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

Nursing practice occurs in the context of conversations with healthcare users, other healthcare professionals, and healthcare institutions. This discussion paper draws on symbolic interactionism and Fairclough's method of critical discourse analysis to examine language that nurses use to describe the people in their care and their practice. We discuss how nurses’ use of language constructs meaning about healthcare users and their own work. Through language, nurses are articulating what they believe about healthcare users and nursing practice. We argue that the (...) language nurses use can contribute to viewing their practice as tasks on bodies that must be accomplished efficiently and objectively within the biomedical model, rather than relational and person‐centered. Moreover, the language nurses use can perpetuate a sense of powerlessness within healthcare systems yet paradoxically they are in a position of power over healthcare users. Nurses’ compliance with the efficiency and biomedical model results in a lack of emphasis on the full breadth of nursing work, which could be enacted in relational rather than power‐laden practices. We conclude by positing that careful use of language among nurses in all settings is essential, if we are to begin to articulate what nursing is to ourselves and to others. (shrink)

The increase in ethnically and linguistically diverse older adults in Canada necessitates attention to their experiences and needs for healthy ageing. Arab immigrant women often report challenges in maintaining health, but little is known about their ageing experiences. This interpretive descriptive study uses a transnational life course framework to understand Arab Muslim immigrant women's experiences of engaging in health‐promoting practices as they age in Canada. Women's stories highlight social dimensions of health such social connectedness, social roles and social support that (...) are constructed and maintained within different migration contexts across the life course. Barriers and facilitators to healthy ageing in this population centred around five themes: (i) the necessity of staying strong, (ii) caring for self while caring for others, (iii) double jeopardy of chronic illnesses and loneliness, (iv) inadequate support within large social networks and (v) navigating access to health‐supporting resources. The findings point to transnational connections and post‐migration social support as major influencers in creating facilitators and barriers to healthy ageing for Arab Muslim immigrant women. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

Narrative analysis is well established as a means of examining the subjective experience of those who suffer chronic illness and cancer. In a study of perceptions of the outcomes of treatment of cancer of the colon, we have been struck by the consistency with which patients record three particular observations of their subjective experience: the immediate impact of the cancer diagnosis and a persisting identification as a cancer patient, regardless of the time since treatment and of the presence or absence (...) of persistent or recurrent disease; a state of variable alienation from social familiars, expressed as an inability to communicate the nature of the experience of the illness, its diagnosis and treatment; and a persistent sense of boundedness, an awareness of limits to space, empowerment and available time. These subjectivities were experienced in varying degree by all patients in our study. Individual responses to these experiences were complex and variable. The experiences are best understood under the rubric of a category we call “liminality”. We believe that all cancer patients enter and experience liminality as a process which begins with the first manifestations of their malignancy. An initial acute phase of liminality is marked by disorientation, a sense of loss and of loss of control, and a sense of uncertainty. An adaptive, enduring phase of suspended liminality supervenes, in which each patient constructs and reconstructs meaning for their experience by means of narrative. This phase persists, probably for the rest of the cancer patient’s life. The experience of liminality is firmly grounded in the changing and experiencing body that houses both the disease and the self. Insights into the nature of the experience can be gained from the Existentialist philosophers and from the history of attitudes to death. Understanding liminality helps us to understand what it is that patients with cancer seek from the system to which they turn for help. Its explication should therefore be important for those who provide health care, those who educate health care workers and those concerned to study and use outcomes as administrative and policy making instruments. (shrink)

High-dose chemotherapy and autologous stem cell transplantation is used to treat some advanced malignancies. It is a traumatic procedure, with a high complication rate and significant mortality. ASCT patients and their carers draw on many sources of information as they seek to understand the procedure and its consequences. Some seek information from beyond orthodox medicine. Alternative beliefs and practices may conflict with conventional understanding of the theory and practice of ASCT, and ‘contested understandings’ might interfere with patient adherence to the (...) strict and demanding protocols required for successful ASCT.The present study, conducted in Sydney, Australia, examines narrative-style interviews with 10 sequentially recruited ASCT patients and nine of their carers conducted at the time of transplant and three months later. Transcripts were read for instances of mention of alternative advice, and for instances of contested understanding of information relevant to the transplant.Patients and carer pairs expressed closely concordant views about alternative advice. Five pairs were consulting alternative practitioners. Contested understanding was expressed in four domains—understandings of the transplant itself and its underlying theory, of the relationship between the components of the ‘transplant’, of the nature and role of stem cells, and of beliefs about bodily function and life-style. Contested understandings of the transplant treatment were expressed as predominantly personal interpretations of orthodox informationPatients and carers seemed to recognise that alternative and conventional systems were discordant, yet they were able to separate the two, and adhere to each practice without prejudicing their medical treatment. A single case of late, post-transplant repudiation of Western medicine is discussed to emphasise some of the possible determinants of dissonance when it does occur. (shrink)

