Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.Trial RegistrationISRCTN89993391. (shrink)

ObjectivesTo investigate which of two sources of information about an older adult’s wishes—choices made in an advance directive or proxy’s opinion—provides better insight into the older adult’s preferences measured in hypothetical clinical situations involving decisional incapacity.MethodsSecondary analyses of data collected from 157 community-dwelling, decisionally competent adults aged 70 years and over who attended a group information session on advance directives with their proxy. Older adults were invited to complete a directive introduced during the session, designed to express healthcare preferences. An (...) average of 3 months later, older adults were asked during an interview whether they would want to receive each of four medical interventions and what their goals of care would be should they develop one of three sudden health events, assuming that they had severe dementia. Proxies were asked to guess the older adult’s answers in each of the seven scenarios.ResultsEighty per cent of the older adults completed the directive. Choices they made in the directive were more in line with the preferences they stated during the interview than were their proxies’ guesses at their answers. However, concordance was relatively low, with percentages of agreement ranging from 43% to 83% across scenarios.ConclusionsFindings suggest that a directive might provide better insight into a person’s wishes than the person’s proxy, although neither source is perfect. A multifaceted decision-making model that includes both sources of information might better serve the interests of older adults who have lost the capacity to make decisions on their own.Trial registration numberISRCTN89993391; Post-results. (shrink)

Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario’s protocols were presented to the public in a democratic deliberation during the summer of 2022. Objectives (1) To explore the perspectives of Quebec and Ontario (...) citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. Methods This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. Results A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value – a less acceptable tiebreaker. Conclusion Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria. (shrink)

BackgroundHealthcare professionals and surrogate decision-makers often face the difficult decision of whether to initiate or withhold antibiotics from people with dementia who have developed a life-threatening infection after losing decisional capacity.MethodsWe conducted a vignette-based survey among 1050 Quebec stakeholders (senior citizens, family caregivers, nurses and physicians; response rate 49.4%) to (1) assess their attitudes toward withholding antibiotics from people with dementia lacking decisional capacity; (2) compare attitudes between dementia stages and stakeholder groups; and (3) investigate other correlates of attitudes, including (...) support for continuous deep sedation (CDS) and medical assistance in dying (MAID). The vignettes feature a woman moving along the dementia trajectory, who has refused in writing all life-prolonging interventions and explicitly requested that a doctor end her life when she no longer recognizes her loved ones. Two stages were considered after she had lost capacity: the advanced stage, where she likely has several more years to live, and the terminal stage, where she is close to death.ResultsSupport for withholding antibiotics ranged from 75% among seniors and caregivers at the advanced stage, to 98% among physicians at the terminal stage. Using the generalized estimating equation approach, we found stakeholder group, religiosity, and support for CDS and MAID, to be associated with attitudes toward antibiotics.ConclusionsFindings underscore the importance for healthcare professionals of discussing underlying values and treatment goals with people at an early stage of dementia and their relatives, to help them anticipate future care decisions and better prepare surrogates for their role. Findings also have implications for the scope of MAID laws, in particular in Canada where the extension of MAID to persons lacking decisional capacity is currently being considered. (shrink)

Science has always been tightly associated with environmental ethics in a way traditional ethics has not. However, despite this proximity, science has had a merely informational role, where it must inform ethics but not intervene in ethical judgment. Science is seen as an amoral enterprise, requiring an ethics rather than recommending one. In this paper I try to go against this common view. First, I give a critique of the naturalistic fallacy following the lines of Frankena. Then I go on (...) to describe the two possible roles science can have in ethical though, and in environmental ethics in particular. As it turns out, science does not only inform ethics, but can actually have moral import and intervene in moral judgment. Finally, from an ecocentric point of view, I try to illustrate this last point by construing the ecological notion of resilience as a moral boundary—a scientifically determined boundary between right and wrong. (shrink)

Inspired by, and in close relation with, the contributions of this special issue, Kuperberg elegantly links event comprehension, production, and learning. She proposes an overarching hierarchical generative framework of processing events enabling us to make sense of the world around us and to interact with it in a competent manner.

