Objective: To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions. Design: Prospective clinical interventional study. Setting: Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland. Participants: Nine junior physicians in postgraduate training. Intervention: Information on the ethics of DNR and implementation of new DNR orders. Measurements and main results: Accurate understanding, interpretation, and use of (...) DNR orders, especially with respect to the patients’ involvement in the decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision. Conclusion: An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

Objective: To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions.Design: Prospective clinical interventional study.Setting: Internal medicine department of the hospital of La Chaux-de-Fonds, Switzerland.Participants: Nine junior physicians in postgraduate training.Intervention: Information on the ethics of DNR and implementation of new DNR orders.Measurements and main results: Accurate understanding, interpretation, and use of DNR orders, especially with respect to the (...) patients’ involvement in the decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% after the intervention and the patients’ involvement went from 17% to 48% . Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision.Conclusion: An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

Background Decisions regarding Cardio-Pulmonary Resuscitation (CPR) and Do Not Attempt Resuscitation (DNAR) orders remain demanding, as does including patients in the process. Objectives To explore physicians’ justification for CPR/DNAR orders and decisions regarding patient inclusion, as well as their reports of how they initiated discussions with patients. Methods We administered a face-to-face survey to residents in charge of 206 patients including DNAR and CPR orders, with or without patient inclusion. Results Justifications were provided for 59% of DNAR orders and included (...) severe comorbidity, patients and families’ resuscitation preferences, patients’ age, or poor prognosis or quality of life. Reasons to include patients in CPR/DNAR decisions were provided in 96% and 84% of cases, and were based on respect for autonomy, clinical assessment of the situation as not too severe, and the view that such inclusion was required. Reasons for not including patients were offered in 84% of cases for CPR and in 70% for DNAR. They included absent decision-making capacity, a clinical situation viewed as good (CPR) or offering little hope of recovery (DNAR), barriers to communication, or concern that discussions could be emotionally difficult or superfluous. Decisions made earlier in the patient's management were infrequently viewed as requiring revision. Residents reported a variety of introductions to discussions with patients. Conclusions These results provide better understanding of reasons for CPR/DNAR decisions, reasons for patient inclusion or lack thereof, and ways in which such inclusion is initiated. They also point to potential side-effects of implementing CPR/DNAR recommendations without in-depth and practical training. This should be part of a regular audit and follow-up process for such recommendations. (shrink)

Cet article présente un service de consultation conjugale situé en Suisse romande, non médicalisé, dont l’orientation psychodynamique et le travail auprès des couples n’est pas sans rappeler la pratique française des conseillers conjugaux-thérapeutes de couple « ancien modèle ». Si l’appellation de consultation conjugale a été retenue, malgré ses inconvénients, c’est qu’elle permet de toucher un très large public, en particulier de nombreuses personnes insuffisamment individuées pour qui l’appartenance au « Nous-couple » est constitutive. Par rapport aux objectifs de travail, (...) l’auteure explore deux voies, illustrées par deux vignettes cliniques : l’une vise à recouvrir une problématique sous-jacente en rétablissant un équilibre antérieur, l’autre à découvrir l’arrangement défensif du couple en introduisant une dynamique de changement. (shrink)

In this paper, I discuss nurses' ongoing difficulty in engaging with politics and address the persistent belief that political positioning is antithetical to quality nursing care. I suggest that nurses are not faced with choosing either caring for their patients or engaging with politics. I base my discussion on the assumption that such dichotomy is meaningless and that engaging with issues of relationships firmly grounds nursing in the realm of politics. I argue that the ethical merit of nursing care relies (...) instead on positioning nurses squarely at the centre of care activities, experiences, and functions. Such positioning makes possible what Foucault called ‘practices of self‐formation’, that is, micro‐level processes that balance out the ubiquitous economic, cultural, legal, and scientific technologies that steadily constitute subjects in this era of modernity. Nurses, then, become not a group that needs to be controlled and governed, but individuals who must care for their self before they may care for anyone else. (shrink)

