Background Making the right decisions, while simultaneously showing respect for patient autonomy, represents a great challenge to nursing home staff in the issues of life-prolonging treatment, hydration, nutrition and hospitalisation to dying patents in end-of-life. Objectives To study how physicians and nurses protect nursing home patients' autonomy in end-of-life decisions, and how they justify their practice. Design A qualitative descriptive design with analysis of the content of transcribed in-depth interviews with physicians and nurses. Participants Nine physicians and ten nurses in (...) 10 nursing homes in Norway. Results and interpretations Assessment of the patient's competence to consent to treatment is almost absent. The physicians build their practice on the principles of beneficence and nonmaleficence. Nurses tend to trust the patients' rejection of life support, even when the patients have difficulty speaking or suffer from dementia. Relatives were, according to the health personnel, included in decision-making processes to a very limited extent. However, futile life support is sometimes provided contrary to the physicians' judgement of what constitutes the patient's best interest on occasions when they are pressurised by next of kin. Conclusions The study reveals a need to improve decision-making routines according to ethical ideals and legislation. Conflicts between relatives and healthcare professionals in the decision-making process deflect the focus from searching for the best possible treatment for the terminal patient. Further discussion is required as to whether the concept of autonomy is applicable in situations in which the patient is impaired and dying. (shrink)

Archaeological excavations carried out at Pentridge Prison discovered the ruins and foundations of three panopticon exercise yards. This paper details the scope and observations of the excavation program and discusses the influence of Jeremy Bentham’s panopticon model on penal reform and prison design in Australia in the middle of the 19th Century.

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Public education is not just a way to organise and fund education. It is also the expression of a particular ideal about education and of a particular way to conceive of the relationship between education and society. The ideal of public education sees education as an important dimension of the common good and as an important institution in securing the common good. The common good is never what individuals or particular groups want or desire, but always reaches beyond such particular (...) desires towards that which societies as a whole should consider as desirable. This does, of course, put the common good in tension with the desires of individuals and groups. Neo-liberal modes of governance have, over the past decades, put this particular educational set up under pressure and have, according to some, eroded the very idea of the common good. This set of contributions reflects on this state of affairs, partly through an exploration of the idea of publicness itself – how it can be rearticulated and regained – and partly through reflections on the current state of education in the ‘north’ and the ‘south.’. (shrink)

We are in the midst of an unprecedented, human-caused, environmental crisis.

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services such as clinical ethics committees (...) (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethics resources were more evenly distributed. Although most respondents (81%) reported that they would find help useful in facing ethical difficulties, they reported having used the available services infrequently (14%). Physicians with greater confidence in their knowledge of ethics (P = 0.001), or who had had ethics courses in medical school (P = 0.006), were more likely to have used available services. Access to help in facing ethical difficulties among general physicians in the surveyed countries is provided by a mix of official ethics support services and other resources. Developing ethics support services may benefit from integration of informal services. Development of ethics education in medical school curricula could lead to improved physicians sensititity to ethical difficulties and greater use of ethics support services. Such support services may also need to be more proactive in making their help available. (shrink)

Existing social disparities in the United States are inconsistent with the promise of democracy; therefore, there was a need for critical conceptualization of the first principles that undergird American democracy and the genesis of democratic social change in America. This constructivist grounded theory study aimed to construct a grounded theory that provides an understanding of the process of American democratic social change as it emerged from the nation’s founding documents. A post hoc polytheoretical framework including Foucault’s, Bourdieu’s, and Marx and (...) Engels’s theories of power was used to understand power dynamics. The research question focused on understanding the process of democratic social change in America. The sample comprised the Articles of Confederation, the U.S. Declaration of Independence, The Federalist Papers, and the U.S. Constitution. The documents were retrieved from the National Archives and Library of Congress. The data analysis plan incorporated successive comparison, situational and dramaturgical analysis, deconstruction, and perspective taking as strategies. The result was the construction of a democratic social change process theory preceded by five grounded theories: (a) first principles of democracy, (b) first principles of democracy conceptual framework, (c) socio-ethical principles of democracy, (d) demoralizing process, and (e) either-or approach to democracy. Positive social change implications include applying a democratic social change process to future social change endeavors across domains and levels of analysis, a normative framework for a republican form of government, and a tool to analyze and minimize the latent consequences of social justice policies. (shrink)

