Background In 2001 a report on the provision of clinical ethics support in UK healthcare institutions identified 20 clinical ethics committees. Since then there has been no systematic evaluation or documentation of their work at a national level. Recent national surveys of clinical ethics services in other countries have identified wide variation in practice and scope of activities. Objective To describe the current provision of ethics support in the UK and its development since 2001. Method A postal/electronic questionnaire survey administered (...) to the chairs of all 82 clinical ethics services registered with the UK Clinical Ethics Network in July 2010. Results Response rate was 62% with the majority of responding services situated in acute trusts. All services included a clinical ethics committee with one service also having a clinical ethicist. Lay members were present in 72% of responding committees. Individual case consultation has increased since 2001 with 29% of chairs spending more than 50% of their time on this. Access to and involvement in the process of case consultation is less for patients and families than for clinical staff. There is wide variation in committee processes and levels of institutional support. Over half of the responding committees undertook some form of evaluation. Conclusion Clinical ethics services in the UK are increasing as is their involvement in case consultation. However, the significant variation in committee processes suggests that further qualitative research is needed to understand how these committees function and the role they play in their institution. (shrink)

Hannah James makes a persuasive case for the use of donated bodies and body parts in surgical training, enabling high fidelity training, improved competency of surgeons and reduced risk of harm to patients from trainees ‘learning on the job’.1 She also identifies some pertinent ethical questions that arise from this practice that should be considered by training organisations, regulatory authorities and the trainees themselves. Many countries throughout the world have regulated programmes, governed by strict ethical principles, for donating bodies, usually (...) to academic institutions for the purposes of medical education.2 In the UK the Human Tissue Authority sets out guiding principles for institutions licensed to handle human tissue including donation of bodies for anatomical examination, education and research; consent, dignity, quality, and honesty and openness.3 The Nuffield Council on Bioethics, in its 2011 report, Human Bodies: donation for medicine and research, identified a number of relevant ethical values including autonomy, altruism, justice, dignity, reciprocity, maximising welfare, and honesty and respect.4 While this report did not focus specifically on donation of human tissue for education and training the principles identified are equally relevant in this context. In terms of maximising welfare whole body donation for education and training provides benefit to many patients over a relatively short time frame …. (shrink)

Since the 1980s, there has been an increasing acknowledgement of the importance of recognising the ethical dimension of clinical decision-making. Medical professional regulatory authorities in some countries now include ethical knowledge and practice in their required competencies for undergraduate and post graduate medical training. Educational interventions and clinical ethics support services have been developed to support and improve ethical decision making in clinical practice, but research evaluating the effectiveness of these interventions has been limited. We undertook a systematic review of (...) the published literature on measures or models of evaluation used to assess the impact of interventions to improve ethical decision making in clinical care. We identified a range of measures to evaluate educational interventions, and one tool used to evaluate a clinical ethics support intervention. Most measures did not evaluate the key impact of interest, that is the quality of ethical decision making in real-world clinical practice. We describe the results of our review and reflect on the challenges of assessing ethical decision making in clinical practice that face both developers of educational and support interventions and the regulatory organisations that set and assess competency standards. (shrink)

Objective—To identify and describe the current state of clinical ethics support services in the UK.Design—A series of questionnaire surveys of key individuals in National Health Service (NHS) trusts, health authorities, health boards, local research ethics committees and health professional organisations. Interviews with chairmen/women of clinical ethics committees identified in the surveys.Setting—The UK National Health Service.Results—Responses to the questionnaires were received from all but one NHS trust and all but one health authority/board. A variety of models of clinical ethics support were (...) identified including twenty formal clinical ethics committees (CECs). A further twenty NHS trusts expressed an intention to establish a CEC within the next twelve months. Most CECs in the UK have been in existence less than five years and are still defining their role. The chairmen identified education of committee members and contact with other ethics committees as important requirements for committee development. Problems were identified around lack of support for the committee and with raising the profile of the committee within the institution. There has been little evaluation of clinical ethics support services either in the UK or in other countries with longer established services. What evaluation has occurred has focused on process rather than outcome measures.Conclusions—Clinical ethics support services are developing in the UK. A number of issues have been identified that need to be addressed if such support services are to develop effectively. (shrink)

