Family Medicine Groups (FMGs) are the most recently developed primary care organizations in Quebec (Canada). Nurses within FMGs play a central role for patients with chronic diseases (CD). However, this complex role and the nursing activities related to this role vary across FMGs. Inadequate knowledge of nursing activities limits the implementation of exemplary nursing practices. This study aimed to describe FMG nursing activities with patients with CD and to describe the facilitators and barriers to these activities. A multiple‐case study was (...) performed with ten nurses practicing among patients with CD in FMGs. Five data sources were used to provide an in‐depth description of nursing activities and the facilitators and barriers to the development of these activities. After qualitative data analysis, findings show that nursing activities are clustered into five domains: Global assessment of the patient, Care management, Health promotion, Nurse–physician collaboration, and Planning services for patients with CD. Activities vary depending on contextual factors identified in each case. This multiple‐case study provides a clear description of nursing activities with patients with CD. There is a need for improved nursing activities and expertise in domains of activities that are less present in FMGs, such as case management and interprofessional collaboration. (shrink)

Nursing as a profession has a social mandate to contribute to the good of society through knowledge-based practice. Knowledge is built upon theories, and theories, together with their philosophical bases and disciplinary goals, are the guiding frameworks for practice. This article explores a philosophical perspective of nursing's social mandate, the disciplinary goals for the good of the individual and society, and one approach for translating knowledge into practice through the use of a middle-range theory. It is anticipated that the integration (...) of the philosophical perspective and model into nursing practice will strengthen the philosophy, disciplinary goal, theory, and practice links and expand knowledge within the discipline. With the focus on humanization, we propose that nursing knowledge for social good will embrace a synthesis of the individual and the common good. This approach converges vital and agency needs described by Hamilton and the primacy of maintaining the heritage of the good within the human species as outlined by Maritain. Further, by embedding knowledge development in a changing social and health care context, nursing focuses on the goals of clinical reasoning and action. McCubbin and Patterson's Double ABCX Model of Family Adaptation was used as an example of a theory that can guide practice at the community and global level. Using the theory-practice link as a foundation, the Double ABCX model provides practising nurses with one approach to meet the needs of individuals and society. The integration of theory into nursing practice provides a guide to achieve nursing's disciplinary goals of promoting health and preventing illness across the globe. When nursing goals are directed at the synthesis of the good of the individual and society, nursing's social and moral mandate may be achieved. (shrink)

Harvey and Gurvir’s Law is a bill proposed to the Legislative Assembly of Ontario (Canada) to reduce stigma and bias associated with Down syndrome, by developing and disseminating quality information about Down syndrome in the context of prenatal testing.

Bayefsky and Berkman argue in favor of evidence-based policy development for expanded prenatal genetic testing. They propose to identify what kinds of information pregnant persons, their par...

In "Implementing Expanded Prenatal Genetic Testing: Should Parents Have Access to Any and All Fetal Genetic Information?," Bayefsky and Berkman argue in favor of establishing three categorie...

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments (n=98; proportion of participation was (...) 99%) conducted in 2015 across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments conducted in 2015 across publicly (...) funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

We give a general method for producing various effective Null and Positivstellensätze, and getting new Positivstellensätze in algebraically closed valued fields and ordered groups. These various effective Nullstellensätze produce algebraic identities certifying that some geometric conditions cannot be simultaneously satisfied. We produce also constructive versions of abstract classical results of algebra based on Zorn's lemma in several cases where such constructive version did not exist. For example, the fact that a real field can be totally ordered, or the fact that (...) a field can be embedded in an algebraically closed field. Our results are based on the concepts we develop of dynamical proofs and simultaneous collapse. (shrink)

