Clinical ethics committees aim to resolve conflict, facilitate communication and ease moral distress in health care. Dialogue in committee discussions is complex and involves a balance between implicitly and explicitly expressed values of patients, families and professionals. Evaluating effectiveness and concrete outcomes is challenging and most studies focus on broad benefits such as quality of care and reduction of unnecessary or unwanted treatments. In this paper we propose ‘physician satisfaction’ as a valuable outcome. We refer to the clinical ethics approach (...) followed at one large paediatric hospital in Australia, propose reasons for the often-expressed feeling of satisfaction and discuss why this feeling matters. We conclude that physician satisfaction is a valid measure of an effective ethics consultation because it implies the person has been listened to and respected by others, and has perhaps developed greater understanding of and insights into their own work and values, and those of others. (shrink)

Hospitals are places where patients are unwell, where patients and their families may be upset, confused, frustrated, in pain, and vulnerable. The likelihood of these experiences and emotions manifesting in anger and aggressive behaviour is high. In this paper, we describe the involvement of a clinical ethics service responding to a request to discuss family aggression within a rehabilitation department in a large paediatric hospital in Australia. We suggest two key advantages of involving a clinical ethics service in discussions about (...) how to respond to family aggression. First, the process of ethics deliberation provides an opportunity for clinicians to be involved in the solution by articulating their perspectives, tolerance levels, and general concerns about the effects of family aggression towards staff. Second, supporting clinicians to articulate and identify the impact of parental aggression directly counters the disadvantages of the more blunt zero-tolerance policy response, which is necessarily imposed from the top down. (shrink)

In this paper, we put forward the view that emotions have a legitimate and important role in health professional ethics education. This paper draws upon our experience of running a narrative ethics education programme for ethics educators from a range of healthcare disciplines. It describes the way in which emotions may be elicited in narrative ethics teaching and considers the appropriate role of emotions in ethics education for health professionals. We argue there is a need for a pedagogical framework to (...) productively incorporate the role of emotions in health professional ethics teaching. We suggest a theoretical basis for an ethics pedagogy that integrates health professional emotions in both the experience and the analysis of ethical practice, and identify a range of strategies to support the educator to incorporate emotion within their ethics teaching. (shrink)

Ethics education is recognized as an integral component of health professionals’ education and has been occurring in various guises in the curricula of health professional training in many countries since at least the 1970s. However, there are a number of different aims and approaches adopted by individual educators, programs, and, importantly, different health professions that may be characterized according to strands or trends in ethics education.

:A common goal of ethics education is to equip students who later become health practitioners to not only know about the ethical principles guiding their practice, but to also autonomously recognize when and how these principles might apply and assist these future practitioners in providing care for patients and families. This article aims to contribute to discussions about ethics education pedagogy and teaching, by presenting and evaluating the use of the visual arts as an educational approach designed to facilitate students’ (...) moral imagination and independent critical thinking about ethics in clinical practice. We describe a sequence of ethics education strategies over a 3 year Doctor of Physiotherapy program, focusing on the final year professional ethics assessment task, which involved the use of visual arts to stimulate the exploration of ethics in healthcare. The data were analyzed using both thematic and content analysis. Two key themes centered on emotional responses and lateral thinking. The use of artwork appeared to facilitate imaginative, emotional, and conceptual thinking about ethics and clinical experience. This study provides some evidence to support the effectiveness of the use of the visual arts in promoting students’ recognition of ethical dimensions within their clinical experience and reflection on their emerging professional identity. As one student noted, she left the museum “somewhat changed.”. (shrink)

A notable feature of the COVID-19 pandemic is that children are less at risk of becoming infected or, if infected, less likely to become seriously unwell, so ethical discussions have consequently focused on the adult healthcare setting. However, despite a lower risk of children becoming acutely ill with COVID-19, there nevertheless may be significant and potentially sustained effects of COVID-19 on the physical, psychological, and emotional health and well-being of children. Focusing on the context of children’s cancer care, and specifically (...) bone marrow transplant, we describe some of these effects and then address one specific ethical challenge that arises. That is the question of what and how much to tell children whose cancer treatment has been changed because of COVID-19. Drawing on our previous work on the ethical reasons for telling the truth to younger children we link different ethical reasons to the different types of information that could be given to children in this context. We argue that children should be given an explanation of the changes that they will directly experience, including some changes to the process of their actual medical treatment; but not about increased risk associated with these changes, unless they specifically ask for this information. (shrink)

Bioethics, Volume 35, Issue 7, Page 696-703, September 2021.