The development of ethics case consultation over the past 30 years, initially in North America and recently in Western Europe, has primarily taken place in the secondary or tertiary healthcare settings. The predominant model for ethics consultation, in some countries overwhelmingly so, is a hospital-based clinical ethics committee. In the United States, accreditation boards suggest the ethics committee model as a way of meeting the ethics component of the accreditation requirement for payment by Health Maintenance Organizations, and in some European (...) countries, there are legislatory requirements or government recommendations for hospitals to have clinical ethics committees. There is no corresponding pressure for primary care services to have ethics committees or ethics consultants to advise clinicians, patients, and families on the difficult ethical decisions that arise in clinical practice. (shrink)

Philosophers and others have questioned whether or not expertise in morality is possible. This debate is not only theoretical, but also affects the perceived legitimacy of clinical ethicists. One argument against moral expertise is that in a pluralistic society with competing moral theories no one can claim expertise regarding what another ought morally to do. There are simply too many reasonable moral values and intuitions that affect theory choice and its application; expertise is epistemically uniform. In this article, we discuss (...) how similar concerns have recently threatened to undermine expertise in medicine and science. In contrast, we argue that the application of values is needed to exercise medical, scientific, and moral expertise. As long as these values are made explicit, worries about a pretense to authority in the context of a liberal democracy are ill-conceived. In conclusion, we argue for an expertise that is epistemically diverse. (shrink)

No healthcare system has sufficient funds to provide the best possible treatment for all patients in all situations. Three new pharmaceutical products are licensed each month, on average, in the U.K. Most have some benefits over existing drugs but many are expensive. When is the extra benefit worth the extra cost? Managed care systems such as seen in the U.S., and publicly funded systems such as the British National Health Service (NHS), face this fundamental issue. Several governments (for example those (...) in New Zealand, Sweden, and the Netherlands) have taken a lead both in acknowledging that rationing healthcare is necessary, and in outlining how priorities are to be determined. In addition, the state of Oregon addressed the issue of rationing with considerable public involvement. (shrink)

La Colombiade war bis zur französischen Revolution ein in Frankreich und in den westeuropäischen Ländern vielbeachtetes Epos. Aus heutiger Sicht ist das gut lesbare Gedicht erneut von Interesse: es wägt Segnungen und Schäden der Kolonialisierung gegeneinander ab, propagiert die Idee eines auf wissenschaftlichem und humanistischem Ethos gegründeten Europas, und artikuliert das aufklärerische Selbstbewusstsein einer schreibenden Frau. Die Einführung der Herausgeberin stellt das Gedicht in den Wissenshorizont der Entstehungszeit und skizziert die Rezeption. Der Anhang informiert über Textvarianten, bringt erläuternde Anmerkungen und (...) einen bibliographischen Informationsteil. (shrink)

Depuis près d'un demi-siècle, Madame Hélène ACKERMANS a coopéré très activement à l'organisation de l'École des sciences philosophiques et religieuses des F.U.S.L. Avec Monseigneur Henri van Camp, elle a donné à la tribune des leçons publiques sa renommée internationale ; auprès de l'actuel comité de direction, elle n'a cessé de prodiguer ses multiples compétences et ses conseils avisés. En hommage à son travail, il a été demandé à quelques-uns des penseurs avec lesquels Madame Hélène ACKERMANS a noué des liens d'amitié, (...) de réfléchir au rôle de la philosophie dans la Cité. (shrink)

This article examines whether a training program in ethical decision making can change young athletes’ doping attitudes. Fifty-two young elite athletes were randomly assigned to either an ethical decision-making training group or a standard-knowledge-based educational program group. Another 17 young elite athletes were recruited for no-treatment control purposes. The ethical decision-making training comprised six 30-min online sessions in which the participants had to work through 18 ethical dilemmas related to doping. The standard-knowledge-based educational program was also conducted in six online (...) sessions of comparable length to that of the ethical training. A short version of the Performance Enhancement Attitude Scale was administered to measure the effects of the trainings on doping attitude. Prior to as well as after the intervention, the mean doping attitude scores of the young athletes were low to very low, indicating vehement rejections of doping. The results of our experiment showed that the ethical training led to an attenuation of these rejections. No intervention effect was found in the standard education group. The observed slight increase in the doping attitude score could be an indication that the ethical decision-making training was successful in breaking up the athletes’ stereotypical style of reasoning about doping. (shrink)

