions which may increase the spread of HIV infection. This paper examines these two lines of argument with regard to (...) the ethical aspects of psychological bases of health care, clinical contact, public perceptions of AIDS and the comparative perspective. It is concluded that the psychosocial aspects of HIV infection impose ethical psychological, as well as medical, obligations to reduce harm and prevent the spread of infection. (shrink)

Arguments for the provision of foreign aid to help relieve the blight of developing countries have traditionally centred on obligations of benevolence and a duty to help those less fortunate.1 However, the War on Terror has resulted in a significant shift in how foreign aid is perceived. International prosperity and stability are now recognized as key elements in a fight to ameliorate the conditions that give rise to terrorism. Public support for foreign aid in general, normally unpopular, has increased since (...) 11 September 2001 due to greater public understanding of its role in combating terrorism.2 In particular, the need to address attitudes of foreign civilians toward the United States has become more widely recognized as a key component of efforts to reduce the ferment of the terrorist mindset. These strategies have assumed particular importance in light of the non-traditional nature of the threat posed by contemporary terrorism: a threat posed not by states or armies, but by individuals and groups who blend into, garner both the implicit and explicit support of, and are recruited from general civilian populations. (shrink)

In her classic 1993 article, “The Struggle for the Soul of Health Insurance,” Deborah Stone contrasted the principle of mutual aid—“the essence of community” in the face of sickness—and the principle of actuarial fairness, under which “each person should pay for his own risk.” Stone claimed that “in most societies sickness is widely accepted as a condition that should trigger mutual aid,” while in the United States, a competitive insurance industry fosters in people “a sense of their difference, rather than (...) their commonalities, and their responsibility for themselves only, rather than their interdependence,” leading to the fragmentation of “communities into ever‐smaller, more homogeneous groups” and “the destruction of mutual aid.” The United States has, as Stone observes, long been an outlier in its approach to financing care for sickness. Over the past half century, we have developed mutual aid‐based programs to care for some, but most Americans have had to pay the “actuarially fair” cost of their care, either as individuals or as employee groups. Mutual aid has existed only on a limited scale. The Affordable Care Act is the most comprehensive attempt to date to remedy this situation. (shrink)

Based on an original interpretation of the core concepts in Nietzsche’s thought, and on their subsequent overcoming, this book embodies a radically new perspective that in essence reconsiders, upon grounded ontological premises and revealed anthropological evidences, both the notions of human and superhuman as still bound to a prevailing standpoint of impotence and limitation. The chief themes of metaphysics, from being to becoming, from entity to identity are all dealt with in the leading terms of the category power and of (...) its dialectical self-negation to inhere in parallel within a far more extended view of the human respecting a dualist assumption and the unfathomable spatio-temporal vastness of the Real in which the phase of man is but infinitesimal. It is supported by more than 500 notes and a glossary with more than 60 key terms, each carefully explained. References are contained to authors spanning millennia and in several fields of knowledge. Narrative suggestions are also included, serving as an aid to the comprehension of the exposition to follow in compliance with the underlying mythical aspect of the argument. A challenge to existing concepts, this book introduces the reader to the actual existence of a human reality which exceeds the hitherto known and considered from whatever point of view and which has remained latent and indistinct under the form of myths, from the dawn of history until nowadays mass media culture as a need of power in an intrinsically powerless human world. Revealed in its necessary function of actual presence antithetical to the limitedness of man, and referred accordingly to the comprehensive meaning of power, this condition radically opposes any limitation thus far ascribed to the human. (shrink)

