This chapter contains sections titled: Notes.

This article deals with nurses’ ethical concerns raised by the consequences of changes in governmental and institutional policies on nursing practice and patient care. The aims of this project were to explore perspectives of registered nurses who provide or manage direct patient care on policies that affect nursing and patient care, and to provide input to policy makers for the development of more patient-centred policies. Four focus groups were conducted with a total of 36 registered nurse participants. The project team (...) identified major themes that emerged in the analysis of transcripts of the focus group discussions. The four major themes were: effects of policy focused on cost containment, effects on quality of care, effects on patient education and access to needed services, and effects on nurses and nursing. The participants identified primarily negative effects of changes in national health policy and legislation that influence institutional policies on patient care and nursing practice. The effects of identified policy changes raised concerns about meeting nurses’ ethical obligations to patients and families. Participants specified key points for consideration by legislators and other policy makers. They viewed nurses who are involved in direct patient care as a critical resource for legislators and other policy makers in the development of public and institutional policies that affect nursing and patient care. (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)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

This article deals with the question of how ethicists respond to practical moral problems emerging in health care practices. Do they remain distanced, taking on the role of an expert, or do they become engaged with nurses and other participants in practice and jointly develop contextualized insights about good care? A basic assumption of dialogical ethics entails that the definition of good care and what it means to be a good nurse is a collaborative product of ongoing (...) dialogues among various stakeholders engaged in the practice. This article discusses the value of a dialogical approach to ethics by drawing on the work of various nursing scholars. We present a case example concerning the quality of freedom restrictions for intellectually disabled people. Issues for discussion include the role and required competences of the ethicist and dealing with asymmetrical relationships between stakeholders. (shrink)

continent. 2.2 (2012): 155–158 Michel Serres. Biogea . Trans. Randolph Burks. Minneapolis: Univocal Publishing. 2012. 200 pp. | ISBN 9781937561086 | $22.95 Conveying to potential readers the significance of a book puts me at risk of glad handing. It’s not in my interest to laud the undeserving, especially on the pages of this journal. This is not a sales pitch, but rather an affirmation of a necessary work on very troubled terms: human, earth, nature, and the problematic world we made. (...) It is this world that aspirates the silence (so to speak), and therefore the subject which, along with the development of the “made world” exports the excess augmentation of the cosmically missing, this silence of the natural, et cetera. Had we learned from Locke that lesson of “labor,” to consume what we need… but perhaps we need more than what matters? Serres’ Biogea has several functions on this manner, if it is indeed a book to be consumed. First, readers searching for novelistic entertainment have a place to dwell. Biogea deserves a place in your back pocket; biographical generosity and poetic fluidity should satisfy most textual fetishes. For lay philosophers who want to refresh their acumen, Biogea deserves a place on the book shelf, one already reads a sorely needed postmodern tune-up here. Serres’ style is clearly French; he leaves few cheese crumbs on his words, rather preciseness and breathing in the work give way to a sweeping manner that breaks the narrative line of sight. A circular narrative and anachronistic fragmentation of terms allows an abyssal atmosphere to swell, if only to pump into the book the externality of its broader text. Biogea aspires to a higher standard and the book, at times, is thinking this negentropic problem too. Univocal, the publisher, has crafted a book appropriate for the hands to hold and the translations are an achievement of an otherwise difficult writer to translate. Terms are the conditions of a broader text. It is important to note that Serres’ content is as much a thinking of terminal ports. There is a regard for the transportation technology of the written word. For me, this is the mark of genius, a craftiness that tells of a book device that I may trust. Serres is an accomplished thinker and a necessary voice to check the putative trendiness of anti-postmodernist and market-driven theory of endless cultural liquidation. Offering interventions on subjectivity as an open system we are given a chance to affirm the human, not merely to discard it, but to engage its poetic image emotion, the calibratory silent sense of the analogic world; the terms on which we base our efforts. 1 The human is the center of its own negation, constantly mediating it. Something deeper at stake appears in the work then, and it is quite obvious from the onset. Certainly, a book is an intensification of possible text and those who brought this actual book into existence have captured a rarity in regards to the subject matter and artistic accomplishment. I mentioned terms as conditions, so let us understand Biogea as bio-yea, a yes to bios . An affirmation of living and accepting presence for all of its defiance of images, words, and things temporal. Therefore Serres’ existence and its existants plays parts; out of linearity and still like a porous bone pumping blood it manufactures into the fleshy life it becomes. Starting from a man named silence chaos emerges, or the man “Old Taciturn” takes up a journey anticipating a great flood. In other words, a development akin to the one in Genesis. In dealing with this ancestral occupation, fusing Genesis with contemporary philosophical terms, Serres initiates this anachronistic fragmentation under the forming subjectivity of his own autobiography. This mutation in the open system is precisely one of Serres’ terms. There an abyss is at work, stated, but also measured by heels on the ground—the abyss dispatching earthen tensions, that which plays our tunes, that which we abide by and recognize in volcanoes, rivers, oceans, earthquakes and weaponry in the battles of the world. Set in later stages of the book, such tensions are harnessed through scientific principles in an attempt to unify the terms of natural force if only to terminate the world. Thus the elevation of the earth into the world is clearly set forth. Here already, and few pages in, a resonance is set forth under appellations such as the river Garonne, a subjectivity as much as it is inhuman, the river is the inhuman that makes us human. I get the sense that Serres is taking up a challenge issued by Wallace Stevens; namely, that the great poems of heaven and hell have been written, but that only the poem of the earth has resisted composition. 2 On this level we cannot avoid the killing factor of silence, given that our cognition blocks its pure, radical obliteration. Thus a silence of attunement to the earth is in a novel dialectic of the rithmic and rhythm. A technological world, a triumph of termination is set forth. If a text imposes its will given the reader who authorizes it, it is made to convey or convect a presupposition to a reader or its inhabitant(s). Text is therefore both, in-content, contenting, contentedness, and in reading it, a way to navigate self-destruction (dis-content). Here then would one note that the “inhuman” reveals itself, “an aperiodic rhythm of lovers and beloved…the sea as our friend…but as our enemy…maternal vivifying sea.” The sea is an open book, or vaginal birth canal, where the engagement of text comes forth: “…woman sea, open vulva.” One sees like the sea, but only after it, when the uninhabitable truth of inhabiting it switches the polarity of the sailors soul: “I was seeing like the sea” (9-11). In other words, we are invited to embrace the nonsense of the visible. At this point I am taken to Jean-François Lyotard’s work The Inhuman , specifically the first entry on negentropy that would be congruent with Serres’ thematic. 3 The human being exports, deports, or transplants its relation through text, through the system— and this is its sense or relation to silence, to music. Unaware of Serres’ proximity to this work, the concept of gender interrelation as regards a solar catastrophe runs clear. It would be, on this basis, that Serres references his peers, the other texts that, as mentioned above, are discarded in philosophy today. For students of philosophy what we have here is perhaps a gift, a needed project. If silence and death are at work, there is a political valence to deal with, and here, much like the domain of the text and the dominion of the reader, we confront the world of natural, fluid violence. The anti-postmodernist critique is in part based on a weak idea that the loss of ideology, of a world vision, motivates the “correlationist” project. 4 Serres seems to offer another way to view this when he notes that whereas persons “sometimes kill,” it is clearly “the collective” that “always kills” (17). What is the collective today, if not an organizing function we never see yet acts in its favor in the name of truth? One feels a sense of enigma here, if only to link to what Stevens remarked of communism as a “grubby faith,” providing this applies for capitalism as well, namely any ideology of progress overly interested in absolutes. Here we get the sense that the inhuman, silence, this type of killing, always killing, could not be matched by human-made, political dynamos. Or that if it comes to an equilibrium, a catastrophe is never too far from us to read with our heels. We are left to note that the forces of nature presuppose and permeate political systems, the more these systems obtain force, the more the system takes upon itself the proper name of nature that motivates its dissemination, albeit falsely. This note, that in an age of ecocide and technological captivity (sustainability and transparency) political regimes won’t grow our soul-learning ears any larger than our tongues, stands clear to us. The promise of technological desubjectification is here pushed aside. Regarding politics, Serres illustrates this fact: Where did this corpse come from? Who was it? Who killed it? I don’t know. I won’t try to find out. I refuse to get vengeance for it. And I only see Garonne. For our victims, today, are the rivers, too. Their waters have irrigated my life, enchanted my thought, invigorated my body; I’ve known them to be threatening, untamable, as dangerous as the sea when it rages. Yes, murderous. They decided to control their courses; dams, sometimes senseless, destroying sites and valleys, reduced entire populations to servile displacements; programs for the irrigation of thirsty farmland, often beneficial of course, completed their drying up.(22) Serres enters into his idea concerning the captivity of language from the natural into a world system: For thousands of years, we have been licking things with our tongues, covering and daubing them so as to appropriate things for ourselves. If language boils down to a convention, this convention took place between the speakers without consulting the thing named, become as a result the property of those who covered it in this way with their drawn or voiced productions. Malfeasance analyzes these acts of appropriation. Thus every inert object, every living thing as well, sleeps under the covers of signs, a little in the way that, today, a thousand posters shouting messages and ugly riots of color drown, with their filthy flood, the landscapes, or better, exclude them from perception because the meaning, almost nil, of this false language and these base images forms an irresistible source of attraction to our neurons and eyes. This appropriation covers the world’s beauty with ugliness. (38-39) Technological concealment coming to bear, we begin to get a sense of another commentary on the condition of sensing, driving home the necessity of a text dealing with such subject matter to be what its terms insist. Thus toward new openings: The new opening. As low beneath our feet as you like, the Biogea opens us to another space, high enough for us to be able to acquire a wisdom there, that of redeveloping this same place differently from our fathers, this place that’s still politically cut up by old hatreds, beneath the flood of tears and blood that we call history. Without this soft place, spiritually very old, but newly conceived in this way, without the juridical construction of a common good, opposed to our filthy ownership, I don’t see how our planet, hard, will survive. Hardness that depends on a softness, material belonging that depends on this temporary rented location (51). Serres enters into a summit on the content and the structure of his work. Archimedes is brought in with the concept of three volcanoes. Meaning fire, but as well earth, water, air. For it was Archimedes’ war machines that sought to lift the earth, thus bringing in the question of principles of science: “can a principle be invented while controlling its consequences?” (66-7). May the earth be put in a sentence, terminated by terminology, appellations, gone wild? By means of these element-dominating laws, this old physicist began to tear nature away from the ancient myths; by a strange return, today we’re plunging our successes back into the anxieties and terrors from which that ancient physics was born. Yes, our new history of science and technology is plunging, today, as though in a loop, into the fundamental human myths from which Empedocles’ first laws came. A major progression and a regression on the nether side of the origins. Consequently, the contemporary time requires that we try to return to that unity in which the principles of hate and love are at the same time human, living, inert and global. We will never attain a deontology of our knowledge and actions without thinking the subjective, the objective, the collective, and the cognitive all together simultaneously. Here, hate and love are the result of these four components.(71) Working then on the concept of fire-starting mirrors to the atomic annihilation of the Second War, Serres works into the subjectivity in question on the matter of rhythm—say rithmic— precisely at that point: Knowledge is changing today. The all-political is dying; the monarchy of the sciences said to be hard is coming to a close. The science of the things of the world will have to communicate just as much as the things of the world do, which do it much better than humans do, who don’t always want to do it. Let’s celebrate two changes this morning. The first one strikes a new blow to our narcissism. No, knowledge and the world don’t resemble our analytical enjoyments of refined cutting up, of endless debates and of exclusions full of hate. They, on the contrary, form a bloc and a sum, alliance and alloys. Uniting the fields of knowledge among themselves the way the things are connected among themselves, the second newness puts into place sets united by interlacing, webs and simplexes that combine with the things of the world, themselves combined, the combined knowledge that understands them.(130-1) Biogea closes on its opening flood thematic, approaching the initial telos of Genesis. Here the trees are brought into a position with atmosphere, the opaque abyssal reservoir, the tomb of the sun, sea in the polarity of the earthen heaven and hell. The poem of the earth then is silent but deadly, indeed, as funny as that phrase is, mainly a tomb gas. The meaning of the living and the non-meaning of things converge in the muteness of the world; this meaning and non-meaning plunge there and come out, the ultimate eddy. Mundus patet: through a fissure, through an opening, a fault, a cleft come noises, calls as small as these apertures. I’m listening, attentive, I’m translating, I’m advancing in the scaled-down meaning and science. Mundus patet: should the world open greatly, it will launch me into its silence. The totality remains silent. Knowledge expanded in elation. White origin of meaning, fountain of joy. (198) Final Remarks One test of a review is the long term trajectory the referee thinks the book will have. I see Serres’ text lending greatly into the vision of Biogea . In fact, in the vision of the novel inquiries of Stephen Jay Gould’s work there is something to be thought on the level of the individual and the species; namely, that humanity and its uniqueness is in its deferral, its thinking and naming, a thinking surrounded by silence that filters into everything, that pulls us through the world, the kinetic pulse we recognize, and all of that we cleave away in the base philosophical maxim of difference itself. Unique individuals are spatial creatures: we dwell, and we ought to get good at it. Yet this is an imaginative space that, if you are crazy enough to believe it, de-term-ine the conditions of its own terms. That is why we are not merely creating spaces on the acceleration of time, or so this ignoramus thinks, to accidentally transcend. Imagination already has this insatiable silence that we drink up and fail to manifest. Space is timeless. The imagination itself, shared by humans for themselves, their objects, and the species as a whole, is a non-defined space of relation; a whole human trajectory as part of nature, and part of worlds that are the other side of thinking nature, the consequence of it, at least our attempt to do so. Our survival is based on our deliberation, our caution, our natural deconstructive sense toward this silence that is already part of the song, sung, singing of this century without end. Good books will let us inhabit this space and recognize a form of life. Serres’ text moves toward dwelling, as noted, in masterful and accessible ways. The pitched battles are the falling replays of anemic and dead politics. As soon as we realize there is humanity, we may be able to enjoy the end of it, our inhuman capability of listening to silence. NOTES 1. See Michel Serres. The Parasite . Minneapolis: University of Minnesota Press. 2007. 2. Wallace Stevens, “Imagination as Value” [ca. 1945], in Collected Poetry and Prose . New York: The Library of America. 1997. 724-39. 3. Jean-François Lyotard. The Inhuman: Reflections on Time . Trans. Geoffrey Bennington & Rachel Bowlby. Stanford, CA: Stanford University Press. 1992. 4. See the introduction: Quentin Melliassoux. After Finitude: An Essay on the Necessity of Contingency . Trans. Ray Brassier. New York: Continuum. 2008. EDITOR'S NOTE: This review was updated on August 8, 2012. Substantial edits include block quotes from the book under review as well as the inclusion of comments from the author. (shrink)