Una profesora de secundaria narra en tres momentos distintos los sucesos que han marcado su devenir como mujer, madre y enseñante durante la pandemia por COVID-19. En un recorrido que transcurre entre la sorpresa, la incertidumbre y el desencanto, emerge la reflexión de que la escuela ya no es ni será la misma, no solo por la diferencia entre la educación presencial y a distancia, sino porque las vidas de todos y todas se han transformado, porque muchos escolares han dejado (...) la escuela, más de cinco millones de niños, niñas y jóvenes. Afirma con contundencia ¡Este bicho tiene aporofobia! en alusión a la desigualdad social y la afectación a las personas en situación de pobreza. Reflexiona en torno a las distintas respuestas del profesorado y del sistema educativo, haciendo una fuerte crítica a la viabilidad y resultados del modelo “aprende en casa”. De ninguna manera es ajena a los efectos de la pandemia en los planos económico, laboral y educativo, pero se muestra renuente a dar credibilidad y adoptar soluciones que ubican la problemática solo en el plano de la voluntad y esfuerzo personal, sin reconocer que se trata de una crisis sistémica, que abarca a las instituciones sociales en conjunto. La expresión de emociones, vivencias y aprendizajes no esperados ante la ruptura de lo cotidiano, así como la experiencia del confinamiento por más de año y medio, permiten avizorar una nueva subjetividad en los actores de la educación, que deberá ser tomada en cuenta en el eventual regreso a los planteles escolares. (shrink)

Resumen: En su libro Mujeres y discursos gerenciales. Hacia la autogestión feminista, María Medina-Vicent aborda desde una perspectiva crítica feminista los discursos gerenciales dirigidos a las mujeres, desvelando el androcentrismo y la presencia —y perpetuación— de tradicionales roles y estereotipos de género en los modelos de gestión. Mi propuesta pretende incidir en dos aspectos del análisis realizado por Medina-Vicent, por un lado, remarcar los peligros de la despolitización de los discursos gerenciales dirigidos a mujeres —sobre todo en tanto que la (...) literatura gerencial acaba por informarnos a todas—. Por otro, profundizar en la crítica que la autora realiza de la cooptación del feminismo por parte de estos discursos.: In her book Mujeres y discursos gerenciales. Hacia la autogestión feminista, Medina-Vicent approaches management discourses aimed at women from a critical feminist perspective, revealing the androcentrism and the presence and perpetuation of traditional gender roles and stereotypes in management models. My proposal aims to highlight two aspects of Medina-Vicent’s analysis: on the one hand, to highlight the dangers of depoliticizing management discourses aimed at women - especially insofar as management literature ends up informing us all. On the other hand, the author’s critique of the co-optation of feminism by these discourses will be explored in greater depth. Palabras clave: discursos gerenciales, teoría feminista, antifeminismo, despolitización. Keywords: managerial discourses, feminist theory, antifeminism, depoliticization. (shrink)

Little previous research has examined attitudes about societal and ethical issues (SEI) among interns participating in research experience for undergraduate programs (REUs) in nanotechnology, thus neglecting an important population for understanding the burgeoning views of the next generation of nanotechnology researchers. This study surveyed a sample of interns (N = 85) participating in the National Nanotechnology Infrastructure Network’s (NNIN) REU program during the summer of 2012. Our questions focused on interns’ experiences with education on ethical issues, as well as their (...) attribution of responsibility for considering ethical issues, motivations to talk about ethical issues, and comfort level of discussing ethical issues with faculty, mentors, lab staff, and other REU students. Among key findings was that lab culture related to the extent to which REU interns felt comfortable discussing ethical issues. In addition, those who reported more discussions about ethical issues with their mentors were more likely to consider themselves as responsible for considering ethical issues. We conclude with recommendations and future research directions. (shrink)

In this paper, we offer a conceptualization of leadership as contemplative. Drawing on MacIntyre’s perspective on virtue ethics and Levinas’ and Gilligan’s work on the ethics of responsibility and care, we propose contemplative leadership as virtuous activity; reflexive, engaged, relational, and embodied practice that requires knowledge from within context and practical wisdom. More than simply offering another way to conceptualize the ethics of leadership, this research contributes to understanding the ethics of leadership in practice. Empirically, we analyze the narratives of (...) those in positions of formal authority and other organizational members in churches. We illustrate contemplative leadership as driven by a good purpose, derived from the unique organizational and broader societal context in which leadership occurs, and grounded in an ethical concern for the other. Contemplative leadership accounts for the complexity of experience and is discerned in mundane and everyday practices. We conclude with the implications for leadership theory, practice, and education. (shrink)

This volume defends a particular set of progressive political interventions on the basis of their being legitimate exercises of coercive political power, specifically focusing on the gendered division of labour, which is widely regarded as the predominant form of gender injustice.