Drawing from ethnographic, empirical, and historical / cultural perspectives, we examine the extent to which visual aspects of music contribute to the communication that takes place between performers and their listeners. First, we introduce a framework for understanding how media and genres shape aural and visual experiences of music. Second, we present case studies of two performances, and describe the relation between visual and aural aspects of performance. Third, we report empirical evidence that visual aspects of performance reliably influence perceptions (...) of musical structure and affective interpretations of music. Finally, we trace new and old media trajectories of aural and visual dimensions of music, and highlight how our conceptions, perceptions and appreciation of music are intertwined with technological innovation and media deployment strategies. (shrink)

We examined whether facial expressions of performers influence the emotional connotations of sung materials, and whether attention is implicated in audio-visual integration of affective cues. In Experiment 1, participants judged the emotional valence of audio-visual presentations of sung intervals. Performances were edited such that auditory and visual information conveyed congruent or incongruent affective connotations. In the single-task condition, participants judged the emotional connotation of sung intervals. In the dual-task condition, participants judged the emotional connotation of intervals while performing a secondary (...) task. Judgements were influenced by melodic cues and facial expressions and the effects were undiminished by the secondary task. Experiment 2 involved identical conditions but participants were instructed to base judgements on auditory information alone. Again, facial expressions influenced judgements and the effect was undiminished by the secondary task. The results suggest that visual aspects of music performance are automatically and preattentively registered and integrated with auditory cues. (shrink)

Volume 20, Issue 7, July 2020, Page 196-198.

Existing social disparities in the United States are inconsistent with Lincoln’s promise of democracy; therefore, there is a need for a critical conceptualization of the first principles that undergird American democracy and the genesis of democratic social change in America. This study aimed to construct a grounded theory that provides an understanding of the process of American democratic social change. The result was the construction of two frameworks: the demoralization process that triggers social change, and a formal grounded theory that (...) could explain democratic social change endeavors across different domains and levels of analysis. This democratic social change grounded theory answers the research question: How do the principles of the American founding documents provide an understanding of the process of American democratic social change? (shrink)

Clinical ethicists encounter the most emotionally eviscerating medical cases possible. They struggle to facilitate resolutions founded on good reasoning embedded in compassionate care. This book fills the considerable gap between current texts and the continuing educational needs of those actually facing complex ethics consultations in hospital settings. 28 richly detailed cases explore the ethical reasoning, professional issues, and the emotional aspects of these impossibly difficult consultations. The cases are grouped together by theme to aid teaching, discussion and professional growth. The (...) cases inform any reader who has a keen interest in the choices made in real-life medical dilemmas as well as the emotional cost to those who work to improve the situations. On a more advanced level, this book should be read by ethics committee members who participate in ethics consultations, individual ethics consultants, clinicians who seek education about complex clinical ethics cases, and bioethics students. (shrink)

The polarities of democracy framework is used to achieve human emancipation by simultaneously managing multiple paradoxes by employing Johnson’s polarity management as the conceptual framework. Although Johnson’s framework may be appropriate for managing other tension-dependent pairs, it is less suitable for managing multiple democratic values when the goal is human emancipation and sustainable democratic social change. Managing multiple polarities is exacerbated by the problem-shifting and problem-creation effect inherent in a tension-driven framework. The aim was to develop a constructivist grounded theory (...) to answer the research question: How can the first principles of democracy be used to reduce dynamic tension and achieve human emancipation? This gap has been filled by a parsimonious conceptual framework based on three democratic principles: human dignity, fairness, and knowledge. The principles of democracy conceptual framework can synthesize the tension between democratic values in order to manage, plan, and evaluate democratic social change initiatives. (shrink)

The article Pragmatismand the Importance of Interdisciplinary Teams in Investigating Personality Changes Following DBS.

Background: The United States symbolizes democracy in the new world and contributes to global prosperity. Nevertheless, incrementalism is a historically dominant national approach to public policy implementation that delays democracy and undermines human dignity. Human flourishing and national development are endangered by slow-moving democratic changes. This necessitates a social justice framework that traces the exploitation of incrementalism and the consequences of opportunity gaps. Objectives: This study aims to construct a grounded theory to address and answer the following research question: Are (...) anti-democratic concepts part of a process or strategy that hinders democratic change, and what reinforces it, if anything? Methods: Two categories emerged from a grounded theory of democratic social change. This combination of anti-democratic tenets and democratic principles led to abductive reasoning to fill the research gap. Results: The key finding was the existence of a systematic approach that led to democracy while simultaneously disempowering the same group through legal and extralegal means. Two processes hinder democracy: incrementalism and an anti-democratic demoralizing process. A constructivist social justice grounded theory was developed to analyze and evaluate public policy for barriers and facilitators of democracy. A thorough analysis and evaluation of the impact and consequences of public policy is recommended to better understand how such policies impede democracy and influence American perceptions of justice. (shrink)