Do philosophic views affect job performance? The authors found that possessing a belief in free will predicted better career attitudes and actual job performance. The effect of free will beliefs on job performance indicators were over and above well-established predictors such as conscientiousness, locus of control, and Protestant work ethic. In Study 1, stronger belief in free will corresponded to more positive attitudes about expected career success. In Study 2, job performance was evaluated objectively and independently by a supervisor. Results (...) indicated that employees who espoused free will beliefs were given better work performance evaluations than those who disbelieve in free will, presumably because belief in free will facilitates exerting control over one’s actions. (shrink)

An educational provision for young children with autism that offers intensive behavioural intervention based on the principles of Applied Behaviour Analysis (ABA), within an early years mainstream school setting in the UK, is described. The ABA Class at Westwood School is a collaborative project between the School of Psychology, Bangor University, two Local Education Authorities in North East Wales (Flintshire and Wrexham) and the local NHS Trust. Using two case examples, two important features of mainstream education for children with autism (...) are considered: access to the National Curriculum, and inclusion with peers in mainstream settings. Standardised test data on outcomes for these children over the initial 12 months of their educational placements are also provided. (shrink)

The use of a concept called "explicativity", for (provisionally) accepting a theory or Hypothesis H, has previously been discussed. That previous discussion took into account the prior probability of H, and hence implicitly its theoretical simplicity. We here suggest that a modification of explicativity is required to allow for what may be called the pragmatic simplicity of H, that is, the simplicity of using H in applications as distinct from the simplicity of the description of H.

Thought uses meaning but not necessarily language. Meaning, in the form of a set of possible concepts and ideas, is a nonphysical reality that lay waiting for brains to become smart enough to represent these ideas. Thus, the brain evolved, whereas meaning was discovered, and language was invented – collectively – as a tool to help the brain use meaning.

Concerns are frequently raised about the extent to which formal consent procedures actually lead to “informed” consent. As part of a study of consent to high-risk medical procedures, we analyzed in-depth interviews with 16 health care professionals working in bone-marrow transplantation in Sydney, Australia. We find that these professionals recognize and act on their responsibility to inform and educate patients and that they expect patients to reciprocate these efforts by demonstrably engaging in the education process. This expectation is largely implicit, (...) however, and when it is not met, this can give rise to trouble that can have adverse consequences for patients, physicians, and relationships within the clinic. We revisit the concept of the sick role to formalize this new role expectation, and we argue that “informed” consent is a process that is usually incomplete, despite trappings and assumptions that help to create the illusion of completeness. (shrink)

It is notorious that Aristotle gives two distinct and seemingly irreconcilable versions of man's eudaimonia in the Nicomachean Ethics. These offer conflicting accounts not only of what the good man should do, but also of what it is good for a man to do. This paper discusses the incompatibility of these two pictures of eudaimonia, and explores the extent to which the notions of 'the life of a good man' and 'the life good for a man' (...) can be successfully united in a single concept of eudaimonia. (shrink)

I trace a brief history of philosophical discussion of the concept WOMAN and identify two key points at which, I argue, things went badly wrong. The first was where when it was agreed that the concept WOMAN must identify a social not biological kind. The second was where it was decided that the concept WOMAN faced a legitimate challenge of being insufficiently “inclusive”, understood in a certain way. I’ll argue that both of these moves are only intelligible, if at all, (...) in the context of an anti-naturalist picture drawn from either post-structuralism or radical feminism. They become incoherent when adopted by methodological naturalists, who – especially when concerned to track oppression and discrimination – have no good reason to deny that WOMAN refers to a pre-given, biological kind. (shrink)

Tomasello argues that humans’ sense of moral obligation emerges early in development, relies on a shared “we,” and serves as the foundation of cooperation. This perspective complements our theoretical view of the human self as information agent. The shared “we” promotes not only proximal cooperative goals but also distal ones via the construction of shared understanding – it promotes culture.

Mechanical devices implanted in the body present implications for broad themes in religious thought and experience, including the nature and destiny of the human person, the significance of a person's embodied experience, including the experiences of pain and suffering, the person's relationship to ultimate reality, the divine or the sacred, and the vocation of medicine. Community-constituting convictions and narratives inform the method and content of reasoning about such conceptual questions as whether a moral line should be drawn between therapeutic or (...) enhancement interventions and/or between somatic and neural/cognitive interventions. By attending to these broader community-forming concepts, it is possible to identify three general orienting themes in religious perspectives on incorporated mechanical devices, which we shall designate as perspectives of “appropriation,” “ambivalence,” and “resistance.”. (shrink)

Business ethics educators strive to produce graduates who not only grasp the principles of ethical decision-making, but who can apply that business ethics education when faced with real-world challenges. However, this has proven especially difficult, as good intentions do not always translate into ethical awareness and action. Complementing a behavioral ethics approach with insights from social psychology, we developed an interventional class module with both online and in-class elements aimed at increasing students’ awareness of their own susceptibility to unconscious (...) biases and, consequently, unethical behaviors. We deployed this intervention within a problem-based learning course, in which students completed real-world projects for actual business clients. Our results suggest that although students appeared universally aware of the importance of ethical issues in business and generally espoused intentions to act ethically, those who received the intervention were significantly more likely to recognize their own susceptibility to perpetuating unethical business behavior and to identify ethical issues specific to their real-world projects. These results have important implications for behavioral ethics pedagogy and provide a de-biasing interventional approach for bridging classroom knowledge with real-world skills. (shrink)

Much feminist philosophy of science has been developed as a reaction against logical empiricism and the associated view that social factors play no role in good science. Recent accounts of the Vienna Circle that highlighted the ways in which some of its members attempted to combine their empiricism with emancipatory politics are used here as a basis on which to reassess the relationship between logical empiricism and feminism. The focus is chiefly on Otto Neurath.