Modern mainstream ethical theories with its overemphasis on autonomy and non-interference have failed to adequately respond to contemporary social problems. A new ethical perspective is very much needed. Thanks to Carol Gilligan's 1982 groundbreaking work, 'In a Different Voice' , we now not only have virtue and communitarian ethicists, but also a group of feminist philosophers, charting a new direction for ethics that tempers modern ethics' obsession with autonomy, contractual rights, and abstract rules. Nel Noddings, in her 'Caring: A (...) class='Hi'>Feminine Approach to Ethics and Moral Education', further contributed to this important discussion. In this work, Noddings proposes a new kind of moral ideal. She calls it "caring." Noddings defines "caring," as a direct, felt concern and action from the one-caring toward the well-being of the cared-for. In other words, care is a state of mental engrossment and motivational displacement that impels caring actions for the happiness of the cared-for and it transcends any rule-bound moral judgment. A caring attitude is best manifest in the spontaneous emotive bond of love between a mother and a child. This human relation of unscrutinized maternal love and care should be the model of ethics. Noddings's theory evokes a vigorous debate concerning whether or not the model can withstand rigorous philosophical scrutiny as a stand-alone ethical theory. This paper first discusses the strengths and weaknesses of a pure care ethics. Secondly, it demonstrates why both the Kantian and the Aristotelian attempts are unsatisfactory, and it offers a Confucian solution to the problems of care ethics. It argues that notwithstanding gender-oppressive practices that are at times associated with Confucianism, Confucian ethics of 'ren' (humaneness) is both more compatible with care ethics and is better equipped with conceptual resources than Kantian liberalism or Aristotelian virtue ethics to handle the moral predicament of the postmodern world. The paper demonstrates that care is an inherent element of Confucian 'ren' but that 'ren' is more than Noddings's care. It examines three essential principles that can be extracted from philosophical classical Confucianism: (1) an affectionate and particularistic approach to persons, (2) the mutual conditioning of the two prominent Confucian virtues -- humaneness (ren) and ritual propriety (li), and (3) the inseparability of the familial and the political self. The last section of the paper applies Confucian care ethics to concrete cases such as the geriatric care crisis and the problem of poverty. (shrink)

There is an ongoing discussion concerning personal vs. impersonal considerations in professional care. In this article, three different positions within the ethics of closeness will be discussed. These are: (a) reserving the ethics of closeness for close experienced others, ‘including the experienced Other’, which is Nortvedt's position; (b) trying to bring the distant, non‐experienced others closer, ‘including the Third’; and (c) finally, an examination of whether a perspective of closeness may lead to the exclusion of various groups in (...) need of help, ‘including the Other at the expense of the Third’. These positions are discussed with a view to clarifying some of the challenges that the ethics of closeness faces when it maintains that greater ethical obligation is associated with personal than with impersonal relations, without discussing the terms on which the obligation is based. Key questions that arise for a nurse or other health professional are: If our primary moral responsibility is for those that are close to us, the experienced others, who is to be responsible for those that are outside the established health services, the non‐experienced others? Is it evident that favouring the experienced others is based on legitimate needs? Can a discussion on the legitimate basis of nursing be avoided in questions relating to closeness and priorities? This discussion touches the heart of our discipline. Is a one‐sided perspective of closeness, rejecting moral responsibility for those with whom we have no relationship, a defensible ethical position? (shrink)

