Drawing on insights from conversation analysis, discursive psychology and social psychology, this article describes some interactional features of two celebrity TV confessionals and the resources used by the TV interviewers and celebrity guests to attribute, accept or deny responsibility for their transgressions. The analytic interest lies in how confessions are locally and interactionally managed, that is, how ‘doing confessing’ is achieved in the television interview context. We show how the host’s opening turn constrains the celebrity guest’s contribution and secures overt (...) admission of guilt, while simultaneously inviting the celebrity guest to tell their side of the story. We also show how celebrity guests produce descriptions which minimize the extent and severity of their transgressions, reduce agency and transform the character of their transgression. In doing so, we argue that celebrity interviewees can convey mitigations and extenuations which diminish the extent of their responsibility – calling into question the very nature of their confession. We propose that our findings demonstrate the hybrid nature of interviewing in the celebrity TV confessional and contribute to our understanding of how ‘doing confessing’ in the public eye is discursively and interactionally negotiated. (shrink)

Our social role/biosocial theory provides a more adequate account of aggression sex differences than does Archer's sexual selection theory. In our theory, these sex differences arise flexibly from sociocultural and ecological forces in interaction with humans' biology, as defined by female and male physical attributes and reproductive activities. Our comments elaborate our theory's explanations for the varied phenomena that Archer presents.

It is not uncommon in educational research and social science in general either to eschew the word truth or to put it in scare quotes in order to signify scepticism about it. After the initial wave of relativism in the philosophy of natural science, a second wave has developed in social science with the rise of postmodernism and poststructuralism. The tendency here is to relativise truth or to bracket out questions of truth. In contradistinction, this paper revindicates the metaphysical nature (...) of truth. Truth is a transcendental precondition of educational inquiry and is best understood as a formal, regulative norm. Realism about truth enjoins a defence of the correspondence theory, which is provided here. At the same time, however, the development of realism in the social sciences has ironically followed the postmodernists in its scepticism about truth and its rejection of the correspondence theory. This paper critically appraises such recent developments, since all research is unintelligible without realism about the social world and whether our substantive knowledge-claims correspond with it. (shrink)

The philosophical difficulties presented by self-deception are vexed and multifaceted. One such difficulty is what I call the ‘doxastic problem’ of self-deception. Solving the doxastic problem involves determining whether someone in a state of self-deception that ∼p both believes that p and believes that ∼p, simply holds one or the other belief, or, as I will argue, holds neither. This final option, which has been almost entirely overlooked to-date, is what I call ‘ nondoxasticism ’ about self-deception. In this article, (...) I present a negative case for nondoxasticism according to which, in the paradigm case of self-deception, there is no explanatory need to attribute the self-deceived person either their undesired belief that p, or their desired belief that ∼p. Folk psychology is replete with concepts other than belief, and if we bear this in mind, it becomes clear that the explanatory roles for which the self-deceived person's purported beliefs have traditionally been enlisted can be comfortably filled without recourse to belief. (shrink)

Whether in characterizing Catharine MacKinnon's theory of gender as itself pornographic or in identifying liberalism as unable to make good on its promises, Wendy Brown pursues a central question: how does a sense of woundedness become the basis for a sense of identity? Brown argues that efforts to outlaw hate speech and pornography powerfully legitimize the state: such apparently well-intentioned attempts harm victims further by portraying them as so helpless as to be in continuing need of governmental protection. "Whether (...) one is dealing with the state, the Mafia, parents, pimps, police, or husbands," writes Brown, "the heavy price of institutionalized protection is always a measure of dependence and agreement to abide by the protector's rules." True democracy, she insists, requires sharing power, not regulation by it; freedom, not protection.Refusing any facile identification with one political position or another, Brown applies her argument to a panoply of topics, from the basis of litigiousness in political life to the appearance on the academic Left of themes of revenge and a thwarted will to power. These and other provocations in contemporary political thought and political life provide an occasion for rethinking the value of several of the last two centuries' most compelling theoretical critiques of modern political life, including the positions of Nietzsche, Marx, Weber, and Foucault. (shrink)

In evolutionary psychology predictions, women’s mate preferences shift between fertile and nonfertile times of the month to reflect ancestral fitness benefits. Our meta-analytic test involving 58 independent reports (13 unpublished, 45 published) was largely nonsupportive. Specifically, fertile women did not especially desire sex in short-term relationships with men purported to be of high genetic quality (i.e., high testosterone, masculinity, dominance, symmetry). The few significant preference shifts appeared to be research artifacts. The effects declined over time in published work, were limited (...) to studies that used broader, less precise definitions of the fertile phase, and were found only in published research. (shrink)

