IntroductionMaking appropriate plans for the provision of hospice care is considered a perceived need in the Iranian health system. The current study aimed to develop a model for establishing hospice care delivery system for the adult patients with cancer.Materials and MethodsThis study is part of a larger study that has been done in four phases. This Health System Policy Research utilized a mixed qualitative-quantitative approach. At the first phase, a qualitative study was conducted which explained the care needs and (...) the requirements for establishing this system from the stakeholders’ perspective. The second phase aimed to examine the current situation of hospice care delivery in Iran and identify and determine the similarities and differences among them in the selected countries. At the third phase, the main areas of the model and the related indicators were extracted and prioritized by consulting with experts. Then the model was formulated. At the fourth phase, the proposed model was validated and finalized in terms of importance, scientific acceptability, and feasibility.ResultsBased on the developed model the first and the most important step in establishing the hospice care delivery system is laying the groundwork in the health system which requires focusing on policymaking. It is necessary to establish hospice centers and implement public awareness raising programs, train, and supply expert manpower, strengthen family physician and referral process, formulate clinical guidelines, encourage the private sector and NGOs.) to invest, develop end-of-life and hospice care service packages, and create quality care indicators. The proposed model had moderate feasibility.ConclusionThis model was developed based on the current Iranian healthcare structure and the needs of terminally ill cancer patients. It can be used as a model tailored to the current state of the health system and community in Iran. It is suggested to use this model as a pilot at the regional level. (shrink)

This paper presents a constructivist grounded theory on the decision-making process that UK home and alternative educators undertake and the related influencing factors. Twenty-one participants from a diverse range of backgrounds were interviewed between one and three times over a two-year period. Some were current home and alternative educators and others were undecided, or had changed their minds about home educating. The core process is entitled ‘Stepping out of the system?’ It was constructed from three main categories: attitudinal direction, surveying (...) the landscape and negotiating obstacles. Parents have opinions of school that developed before they began to consider how to educate their child; attitudes which are affect laden and guide the process of information gathering. The surveying the landscape stage involves both formal research and informal methods such as hearing the views of others and acting upon their own feelings. The final stage, negotiating obstacles, involves finding practical solutions to barriers they may face. The grounded theory is enriched and deepened by Reddy’s (2010) concept of emotional refuges. (shrink)

This chapter contains sections titled: Worker‐Owned Firms Municipal Enterprises Building Community: Neighborhoods and Nonprofits State and National Innovators Integrated Advances and Further Possibilities3 Challenging the Ideology of Unconstrained Wealth Inequality Conclusion References.

In the scenario of growing polarization of promises and dangers that surround artificial intelligence (AI), how to introduce responsible AI and robotics in healthcare? In this paper, we develop an ethical–political approach to introduce democratic mechanisms to technological development, what we call “Caring in the In-Between”. Focusing on the multiple possibilities for action that emerge in the realm of uncertainty, we propose an ethical and responsible framework focused on care actions in between fears and hopes. Using the theoretical perspective of (...) Science and Technology Studies and empirical research, “Caring in the In-Between” is based on three movements: the first is a change of focus from the world of promises and dangers to the world of uncertainties; the second is a conceptual shift from assuming a relationship with robotics based on a Human–Robot Interaction to another focused on the network in which the robot is embedded (the “Robot Embedded in a Network”); and the last is an ethical shift from a general normative framework to a discussion on the context of use. Based on these suggestions, “Caring in the In-Between” implies institutional challenges, as well as new practices in healthcare systems. It is articulated around three simultaneous processes, each of them related to practical actions in the “in-between” dimensions considered: monitoring relations and caring processes, through public engagement and institutional changes; including concerns and priorities of stakeholders, with the organization of participatory processes and alternative forms of representation; and making fears and hopes commensurable, through the choice of progressive and reversible actions. (shrink)

In the scenario of growing polarization of promises and dangers that surround artificial intelligence (AI), how to introduce responsible AI and robotics in healthcare? In this paper, we develop an ethical–political approach to introduce democratic mechanisms to technological development, what we call “Caring in the In-Between”. Focusing on the multiple possibilities for action that emerge in the realm of uncertainty, we propose an ethical and responsible framework focused on care actions in between fears and hopes. Using the theoretical perspective of (...) Science and Technology Studies and empirical research, “Caring in the In-Between” is based on three movements: the first is a change of focus from the world of promises and dangers to the world of uncertainties; the second is a conceptual shift from assuming a relationship with robotics based on a Human–Robot Interaction to another focused on the network in which the robot is embedded (the “Robot Embedded in a Network”); and the last is an ethical shift from a general normative framework to a discussion on the context of use. Based on these suggestions, “Caring in the In-Between” implies institutional challenges, as well as new practices in healthcare systems. It is articulated around three simultaneous processes, each of them related to practical actions in the “in-between” dimensions considered: monitoring relations and caring processes, through public engagement and institutional changes; including concerns and priorities of stakeholders, with the organization of participatory processes and alternative forms of representation; and making fears and hopes commensurable, through the choice of progressive and reversible actions. (shrink)

Technological developments involving robotics and artificial intelligence devices are being employed evermore in elderly care and the healthcare sector more generally, raising ethical issues and practical questions warranting closer considerations of what we mean by “care” and, subsequently, how to design such software coherently with the chosen definition. This paper starts by critically examining the existing approaches to the ethical design of care robots provided by Aimee van Wynsberghe, who relies on the work on the ethics of care by Joan (...) Tronto. In doing so, it suggests an alternative to their non-principled approach, an alternative suited to tackling some of the issues raised by Tronto and van Wynsberghe, while allowing for the inclusion of two orientative principles. Our proposal centres on the principles of autonomy and vulnerability, whose joint adoption we deem able to constitute an original revision of a bottom-up approach in care ethics. Conclusively, the ethical framework introduced here integrates more traditional approaches in care ethics in view of enhancing the debate regarding the ethical design of care robots under a new lens. (shrink)

Agricultural technologies are non-neutral and ethical challenges are posed by these technologies themselves. The technologies we use or endorse are embedded with values and norms and reflect the shape of our moral character. They can literally make us better or worse consumers and/or people. Looking back, when the world’s developed nations welcomed and steadily embraced industrialization as the dominant paradigm for agriculture a half century or so ago, they inadvertently championed a philosophy of technology that promotes an insular human-centricism, despite (...) its laudable intent to ensure food security and advance human flourishing. The dominant philosophy of technology has also seeded particular ethical consequences that plague the well-being of human beings, the planet, and farmed animals. After revisiting some fundamental questions regarding the complex ways in which technology as agent shapes our lives and choices and relegates food and farmed constituents into technological artifacts or commodities, I argue that we should accord an environmental virtue ethic of care—understood as caretaking—a central place in developing a more conscientious philosophy of technology that aims at sustainability, fairness, and humaneness in animal agriculture. While technology shapes society, it also is socially shaped and an environmental virtue ethic of care (EVEC) as an alternative design philosophy has the tools to help us take a much overdue inventory of ourselves and our relationships with the nonhuman world. It can help us to expose the ways in which technology hinders critical reflection of its capacity to alter communities and values, to come to terms with why we may be, in general, disengaged from critical ethical analysis of contemporary agriculture and to consider the moral shape and trajectory and the sustainability of our food production systems going into the future. I end by outlining particular virtues associated with the ethic of care discussed here and consider some likely implications for consumers and industry technocrats as they relate to farming animals. (shrink)