Relationships between self-ratings and expectations of an ideal U.S. president, were studied in 43 men drawn from a university setting in the eastern coast of the U.S.A. The men first rated themselves on personality variables, life choices (agentic and communal), peacefulness, spirituality, and morality. Then they were presented with a vignette requesting that they describe an ideal U.S. president on inventories measuring personality variables, life choices, peacefulness, spirituality, and morality. For the rating of the ideal U.S. president, they also were (...) asked to respond to a 20 item questionnaire that was a composite of several factors on organization and leadership, morality, spirituality, and peacefulness. The respondents belonged to one of seven different political persuasions, similar in some ways to different cultures. Self-ratings of the men and expectations of the president were highly correlated for extraversion, openness, trait morality, agentic and communal life choices. However, no significant correlations were found between the self-ratings and expectations of the president for neuroticism, agreeableness, conscientiousness, peacefulness, nor state morality. The men were also presented with vignettes for the ideal physician and ideal automechanic and asked to rate each of them on the inventory items. Overall, the U.S. President was rated as more neurotic and immoral in terms of ingrained ideas of right and wrong, but also as more caring for others, transcendent, seeking goodness and truth, forgiving, cooperative, and most concerned with matters of justice and mercy, and more concerned with both agentic (power-seeking) and communal (community-minded) life choices than were either the ideal physician or ideal automechanic. The ideal physician was rated as highest in extra-version, openness, agreeableness, conscientiousness, and overall peacefulness, and lowest in neuroticism. The ideal automechanic was rated as highest in state or situational immorality, and lowest in both agentic (power-seeking, business-mindedness) and communal (community-mindedness) life choices, and also lowest in caring for others well-being, transcendence, seeking goodness and truth, forgiveness and cooperation, being concerned with justice and mercy, overall expectations, overall spirituality, and overall organization and leadership. In general, the self-ratings were significantly related to ratings/expectations, of the U.S. President, ideal physician, and ideal automechanic. The men seemed to identify more with the automechanic than with the present or physician. (shrink)

ABSTRACT In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as (...) autonomy and the harm principle, to infectious examples. We argue that this is insufficient, however. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as autonomous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care. (shrink)

In an era of rapidly rising health care costs, physicians and policymakers are searching for new and effective ways to contain health care spending without sacrificing the quality of services provided. These proposals are increasingly articulated in terms of an ethical duty of stewardship. The duty of stewardship in medicine, however, is not at present well understood, and it is frequently conflated with other duties. This article presents a critical analysis of the notion of stewardship, which shows that it has (...) an important and distinctive place in medical ethics. It claims that stewardship in medicine concerns the responsible use of a society’s medical resources and it discusses the extent to which medical professionals are the proper stewards of these resources. The article argues that the duty of stewardship is best understood as a duty that applies in a space between the obligations of health care providers to provide beneficent care to their patients on the one hand and the obligations of citizens to bring about and support a just health care system on the other. Seen with clear eyes, stewardship in medicine is neither a consequence of beneficent medical care nor a substitute for justice. (shrink)

ABSTRACTBuilding trust between researchers and communities involved in research is one goal of community engagement. This paper examines the implications of community engagement for trust within communities, including trust among community volunteers who assist with research and between these volunteers and other community members. We describe the experiences of two groups of community volunteers recruited as part of an HIV and TB intervention trial in Malawi: cluster representatives, recruited both to act as key informants for TB suspects and mortality reporting (...) and to identify and report community concerns, and community counsellors, recruited to provide semi-supervised HIV self-testing. We examine tensions experienced due to playing multiple roles, and the implications of volunteer responsibilities for short- and long-term community relationships. Data was collected through a workshop, in-depth interviews and focus group discussions with volunteers and community members. While the volunteer system init... (shrink)

Background:Within oncology and hematology care, patients are sometimes considered to have such a poor prognosis that they can receive a do not resuscitate order from the physician responsible, stipulating that neither basic nor advanced coronary pulmonary rescue be performed in the event of a cardiac arrest. Studies on do not resuscitate decisions within oncology and hematology units, focusing on the specific role of the nurse in relation to these decisions, are scarce.Objective:The aim of this study was to investigate hematology and (...) oncology nurses’ experiences and perceptions of do not resuscitate orders, in order to achieve a deeper understanding of the nurses’ specific role in these decisions.Research design:A qualitative, descriptive methodology with individual semi-structured interviews was used.Participants and research context:A total of 15 nurses from eight hematology/oncology wards in four hospitals in Sweden were interviewed individually.Ethical considerations:In accordance with national regulations, an ethical review was not required for this study. The research followed international guidelines for empirical research, as outlined in the Helsinki Declaration.Findings:The nurses strived for good nursing care through balancing harms and goods and observing integrity and quality of life as important values. Experienced hindrances for good care were unclear and poorly documented decisions, uninformed patients and relatives, and disagreements among the caregivers and family. The nurses expressed a need for an ongoing discussion on do not resuscitate decisions, including all concerned parties.Conclusion:In order to provide good nursing care, nurses need clear and well-documented do not resuscitate orders, and patients and relatives need to be well informed and included in the decisions. To increase the understanding for each other’s opinions within the medical team, regular ethical discussions are required. (shrink)

Background: Due to the aging society the number of informal caregivers is growing. Most informal caregivers are women working as nurses within a health organization and they have a high risk of developing mental and physical exhaustion. Until now little research attention has been paid to the expectations and needs of double duty caregivers and the role of self-management in managing private-work balance.Objective: The overall aim of this study was to investigate the expectations and needs of double duty caregivers in (...) Netherlands, and to examine the meaning of self-management in managing work-life balance.Method: Different research methods have been applied in this exploratory study. Firstly, a scoping review has been conducted on the topics self-management and sustainable employability of double-duty caregivers using the search engines: CINAHL, MEDLINE, PubMed, and Google Scholar. Furthermore, a qualitative study has been conducted through focus groups with double duty caregivers.Results: Twenty studies that met the inclusion criteria could be identified. We found that double duty caregivers have different motivations for being a double duty caregiver based on internal and external expectations. Double duty caregiving causes a lot of mental and physical pressure for the caregiver. To be able to combine both duty’s, double duty caregivers need flexibility and understanding from the workplace. Through two focus groups we found that social support from the workplace is not enough to be able to manage the situation. Self-management skills are important to be able to communicate effectively with the workplace and community care organizations about the kind of support needed. Also, health care organizations should offer the same support to double duty caregivers as any other informal caregiver.Discussion: Double-duty caregivers are at high risk of developing symptoms of overload and risk of reduced self-management quality and employability levels across time. Health care organizations and the double duty caregiver often wait too long to act instead of taking more preventive measures. Furthermore, community care organizations should dialog with double duty caregivers about their wishes concerning the division of caring tasks. This finding calls for special attention, with long-term solutions at both macro, organizational, and employee level. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Understanding and Experience of Compassion:Aquinas and the Dalai LamaJudith BaradHis Holiness the fourteenth Dalai Lama writes that the essence of Mahayana Buddhism is compassion.1 Although most people recognize compassion as one of the most admirable virtues, it is not easy to find discussions of it by Christian theologians. Instead, Christian theologians tend to discuss charity, a virtue infused by God into a person. Some of (...) these theologians, such as Cardinal Henri de Lubac,2 insist that Christian charity and Buddhist compassion are very different from each other. Are they correct? A good source to investigate this claim is in Aquinas's Summa Theologica, which contains a very developed discussion of charity. If we look at Aquinas's text and compare it to what the current Dalai Lama writes about compassion, we will recognize that they are discussing the same virtue. Moreover, by combining the insights from East and West, as expressed by the thoughts of the current Dalai Lama and St. Thomas Aquinas, we can achieve a better grasp of compassion so that we can more easily practice it in our daily lives. Though remarkably similar, the two accounts offer differing perspectives, which can be incorporated for mutual enrichment.Much of Aquinas's philosophy of compassion derives from his Christian beliefs, just as much of the Dalai Lama's teachings on compassion are based on Tibetan Buddhism. This explains some of the differences in their accounts. Unlike Christians, Buddhists neither believe in a personal God nor in a soul. Yet despite their theological differences, Aquinas and the Dalai Lama generally share a very similar view of compassion. In fact, one could well imagine Aquinas agreeing with the Dalai Lama who, after acknowledging his religious influence, writes that his goal is "to appeal for an approach to ethics based on universal rather than religious principles."3 It is appropriate, therefore, to begin by considering the similarities in their accounts of compassion, starting with their definitions of compassion. [End Page 11]DefinitionsEtymologically, the word "compassion"—compassio—comes from two Latin words: com means "with" and pati means "suffer." Literally, then, "compassion" means "to suffer with." Aquinas discusses compassion as an interior effect of charity, a theological virtue. It is interior because compassion is felt within the person who has charity. The cause of compassion, charity, Aquinas describes as the friendship between God's children and God Himself. Although Aquinas wrote prolifically on the subject of charity, someone could overlook his writing on compassion because he discusses it under the term "mercy." Diana Fritz Cates, for instance, who draws on an Aristotelian-Thomistic ethical framework to develop a theory of compassion, observes, "Aristotle and Thomas have little to say about compassion: hence, it will not be helpful to begin with their accounts."4 However, Aquinas uses the word misericordia (mercy) as a synonym of compassio (compassion). The synonymous relationship between compassion and mercy is also recognized by the Dalai Lama, who affirms, "Mercy and compassion are the same."5Aquinas defines mercy as "heartfelt sympathy for another's distress, impelling us to succor him if we can." If we experience this heartfelt sympathy, we're not discouraged if the person we try to help doesn't respond. Explicitly connecting mercy and compassion, Aquinas add that mercy, misericordia, gets its name "from denoting a person's compassionate heart (miserum cor) for another's unhappiness."6 The concept of "another's unhappiness" is important to his discussion. A necessary condition of being happy, in Aquinas's view, is that an individual must obtain what he or she wishes. Conversely, someone is unhappy when he suffers what he doesn't wish to suffer. Aquinas maintains that the suffering produced by one's frustrated desire for what he or she perceives as good is a sufficient condition for evoking mercy. In regard to the merciful response, it shouldn't matter what the suffering person perceives as good. So long as the person is suffering what he doesn't wish to suffer, this person should be treated mercifully. Suppose a teenager suffers from being unpopular with his peers. Although the compassionate person may not value popularity, she should extend compassion to the... (shrink)

Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term (...) care of patients in VS/UWS. A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making. (shrink)

This guide accompanies the following article(s): ‘Full Disclosure of the “Raw Data” of Research on Humans: Citizens’ Rights, Product Manufacturer’s Obligations and the Quality of the Scientific Database.’Philosophy Compass 6/2 (2011): 90–99. doi: 10.1111/j.1747‐9991.2010.00376.x Author’s Introduction Securing consent (and informed consent) from patients and research study participants is a key concern in patient care and research on humans. Yet, the legal doctrines of consent and informed consent differ in their applications. In patient care, the judicial doctrines of consent and (...) informed consent are disclosure doctrines based on the obligation of physicians to inform their patients of the following types of information: the nature of the procedure the physician is recommending in the patent’s care (P), the alternatives to the physician‐recommendation (A), and the risks of procedure and its alternatives (R). In addition, the physician must provide truthful answers to the patient’s questions (Q) to the best of the physician’s abilities. In research on humans, the onus of disclosure by study sponsors and principal investigators is much greater than in patient care precisely because the purpose of research is not patient care. The purpose of research is the identification and development of new generalizable knowledge. Thus, participation in a research study or trial may not benefit the study volunteer at all. In addition, the participant may carry a heavy risk burden in relationship to any testing of a newly designed drug or device as part of their experiences in the research study. Presently, despite the risks borne by the research study participant, the raw data collected from volunteers in research trials are treated by courts as if they were the private property of the study sponsor rather than generally owed to the public as would be expected by an effort like research participation aimed at contributing to the development of generalizable knowledge. This paper reviews the obligations that study sponsors owe to their study participants based on the very definition of research as a systematic activity whose purpose is to develop generalizable knowledge to help all humans. Author Recommends Court cases Canterbury v. Spence, United States Court of Appeals, District of Columbia Circuit 464 F.2d 772 (1972). (Federal appellate decision heard in the District of Columbia, USA) Reibl v. Hughes, 2 S.C.R. 880 (1980). (Supreme Court of Canada) Rogers v. Whitaker, 175 C.L. R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Canterbury v. Spence is the landmark Federal informed consent case in the United States heard in the District of Columbia. In this case, Judge Spottswood Robinson articulated the reasonable person standard of informed consent. This standard was subsequently adopted by the Supreme Court of Canada (Reibl v. Hughes, 2 S.C.R. 880 (1980)) and the High Court of Australia (Rogers v. Whitaker, 175 C.L. R. 479 (1992)). The House of Lords rejected the reasonable person standard in England in Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985). Book Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. This book is a detailed guide for the review of scientific and ethical aspects of research on humans contained in the research study protocols and research informed consent forms which need to be submitted by study sponsors and principal investigators to institutional review boards (IRBs) for IRB review before a research study can receive approval to be conducted within a human study population in those institutions over which the IRB has authority. It also presents basic definitions in the area of research on humans and basic approaches to help conduct a deep review of the underlying scientific and ethical issues that are present within a research study protocol and its accompanying research informed consent form. Report National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). This U.S. National Commission in the Belmont Report argued for the necessity of a reasonable volunteer standard in research on humans in the United States. Arguing that the professional standard and the reasonable person standard of consent and informed consent were insufficient to base a disclosure standard in research on humans, this National Commission developed the reasonable volunteer standard where a study participant is to be approached in research informed consent with that information that a reasonable volunteer would want to know. Online Materials Belmont Report: Syllabus Topics for Lecture and Discussion Week I: Introduction and Overview Readings: Rogers v. Whitaker, 175 C.L.R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week II: The Different Standards of Consent and Informed Consent Readings: Canterbury v. Spence, 464 F.2d 772 (1972). (Federal appellate opinion heard in the District of Columbia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week III: Definition of Research Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 2 and 3) Week IV: How to Review a Research Study Protocol and Research Informed Consent Form Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 4–6, 10, and 12–14) Week V: Obligations in Research of Humans Versus Patient Care Reading: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). Focus Questions • How do the judicial doctrines of consent in England and Australia compare to the judicial doctrines of informed consent in the United States and Canada? • How does a professional standard of disclosure differ from a reasonable person standard of disclosure? • What is the definition of research? • How is a research study (study proposal and research informed consent form) reviewed from scientific and ethical bases for considerations of approval by an IRB? • How do the obligations of a study sponsor, a principal investigator, and a research team conducting a research trial on human study participants differ from the obligations of a physician caring for a patient? • Should all raw data of research derived from humans be made available to the public for use in developing generalizable knowledge to help others, or should raw data be considered the private property of the study sponsors (for example, prescription drug manufacturers), who fund the research trials? Seminar/project Idea Draw a timeline of the development of the basic concepts of consent and informed consent in patient care and in patient research. On this timeline, first place the dates of the key court cases in England, the United States, Canada, and Australia on consent and informed consent. Then place the date of the development of the Belmont Report. Why do differences exist between these four countries in terms of the legal requirements of informedness of a patient (in medical care) and a study participant (in medical research)? What roles if any do the concepts of self‐determination and self‐decision have in consent and informed consent in patient care and in informed consent in research on humans among the four countries of interest? What are the realities of research on human participants that require a new standard of informed consent, the reasonable volunteer standard, to be developed beyond the two standards in patient care, the professional standard, and the reasonable person standard? Counterpoint Arguments The following are counterpoint arguments that need to be appreciated to more fully understand the concepts that impact the thesis that ‘raw data’ should be open to the public to allow the opportunity of checking of the results of its associated scientific paper and for further analysis. De‐Identified (Anonymized) Raw Data A current approach to identifying (anonymizinig) raw data is based on the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L.104‐191). HIPAA was enacted by the U.S. Congress in 1996 to keep a person’s medical information private. In a research study, a person’s private medical information can become research data. HIPAA’s Privacy Rule allows a covered entity to de‐identify data by removing all 18 elements that could be used to identify the individual or the individual’s relatives, employers, or household members; these elements are enumerated in the Privacy Rule. The covered entity must also have no actual knowledge that the remaining information could be used alone or in combination with other information to identify the individual who is the subject of the information. Under this method, the identifiers that must be removed are the following: 1 Names. 2 All geographic subdivisions smaller than a state, including street address, city, county, precinct, ZIP Code, and their equivalent geographical codes, except for the initial three digits of a ZIP Code if, according to the current publicly available data from the Bureau of the Census: 2a. The geographic unit formed by combining all ZIP Codes with the same three initial digits contains more than 20,000 people. 2b. The initial three digits of a ZIP Code for all such geographic units containing 20,000 or fewer people are changed to 000. 3 All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, and date of death, and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older. 4 Telephone numbers. 5 Facsimile numbers. 6 Electronic mail addresses. 7 Social security numbers. 8 Medical record numbers. 9 Health plan beneficiary numbers. 10 Account numbers. 11 Certificate/license numbers. 12 Vehicle identifiers and serial numbers, including license plate numbers. 13 Device identifiers and serial numbers. 14 Web universal resource locators (URLs). 15 Internet protocol (IP) address numbers. 16 Biometric identifiers, including fingerprints and voiceprints. 17 Full‐face photographic images and any comparable images. 18 Any other unique identifying number, characteristic, or code, unless otherwise permitted by the Privacy Rule for re‐identification. Even though ‘raw data’ can be de‐identified (anonymized) so that there is no way to trace back the data to the study participant from which it was drawn, there are still questions whether the ‘de‐identified raw data’ can be given to other researchers or made public without the original study participant’s approval. It may be the case that this approval could be done at the start of any research study where the individual considering study participation would be counseled on what the process of de‐identification consists of and would be asked whether the participant would allow use of the data by other researchers or made available to the public in a de‐identified state. However, there may be questions of the study participants as to whether the data are truly de‐identified and untraceable back to the study participant since the participant would not be able to see the process actually being carried out in detail in all relevant circumstances. Using Raw Data in Context Simply being in possession of raw data is never enough to build on that data from a research perspective. Researchers need to understand the context of the scientific research study in which the data were collected. This research context includes (but is not limited to): (i) the scientific hypothesis of the research study, (ii) the inclusion and exclusion criteria selected by the research designers of the study to determine which study participants were included and which were excluded from the study, (iii) the methods used to collect the data and possibilities of errors in the data collection processes, and (iv) answers to questions regarding whether any data were excluded from the study data and why these data were excluded. Ownership Rights Over Data There are ownership rights over data. Ownership rights include court decision making related to the question which parties are to be considered as the owners of the data. Possible owners here include (but are not limited to) (i) the study sponsor whose only role was to fund that study, (ii) the principal investigator(s) who developed the scientific hypothesis, and (iii) individual study participants through special contracts made by individual participants who negotiate such contracts with study sponsors and principal investigators to share in the ownership of data. Examples of such data are participant sources of unique gene lines or unique cell lines to be used in future research. Objections to Data Sharing Finally, individual researchers may simply object to sharing data. A researcher’s arguments here may be simply stating that he or she has a right to fully analyze the data since the collection of the data was the researchers’ idea in the first place. These researchers may argue that they have the right to mine the data as fully as they can before deciding to make the data open to the public for others to analyze. Works Cited 1 Kaiser, J. ‘Making Clinical Data Widely Available.’Science 322.5899 (10 Oct. 2008): 217–8. 2 de Lusignan, S., J.F. Metsemakers, P. Houwink, V. Gunnarsdottir, and J. van der Lei. ‘Routinely Collected General Practice Data: Goldmines for Research? A Report of the European Federation for Medical Informatics Primary Care Informatics Working Group (EFMI PCIWG) from MIE2006, Maastricht, The Netherlands.’Informatics in Primary Care 14.3 (2006): 203–9. 3 Sim, I. ‘Human Studies Database Project’, CTSA Data Repositories Symposium (17 Oct. 2008). 23 Nov. 2010. 4 Sim, I., C.G. Chute, H. Lehmann, R. Nagarajan, M. Nahm, and R.H. Scheuermann. ‘Keeping Raw Data in Context.’Science 323.5915 (6 Feb. 2009): 713. 5 U.S. Department of Health and Human Services, National Institutes of Health, HIPAA Privacy Rule, Information for Researchers. 13 Nov. 2010. 6 Wilczynski, N.L., R.B. Haynes, and Hedges Team. ‘EMBASE Search Strategies for Identifying Methodologically Sound Diagnostic Studies for Use by Clinicians and Researchers.’BMC Medicine 29.3 (March 2005): 7. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Aëtıana. The Method and Intellectual Context of a Doxographer, Volume One: The Sources by J. Mansfeld and D. T. RuniaA. A. LongJ. Mansfeld and D. T. Runia. Aëtıana. The Method and Intellectual Context of a Doxographer, Volume One: The Sources. Leiden: E.J. Brill, 1997. Pp. xxii + 371. Cloth, $135.50In this book, the first of a projected series of volumes, Mansfeld and Runia have begun a massive investigation (...) of the (mainly Greek) authors on whom we moderns rely for information about the numerous Greek philosophers whose works have not survived. The thousand-year tradition of Greek philosophy, extending from the Presocratics to Neoplatonism, is largely a story told via quotations, biographies, classifications, epitomes and criticisms. A few great works survive intact, including especially the dialogues of Plato, the technical writings of Aristotle, the sceptical books of Sextus Empiricus, and the Enneads of Plotinus; we also have most of the work on lost philosophers composed by such prolific authors as Cicero, Plutarch and Galen, and there are other well-known “sources,” such as the ten books of Lives and Doctrines, compiled by Diogenes Laertius. The present volume, however, deals with more recondite material: a work (P) on the physical doctrines of the philosophers, misattributed to Plutarch; a similar work, misattributed to Galen (G); the anthology of the Byzantine scholar Stobaeus (S); some chapters of Eusebius’ Praeparatio Evangelica (E); a work of Christian apologetics by the Syrian bishop Theodoret (T); and (in less detail) a few further writers from later antiquity.What unifies this set of authors is the thesis put forward by Hermann Diels in his monumental Doxographi Graeci (1879), to the effect that all of them, directly or indirectly, are derived from a single work composed in about 100 CE by Aetius. According to Diels, Aetius derived his material from a much older collection (Vetusta Placita), and this, in its turn, was ultimately dependent on an extensive work by Aristotle’s pupil and successor, Theophrastus. Diels’ thesis, which underpins his collection of testimonia for the Presocratics (the “A” fragments of Diels/Kranz Vorsokratiker), has been the foundation of all subsequent work on the sources of fragmentary Greek (especially Presocratic) philosophers. Diels gave the name “doxography” to the genre of writing he took to be represented by Aetius and the authors of similar accounts of philosophical doctrines.The volume under review explains, tests, supplements, and revises just that part of Diels’ thesis which invokes Aetius and the subsequent sources supposedly derived from this lost work. Mansfeld and Runia are uniquely qualified for this daunting task. Each of them has worked extensively on the historiography of Greek philosophy. As a Dutch duo in this volume, they bring unrivalled expertise to bear on revisiting the work of the formidable Diels.The good news is that Diels’ Aetian hypothesis has been vindicated for the most part. Although the name Aetius is attested to by only Theodoret, Diels was quite right to deduce that Aetius’ compilation was the source of the material common to P, S, and T, and that E and G make extensive use of P. Hence scholars of ancient philosophy can continue to impose confidence in that part of Diels’ work which takes the story from Aetius into later antiquity. This finding means that the work of Mansfeld and Runia will hardly change one’s judgment concerning what can be known about the actual doctrines of fragmentary philosophers.What it will particularly affect is one’s understanding of the lost Aetius himself and [End Page 523] the surviving authors whose work is directly derived from him. The core of this book (primarily composed by Runia) is a set of chapters on P, S, and T, in which these three authors are studied for their own sake and their different methodologies carefully set out. Diels, under the influence of nineteenth-century philology, treated P, S, and T as if they were variant manuscripts rather than distinct authors. This misled him into regarding the doxographical tradition as much more uniform than it actually is. In earlier works both Mansfeld and Runia have greatly illuminated the dialectical and classificatory ways in which philosophical doctrines were... (shrink)