Bioethics, Volume 36, Issue 7, Page 765-773, September 2022.

The COVID-19 pandemic has highlighted the risks that can be involved in healthcare work. In this paper, we explore the issue of staff safety in clinical work using the example of personal protective equipment in the COVID-19 crisis. We articulate some of the specific ethical challenges around PPE currently being faced by front-line clinicians, and develop an approach to staff safety that involves balancing duty to care and personal well-being. We describe each of these values, and present a decision-making framework (...) that integrates the two. The aim of the framework is to guide the process of balancing these two values when staff safety is at stake, by facilitating ethical reflection and/or decision-making that is systematic, specific and transparent. It provides a structure for individual reflection, collaborative staff discussion, and decision-making by those responsible for teams, departments and other groups of healthcare staff. Overall the framework guides the decision maker to characterise the degree of risk to staff, articulate feasible options for staff protection in that specific setting and identify the option that ensures any decrease in patient care is proportionate to the increase in staff well-being. It applies specifically to issues of PPE in COVID-19, and also has potential to assist decision makers in other situations involving protection of healthcare staff. There are no data in this work. (shrink)

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this (...) area. (shrink)

Alderson critiques our recent book on the basis that it overlooks children’s own views about their medical treatment. In this response, we discuss the complexity of the paediatric clinical context and the value of diverse approaches to investigating paediatric ethics. Our book focuses on a specific problem: entrenched disagreements between doctors and parents about a child’s medical treatment in the context of a paediatric hospital. As clinical ethicists, our research question arose from clinicians’ concerns in practice: What should a clinician (...) do when he or she thinks that parents are choosing a treatment pathway that does not serve the child’s best interests? Alderson’s work, in contrast, focuses on the much broader issue of children’s role in decision-making about treatment and research. We argue that these different types of work are zooming in on different aspects of paediatric ethics, with its complex mix of agents, issues and relationships. Paediatric ethics overall needs a rich mix of approaches,... (shrink)

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion (...) about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia. (shrink)

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion (...) about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia. (shrink)

In this paper, we explore the ethics of restricting visitation to hospitals during an infectious disease outbreak. We aim to answer three questions: What are the features of an ethically justified hospital visitor restriction policy? Should policies include scope for case‐by‐case exemptions? How should decisions about exemptions be made? Based on a critical interpretive review of the existing ethical literature on visitor restrictions, we argue that an ethically justified hospital visitor restriction policy has the following features: proportionality, comprehensiveness, harm mitigation, (...) exemptions for specific patient populations, visitation decisions made separately from a patient's treating clinicians, transparency, and consistency in application. We also argue that an ethical policy ought to include scope for case‐by‐case exemptions for individual patients. We propose a process for ethical decision‐making that provides a shared language and structure to decrease the risks and burdens of decision‐making when clinicians or managers are considering requests for exemptions. (shrink)

In the Ethics Spinoza offers a fuller and more philosophical account of the religious ideal, bringing to full maturity a view he had expressed in his earliest works. By the time Spinoza introduces Amor Dei intellectualis in Ethics Part 5, he has already explicated its three components: God, knowledge, and love. God is the eternal, self‐causing, unique substance; God is absolutely infinite, expressing infinite power in infinitely many ways; God is reducible to nothing else, not even the whole universe. Spinoza's (...) definition of love admits a further important distinction: between external and internal objects of love. Spinoza introduces his concept of Amor Dei intellectualis by suggesting that, in the third kind of knowing, acquiescentia in se ipso becomes indistinguishable from love of God. Love has a particularly important place within Spinoza's account of the affects, and also, therefore, within his religion. (shrink)

