Volume 20, Issue 7, July 2020, Page W17-W19.

In this paper, we reflect upon shame and humiliation as threats to personal and professional integrity and moral agency within contemporary health care. A personal narrative, written by a nurse about a particular shift in a British National Health Service Accident and Emergency Department, is provided as a case study. This is critically reflected and commented upon in dialogue with insights into the nature of shame and humiliation. It is suggested that Accident and Emergency is a locus that is latently (...) prone to dynamics of shame and humiliation, a potential exacerbated within a culture subject to externally‐determined time targets that are enforced by a top‐down system of surveillance and management. The result is that nurses may lose their sense of professional competence and responsibility, moral agency, and integrity, to their own personal detriment, as well as to the detriment of patients with whom they work. Insofar as examining a small part of a whole may suggest insights into the operation and ethos of a very large system, this very particular case study narrative/reflection has some important implications and lessons for the wider organization and provision of health care in Britain and beyond. (shrink)

Medical Humanities the journal started life in 2000 as a special edition of the JME. However, the intellectual taproots of the medical humanities as a field of enquiry can be traced to two developments: calls made in the 1920s for the development of multidisciplinary perspectives on the sciences that shed historical light on their assumptions, methods and practices; refusals to assimilate all medical phenomena to a biomedical worldview. Medical humanities the term stems from a desire to situate the significance of (...) medicine as a product of culture. But despite growing usage over half a century the term defies a unifying encapsulation and continues to conjure up a multitude of discourse communities, including scholars working at the interfaces of health and humanities, arts and health, and medical education and bioethics. The field is intellectually capacious and polymorphous, forming and reforming around critical new research questions and teaching tasks spanning disciplines. (shrink)

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving (...) the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work. (shrink)

Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its purpose. Intervention (...) participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (shrink)

Bioethics case reports generally treat aspects of moral fathomability, characterised and addressed in different ways. This paper reads the case as a textual model of scenarios and draws attention to its structure, narrative shape, linguistic register, and the effects of tone and temporality on reader expectation and responsiveness. Such textual elements of case composition reflect authorial purpose and influence the interpretation, including moral and ethical interpretation, of bioethics cases.

In the face of a perceived lack of widespread understanding of the theoretical issues underlying the development, dissemination and implementation of clinical guidelines, the Royal College of General Practitioners Guidelines Group developed a 2-day course aimed at teaching the theory in these areas. The course was targeted at potential opinion formers and ran on six occasions. Postal questionnaire assessment of the course revealed high levels of satisfaction with all aspects of the course and high levels of reported use of the (...) knowledge gained. Further developments of the course are discussed. (shrink)

There are very few medical ethics courses in British medical schools which are a formal part of the clinical curriculum. Such a programme is described in the following, along with the way in which the long-term curriculum committee of the University College and Middlesex Hospital Joint Medical School was persuaded to make it compulsory for first-year students. Pedagogical lessons which have been learned in its planning and implementation are outlined and teaching materials are included concerning student and course assessment which (...) should be useful for others engaged in similar work. Finally, some of the institutional obstacles facing such attempts are discussed, particularly problems concerning timetabling, different types of opposition and the consequent importance of building alliances among clinical teaching staff. (shrink)

The identification of additional subunits of the cGMP-gated cation channel suggests exciting questions about their regulatory roles and about structure/functional relationships. How do the different subunits interact? How is the complex assembled into the plasma membrane? Divalent cations have been implicated in the regulation of adaptation. One often overlooked cation is magnesium. Could this ion play a role in phototransduction?

The first part of the book, dedicated to 'Rhetorical and Epistemological Aspects of Science Writing', addresses how scientific pursuits and methods feed into multi-level texts that generate responses within science, society, and culture.

A general practitioner (GP) recounts events which unfolded after visiting a patient at home. She was found to be suffering from an entirely curable clinical condition which was worsening as a result of refusal to accept effective medical treatment. The effects upon a grown-up son of the patient's refusal, and the increasing burden of care falling upon local district nursing services, were factors which influenced the GP's thinking and decision making.

The term “listening niche” refers to the contexts in which people listen to music including what music they are listening to, with whom, when, where, and with what media. The first experiment investigates undergraduate students’ music listening niches in the initial COVID-19 lockdown period, 4 weeks immediately after the campus shut down abruptly. The second experiment explores how returning to a hybrid semester, the “new normal,” further affected these listening habits. In both experiments, the participants provided a list of their (...) most frequently listened-to songs during the respective period of time. From these, they identified one song that seemed most associated with this period, their “signature song,” and stated why this song seemed relevant. These reasons were coded on nine underlying themes. Three clusters were found to underlie the themes: emotional responses memory associations, and discovery of new music. We identified songs and reasons for selecting them that represented the three clusters and related these to the lyrical content. Compared to before the pandemic, participants in both experiments report listening more in general and on Spotify, but there were no differences in listening between lockdown and the new normal. Whom they were listening with shifted overtime from family members to significant others and finally to other friends and roommates. These results demonstrate how students listen to and find new music that is meaningful to them during this unprecedented pandemic. (shrink)

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Profiles of art education in nineteen countries around the world by citizens or longtime residents of those countries comprise the core of this book. Guidelines for the cross-cultural study of art education are presented by the editors in a general introduction and three part introductions, and also by contributing specialists. The nineteen national profiles, with accompanying examples of children's artwork, make up the largest section of the book, Part II. The three chapters in Part I review research that has identified, (...) on one hand, certain universal characteristics of children's artwork attributable to common human stages of development, and, on the other hand, certain differing and unique cultural influences. The need for further research on this distinction is emphasized. Contributors to Part I are Elliot W. Eisner, William Ives and Howard Gardner, and Marjorie and Brent Wilson. The three chapters in Part III discuss three major problems in art education: the use of museum visits, the worldwide attempt to establish valid tests of teacher and pupil proficiency in art, and the design of sound and useful cross-cultural research. Resources for such research are described. Contributors to Part III are Robert Ott and Lois Swan Jones, William Bradley, and Frances E. Anderson. Professionals and students in art education can broaden their perspective through Art in Education, while their counterparts in child development and psychology can gain insights into the creative process. Profiles: Western Europe—England,Finland, Germany, Netherlands; Eastern Europe—Hungary, Poland, Soviet Union; Middle East and South Asia Afghanistan, Egypt, India, Israel; East Asia and the Pacific Australia, China, Japan; Africa—Ghana, Nigeria, South Africa; The Americas—Brazil, United States. (shrink)