To investigate the current status of hospital clinical ethics committees (CEC) and how they have evolved in Canada over the past 20 years, this paper presents an overview of the findings from a 2008 survey and compares these findings with two previous Canadian surveys conducted in 1989 and 1984. All Canadian hospitals over 100 beds, of which at least some were acute care, were surveyed to determine the structure of CEC, how they function, the perceived achievements of these committees and (...) opinions about areas with which CEC should be involved. The percentage of hospitals with CEC in our sample was found to be 85% compared with 58% and 18% in 1989 and 1984, respectively. The wide variation in the size of committees and the composition of their membership has continued. Meetings of CEC have become more regularised and formalised over time. CEC continue to be predominately advisory in their nature, and by 2008 there was a shift in the priority of the activities of CEC to meeting ethics education needs and providing counselling and support with less emphasis on advising about policy and procedures. More research is needed on how best to define what the scope of activities of CEC should be in order to meet the needs of hospitals in Canada and elsewhere. More research also is needed on the actual outcomes to patients, families, health professionals and organisations from the work of these committees in order to support the considerable time committee members devote to this endeavour. (shrink)

Nurses and physicians may experience ethical conflict when there is a difference between their own values, their professional values or the values of their organization. The distribution of limited health care resources can be a major source of ethical conflict. Relatively few studies have examined nurses' and physicians' ethical conflict with organizations. This study examined the research question ‘What are the organizational ethical conflicts that hospital nurses and physicians experience in their practice?’ We interviewed 34 registered nurses, 10 nurse managers, (...) and 31 physicians as part of a larger study, and asked them to describe their ethical conflicts with organizations. Through content analysis, we identified themes of nurses' and physicians' ethical conflict with organizations and compared the themes for nurses with those for physicians. (shrink)

While the influence of emotion on individuals'' ethical decisions has been identified by numerous researchers, little is known about how emotions influence individuals'' ethical decision process. Thus, it is not clear whether different emotions promote and/or discourage ethical decision-making in the workplace. To address this gap, this paper develops a model that illustrates how emotion affects the components of individuals'' ethical decision-making process. The model is developed by integrating research findings that consider the two dimensions of emotion, arousal and feeling (...) state, into an applied cognitive-developmental perspective on the process of ethical decision-making. The model demonstrates that certain emotional states influence the individual''s propensity to identify ethical dilemmas, facilitate the formation of the individual''s prescriptive judgments at sophisticated levels of moral development, lead to ethical decision choices that are consistent with the individual''s prescriptive judgements, and promote the individual''s compliance with his or her ethical decision choices. In particular, the model suggests that individuals experiencing arousal and positive affect resolve ethical dilemmas in a manner consistent with more sophisticated cognitive moral structures. Implications for theory and practice are discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Maurice Blanchot and the Literature of TransgressionColette GaudinMaurice Blanchot and the Literature of Transgression, by John Gregg; 241 pp. Princeton: Princeton University Press, 1994, $29.95.In the preface to The Gaze of Orpheus (1981), the first book in English to present a collection of Maurice Blanchot’s critical essays, Geoffrey Hartman recalls his excitement on discovering this philosopher-novelist in the fifties. As for Hélène Cixous, she speaks of “Blanchot’s terrifying (...) but admirable art.” Blanchot indeed holds a paradoxical place in French literature and criticism. His books constitute a fundamental work of our time, yet his reflection developed in total independence of the noisiest intellectual debates of his times. A contemporary of Sartre, a friend of Georges Bataille and of Emmanuel Levinas, Blanchot began his career as a literary chronicler before World War II, even collaborating for a few years in rightist publications. But he generally remained at a forbidding distance from the media and the public, revealing [End Page 160] himself only through his writings: three novels, a number of terse short stories or récits, and an abundant critical corpus evolving toward fragmentary meditations on the conditions of literature’s possibility and on the experience of writing. He was the first, in the midst of the existentialist wave following the war, to pay close attention to the poetics of Mallarmé and Rilke, the art of Flaubert or Kafka, and the ethical provocations of Nietzsche, all of which were to become trademarks of postmodernist thinkers. Yet our present familiarity with these motifs does not make Blanchot less difficult and even less esoteric.With Maurice Blanchot and the Literature of Transgression, John Gregg now gives us the first English book-length study devoted exclusively to Blanchot, organized around solid analyses of several difficult texts—more extensively of the novel Le Très-Haut and the fragmentary narrative L’Attente l’oubli. There is unfortunately very little excitement or terror in the way Gregg presents his work, which bears traces of the doctoral thesis it evidently once was. Whereas the choice of transgression, as the focus of the study is quite appropriate, the title suggests, somewhat misleadingly, that transgression will be treated as a theme common to a group of authors including Blanchot. The “Introduction,” barely more than an extended table of contents, fails to prepare the reader for the provocative notion of transgression illustrated and theorized in Blanchot’s writing, a notion inherited from psychoanalysis and ethnology via Bataille, and which has to do with the law, Eros, and negativity. In his opening pages, moreover, we are confronted with concepts that Gregg takes for granted. A neologism such as “worklessness” (p. 8), for instance, does not make sense without a minimal gloss relating it to Blanchot’s pair of opposites, œuvre/désœuvrement. Similarly, the opposition between “regional economy” and “general economy,” which is Gregg’s constant point of reference, needs to be anchored historically and philosophically in order to accomplish its function.To nuance the preceding criticism, it should be stressed that Blanchot’s thought defies summary, linear exposition, and dialectical closure, just as his fiction illustrates the impossibility of narration. His work draws on multiple influences and at the same time is fiercely original. His reflection proceeds through two apparently contradictory processes, dispersion and repetition, the function of the latter being more to situate what is said in its difference from itself than to convince others. Gregg’s first chapter (poorly titled “Literature and transgression”) rightly indicates the ambivalent Hegelian heritage found in Blanchot as well as in Bataille. For if Hegel is a great inspiration to them, he is also a constant foil, in that he ignores the surplus of negativity that no dialectic can absorb through the historical or artistic process. Gregg’s method, that of tracing a pattern of nondialectical play of opposites in Blanchot’s writing, takes on its full effectiveness in the following chapters, in which he shows the circular relation (or exigence circulaire) that Blanchot establishes repeatedly between death and writing in his definition of the “suicidal artist.” The study of Orpheus as a mythical portrayal of writing and reading equates [End Page... (shrink)