Background: Obtaining patients’ informed consent is an ethical and legal obligation in healthcare practice. Whilst the law provides prescriptive rules and guidelines, ethical theories of autonomy provide moral foundations. Models of practice of consent, have been developed in the bioethical literature to assist in understanding and integrating the ethical theory of autonomy and legal obligations into the clinical process of obtaining a patient’s informed consent to treatment.Aims: To review four models of consent and analyse the way each model incorporates the (...) ethical meaning of autonomy and how, as a consequence, they might change the actual communicative process of obtaining informed consent within clinical contexts.Methods: An iceberg framework of consent is used to conceptualise how ethical theories of autonomy are positioned and underpin the above surface, and visible clinical communication, including associated legal guidelines and ethical rules. Each model of consent is critically reviewed from the perspective of how it might shape the process of informed consent.Results and discussion: All four models would alter the process of obtaining consent. Two models provide structure and guidelines for the content and timing of obtaining patients’ consent. The two other models rely on an attitudinal shift in clinicians. They provide ideas for consent by focusing on underlying values, attitudes and meaning associated with the ethical meaning of autonomy.Conclusions: The paper concludes that models of practice that explicitly incorporate the underlying ethical meaning of autonomy as their basis, provide less prescriptive, but more theoretically rich guidance for healthcare communicative practices. (shrink)

How do people understand questions about cause and prevent? Some theories propose that people affirm that A causes B if A's occurrence makes a difference to B's occurrence in one way or another. Other theories propose that A causes B if some quantity or symbol gets passed in some way from A to B. The aim of our studies is to compare these theories' ability to explain judgements of causation and prevention. We describe six experiments that compare judgements for causal (...) paths that involve a mechanism, i.e. a continuous process of transmission or exchange from cause to effect, against paths that involve no mechanism yet a change in the cause nevertheless brings about a change in the effect. Our results show that people prefer to attribute cause when a mechanism links cause to effect. In contrast, prevention is sensitive both to the presence of an interruption to a causal mechanism and to a change in the outcome in the absence of a mechanism. In this sense, ‘prevent’ means something different than ‘cause not'. We discuss the implications of our results for existing theories of causation. (shrink)

Spinoza is widely regarded as either a God-forsaking atheist or a God-intoxicated pantheist, but Clare Carlisle says that he was neither. In Spinoza's Religion, she sets out a bold interpretation of Spinoza through a lucid new reading of his masterpiece, the Ethics. Putting the question of religion centre-stage but refusing to convert Spinozism to Christianity, Carlisle reveals that "being in God" unites Spinoza's metaphysics and ethics. Spinoza's Religion unfolds a powerful, inclusive philosophical vision for the modern age--one that is (...) grounded in a profound questioning of how to live a joyful, fully human life. Like Spinoza himself, the Ethics doesn't fit into any ready-made religious category. But Carlisle shows how it wrestles with the question of religion in strikingly original ways, responding both critically and constructively to the diverse, broadly Christian context in which Spinoza lived and worked. Philosophy itself, as Spinoza practiced it, became a spiritual endeavor that expressed his devotion to a truthful, virtuous way of life. Offering startling new insights into Spinoza's famously enigmatic ideas about eternal life and the intellectual love of God, Carlisle uncovers a Spinozist religion that integrates self-knowledge, desire, practice, and embodied ethical life to reach toward our 'highest happiness'--to rest in God. Seen through Carlisle's eyes, the Ethics prompts us to rethink not only Spinoza but also religion itself. (shrink)

A vibrant portrait of four college friends-Iris Murdoch, Philippa Foot, Elizabeth Anscombe, and Mary Midgley-who formed a new philosophical tradition while Oxford's men were away at war.

Clare Carlisle's innovative and moving biography writes Kierkegaard's remarkable life as far as possible from his own perspective, conveying what it was like to be this Socrates of Christendom.

Michel Clare est né le 21 février 1927 à Sceaux. Études secondaires, bachelier. Résistance et séjour au Maquis de Lorris à dix-sept ans. Puis sport pour guérir des déceptions d’après la Libération : athlétisme, champion de France du 800 mètres en 1949. De nombreuses fois international. Entre à l’Equipe en 1953 où il occupe les fonctions de grand reporter et spécialiste du ski. Auteur d’un livre sur le Ski (La table ronde). Lauréat de l’Académie des Sports pour une enquête (...) sur les universités américaines et du concours du meilleur article du journalisme sportif. A couvert tous les Jeux olympiques d’hiver et d’été de cette dernière décennie. Collabore, de façon épisodique, à Esprit. (shrink)