This book explores five Platonic dialogues: Lysis, Charmides, Protagoras, Euthydemus, and the Republic. This book uses Socrates’ narrative commentary as its primary interpretive framework. No one has engaged in a sustained attempt to explore the Platonic dialogues from this angle. As a result, it offers a unique contribution to Plato scholarship. The portrait of Socrates that emerges challenges the traditional view of Socrates as an intellectualist and offers a holistic vision of philosophical practice.

Anne-Marie Søndergaard Christensen presents a new account of the role of moral philosophy and its relationship to our ordinary moral lives. She challenges the idea that moral theories have an authoritative explanatory or action-guiding role, and develops instead a descriptive, pluralistic, and elucidatory conception of moral philosophy.

Ce colloque devenu livre comble une lacune. Alors que le sujet a été labouré pour le xviiie siècle, aucune synthèse n’existait jusque-là sur le mariage dans la littérature du xixe siècle. Or, la rupture avec les Lumières est frappante comme l’attestent, par exemple, les réécritures d’Inès de Castro étudiées par Maurizio Melai. Le thème du « mariage interdit », inspiré par la tragédie d’Houdar de la Motte (1723) mais subverti un siècle plus tard, illustre le passage de l’Ancien Régime aristocr...

‘Gender’, understood as the social construction of sex, is a key concept for feminists working at the interface of theory and policy. This article examines challenges to the concept which emerged from different groups at the UN Fourth World Conference on Women in Beijing, September 1995, an important arena for struggles over feminist public policies. The first half of the article explores contradictory uses of the concept in the field of gender and development. Viewpoints from some southern activist women at (...) the NGO Forum of the Beijing Conference are presented, Some of them argued that the way ‘gender’ has been deployed in development institutions has led to a depoliticization of the term, where feminist policy ambitions are sacrificed to the imperative of ease of institutionalization. ‘Gender’ becomes a synonym for ‘women’, rather than a form of shorthand for gender difference and conflict and the project of transformation in gender relations. ‘Gender sensitivity’ can be interpreted by non-feminists as encouragement to use gender-disaggregated statistics for development planning, but without consideration of relational aspects of gender, of power and ideology, and of how patterns of subordination are reproduced. A completely different attack on ‘gender’ came from right-wing groups and was battled out over the text of the Platform for Action agreed at the official conference. Six months prior to the conference, conservative groups had tried to bracket for possible removal the term ‘gender’ in this document, out of opposition to the notion of socially constructed, and hence mutable, gender identity. Conservative views on gender as the ‘deconstruction of woman’ are discussed here. The article points out certain contradictions and inconsistencies in feminist thinking on gender which are raised by the conservative backlash attack on feminism and the term ‘gender’. (shrink)

In "Implementing Expanded Prenatal Genetic Testing: Should Parents Have Access to Any and All Fetal Genetic Information?," Bayefsky and Berkman argue in favor of establishing three categorie...

Anne-Marie Schultz explores Plato’s presentation of Socrates as a philosopher who tells narratives about himself in the Theaetetus, Symposium, Apology, and Phaedo. She argues that scholars should regard Socrates as a public philosopher, while examining Socratic self-disclosive practices in the works of bell hooks, Kathy Khang, and Ta-Neishi Coates.