The socioeconomic and ethnic characteristics of parents are some of the most important correlates of adverse health outcomes in childhood. However, the relationships between ethnic, economic, and behavioral factors and the health outcomes responsible for this pervasive finding have not been specified in child health epidemiology. The general objective of this paper is to propose a theoretical approach to the study of maternal behaviors and child health in diverse ethnic and socioeconomic environments. The specific aims are: (a) to describe a (...) causal pathway between the utility that women obtain through work outside the home and through child care and disease hazard rates in childhood using an optimization model; (b) to specify the influence of ethnic and socioeconomic factors on model constraints; (c) to use the model as a tool to learn about how different combinations of maternal wage labor and child care time might influence child health outcomes in diverse social contexts; (d) to identify parameters that will require measurement in future research; (e) to discuss research strategies that will enable us to obtain these measurements; and (f) to discuss the implications of the model for biostatistical modeling and public health intervention. Optimization models are powerful heuristic tools for understanding how ethnic, environmental, family, and personal characteristics can place important constraints on both the quality and quantity of care that women can provide to their children. They provide a quantitative appreciation for the difficult trade-offs that most women face between working in order to purchase basic goods that children cannot do without (e.g., food, clothing, shelter, health insurance), and increasing offspring well-being through child care (e.g., training in social skills, affection, protection from environmental hazards, help with homework). (shrink)