The real-world navigation of ethics-in-practice versus the bureaucracy of institutional ethics remains challenging. This is especially true for research with children and young people who may be co...

Workplace bullying has a well-established body of research internationally, but the United States has lagged behind the rest of the world in the identification and investigation of this phenomenon. This paper presents a managerial perspective on bullying in organizations. The lack of attention to the concept of workplace dignity in American organizational structures has supported and even encouraged both casual and more severe forms of harassment that our workplace laws do not currently cover. The demoralization victims suffer can create toxic (...) working environments and impair organizational productivity. Some methods of protecting your organization from this blight of bullying are proposed. Bullying has always been part of the human condition; history is rife with references to abuse of power and unnecessary or excessive force. The classic bully story is of Joseph and his brothers, a tale of envy and hostility. The refinement of bullying to include various forms of legally defined social harassment is a relatively late phenomenon, however, dating to the Civil Rights Act of 1964. In the United States, bullying is not illegal, whereas it is illegal in many other countries. Bullying is not about benign teasing, nor does it include the off-color jokes, racial slurs, or unwelcome advances that are the hallmarks of legally defined harassment. Workplace bullying is the pattern of destructive and generally deliberate demeaning of co-workers or subordinates that reminds us of the activities of the schoolyard bully. Unlike the schoolyard bully, however, the workplace bully is an adult, usually (but not always) aware of the impact of his or her behavior on others. Bullying in the workplace, often tacitly accepted by the organizational leadership, can create an environment of psychological threat that diminishes corporate productivity and inhibits individual and group commitment. The two examples that follow will help to clarify the difference between harassment and bullying. (shrink)

Classical Confucian philosopher Mengzi 孟子 offers resources that can help shed light on the metaphysical status of moral qualities and answer the question of how we come to perceive them. I argue that Mengzi puts forward an account of virtue as sensitivity similar to that offered by John McDowell. Both thinkers endorse a particular kind of motivationally internalist naturalistic moral realism, and both explain virtue as analogous to perception of secondary qualities. I offer an original contribution to existing literature by (...) further arguing that Mengzi’s view includes an understanding of moral perception as including perception of uniquely human roles and the moral obligations they generate. This essay thus offers a novel textual interpretation of the _Mengzi_. Based on this interpretation, it then puts forth the argument that Mengzi’s version of virtue as sensitivity allows the Confucian thinker to avoid criticisms of McDowell’s “Sensitivity Account” of virtue. In particular, I argue that Mengzi’s account of sensitivity—as one that includes sensitivity to human roles and relationships—is better able to explain variation in perceived moral qualities both over time and across cultures. This is because Mengzi’s view recognizes that what is called for morally shifts with the agent’s social roles. Thus, a Mengzian-influenced Sensitivity Account of virtue can better account for differences in moral judgment by emphasizing that moral facts are a feature of human relationships, which likewise vary between cultures and individuals and change over time. (shrink)

El desarrollo creciente de la novela negra neo-detectivesca en Chile es una prueba más de que atravesamos por un cambio artístico fundamental. Tecnológica y estéticamente impecables, las variantes de esta novela suelen ser producidas por escritores rigurosamente profesionales. Sin embargo y a pesar de los factores mencionados, ésta no está exenta de popularidad y éxito de ventas. Elalemán de Atacama de Roberto Ampuero es la segunda de la saga de su detective ficcional Cayetano Brulet. Como otras de sus novelas, ésta (...) conlleva una reflexión sobre el entreguismo de la nación-estado, los efectos devastadores de la economía global, la precariedad de los grupos étnicos y la destrucción ecológica. (shrink)

General semantics reveals ambiguities in the Bible.