Great Britain subjugated colonists using various power strategies, including dehumanization, misinformation, fear, and other divisive strategies. The Founders described these oppressive strategies as “a long train of abuses and usurpations.” Throughout the Declaration of Independence and the U.S. Constitution, the Founding Fathers imbued the people with hope in a government for the people: one unlike that of the monarchy, which sought to protect itself at the expense of colonists. As a result, the Founders created a government more likely to lead (...) with fairness, demonstrate respect for human dignity, unite Americans as one people, empower citizens through hope, and lead the nation toward security. This socio-ethical framework was an abductive discovery nested within a grounded theory study where it had been concluded that the first principles of democracy were woven within the American founding documents. Using Charmaz’s constructivist grounded theory, the first principles of democracy—knowledge, fairness, human dignity, hope, unity, and security—were used to answer an emerging research question: Are there two democratic frameworks in the founding documents, and how do they differ? The first principles of democracy promote a culture of ethics, resilience, and freedom. Their empowering disposition makes them suitable as a normative framework for a democratic government for the people. (shrink)

An outstanding group of leaders left evidence that a richer and more sustainable democracy could be achieved with American independence and democratic principles integrated into a new republican form of government. They were moved by principles that are the very spirit of democracy. These principles are needed to enhance democracy and improve well-being. Using the constructivist tradition of grounded theory and Aristotle’s conception of abstraction, the article proposes a theory of the first principles of democracy based on substantive data: the (...) Declaration of Independence, the Articles of Confederation, The Federalist Papers, and the United States Constitution. Knowledge, fairness, human dignity, hope, unity, and security are the first principles of democracy and are regarded as the bedrock of democracy and a government framework for the people. This theory contributed to a formal model of democratic social change. It also contributes a conceptual framework that supports Solum’s semantic originalism, a theory of constitutional interpretation. The principles of democracy can revitalize democracy and provide new possibilities by protecting education as an innate human right, abolishing capital punishment, criminalizing private prisons on the stock market, and reevaluating the proportionality of prison sentences. (shrink)

Few scholars have explored the founding documents to identify the deliberate social change strategy that led to America's independence and a new form of government that was of, by, and for the people. This study aimed to apply a post-hoc polytheoretical framework of power to the findings of a democratic social change study to understand the dynamics of power between Great Britain and the American colonists. The original study employed the constructivist grounded theory tradition to explore democracy in the Declaration (...) of Independence, the Articles of Confederation, The Federalist Papers, and the United States Constitution. This produced two frameworks of power strategies, one empowering and the other demoralizing: principles of democracy and anti-democratic tenets. To gain a holistic perspective of the interplay of power, a polytheoretical framework of power consisting of theories of power proposed by Marx and Engels, Bourdieu, and Foucault was employed to discuss the findings. The findings suggested that democratic social change interacts with structural forces, culture, and power strategy selection. This could provide an alternative lens through which to explore whether people of color in America were used instrumentally to sustain democracy. (shrink)

This thesis examines the key moral principles that should govern decision-making by police and military when using lethal force. To this end, it provides an ethical analysis of the following question: Under what circumstances, if any, is it morally justified for the agents of state-sanctioned security institutions to use lethal force, in particular the police and the military? Recent literature in this area suggests that modern conflicts involve new and unique features that render conventional ways of thinking about the ethics (...) of armed conflict, and the use of lethal force, as inadequate or redundant. In particular, there is an increased concern with the moral difficulties created by “non-standard” cases. This is where the police or military are obliged to operate outside their conventional contexts. In such non-standard cases, on what moral basis can (or should) state actors – especially the police and military – use lethal force? One approach argues that there is nothing morally exceptional about the use of lethal force by police or military. This says the only available moral justification for using lethal force is killing in self-defence or defence of others. In contrast, I use an institutional approach to develop a moral framework for the state’s morally exceptional use of lethal force. The institutional approach is concerned with the ends (telos) or purpose of a social institution. It says that the moral purpose of a social institution alters the moral responsibilities of its agents; what is referred to as role morality. My analysis demonstrates that there is an important moral distinction between justified killing in self-defence and state-sanctioned uses of lethal force. My claim is that police and military uses of lethal force are not morally justified in the same way as the average person’s use of lethal force (i.e. self-defence or defence of others). Instead, I argue that the state-sanctioned institutional role of police and military give these state actors special moral duties, and therefore exceptional moral justification, for using lethal force. I argue that the institutional end of the police is the preservation of public safety. This includes using lethal force where it is necessary to protect life and prevent serious injury to jurisdictional inhabitants. In contrast, a morally responsible state uses military force to defend the “common good.” That is, when it is necessary to defend the peaceful functioning of a state from armed threats or other forms of political violence. I then conclude that non-standard cases require the addition of jus ad vim (or the just use of military force short-of-war) as a hybrid element to the moral framework for the state-sanctioned use of lethal force. This provides a better way of applying ethics to the use of military force when defending the common good against serious threats in non-standard cases. This is because jus ad vim complements the conventional military paradigm by permitting the use of military capabilities to defend the common good. But, at the same time, it inhibits the move towards the more destructive levels of violence characteristic of conventional warfighting. (shrink)