Change is inevitable, and increasingly rapid and continuous in healthcare as organizations strive to adapt, improve and innovate. Organizational change challenges healthcare providers because it restructures how and when patient care delivery is provided, changing ways in which nurses must carry out their work. The aim of this doctoral study was to explore frontline nurses’ experiences of living with rapid and continuous organizational change. A critical hermeneutic approach was utilized. Participants described feeling voiceless, powerless and apolitical amidst rapid and continuous (...) organizational changes which fuelled apathy, cynicism and disengagement from the organization. However, critical analysis of the data showed that nurses actively engaged with power, voice and politics through resistant and transgressive behaviours in micro‐ethical moments of practice. There is a need to reconceptualize the concepts of voice, power and politics in nursing as there is dissonance between nurses’ beliefs about these concepts and what they are enacting in practice. Recognizing their enactment of power, voice and political agency at the micro‐level may empower nurses. Empowerment would mitigate the high levels of reports of powerlessness experienced in practice during organizational changes. (shrink)

The purpose of this text is to tell the story of the implementation of the _Act Respecting End-of-Life Care,_ referred to hereafter as _Law 2_ (Gouvernement du Québec, 2014) with an emphasis on the ambiguous role of ethics in the Interdisciplinary Support Groups (ISGs), created by Quebec's _Ministère de la santé et des services sociaux_ (MSSS). As established, ISGs provide “clinical, administrative and ethical support to health care professionals responding to a request for Medical aid in dying (MAiD)” (Gouvernement du (...) Québec, 2015). It is suggested that their composition includes the participation of a person with an expertise in ethics. These ISGs represent an important innovation for stakeholders involved in MAiD. To date, no scientific research has specifically addressed ISGs and little research has been conducted in other jurisdictions on the roles, operations and practices of MAiD support structures, especially the implication of ethics. Several ISGs have certainly developed promising practices that could benefit all stakeholders in the wider field of ethics and end of life. We will explore the development of ISGs in Quebec as a support structure for MAiD by highlighting the role that ethics has played (and should play) in these morally and humanly challenging situations. (shrink)

Inner speech has been shown to vary in form along several dimensions. Along condensation, condensed inner speech forms have been described, that are supposed to be deprived of acoustic, phonological and even syntactic qualities. Expanded forms, on the other extreme, display articulatory and auditory properties. Along dialogality, inner speech can be monologal, when we engage in internal soliloquy, or dialogal, when we recall past conversations or imagine future dialogues involving our own voice as well as that of others addressing us. (...) Along intentionality, it can be intentional (when we deliberately rehearse material in short-term memory) or it can arise unintentionally (during mind wandering). We introduce the ConDialInt model, a neurocognitive predictive control model of inner speech that accounts for its varieties along these three dimensions. ConDialInt spells out the condensation dimension by including inhibitory control at the conceptualization, formulation or articulatory planning stage. It accounts for dialogality, by assuming internal model adaptations and by speculating on neural processes underlying perspective switching. It explains the differences between intentional and spontaneous varieties in terms of monitoring. We present an fMRI study in which we probed varieties of inner speech along dialogality and intentionality, to examine the validity of the neuroanatomical correlates posited in ConDialInt. Condensation was also informally tackled. Our data support the hypothesis that expanded inner speech recruits speech production processes down to articulatory planning, resulting in a predicted signal, the inner voice, with auditory qualities. Along dialogality, covertly using an avatar’s voice resulted in the activation of right hemisphere homologues of the regions involved in internal own-voice soliloquy and in cerebellar deactivation, consistent with internal model adaptation. Switching from first-person to third-person perspective resulted in activations in precuneus and parietal lobules. Along intentionality, compared with intentional inner speech, mind wandering with inner speech episodes was associated with greater bilateral inferior frontal activation and decreased activation in left temporal regions. This is consistent with the reported subjective evanescence and presumably reflects condensation processes. Our results provide neuroanatomical evidence compatible with predictive control and in favor of the assumptions made in the ConDialInt model. (shrink)

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Das Thema dieser Arbeit ist Hegels berühmte und berüchtigte These vom "Ende der Kunst". Der Verfasser bemüht sich insbesondere darum, diese These im Zusammenhang mit ihren Voraussetzungen zu analysieren und einer Kritik zu unterziehen.