Table of contentsI1 Proceedings of the 4th World Conference on Research IntegrityConcurrent Sessions:1. Countries' systems and policies to foster research integrityCS01.1 Second time around: Implementing and embedding a review of responsible conduct of research policy and practice in an Australian research-intensive universitySusan Patricia O'BrienCS01.2 Measures to promote research integrity in a university: the case of an Asian universityDanny Chan, Frederick Leung2. Examples of research integrity education programmes in different countriesCS02.1 Development of a state-run “cyber education program of research ethics” in (...) KoreaEun Jung Ko, Jin Sun Kwak, TaeHwan Gwon, Ji Min Lee, Min-Ho LeeCS02.3 Responsible conduct of research teachers’ training courses in Germany: keeping on drilling through hard boards for more RCR teachersHelga Nolte, Michael Gommel, Gerlinde Sponholz3. The research environment and policies to encourage research integrityCS03.1 Challenges and best practices in research integrity: bridging the gap between policy and practiceYordanka Krastev, Yamini Sandiran, Julia Connell, Nicky SolomonCS03.2 The Slovenian initiative for better research: from national activities to global reflectionsUrsa Opara Krasovec, Renata SribarCS03.3 Organizational climate assessments to support research integrity: background of the Survey of Organizational Research Climate and the experience with its use at Michigan State UniversityBrian C. Martinson, Carol R. Thrush, C.K. Gunsalus4. Expressions of concern and retractionsCS04.1 Proposed guidelines for retraction notices and their disseminationIvan Oransky, Adam MarcusCS04.2 Watching retractions: analysis of process and practice, with data from the Wiley retraction archivesChris Graf, Verity Warne, Edward Wates, Sue JoshuaCS04.3 An exploratory content analysis of Expressions of ConcernMiguel RoigCS04.4 An ethics researcher in the retraction processMichael Mumford5. Funders' role in fostering research integrityCS05.1 The Fonds de Recherche du Québec’s institutional rules on the responsible conduct of research: introspection in the funding agency activitiesMylène Deschênes, Catherine Olivier, Raphaëlle Dupras-LeducCS05.2 U.S. Public Health Service funds in an international setting: research integrity and complianceZoë Hammatt, Raju Tamot, Robin Parker, Cynthia Ricard, Loc Nguyen-Khoa, Sandra TitusCS05.3 Analyzing decision making of funders of public research as a case of information asymmetryKarsten Klint JensenCS05.4 Research integrity management: Empirical investigation of academia versus industrySimon Godecharle, Ben Nemery, Kris Dierickx5A: Education: For whom, how, and what?CS05A.1 Research integrity or responsible conduct of research? What do we aim for?Mickey Gjerris, Maud Marion Laird Eriksen, Jeppe Berggren HoejCS05A.2 Teaching and learning about RCR at the same time: a report on Epigeum’s RCR poll questions and other assessment activitiesNicholas H. SteneckCS05A.4 Minding the gap in research ethics education: strategies to assess and improve research competencies in community health workers/promoteresCamille Nebeker, Michael Kalichman, Elizabeth Mejia Booen, Blanca Azucena Pacheco, Rebeca Espinosa Giacinto, Sheila Castaneda6. Country examples of research reward systems and integrityCS06.1 Improving systems to promote responsible research in the Chinese Academy of SciencesDing Li, Qiong Chen, Guoli Zhu, Zhonghe SunCS06.4 Exploring the perception of research integrity amongst public health researchers in IndiaParthasarathi Ganguly, Barna Ganguly7. Education and guidance on research integrity: country differencesCS07.1 From integrity to unity: how research integrity guidance differs across universities in Europe.Noémie Aubert Bonn, Kris Dierickx, Simon GodecharleCS07.2 Can education and training develop research integrity? The spirit of the UNESCO 1974 recommendation and its updatingDaniele Bourcier, Jacques Bordé, Michèle LeducCS07.3 The education and implementation mechanisms of research ethics in Taiwan's higher education: an experience in Chinese web-based curriculum development for responsible conduct of researchChien Chou, Sophia Jui-An PanCS07.4 Educating principal investigators in Swiss research institutions: present and future perspectivesLouis Xaver Tiefenauer8. Measuring and rewarding research productivityCS08.1 Altimpact: how research integrity underpins research impactDaniel Barr, Paul TaylorCS08.2 Publication incentives: just reward or misdirection of funds?Lyn Margaret HornCS08.3 Why Socrates never charged a fee: factors contributing to challenges for research integrity and publication ethicsDeborah Poff9. Plagiarism and falsification: Behaviour and detectionCS09.1 Personality traits predict attitude towards plagiarism of self and others in biomedicine: plagiarism, yes we can?Martina Mavrinac, Gordana Brumini, Mladen PetrovečkiCS09.2 Investigating the concept of and attitudes toward plagiarism for science teachers in Brazil: any challenges for research integrity and policy?Christiane Coelho Santos, Sonia VasconcelosCS09.3 What have we learnt?: The CrossCheck Service from CrossRefRachael LammeyCS09.4 High p-values as a sign of data fabrication/falsificationChris Hartgerink, Marcel van Assen, Jelte Wicherts10. Codes for research integrity and collaborationsCS10.1 Research integrity in cross-border cooperation: a Nordic exampleHanne Silje HaugeCS10.3 Research integrity, research misconduct, and the National Science Foundation's requirement for the responsible conduct of researchAaron MankaCS10.4 A code of conduct for international scientific cooperation: human rights and research integrity in scientific collaborations with international academic and industry partnersRaffael Iturrizaga11. Countries' efforts to establish mentoring and networksCS11.1 ENRIO : a network facilitating common approaches on research integrity in EuropeNicole FoegerCS11.2 Helping junior investigators develop in a resource-limited country: a mentoring program in PeruA. Roxana Lescano, Claudio Lanata, Gissella Vasquez, Leguia Mariana, Marita Silva, Mathew Kasper, Claudia Montero, Daniel Bausch, Andres G LescanoCS11.3 Netherlands Research Integrity Network: the first six monthsFenneke Blom, Lex BouterCS11.4 A South African framework for research ethics and integrity for researchers, postgraduate students, research managers and administratorsLaetus OK Lategan12. Training and education in research integrity at an early career stageCS12.1 Research integrity in curricula for medical studentsGustavo Fitas ManaiaCS12.2 Team-based learning for training in the responsible conduct of research supports ethical decision-makingWayne T. McCormack, William L. Allen, Shane Connelly, Joshua Crites, Jeffrey Engler, Victoria Freedman, Cynthia W. Garvan, Paul Haidet, Joel Hockensmith, William McElroy, Erik Sander, Rebecca Volpe, Michael F. VerderameCS12.4 Research integrity and career prospects of junior researchersSnezana Krstic13. Systems and research environments in institutionsCS13.1 Implementing systems in research institutions to improve quality and reduce riskLouise HandyCS13.2 Creating an institutional environment that supports research integrityDebra Schaller-DemersCS13.3 Ethics and Integrity Development Grants: a mechanism to foster cultures of ethics and integrityPaul Taylor, Daniel BarrCS13.4 A culture of integrity at KU LeuvenInge Lerouge, Gerard Cielen, Liliane Schoofs14. Peer review and its role in research integrityCS14.1 Peer review research across disciplines: transdomain action in the European Cooperation in Science and Technology “New Frontiers of Peer Review ”Ana Marusic, Flaminio SquazzoniCS14.2 Using blinding to reduce bias in peer reviewDavid VauxCS14.3 How to intensify the role of reviewers to promote research integrityKhalid Al-Wazzan, Ibrahim AlorainyCS14.4 Credit where credit’s due: professionalizing and rewarding the role of peer reviewerChris Graf, Verity Warne15. Research ethics and oversight for research integrity: Does it work?CS15.1 The psychology of decision-making in research ethics governance structures: a theory of bounded rationalityNolan O'Brien, Suzanne Guerin, Philip DoddCS15.2 Investigator irregularities: iniquity, ignorance or incompetence?Frank Wells, Catherine BlewettCS15.3 Academic plagiarismFredric M. Litto16. Research integrity in EuropeCS16.1 Whose responsibility is it anyway?: A comparative analysis of core concepts and practice at European research-intensive universities to identify and develop good practices in research integrityItziar De Lecuona, Erika Löfstrom, Katrien MaesCS16.2 Research integrity guidance in European research universitiesKris Dierickx, Noémie Bonn, Simon GodecharleCS16.3 Research Integrity: processes and initiatives in Science Europe member organisationsTony Peatfield, Olivier Boehme, Science Europe Working Group on Research IntegrityCS16.4 Promoting research integrity in Italy: the experience of the Research Ethics and Bioethics Advisory Committee of the Consiglio Nazionale delle Ricerche Cinzia Caporale, Daniele Fanelli17. Training programs for research integrity at different levels of experience and seniorityCS17.1 Meaningful ways to incorporate research integrity and the responsible conduct of research into undergraduate, graduate, postdoctoral and faculty training programsJohn Carfora, Eric Strauss, William LynnCS17.2 "Recognize, respond, champion": Developing a one-day interactive workshop to increase confidence in research integrity issuesDieter De Bruyn, Bracke Nele, Katrien De Gelder, Stefanie Van der BurghtCS17.4 “Train the trainer” on cultural challenges imposed by international research integrity conversations: lessons from a projectJosé Roberto Lapa e Silva, Sonia M. R. Vasconcelos18. Research and societal responsibilityCS18.1 Promoting the societal responsibility of research as an integral part of research integrityHelene IngierdCS18.2 Social responsibility as an ethical imperative for scientists: research, education and service to societyMark FrankelCS18.3 The intertwined nature of social responsibility and hope in scienceDaniel Vasgird, Stephanie BirdCS18.4 Common barriers that impede our ability to create a culture of trustworthiness in the research communityMark Yarborough19. Publication ethicsCS19.1 The authors' forum: A proposed tool to improve practices of journal editors and promote a responsible research environmentIbrahim Alorainy, Khalid Al-WazzanCS19.2 Quantifying research integrity and its impact with text analyticsHarold GarnerCS19.3 A closer look at authorship and publication ethics of multi- and interdisciplinary teamsLisa Campo-Engelstein, Zubin Master, Elise Smith, David Resnik, Bryn Williams-JonesCS19.4 Invisibility of duplicate publications in biomedicineMario Malicki, Ana Utrobicic, Ana Marusic20. The causes of bad and wasteful research: What can we do?CS20.1 From countries to individuals: unravelling the causes of bias and misconduct with multilevel meta-meta-analysisDaniele Fanelli, John PA IoannidisCS20.2 Reducing research waste by integrating systems of oversight and regulationGerben ter Riet, Tom Walley, Lex Marius BouterCS20.3 What are the determinants of selective reporting?: The example of palliative care for non-cancer conditionsJenny van der Steen, Lex BouterCS20.4 Perceptions of plagiarism, self-plagiarism and redundancy in research: preliminary results from a national survey of Brazilian