Les femmes engagées dans l'Église constituent les piliers de la vie ecclésiale mais restent des sujettes mineures dans cette institution qui ne leur reconnaît pas, dans les faits, un statut d'égalité avec les hommes. Depuis plus de vingt ans, elles revendiquent des transformations : elles veulent participer à la rédaction des discours officiels, obtenir de meilleurs conditions de travail, mettre de l'avant l'usage du langage inclusif dans les liturgies. Ces femmes, qui détiennent dans une proportion déplus en plus importante une (...) formation en théologie, s'efforcent de conscientiser le clergé à la nécessité de développer avec elles des rapports égalitaires qui impliquent un véritable partage des pouvoirs et des responsabilités. Compte tenu du haut niveau de résistance au changement, il faudrait sans doute que ces femmes acceptent de désobéir à l'ordre clérical et qu'elles osent transgresser les règles de fonctionnement sexiste si elles veulent parvenir à mettre en place une ecclésia égalitaire.Although women constitute the pillars in the ongoing life of the Church, their status is not equal to that of men and they play a secondary role in the institution. For at least the last twenty years, women have been demanding changes such as : the participation in the elaboration of official statements, the betterment of working conditions and the use of inclusive language in liturgical celebrations. Many women, who have a theological formation, endeavour to make the clergy realize the necessity of developing relationhips of real equality. This implies a concrete division of power and responsability. Given the degree of resistance in the institutional Church, women may have to accept disobedience to clerical power, thus breaking the rules of a sexist functioning in order to establish an Ecclesia of equality. (shrink)

In “Non-invasive prenatal testing for ‘non-medical’ traits: Ensuring consistency in ethical decision-making,” Bowman-Smart et al. (2023) lay out arguments both for and against the potential use of...

It has become a truism that the ethics of artificial intelligence (AI) is necessary and must help guide technological developments. Numerous ethical guidelines have emerged from academia, industry, government and civil society in recent years. While they provide a basis for discussion on appropriate regulation of AI, it is not always clear how these ethical guidelines were developed, and by whom. Using content analysis, we surveyed a sample of the major documents (_n_ = 47) and analyzed the accessible information regarding (...) their methodology and stakeholder engagement. Surprisingly, only 38% report some form of stakeholder engagement (with 9% involving citizens) and most do not report their methodology for developing normative insights (15%). Our results show that documents with stakeholder engagement develop more comprehensive ethical guidance with greater applicability, and that the private sector is least likely to engage stakeholders. We argue that the current trend for enunciating AI ethical guidance not only poses widely discussed challenges of applicability in practice, but also of transparent development (as it rather behaves as a black box) and of active engagement of diversified, independent and trustworthy stakeholders. While most of these documents consider people and the common good as central to their telos, engagement with the general public is significantly lacking. As AI ethics moves from the initial race for enunciating general principles to more sustainable, inclusive and practical guidance, stakeholder engagement and citizen involvement will need to be embedded into the framing of ethical and societal expectations towards this technology. (shrink)

Research Ethics, Volume 18, Issue 2, Page 126-131, April 2022. Engaging citizens and patients in research has become a truism in many fields of health research. It is now seen as a laudable—if not compulsory—activity in research for yielding more impactful and meaningful citizen/patient outcomes and steering research in the right direction. Although this research approach is increasingly common and commendable, we recently encountered a major obstacle in obtaining an ethics certificate from an institutional review board to conduct a study (...) that places citizen/patient perspectives on equal footing with those of academic/policy experts. The obstacle was the interpretation of fairness in terms of compensation for research participation. In terms of research ethics, this raised an important question: Should all types of participants be compensated equally, or should exceptions be made for citizen/patient participants? We argue that there are good reasons for exceptionalism and that clearer guidance on citizen/patient engagement in research should be embedded into research ethics doctrine. (shrink)

Engaging citizens and patients in research has become a truism in many fields of health research. It is now seen as a laudable—if not compulsory—activity in research for yielding more impactful and meaningful citizen/patient outcomes and steering research in the right direction. Although this research approach is increasingly common and commendable, we recently encountered a major obstacle in obtaining an ethics certificate from an institutional review board to conduct a study that places citizen/patient perspectives on equal footing with those of (...) academic/policy experts. The obstacle was the interpretation of fairness in terms of compensation for research participation. In terms of research ethics, this raised an important question: Should all types of participants be compensated equally, or should exceptions be made for citizen/patient participants? We argue that there are good reasons for exceptionalism and that clearer guidance on citizen/patient engagement in research should be embedded into research ethics doctrine. (shrink)

Objectives To review the extant literature on HIV criminal laws, and to determine the impact of these laws on public health practice.Methods The available research on this topic was obtained and reviewed.Results The extant literature addressed three main topics: people's awareness of HIV criminal laws; people's perceptions of HIV criminal laws; and the potential effects of HIV criminal laws on people's sexual, HIV-status disclosure and healthcare-seeking practices. Within these categories, the literature demonstrated a high level of awareness of HIV criminal (...) laws, but a poor comprehension of these laws. For perceptions, on the whole, the quantitative research identified support for, while the qualitative literature indicated opposition to, these laws. Lastly, the behavioural effects of HIV criminal laws appear to be complex and non-linear.Conclusions A review of the extant literature from a public health perspective leads to the conclusion that HIV criminal laws undermine public health. (shrink)