RACINE L and PERRON A. Nursing Inquiry 2012; 19: 190–201 Unmasking the predicament of cultural voyeurism: a postcolonial analysis of international nursing placementsThe growing interest in international nursing placements cannot be left unnoticed. After 11 years into this twenty‐first century, violations of human rights and freedom of speech, environmental disasters, and armed conflicts still create dire living conditions for men and women around the world. Nurses have an ethical duty to address issues of social justice and global health as (...) a means to fulfil nursing’s social mandate. However, international placements raise some concerns. Drawing on the works of postcolonial theorists in nursing and social sciences, we examine the risk of replicating colonialist practices and discourses of health in international clinical placements. Referring to Bakhtin’s notions of dialogism and unfinalizability, we envision a culturally safe nursing practice arising from dialogical encounters between the Self as an Other and with the Other as an Other. We suggest that exploring the intricacies of cultural and race relations in everyday nursing practice are the premises upon which nurses can understand the broader historic, racial, gendered, political and economic contexts of global health issues. Finally, we make suggestions for developing culturally safe learning opportunities at the international level without minimizing the impact of dialogical cultural encounters occurring at the local and community levels. (shrink)

The idea of agency has long been used in the nursing literature in the study of nurses' roles regarding the patients they take care of, but it has not often been used to study its relationship with nurses themselves and their status in the healthcare system. The purpose of this article is to analyze how the idea of agency is used in nursing research to better understand how we might advance our thinking around nurses' agency to shape nursing and healthcare (...) with an emancipatory intent. Based on the results of a literature review focused on the study of conceptions, treatments, and applications of the concept of agency in nursing, we present a critical discussion to reflect on the need to consistently define the idea of nurses' agency, to guide research concerned with this topic in theoretical frameworks with emancipatory and social change tenets, and to make a call to develop the idea of agency as a central one to rework nurses' relationship with themselves. The idea of agency provides a valuable analytical framework for the study of a wide range of issues around nurses' status in healthcare organizations and in the healthcare system while offering a means for nurses' emancipation. (shrink)

In everyday discourse and in the context of social scientific research we often attribute intentional states to groups. Contemporary approaches to group intentionality have either dismissed these attributions as metaphorical or provided an analysis of our attributions in terms of the intentional states of individuals in the group.Insection1, the author argues that these approaches are problematic. In sections 2 and 3, the author defends the view that certain groups are literally intentional agents. In section 4, the author argues that there (...) are significant reasons for social scientists and philosophers of social science to acknowledge the adequacy of macro-level explanations that involve the attribution of intentional states to groups. In section 5, the author considers and responds to some criticisms of the thesis she defends. (shrink)

There are those who would argue that, recently, the profession of nursing has made a radical shift, while others believe that a schism has been created among both scholars and clinicians as a result of the emerging dominance of the evidence‐based nursing movement. This paper offers a philosophical critique of this movement using Gilles Deleuze and Felix Guattari’s concept of schizoanalysis. As a conclusion, the authors posit that nursing professionals maintain a stance of academic freedom of thought and scientific integrity (...) through the acceptance of multiplicity, diversity, and polyvocality, and by challenging with politically charged concepts the totalizing perspectives that often spread through the profession/discipline of nursing. (shrink)