OBJECTIVES: To ascertain which conditions nurses believe should be in a law allowing active voluntary euthanasia (AVE). DESIGN: Survey questionnaire posted to registered nurses (RNs). SETTING: Australian Capital Territory (ACT) at the end of 1996, when active voluntary euthanasia was legal in the Northern Territory. SURVEY SAMPLE: A random sample of 2,000 RNs, representing 54 per cent of the RN population in the ACT. MAIN MEASURES: Two methods were used to look at nurses' opinions. The first involved four vignettes which (...) varied in terms of critical characteristics of each patient who was requesting help to die. The respondents were asked if the law should be changed to allow any of these requests. There was also a checklist of conditions, most of which have commonly been included in Australian proposed laws on AVE. The respondents chose those which they believed should apply in a law on AVE. RESULTS: The response rate was 61%. Support for a change in the law to allow AVE was 38% for a young man with AIDS, 39% for an elderly man with early stage Alzheimer's disease, 44% for a young woman who had become quadriplegic and 71% for a middle-aged woman with metastases from breast cancer. The conditions most strongly supported in any future AVE law were: "second doctor's opinion", "cooling off period", "unbearable protracted suffering", "patient fully informed about illness and treatment" and "terminally ill". There was only minority support for "not suffering from treatable depression", "administer the fatal dose themselves" and "over a certain age". CONCLUSION: Given the lack of support for some conditions included in proposed AVE laws, there needs to be further debate about the conditions required in any future AVE bills. (shrink)

Le concept de conflit revêt divers aspects. Entre les litiges, les violences, les différends, les désaccords, les guerres, il importe de définir les éléments de la conflictualité et le caractère institutionnel des recherches en matière de gestion et de résolution des conflits de nos jours. Néanmoins, nous sommes parvenus à percevoir que la clé du succès des résolutions des conflits pour une paix durable réside dans l’expérience humaine de la culpabilité et du pardon. Ce n’est certes pas des éléments nouveaux (...) pour les spécialistes et les diplomates en matière de gestion des conflits. Cependant, Ces deux notions sont reléguées au second plan au profit de compromis et de mesures coercitives à l’encontre des factions en conflits. Notre vision de la résolution des conflits est que sans la mise en exergue de l’expérience de la culpabilité et du pardon, les peuples vivront dans un conflit perpétuel qu’ils transmettront aux générations futures : la haine durable (sustainablehate). Est-il possible d’institutionnaliser le pardon et de mener des actions conduisant à une véritable culpabilité collective et individuelle préalable à toute réconciliation durable des peuples? La nature et la fréquence de nos conflits obligent à reconsidérer les méthodes d’approche jusqu’ici utilisées. En effet, c’est ce que tentent de faire certaines commissions pour la réconciliation appelée pour la plupart « Dialogue – Vérité – Réconciliation ; Dialogue – Justice – Réconciliation ; justice et paix, etc ». où les belligérants, les bourreaux et les victimes sont invités à l’aveu, à la vérité et au pardon pour un re-vivre ensemble. Mais dans l’espace d’un processus de réconciliation engagé à travers desdites commissions, les ballets de confessions aussi bien que les sentiments de victimisation se succèdent avant à l’arrière fond l’amnistie pour les bourreaux et l’octroi du pardon de la part des victimes. Cela, parait peu convainquant pour la raison que ces commissions sont en majeure partie installées par les vainqueurs du moment. Dans une certaine Afrique surtout, ces derniers (les vainqueurs) sont aidés par des alliés occidentaux de hauts niveaux. Il s’agit alors de processus où la paix est provisoire et se maintient au bout de la force ; et où les bourreaux sont toujours les autres. (shrink)

PurposeTo explore and describe a trained communication partner’s use of responsive strategies in dyadic interaction with adults with Rett syndrome.IntroductionResponsive partner strategies facilitate social, communicative, and linguistic development. The common feature is that the communication partner responds contingently to the other’s focus of attention and interprets their acts as communicative. Research on responsive partner strategies that involves individuals with significant communication and motor disabilities remains sparse. The same applies to if, and how, the use of communication aids impacts on the (...) partner’s use of responsive strategies.Materials and methodsA therapist, trained in responsive partner strategies and aided communication interacted during 14 sessions with each of three participants. The participants were adults with Rett syndrome. A gaze-controlled device and responsive strategies were used during all sessions. The Responsive Augmentative and Alternative Communication Style scale was used to assess the partner’s responsiveness. RAACS consists of 11 items including ratings of to what extent the partner is being attentive to, confirms, and expands the individual’s communication. During eight of the 14 sessions, aided AAC Modelling was also used, i.e., the communication partner pointed at symbols on the gaze-controlled device while interacting. In addition to RAACS, each time the communication partner confirmed or expanded on communication when the participants used the gaze-controlled device and the participants did not use the gaze-controlled device was counted. Descriptive statistics were used to present the results. Non-parametric tests were used to compare means between the two conditions and between participants.ResultsInter-rater agreement for the different RAACS items ranged from 0.73 to 0.96 and was thus found to be fair to excellent. The communication partner’s use of responsive strategies varied when communicating with different participants and the scores were higher when aided AAC modeling was used. The communication partner’s number of responses and use of responsive strategies were higher when the participants communicated through a gaze-controlled device.ConclusionThe communication partner’s use of responsive and scaffolding strategies is not a fixed construct but varies in interactions with different non-speaking persons. The same is true whether the non-speaking person uses a gaze-controlled device with digitized speech or not. (shrink)