Attachment is an emotional bond between two people where one seeks care from the other. In the prototypical case, the child attaches to their mother. The most recent theoretical developments point out that attachment is multidimensional – meaning that the phenomenon pertains to multiple domains related to the relationship with the caregiver. However, researchers have so far modeled attachment computationally by mostly adopting a classical categorical (as opposed to dimensional) standpoint that sees the system as controlling caregiver proximity. In contrast, (...) we adopt here adimensional perspective(DP) and consider dimensions to be the system’s set-goals. We hypothesize that the resulting multidimensional controller should lead to valid (or even better) models of the phenomenon. To start testing this hypothesis, we built a DP-informed agent-based model of attachment inspired by the widely-studied Strange Situation Procedure. In this context, child and mother show the nature of attachment bonds through their behavioral and emotional expressions. By modeling them as point-agents moving in a two-dimensional arena, we simulated child-mother interactions for the avoidant and ambivalent attachment dimensions. The generated dynamical patterns – characterized by the alternation between approach and exploration – matched those described in the attachment literature, thereby confirming the implementability and validity of the DP. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction:Developing Health Care in Severely Resource-Constrained SettingsPaul Farmer and Sadath SayeedThis symposium of Narrative Inquiry in Bioethics catalogues the experiences of health care providers working in resource-poor settings, with stories written by those on the frontlines of global health. Two commentaries by esteemed scholars Renee Fox and Byron and Mary-Jo Good accompany the narratives, helping situate the lived experiences of global health practitioners within the frameworks of sociology and (...) medical anthropology respectively.The burgeoning interest in global health among students, health science trainees, clinical practitioners, social entrepreneurs, philanthropists, and government officials is often linked with substantial moral claims. People working in global health often start with the rhetorical premise that each and every human being, regardless of economic, social, or political circumstances that lie beyond his or her control, deserves equal access to quality health care services. This is a bold position at risk of trivialization, in part because the sentiment is so commonplace among global health equity activists.Despite this relatively recent global outpouring of solidarity and concern, billions of poor people still lack access to basic health services. All too often, interventions that perpetuate existing trade practices and market economics are promoted, usually to the detriment of the poor. As our good friend and colleague Arthur Kleinman warns:The irrelevance of ethics can be seen when considering universal ethical formulations of justice and equity that do not begin with the local moral conditions of poor people, those experiencing the systematic injustice of higher disease rates and fewer health-care resources because of their positioning at the bottom of local social structures of power.(1999, p.72)If we are serious about reducing health disparities globally, we must be prepared to mobilize resources in Africa just as we would in the United States or in Europe. If we fetishize cost-effective (read: low-cost) interventions for the poor, we must ask whether we use the same metrics in other situations. In other words, we must always strive to address the fundamental structural and social causes of health inequity.We believe that global health must avoid the "iron cage of rationality," to use sociologist Max Weber's words. One unanticipated consequence of the growth of global health as a field is that the "audit culture"—which encourages accountability and effectiveness—can at times reinforce power differentials between donors (whether government agencies or multilateral foundations) and their intended beneficiaries. Agendas are often set not by community members but by global health leaders who rarely demonstrate sustained commitments to a local community. [End Page 73]As the guest editors of this issue, we hope to recapture the soul of global health work through the art of storytelling. Narratives, even when presented as raw and unrefined as many within this issue, remind us of the immense challenges—both programmatic and moral—involved in this work. The profound scarcity of resources available to health providers in poor countries forces ethical questions on doctors, nurses, pharmacists, social workers, and other health care workers, who make difficult choices every day about what to do with the few resources they have. These are the ethical dilemmas of mortal dramas at their most dire. Global health work demands of its practitioners an alternate mode of audit than academic methodologies can provide. Narratives return us to the basic human commitments that led many of us to this work, and they remind us to use words like equality and justice meaningfully.The narratives that follow offer unmitigated perspectives on the working lives of global health practitioners. They highlight the translation of the moral and programmatic challenges of health care delivery into real choices: for example, between a visiting surgeon's desire to treat a patient and his capacity (or really incapacity) to provide follow-up care. They acknowledge the necessity of interdisciplinary cooperation in resource-constrained settings, as well as the difficulties in collaborating across cultures and continents. Most importantly, they make the claim that a newborn in distress in a tent in Port-au-Prince merits the same resources and attention as one in Boston, and that his or her death merits the same indignation. They demonstrate the radical solidarity inherent in the... (shrink)

Developing a national code for psychologists is a complex process that requires endurance and a proper understanding of not only contemporary needs but also cultural conditions. There are many issues to be considered carefully. It is better to look at code development beyond a text creation and rather as a process in which an ethics system may be created. In order not to merely repeat well-known codes, there are several steps that should be considered. This article intends (...) to address the conflict between suitability to the larger ethical systems and creating an innovative text. As a recent example, the development of the Turkish Psychological Association (TPA) ethics code is presented. (shrink)

Few sectors are more ethically contentious than dairy, with debates tending to be polarised between “intensification” and “abolitionist” narratives which often drown out alternative voices operating in-between. This paper examines the marginal spaces occupied by a group of farmers in the United Kingdom who are attempting to move towards what they see as “more ethical” dairying. Drawing on findings from ethnographic research on five farms which have adopted “cow-calf contact rearing”—which focuses on keeping calves with their mothers longer, in opposition (...) to conventional practices of removing them shortly after birth—it asks what values underpin this alternative approach, and how and why “ethical” dairies seek to dairy ethically. To do this, it draws on a feminist epistemology and methodology that sees ethics as situated and contextual, and finds an “ethics of care” to be central to changing entanglements between humans and nonhuman animals. Instead of casting dairy as either “good” or “bad”, it explores the activities of farms which are trying to move towards what they perceive to be “better”, and draws three conclusions: (a) “ethical” dairying demonstrates a heterogeneity of dairy practices which are grounded in “care” and are happening between narrative extremes of intensification versus abolition; (b) although this practice may be, and could be, commodified, farmers are primarily guided by strong ideological principles and influenced by affective and empathetic “entanglements” with cows and calves, the agency of bovines themselves, and their social and ecological environment; and (c) “cow-calf contact rearing” represents a significant shift from a focus on the broader welfare environment towards centring the quality of individual cows’ lives. Ultimately, the paper argues that we should pay greater attention to alternative economies built on an “ethics of care” when envisaging new sustainable food and agricultural systems. (shrink)

IntroductionCognition generally declines gradually over time due to progressive degeneration of the brain, leading to dementia and eventual loss of independent functions. The rate of regression varies among the six cognitive domains. Current modality of cognitive assessment using neuropsychological paper-and-pencil screening tools for cognitive impairment such as the Montreal Cognitive Assessment has limitations and is influenced by age. Virtual reality is considered as a potential alternative tool to assess cognition. A novel, fully immersive automated VR system has been developed (...) to assess the six cognitive domains. As cognition is associated with age, VR performance is postulated to vary with age using this system.AimsThis is a feasibility study to evaluate the VR performance of cognitively healthy adults aged between 35 and 74 years old, based on the performance score and completion time using the CAVIRE system.MethodsConducted in a public primary care clinic in Singapore, 25 multi-ethnic Asian adults were recruited in each of the four age groups in years: 35–44; 45–54; 55–64, and 65–74. The eligibility criteria included a MoCA score of 26 or higher to reflect normal cognition and understanding English instructions. They completed common daily activities ranging from brushing teething to shopping, across 13 VR segments. Their performances scores and completion time were automatically computed by the CAVIRE system. These VR performance indices were compared across the four age groups using one-way ANOVA, F-test of the hypothesis, followed by pair-wise comparisons in the event of a significant F-test.ResultsOne participant dropped out from Group 1. The demographic characteristics of 99 participants were similar across the 4 age groups. Overall, younger participants in Groups 1 and 2 attained higher VR performance scores and shorter completion time, compared to those in Groups 3 and 4, in all six cognitive domains.ConclusionThe CAVIRE VR performance scores and completion time significantly differ between the younger and older Asian participants with normal cognition. Enhancements to the system are needed to establish the age-group specific normal performance indices. (shrink)

The development of health sciences along with the continuous technological progress contribute to the emergence of web applications. There exist many applications supporting the work of doctors, whereas the market definitely lacks solutions supporting the work of nurses. This is particularly evident in long-term geriatric home care, in which the nursing specialization is developing rapidly. Care of elderly patients requires the nurse to collect medical documents from each visit. Considering the large number of diseases affecting elderly people and the number (...) of required visits – which should exceed 4 a week – a decision was made to develop an Internet application supporting the work of nurses in long-term geriatric care. The application facilitates the process of geriatric patient description in order to eliminate the need for filling in paper medical records. This study presents the method of developing an Internet application supporting the work of nurses in long-term geriatric care. The software was developed based on an analysis of conclusions from a social study carried out in a group of 42 nurses providing geriatric long-term home medical care services in the district of Białystok, Poland. The aim of the study was to determine the features, functionality, and declarative interest in using the software. Conclusions from the analysis indicated that the attempt to develop the application had been justified. Moreover, conclusions from the social survey formed the basis for formulating the design assumptions. The web application was developed in the following technologies: HTML 5, CSS3, JavaScript, PHP 7, and MySQL. First, a prototype of the solution was tested in a XAMPP environment. After successful tests, the app was tested in a nursing practice. The obtained test results raise high hopes for potential commercialization of the application. (shrink)