In “Group Testimony” (2007) I argued that the testimony of a group cannot be understood (or at least cannot always be understood) in a summative fashion; as the testimony of some or all of the group members. In some cases, it is the group itself that testifies. I also argued that one could extend standard reductionist accounts of the justification of testimonial belief to the case of testimonial belief formed on the basis of group testimony. In this paper, I explore (...) the issue of group testimony in greater detail by focusing on one putative source of testimony, that of Wikipedia. My aim is to the answer the following questions: Is Wikipedia a source of testimony? And if so, what is the nature of that source? Are we to understand Wikipedia entries as a collection of testimonial statements made by individuals, some subset of individuals, or is Wikipedia itself (the organization or the Wikipedia community) the entity that testifies? If Wikipedia itself is a source of testimony, what resources do we have for assessing the trustworthiness of such an unusual epistemic source? In answering these questions I hope to further elucidate the nature of collective epistemic agency (Tollefsen 2006), of which group testimony is a paradigm example. When a mans Discourse begineth…at some saying of another, of whose ability to know the truth, and of whose honesty in not deceiving, he doubteth not; and then the Discourse is not so much concerning the Thing, as the Person; and the Resolution is called Beleefe, and Faith: Faith in the man. (1651/1991, Ch. 7; p. 48). (shrink)

Study of concept of Brahman in Upanishads with special reference to the philosophy of Śāṇḍilya.

Nurses have their own ways of talking about their experiences of injustice in healthcare organizations. The aim of this article is to describe how nurses talk about their work‐life experiences and discuss the discursive effects that arise from nurses' use of language regarding their political agency. To this end, we present the findings garnered from a study focused on exploring how nurses deploy their political agency to project their idea of social and political justice in public healthcare organizations and how (...) they face the challenges and uncertainties of (re)thinking their institutional order when it does not resonate with their professional ethos. We then discuss the implications that nurses' use of language has in relation to their ability to deploy their political agency to oppose the forms of injustice they face in their daily practice. We conclude by stating that careful attention should be placed on understanding the discursive implications of nurses' use of language on their individual and collective emancipation in healthcare organizations. (shrink)

This article aims to present the life and work of German thinker Hartmut Rosa as a philosopher of interest for nursing. Although his theoretical framework remains fairly unknown in the nursing domain, its main key concepts open up a philosophical and sociological approach that can contribute to the understanding of a wide range of study phenomena related to nurses, nursing, and healthcare. The concepts of social acceleration, alienation, and resonance are useful to explore healthcare organizations' performance by bringing the time (...) dimension of modernity to the center; to grasp nurses' experiences of caring for patients; and to understand nurses as agents endowed with the capacity to deploy their political agency to create alternative forms of relationship to themselves, to others, and the world, challenging the institutional order of healthcare organizations when it fails to resonate with their professional ethos. In this article, we propose Hartmut Rosa's theoretical framework as a new and inspiring phenomenological and critical lens that should be further explored to advance knowledge concerning phenomena that are found at the crossroads of the nursing domain and other fields of knowledge. (shrink)

Although there have been a number of recent discussions about the emotions that we bring with us to our epistemic endeavors, there has been little, if any, discussion of the emotions we bring with us to epistemic appraisal. This paper focuses on a particular set of emotions, the reactive attitudes. As Peter F. Strawson and others have argued, our reactive attitudes reveal something deep about our moral commitments. A similar argument can be made within the domain of epistemology. Our "epistemic (...) reactive attitudes" reveal our epistemic commitments. Reflection on the role they play in our practice of epistemic appraisal can contribute to a number of different debates in contemporary epistemology, including the nature of epistemic norms and epistemic responsibility. (shrink)

The debate surrounding the issue of collective moral responsibility is often steeped in metaphysical issues of agency and personhood. I suggest that we can approach the metaphysical problems surrounding the issue of collective responsibility in a roundabout manner. My approach is reminiscent of that taken by P.F. Strawson in "Freedom and Resentment" (1968). Strawson argues that the participant reactive attitudes - attitudes like resentment, gratitude, forgiveness and so on - provide the justification for holding individuals morally responsible. I argue that (...) the framework of the reactive attitudes extends to collectives and provides the justification for holding collectives morally responsible. (shrink)

Исследование посвящено философскому осознанию природы духовности человека. Автор рассматривает духовность внутреннего мира человека как единство высших чувств души и нравственного сознания. Для специалистов в области философии, методологии науки.