The purpose of this article is threefold. First, it aims to delineate the flow of resources and the claims on those resources within the humanitarian aid system by locating task structures and functional units across the aid chain. Second, it draws on this account to highlight tensions in the system. Different stations in the organisational process are conditioned by the tasks assigned to them, how those tasks are anchored in a moral economy, and their historical interrelations. Third, it explores how (...) aid organisations are perceived by experts in different parts of the aid chain. Four key agents were invited to recount their work experiences. We then consider how the outlook of the interviewees was shaped by their place in the aid chain. The interviews are an inventory of experiences, a preliminary corroboration of the organisational analysis that preceded them, and a source of future hypotheses. (shrink)

This paper theorizes that the effect of human rights violations on US economic aid is conditioned by the salience of US national security concerns. National security concerns will be more salient in situations where recipients contribute to maintaining US security and in temporal eras when the USA is perceived as being under increased external threat. As the relational and temporal salience of national security increases, any negative effect of human rights violations on US economic aid should decrease. I test this (...) hypothesis by examining US economic aid allocations to states from 1977 to 2005. The results show that the salience of national security concerns present in the US-recipient relationship does condition the relationship between human rights violations and US economic aid. There are also significant differences between different temporal eras of US foreign aid allocation. Future work should address how conflicts between interests and values in US foreign policy are negotiated. (shrink)

Context: In most jurisdictions where medical-aid-in-dying is available, this option is reserved for individuals suffering from incurable physical conditions. Currently, in Canada, people who have a mental illness are legally excluded from accessing MAiD. Methods: We developed a questionnaire for mental health care providers to better understand their perspectives related to ethical issues in relation to MAiD in the context of severe and persistent suffering caused by mental illness. We used a mixed-methods survey approach, using a concurrent embedded model with (...) both closed and open-ended questions. Findings: 477 healthcare providers from the province of Québec completed the questionnaire. One third of the sample were nurses, one quarter psychologists and one quarter psycho-educators. Nearly half of the respondents considered that people with a severe mental illness should be granted the right to opt for MAiD as a way to end their suffering. Respondents were more likely to feel comfortable listening to the person and participating in discussions related to MAiD for a mental illness than offering care or the means for the person to access MAiD. Most reported that they had not received adequate/sufficient training, education or preparation in order to address ethical questions surrounding MAiD. Conclusions: The findings highlight how extending MAiD to people with a mental illness would affect daily practices for mental healthcare providers who work directly with people who may request MAiD. The survey results also reinforce the need for adequate training and professional education in this complex area of care. (shrink)

This is the fourth paper in the invited collection. Shotwell examines the work of direct-action activists as forms of medical activism that express a non-reductionist and complex intersectional science and technology practice, bridging lay and professional medical contexts. Shotwell draws on Lorraine Code’s generative theory of the importance of “ecological thinking” as one way to practice what she calls “epistemic responsibility,” and to think about the varied and complex early responses of activists in Canada to AIDS. Activists made wide-ranging, theoretically (...) sophisticated, and socially significant interventions in how AIDS manifested in Canada; their interventions manifested a kind of political work welcoming to unpredictable and emergent medical and social situations. Three preliminary insights are offered, from an ongoing research project investigating the history of AIDS activism in the Canadian context: the usefulness of Code’s conception of the social imaginary for understanding how calcified social relations shape and limit the conditions for responsible knowing; the importance of recognizing the communal and social nature of knowledge as a key piece of epistemic responsibility, articulated in terms of collective epistemic privilege; and the possibility for practices of epistemic responsibility to create virtuous epistemic effects beyond what is known or intended by particular agents. (shrink)

