Bioethics, Volume 36, Issue 3, Page 313-317, March 2022.

Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case‐based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from (...) moral philosophy, including consequentialism, deontology, and principlism.In this article we hope to make a case for augmenting the focus of education in medical ethics. We propose complementing the traditional approach to medical ethics with a more embedded approach, one that has been described by others as “microethics,” the ethics of everyday clinical practice. (shrink)

There is currently little empirical information about attitudes towards cognitive enhancement - the use of pharmaceutical drugs to enhance normal brain functioning. It is claimed this behaviour most commonly occurs in students to aid studying. We undertook a qualitative assessment of attitudes towards cognitive enhancement by conducting 19 semi-structured interviews with Australian university students. Most students considered cognitive enhancement to be unacceptable, in part because they believed it to be unethical but there was a lack of consensus on whether it (...) was similar or different to steroid use in sport. There was support for awareness campaigns and monitoring of cognitive enhancement use of pharmaceutical drugs. An understanding of student attitudes towards cognitive enhancement is important in formulating future policy. (shrink)

"I found this a fascinating book: wide-ranging, readable." —Alison Jaggar Bell shows how the flesh-and-blood female body engaged in sexual interaction for payment has no inherent meaning and is signified differently in different cultures ...

Addiction is increasingly described as a “chronic and relapsing brain disease”. The potential impact of the brain disease model on the treatment of addiction or addicted individuals’ treatment behaviour remains uncertain. We conducted a qualitative study to examine: (i) the extent to which leading Australian addiction neuroscientists and clinicians accept the brain disease view of addiction; and (ii) their views on the likely impacts of this view on addicted individuals’ beliefs and behaviour. Thirty-one Australian addiction neuroscientists and clinicians (10 females (...) and 21 males; 16 with clinical experience and 15 with no clinical experience) took part in 1 h semi-structured interviews. Most addiction neuroscientists and clinicians did not uncritically support the use of brain disease model of addiction. Most were cautious about the potential for adverse impacts on individuals’ recovery and motivation to enter treatment. While some recognised the possibility that the brain disease model of addiction may provide a rationale for addicted persons to seek treatment and motivate behaviour change, Australian addiction neuroscientist and clinicians do not assume that messages about “diseased brains” will always lead to increased treatment-seeking and reduced drug use. Research is needed on how neuroscience research could be used in ways that optimise positive outcomes for addicted persons. (shrink)

Developments in neuroscience have raised the possibility that pharmaceuticals may be used to enhance memory, mood, and attention in people who do not have an illness or disorder, a practice known as “cognitive enhancement.” We describe historical experiences with two medicinal drugs for which similar enhancement claims were made, cocaine in the late 19th and early 20th centuries, and amphetamines in the mid 20th century. These drugs were initially introduced as medicinal agents in Europe and North America before becoming more (...) widely used for a variety of purposes, including what would nowadays be considered cognitive enhancement. Their trajectory of use conformed to the typical use cycle of psychotropic drugs. There was an initial steep rise in prescribing for medical use, followed by expanded nonmedical use that was fueled by enthusiasm for the drugs’ effects. As the number of regular users increased, problems related to use (such as addiction) became apparent, societal concern increased, and laws were passed banning nonmedical use and eventually, medical use. This historical experience draws attention to the adverse side effects of enhancement use that only become apparent with regular, wide-scale use of a drug. We highlight the similarities between the enthusiasms for cocaine and amphetamines and the current enthusiasms for using prescription stimulants for cognitive enhancement. We argue bioethicists should not encourage the cognitive enhancement use of drugs such as methylphenidate in the absence of evidence on the efficacy and safety of their use for cognitive enhancement purposes. (shrink)