Contemporary analytic epistemology exhibits an individualistic bias. The standard analyses of knowledge found in current epistemological discussions assume that the only epistemic agents worthy of philosophical consideration are individual cognizers. The idea that collectives could be genuine knowers has received little, if any, serious consideration. This individualistic bias seems to be motivated by the view that epistemology is about things that go on inside the head. In this paper I challenge this type of epistemic individualism by arguing that certain groups (...) are intentional agents and that cognition occurs at the level of groups. In section I, I extend a plausible and well-defended account of individual intentionality to organizations. In section II, I appeal to research on distributed cognition in order to challenge the view that cognition occurs exclusively in the individual mind-brain. Having established that groups can be believers and cognizers, I turn to the issue of the justification of group belief. In section III, consider whether a reliabilist account of justification can be extended to groups. (shrink)

Recent discussions of rational deliberation in science present us with two extremes: unbounded optimism and sober pessimism. Helen Longino (1990) sees rational deliberation as the foundation of scientific objectivity. Miriam Solomon (1991) thinks it is overrated. Indeed, she has recently argued (2006) that group deliberation is detrimental to empirical success because it often involves groupthink and the suppression of dissent. But we need not embrace either extreme. To determine the value of rational deliberation we need to look more closely at (...) the practice and practitioners of science. I offer a closer look here by exploring the joint agency of small research teams. Although there are factors that contribute to the suppression of dissent in group contexts, a closer look at the literature on group dynamics suggests that there are ways to mitigate the effects of groupthink. Thus, there is reason to be cautiously optimistic about the value of rational deliberation within certain scientific contexts. (shrink)

Upon doing something generous for someone with whom you are close, some kind of reciprocity may be appropriate. But it often seems wrong to actually request reciprocity. This chapter explores the wrongness in making these requests, and why they can nevertheless appear appropriate. After considering several explanations for the wrongness at issue (involving, e.g. distinguishing oughts from obligation, the suberogatory, imperfect duties, and gift-giving norms), a novel proposal is advanced. The requests are disrespectful; they express that their agent insufficiently trusts (...) the hearer to recognize their own reasons to reciprocate, and the close relationship between them morally requires this kind of trust. This proposal is articulated and situated in the recent discussion of the normativity of requests. The chapter concludes by explaining how these requests may appear appropriate. Agents in these relationships often have standing to make requests, though the standing is lacking in these particular cases. (shrink)

This article presents a novel theoretical approach to explore nurse executives’ paradoxical identity and agency of executive and nurse in homecare organizations. This complex phenomenon has yet to be well theorized or analyzed. Through a synthesis of literature, we demonstrate that Critical Management Studies, as informed by Foucault, and the Sociology of Ignorance, can create a different understanding of the complex interplay between knowledge and nonknowledge (ignorance) that positions nurse executives in both influential and precarious ways in homecare organizations. This (...) theoretical framework has the potential to allow for the explicit exploration of nurse executives’ strategic epistemic and discursive positioning and highlights hierarchal power structures within homecare organizations. We posit that this framework, that spans nursing, management and sociology disciplines, sets a different understanding of homecare organizations as epistemic landscapes, exposing institutional knowledge and ignorance dynamics that remain largely concealed and unchallenged, yet are integral to understanding nurse executives’ epistemic agency. (shrink)

Name der Zeitschrift: Semiotica Jahrgang: 2017 Heft: 214 Seiten: 29-39.

Despite changes to research and practice, that, to some degree, acknowledge that people are shaped by their contexts, the treatment of mental illness remains largely focused on interventions that take place at the level of the individual. Conceptualizing mental illness as something that resides in individuals can lead to reliance on neurobiological and psychotherapeutic solutions, and away from conversations about not only contextual causes of mental distress, but also sociopolitical solutions to mental distress. Further, it can lead to the use (...) of mental health interventions that focus on the biology of an individual without a consideration for how those interventions themselves may have psychological, social, or political consequences that act to shape an individual's identity, agency, and relationship to their community. This paper examines one medicolegal intervention, the community treatment order, using the philosophical work of Grosz and Foucault to consider how this intervention affects the experience and construction of identity, and the impact of this on an individual's sense of agential membership in a community. This discussion aims to increase understanding of the individual and social implications of interventions for mental illness, and provide a conceptualization of the relationship between identity, agency, and ethics which can inform critical research and nursing practice more broadly. (shrink)