In an historic first, two ethics committees - one from Laos, the other from France - met in Vientiane in October 2015. Researchers examined a multitude of ethical issues related to health, the environment, and societies in countries in the Mekong region. Urgent, universal questions were discussed in local contexts ; productive debates illustrated a complex array of possible solutions. This book, born out of that meeting, serves as a guide for those working across the spectrum of scientific fields on (...) paths to promote justice and reduce suffering. Like the Mekong River, the field of research ethics does not run in a straight line ; and like that river, everyone it touches discovers that what may initially appear to separate us ultimately serves to bring us together. (shrink)

Green consumerism is on the rise in America, but its environmental effects are contested. Does green marketing contribute to the greening of American consciousness, or does it encourage corporate greenwashing? This tenuous ethical position means that eco-marketers must carefully frame their environmental products in a way that appeals to consumers with environmental ethics and buyers who consider natural products as well as conventional items. Thus, eco-marketing constructs a complicated ethical identity for the green consumer. Environmentally aware individuals are already guided (...) by their personal ethics. In trying to attract new consumers, environmentally minded businesses attach an aesthetic quality to environmental goods. In an era where environmentalism is increasingly hip, what are the implications for an environmental ethics infused with a sense of aesthetics? This article analyzes the promotional materials of three companies that advertise their environmental consciousness: Burt's Bee's Inc., Tom's of Maine, Inc., and The Body Shop Inc. Responding to an increasing online shopping market, these companies make their promotional and marketing materials available online, and these web-based materials replicate their printed catalogs and indoor advertisements. As part of selling products to consumers based on a set of ideological values, these companies employ two specific discursive strategies to sell their products: they create enhanced notions of beauty by emphasizing the performance of their natural products, and thus infuse green consumerism with a unique environmental aesthetic. They also convey ideas of health through community values, which in turn enhances notions of personal health to include ecological well-being. This article explicates the ethical implications of a personal natural care discourse for eco-marketing strategies, and the significance of a green consumer aesthetic for environmental consciousness in general. (shrink)

_From Illiteracy to Literature_ presents innovative material based on research with ‘non-reading’ children and re-examines the complex relationship between psychoanalysis and literature, through the lens of the psychical significance of reading: the forgotten adventure of our coming to reading. Anne-Marie Picard draws on two specific fields of interest: firstly the wish to understand the nature of literariness or the "literary effect", i.e. the pleasures we derive from reading; secondly research on reading pathologies carried out at St Anne’s (...) Hospital, Paris. The author uses clinical observations of non-reading children to answer literary questions about the reading experience, using psychoanalytic theory as a conceptual framework. The notion that reading difficulties or phobias should be seen as a symptom in the psychoanalytic sense, allows Picard to shed light on both clinical vignettes taken from children’s case histories and reading scenes from literary texts. Children experiencing difficulties in learning to read highlight the imaginary stakes of the confrontation with the arbitrary nature of the letter and the "price to pay" for one’s entrance into the Symbolic. Picard applies the lesson "taught" by these children to a series of key literary texts featuring, at their very core, this confrontation with the signifier, with the written code itself.. This book argues that there is something in literature that drives us back, again and again, to the loss we have suffered as human beings, to what we had to undergo to become human: our subjection to the common place of language. Picard shows complex Lacanian concepts "at work" in the field of reading pathologies, emphasizing close reading and a clinical attention to the "letter" of the texts, far from the "psychobiographical" attempts at psychologizing literary authors. _From Illiteracy to Literature_ presents a novel psychodynamic approach that will be of great interest to psychotherapists and language pathologists, appealing to literary scholars and those interested in the process of reading and "literariness.". (shrink)

IN THE FIRST SEVERAL PARAGRAPHS of Nicomachean Ethics 9.8, Aristotle asks "whether a man should love himself most", and asserts that "men say that one ought to love best one's best friend". Yet earlier Aristotle describes loving as more essential to friendship than being loved; furthermore, he emphasizes that a man wishes well to his friend for his friend's sake, not as a means to his own happiness. Note also Aristotle's continued emphasis upon man as a political animal. In the (...) Politics as well as the Nicomachean Ethics, Aristotle describes the biological, even instinctive tendency of humans to seek each other's company. He considers it absurd for a man even to imagine living alone, since "without friends no one would choose to live, though he had all other goods". It is only the human animal, however, who is even capable of that genuine friendship which, although rare, Aristotle considers "not only necessary but also noble; for... we think it is the same people that are good men and are friends" ; these friends are "alike in their excellence", one loving another "as being the man he is". (shrink)