During the pandemic lockdown period, residents had to stay at home and increased stress and other mental health problems have been associated with the lockdown period. Since most public parks were closed, community parks within gated residential areas became the most important green space in Chinese cities, and the use of such space might help to reduce the residents’ stress levels. This study aimed to investigate to what extent urban residents in China used community parks, engaged in outdoor activity during (...) the lockdown period and if the use of such spaces helped to reduce their stress levels. An online questionnaire survey was carried out from 23 March to 23 April 2020. Ordinary Least Squares regression was used to analyse the association between community park use, outdoor activity, willingness to engage in outdoor activity, and stress level. All results have been further analysed by two-sampled t-test to explore the difference between young and old age groups. We found that the overall self-reported stress level of the respondents was relatively moderate during the lockdown period. Respondents had generally reduced their use of community parks and engagement in outdoor activity. There was no significant association between stress level and the use of community parks or the engagement in outdoor activities. However, we found that older people showed much lower stress levels, used community parks more frequently, and engaged in more outdoor activities than younger adults. The findings suggest that outdoor activities and spatial characteristics in urban China differ from Western studies and advance the need to integrate the stress management role of community parks with urban green space policy to optimise the use of community parks blended in with everyday life, particularly during the lockdown period. (shrink)

Women generally initiate, lead, and constitute the rank and file of environmental justice activism. However, there is little research on why there are comparatively so few men involved in these movements. Using the environmental justice movement in the Central Appalachian coalfields as a case study, we examine the ways that environmental justice activism is gendered, with a focus on how women’s and men’s identities both shape and constrain their involvement in gendered ways. The analysis relies on 20 interviews with women (...) and men grassroots activists working for environmental justice in the coalfields of Appalachia. We find that women draw on their identities as “mothers” and “Appalachians” to justify their activism, while the hegemonic masculinity of the region, which is tied to the coal industry, has the opposite effect on men, deterring their movement involvement. We explore the implications of these findings for understanding the relationship of gender to environmental justice activism. (shrink)

This paper focuses on local constructions of 'nature' in governance processes, and the importance of historical and institutional contexts for their genesis and functioning. Through extensive field study in the Romanian Danube Delta, it is demonstrated that the origin and distribution of certain concepts can be credited to a history of conflicts over land and resource use. Considering the implications for participatory natural resource governance, we argue that this capacity of the governance context to produce and transform concepts of nature, (...) poses real challenges. To these challenges can be added legacies of disempowerment and marginalisation, evident in local inhabitants' images and concepts of nature, which we seek to understand by developing a theory of traumatic nature. (shrink)

Impaired control over drug use is a defining characteristic of addiction in the major diagnostic systems. However there is significant debate about the extent of this impairment. This qualitative study examines the extent to which leading Australian addiction neuroscientists and clinicians believe that addicted individuals have control over their drug use and are responsible for their behaviour. One hour semi-structured interviews were conducted during 2009 and 2010 with 31 Australian addiction neuroscientists and clinicians (10 females and 21 males; 16 with (...) clinical experience and 15 with no clinical experience). Although many addiction neuroscientists and clinicians described uncontrolled or compulsive drug use as characteristic of addiction, most were ambivalent about whether or not addicted people could be said to have no control of their drug use. Most believed that addicted individuals have fluctuating levels of impaired control over their drug use but they nonetheless believed that addicted persons were responsible for their behaviour, including criminal behaviour engaged in to fund their drug use. Addiction was not seen as exculpating criminal behaviour but as a mitigating factor. (shrink)

It is usually supposed that the Dirac and radiation equations predict that the phase of a fermion will rotate through half the angle through which the fermion is rotated, which means, via the measured dynamical and geometrical phase factors, that the fermion must have a half-integral spin. We demonstrate that this is not the case and that the identical relativistic quantum mechanics can also be derived with the phase of the fermion rotating through the same angle as does the fermion (...) itself. Under spatial rotation and Lorentz transformation the bispinor transforms as a four-vector like the potential and Dirac current. Previous attempts to provide this form of transformational behavior have foundered because a satisfactory current could not be derived.(14). (shrink)

This article describes the ethical conflicts that a sample of US nurse utilization reviewers faced in their work, and also each nurse’s self-reported ethical orientation that was used to resolve the dilemmas. Data were collected from a sample of 97 registered nurses who were working at least 20 hours per week as utilization reviewers. Respondents were recruited from three managed care organizations that conduct utilization reviews in a large midwestern city. A cross-sectional survey design was used to collect demographic data (...) and to ask closed-response, short-answer and open-ended questions. Ethical conflicts reported by nurses were similar across utilization review settings and many were justice orientated. Self-reported ethical orientations were similar across organizations, with beneficence dominating. Implications of these findings are discussed. (shrink)

Americanization in Two Immigrant Theravada Buddhist Temples. Paul David Numrich. University of Tennessee, Knoxville 1996. xxiv, 181 pp. Illustrations. $25. ISBN 0-87049-905-X.