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The world is riddled with human suffering, poverty, and destitution. In the face of this moral tragedy, the least that the global wealthy can do is try to support aid programs aimed at relieving the plight of the very poor. Many political leaders, pop stars, and religious personalities have realized this, and routinely urge us to be more sensitive to the conditions of the distant needy. Giving aid thus seems to be one of the most important moral imperatives of our (...) time. (Published: 22 June 2011) Citation: Ethics & Global Politics, Vol. 4 , No. 2, 2011, pp. 125-134. DOI: 10.3402/egp.v4i2.7220. (shrink)

A previous study demonstrated that consonant recognition improved significantly in normal hearing listeners when useful frequency and time ranges were intensified by 6 dB. The goal of this study was to determine whether bilateral cochlear implant and bilateral hearing aid users experienced similar enhancement on consonant recognition with these intensified spectral and temporal cues in noise. In total, 10 BCI and 10 BHA users participated in a recognition test using 14 consonants. For each consonant, we used the frequency and time (...) ranges that are critical for its recognition, identified from normal hearing listeners. Then, a signal processing tool called the articulation-index gram was utilized to add a 6 dB gain to target frequency and time ranges. Consonant recognition was monaurally and binaurally measured under two signal processing conditions, unprocessed and intensified target frequency and time ranges at +5 and +10 dB signal-to-noise ratio and in quiet conditions. We focused on three comparisons between the BCI and BHA groups: AI-Gram benefits, enhancement in binaural benefits via the AI-Gram processing, and reduction in binaural interferences via the AI-Gram processing. The results showed that the mean AI-Gram benefit was significantly improved for the BCI and BHA groups. However, the mean binaural benefit was not improved after AI-Gram processing. Individual data showed wide ranges of the AI-Gram benefit and binaural benefit for both groups. Individual data also showed a decrease in binaural interference in both groups after AI-Gram processing. These results suggest that the frequency and time ranges, intensified by the AI-Gram processing, contribute to consonant enhancement for monaural and binaural listening and both BCI and BHA technologies. The intensified frequency and time ranges helped to reduce binaural interference but contributed less to the synergistic binaural benefit in consonant recognition for both groups. (shrink)

Common sense suggests that if a war is unjust, then there is a strong moral reason not to contribute to it. I argue that this presumption is mistaken. It can be permissible to contribute to an unjust war because, in general, whether it is permissible to perform an act often depends on the alternatives available to the actor. The relevant alternatives available to a government waging a war differ systematically from the relevant alternatives available to individuals in a position to (...) contribute to the war. Hence the conditions determining whether it is permissible for a government to wage a war often differ from the conditions determining whether it is permissible for others to promote that war. This difference is manifest most often in unjust wars with putatively humanitarian aims—an increasingly common type of war. (shrink)

This paper theorizes that the effect of human rights violations on US economic aid is conditioned by the salience of US national security concerns. National security concerns will be more salient in situations where recipients contribute to maintaining US security and in temporal eras when the USA is perceived as being under increased external threat. As the relational and temporal salience of national security increases, any negative effect of human rights violations on US economic aid should decrease. I test this (...) hypothesis by examining US economic aid allocations to states from 1977 to 2005. The results show that the salience of national security concerns present in the US-recipient relationship does condition the relationship between human rights violations and US economic aid. There are also significant differences between different temporal eras of US foreign aid allocation. Future work should address how conflicts between interests and values in US foreign policy are negotiated. (shrink)

Nietzsche's vision of the 'overman' continues to haunt the postmodern imagination. His call that 'man is something that must be overcome' can no longer be seen as simple rhetoric. Our experiences of the hybrid realities of artificial life have made the 'transhuman' a figure that looks over us all. Inspired by this vision, Keith Ansell Pearson sets out to examine if evolution is 'out of control' and machines are taking over. In a series of six fascinating perspectives, he links Nietzsche's (...) thought with the issues at stake in contemporary conceptions of evolution from the biological to the technological. _Viroid Life; Perspectives on Nietzsche and the Transhuman Condition_ considers the hybrid, 'inhuman' character of our future with the aid of Nietzsche's philosophy. Keith Ansell Pearson contrasts Nietzsche and Darwin before introducing the more recent figures such as Giles Deleuze and Guy Debord to sketch a new thinking of technics and machines and stress the ambiguous character of our 'machine enslavement'. (shrink)