Why Don't You Just Talk to Him? looks at the broad political contexts in which violence, specifically domestic violence, occurs. Kathleen Arnold argues that liberal and Enlightenment notions of the social contract, rationality and egalitarianism -- the ideas that constitute norms of good citizenship -- have an inextricable relationship to violence. According to this dynamic, targets of abuse are not rational, make bad choices, are unable to negotiate with their abusers, or otherwise violate norms of the social contract; (...) they are, thus, second-class citizens. In fact, as Arnold shows, drawing from Nietzsche and Foucault's theories of power and arguing against much of the standard policy literature on domestic violence, the very mechanisms that purportedly help targets of domestic abuse actually work to compound the problem by exacerbating the power differences between the abuser and the abused. The book argues that a key to understanding how to prevent domestic violence is seeing it as a political rather than a personal issue, with political consequences. It seeks to challenge Enlightenment ideas about intimacy that conceive of personal relationships as mutual, equal and contractual. Put another way, it challenges policy ideas that suggest that targets of abuse can simply choose to leave abusive relationships without other personal or economic consequences, or that there is a clear and consistent level of help once they make the choice to leave. Asking "Why Don't You Just Talk to Him?" is in reality a suggestion riven with contradictions and false choices. Arnold further explores these issues by looking at two key asylum cases that highlight contradictions within the government's treatment of foreigners and that of long-term residents. These cases expose problematic assumptions in the approach to domestic violence more generally. Exposing major injustices from the point of view of domestic violence targets, this book promises to generate further debate, if not consensus. (shrink)

With a focus on end-of-life discussion in aging and chronically ill populations, this book offers insight into the skill of communicating in complex and emotionally charged discussions. This text is written for all clinicians and professionals in the fields of healthcare and public health who are faced with questions of ethical deliberation when a patient's illness turns from chronic to terminal. This skill is required to manage care well in an age of advanced technology, and numerous autonomous choices. With a (...) palliative care and ethics focus, the manuscript provides case studies illustrating issues which occur in the acuity and chronicity of end of life. Clear tools for clinicians, such as scripting and "the advance care planning video library" are included. The book focuses on the unique concept of outpatient ethics, including readmission prevention and shortened length of stay through good communication for clinicians who will be required to conduct this discussion with patients. The ethical undertone in this text provides a perfect opening for application in healthcare ethics classes, both in fields of public health and healthcare. Medical scholars and physicians, nurse practitioners and physician's assistants, as well as social workers, both in practice and training, will benefit from this text. (shrink)

Viola Cordova was the first Native American woman to receive a PhD in philosophy. Even as she became an expert on canonical works of traditional Western philosophy, she devoted herself to defining a Native American philosophy. Although she passed away before she could complete her life’s work, some of her colleagues have organized her pioneering contributions into this provocative book. In three parts, Cordova sets out a complete Native American philosophy. First she explains her own understanding of the nature of (...) reality itself—the origins of the world, the relation of matter and spirit, the nature of time, and the roles of culture and language in understanding all of these. She then turns to our role as residents of the Earth, arguing that we become human as we deepen our relation to our people and to our places, and as we understand the responsibilities that grow from those relationships. In the final section, she calls for a new reverence in a world where there is no distinction between the sacred and the mundane. Cordova clearly contrasts Native American beliefs with the traditions of the Enlightenment and Christianized Europeans. By doing so, she leads her readers into a deeper understanding of both traditions and encourages us to question any view that claims a singular truth. From these essays—which are lucid, insightful, frequently funny, and occasionally angry—we receive a powerful new vision of how we can live with respect, reciprocity, and joy. (shrink)

The turn of the nineteenth century marked a rich and exciting explosion of philosophical energy and talent. The enormity of the revolution set off in philosophy by Immanuel Kant was comparable, by Kant's own estimation, with the Copernican Revolution that ended the Middle Ages. The movement he set in motion, the fast-moving and often cantankerous dialectic of `German Idealism', inspired some of the most creative philosophers in modern times: including G.W.F. Hegel and Arthur Schopenhauer as well as those who reacted (...) against Kant - Marx and Kierkegaard, for example. This volume traces the emergence of German Idealism from Kant and his predecessors through the first half of the nineteenth century, ending with the irrationalism of Kierkegaard. It provides a broad, scholarly introduction to this period for students of philosophy and related disciplines, as well as some original interpretations of these authors. Each chapter is written by a distinguished scholar in the field. A glossary of technical terms together with a chronological table of philosophical, scientific and other important cultural events are provided. (shrink)