I consider the first part of Marty’s Raum und Zeit, which treats of both the nature of space and spatial perception. I begin by sketching two charges that Marty raises against Kantian and Brentanian conceptions of space (and spatial perception) respectively, before detailing what I take to be a characteristically Martyan picture of space perception, though set against the backdrop of contemporary philosophy of perception. Marty has it that spatial relations are non-real but existent, causally inert relations that are grounded (...) in space, which is itself non-real but existent. Objects do not inhere in space in the way properties inhere in substances. Rather, there is a ‘non-real’ relation of ‘fulfillment’ (Erfüllung) that holds between objects and places in space, which itself subsists. I consider whether any contemporary philosophy of perception is equipped to make sense of Martyan space perception and I suggest that the most promising conception is Naïve Realism. I then outline a difficulty for this theoretical translation. Naïve Realism is a direct theory of perception whereby S is said to perceive O just in case S stands in a psychological relation of acquaintance with O, where this relation is both non-representational and explanatorily primitive. For Marty however, all relations are non-real and, insofar as they are grounded, are neither fundamental, nor brute or primitive in an explanatory sense. I close by detailing what I thereby take a distinctively Martyan form of Naïve Realism to involve. The central theoretical tenet that phenomenal character is fundamentally constituted by worldly objects is preserved; but the manifestly relational structure of the acquaintance relation, construed in particular as a relation of awareness, is treated as derivative. I make headway in spelling out the latter claim by bringing Marty into fleeting conversation with another Thomist - G.E.M. Anscombe. (shrink)

This chapter examines the relationship between Soren Kierkegaard and Martin Heidegger. It explains that Heidegger mentioned Kierkegaard in much of his work from the early 1920s until his latest writings, but did not clarify the relationship between his own thought and Kierkegaard's. The chapter analyses Kierkegaard's distinctive contribution to philosophy and evaluates how this was taken up by Heidegger in his writings, particularly in Being and Time. It also evaluates the extent to which contemporary interpretation of Kierkegaard was influenced by (...) Heidegger's philosophy. (shrink)

Reflections on revolutionising: A voyage without a compass -- Notes -- Bibliography -- Index.

Progress -- Loss -- Return -- Amenability -- Citation tactics -- Affective subjects.

Contract cheating is a major problem in Higher Education because it is very difficult to detect using traditional plagiarism detection tools. Digital forensics techniques are already used in law to determine ownership of documents, and also in criminal cases, where it is not uncommon to hide information and images within an ordinary looking document using steganography techniques. These digital forensic techniques were used to investigate a known case of contract cheating where the contract author has notified the university and the (...) student subsequently confirmed that they had contracted the work out. Microsoft Word documents use a format known as Office Open XML Format, and as such, it is possible to review the editing process of a document. A student submission known to have been contracted out was analysed using the revision identifiers within the document, and a tool was developed to review these identifiers. Using visualisation techniques it is possible to see a pattern of editing that is inconsistent with the pattern seen in an authentic document. (shrink)

'Philosophy in a world of women. I reflected, talking with Mary, Pip and Elizabeth, how much I love them.' Two brilliant young scholars uncover the major philosophical contributions of four women whose ideas could have changed the course of twentieth-century thought. Written with energy, expertise and panache, The Quartet is a page-turning blend of research and recovery, storytelling, and a call to arms. Iris Murdoch, Philippa Foot, Mary Midgley and Elizabeth Anscombe were great friends and comrades in the intellectual trenches, (...) rethinking the possibilities of moral philosophy when the men 'left the room' and taking on the establishment, ultimately embodied by President Truman. Mac Cumhaill and Wiseman bring these women out of the shadows and into vivid colour. (shrink)

In a recent unit of study in an undergraduate Health Sciences pathway course, we identified a set of essays which exhibited similarity of content but demonstrated the use of bizarre and unidiomatic language. One of the distinct features of the essays was the inclusion of unusual synonyms in place of expected standard medical terminology.We suspected the use of online paraphrasing tools, but were also interested in investigating the possibility of the use of online language translation tools. In order to test (...) the outputs of these tools, we used as a seed document a corpus of text which had been provided to the students as prompt for the essay. This document was put through six free online paraphrasing tools and six separate iterative language translations through the online Google Translate™ tool.The results demonstrated that free online paraphrasing tools did not identify medical terminology as standardised or accepted nomenclature and substituted synonyms, whereas Google Translate™ largely preserved medical terminology.We believe that textual indicators such as the absence of standard discipline-based terminology may be of assistance in the identification of machine paraphrased text. (shrink)