Se realizó una investigación cualitativa, durante noviembre de 2013 a noviembre de 2015 con el objetivo de mostrar un protocolo de salud como tecnología social para la promoción y prevención de las manifestaciones oftalmológicas en pacientes con VIH/sida. Se utilizaron métodos teóricos y empíricos los cuales permitieron conocer antecedentes del problema a investigar, realizar acciones y caracterizar el fenómeno en estudio. El protocolo constituye una tecnología social, debido a que está compuesto por normas y procedimientos para la conducción de un (...) proceso social no relacionado con la esfera productiva. El diseño de esta tecnología social propicia un adecuado diagnóstico, tratamiento y seguimiento de las enfermedades oculares en pacientes con VIH/sida, sustentado en la teoría del conocimiento. A qualitative investigation was carried out during November 2013 to November 2015 with the objective of developing a protocol as social technology for the promotion and prevention of ophthalmologic manifestations in patients with HIV/AIDS. Theoretical and empirical methods that allowed knowing the antecedents of the problem under investigation, to carry out actions and to characterize the studied phenomenon, were used. The protocol constitutes a social technology, because it is composed by norms and procedures for the conduction of a social process that is not related with the productive area. The design of this social technology favors an adequate diagnosis, treatment and follow-up of eye conditions in patients with HIV/ AIDS, based on the theory of knowledge. (shrink)

Auditory scene analysis is an elementary aspect of music perception, yet only little research has scrutinized auditory scene analysis under realistic musical conditions with diverse samples of listeners. This study probed the ability of younger normal-hearing listeners and older hearing-aid users in tracking individual musical voices or lines in JS Bach's The Art of the Fugue. Five-second excerpts with homogeneous or heterogenous instrumentation of 2–4 musical voices were presented from spatially separated loudspeakers and preceded by a short cue for signaling (...) the target voice. Listeners tracked the cued voice and detected whether an amplitude modulation was imposed on the cued voice or a distractor voice. Results indicated superior performance of young normal-hearing listeners compared to older hearing-aid users. Performance was generally better in conditions with fewer voices. For young normal-hearing listeners, there was interaction between the number of voices and the instrumentation: performance degraded less drastically with an increase in the number of voices for timbrally heterogeneous mixtures compared to homogeneous mixtures. Older hearing-aid users generally showed smaller effects of the number of voices and instrumentation, but no interaction between the two factors. Moreover, tracking performance of older hearing aid users did not differ when these participants did or did not wear hearing aids. These results shed light on the role of timbral differentiation in musical scene analysis and suggest reduced musical scene analysis abilities of older hearing-impaired listeners in a realistic musical scenario. (shrink)

Recent scholarly and practitioner research on the work of non-governmental organizations has been concerned with questions about the moral legitimacy of humanitarian aid in settings of armed conflict. At issue is the extent to which NGO activities are said to affect the conduct and outcome of warfare, thereby potentially implicating humanitarian aid in the partisan interests which it has traditionally eschewed as a condition of its legitimacy. This paper explores how such issues are taken up in the explanations offered by (...) humanitarian aid operatives in descriptions of the work they carry out in settings of armed conflict. Drawing on a corpus of conversational material recorded in open-ended interviews with representatives of various NGOs that operate in Israel and the Occupied Palestinian Territories, I examine how speakers work to make themselves accountable to demands for sympathetic affiliation with the losing parties in the Palestinian-Israeli conflict while maintaining a non-aligned stance relative to the partisan considerations that animate that conflict’s conduct. Both in first-hand narrative accounts of personal transformation and in descriptions of contrastive examples where professional colleagues are said to maintain a too-sympathetic affiliation with the partisan concerns of the Palestinian population whose needs they service, speakers work to provide for the legitimacy of their professional activities in the context of otherwise conflicting demands for moral accountability. (shrink)