ABSTRACT:In a world filled with poverty, environmental degradation, and moral injustice, social enterprises offer a ray of hope. These organizations seek to achieve social missions through business ventures. Yet social missions and business ventures are associated with divergent goals, values, norms, and identities. Attending to them simultaneously creates tensions, competing demands, and ethical dilemmas. Effectively understanding social enterprises therefore depends on insight into the nature and management of these tensions. While existing research recognizes tensions between social missions and business ventures, (...) we lack any systematic analysis. Our paper addresses this issue. We first categorize the types of tensions that arise between social missions and business ventures, emphasizing their prevalence and variety. We then explore how four different organizational theories offer insight into these tensions, and we develop an agenda for future research. We end by arguing that a focus on social-business tensions not only expands insight into social enterprises, but also provides an opportunity for research on social enterprises to inform traditional organizational theories. Taken together, our analysis of tensions in social enterprises integrates and seeks to energize research on this expanding phenomenon. (shrink)

ABSTRACT:In a world filled with poverty, environmental degradation, and moral injustice, social enterprises offer a ray of hope. These organizations seek to achieve social missions through business ventures. Yet social missions and business ventures are associated with divergent goals, values, norms, and identities. Attending to them simultaneously creates tensions, competing demands, and ethical dilemmas. Effectively understanding social enterprises therefore depends on insight into the nature and management of these tensions. While existing research recognizes tensions between social missions and business ventures, (...) we lack any systematic analysis. Our paper addresses this issue. We first categorize the types of tensions that arise between social missions and business ventures, emphasizing their prevalence and variety. We then explore how four different organizational theories offer insight into these tensions, and we develop an agenda for future research. We end by arguing that a focus on social-business tensions not only expands insight into social enterprises, but also provides an opportunity for research on social enterprises to inform traditional organizational theories. Taken together, our analysis of tensions in social enterprises integrates and seeks to energize research on this expanding phenomenon. (shrink)

Tolerance is generally regarded as an unqualified achievement of the modern West. Emerging in early modern Europe to defuse violent religious conflict and reduce persecution, tolerance today is hailed as a key to decreasing conflict across a wide range of other dividing lines-- cultural, racial, ethnic, and sexual. But, as political theorist Wendy Brown argues in Regulating Aversion, tolerance also has dark and troubling undercurrents. Dislike, disapproval, and regulation lurk at the heart of tolerance. To tolerate is not to (...) affirm but to conditionally allow what is unwanted or deviant. And, although presented as an alternative to violence, tolerance can play a part in justifying violence--dramatically so in the war in Iraq and the War on Terror. Wielded, especially since 9/11, as a way of distinguishing a civilized West from a barbaric Islam, tolerance is paradoxically underwriting Western imperialism. Brown's analysis of the history and contemporary life of tolerance reveals it in a startlingly unfamiliar guise. Heavy with norms and consolidating the dominance of the powerful, tolerance sustains the abjection of the tolerated and equates the intolerant with the barbaric. Examining the operation of tolerance in contexts as different as the War on Terror, campaigns for gay rights, and the Los Angeles Museum of Tolerance, Brown traces the operation of tolerance in contemporary struggles over identity, citizenship, and civilization. (shrink)

Do famous athletes have special obligations to act virtuously? A number of philosophers have investigated this question by examining whether famous athletes are subject to special role model obligations (Wellman 2003; Feezel 2005; Spurgin 2012). In this paper we will take a different approach and give a positive response to this question by arguing for the position that sport and gaming celebrities are ‘ambassadors of the game’: moral agents whose vocations as rule-followers have unique implications for their non-lusory lives. According (...) to this idea, the actions of a game’s players and other stakeholders—especially the actions of its stars—directly affect the value of the game itself, a fact which generates additional moral reasons to behave in a virtuous manner. We will begin by explaining the three main positions one may take with respect to the question: moral exceptionalism, moral generalism, and moral exemplarism. We will argue that no convincing case for moral exemplarism has thus far been made, which gives us reason to look for new ways to defend this position. We then provide our own ‘ambassadors of the game’ account and argue that it gives us good reason to think that sport and game celebrities are subject to special obligations to act virtuously. (shrink)