The focus of this article is on the Business Council of Australia, an association of the CEOs of the 100 or so largest companies operating in Australia. Since its inception the BCA has been an influential supporter of largely successful efforts to neoliberalize and internationalize the Australian economy. Running in parallel with these developments, however, the BCA has moved from being a “somewhat strong” to a relatively weak policy organization. This article argues these two trends are causally related. Neoliberal-inspired economic (...) restructuring and economic internationalization have weakened the “logic of membership” and the “logic of influence” of the BCA, leading to a process of organizational involution. Furthermore, potential offsets to what I describe as the organizational predations of neoliberalism and internationalization—especially via a willingness or capacity to forge supportive or mutualistic relations with the state—have not been realized. (shrink)

The purpose of this study was to determine if reading achievement of students from high-poverty US schools differs as a function of participation in summer tutoring versus access to books. Data fro...

We have shown in a previous paper that the Dirac bispinor can vary like a four-vector and that Quantum Electrodynamics can be reproduced with this form of behaviour. In Part I of this paper, we show that QED with the same transformational behaviour also holds in an alternative space we call M-space. We use the four-vector behaviour to model the two-body interaction in M and show that this has similar physical properties to the usual model in L which it predicts. (...) In Part II of this paper we use M-space to show that QED can be reduced to two simple rules for a two-body interaction. (shrink)

“Lambeth Palace is my Washpot. Over Fulham have I cast my breeches.” So declared the novelist and secularist H. G. Wells in a letter to his mistress, Rebecca West, in May 1917. His claim was that, because of him, Britain was “full of theological discussion” and theological books were “selling like hot cakes”. He was lunching with liberal churchmen and dining with bishops. Certainly, the first of the books published during Wells’s short “religious period”, the novel Mr. Britling Sees It (...) Through, had sold very well on both sides of the Atlantic and made Wells financially secure. Geoffrey Studdert Kennedy (“Woodbine Willie”) wrote that, “Everyone ought to read Mr. H. G. Wells’s great novel, Mr. Britling Sees It Through. It is a gallant and illuminating attempt to state the question, and to answer it. His thought has brought him to a very real and living faith in God revealed in Jesus Christ, and has also brought relief to many troubled minds among the officers of the British Army.” Yet, Wells’s God was explicitly a finite God, and his theology was far from orthodox. How can we account for his boast and for the clerical affirmation which he certainly did receive? This article examines and re-evaluates previous accounts of the responses of clergy to Wells’s writing, correcting some narratives. It discusses the way in which many clergy used Mr. Britling as a means by which to engage in a populist way with the question of theodicy, and examines the letters which Wells received from several prominent clerics, locating their responses in the context of their own theological writings. This is shown to be key to understanding the reaction of writers such as Studdert Kennedy to Mr. Britling Sees It Through. Finally, an assessment is made of the veracity of Wells’s boasting to his mistress, concluding that his claims were somewhat exaggerated. “Lambeth Palace is my Washpot, Over Fulham have I cast my breeches.” Mit diesen Worten erklärte der literarisch außergewöhnlich erfolgreiche und entschieden säkular denkende, kirchenkritische Schriftsteller und Science-Fiction-Pionier Herbert George Wells seiner Geliebten, dass seinetwegen Großbritannien “full of theological discussion” sei. Nicht ohne Eitelkeit schrieb er es seinem im September 1916 mit Blick auf den Krieg geschriebenen und stark autobiographisch gefärbten Roman Mr. Britling Sees it Through von knapp 450 Seiten zu, dass theologische Bücher reißenden Absatz fänden. Auch war er stolz darauf, liberale Kleriker zum Lunch zu treffen und von Bischöfen zum abendlichen Dinner eingeladen zu werden. In einer kurzen Phase seines Lebens war – oder inszenierte sich – Wells als ein frommer, gläubiger Mensch. Sein damals veröffentlichter Roman Mr. Britling Sees It Through verkaufte sich sowohl in Nordamerika als auch im Heimatland so gut, dass der Autor nun definitiv finanziell gesichert war. Der anglikanische Priester und Dichter Geoffrey Studdert Kennedy, der im Ersten Weltkrieg Woodbine Willie genannt wurde, weil er verletzten und sterbenden Soldaten in den Phasen der Vorbereitung auf den Tod Woodbine-Zigaretten anbot, empfahl die Lektüre von Wells’ “great novel” Mr. Britling mit den Worten: “It is a gallant and illuminating attempt to state the question, and to answer it. His thought has brought him to a very real and living faith in God revealed in Jesus Christ, and has also brought relief to many troubled minds among the officers of the British Army.” Allerdings war H. G. Wells’ Gott ein durchaus endlicher Gott, und seine Theologie war alles andere als orthodox. Wie lassen sich dennoch seine evidente Prahlerei und die emphatische Zustimmung zu seinem Roman in den britischen Klerikereliten erklären? Im Aufsatz werden zunächst einige ältere Deutungen der Zustimmung führender Kleriker zu Wells’ Roman untersucht und einige der dabei leitenden Deutungsmuster kritisch infrage gestellt. Deutlich wird, dass nicht wenige anglikanische Geistliche Mr. Britling dazu nutzten, um höchst populistisch das umstrittene Theodizeeproblem anzusprechen. Auch werden die Briefe prominenter Geistlicher an Wells analysiert, mit Blick auf ihre eigenen Publikationen. Diese Reaktionen haben stark Studdert Kennedys Haltung zu Mr. Britling Sees It Through beeinflusst. Besonders aufrichtig war Wells mit Blick auf sich selbst allerdings nicht. Die Selbstinszenierung gegenüber seiner Geliebten war einfach nur peinliche Übertreibung. (shrink)