Background Despite news reports of morally distressing situations resulting from complex and demanding community-care delivery in Canada, there has been little research on the topic of ethical conflicts experienced by community-based health care professionals. Research aim To identify ethical conflicts experienced by community nurses. Research design Data were collected using semi-structured interviews and then relevant text was extracted and condensed using qualitative content analysis. This research was part of a larger grounded theory project examining how community nurses manage ethical conflict. (...) Research context and participants Community nurses, including 13 public health nurses and 11 home care nurses from two Canadian provinces, were interviewed. Ethical considerations Study approval was granted by the Health Research Ethics Authority of Newfoundland and Labrador and by provincial health authorities. Findings Seven ethical conflicts were identified and assigned to one of two groups. In the grouping categorized as challenges with obligations or risks, the ethical conflicts were: (1) screening for child developmental issues knowing there is a lack of timely early intervention services; (2) encountering inequities in the health care system; (3) not fulfilling principles, goals, and initiatives of primary and secondary prevention; and (4) feeling powerless to advocate for clients. The remaining ethical conflicts were categorized as challenges with process, risks, and consequences, and were: (5) jeopardizing therapeutic relationships while reporting signs of a child at risk; (6) managing confidentiality when neighbors are clients; and (7) supporting client autonomy and decision-making but uncertain of the consequences. Conclusions Research investigation will continue to be important to raise awareness and mobilize ethics supports as health care services are steadily shifted from institutional to community settings. Moreover, with heightened potential for communicable disease outbreaks across international borders from global warming, community nurses around the world will continue to be required to address ethically-difficult care situations with competence and compassion. (shrink)