Background. The concept of empathy in students has gained significant attention in medical education. Whether implementing formal educational interventions to promote long-term and effective empathy levels leads to sustained increased empathy levels in students, is however less clear. Objectives. The study aimed to evaluate the trajectory of medical students’ self-perceived empathy levels during their 6-year MB ChB degree. Methods. A longitudinal, prospective study was conducted over 4 years. A cohort of 292 medical students was invited to participate. Participants completed the (...) Jefferson Scale of Empathy for Students (JSE-S) at three intervals during their studies. The students attended two workshops related to empathic patient interactions during this time. The JSE-S mean score by age and gender was compared, making use of a linear regression model. Results. A total of 119 students completed the study. Students’ total empathy levels were similar during the first and the last measuring point (110), but there was a significant rise in the intermediate measuring point (113.3). When the male and female cohorts’ scores were interpreted separately, both genders demonstrated a similar pattern to the total score, although females’ JSE-S scores were higher than the males. Conclusion. The results of the study confirm that educational interventions can increase students’ self-perceived empathy levels; however, we suggest that students require reinforcement and multiple opportunities to practise and observe empathic communication with patients to sustain high levels of empathy. Follow-up sessions to specifically target the promotion of empathy should be implemented; otherwise the long-term effect of educational interventions might be limited. (shrink)

Informal political representation can be a political lifeline, particularly for oppressed and marginalized groups. Such representation can give these groups some say, however mediate, partial, and imperfect, in how things go for them. Coeval with the political goods such representation offers these groups are its particular dangers to them. Mindful of these dangers, skeptics challenge the practice for being, inter alia, unaccountable, unauthorized, inegalitarian, and oppressive. These challenges provide strong pro tanto reasons to think the practice morally impermissible. This paper (...) considers the question: On what conditions is the informal political representation of oppressed and marginalized groups permissible? By responding to skeptics’ challenges, I develop a systematic account of moral constraints that, if adopted, would make such representation permissible. The account that emerges shows that informal political representatives (IPRs) must aim to fulfill two sets of sometimes conflicting duties to the represented: democracy within duties, which concern how the representative treats and relates to the represented, and justice without duties, which concern how the representative’s actions advance the aims of the representation. (shrink)

_John Stuart Mill_ investigates the central elements of the 19th century philosopher’s most profound and influential works, from _On Liberty_ to _Utilitarianism_ and _The Subjection of Women_. Through close analysis of his primary works, it reveals the very heart of the thinker’s ideas, and examines them in the context of utilitarianism, liberalism and the British empiricism prevalent in Mill’s day. • Presents an analysis of the full range of Mill’s primary writings, getting to the core of the philosopher’s ideas. • (...) Examines the central elements of Mill’s writings in easily accessible prose • Places Mill’s work and thought within the larger cultural and social context of 19th century Britain • Illustrates the continued relevance of Mill’s philosophy to today’s reader. (shrink)

Wendy Brown's work commands widespread attention and respect, and there has been considerable interest as to how it would develop after "States of Injury." This book will not disappoint.

Informal political representation—the phenomenon of speaking or acting on behalf of others although one has not been elected or selected to do so by means of a systematized election or selection procedure—plays a crucial role in advancing the interests of groups. Sometimes, those who emerge as informal political representatives (IPRs) do so willingly (voluntary representatives). But, often, people end up being IPRs, either in their private lives or in more public political forums, over their own protests (unwilling representatives) or even (...) without their knowledge (unwitting representatives)—that is, they are conscripted. None of the few theories of informal political representation extant accommodate conscripted IPRs. The account detailed here introduces the phenomenon of conscripted informal political representation and explains its place in a complete theory of informal political representation. Conscripted IPRs can, like their voluntary counterparts, come to have significant power to influence how various audiences regard those for whom the conscripted IPRs speak or act. Upon attaining such power to influence, conscripted IPRs, like their voluntary counterparts, come to have pro tanto duties to those they represent—duties that arise despite IPRs’ unwittingness or unwillingness. Understanding the phenomenon of conscripted informal political representation allows us to surface essential normative questions about informal political representation that are otherwise occluded. (shrink)

Journal of Political Philosophy, Volume 29, Issue 4, Page 429-455, December 2021.