Despite the prominence of person‐centred care (PCC) in nursing, there is no general agreement on the assumptions and the meaning of PCC. We sympathize with the work of others who rethink PCC towards relational, embedded, and temporal selfhood rather than individual personhood. Our perspective addresses criticism of humanist assumptions in PCC using critical posthumanism as a diffraction from dominant values We highlight the problematic realities that might be produced in healthcare, leading to some people being more likely to be disenfranchised (...) from healthcare than others. We point to the colonial, homo‐ and transphobic, racist, ableist, and ageist consequences of humanist traditions that have influenced the development of PCC. We describe the deep rooted conditions that structurally uphold inequality and undermine nursing practice that PCC reproduces. We advocate for the self‐determination of patients and emphasize that we support the fundamental mechanisms of PCC enabling patients' choice; however, without critical introspection, these are limited to a portion of humans. Last, we present limitations of our perspective based on our white*‐cisheteropatriarchy** positionality. We point to the fact that any reimagining of models such as PCC should be carefully done by listening, following, and ceding power to people with diversity dimensions*** and the lived experience or expertise that exists from diverse perspectives. We point towards Black, queer feminism, and critical disabilities studies to contextualize our point of critique with humanism and PCC to amplify equity for all people and communities. Theory and philosophy are useful to understand restrictive factors in healthcare delivery and to inform systematic strategies to improve the quality of care so as not to perpetuate the oppression of groups of people with diversity dimensions. *We purposely capitalize Black and use lower case for white to decentre whiteness and as an intentional act of antiracism (see White Homework a podcast series by Tori W. Douglas). **Cisheteropatriarchy describes people with intersecting identities of dominant social groups; cisgender is the gender identity that aligns with the gender you were assigned at birth, hetero means heterosexual, and patriarchy refers to structural systems of power based on maleness where women are often excluded and hold less power. ***With diversity dimensions, we refer to subjective lived experience and material realities of people that exist outside the ‘dominant minorities' of white‐cisheteropatriarchy, meaning groups of people in society who historically and currently hold more power and through this, structurally dominate the norms and possibilities of living for other people. (shrink)

This conceptual paper addresses Management Accounting and Control Systems (MACS) from a communication process perspective as opposed to a functionaldesign perspective. Its arguments originate from a social-constructionist perspective on the organization. Its line of argument is that building a social theoryof a social phenomenon such as MACS, demands that attention be paid to the characteristics of the communication process. An existing theoretical frameworkthat does the same is Giddens’ structuration theory, but it is only partly satisfactory because it refuses to consider (...) communication-as-interaction from a dynamiccontextual perspective, instead falling back on an argument related to the behavioural aspects of agency. An alternative is a semiotic-based communicationperspective that includes context as well as addresses the epistemological level of a MACS theory based on communication. The semiotic model of Jakobson is provided and developed as a specific alternative. (shrink)

In this paper we investigate the connection between forms of sustainability and masculinity through a study of everyday life in a Danish alternative slaughterhouse. In contrast to the predominant form of slaughterhouses today in Western contexts, the ‘alternative’ slaughterhouse is characterized as non-industrial in scale and articulating some form of a sustainability orientation. Acknowledging the variability of the term, we firstly explore how ‘sustainability’ is understood and practiced in this place. We then illuminate the situated manifestations of masculinities, which appear (...) predominantly- though not exclusively- hegemonic in nature. We next reflect on how the situated and particular sustainability of this site come to bear on a workplace long characterized as a masculinized site of, e.g., violence and repression, showing how the sustainability of the alternative slaughterhouse has potential to nourish alternative masculinities. We finally call for more attention at this nexus of sustainability and masculinities studies, to examine how the broad sustainability turn in food systems needs to be further examined in relation to what masculinities it perpetuates, as well as how a focus on masculinities may enhance our understanding of varying forms of sustainability, especially their potential for ecologically and socially just food systems. (shrink)

Even as the conventional energy system is fundamentally challenged by the “energy-environment crisis,” its adherents have presented the prospect of “abundant” and purportedly “green” nuclear power as part of a strategy to address the crisis. Surveying the development of nuclear power in India, this article finds that it is predisposed to centralization and secrecy, that nuclear power as energy policy is based on a presumption that overabundance is imperative for viable forms of social and economic development; its institutionalization has tended (...) to reduce deliberations on energy policy and human well-being to narrowly technocratic terms. Given these proclivities, nuclear power, as evaluated in this article, is considered unlikely to facilitate a viable response to the energy-environment crisis. Alternatives are thus surveyed here to include the sustainable energy utility and the capability approach as well as synergies between them, to challenge the offer of nuclear power as a response to the energy-environment crisis. (shrink)

Alternative agricultural systems, like organic and local agriculture, are becoming increasingly important in Europe to the detriment of conventional methods. As a matter of fact, sustainable agriculture, which started as a niche sector, has been able to conquer a significant share of the European agro-food market. Institutional promotion along with increasing consumer demand has allowed for the development of different agricultural models, from the farm to the fork, with an increasing focus on the ethical issues associated with the agro-food production (...) system. For instance, the organic agriculture agro-food chain is based on four principles, namely health, ecology, fairness and care with the goal of competing in the global agro-food market while respecting the environment, livestock, producers, and consumers. Within these themes, the seed market represents an extremely complex part of the whole picture. The present paper analyses the historical evolution of the seed sector by identifying the main issues related to sustainable agricultural systems and protection of biodiversity. It follows the identification of different seed markets based on different farm types. The two aspects are then discussed and matched in order to identify the main issues characterizing the sector. A review of possible solutions to those problems, taking into account their ethics, is also provided. (shrink)

The utilization of alternative medical therapies and practitioners has increased dramatically in the U.S. in the last two to three decades. This trend seems paradoxical when one considers the rapid advances taking place in biomedical knowledge and technology during this same time period. Observers both inside and outside of the medical profession have attempted to explain the rising popularity of alternative medicine by proposing that it signals a growing sense of dissatisfaction and disenchantment with professional biomedical practices on the part (...) of the lay public. This paper challenges this thesis and offers an alternative explanation, arguing that the rise of alternative medicine is a consequence of the success and expanding influence of biomedicine rather than its failure and declining authority. The argument presented draws primarily on Ulrich Beck’s “risk society” perspective and theory of “reflexive modernization,” with specific attention to his analysis of the “reflexive scientization” process. The application of this perspective allows us to understand the emergence and development of alternative medicine as an unanticipated consequence of the process of reflexive biomedicalization in the late modern era. (shrink)

This paper provides an interpretation, based on the social systems theory of German sociologist Niklas Luhmann, of the recent paradigmatic shift of mental health care from an asylum-based model to a community-oriented network of services. The observed shift is described as the development of psychiatry as a function system of modern society and whose operative goal has moved from the medical and social management of a lower and marginalized group to the specialized medical and psychological care of the whole population. (...) From this theoretical viewpoint, the wider deployment of the modern social order as a functionally differentiated system may be considered to be a consistent driving force for this process; it has made asylum psychiatry overly incompatible with prevailing social values (particularly with the normative and regulative principle of inclusion of all individuals in the different functional spheres of society and with the common patterns of participation in modern function systems) and has, in turn, required the availability of psychiatric care for a growing number of individuals. After presenting this account, some major challenges for the future of mental health care provision, such as the overburdening of services or the overt exclusion of a significant group of potential users, are identified and briefly discussed. (shrink)

Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity is also seen as a way to handle practical problems, and (...) methodologies have emerged to deal with dynamic processes of practice improvement. An example is responsive evaluation. In this article we investigate the relationship between moral deliberation and responsive evaluation, describe their common basis in dialogical ethics and pragmatic hermeneutics, and explore the relevance of both for improving the quality of care. The synergy between the approaches is illustrated by a case example in which both play a distinct and complementary role. It concerns the implementation of quality criteria for coercion in Dutch psychiatry. (shrink)

Person‐centred care, with its central focus on the patient in partnership with healthcare practitioners, is considered to be the contemporary gold standard of care. This type of care implies effective communication from and by both the patient and the healthcare practitioner. This is often problematic in the case of the paediatric population, because of the many communicative challenges that may arise due to the child's developmental level, illness and distress, linguistic competency and disabilities. The principle of universal design put (...) forth in conventions and legislation means that the design of products and services should be usable by all people, to the greatest extent possible. Augmentative and alternative communication encompasses strategies, for example pictures and apps, that are typically used with people with communication disability. In this position paper, we argue for the universal use of augmentative and alternative communication to support person‐centred communication and care for children, regardless of age or potential disability. Clinical examples are shared from three different paediatric care settings where pictorial supports were applied universally. Interviews were conducted with children and adolescents (with and without disabilities), parents and healthcare practitioners, and the principles of universal design were used as a framework to demonstrate how person‐centred communication is supported in paediatric care. (shrink)

Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)