Hospitals in many countries have had clinical ethics committees for over 20 years. Despite this, there has been little research to evaluate these committees and growing evidence that they are underutilized. To address this gap, we investigated the question ‘What are the barriers and facilitators nurses and physicians perceive in consulting their hospital ethics committee?’ Thirty-four nurses, 10 nurse managers and 31 physicians working at four Canadian hospitals were interviewed using a semi-structured interview guide as part of a larger investigation. (...) We used content analysis of the interview data related to barriers and facilitators to use of hospital ethics committees to identify nine categories of barriers and nine categories of facilitators. These categories as well as their subcategories are discussed and those specific to nurses or physicians are identified. The need to increase health professionals' use of clinical ethics committees through reducing barriers and maximizing facilitators is discussed. (shrink)

Much of the literature on clinical ethical conflict has been specific to a specialty area or a particular patient group, as well as to a single profession. This study identifies themes of hospital nurses’ and physicians’ clinical ethical conflicts that cut across the spectrum of clinical specialty areas, and compares the themes identified by nurses with those identified by physicians. We interviewed 34 clinical nurses, 10 nurse managers and 31 physicians working at four different Canadian hospitals as part of a (...) larger study on clinical ethics committees and nurses’ and physicians’ use of these committees. We describe nine themes of clinical ethical conflict that were common to both hospital nurses and physicians, and three themes that were specific to physicians. Following this, we suggest reasons for differences in nurses’ and physicians’ ethical conflicts and discuss implications for practice and research. (shrink)

This study examined the association of nurses’ ethical conflict with hospitals with organizational commitment, stress, turnover intention, absence and turnover. Participants were 410 nurses working at four different Canadian hospitals. A longitudinal design was used where nurses completed a questionnaire to capture ethical conflict, stress and organizational commitment, and one year later, measures of turnover intention, absence and actual turnover were obtained for the same sample. We found three aspects of nurses’ ethical conflict with hospitals: patient care values, value of (...) nurses, and staffing policy values. Our findings showed that all three aspects of nurses’ ethical conflict are associated with stress and patient care values is associated with actual turnover. We also found that staffing policy values is predictive of turnover intention, and that patient care values is predictive of absenteeism. Thus, our findings show the multidimensionality of nurses’ ethical conflict with hospitals. Further implications of our findings for practice and theory are discussed. (shrink)

Cette édition numérique a été réalisée à partir d'un support physique, parfois ancien, conservé au sein du dépôt légal de la Bibliothèque nationale de France, conformément à la loi n° 2012-287 du 1er mars 2012 relative à l'exploitation des Livres indisponibles du XXe siècle. La philosophie de Platon se trouve ici interrogée sur la conception de l'alphabet, c'est-à-dire sur les éléments qui rendent possibles la lecture, l'écriture et l'énonciation de quelque pensée que ce soit. « Copyright Electre » Pages de (...) début Introduction Note bibliographique I - De l'écriture II - Une chimère d'écriture III - Le savoir des lettres IV - On n'entend pas la voix de Platon V - L'ame comme un livre VI - L'épaisseur du sémantique VII - L'orthotès, orthophonie, orthographe VIII - Redécouverte du phonétique IX - Stoicheïologie et définition X - La combinaison des genres et le concept d'élément XI - De la lecture XII - Le réceptacle Les archétypes et leur inscription ConclusionIndex nominum Index rerum Pages de fin. (shrink)

If the professionalization of the social professions is increasingly based on the model of professionalization engineering, what are the imaginaries underlying this movement? How can we understand that the profession of engineer, the one who, at least in the imagination, invents and designs machines with a magically predictable functioning, can be the model for designing training systems for the helping professions? This contribution proposes to explore these questions through two mythological figures often summoned when it comes to engineering and technology (...) : Prometheus and Hephaestus. These two figures will help us to move from the model of professionalization engineering to ingenium. (shrink)

Peut-on interpréter le Cratyle sans recourir aux développements du Théétète et du Sophiste sur la proposition verbale ? L'exigence analytique, présentée pour la première fois par G. Ryle, autorise à examiner la prétention soit des noms, soit de leurs éléments phonétiques à jouer le rôle de « signifiants » authentiques. Could we give an interpretation of Cratylus without looking at the later dialogues (Theaetetus and Sophist) which carry Plato on to the concept of verbal proposition ? The requirements of analytical (...) philosophers (first, G. Ryle) lead us to examine the claim of the word or of its phonetic elements as genuine « significantes ». (shrink)

A multiple-case study of four hospital ethics committees in Canada was conducted and data collected included interviews with key informants, observation of committee meetings and ethics-related hospital documents, such as policies and committee minutes. We compared the hospital committees in terms of their structure, functioning and perceptions of key informants and found variation in the dimensions of empowerment, organizational culture of ethics, breadth of ethics mandate, achievements, dynamism, and expertise.