“Lambeth Palace is my Washpot. Over Fulham have I cast my breeches.” So declared the novelist and secularist H. G. Wells in a letter to his mistress, Rebecca West, in May 1917. His claim was that, because of him, Britain was “full of theological discussion” and theological books were “selling like hot cakes”. He was lunching with liberal churchmen and dining with bishops. Certainly, the first of the books published during Wells’s short “religious period”, the novel Mr. Britling Sees It (...) Through, had sold very well on both sides of the Atlantic and made Wells financially secure. Geoffrey Studdert Kennedy (“Woodbine Willie”) wrote that, “Everyone ought to read Mr. H. G. Wells’s great novel, Mr. Britling Sees It Through. It is a gallant and illuminating attempt to state the question, and to answer it. His thought has brought him to a very real and living faith in God revealed in Jesus Christ, and has also brought relief to many troubled minds among the officers of the British Army.” Yet, Wells’s God was explicitly a finite God, and his theology was far from orthodox. How can we account for his boast and for the clerical affirmation which he certainly did receive? This article examines and re-evaluates previous accounts of the responses of clergy to Wells’s writing, correcting some narratives. It discusses the way in which many clergy used Mr. Britling as a means by which to engage in a populist way with the question of theodicy, and examines the letters which Wells received from several prominent clerics, locating their responses in the context of their own theological writings. This is shown to be key to understanding the reaction of writers such as Studdert Kennedy to Mr. Britling Sees It Through. Finally, an assessment is made of the veracity of Wells’s boasting to his mistress, concluding that his claims were somewhat exaggerated. “Lambeth Palace is my Washpot, Over Fulham have I cast my breeches.” Mit diesen Worten erklärte der literarisch außergewöhnlich erfolgreiche und entschieden säkular denkende, kirchenkritische Schriftsteller und Science-Fiction-Pionier Herbert George Wells seiner Geliebten, dass seinetwegen Großbritannien “full of theological discussion” sei. Nicht ohne Eitelkeit schrieb er es seinem im September 1916 mit Blick auf den Krieg geschriebenen und stark autobiographisch gefärbten Roman Mr. Britling Sees it Through von knapp 450 Seiten zu, dass theologische Bücher reißenden Absatz fänden. Auch war er stolz darauf, liberale Kleriker zum Lunch zu treffen und von Bischöfen zum abendlichen Dinner eingeladen zu werden. In einer kurzen Phase seines Lebens war – oder inszenierte sich – Wells als ein frommer, gläubiger Mensch. Sein damals veröffentlichter Roman Mr. Britling Sees It Through verkaufte sich sowohl in Nordamerika als auch im Heimatland so gut, dass der Autor nun definitiv finanziell gesichert war. Der anglikanische Priester und Dichter Geoffrey Studdert Kennedy, der im Ersten Weltkrieg Woodbine Willie genannt wurde, weil er verletzten und sterbenden Soldaten in den Phasen der Vorbereitung auf den Tod Woodbine-Zigaretten anbot, empfahl die Lektüre von Wells’ “great novel” Mr. Britling mit den Worten: “It is a gallant and illuminating attempt to state the question, and to answer it. His thought has brought him to a very real and living faith in God revealed in Jesus Christ, and has also brought relief to many troubled minds among the officers of the British Army.” Allerdings war H. G. Wells’ Gott ein durchaus endlicher Gott, und seine Theologie war alles andere als orthodox. Wie lassen sich dennoch seine evidente Prahlerei und die emphatische Zustimmung zu seinem Roman in den britischen Klerikereliten erklären? Im Aufsatz werden zunächst einige ältere Deutungen der Zustimmung führender Kleriker zu Wells’ Roman untersucht und einige der dabei leitenden Deutungsmuster kritisch infrage gestellt. Deutlich wird, dass nicht wenige anglikanische Geistliche Mr. Britling dazu nutzten, um höchst populistisch das umstrittene Theodizeeproblem anzusprechen. Auch werden die Briefe prominenter Geistlicher an Wells analysiert, mit Blick auf ihre eigenen Publikationen. Diese Reaktionen haben stark Studdert Kennedys Haltung zu Mr. Britling Sees It Through beeinflusst. Besonders aufrichtig war Wells mit Blick auf sich selbst allerdings nicht. Die Selbstinszenierung gegenüber seiner Geliebten war einfach nur peinliche Übertreibung. (shrink)