Discussions about the impacts of marketing systems on society have been strongly encouraged in the field of macromarketing. However, these studies have focused on analyzing human and organizational actors, neglecting, to a large extent, the impacts of practices of marketing systems on other non-human stakeholders, such as those associated with or materialized in the form of a product. This article debates the material basis of the product of animal origin based on the concepts of justice, stakeholder theory, and externalities. An (...) argument was developed attributing the status of a moral agent to the animals used to make products and focusing on this debate, arguing for the establishment of a consumption pattern that morally considers animals. This was made feasible by new alternatives for food performances exemplified by the conduct of vegetarian and vegan consumers. (shrink)

In this book I show that science suffers from a damaging but rarely noticed methodological disease, which I call rationalistic neurosis. It is not just the natural sciences which suffer from this condition. The contagion has spread to the social sciences, to philosophy, to the humanities more generally, and to education. The whole academic enterprise, indeed, suffers from versions of the disease. It has extraordinarily damaging long-term consequences. For it has the effect of preventing us from developing traditions and institutions (...) of learning rationally devoted to helping us learn how to make progress towards a wiser, more civilized world. On our fragile earth, overcrowded, fraught with injustice, inequality and conflict, menaced by unprecedented and terrifying technological and industrial means for change and destruction, we urgently need to acquire a little more wisdom and civilization if we are to avoid repeating horrors of the kind suffered by so many during the 20th century (and already suffered by many in the first few years of the 21st century). We can ill afford to have in our hands instruments of learning botched and bungled from the standpoint of helping us learn how to live more wisely. It may seem scarcely credible that something as important as our institutions of learning can suffer from wholesale, structural defects. Why has this not been noticed before? Why have not armies of scientists and scholars appreciated the point and, long ago, put the matter right? The answer will emerge as my argument unfolds. I will show that one of the most damaging features of rationalistic neurosis is that it has built-in methodological and institutional mechanisms which effectively conceal that anything is wrong. But there is also an immediately obvious reason: specialization, and the resulting fragmentation of academia, has resulted in a situation in which hardly anyone takes responsibility for the overall ideals, the overall aims and methods, of academic inquiry. Academics, these days, are specialists, furiously trying to keep abreast of developments in their own specialist fields. They have no time, and no inducement, to lift their eyes from their particular disciplines, and look at the whole endeavour. Science has long been under attack, at least since the Romantic movement. Blake objected to “Single vision & Newton’s sleep” and declared that “Art is the Tree of Life... Science is the Tree of Death”. Keats lamented that science will “clip an Angel’s wings” and “unweave a rainbow”. Whereas the Enlightenment had valued science and reason as tools for the liberation of humanity, Romanticism found science and reason oppressive and destructive, and instead valued art, imagination, inspiration, individual genius, emotional and motivational honesty rather than careful attention to objective fact. Much subsequent opposition to science stems from, or echoes, the Romantic opposition of Blake, Wordsworth, Keats and many others. There is the movement Isaiah Berlin has described as the “Counter-Enlightenment” (Berlin, 1979, ch. 1). There is existentialism, with its denunciation of the tyranny of reason, its passionate affirmation of the value and centrality of irrationality in human life, from Dostoevsky, Kierkegaard and Nietzsche to Heidegger and Sartre (see, for example, Barrett, 1962). There is the attack on Enlightenment ideals concerning science and reason undertaken by the Frankfurt school, by postmodernists and others, from Horkheimer and Adorno to Lyotard, Foucault, Habermas, Derrida, MacIntyre and Rorty (see Gascardi, 1999). The soul-destroying consequences of valuing science and reason too highly is a persistent theme in literature: it is to be found in the works of writers such as D.H. Lawrence, Doris Lessing, Max Frisch, Y. Zamyatin. There is persistent opposition to modern science and technology, and to scientific rationality, often associated with the Romantic wing of the green movement, and given expression in such popular books as Marcuse’s One Dimensional Man, Roszak’s Where the Wasteland Ends, Berman’s The Reenchantment of the World and Appleyard’s Understanding the Present. There is the feminist critique of science and conceptions of science: see, for example, Fox Keller (1984) and Harding (1986). And there are the corrosive implications of the so-called “strong programme” in the sociology of knowledge, and of the work of social constructivist historians of science, which depict scientific knowledge as a belief system alongside many other such conflicting systems, having no more right to claim to constitute knowledge of the truth than these rivals, the scientific view of the world being no more than an elaborate myth, a social construct (see Barnes and Bloor, 1981; Bloor, 1991; Barnes, Bloor and Henry, 1996; Shapin and Schaffer, 1985; Shapin, 1994; Pickering, 1984; Latour, 1987). This latter literature has provoked a counter-attack by scientists, historians and philosophers of science seeking to defend science and traditional conceptions of scientific rationality: see Gross and Levitt (1994), Gross, Levitt and Lewis (1996), and Koertge (1998). This debate between critics and defenders of science came abruptly to public attention with the publication of Alan Sokal’s brilliant hoax article ‘Transgressing the boundaries’ in a special issue of the cultural studies journal Social Text in 1996 entitled Science Wars: see Sokal and Bricmont (1998). What does this book have to contribute, given the above avalanche of criticism of science? The criticisms of science developed in this book are diametrically opposed to the above, in so far as the above criticisms oppose scientific rationality, seek to diminish or restrict its influence, or hold that it is unattainable. My central point is that we suffer, not from too much scientific rationality, but from not enough. What is generally taken to constitute scientific rationality is actually nothing of the kind. It is rationalistic neurosis, a characteristic, influential and damaging kind of irrationality masquerading as rationality. Science is damaged by being trapped within a widely upheld but severely defective philosophy of science; free science from this defective philosophy, provide it with a more intellectually rigorous philosophy, and it will flourish in both intellectual and humanitarian terms. And more generally, as we shall see, academic inquiry as a whole is damaged by being trapped within an intellectually defective philosophy of inquiry; free it from this defective philosophy, from its rationalistic neurosis, and it will flourish in intellectual and human terms. It is not reason that is damaging, but defective pretensions to reason — rationalistic neurosis —masquerading as reason. Thus what I seek to do here is the exact opposite of what all those who oppose science and scientific rationality do. I shall argue that Reason, the authentic article, arrived at by generalizing the progress-achieving methods of science, can have profoundly liberating and enriching consequences for all worthwhile, problematic aspects of life, and thus deserves to enter into every aspect of life. The bare bones of the argument of this book can be stated quite simply like this. Science cannot proceed without making the substantial metaphysical assumption that the universe is physically comprehensible (to some extent at least). But this conflicts with the orthodox view that in science everything is assessed impartially with respect to evidence, nothing being permanently assumed independently of evidence. So the metaphysical assumption of comprehensibility is repressed. Science pretends that no such assumption is made. But this damages science. For the assumption is substantial, influential and highly problematic. It needs to be made explicit within science so that it can be critically scrutinized, so that alternatives can be developed and considered. Pretending the assumption is not being made undermines the intellectual rigour of science, its intellectual value and success. And it does not stop there. For science also makes value assumptions. Quite properly, science is concerned to discover that which is of value. New factual knowledge devoid of all value (whether intellectual or practical) does not contribute to science. But the orthodox view of science holds that values have no place within science. As in the case of metaphysics, here too, science pretends that values have no role to play within the intellectual domain of science. And this damages science. For values are, if anything, even more influential and problematic than metaphysics (in influencing the direction of research). Here too, values need to be made explicit within science so that they can be scrutinized, so that alternatives can be developed and assessed. Pretending that values play no role within the intellectual domain damages science; both the intellectual and the practical aspects of science are adversely affected. Science fails to pursue those avenues of research that lie in the best interests of humanity. And it goes further. Science is pursued in a social, cultural, economic and political context. It is a part of various social, economic and political projects which seek to achieve diverse human objectives. But the idea that science is an integral part of humanitarian or political enterprises with political ends clashes, once again, with the official view of science that the aim of science is to improve factual knowledge. The political objectives of science are repressed. And, once again, this damages science. For, of course, the political objectives of science, like all our political objectives, are profoundly problematic. These need to be made explicit so that they can be scrutinized, so that alternatives can be developed and considered. The pretence that science does not have this political dimension once again undermines the intellectual rigour of science, and its human value. It lays science open to becoming a part of economic, corporate and political enterprises that are not in the best interests of humanity. The upshot of the line of argument just indicated is that we need to bring about a revolution in the aims and methods of science, and of academic inquiry more generally. Natural science needs to change; its relationship with the rest of academic inquiry, with social inquiry and the humanities, needs to change; and