PhDsSonia Vasconcelos, Martha Sorenson, Francisco Prosdocimi, Hatisaburo Masuda, Edson Watanabe, José Carlos Pinto, Marisa Palácios, José Lapa e Silva, Jacqueline Leta, Adalberto Vieyra, André Pinto, Mauricio Sant’Ana, Rosemary Shinkai21. Are there country-specific elements of misconduct?CS21.1 The battle with plagiarism in Russian science: latest developmentsBoris YudinCS21.2 Researchers between ethics and misconduct: A French survey on social representations of misconduct and ethical standards within the scientific communityEtienne Vergès, Anne-Sophie Brun-Wauthier, Géraldine VialCS21.3 Experience from different ways of dealing with research misconduct and promoting research integrity in some Nordic countriesTorkild VintherCS21.4 Are there specifics in German research misconduct and the ways to cope with it?Volker Bähr, Charité22. Research integrity teaching programmes and their challengesCS22.1 Faculty mentors and research integrityMichael Kalichman, Dena PlemmonsCS22.2 Training the next generation of scientists to use principles of research quality assurance to improve data integrity and reliabilityRebecca Lynn Davies, Katrina LaubeCS22.3 Fostering research integrity in a culturally-diverse environmentCynthia Scheopner, John GallandCS22.4 Towards a standard retraction formHervé Maisonneuve, Evelyne Decullier23. Commercial research and integrityCS23.1 The will to commercialize: matters of concern in the cultural economy of return-on-investment researchBrian NobleCS23.2 Quality in drug discovery data reporting: a mission impossible?Anja Gilis, David J. Gallacher, Tom Lavrijssen, Malwitz David, Malini Dasgupta, Hans MolsCS23.3 Instituting a research integrity policy in the context of semi-private-sector funding: an example in the field of occupational health and safetyPaul-Emile Boileau24. The interface of publication ethics and institutional policiesCS24.1 The open access ethical paradox in an open government effortTony SavardCS24.2 How journals and institutions can work together to promote responsible conductEric MahCS24.3 Improving cooperation between journals and research institutions in research integrity casesElizabeth Wager, Sabine Kleinert25. Reproducibility of research and retractionsCS25.1 Promoting transparency in publications to reduce irreproducibilityVeronique Kiermer, Andrew Hufton, Melanie ClyneCS25.2 Retraction notices issued for publications by Latin American authors: what lessons can we learn?Sonia Vasconcelos, Renan Moritz Almeida, Aldo Fontes-Pereira, Fernanda Catelani, Karina RochaCS25.3 A preliminary report of the findings from the Reproducibility Project: Cancer biologyElizabeth Iorns, William Gunn26. Research integrity and specific country initiativesCS26.1 Promoting research integrity at CNRS, FranceMichèle Leduc, Lucienne LetellierCS26.2 In pursuit of compliance: is the tail wagging the dog?Cornelia MalherbeCS26.3 Newly established research integrity policies and practices: oversight systems of Japanese research universitiesTakehito Kamata27. Responsible conduct of research and country guidelinesCS27.1 Incentives or guidelines? Promoting responsible research communication through economic incentives or ethical guidelines?Vidar EnebakkCS27.3 Responsible conduct of research: a view from CanadaLynn PenrodCS27.4 The Danish Code of Conduct for Research Integrity: a national initiative to promote research integrity in DenmarkThomas Nørgaard, Charlotte Elverdam28. Behaviour, trust and honestyCS28.1 The reasons behind non-ethical behaviour in academiaYves FassinCS28.2 The psychological profile of the dishonest scholarCynthia FekkenCS28.3 Considering the implications of Dan Ariely’s keynote speech at the 3rd World Conference on Research Integrity in MontréalJamal Adam, Melissa S. AndersonCS28.4 Two large surveys on psychologists’ views on peer review and replicationJelte WichertsBrett Buttliere29. Reporting and publication bias and how to overcome itCS29.1 Data sharing: Experience at two open-access general medical journalsTrish GrovesCS29.2 Overcoming publication bias and selective reporting: completing the published recordDaniel ShanahanCS29.3 The EQUATOR Network: promoting responsible reporting of health research studiesIveta Simera, Shona Kirtley, Eleana Villanueva, Caroline Struthers, Angela MacCarthy, Douglas Altman30. The research environment and its implications for integrityCS30.1 Ranking of scientists: the Russian experienceElena GrebenshchikovaCS30.4 From cradle to grave: research integrity, research misconduct and cultural shiftsBronwyn Greene, Ted RohrPARTNER SYMPOSIAPartner Symposium AOrganized by EQUATOR Network, Enhancing the Quality and Transparency of Health ResearchP1 Can we trust the medical research literature?: Poor reporting and its consequencesIveta SimeraP2 What can BioMed Central do to improve published research?Daniel Shanahan, Stephanie HarrimanP3 What can a "traditional" journal do to improve published research?Trish GrovesP4 Promoting good reporting practice for reliable and usable research papers: EQUATOR Network, reporting guidelines and other initiativesCaroline StruthersPartner Symposium COrganized by ENRIO, the European Network of Research Integrity OfficersP5 Transparency and independence in research integrity investigations in EuropeKrista Varantola, Helga Nolte, Ursa Opara, Torkild Vinther, Elizabeth Wager, Thomas NørgaardPartner Symposium DOrganized by IEEE, the Institute of Electrical and Electronics EngineersRe-educating our author community: IEEE's approach to bibliometric manipulation, plagiarism, and other inappropriate practicesP6 Dealing with plagiarism in the connected world: An Institute of Electrical and Electronics Engineers perspectiveJon RokneP7 Should evaluation of raises, promotion, and research proposals be tied to bibliometric indictors? What the Institute of Electrical and Electronics Engineers is doing to answer this questionGianluca SettiP8 Recommended practices to ensure conference content qualityGordon MacPhersonPartner Symposium EOrganized by the Committee on Freedom and Responsibility in the Conduct of Science of ICSU, the International Council for ScienceResearch assessment and quality in science: perspectives from international science and policy organisationsP9 Challenges for science and the problems of assessing researchEllen HazelkornP10 Research assessment and science policy developmentCarthage SmithP11 Research integrity in South Africa: the value of procedures and processes to global positioningRobert H. McLaughlinP12 Rewards, careers and integrity: perspectives of young scientists from around the worldTatiana Duque MartinsPartner Symposium FOrganized by the Online Resource Center for Ethics Education in Engineering and Science / Center for Engineering, Ethics, and Society of the National Academy of EngineeringP13 Research misconduct: conceptions and policy solutionsTetsuya Tanimoto, Nicholas Steneck, Daniele Fanelli, Ragnvald Kalleberg, Tajammul HusseinPartner Symposium HOrganized by ORI, the Office of Research Integrity; Universitas 21; and the Asia Pacific Research Integrity NetworkP14 International integrity networks: working together to ensure research integrityPing Sun, Ovid Tzeng, Krista Varantola, Susan ZimmermanPartner Symposium IOrganized by COPE, the Committee on Publication EthicsPublication without borders: Ethical challenges in a globalized worldP15 Authorship: credit and responsibility, including issues in large and interdisciplinary studiesRosemary ShinkaiPartner Symposium JOrganized by CITI, the Cooperative Institutional Training InitiativeExperiences on research integrity educational programs in Colombia, Costa Rica and PeruP16 Experiences in PeruRoxana LescanoP17 Experiences in Costa RicaElizabeth HeitmanP18 Experiences in ColumbiaMaria Andrea Rocio del Pilar Contreras NietoPoster Session B: Education, training, promotion and policyPT.01 The missing role of journal editors in promoting responsible researchIbrahim Alorainy, Khalid Al-WazzanPT.02 Honorary authorship in Taiwan: why and who should be in charge?Chien Chou, Sophia Jui-An PanPT.03 Authorship and citation manipulation in academic researchEric Fong, Al WilhitePT.04 Open peer review of research submission at medical journals: experience at BMJ Open and The BMJTrish GrovesPT.05 Exercising authorship: claiming rewards, practicing integrityDésirée Motta-RothPT.07 Medical scientists' views on publication culture: a focus group studyJoeri Tijdink, Yvo SmuldersPoster Session B: Education, training, promotion and policyPT.09 Ethical challenges in post-graduate supervisionLaetus OK LateganPT.10 The effects of viable ethics instruction on international studentsMichael Mumford, Logan Steele, Logan Watts, James Johnson, Shane Connelly, Lee WilliamsPT.11 Does language reflect the quality of research?Gerben ter Riet, Sufia Amini, Lotty Hooft, Halil KilicogluPT.12 Integrity complaints as a strategic tool in policy decision conflictsJanneke van Seters, Herman Eijsackers, Fons Voragen, Akke van der Zijpp and Frans BromPoster Session C: Ethics and integrity intersectionsPT.14 Regulations of informed consent: university-supported research processes and pitfalls in implementationBadaruddin Abbasi, Naif Nasser AlmasoudPT.15 A review of equipoise as a requirement in clinical trialsAdri LabuschagnePT.16 The Research Ethics Library: online resource for research ethics educationJohanne Severinsen, Espen EnghPT.17 Research integrity: the view from King Abdulaziz City for Science and TechnologyDaham Ismail AlaniPT. 18 Meeting global challenges in high-impact publications and research integrity: the case of the Malaysian Palm Oil BoardHJ. Kamaruzaman JusoffPT.19 University faculty perceptions of research practices and misconductAnita Gordon, Helen C. HartonPoster Session D: International perspectivesPT.21 The Commission for Scientific Integrity as a response to research fraudDieter De Bruyn, Stefanie Van der BurghtPT. 22 Are notions of the responsible conduct of research associated with compliance with requirements for research on humans in different disciplinary traditions in Brazil?Karina de Albuquerque Rocha, Sonia Maria Ramos de VasconcelosPT.23 Creating an environment that promotes research integrity: an institutional model of Malawi Liverpool Welcome TrustLimbanazo MatandikaPT.24 How do science policies in Brazil influence user-engaged ecological research?Aline Carolina de Oliveira Machado Prata, Mark William NeffPoster Session E: Perspectives on misconductPT.26 What “causes” scientific misconduct?: Testing major hypotheses by comparing corrected and retracted papersDaniele Fanelli, Rodrigo Costas, Vincent LarivièrePT.27 Perception of academic plagiarism among dentistry studentsDouglas Leonardo Gomes Filho, Diego Oliveira GuedesPT. 28 a few bad apples?: Prevalence, patterns and attitudes towards scientific misconduct among doctoral students at a German university hospitalVolker Bähr, Niklas Keller, Markus Feufel, Nikolas OffenhauserPT. 