We complete our previous(1, 2) demonstration that there is a family of new solutions to the photon and Dirac equations using spatial and temporal circles and four-vector behaviour of the Dirac bispinor. We analyse one solution for a bound state, which is equivalent to the attractive two-body interaction between a charged point particle and a second, which remains at rest. We show this yields energy and angular momentum eigenvalues that are identical to those found by the usual method of solving (...) of the Dirac equation,(4) including fine structure. We complete our previous derivation(2) of QED from a set of rules for the two-body interaction and generalise these. We show that QED may be decomposed into a two-body interaction at every point in spacetime. (shrink)

This article critically evaluates and contests the flagship benefit delivery system Universal Credit for lone mothers by focusing on some of the ethical challenges it poses, as well as some key implications it holds for social work with lone mothers and their children. Universal Credit was first introduced in the United Kingdom (UK) in 2008, and echoes conditionality-based welfare policies adopted by neoliberal governments internationally on the assumption that paid employment offers a route out of poverty for citizens. However, research (...) evidence suggests that the risks of conditionality polices for lone parents can often include increased poverty, a deterioration in mental health or even destitution posed by paternalistic sanctions or precarious low-paid employment, which can undermine parenting capacities and children’s well-being. The article also critically appraises and questions challenges posed by an increased reliance upon contractual ethics by governments, alongside the wider behaviour-modifying policies of the workfare-orientated state. This includes that working-class lone mothers can erroneously be stigmatised as representing a morally challenged dependent burden through activation policies and risk-averse social work practices. (shrink)