: Green consumerism is on the rise in America, but its environmental effects are contested. Does green marketing contribute to the greening of American consciousness, or does it encourage corporate greenwashing? This tenuous ethical position means that eco-marketers must carefully frame their environmental products in a way that appeals to consumers with environmental ethics and buyers who consider natural products as well as conventional items. Thus, eco-marketing constructs a complicated ethical identity for the green consumer. Environmentally aware individuals are already (...) guided by their personal ethics. In trying to attract new consumers, environmentally minded businesses attach an aesthetic quality to environmental goods. In an era where environmentalism is increasingly hip, what are the implications for an environmental ethics infused with a sense of aesthetics? This article analyzes the promotional materials of three companies that advertise their environmental consciousness: Burt's Bee's Inc., Tom's of Maine, Inc., and The Body Shop Inc. Responding to an increasing online shopping market, these companies make their promotional and marketing materials available online, and these web-based materials replicate their printed catalogs and indoor advertisements. As part of selling products to consumers based on a set of ideological values, these companies employ two specific discursive strategies to sell their products: they create enhanced notions of beauty by emphasizing the performance of their natural products, and thus infuse green consumerism with a unique environmental aesthetic. They also convey ideas of health through community values, which in turn enhances notions of personal health to include ecological well-being. This article explicates the ethical implications of a personal natural care discourse for eco-marketing strategies, and the significance of a green consumer aesthetic for environmental consciousness in general. (shrink)

Although previous studies have found that video games induce stress, studies have not typically measured all salient indicators of stress responses including stress appraisals, cardiovascular indicators, and emotion outcomes. The current study used the Biopsychosocial Model of Challenge and Threat (Blascovich & Tomaka, 1996) to determine if video games induce a cardiovascular stress response by comparing the effects of threat and challenge appraisals across two types of video games that have shown different cardiovascular outcomes. Participants received challenge or threat appraisal (...) instructions, and played a fighting game (Mortal Kombat) or a puzzle game (Tetris). Study outcomes were heart rate variability, systolic and diastolic blood pressure, and positive and negative emotion ratings measured before, during and after gameplay. Results indicated that threat appraisal instructions increased negative emotion ratings and decreased heart rate variability, but not blood pressure, which is an essential marker for cardiovascular stress responses. Increased blood pressure and decreased heart rate variability was associated with fighting game players when compared with the puzzle game players, indicating a cardiovascular stress response; however, fighting game players also reported higher positive emotion ratings. Based on the study findings, video games do not induce stress responses like mental stressors used in previous research, demonstrating that the interactive player experience in video gaming may have more complex effects on stress outcomes. Future research should comprehensively measure biopsychosocial stress indicators and multiple emotional states over time to fully examine the relationship between video games and stress. (shrink)

_From a renowned foreign-policy expert, a new paradigm for strategy in the twenty-first century_ In 1961, Thomas Schelling’s _The Strategy of Conflict_ used game theory to radically reenvision the U.S.-Soviet relationship and establish the basis of international relations for the rest of the Cold War. Now, Anne-Marie Slaughter—one of _Foreign Policy’_s Top 100 Global Thinkers from 2009 to 2012, and the first woman to serve as director of the State Department Office of Policy Planning—applies network theory to develop (...) a new set of strategies for the post-Cold War world. While chessboard-style competitive relationships still exist—U.S.-Iranian relations, for example—many other situations demand that we look not at individual entities but at their links to one another. We must learn to understand, shape, and build on those connections. Concise and accessible, based on real-world situations, on a lucid understanding of network science, and on a clear taxonomy of strategies, this will be a go-to resource for anyone looking for a new way to think about strategy in politics or business. (shrink)