Real Language Series General Editors:Jennifer Coates, Jenny Cheshire, Euan Reid This is a sociolinguistics series about the relationships between language, society and social change. Books in the series draw on natural language data from a wide range of social contexts. The series takes a critical approach to the subject, challenging current orthodoxies, and dealing with familiar topics in new ways. Gender and Discourse offers a critical new approach to the study of language and gender studies. Women moving into the public (...) domains of power traditionally monopolised by men are creating new identities for themselves, and the language that is used by them and about them offers an insight into gender roles. Clare Walsh reviews the current dominance/difference debates, and proposes a new analytical framework which combines the insights of critical discourse and feminist perspectives on discourse to provide a new perspective on the role of women in public life. A superbly accessible book designed for students and researchers in the field, the book features: - topical case studies from the arenas of politics, religion and activism- a new analytical framework, also summarised in chart form so the reader can apply their own critical analyses of texts. - written and visual text types for the reader's own linguistic and semiotic analysis. 'This important book takes up a neglected question in the study of language and gender - what difference women make to the discourse of historically male-dominated institutions - and brings to bear on it both the insights of feminist scholarship and evidence from women's own testimony. Clare Walsh's analysis of the dilemmas women face is both subtle and incisive, taking us beyond popular 'Mars and Venus' stereotypes and posing some hard questions for fashionable theories of language, identity and performance. (shrink)

Teacher Subject Identity in Professional Practicefocuses on a key, but neglected, element of a teacher's identity: that of their subject expertise.Studies of teachers' professional practice have shown the importance of a teacher's identity and the extent to which it can affect their resilience, commitment and ultimately their effectiveness. Drawing upon narrative research undertaken with a range of teachers over a period of 14 years, the book explores how subject expertise can play a significant role in teacher identity, acting as a (...) professional compass guiding teachers at all levels of their professional practice. It reveals powerful individual stories of meaning-making which highlight the dynamic importance of teachers' subject expertise The book's metaphor of a professional compass goes to the heart of teacher professionalism, and provides a valuable mechanism to enable teachers to respond to challenges they face in their daily practice. It enables teachers to consider the moral dimensions of their practice, and can constitute a significant component in professional formation and identity. Throughout the book the importance of subject expertise for teachers' professional practice is explored at a range of scales: from the classroom to broad education policy, and at different stages of a teacher's career which offers readers a deeper understanding of the importance of subject expertise for teachers. Teacher Subject Identity in Professional Practicemakes a significant contribution to an under-researched area. It identifies the role and significance of teachers' subject expertise as a dimension of their teacher identity. The book is key reading for teacher educators, policy makers and researchers with an interest in teachers' professional development and practice. (shrink)

This is a somewhat polemical, and very passionate, consideration of the house that scholasticism built, and those who were excluded from it.

This study investigated whether temporal clustering of autobiographical memories around periods of self-development would also occur when imagining future events associated with the self. Participants completed an AM task and future thinking task. In both tasks, memories and future events were cued using participant-generated identity statements . Participants then dated their memories and future events, and finally gave an age at which each identity statement was judged to emerge. Dates of memories and future events were recoded as temporal distance from (...) the identity statement used to cue them. AMs and future events both clustered robustly around periods of self-development, indicating the powerful organisational effect of the self. We suggest that life narrative structures are used to organise future events as well as memories. (shrink)

Much of the philosophical work on perception has focused on vision. Recently, however, philosophers have begun to correct this ‘tunnel vision’ by considering other modalities. Nevertheless, relatively little has been written about the chemical senses—olfaction and gustation. The focus of this paper is olfaction. In this paper, I consider the question: does human olfactory experience represents objects as thus and so? If we take visual experience as the paradigm of how experience can achieve object representation, we might think that the (...) answer to this question is no. I argue that olfactory experience does indeed represent objects—just not in a way that is easily read from the dominant visual case. (shrink)