Recently, focus groups and qualitative interviews with nurses who provide frontline care for persons living with HIV highlighted the contentiousness surrounding the seemingly innocuous activity of counselling clients about HIV‐status disclosure, hereafter disclosure counselling. These empirical studies highlighted that while some nurses felt they should instruct clients to disclose their HIV‐positive status if HIV transmission were possible, other nurses were equally adamant that such counselling was outside the nursing scope of practice. A review of these opposing perceptions about disclosure counselling, (...) including an examination of the empirical evidence which supports each point, revealed that the dichotomous arguments needed to be nuanced. The empirical evidence about serostatus disclosure neither supported nor refuted either of these assertions; rather, it substantiated parts of each. To create this understanding, both empirical and theoretical works are used. First, the results of empirical studies about serostatus disclosure, or lack thereof and HIV transmission is presented; as part of this, Marks and Crepaz's HIV disclosure and exposure framework is examined. Second, the work of Michel Foucault on disciplinary and pastoral power is drawn from. The outcome is a nuanced understanding about the interrelationships between disclosure counselling and nursing practice and a final interpretation about what this understanding means for public health practice. (shrink)

A target question for the scientific study of consciousness is how dimensions of consciousness, such as the ability to feel pain and pleasure or reflect on one’s own experience, vary in different states and animal species. Considering the tight link between consciousness and moral status, answers to these questions have implications for law and ethics. Here we point out that given this link, the scientific community studying consciousness may face implicit pressure to carry out certain research programs or interpret results (...) in ways that justify current norms rather than challenge them. We show that because consciousness largely determines moral status, the use of nonhuman animals in the scientific study of consciousness introduces a direct conflict between scientific relevance and ethics—the more scientifically valuable an animal model is for studying consciousness, the more difficult it becomes to ethically justify compromises to its well-being for consciousness research. Finally, in light of these considerations, we call for a discussion of the immediate ethical corollaries of the body of knowledge that has accumulated and for a more explicit consideration of the role of ideology and ethics in the scientific study of consciousness. (shrink)

According to the perceptual-attentional limitations hypothesis, the confusion between expressions of disgust and anger may be due to the difficulty in perceptually distinguishing the two, or insufficient attention to their distinctive cues. The objective of the current study was to test this hypothesis as an explanation for the confusion between expressions of disgust and anger in adults using eye-movements. In Experiment 1, participants were asked to identify each emotion in 96 trials composed of prototypes of anger and prototypes of disgust. (...) In Experiment 2, fixation points oriented participants’ attention toward the eyes, the nose, or the mouth of each prototype. Results revealed that disgust was less accurately recognised than anger (Experiment 1 and 2), especially when the mouth was open (Experiment 1 and 2), and even when attention was oriented toward the distinctive features of disgust (Experiment 2). Additionally, when attention was oriented toward certain zones, the eyes (which contain characteristics of anger) had the longest dwell times, followed by the nose (which contains characteristics of disgust; Experiment 2). Thus, although participants may attend to the distinguishing features of disgust and anger, these may not aid them in accurately recognising each prototype. (shrink)