In dialogue with the most famous myth for the origin of different languages - The Tower of Babel - A Psychoanalytic Exploration on Sameness and Otherness: Beyond Babel provides a series of timely reflections on the themes of sameness and otherness from a contemporary psychoanalytic perspective. How are we dealing with communication and its difficulties, the confusion of tongues and loss of common ground within a European context today? Can we move beyond Babel? Confusion and feared loss of shared values (...) and identity are a major part of the daily work of psychoanalytic psychotherapists. Bringing together an international range psychoanalytic practitioners and researchers, the book is divided into six parts and covers an array of resonant topics, including: language and translation; cultural identity; families and children; the cyber world; the psychotherapeutic process; and migration. Whereas the quest for unity, which underpins the myth of Babel, leads to mystification, simplification and the exclusion of people or things, multilingual communities necessitate mutual understanding through dialogue. This book examines those factors which further or threaten communication, aiming not to reduce but to gain complexity. It suggests that diversification enriches communication and that, by relating to others, we can create something new. As opposed to cultural and linguistic homogeneity, Babel is not only a metaphor for mangled communication, alienation, and distraction, it is also about the acceptance or rejection of differences between self and other. This book will be of great interest to psychoanalytic psychotherapists and researchers from a wide variety of backgrounds. (shrink)

In this paper, I explore three autobiographical narratives that Plato’s Socrates tells: his report of his conversations with Diotima, his account of his testing of the Delphic oracle, and his description of his turn from naturalistic philosophy to his own method of inquiry.1 This Platonic Socrates shows his auditors how to philosophize for the future through a narrative recollection of his own past. In these stories, Plato presents us with an image of a Socrates who prepares others to do philosophy (...) without him. In doing so, Plato’s Socrates exhibits philosophical care for his students. In the first part of the paper, I briefly discuss Socrates’ overall narrative style as Plato depicts it in the five dialogues that Socrates narrates. I then analyze each of these autobiographical accounts with an eye toward uncovering what they reveal about Plato’s presentation of Socrates’ philosophical practice.2 Finally, I offer a brief description of what it might mean to practice philosophy as care for self and care for others in a Socratic fashion. (shrink)

This paper begins with a brief examination of the contemporary American political landscape. I describe three recent events that illustrate how attempts to control the narrative about events that transpired threaten to undermine our shared reality. I then turn to Book I of Plato’s Republic to explore the potentially tyrannizing effect of Socrates’s narrative voice. I focus on his descriptions of Glaucon, Polemarchus and his slave, and Thrasymachus to show how Plato presents Socrates’s narrative activity as a process that controls (...) how the auditor understands the events that follow. I then turn to an alternate understanding of Socratic narrative which extols its philosophically and politically liberatory possibilities. I use my own previous work on Socratic narrative, Jill Frank’s Poetic Justice, and Rebecca’s LeMoine’s Plato’s Cave as three examples that emphasize the more positive dimensions of Socratic narrative. Finally, I end with a brief exploration of Cornel West’s Democracy Matters, and bell hooks’ works on pedagogy to argue for the possibility a Socratically-informed public space for political discourse. (shrink)

Anne-Marie McCallion ABSTRACT: This is an interview with Rianna Walcott, the co-founder of Project Myopia – a student-led initiative to decolonise university curricula. The discussion explores the difference between ‘diversity’ and ‘decolonisation’: how these two concepts relate to and contradict one another. Walcott outlines some of the recent student efforts to ‘decolonise’ the university and ….

The aim of this article is to add to the research surrounding nurses' work in hospitals. Throughout history, nurses have faced adverse working conditions, an aspect of their work that remains remarkably unchanged today. Prevailing historical ideologies and sociopolitical conditions influences the context of nurses' work in contemporary hospitals. This research revealed how ruling patriarchal power and nurses' altruistic ways normalize the conditions in hospitals as nurses' work. Moving discourses further add to the work of nurses in hospitals. For example, (...) cost containment strategies, overcapacity and short staffing have resulted in practices to accommodate these problems. While contemporary hospitals may look different, clearly, inside, little has changed since the early days; hospital issues have clearly become an ordinary part of nurses' work. This article discusses how the conditions in hospitals have become an ordinary part of nurses' work. The research in this article emphasizes how prevailing ideologies and institutional discourses make invisible and taken‐for‐granted, how this normalizing of nurses' work contributes to sustaining the hospital's power. (shrink)