La réflexion philosophique, dont l'ouverture à l'univers dans lequel nous nous découvrons - avec une acuité proportionnelle à un étonnement renouvelé - n'a pas de limites, n'en est que plus tributaire des sciences et des techniques, des arts et de multiples activités qui régissent plus ou moins fructueusement notre expérience. Or, au sein des sciences humaines, privilégiées pour éclairer une condition que nous ne saurions cesser d'interpréter, peu d'oeuvres du dernier siècle auront enrichi en le précisant notre être-au-monde, comme la (...) théorie linguistique de Gustave Guillaume, assez solitaire, et les recherches multiformes de Jean Piaget - où la psychologie de l'enfant a souvent occulté la visée épistémologique et son enracinement biologique (cf Biologie et connaissance, 1967) et ses prolongements pédagogiques, voire éthiques. Le Cinquantenaire et le Trentenaire de leur disparition appelaient un hommage d'autant plus impératif qu'ils sont restés marginaux ou ignorés dans les milieux philosophiques, malgré la centralité de leurs élucidations. Leur commune orientation génétique et structurale n'ayant suscité aucun échange, pendant la contemporanéité de publications d'un tiers de siècle (1923-1960), mesurer leur complémentarité s'impose d'autant plus. S'ils peuvent aider à repenser la condition humaine, c'est qu'ils auront contribué à dissiper le "mystère de la pensée". L'un cherchant à habiliter les caractères systématique et cinétique des langues, irremplaçables moyens de penser ; l'autre dans un vis-à-vis cognitif et opératoire de Freud, en relavant sur les plans épistémologique et logique, notamment, l'élan révolutionnaire de la seconde modernité, autour de l'évolutionnisme. Mais les thèmes majeurs du constructivisme, du schème et de la symbolisation - et plus largement du temps et du langage - auront sans doute aidé à spécifier les mutations autorisées par la révolution critique. Entre l'Instant du je parle et un décentrement exigible pratiquement (éthique) comme théoriquement (épistémique), c'est bien la condition humaine dans son ensemble qui est concernée. Si repenser cette Condition s'impose en permanence, il importe de ne pas manquer des oeuvres qui, par-delà toute mode, proposent à notre expérience des fondations résistant à d'inéluctables vicissitudes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diacritics 29.3 (1999) 81-101 [Access article in PDF] Sex without Sex, Queering the Market, the Collapse of the Political, the Death of Difference, and AIDS: Hailing Judith Butler Brett Levinson It is interesting to note that in Judith Butler's study of the social construction of sex, Gender Trouble (as well as in the sequel, Bodies That Matter), one finds barely a trace of sex. Or to put matters more (...) bluntly: in Butler's study of gender critiques that avoid or dismiss the matters of hetero- and homosexuality, in her examination of the relationship of gayness and lesbianism to feminism, and in her exposition of a politics of queerness--as to fucking, not a word. This omission is not tangential to Gender Trouble. It determines Butler's entire undertaking. 1. The (In)difference of Performance By illustrating that sex, like gender, is a social construction, Butler strives to tear not sex but both sex and gender from biological essentialism. For as Butler insists, as soon as we imagine sex (woman/man) as naturally given, and gender (feminine/masculine) as a product of social forces, we fall into the very gender essentialism that we seemingly called into question. This is because the sex/gender binary makes sex the ground of gender: a woman may be masculine or feminine, and she may subvert the social norms that demand that women act in a certain manner. But throughout all of these gender reversals, she remains a woman. Her behavior, therefore, is either far from her sex (if she is subversive) or close to it (if she conforms). But in either case, it is measured in terms of that sex, which stands as the essence or foundation of the conduct. Hence, within such a discourse, gender stereotypes do not actually emerge as social (thereby deconstructible) constructs since the substructure (sex) of their edifice is given prior to production.This thesis, which ultimately reveals that the sex/gender split reproduces the woman/man binary--the foundation of sexism--opens the way for one of Butler's most renowned interventions: her theory of performativity. Butlerian performance traces the intersection of Derrida's concept of mimesis and Foucault's understanding of power. Derrida argues that if a mark (in writing) or a sound (in speech) is to form part of a language, it must be iterable. Language hinges on social conventions, and social conventions on repetition, ritual. Repetition, therefore, does not follow (from) a pregiven [End Page 81] [Begin Page 83] sign but is a condition of its possibility: a sign must be repeatable before it is a sign. 1Derrida often translates these ideas into an analysis of "the citation," a fact Butler fully exploits. An articulation, Derrida argues, must be a priori citable (again, iterable) if it is to function as an articulation, as a "speech act." This means that deviance, miscitation, recontextualization, and the possible transformation or loss of an enunciation--any or all of which could occur via a citation--belong essentially to that enunciation. The repetitions that yield rituals, habits, and then norms are the same iterations that undermine those norms. But this is true not only for speech. It holds as well for the law: the citing, execution, reading, writing, and acknowledgment of the law, hence the possibility of the law's shift and even disappearance, pertain to the law's groundwork.Gender Trouble posits patriarchy and compulsive heterosexuality as two such citable laws. And as laws, they are powerful but not inevitable. Indeed, because the law of normalcy harbors its own deviance as a condition of its public emergence or deployment, this normalcy opens the way for its own transgression. One is indeed subject to the law of the norm. But this subjection cannot not grant the very alternative agency/subjectivity it strives to suppress.Hence for Butler, queer types such as the "femme" or the "butch," as they perhaps flaunt (through dress, bodily image, or public demonstration) the constructed character of their own sexual identities, recite and dis-cover the constructed, artificial... (shrink)