Multidisciplinary healthcare committees meet regularly to discuss patients’ candidacy for emerging functional neurosurgical procedures, such as Deep Brain Stimulation . Through debate and discussion around the surgical candidacy of particular patients, functional neurosurgery programs begin to mold practice and policy supported both by scientific evidence and clear value choices. These neurosurgical decisions have special considerations not found in non-neurologic committees. The professional time used to resolve these conflicts provides opportunities for the emergence of careful, ethical practices simultaneous with the expansion (...) of therapy applications. (shrink)

Objective: To develop an approach for seeking informed consent to examine tissues retained from a previous study of sudden infant death syndrome as part of a study on asthma, and to document responses and participation rate.Design: Pilot open-ended approach to 10 volunteer SIDS parents, followed by staged approach to seek consent from the target SIDS families for the asthma study.Participants: Parents of SIDS infants known to SIDS and Kids Victoria and parents of SIDS infants from the 1991–2 SIDS in Victoria (...) case–control study.Main outcomes: Qualitative responses of the piloted parents and study parents, and participation rates.Results: The pilot group responses were used to refine the written material to be provided. Of the 72 families for which contact details were available, 45 gave verbal consent for contact by the Victorian Institute of Forensic Medicine regarding the asthma study, three refused and 24 did not respond to two letters. Thirty-three completed consent forms, all positive for participation in the asthma study, giving a positive response rate of 73% .Conclusions: The use of postmortem tissue for research is acceptable to the next of kin when an approach is sensitive to their concerns and needs and is made by experienced counsellors from a familiar organisation. Despite the painful memories evoked by the approach of the research group, the acceptance rate among those who could be contacted was high. (shrink)

All lives contain negative events, but how we think about these events differs across individuals; negative events often include positive details that can be remembered alongside the negative, and the ability to maintain both representations may be beneficial. In a survey examining emotional responses to the 2013 Boston Marathon bombings, the current study investigated how this ability shifts as a function of age and individual differences in initial experience of the event. Specifically, this study examined how emotional importance, involvement, and (...) self-reported surprise upon hearing about the event related to the tendency to report focusing on the negative and positive aspects of the bombings. Structural equation models revealed that while greater emotional importance and surprise were associated with a greater focus on negative elements, involvement and age were associated with increased consideration of positive aspects. Further, emotional importance was more strongly related to an increased focus on negative aspects for young adults and an increased focus on positive aspects for older adults, highlighting a tendency for older adults to enhance positive features of an otherwise highly negative event. (shrink)

Objective To study how doctors care for their patients, both medically and as fellow humans, through observing their conduct in patient–doctor encounters. Design Qualitative study in which 101 videotaped consultations were observed and analysed using a Grounded Theory approach, generating explanatory categories through a hermeneutical analysis of the taped consultations. Setting A 500-bed general teaching hospital in Norway. Participants 71 doctors working in clinical non-psychiatric departments and their patients. Results The doctors were concerned about their patients' health and how their (...) medical knowledge could be of service. This medical focus often over-rode other important aspects of the consultations, especially existential elements. The doctors actively directed the focus away from their patients' existential concerns onto medical facts and rarely addressed the personal aspects of a patient's condition, treating them in a biomechanical manner. At the same time, however, the doctors attended to their patients with courteousness, displaying a polite and friendly attitude and emphasising the relationship between them. Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors' social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof. (shrink)