Suave, mari magno turbantibus aequora ventise terra magnum alterius spectare laborem;non quia vexari quemquamst iucunda voluptas,sed quibus ipse malis careas quia cernere suave est.suave etiam belli certamina magna tueri 5per campos instructa tua sine parte pericli.sed nil dulcius est, bene quam munita tenereedita doctrina sapientum templa serena,despicere unde queas alios passimque videreerrare atque viam palantis quaerere vitae, 10certare ingenio, contendere nobilitate,noctes atque dies niti praestante laboread summas emergere opes rerumque potiri.o miseras hominum mentes, o pectora caeca!qualibus in tenebris vitae quantisque (...) periclis 15degitur hoc aevi quodcumquest! nonne viderenil aliud sibi naturam latrare, nisi utquicorpore seiunctus dolor absit, mensque fruaturiucundo sensu cura semota metuque?(Lucr. 2.1–19)It is pleasant, when the winds stir up the waters on the great sea,to watch the great struggle of another from land;not because it is a great pleasure that anyone be troubled,but because it is pleasant to observe the troubles you yourself lack.It is also pleasant to watch the great contests of war 5spread out over the plains without taking any part in the danger.But nothing is more pleasing than to hold lofty yet calm templesthat are well defended by the teachings of wise men,from which you can look down and see others everywherego astray and wander while seeking the path of their life, 10competing in wits and contending over their nobility;throughout nights and days they strive with outstanding labourto come out at the peak of riches and have power over everything.O wretched minds of men, O blind hearts!In what shadows of life and in how many dangers 15is this bit of life, whatever it may be, being spent by you! Do you not seethat nature barks for nothing other than this – thatgrief be separated from the body and far away, and that the mind enjoypleasant feelings cut off from anxiety and fear?Epicurus' advice to his young friend Pythocles to ‘flee all education, raising up the top sail’ (παιδείαν δὲ πᾶσαν, μακάριε, ϕεῦγε τἀκάτιον ἀράμενος, Diog.Laert. 10.6 = Epicurus fr. 163 Us.) contains an allusion to Circe's advice to Odysseus inOdyssey12.37–58. For much of the Greek (and Roman) world, education was based on the Homeric epics, and thus Epicurus' statement represents a complicated position towards Homer in particular and poetry in general. Epicurean philosophy rejects poetry because it is misleading about the gods and the nature of the soul, but Epicurus and his followers, most notably Philodemus and Lucretius, engage in poetic allusion and even the composition of poetry. Much work has been done on allusions to poetry in all three writers, but I hope here to bring out a heretofore unnoticed poetic allusion at the start ofDe rerum naturaBook 2, in which Lucretius makes a programmatic statement about not only his philosophy, but also his poetry and its place in the poetic tradition. (shrink)

Joyce's review of _Humanism, Philosophical Essays: A Collection of Essays on Pragmatism_, by Ferdinand Canning Scott Schiller, was written at a critical moment in the development of Joyce's fiction (before "The Sisters", before the essay "A Portrait of the Artist," and during Joyce's writing of his aesthetic theory. The review was published in the _Dublin Express_ on November 12, 1903. The diary entries at the end of _A Portrait of the Artist as a Young Man_ hint at the fallibilism and (...) reality of experience at the bedrock of Peircean semiotics and the revolutionary style of Joyce. Unfortunately the mocking style of Joyce's review may be why it has not received attention and perhaps why the review has not been included in a recent collection of Joyce's non-fiction writings. Joyce mocks Schiller’s style and thought, which is "prone to stylistic violations such as: vulgarity ... excessively ornate language ... pomposity ... exaggeration ... and avoiding the issue" as Joseph Porrovecchio states in a dissertation on Schiller's rhetoric. Schiller not only provoked Joyce to mock him, he also provoked Charles Peirce, the founder of pragmatism, to rename his philosophy "pragmaticism" adding an "ic" to it to differentiate it from Schiller’s use of the word. This essay shows Joyce knew about Charles Peirce, whose influence was extensive, continuing through Finnegans Wake, as discussed in Roy Benjamin’s The Triptych Vision: Joyce and Peirce. (shrink)

Physicists regularly invoke universal laws, such as those of motion and electromagnetism, to explain events. Biological and medical scientists have no such laws. How then do they acquire a reliable body of knowledge about biological organisms and human disease? One way is by repeatedly returning to, manipulating, observing, interpreting, and reinterpreting certain subjects—such as flies, mice, worms, or microbes—or, as they are known in biology, “model systems.” Across the natural and social sciences, other disciplinary fields have developed canonical examples that (...) have played a role comparable to that of biology’s model systems, serving not only as points of reference and illustrations of general principles or values but also as sites of continued investigation and reinterpretation. The essays in this collection assess the scope and function of model objects in domains as diverse as biology, geology, and history, attending to differences between fields as well as to epistemological commonalities. Contributors examine the role of the fruit fly Drosophila and nematode worms in biology, troops of baboons in primatology, box and digital simulations of the movement of the earth’s crust in geology, and meteorological models in climatology. They analyze the intensive study of the prisoner’s dilemma in game theory, ritual in anthropology, the individual case in psychoanalytic research, and Athenian democracy in political theory. The contributors illuminate the processes through which particular organisms, cases, materials, or narratives become foundational to their fields, and they examine how these foundational exemplars—from the fruit fly to Freud’s Dora—shape the knowledge produced within their disciplines. Contributors Rachel A. Ankeny Angela N. H. Creager Amy Dahan Dalmedico John Forrester Clifford Geertz Carlo Ginzburg E. Jane Albert Hubbard Elizabeth Lunbeck Mary S. Morgan Josiah Ober Naomi Oreskes Susan Sperling Marcel Weber M. Norton Wise. (shrink)