most importantly and dramatically, academic inquiry as a whole needs to change. The basic task of the academic enterprise needs to become to help humanity learn how to tackle its problems of living in more cooperatively rational ways than at present. We need to put the intellectual tasks of articulating our problems of living, and proposing and critically assessing possible solutions, possible and actual actions, at the heart of academic inquiry. The basic task needs to be to help humanity learn a bit more wisdom – wisdom being the capacity to realize what is of value in life, for oneself and others, wisdom including knowledge and technological know-how, but much else besides. Natural science, despite its flaws, has massively increased our knowledge and technological know-how. This in turn has led to a massive and sometimes terrifying increase in our power to act. Often this unprecedented power to act is used for human good, as in medicine or agriculture. But it is also used to cause harm, whether unintentionally (initially at least) as when industrialization and modern agriculture lead to global warming, destruction of natural habitats and rapid extinction of species, or intentionally, as when the technology of war is used by governments and terrorists to maim and kill. Before the advent of modern science, when we lacked the means to do too much damage to ourselves and the planet, lack of wisdom did not matter too much. Now, with our unprecedented powers to act, bequeathed to us by science, lack of wisdom has become a menace. This is the crisis behind all the other current global crises: science without wisdom. In these circumstances, to continue to pursue knowledge and technological know-how dissociated from a more fundamental quest for wisdom can only deepen the crisis. As a matter of urgency, we need to free science and academia of their neuroses; we need to bring about a revolution in the academic enterprise so that the basic aim becomes to promote wisdom by intellectual and educational means. At present science and the humanities betray both reason and humanity. The argument of this book, which I have just summarized, begins with a discussion of the philosophical and methodological problems that beset theoretical physics. At once, many of those who are concerned about moral, political and environmental issues that plague our world today, will feel impatient. What have the methodological problems of theoretical physics to do with third world poverty, war and the threat of war, pollution, extinction of species, the menace of conventional, chemical, biological and nuclear armaments? I can only plead with such a reader: patience. The root cause of the sickness of our times does indeed lie, I claim, with a methodological sickness of natural science or, even more specifically, of physical science. What makes the modern world so utterly different from all previous ages is our possession of modern science and technology. This is the instrument that has changed the conditions of human life almost beyond all recognition, and put unprecedented, and sometimes terrifying, powers into our hands. One should not dismiss out of hand the suggestion that a part of our problem may lie with this instrument, this engine, of rapid change. We see, here, too, the way in which intellectual specialization, referred to above, has effectively concealed from view the nature and extent of the problem that confronts us. The argument that I shall develop in what follows begins with physics, with problems concerning the aims and methods of physics. But it then leaps to social science, to philosophy, to the humanities, to education, to psychotherapy, and to politics: in the end there is scarcely an aspect of modern life that is not touched and, potentially, affected by the argument. How many academic experts are prepared to follow, to take seriously, an argument that ranges so recklessly across such a wide range of academic disciplines? How many non-academic non-experts? But just this is what the argument and message of this book requires. I hope that the reader will endure with patience the somewhat esoteric discussion concerning the aims and methods of physics pursued in chapter one. This may not seem to have anything much to do with the urgent problems of our times, but it does. This is in part how the intellectual disaster I seek to expose in this book conceals itself from view: it buries itself in the obscure, recondite field of the philosophy of physics. Those who devote their lives to the philosophy of physics are, by and large, too myopic to see how their specialized field of study has anything to do with the great and dreadful humanitarian problems and disasters of our age; and those who are above all concerned with these humanitarian disasters have no time at all for abstruse issues concerning the aims and methods of physics. And so the connection is never made. As it happens, the methodological neurosis of physics, with which we begin in chapter one, is actually a quite simple matter to grasp. It does not require any real knowledge of physics to understand. Indeed, physicists and philosophers of physics are much more likely to find the argument difficult to follow than are non-experts. We non-scientists can stand back and see the whole wood; scientists, trained to think in terms of the current orthodox conception of science, trapped in the thickets of research, will find this much harder to do. In an attempt to take this peculiar circumstance into account, I have arranged the exposition as follows. In chapter one I give a simple exposition of the case for declaring natural science to suffer from what I call "rationalistic neurosis"; this avoids all technicalities, and goes straight to the heart of the matter. In the appendix I tackle a host of more technical objections that may be made to the elementary argument of chapter one. So, those experts in the fields of the philosophy of physics and philosophy of science who find the argument of chapter one naïve and unconvincing, should consult the appendix before tossing the book away in disgust. I write in the hope that there will be a few who will not dismiss out of hand the suggestion that the question of how we are to go about learning how to live in wiser and more civilized ways might have something to learn from scientific learning, and will take the trouble to pursue the line of argument traced out in this book. I write in the hope that these few will grasp just how desperate our situation is, how urgent the need to change the status quo, and will do everything in their power to alert others to the need to heal the methodological sickness from which our institutions and traditions of learning at present suffer. To begin with, we need a campaigning organization, modelled perhaps on "Friends of the Earth", which might be called something like "Friends of Wisdom". (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Caring for Landscapes of Justice in Perilous Settler EnvironmentsMishuana Goemanindians are the "singing remnants" or "graffiti," in the words of Leanne Betasamosake Simpson ("i am graffiti"). The forms this graffiti takes, our inscriptions on the landscape, are as numerous as our Nations, abundant as our ancestors who loved, lived, and passed down knowledge of our lands and histories. "You are the result of the love of thousands," writes Linda (...) Hogan, who beseeches us to listen to the environment surrounding us (159). Deborah Miranda (Coastal Esselen and Chumash) reminds us that we are also the result of violent histories, in her tribal memoir Bad Indians, a book that relishes the tales of her ancestors who resist and act out to survive. This harm, genocide, and settler mapping of worlds also must be attuned to in our surroundings and in "our bodies [that are] bridges over which our descendants cross, spanning unimaginable landscapes of loss" (Miranda 74). Visual cartographic mapping has been part and parcel of the erasure of California Indians, relegated to the small, contained, and past temporal space of a romanticized mission.This paper centers on the NDN Collective's work and the photography of Cara Romero's project Tongvaland and the works of Gabrielino Tongva artist Mercedes Dorame. The setting of these projects is in the sprawling landscape of Los Angeles, or the homelands of the Gabrielino Tongva people, who call it Tovaangar. I will examine the anti-colonial aesthetics and care practices mapped out in the work rather than presenting a "true" Indigenous map or alternative map. Mapping a history of the landscape by creating a "new" narrative or "true" narrative is not enough. As Maori scholar Linda Tuhwi Smith states, "[w]e believe that history is also about justice, that understanding history will enlighten our decisions about the future. Wrong. History is also about power. In fact, history is mostly about power. … [A] thousand accounts of the truth will not alter the fact that indigenous peoples are still marginal [End Page 50] and do not possess the power to transform history into justice" (34). The Gabrielino Tongva, who comprise an estimated 2,300 people, do not possess the population power and cannot access the form of voting or democracy to make the changes needed just by telling their truth. Across California, people know about the raw deal, the embezzlement, the genocide, and the so-called lost treaties. In fact, under Eisenhower, recompense was paid out in small amounts to Tongva families of the dispossessed. Instead, to continue with the words of Smith, "[i]t is also about reconciling and reprioritizing what is really important about the past with what is important about the present" (111). What Romero and the NDN Collective—made up of numerous tribal leaders, scholars, and other artists—did was relay and prioritize how they wanted to be seen in their homelands. These billboards invite us in, in a gift of sharing, or what tribal cultural leader Craig Torres related to me as a spirit of Maxxa, a sharing, gifting, or swapping of knowledge. Dorame's beautiful and critical installations in public art spaces reflect Maxxa—they invite the viewers to think through land from her curious arrangements. As artists, part of their practice is not that of a Western version of a tortured genius but instead is energized by pulling in community and creating a collective practice. They undo settler space together and with us. The cartographic practices of these California Indians' creative arts exemplify communities of care that must be considered when we think through the unmapping of settler terrains. This question requires an approach of radical care. As Hi'ilei Hobart and Tamara Kneese make clear, the notion of care is "inseparable from systemic inequalities and power systems" (Hobart and Kneese 1).The work of the NDN Collective and Dorame counters a settler-based, commercial map of Los Angeles. Indigenous people, relegated by the settler state as expendable and erasable graffiti, confront capitalist and state ordinances at various scales. Rather than understand this as a subjugated positionality, I posit that graffiti is the critique necessary and valuable to understanding interlocking structures of oppression. In the following words of Leanne... (shrink)