Serious mental illness (SMI) has long posed a dilemma to society. The use of community treatment orders (CTOs), a legal means by which to deliver mandated psychiatric treatment to individuals while they live in the community, is a contemporary technique for managing SMI. CTOs (or a similar legal mechanism) are used in every province in Canada and in many jurisdictions around the world in the care and management of clients with severe and persistent mental illness (most frequently schizophrenia) who have (...) a history of treatment non‐compliance and subsequent relapse. Although there is ongoing controversy around CTOs, their use continues to be on the rise. René Girard's mimetic theory, in which he posits the social utility of the scapegoat mechanism, may shed some light on how established cultural patterns contribute to contemporary responses to SMI: how culture depends on the reproduction of certain narratives, and how these act to shape the identity of those involved. The CTO specifically can be seen to act as a scapegoating mechanism, wherein, by singling out and controlling individuals who appear to threaten social order, social order is restored. This paper reviews Girard's theory, looks at how it has been applied to SMI, and then considers how it may illuminate the social role of the CTO. This examination may provide mental health nurses with insight into the constructed identities of their patients, as well as the role of mental health care within broader cultural narratives. (shrink)

There is a small, but growing, number of philosophers who acknowledge the existence of plural subjects – collective agents that act in the world and are the appropriate subject of intentional state ascriptions. Among those who believe in collective agency, there are some who wish to limit the types of intentional state ascriptions that can be made to collectives. According to rejectionists, although groups can accept propositions, they cannot believe them. In this paper I argue that, given the centrality of (...) belief and the similarities between individual belief and collective attitudes, we ought to reject rejectionism. If one believes in collective agency, one must also believe in collective belief. (shrink)

Violations of ethical conductThis article is about torture, power and the breach of ethical conduct among military doctors, nurses and medics in the “War on Terror”. Violations of ethical conduct have been widely recounted in academic and non-academic journals and reports.1 This paper is also a call to international boards of doctors and nurses to intervene directly to stop abuses undertaken by US military healthcare providers under the guise of the War on Terror. With evidence growing that US military and (...) security services are actively engaged in the ill treatment, torture and deaths of suspects, details about the participation of healthcare professionals in such unlawful and unethical activities remain for the most part timidly accounted for. But according to current literature on this topic, there is increasing evidence that US doctors, nurses and medics have been complicit in torture and other unethical activities in Afghanistan, Iraq and Guantanamo Bay .2–4The US government has inadequately dealt with these facts. Senior officials in the Bush administration who have played a major part in conducting the War on Terror have been either promoted or asked to remain in their posts. More seriously, despite worldwide condemnation of the reality behind the photos, allegations of torture continue at Guantanamo Bay, Cuba.5 The graphic and appalling nature of several photographs are by no means the only evidence of abuses conducted by the US on its own territory and abroad. But the complicity of healthcare professionals in many venues , such as in capital punishment procedures in the US, exacerbates the already disturbing extent of bio-political abuses by the US government.Doctors and nurses often top the polls as caring and trustworthy professionals.6 Indeed, so strong …. (shrink)

In this paper we present a framework for the dynamic and automatic generation of novel knowledge obtained through a process of commonsense reasoning based on typicality-based concept combination. We exploit a recently introduced extension of a Description Logic of typicality able to combine prototypical descriptions of concepts in order to generate new prototypical concepts and deal with problem like the PET FISH (Osherson and Smith, 1981; Lieto & Pozzato, 2019). Intuitively, in the context of our application of this logic, the (...) overall pipeline of our system works as follows: given a goal expressed as a set of properties, if the knowledge base does not contain a concept able to fulfill all these properties, then our system looks for two concepts to recombine in order to extend the original knowledge based satisfy the goal. (shrink)