Retrofit is a rising area of concern for Science and Technology Studies scholars of infrastructure. This paper sits at the junction between applied and theoretical approaches by using STS to support interventions in urban infrastructure systems and expand STS critique of retrofit. It discusses findings from a multidisciplinary project piloting retrofit possibilities to positively impact the way water, energy, and food resources were consumed in a London housing estate. Through qualitative research, we found that residents were making social and material (...) interventions in infrastructure systems to manage the way resources were consumed at home, driven by a commonly held motivation to avoid wastefulness. We then mapped the social and material factors that helped or hindered these individual ambitions and used them to inform our codesign process. We found it helpful to think of the residents as an infrastructural community; a group of residents that share a material connection that can help mobilize collective action on shared consumption. We suggest this concept is useful for interventions and critiques of infrastructure retrofit, particularly in cities in the Global North where retrofit programs aim to rescale national systems to neighborhood levels. The concept highlights the possibilities for participation that emerge from bottom-up retrofit. (shrink)

Local perceptions of protected areas are important for conservation and the sustainability of protected areas. We undertook qualitative and ethnographic fieldwork to explore relationships between people and protected areas in the Blouberg mountain range, South Africa. The history of land use and current relationships with protected areas reveal legacies of marginalisation and immiseration, giving credence to a theory of traumatic nature. The impacts of traumatic nature manifest themselves in local discourses and narratives of nature, protected areas and conservation.

Patient and family emotional harm after medical errors may be profound. At an Agency for Healthcare Research and Quality conference to establish a research agenda on this topic, the authors used visual images as a gateway to personal reflections among diverse stakeholders. Themes identified included chaos and turmoil, profound isolation, organizational denial, moral injury and betrayal, negative effects on families and communities, importance of relational skills, and healing effects of human connection. The exercise invited storytelling, enabled psychological safety, and fostered (...) further collaborative discussion. The authors discuss implications for quality/safety, educational innovation, and qualitative research. (shrink)

Smajdor invites welcome interrogation of the distance between our philosophical justifications of how we engage people in decisions about healthcare or research, and the ways we do so.1 She notes the implicit elision made between autonomy and informed consent, and argues the latter alone cannot secure the former, proposing a more flexible approach. As researchers working with people with dementia (PwD), we share Smajdor’s reservations. We argue that an autonomy worthy of respect requires not just decision-making capacity, but also authenticity; (...) the ability to determine for oneself what is good for oneself.2 Furthermore, our relationships support or undermine both capacity and authenticity, and autonomous expression manifests throughout evolving relationships. This invites us to view respect differently—as an ongoing conversation with another person, capable of holding values that may move us. In Smajdor’s terminology, it requires that we recognise them. We describe how we operationalise this in our research. Three broad arguments usually support respect for autonomy.2 One—owed to JS Mill—holds that permitting individuals free choice promotes utility of all, by helping them fulfil ideas of the good, demonstrating ‘experiments in living’. Another draws from Kant’s categorical imperative; its Formula of Humanity holds that the capacity to determine our own values gives us reason to act, and we ought, therefore, to treat others’ values with the respect we show our own. Lastly, many simply assume ‘liberal neutrality’—an intrinsic value in people being permitted to pursue the …. (shrink)

This article revisits and further develops Mitchell et al.’s (Acad Manag Rev 22(4):853–886, 1997 ) theory of stakeholder identification and salience. Stakeholder salience holds considerable unrealized potential for understanding how organizations may best manage multiple stakeholder relationships. While the salience framework has been cited numerous times, attempts to develop it further have been relatively limited. We begin by reviewing the key contributions of other researchers. We then identify and seek to resolve three residual weaknesses in Mitchell et al.’s ( 1997 (...) ) framework, thereby strengthening its foundations for further development. We argue, first, that urgency is not relevant for identifying stakeholders; second, that it is primarily the moral legitimacy of the stakeholder’s claim that applies to stakeholder salience; and last, that the salience of stakeholders will vary as the degrees of the attributes vary. These insights inform revised definitions of stakeholder salience and legitimacy, and necessitate a new theoretical underpinning for the role of legitimacy. Finally, we present an extensive agenda for future research with the objective of refueling research in stakeholder salience. (shrink)