I develop the foundation for cosmopolitan care, an underexplored variety of moral cosmopolitanism. I begin by offering a characterization of contemporary cosmopolitanism from the justice tradition. Rather than discussing the political, economic or cultural aspects of cosmopolitanism, I instead address its moral dimensions. I then employ a feminist philosophical perspective to provide a critical evaluation of the moral foundations of cosmopolitan justice, with an eye toward demonstrating the need for an alternative account of moral cosmopolitanism as cosmopolitan care. After providing (...) an explanation of how care ethics in connection with Kantian ethics generates a duty to care, I consider one main feature of cosmopolitan care, namely the theory of obligation it endorses. In developing this account, I place special emphasis on the practical ramifications of the theory by using it to analyze gender violence in conflict zones. (shrink)

Caring can be viewed as a set of specific activities and relations in the context of health care, social solidarity and interpersonal relations. On the other hand, caring can also be considered as a general attitude and structure of all our activities. Martin Heidegger developed an ontological analysis of “Sorge” as the foundational structure of our being in the world. The paper explains Heidegger’s concept of “Sorge” and confronts it with the criticism of Emmanuel Levinas who formulates an alternative (...) view on caring as responsibility for the vulnerability of the other. Vulnerability is a key notion to understand caring as an ethical and non paternalistic relation to all beings. The paper applies the notions of caring and vulnerability to the sphere of economics. It distinguishes between caring as philanthropy and caring as relational economy. Today, civil economy is represented in different types of cooperative entrepreneurship, but its potential is not restricted to specific juridical forms of cooperation. All types of entrepreneurship based on trust and cooperation imply a logic of caring that precedes and corrects the logic of profit maximization. (shrink)

In this paper I develop three conceptions of the relationship between evolutionary and developmental biology. I further argue that: (a) the choice between them largely turns on as yet unresolved empirical considerations; (b) none of these conceptions demand a fundamental conceptual reevaluation of evolutionary biology; and (c) while developmental systems theorists have constructed an important and innovative alternative to the standard view of the genotype/phenotype relations, in considering the general issue of the relationship between evolutionary and developmental biology, we can (...) remain neutral on this debate. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 389 From the perspective of this reviewer, the presently most obvious fault in this lecture lies in Putnam's criticisms of "the coherence theorists, Ludwig, et al." (p. 97). In this criticism, it is apparently assumed that the adequacy of their proposed solution to the problem considered must be judged solely on the basis of what is presently known. Since Putnam himself acknowledges that no satisfactory interpretation (...) of quantum mechanics exists, this seems unwarranted. The superficiality of the criticism of this position makes this particularly notable. He states, for example, "to say that a wave gives an incomplete description of the state of a system is to say that systems whose state can be described by that wave function may really be in several quite different physical conditions." He then adopts the doubtful strategy of appealing to the meaning of completeness and incompleteness (they are not a matter of degree) in justification of the position that it is improper to say that a wave gives an incomplete descriptionl Despite the fact that, taken as a whole, his brief criticism of the coherence theory is somewhat ungracious. Putnam has set forth the principle issues sur~ rounding the problem with discerning lucidity. Paul K. Feyerabend, in "Problems of Empiricism," places a revisionist's version of empiricism in a carefully developed historical perspective. Empiricism as it has been known is both incomplete and weakened by undesirable assumptions. The incompleteness is to be removed by regarding empiricism as a cosmological hypothesis concerning the relation between man and the universe. The version of empiricism thus admitted has the character of a scientific theory. The undesirable assumptions are views no longer tenable of the nature and content of what is given in sense. Feyerbend understands sensations and perceptions as indicators on a par with indications of physical instruments, and likewise in need of interpretation. A philosophical method is proposed which requires theoretical pluralism instead of the theoretical monism that is (inappropriately) the ideal of much of contemporary empiricism (p. 149). The function of theoretical alternatives is to provide the means of criticizing accepted theory, to which he accords careful historical treatment. "Low level theories" are to guide us to crucial experiments, while "high level theories" are to represent the basic element of the universe. Here again the reader will find a theme which emerges erpeatedly in these lectures. This theme might be stated as follows. Both macrocosmic and microcosmic systems must ultimately be involved in scientific explanation. The crucial problem that emerges is how these two are to be related or in some degree integrated. By the way in which he develops the role of alternative theories, Feyerabend has affirmed one of the principle theoretical components of what Hegel was minded to call metaphysics. An additional observation, for which what I have said should furnish some justification: Many points made throughout this exposition (115 pp. in length) might properly be regarded as together constituting a rapprochement of empiricism and rationalism. It may very well occur to the thoughtful reader that Feyerabend, in his reconstruction of empiricism, has come very near to conceding all that a critical rationalist could ask. Other lectures included in the book are, "The Thermodynamics of Purpose," by David Hawkins, "The Physics of the Large," by Philip Morrison, and "The Ethical Dimension of Scientific Research," by Nicholas Rescher. In the last-mentioned lecture, Professor Rescher points up some generally little understood ethical problems confronted by the scientist in the practice of his profession. DARREL E. CICIRISTENSEN Wo]lord College BOOK NOTES Colin Cherry, On Human Communications: A Review, a Survey, and a Criticism. Cambridge: The M.I.T. Press, 1966. Pp. xiv + 337. (This is an unabridged and unaltered edition of the work first published by the M.I.T. Press in 1957.) $10.00. "In preparation of the current volume, I have examined the original carefully and have decided not to withdraw from anything said there, but merely to add some comments, to up- 390 HISTORY OF PHILOSOPHY date some figures, and to extend the bibliography.... Since detailed reference is impossible, I have decided to restrict the new Bibliography to useful sources of reference, a few of the more significant... (shrink)

An aging population is often taken to require a profound reorganization of the prevailing health care system. In particular, a more cost-effective care system is warranted and ICT-based home care is often considered a promising alternative. Modern health care devices admit a transfer of patients with rather complex care needs from institutions to the home care setting. With care recipients set up with health monitoring technologies at home, spouses and children are likely to become involved in the caring process (...) and informal caregivers may have to assist kin-persons with advanced care needs by means of sophisticated technology. This paper investigates some of the ethical implications of a near-future shift from institutional care to technology-assisted home care and the subsequent impact on the care recipient and formal- and informal care providers. (shrink)

Medical migration appears to be an increasing global phenomenon, with complex contributing factors. Although it is acknowledged that such movements are inevitable, given the current globalized economy, the movement of health professionals from their country of training raises questions about equity of access and quality of care. Concerns arise if migration occurs from low- and middle-income countries to high-income countries. The actions of HICs receiving medical practitioners from LMICs are examined through the global justice theories of John Rawls and Immanuel (...) Kant. These theories were initially proposed by Pogge and Tan and, in this work, are extended to the issue of medical migration. Global justice theories propose that instead of looking at health needs and workforce issues within their national boundaries, HICs should be guided by principles of justice relevant to the needs of health systems on a global scale. Issues of individual justice are also considered within the framework of rights and social responsibilities of individual medical practitioners. Local and international policy changes are suggested based on both global justice theories and the ideals of individual justice. (shrink)

This article develops an approach to ethical globalization based on a feminist, political ethic of care; this is achieved, in part, through a comparison with, and critique of, Thomas Pogge's World Poverty and Human Rights. In his book, Pogge makes the valid and important argument that the global economic order is currently organized such that developed countries have a huge advantage in terms of power and expertise, and that decisions are reached purely and exclusively through self-interest. Pogge uses an institutional (...) rights framework to argue that direct responsibility for global poverty and inequality lies with the citizens of developed countries, since suffering and death are caused by global economic arrangements designed and imposed by our governments. While this argument is certainly compelling, I have argued that it tells us little about the actual effects of globalization on the real people of the South - including women, children and the elderly. As a result, it can offer little in the way of real alternatives or policy prescriptions. As a moral orientation, a care ethic relies on a relational moral ontology, and leads us to consider different values in terms of human flourishing. Moreover, it pushes us to consider the normative implications of aspects of the global political economy which are usually not 'seen' at all, including the global distribution of care work and the corresponding patterns of gender and racial inequality, the underprovision of care and resources for caring work in both the developed and developing world, and the ways in which unpaid or low-paid caring work helps to sustain a cycle of exploitation and inequality on a global scale. (shrink)