People with mild to moderate intellectual or multiple disabilities may have serious difficulties in accessing leisure events, managing communication exchanges with distant partners, and performing functional daily activities. Recently, efforts were made to develop and assess technology-aided programs aimed at supporting people in all three areas. This study assessed a new technology-aided program aimed at helping four participants with intellectual and multiple disabilities in the aforementioned areas. The program, which was implemented following a non-concurrent multiple baseline across participants design, relied (...) on the use of a smartphone or tablet connected via Bluetooth to a two-switch device. This device served to select leisure and communication events and to control the smartphone or tablet’s delivery of step instructions for the activities scheduled. Data showed that during the baseline phase, three participants failed in each of the areas while one participant managed to access a few leisure events. During the intervention phase, all participants managed to independently access leisure events, make telephone calls, and carry out activities. These results suggest that the program might be a useful tool for helping people with intellectual and multiple disabilities improve their condition in basic areas of daily life. (shrink)

This article examines bioethics in Tanzania, particularly in relation to the HIV/AIDS epidemic for the following reasons: First, not only is HIV/AIDS the most alarming health problem in most parts of Africa, but the complexity of issues involved in medical and research ethics clearly illustrates the various levels of problems that bioethics—more precisely, both professional medical ethics and research ethics—faces in a poor, developing country. The article defends uniformity in the general, international bioethical guidelines but calls for wider discussion in (...) their applicability in different economic and social conditions by claiming that in the present debates the issues of distributive justice, culture, and individual professional judgment have been tangled together in a manner that tends to justify double standards in practice. To avoid this confusion there is a need to find a more coherent approach to bioethics that brings together the normative requirements set by international guidelines, national policy planning, social ethics, and professional medical ethics. a. (shrink)

In this article, the main complexities of understanding and curbing the HIV/AIDS pandemic in (South) Africa, are discussed. These are: 1. Poverty as niche or social context of the pandemic, 2. Denial, lack of leadership and the politicization of the public discourse on AIDS, 3. Problems related to accomplishing behavior changes under conditions of deprivation and illiteracy, 4. Women's vulnerability, and 5. The disenchantment of intimacy brought about by the pandemic. In each case, some solutions are suggested, although the notion (...) of complexity does not allow for definitive solutions. Concluding remarks deal with the possible philosophical and moral sense that we might make of the pandemic. (shrink)

In this paper I try to defend three claims: first, that there is a requirement to aid and a correlative right to be aided; second, that the conditions under which this right applies can be precisely stated and given a convincing contractualist rationale; and third, that the existence of this right has no relevance for the justifiability of social welfare programs.