We invoke the ideal of tolerance in response to conflict, but what does it mean to answer conflict with a call for tolerance? Is tolerance a way of resolving conflicts or a means of sustaining them? Does it transform conflicts into productive tensions, or does it perpetuate underlying power relations? To what extent does tolerance hide its involvement with power and act as a form of depoliticization? Wendy Brown and Rainer Forst debate the uses and misuses of tolerance, an (...) exchange that highlights the fundamental differences in their critical practice despite a number of political similarities. Both scholars address the normative premises, limits, and political implications of various conceptions of tolerance. Brown offers a genealogical critique of contemporary discourses on tolerance in Western liberal societies, focusing on their inherent ties to colonialism and imperialism, and Forst reconstructs an intellectual history of tolerance that attempts to redeem its political virtue in democratic societies. Brown and Forst work from different perspectives and traditions, yet they each remain wary of the subjection and abnegation embodied in toleration discourses, among other issues. The result is a dialogue rich in critical and conceptual reflections on power, justice, discourse, rationality, and identity. (shrink)

On one hand, Chinese consumers are well known for conspicuous consumption and the adoption of luxury products and named brands. On the other hand, they also have a bad reputation for buying counterfeit products. Their simultaneous preferences for two contrasting types of product present a paradox that has not been addressed in the literature. This study attempts to present an explanation of this paradox by examining the effects of traditional Chinese cultural values and consumer values on consumers’ deontological judgment of (...) pirated CDs and the amount of social benefits they perceive they gain from them. We interviewed 300 Hong Kong Chinese consumers, and found that face consciousness increased materialism and risk aversion, thereby producing a favorable deontological judgment of pirated CDs. Face consciousness also has a direct effect on the amount of social benefits perceived in pirated CDs. Both favorable deontological judgment and perceived social benefits contributed to a strong intention to buy pirated CDs. The results are discussed in a cultural perspective. (shrink)

Humanity and the very notion of the human subject are under threat from postmodernist thinking which has declared not only the 'Death of God' but also the 'Death of Man'. This book is a revindication of the concept of humanity, rejecting contemporary social theory that seeks to diminish human properties and powers. Archer argues that being human depends on an interaction with the real world in which practice takes primacy over language in the emergence of human self-consciousness, thought, emotionality (...) and personal identity - all of which are prior to, and more basic than, our acquisition of a social identity. This original and provocative new book from leading social theorist Margaret S. Archer builds on the themes explored in her previous books Culture and Agency (CUP 1988) and Realist Social Theory (CUP 1995). It will be required reading for academics and students of social theory, cultural theory, political theory, philosophy and theology. (shrink)

Neoliberalism and neoconservatism are two distinct political rationalities in the contemporary United States. They have few overlapping formal characteristics, and even appear contradictory in many respects. Yet they converge not only in the current presidential administration but also in their de-democratizing effects. Their respective devaluation of political liberty, equality, substantive citizenship, and the rule of law in favor of governance according to market criteria on the one side, and valorization of state power for putatively moral ends on the other, undermines (...) both the culture and institutions of constitutional democracy. Above all, the two rationalities work symbiotically to produce a subject relatively indifferent to veracity and accountability in government and to political freedom and equality among the citizenry. (shrink)

Concern for human vulnerability seems to be at the heart of bioethical inquiry, but the concept of vulnerability is under-theorized in the bioethical literature. The aim of this article is to show why bioethics needs an adequately theorized and nuanced conception of vulnerability. We first review approaches to vulnerability in research ethics and public health ethics, and show that the bioethical literature associates vulnerability with risk of harm and exploitation, and limited capacity for autonomy. We identify some of the challenges (...) emerging from this literature: in particular, how to reconcile universal human vulnerability with a context-sensitive analysis of specific kinds and sources of vulnerability; and how to reconcile obligations to protect vulnerable persons with obligations to respect autonomy. We then briefly survey some of the theoretical resources available within the philosophical literature to address these challenges, and to assist in understanding the conceptual connections between vulnerability and related concepts such as harm, exploitation, needs, and autonomy. We also sketch out a taxonomy of sources and kinds of vulnerability. Finally, we consider the implications for policy evaluation of making vulnerability an explicit and central focus of bioethics. Our investigation is in the form of a broad survey motivating a research agenda rather than a detailed analysis. (shrink)

Lloyd (2009) contends that climate models are confirmed by various instances of fit between their output and observational data. The present paper argues that what these instances of fit might confirm are not climate models themselves, but rather hypotheses about the adequacy of climate models for particular purposes. This required shift in thinking—from confirming climate models to confirming their adequacy-for-purpose—may sound trivial, but it is shown to complicate the evaluation of climate models considerably, both in principle and in practice.