This research looks what happens to human reproduction when human genetic information is digitized. By employing speculative design as a transdisciplinary strategy to construct such an alternative future to open up public dialogues, it aims to stimulate audiences in an artistic way to deliberate two key questions: (1) how will biotechnology recondition and recontextualize the natural processes of genetic information (i.e. expression, replication, transmission and mutation) and our physiological processes (e.g. reproduction)? And (2) what might be the ethical, legal and (...) social implications (ELSI) for using such biotechnology? To this end, this practice-based research introduces the ‘e-gamete Digital Procreation Service’ (2019) – a speculative design project that has been developed as an approach to invite audiences to a future scenario of network-transmitted genetic information and computer-simulated human procreation. The carefully designed future service (an ironic practice of commercialization) allows human reproduction to take place outside of the human body. Audiences are encouraged to contemplate what novel situations might occur within their own futures and to consider broader questions like how family, parenthood, marriage, etc. are redefined and what new social relationships might emerge. By employing speculative design as an artistic research tool/tactic to step outside the technical limitations and craft the future service, the project asks vital question about the future in a provocative and quasi-realistic manner. Thus, the research forms a unique entanglement of sensitive topics by dealing with future biotechnology and human reproduction. (shrink)

The design of medical knowledge-based computer systems requires effective interdisciplinary communication for the development of a community sharing common goals and a common language for design. Over the past 9 years the Perinatal Research Group, an interdisciplinary team of computer scientists, engineers and clinicians, have developed a prototype knowledge-based computer system to aid clinicians in the care of women in labour. The group were uncertain which approach to adopt to progress this system from a prototype to a useful clinical tool (...) to support decision making. A case study and activity theory analysis, of an existing clinical knowledge-based computer system in routine use, helped to resolve a number of communication and methodological issues that the design team encountered. Sharing of backgrounds and perspectives caused the design team to question previous assumptions and to explore alternative functions and roles for knowledge-based computer systems in maternity care. We are now undertaking a longitudinal case study and activity theory analysis of obstetric teams and women in labour to analyse the relationships between clinicians, patients and technology. This work will inform the development of our knowledge-based computer system to place the patient at the centre of the decision-making process. (shrink)

In _Psychoanalytic Therapy as Health Care_, a timely and trenchant consideration of the clash of values between managed care and psychoanalysis, contributors elaborate a thoughtful defense of the therapeutic necessity and social importance of contemporary psychoanalytic and psychodynamic approaches in the provision of mental health care. Part I begins with the question of where psychoanalytic treatments now stand in relation to health care; contributors offer explanations of the current state of affairs and consider possible directions of future developments. Part II (...) looks directly at the conundrums that have resulted from the attempt to integrate psychotherapy and managed care, with contributors examining the ethical and legal dimensions of confidentiality, privacy, and reporting to third parties. Part III opens to wider consideration of the experiences of psychoanalysts under health care systems throughout the world. Finally, Part IV demonstrates the relevance of contemporary psychoanalytic approaches to a variety of contemporary patient populations, with contributors focusing on the applicability of analytically oriented treatment to AIDS patients, seriously disturbed young adults, and inner-city clinic patients. Collectively, the contributors to _Psychoanalytic Therapy as Health Care_ convincingly refute the claim that psychoanalytically informed therapy is an esoteric treatment suited only to the "worried well." Drawing on a wide range of clinical and empirical evidence, they forcefully argue that contemporary psychoanalytic approaches are applicable to seriously distressed persons in a variety of treatment contexts. Failure to include such long-term therapies within health care delivery systems, they conclude, will deprive many patients of help they need - and help from which they can benefit in enduring ways that far transcend the limited treatment goals of managed care. (shrink)

Uriah Kriegel presents a rich exploration of the philosophy of the great nineteenth-century thinker Franz Brentano. He locates Brentano at the crossroads where the Anglo-American and continental European philosophical traditions diverged. At the centre of this account of Brentano's philosophy is the connection between mind and reality. Kriegel aims to develop Brentano's central ideas where they are overly programmatic or do not take into account philosophical developments that have taken place since Brentano's death a century ago; and to offer a (...) partial defense of Brentano's system as quite plausible and in any case extraordinarily creative and thought-provoking. Brentano's system grounds a complete metaphysics and value theory in a well-developed philosophy of mind, and accordingly the book is divided into three parts, devoted to Brentano's philosophy of mind, his metaphysics, and his moral philosophy. The book's fundamental ambition is to show how Brentano combines the clarity and precision of the analytic philosopher with the sweeping vision of the continental philosopher. Brentano pays careful attention to important distinctions, conscientiously defines key notions, presents precise arguments for his claims, judiciously considers potential objections, and in general proceeds very methodically - yet he does so not as an end in itself, but as a means only. His end is the crafting of a grand philosophical system in the classical sense, attempting to produce nothing less than a unified theory of the true, the good, and the beautiful. (shrink)

In this thesis, I investigate realist, anti-realist and pluralist views in the philosophy of science and the philosophy of complexity. The philosophy of science can inform the philosophy of complexity and vice versa because we can consider scientific inquiry to largely involve the study of complex systems. I however find that the relevant realist, anti-realist and pluralist views are problematic in various ways, and that a version of pragmatism suggests a promising alternative. This version of pragmatism incorporates elements of pluralism, (...) but maintains a commitment to epistemic hierarchy, convergence and progress. The way to develop such a version of pragmatism is, I argue, by rebooting William Whewell’s 19th century philosophy of science. Whewell however held to the following two transcendental claims: 1. Empirical inquiry undertaken in science properly practiced can reveal necessary truths. 2. The revelation of such necessary truths grants us a glimpse of the mind of God. Such transcendental claims are obviously at odds with pragmatism. There are however core features of Whewell’s view that are notably pragmatist in nature, features that explicitly inspired Charles Sanders Piece’s convergent pragmatism. These are as follows: 3. Subject and object (or mind and world) are inextricably entwined during scientific inquiry; they are not separated by anything like a correspondence relationship. 4. Science progresses via what Whewell calls the consilience of inductions (an ongoing merging of scientific theories, a merging that increases our understanding of the world over time). I modify Whewell’s view by stripping away its transcendental elements while maintaining its pragmatist elements. What remains is, I argue, a robust and novel kind of pragmatism suitable for being introduced into the contemporary philosophy of science. Whewell suitably-pragmatised can offer new insights into ongoing debates, particularly those around the nature of scientific progress, scientific truth and scientific understanding. (shrink)

This study addresses the question of justice in health care. Increasing numbers of Americans are uninsured, the cost of health care is escalating, and is projected to continue doing so. In response to these and other concerns, Americans have looked to their neighbor to the north, Canada, for possible help in treating the ills of America's health care system. In addition to offering a comparative analysis of the Canadian and American health care systems, we have sought to identify the facts (...) that motivate concerns on both sides of the border. It is within this larger context, we argued, that the question of justice in health care must be answered. ;We consider two alternative answers that have been advanced in response to the question of justice in health care, Norman Daniels' fair equality of opportunity argument and Allen Buchanan's enforced beneficence arguments for a right to a decent minimum of health care. After subjecting these arguments to critical scrutiny, we found that they could not bear the moral weight that the authors thought they could. ;We then considered an alternative account that might be used to address the question of justice in health care, David Gauthier's theory of justice. We concluded, among other things, that under his theory people would have a right to a just minimum of health care. In addition, we argued that a just minimum of health care would resolve the theory-dependent version of the bottomless pit problem. (shrink)

Background: Not all patients are considered equal. For patients who are considered to be “very important persons,” care can be different from that of other patients with advantages of greater access to resources, special attention from staff, and options for luxurious hospital amenities. While very important person care is common and widely accepted by healthcare administration, it has negative implications for both very important person and non-very important person patients, supports care disparities and inequities, and can create serious (...) ethical dilemmas for healthcare professionals. Very important person care can also result in negative care outcomes for its recipients. Objective: This article sought to explore the implications and ethical considerations of very important person care within the context of United States healthcare system, and integrate bioethical principles and American Nurses Association Code of Ethics for Nurses to influence recommendations for managing ethical dilemmas associated with very important person care. Method: A synthesis of the literature on very important person care was undertaken for this article. Ethical considerations: Ethical conduct was considered and respected when performing the literature review, referencing sources, and establishing authorship. Findings: According to the published literature, very important person care bares both positive and negative implications for patients, and negative implications for nurses. Nurses are the most affected by the demands from their administrators to provide special care and attention to patients in the “very important person” category and their families. Very important person care can be disruptive, disorienting, challenging, and stressful to nurses. Conclusion: While physicians and other healthcare professionals have commented on very important person care, limited work has been done in nursing. There have not been any empirical studies on very important person care. Therefore, in order to minimize the negative implications of very important person care, studies of this phenomenon are warranted. Exposing very important person care is important in the development of an ethical healthcare system. Moreover, understanding the ethical principles surrounding the concept of very important person care will empower nurses to effectively manage conflicts and ethical dilemmas that arise with very important person care. (shrink)