Il était sans doute audacieux de choisir une notion aussi peu stabilisée d’un point de vue théorique (en même temps qu’assise sur un véritable usage pédagogique) que celle de registre pour donner son unité à un volume de Mélanges. Les contributeurs ont, cependant, volontiers relevé le défi, et l’ouvrage représente de ce fait l’espace d’une vraie confrontation théorique, dont le lieu commun serait constitué par l’article d’Alain Viala (« Des registres », Pratiques, n°109-110, 2001). Ainsi soup..

Il était sans doute audacieux de choisir une notion aussi peu stabilisée d’un point de vue théorique (en même temps qu’assise sur un véritable usage pédagogique) que celle de registre pour donner son unité à un volume de Mélanges. Les contributeurs ont, cependant, volontiers relevé le défi, et l’ouvrage représente de ce fait l’espace d’une vraie confrontation théorique, dont le lieu commun serait constitué par l’article d’Alain Viala (« Des registres », Pratiques, n°109-110, 2001). Ainsi soup...

Catalog of the collection of the Madamkhand Museum of Art, named after the wife of Batzhargalyn Batbai︠a︡r, businessman and member of the Mongolian Khural.

Artykuł stanowi uzasadnienie twierdzącej odpowiedzi na pytanie, czy możliwa jest „Nauka o książce Katalogi oraz bibliografie pełnią funkcję przewodników wskazujących czytelnikom drogi poznania; zawierają one wiedzę szczególną i specyficzną. Przedmiotem rozważań jest analiza definicji bibliografii sformułowanych przez teoretyków zajmujących się tą problematyką: scharakteryzowane zostały koncepcje, których autorami są: W. Greg, F. Bowers, D. P. Mc Kenzie. Porównanie różnych poglądów, dotyczących przedmiotu, zakresu oraz zadań bibliografii, jest źródłem refleksji, ukazującej znaczenie pracy bibliografa w różnych aspektach. „Nauka o książce” jako główny przedmiot (...) swych zainteresowań uznaje tę oryginalną wiedzę, która jest rezultatem pracy bibliografa. (shrink)

How should one define the republican democratic and ‘ laïque’ spirit in both the most concise and effective manner, as well as that most suited to the French case? The republican spirit resides without doubt in refusing submission to any single individual whoever that individual may be. The democratic spirit does not consist of decreeing the sovereignty of the people, but in developing formal modalities of political life allowing the people not to be divested of it. The ‘ laïque’ spirit (...) rejects all distinctions concerning the nature and rights of citizens; it also equally rejects religious laws being imposed over political law. (shrink)

This essay brings psychoanalytic theory on trauma together with film and television criticism on rape narrative in an analysis of Michael Coel’s 2020 series I May Destroy You. Beyond the limited carceral framework of the police procedural, which dislocates the act of violence from the survivor’s history and context, Coel’s polyvalent, looping narrative metabolizes rape television’s forms and genres in order to stage and restage both trauma and genre again and anew. Contesting common conceptions of vulnerability and susceptibility that prefigure (...) a violent breach of autonomy, Coel’s series and her interviews about it invite an ethics of looking that embraces a curiosity in the unknowable and untreatable kernel of subjective experience and defies and resists a policing of the survivor’s thoughts and emotions. By emphasizing and exploring what psychoanalysis calls the “afterwardness” of trauma, Coel foregrounds her main character’s subjectivity prior to her victimization, widens the sphere of consequence beyond the victim and criminal justice system to the survivor’s larger community, and entreats that community to preserve a space for her to look and look again at everything, without judgment. (shrink)