As neural implants transition from engineering design and testing into human subjects research, careful consideration must be paid to the ethical elements in developing research protocols. Although these ethical aspects may be framed by the design choices of the engineering, a number of challenging choices arise. In spite of many ethical considerations for neural implant technologies being shared with generic research ethics questions, there are subsets needing special attention. Even in considerations requiring increased attention, substantial overlap can be found with (...) research ethics questions for general medical implants and for psychiatric pharmaceuticals. The special attention to specific ethical questions in neural implants exists because of the value placed on preserving cognition and control as well as our continued memory of significant past research abuses in neurosurgery. This paper focuses on three issues of particular saliency to neural implant testing: inclusion/exclusion of subjects with psychiatric conditions, consent withdrawal of research subjects, and enhancement as a goal. (shrink)

Grounded theory methodology is perceived as challenging due to its systematic and rigorous process. However, this is because most people do not realize that the strategies used in the grounded theory data analysis process are used by laypeople and professionals regularly, if not daily. This article aims to help others interested in grounded theory with a background in qualitative data analysis feel comfortable engaging in the methodology and constructing multiple theories in the same study. It shares my latest experience incorporating (...) various data analysis strategies with the constructivist approach: holistic and systems thinking, situational analysis, dramaturgical analysis, perspective taking, and abstraction. The examples remove the mystery from abstraction and abductive reasoning. (shrink)

Objectives: To summarise the types of case brought to the Clinical Ethics Committee of the National Hospital of Norway from 1996 to 2002 and to describe and discuss to what extent issues of information/communication have been involved in the ethical problems. Design: Systematic review of case reports. Findings: Of the 31 case discussions, (20 prospective, 11 retrospective), 19 cases concerned treatment of children. Twenty cases concerned ethical problems related to withholding/withdrawing of treatment. In 25 cases aspects of information/communication were involved (...) in the ethical problem, either explicitly (n = 3) or implicitly (n = 22). Conclusion: Problems related to information/communication may underlie a classic ethical problem. Identification of these “hidden” problems may be important for the analysis, and hence, the solution to the ethical dilemma. (shrink)

© 2014 Taylor Francis. The Centers for Disease Control and Prevention recommends routine human immunodeficiency virus testing of every client presenting for services in venues where HIV prevalence is high. Because older adults have particularly poor prognosis if they receive their diagnosis late in the course of HIV disease, any screening provided to younger adults in these venues should also be provided to older adults. We examined aging-related disparities in recent and ever HIV testing in a probability sample of at-risk (...) adults seeking services in needle exchange sites, sexually transmitted disease clinics, and Latino community clinics that provide HIV testing. Using multiple logistic regression with generalized estimating equations, we estimated associations between age category and each HIV testing outcome. Even after controlling for covariates such as recent injection drug use, older adults had 40% lower odds than younger adults did of having tested in the past 12 months or ever. Aging-related disparities in HIV testing exist among clients of these high HIV prevalence venues and may contribute to known aging-related disparities in late diagnosis of HIV infection and poor long-term prognosis. (shrink)

In emergency research, obtaining informed consent can be problematic. Research to develop and improve treatments for patients admitted to hospital with life-threatening and debilitating conditions is much needed yet the issue of research without consent (RWC) raises concerns about unethical practices and the loss of individual autonomy. Consistent with the policy and practice turn towards greater patient and public involvement in health care decisions, in the US, Canada and EU, guidelines and legislation implemented to protect patients and facilitate acute research (...) with adults who are unable to give consent have been developed with little involvement of the lay public. This paper reviews research examining public opinion regarding RWC for research in emergency situations, and whether the rules and regulations permitting research of this kind are in accordance with the views of those who ultimately may be the most affected. (shrink)

The US-Australia strategic relationship has evolved from more or less an adversarial position in the 19th century to an Australia largely dependent on the US during the Cold War to the interdependent partnership we see today. Strategic interdependence means that the US-Australia relationship is not merely a one-sided affair; that Australia has something of substance to offer the strategic relationship. Part of the reason that the relationship is strong is because of a shared language, similar social values, and compatible political-legal (...) systems. Moreover, the relationship has been thoroughly institutionalised via intelligence cooperation, defence science collaboration, and extensive personal relationships. But what the US really seems to value is Australia’s reliability as an ally. I argue that Australia best demonstrates its reliability as an ally, however, when it follows US strategic decision-making for the right reasons. This sense of reliability is more akin to trustworthiness than it is to loyalty. History demonstrates that Australia has not always agreed with the US. But agreeing doesn’t matter so much when Australia has established a track record of consistently applying sound reasoning to its strategic decisions and it has made substantive contributions to jointly sought after strategic outcomes. (shrink)