Divya is a surrogate mother from India. Aaliyah, an African-American teenager, has just terminated her pregnancy. Samantha, on the other hand, is childless and looking for ways to adopt. What connects these three women? Other than being sites for reproduction, one tends to think nothing else brings them together. This fantastic book shows us otherwise by revealing the interconnection of three reproductive lifecycles through neoliberalism and its biopolitical impact on their "choices". Modhumita Roy and Mary Thompson have thematically married twelve (...) impactful and unique essays that bring the stories of actual and fictional women to life.To understand how the... (shrink)

In this book, Roy Bhaskar sets out to revindicate ontology, critiquing the reduction of being in favor of knowledge, which he calls the "epistemic fallacy".

The eclipse riddle -- Seeing surfaces -- The disappearing act -- Spinning shadows -- Berkeley's shadow -- Para-reflections -- Para-refractions : shadowgrams and the black drop -- Goethe's colored shadows -- Filtows -- Holes in the light -- Black and blue -- Seeing in black and white -- We see in the dark -- Hearing silence.

The paper argues against Peacocke's moderate rationalism in modality. In the first part, I show, by identifying an argumentative gap in its epistemology, that Peacocke's account has not met the Integration Challenge. I then argue that we should modify the account's metaphysics of modal concepts in order to avoid implausible consequences with regards to their possession conditions. This modification generates no extra explanatory gap. Yet, once the minimal modification that avoids those implausible consequences is made, the resulting account cannot support (...) Peacocke's moderate rationalism. (shrink)

Clinical trials emerged in rapid succession as the COVID-19 pandemic created an unprecedented need for life-saving therapies. Fair and equitable subject selection in clinical trials offering investigational therapies ought to be an urgent moral concern. Subject selection determines the distribution of risks and benefits, and impacts the applicability of the study results for the larger population. While Research Ethics Committees monitor fair subject selection within each trial, no standard oversight exists for subject selection across multiple trials for the same disease. (...) Drawing on the experience of multiple clinical trials at a single academic medical centre in the USA, we posit that concurrent COVID-19 trials are liable to unfair and inequitable subject selection on account of scientific uncertainty, lack of transparency, scarcity and, lastly, structural barriers to equity compounded by implicit bias. To address the critical gap in the current literature and international regulation, we propose new ethical guidelines for research design and conduct that bolsters fair and equitable subject selection. Although the proposed guidelines are tailored to the research design and protocol of concurrent trials in the COVID-19 pandemic, they may have broader relevance to single COVID-19 trials. (shrink)

Can God create a stone too heavy for him to lift? Can time have a beginning? Which came first, the chicken or the egg? Riddles, paradoxes, conundrums--for millennia the human mind has found such knotty logical problems both perplexing and irresistible. Now Roy Sorensen offers the first narrative history of paradoxes, a fascinating and eye-opening account that extends from the ancient Greeks, through the Middle Ages, the Enlightenment, and into the twentieth century. When Augustine asked what God was doing before (...) He made the world, he was told: "Preparing hell for people who ask questions like that." A Brief History of the Paradox takes a close look at "questions like that" and the philosophers who have asked them, beginning with the folk riddles that inspired Anaximander to erect the first metaphysical system and ending with such thinkers as Lewis Carroll, Ludwig Wittgenstein, and W.V. Quine. Organized chronologically, the book is divided into twenty-four chapters, each of which pairs a philosopher with a major paradox, allowing for extended consideration and putting a human face on the strategies that have been taken toward these puzzles. Readers get to follow the minds of Zeno, Socrates, Aquinas, Ockham, Pascal, Kant, Hegel, and many other major philosophers deep inside the tangles of paradox, looking for, and sometimes finding, a way out. Filled with illuminating anecdotes and vividly written, A Brief History of the Paradox will appeal to anyone who finds trying to answer unanswerable questions a paradoxically pleasant endeavor. (shrink)