The central problem of social theory is 'structure and agency'. How do the objective features of society influence human agents? Determinism is not the answer, nor is conditioning as currently conceptualised. It accentuates the way structure and culture shape the social context in which individuals operate, but it neglects our personal capacity to define what we care about most and to establish a modus vivendi expressive of our concerns. Through inner dialogue, 'the internal conversation', individuals reflect upon their social situation (...) in the light of current concerns and projects. On the basis of a series of unique, in-depth interviews, Archer identifies three distinctive forms of internal conversation. These govern agents' responses to social conditioning, their individual patterns of social mobility and whether or not they contribute to social stability or change. Thus the internal conversation is seen as being the missing link between society and the individual, structure and agency. (shrink)

'Is politics gendered? Wendy Brown things so, and argues for this point with elegance, imagination and pungent phrases. Brown's book is challenging, provocative and...original; it does force us to question the degree to which gender controls our politics.'-THE REVIEW OF POLITICS.

Taking its cue from sign languages, this paper pulls together a range of studies to support the proposal that the recruitment and composition of body actions counts as evidence for linguistic properties. Adopting the view that compositionality is the foundational organizing property of language, we find first that actions of the hands, face, head, and torso in sign languages directly reflect linguistic components, as well as certain aspects of compositional organization among them that are common to all languages, signed and (...) spoken. Work on emerging sign languages strengthens the approach by showing that the gradual recruitment of bodily articulators for linguistic functions directly maps the way in which a new language increases in complexity over time. While compositional communication is almost exclusively restricted to humans, it is not restricted to language. In the spontaneous, intense emotional displays of athletes, different emotional states are correlated with actions of particular face and body features and feature groupings, indicating a much more ancient compositional foundation for language. (shrink)

An underexamined insight of W. E. B. Du Bois’s John Brown is that John Brown worked for much of his life to cultivate democratic relationships with the Black Americans with and for whom he worked. Brown did so through practicing deference and deliberation, and by seeking authorization. However, Brown’s commitment to these practices faltered at a crucial moment in decision making: when he raided Harpers Ferry absent widespread support. Examining this aspect of John Brown brings into relief an overlooked tragic (...) choice Brown made: To act in accordance with his own substantive vision of what justice required, Brown eschewed democratic ideals and practices that grounded the distinctive relations of equality he had cultivated with the Black communities with and for whom he worked. (shrink)

How might people be wronged in relation to their feelings, moods, and emotions? Recently philosophers have begun to investigate the idea that these kinds of wrongs may constitute a distinctive form of injustice: affective injustice (Archer & Mills 2019; Mills 2019; Srinivasan 2018; Whitney 2018). In previous work, we have outlined a particular form of affective injustice that we called emotional imperialism (Archer & Matheson 2022). This paper has two main aims. First, we aim to provide an expanded (...) account of the forms that emotional imperialism can take. We will do so by drawing inspiration from William Reddy’s concept of an emotional regime and investigating ways in which colonial powers of the 18th to 20th Centuries sought to impose their emotional regimes on their colonial subjects. Second, we will offer more expansive accounts of both emotional imperialism and affective injustice that can accommodate these additional forms of emotional imperialism. (shrink)

Current conceptions of human language include a gestural component in the communicative event. However, determining how the linguistic and gestural signals are distinguished, how each is structured, and how they interact still poses a challenge for the construction of a comprehensive model of language. This study attempts to advance our understanding of these issues with evidence from sign language. The study adopts McNeill's criteria for distinguishing gestures from the linguistically organized signal, and provides a brief description of the linguistic organization (...) of sign languages. Focusing on the subcategory of iconic gestures, the paper shows that signers create iconic gestures with the mouth, an articulator that acts symbiotically with the hands to complement the linguistic description of objects and events. A new distinction between the mimetic replica and the iconic symbol accounts for the nature and distribution of iconic mouth gestures and distinguishes them from mimetic uses of the mouth. Symbiotic symbolization by hand and mouth is a salient feature of human language, regardless of whether the primary linguistic modality is oral or manual. Speakers gesture with their hands, and signers gesture with their mouths. (shrink)

In this wide-ranging interview Professor Margaret Archer discusses a variety of aspects of her work, academic career and influences, beginning with the role the study of education systems played in...