Across career development and academic advising literature, scholars describe a common and unsettling tension between when to challenge and support students’ goals. Many programs of study include selective admission or gateway prerequisite courses. Students may also need to modify their goals while pursuing competitive employment or graduate school programs. As career professionals and academic advisors begin to perceive that students may not be able to achieve their aspirations, they may discuss different pathways and alternative careers. Some academic advisors use predictive (...) analytics to identify students who may not progress within their chosen degree program, which further compounds the ethical dilemma. If practitioners do not engage in ethical inquiry and deliver feedback carefully, some students could experience distress or pivot away from their goals unnecessarily. As they discuss career alternatives, practitioners can consider the integrated literature review included in this article. Practitioners can use scholars’ different frameworks and thematic recommendations to bring equity and ethical integrity to their career conversations. (shrink)

My purpose is to offer an assessment of the scientific legacy of Converse's “Belief Systems” by reviewing five productive lines of research stimulated by his authoritative analysis and unsettling conclusions. First I recount the later life history of Converse's notion of “nonattitudes,” and suggest that as important as nonattitudes are, we should be paying at least as much attention to their opposite: attitudes held with conviction. Second, I argue that the problem of insufficient information that resides at the center of (...) Converse's analysis has not gone away, and that newly fashioned models of information processing offer only partial remedies. Third, I suggest that the concept of the “average voter” is a malicious fiction, as it blinds us to the enormous variation in political attention, interest, and knowledge that characterizes mass publics, in Converse's time as in our own. Fourth, I develop an affirmative aspect of Converse's analysis that has mostly been overlooked: namely, that if ideological reasoning is beyond most citizens’ capacity and interest, they might fall back on a simple and reasonable alternative, which I will call “group‐centrism.” And fifth, I consider the possibility that while the majority of individual citizens falls short of democratic standards, the public as a whole might do rather well. (shrink)

Logic is traditionally considered to be a purely syntactic discipline, at least in principle. However, prof. David Isles has shown that this ideal is not yet met in traditional logic. Semantic residue is present in the assumption that the domain of a variable should be fixed in advance of a derivation, and also in the notion that a numerical notation must refer to a number rather than be considered a mathematical object in and of itself. Based on his (...) work, the central question of this thesis is what kind of logic, if any, results from removing this semantic residue from traditional logic.We differ from traditional logic in two significant ways. The first is that the assumption that a numerical notation must refer to a number is denied. Numerical notations are considered as mathematical objects in their own right, related to each other by means of rewrite rules. The traditional notion of reference is then replaced by the notion of reduction (by means of the rewrite rules) to a normal form. Two numerical notations that reduce to the same normal form would traditionally be considered identical, as they would refer to the same number, and hence they would be interchangeable salva veritate. In the new system, called Buridan-Volpin (BV), the numerical notations themselves are the elements of the domains of variables, and two numerical notations that reduce to the same normal form need not be interchangeable salva veritate, except when they are syntactically identical (i.e., have the same Gödel number).The second is that we do away with the assumption that the domains of variables need to be fixed in advance of a derivation. Instead we focus on what is needed to guarantee preservation of truth in every step of a derivation. These conditions on the domains of the variables, accumulated in the course of a derivation, are combined in a reference grammar. Whereas traditionally a derivation is considered valid when the conclusion follows from the premisses by way of the derivation rules (and possibly axioms), in the BV system a derivation must meet the extra condition that no inconsistency occurs within the reference grammar. For if the reference grammar were to give rise to inconsistency (i.e., it would be impossible to assign domains to all the variables without breaking at least one of the conditions placed on them in the reference grammar), there is no longer a guarantee that truth has been preserved in every step of the derivation, and hence the truth of the conclusion is not guaranteed by the derivation.In Chapter 2 the BV system is introduced in some formal detail. Chapter 3 gives some examples of derivations, notably totality of addition, multiplication and exponentiation, as well as a lemma needed for the proof of Euclid’s Theorem. These examples, taken from prof. Isles’ First-Order Reasoning and Primitive Recursive Natural Number Notations, show that there is a real proof-theoretical difference between traditional logic and the BV system. Here we also find the first major point of departure between myself and prof. Isles, centered on the notion of inheritance of conditions in the reference grammar by way of lemmata. These different points of view are best illustrated in the sections on the totality of exponentiation and on Euclid’s Lemma: prof. Isles maintains that the proof of totality of exponentiation is not BV valid, while I maintain that it is. But I do agree with him that the traditional proof of Euclid’s Lemma is not BV valid. Chapter 6 also expands the arguments for my choice in this matter.Now that it has been shown that there is a difference between traditional logic and BV, the properties of BV need to be examined. In Chapter 4 we give a proof of Cut-elimination for BV minus induction and the subformula property for BV, which allows us to prove the consistency of BV minus induction. We also expand on the reasons for excluding induction. In Chapter 5 we consider in detail the proof of a finite analog to the Löwenheim–Skolem theorem given by prof. Isles in his article with the same title. He proves that under certain conditions it is always possible, given the existence of a (possibly uncountable) model for a derivation, to give a finite model for this derivation. The system he considers deviates from BV as considered in this thesis in two significant ways: it does not contain the induction rule and the domains contain numbers instead of numerical notations. We then go on to show that it is possible to extend the result to include induction, in the sense that the existence of a possibly uncountable model for a derivation guarantees the existence of a model that is at most countable. We also consider the complications that arise from taking numerical expressions instead of numbers as the elements of domains.Finally, in Chapter 6 we consider the philosophical consequences of the BV system, informed by the formal results from the previous chapters. In particular we discuss the relation between reduction and reference, the status of reference grammars, the notion of induction and its function within BV, and some brief considerations on the consequences of the BV system for the discussion regarding nominalism and realism with regard to mathematical objects. The object of the chapter is twofold. On the one hand applying the formal results to philosophical questions, on the other hand arguing that BV is not just a theoretically acceptable alternative to traditional logic, but is in fact deserving of further development and research into its properties. The latter will probably appeal most to those of a nominalist and/or finitist bent.Abstract prepared by Harrie de Swart and Sven Storms.E-mail:[email protected]:https://research.tilburguniversity.edu/files/6170 1294/Storms_The_Buridan_Volpin_04_05_2022.pdf. (shrink)

With the prevalence of complementary and alternative medicine (CAM) increasing in western societies, questions of the ethical justification of these alternative health care approaches and practices have to be addressed. In order to evaluate philosophical reasoning on this subject, it is of paramount importance to identify and analyse possible arguments for the ethical justification of CAM considering contemporary biomedical ethics as well as more fundamental philosophical aspects. Moreover, it is vital to provide adequate analytical instruments for this task, such as (...) separating ‘CAM as belief system’, and ‘CAM as practice’, Findings show that beneficence and non-maleficence are central issues for an ethical justification of CAM as practice, while freedom of thought and religion are central to CAM as belief system. Many justification strategies have limitations and qualifications that have to be taken into account. Singularly descriptive premises in an argument often prove to be more problematic than universal ethical principles. Thus, non-ethical issues related to a general philosophical underpinning - e.g. epistemology, semantics, and ontology - are highly relevant for determining a justification strategy, especially when strong metaphysical assumptions are involved. Even if some values are shared with traditional biomedicine, axiological differences have to be considered as well. Further research should be done about specific CAM positions. These could be combined with applied qualitative social research methods. (shrink)

In this commentary, I suggest expanding the deliberative aspects of critical care policy development in two ways. First, critical-care policy development should expand the scope of deliberation by leaving fewer issues up to expertise or private choice. For instance. it should allow deliberation about the relevance of age, disability, social position, and psychological well-being to allocation decisions. Second, it should broaden both the set of costs considered and the set of stakeholders represented in the deliberative process. In particular, it (...) should consider efforts to reduce the cost of end-of-life care and to redirect resources away from the provision of costly interventions, and should expand the set of individuals included in deliberation to include stakeholders outside the health-care system. (shrink)

Development is concerned with the transformation of people to foster their health, wholeness and growth. The link between health and development points to religion as potential social capital for development. There is an ongoing debate about the role of pastoral care as a religious resource in global healthcare contexts. This is unfortunately not the case in Africa, as pastoral care has not received sufficient attention for its role in healthcare and development in development discourses. The limited research on pastoral care (...) in healthcare contexts in Africa has implications for African healthcare systems, pastoral care and the delivery of an effective, holistic and quality healthcare service. Taking as its point of departure a thesis about the potential of religion as a social capital resource for development, the article argues for pastoral care as a viable religious resource for healthcare and development. Osmer’s theological task of good practice is employed as an interdisciplinary engagement in dialogue with selective perspectives in the disciplines of development and health and social sciences for appropriate analysis. (shrink)