The Good Supervisor engages readers in dialogue and active reflection on the strategies of effective supervision of PhDs, postgraduate and undergraduate research. Accessibly written, it encourages supervisors to reflect on and enhance their research supervision practice with a diversity of students on a variety of research projects: Postgraduate and undergraduate levels, international and distance students practice and professional research research leading to creative process and products/creations the PhD by publication supervising your colleagues interpersonal skills managing diversity in learning styles, gender, (...) age and culture. The book is also useful for students undertaking research. There is special focus on research skills development.and on supporting students through and beyond the examination process. (shrink)

Recent calls for reinstituting mandatory home economics education have emphasized its potential to advance gender egalitarian aims. The thought is that, because women’s disproportionate performance of caregiving and household labor is partially caused by gender socialization that better prepares women than men for such work, we can disrupt gender inegalitarian work distributions by preparing everyone for the sort of work in question. The curricula envisioned in these calls are gender-neutral, in the sense that they recommend identical educational interventions for all (...) genders. By exploiting a parallel between gender-neutral educational policies and gender-neutral family leave policies, we argue first that gender-neutral home economics instruction is unlikely to advance gender egalitarian aims, and may in fact reinforce the very outcomes it is meant to disrupt. However, we further argue that a more radical home economics curriculum could avoid these difficulties. To the extent that we value educational interventions as a possible means for advancing gender egalitarian aims, we have good reason to seriously consider adopting a gender non-neutral program in which all and only boys receive mandatory caregiving instruction. (shrink)

Objective: To assess the knowledge of four groups of individuals regarding who is legally authorised to consent to health care or research involving older patients.Design: A provincewide postal survey.Setting: Province of Quebec, Canada.Participants: Three hundred older adults, 434 informal caregivers of cognitively impaired individuals, 98 researchers in aging and 136 members of research ethics boards .Measurements: Knowledge was assessed through a pretested postal questionnaire comprising five vignettes that describe hypothetical situations involving an older adult who requires medical care or is (...) solicited for research. The respondent had to identify the person who is legally authorised to provide consent.Results: Nearly 80% of all respondents provided the correct answer when the hypothetical scenario depicted a person who was competent to consent or incompetent but legally represented. Knowledge was worse for the scenario describing a research situation that involved an incompetent adult without a legal guardian.Conclusion: The observed lack of knowledge raises doubts about the ability of current legislation to truly protect the rights of older adults with diminished decision making capacity. It points to the need for educational programmes aimed at increasing public awareness of the legislation put in place for those requiring special protection. (shrink)

Commodity chain analysis (Bair and Ramsay, 2003 Multinational Companies and Global Human Resource Strategies) is used to explore where economic pressure (from consumers) or socio-political pressure (from governments and NGOs) can be applied to reduce worker exploitation. Six paths are illustrated with examples of successful and unsuccessful application of pressure. Three conclusions are reached :Economic pressure on companies and brand owners is more likely to lead to improved workplace conditions than socio-political pressure; Brand owners are more likely to implement improved (...) workplace conditions than retailers; and Retailers who are under extreme consumer price pressure will resist improving workplace conditions. (shrink)

Autistic children with sensory processing differences successfully navigate and engage in meaningful family daily occupations within home and community environments through the support of their family. To date however, much of the research on autistic children with sensory processing differences, has primarily been deficit focused, while much of the caregiver research has focused on issues of distress, burden, effort, and emotional trauma in coping with their child's diagnosis. This study aimed to conduct a qualitative evidence synthesis, using a meta-ethnographic approach (...) to explore the gap identified in understanding successful occupational experiences of family participation and daily family routines when supporting an autistic child with sensory processing differences and to offer an alternative strengths-based perspective. Inclusion criteria were studies which were peer-reviewed qualitative design, published from 2000 to 2021, and that concerned parents/caregivers' perspectives of family occupations of children diagnosed with autism spectrum disorder. Studies were electronically searched in eight databases from October to December 2021 and 23 studies were identified which met the inclusion criteria. Noblit and Hare's seven step approach for conducting analysis in meta-ethnography was used, and three themes identified: sensory processing differences in daily life, what is hard about hard, and orchestrating family life. Results identified the centrality of sensory experiences in understanding family life. Living with unpredictability while orchestrating certainty through routines was core to successful participation. This review provides insights into how parents negotiate the complexities of constructing family life when living with an autistic child. The results can inform the design of future interventions that specifically address the relationship between meaningful participation in family occupations and daily routines and sensory processing in autistic children.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022298938, identifier: CRD42022298938. (shrink)