This article explores the question of the efficacy of state-level food sovereignty projects for democratizing local control over food systems by examining the case of Nicaragua, where the Ortega administration adopted food sovereignty into policy. The main task of food sovereignty is to transform the power relations that govern food systems. This article builds on the previous work of food sovereignty scholars by arguing that devolving power to local territories is necessary but insufficient for deepening democracy, and rather must be (...) coupled with broader transformations in state-society relations. In particular, it argues that how power is exercised in different sites and scales of decision-making is critical for gauging the extent to which local democratic control of food systems is realized. This study examines the implementation of two models of food governance that emerged in Nicaragua in the years immediately following Ortega’s election in 2007. It finds that while the two models created opportunities to deepen democracy, the state’s lack of support for autonomous citizen mobilization and their attempts to co-opt spaces for participatory democratic governance have strongly contributed to the failure of these mechanisms to enhance local control over food systems. (shrink)

Once a term used primarily by moral philosophers, “moral distress” is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? “Plight” encompasses not (...) only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of “efficiency,” is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals’ moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim. (shrink)

Biological dysfunction is regarded, in many accounts, as necessary and perhaps sufficient for disease. But although disease is conceptualized as all-or-nothing, biological functions often differ by degree. A tension is created by attempting to use a continuous variable as the basis for a categorical definition, raising questions about how we are to pinpoint the boundary between health and disease. This is the line-drawing problem. In this paper, we show how the line-drawing problem arises within “dysfunction-requiring” accounts of disease, such as (...) those of Christopher Boorse and Jerome Wakefield. We then provide several detailed examples to establish that biological dysfunction cannot provide a boundary. We examine potential ways of resolving the line-drawing problem, either by dropping one of the claims that generates it, or by appealing to additional criteria. We argue that two of these options are plausible, and that each of these can be applied with regard to different diseases. (shrink)

Unable to answer the call of our patients: mental health nurses’ experience of moral distress When health practitioners’ moral choices and actions are thwarted by constraints, they may respond with feelings of moral distress. In a Canadian hermeneutic phenomenological study, physicians, nurses, psychologists and non‐professional aides were asked to identify care situations that they found morally distressing, and to elaborate on how moral concerns regarding the care of patients were raised and resolved. In this paper, we describe the experience of (...) moral distress related by nurses working in mental healthcare settings who believed that lack of resources (such as time and staff) leads to dispiritedness, lack of respect, and absence of recognition (for both patients and staff) which severely diminished their ability to provide quality care. The metaphors of flashlight and hammer are used to elaborate nurses’ possible responses to intolerable situations. (shrink)

RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

While the economic and environmental dimensions of the triple bottom line have been covered extensively by management theory and practice, the social dimension remains largely underrepresented. The resource-based view of the firm and the natural resource-based view of the firm are revisited to lay the theoretical foundation for exploring how the social dimension might be addressed. Social capabilities are then explored by looking at the social entrepreneurship literature and illustrative cases with the purpose of elaborating RBV toward a social resource-based (...) view of the firm. Three illustrative cases, which represent social businesses located in catastrophe-ridden Haiti, show how capabilities are used to overcome challenging constraints. The goal for the social entrepreneur is to employ the appropriate capabilities to ensure economic success, a positive environmental impact, and social benefits that leave the local community in a better position than without the business. Just as NRBV is a previous elaboration of RBV, so can SRBV be an elaborated theoretical foundation for future research. The components of a theory are systematically addressed by extending the range of variables, extending the domain, and offering propositions on variable relationships and outcome predictions. By highlighting the social capabilities of social entrepreneurs, this research illuminates the micro-foundations of corporate social responsibility, emphasizing the value of individual level analyses. (shrink)

In Europe, welfare state provision has been subjected to 'market forces'. Over the last two decades, the framework of economic competitiveness has become the defining aim of education, to be achieved by new managerialist techniques and mechanisms. This book thoughtfully and persuasively argues against this new vision of education. This in-depth major study will be of great interest to researchers in the sociology of education, education policy, social theory, organization and management studies, and also to professionals concerned about the deleterious (...) impact of current education policy on children's learning and welfare. (shrink)