29 Analysis of retraction notices published by BioMed CentralMaria K. Kowalczuk, Elizabeth C. MoylanPT.31 "He did it" doesn't work: data security, incidents and partnersKatie SpeanburgPoster Session F: Views from the disciplinesPT.32 Robust procedures: a key to generating quality results in drug discoveryMalini Dasgupta, Mariusz Lubomirski, Tom Lavrijssen, David Malwitz, David Gallacher, Anja GillisPT.33 Health promotion: criteria for the design and the integrity of a research projectMaria Betânia de Freitas Marques, Laressa Lima Amâncio, Raphaela Dias Fernandes, Oliveira Patrocínio, and Cláudia Maria Correia Borges RechPT.34 Integrity of academic work from the perspective of students graduating in pharmacy: a brief research studyMaria Betânia de Freitas Marques, Cláudia Maria Correia Borges Rech, Adriana Nascimento SousaPT.35 Research integrity promotion in the Epidemiology and Health Services, the journal of the Brazilian Unified Health SystemLeila Posenato GarciaPT.36 When are clinical trials registered? An analysis of prospective versus retrospective registration of clinical trials published in the BioMed Central series, UKStephanie Harriman, Jigisha PatelPT.37 Maximizing welfare while promoting innovation in drug developmentFarida LadaOther posters that will be displayed but not presented orally:PT.38 Geoethics and the debate on research integrity in geosciencesGiuseppe Di Capua, Silvia PeppoloniPT.39 Introducing the Professionalism and Integrity in Research Program James M. DuBois, John Chibnall, Jillon Van der WallPT.40 Validation of the professional decision-making in research measureJames M. DuBois, John Chibnall, Jillon Van der Wall, Raymond TaitPT.41 General guidelines for research ethicsJacob HolenPT. 42 A national forum for research ethicsAdele Flakke Johannessen, Torunn EllefsenPT.43 Evaluation of integrity in coursework: an approach from the perspective of the higher education professorClaudia Rech, Adriana Sousa, Maria Betânia de Freitas MarquesPT.44 Principles of geoethics and research integrity applied to the European Multidisciplinary Seafloor and Water Column Observatory, a large-scale European environmental research infrastructureSilvia Peppoloni, Giuseppe Di Capua, Laura BeranzoliF1 Focus track on improving research systems: the role of fundersPaulo S.L. Beirão, Susan ZimmermanF2 Focus track on improving research systems: the role of countriesSabine Kleinert, Ana MarusicF3 Focus track on improving research systems: the role of institutionsMelissa S. Anderson, Lex Bouter. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Negotiating Maternal IdentityAdrienne Rich’s Legacy for Inquiry into the Political-Philosophical Dimensions of Pregnancy and ChildbirthCandace JohnsonGiving birth has been described as the crossing of an imaginary threshold, which separates an independent maternal self from some sort of dual or subordinate existence. The metaphor of a border has also been employed to demonstrate this transformation, which may be liberating, oppressive, or some complex combination thereof (Weir 2006; Martinez 2004). What (...) happens, in psychic and sociopolitical terms, in the journey across this border? Can a woman, as an independent, autonomous being, preserve her identity, her selfhood as a mother? Is the transition to motherhood an expression of culture or nature? The answers to these questions are infinitely complex, yet are at the core of philosophical, political, and personal explorations of the maternal. Central to these explorations are academic critiques and personal responses to the biomedical mediation of the transition to motherhood. For some women, medical intervention in pregnancy and childbirth is inherently oppressive, whereas for other women such intervention is a marker of privilege. In a groundbreaking volume published in 1998, Margaret Lock and Patricia Kaufert argue that women respond to different biomedical interventions in pragmatic ways, which reflect their lived experiences. They claim that “it is more appropriate to understand women’s responses in medical settings as reflecting their daily experiences as part of a domestic group, a community, or a society” (19). [End Page 65]I would like to advance this analysis by suggesting that women respond to biomedical intervention in pregnancy and childbirth in ways that reflect not simply their practical needs and realities, but important details about inequality and identity. Women’s relative degrees of power and agency in society are expressed through their preferences for care during pregnancy and childbirth. In addition, and in connection with the (structural) dynamics of inequality, these preferences reflect the complexities of shifting, negotiated, maternal identities. In order to consider the ways in which women negotiate maternal identity through their preferences concerning care during pregnancy and childbirth, I will examine the contributions of Adrienne Rich, which effectively serve as the foundation for this and countless other areas of women’s and gender studies. In Of Woman Born, Rich dedicates two full chapters to childbirth, and explains in these chapters that the institution of childbirth has come to dominate and eclipse women’s experiences. Moreover, the patriarchal circumscription of childbirth is reinforced by the isolation of childbirth (and motherhood) from other life events. Rich demonstrates these problems through the metaphor of “giving birth to oneself ” (29), which has (at least) two distinct meanings: self actualization and self replacement.My investigation into these meanings will include an examination of Rich’s philosophical treatment of pregnancy and childbirth and an assessment of the sociopolitical implications of both conceptions of “giving birth to oneself.” I will then subject these conceptions to empirical testing, as Rich insists. Such empirical testing is crucial because the social and political dimensions of the institutions of childbirth and motherhood are complex and differ from one context to the next. Rich explains that[t]o hold power over others means that the powerful is permitted a kind of short-cut through the complexity of human personality. He does not have to enter intuitively into the souls of the powerless, or to hear what they are saying in their many languages, including the language of silence. Colonialism exists by virtue of this short-cut—how else could so few live among so many and understand so little?(65)This essay will avoid a similar shortcut often taken by theorists, which builds philosophical arguments without empirical support. The empirical cases to be considered in the context of philosophical debate include Canada, Honduras, and Cuba, and details of each case will be drawn from extensive interview data from a larger empirical study.1 In the Canadian context, resistance to the constraining effects of motherhood as institution is reduced to resistance to medical regulation of pregnancy and childbirth. The benefit indicated by this resistance is that women have found ways to expand their range of options and reinterpret the birthing event, thereby integrating it into other realms [End Page 66... (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Whereas empathy is most often looked upon as a virtue and essential skill in contemporary health care, the relationship to sympathy is more complicated. Empathic approaches that lead to emotional arousal on the part of the health care professional and strong feelings for the individual patient run the risk of becoming unprofessional in nature and having the effect of so-called compassion fatigue or burnout. In this paper I want to show that approaches to empathy in health care that attempt (...) to solve these problems by cutting empathy loose from sympathy—from empathic concern—are mistaken. Instead, I argue, a certain kind of sympathy, which I call professional concern, is a necessary ingredient in good health care. Feeling oneself into the experiences and situation of the patient cannot be pursued without caring for the patient in question if the empathy is going to be successful. Sympathy is not only a thing that empathy makes possible and more or less spontaneously provides a way for but is something that we find at work in connection to empathy itself. In the paper I try to show how empathy is a particular form of emotion in which I feel with, about, and for the other person in developing an interpretation of his predicament. The with and for aspects of the empathy process are typically infused by a sympathy for the person one is empathizing with. Sympathy can be modulated into other ways of feeling with and for the person in the empathy process, but these sympathy-replacement feelings nevertheless always display some form of motivating concern for the target. Such an understanding of empathy is of particular importance for health care and other professions dealing with suffering clients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:61 PROJECTIONISM, REALISM, AND HUME'S MORAL SENSE THEORY* Introduction The character of Hume's moral theory is currently a topic of considerable discussion.1 We find in the recent literature essentially two sorts of interpretation of Hume's theory. On the one side there is the view that, for Hume, the distinction between virtue and vice is reducible to the moral sentiments of approval and disapproval. Associated with this view is the (...) further claim that Hume ascribes to us the belief that virtue and vice exist as the counterparts to these sentiments; and, in addition, that this belief is, for Hume, a mistaken one. For reasons which will become obvious this may be described as the Projectionist account of Hume. On the other side, there is the attempt to represent Hume's moral theory as a form of realism, i.e., a theory according to which there are moral properties belonging to actions, or the agents who perform them, which provide objective correlates of the feelings which those actions, or the agents concerned, induce in us as spectators. Now clearly an important part of what is at stake between these different interpretations is the question of how seriously we should take Hume's own description of this theory as one according to which moral distinctions are derived from a moral sense. It is characteristic of the Projectionist interpretation to suggest that 'sense' is equivalent here to 'sentiment', and, indeed, that Hume's moral sense theory is tantamount to the denial that there is anything in Objects' themselves corresponding to our moral (or aesthetic) sentiments. The Realist interpretation, on the other hand, stresses the importance of Hume's references in 62 the Treatise to a moral (and aesthetic) sense, and the precedent provided in this respect by Hutcheson; and it takes seriously the idea that this sense enables us to become acquainted, via the sentiments involved, with the qualities of virtue and vice. My own interest in these different interpretations concerns their disagreement about the way in which we should understand Hume's notion of a moral sense. I wish to argue against the Projectionist interpretation, and its dismissive treatment of Hume's references to a moral sense, though it is a further question whether the view of Hume which emerges deserves the name of 'Realism'. 1. The Projectionist Interpretation It seems clear that the notion of a moral sense cannot be intended literally, i.e., as though there is a form of moral sense-perception strictly comparable to the modes of perception provided by the external senses. It is, presumably, part of the definition of a sense that it is a faculty whose function depends upon stimulation of an organ or, at least, receptors peculiar to that sense; and, furthermore, in the case of the various external senses there is -- except for the contact sense of touch -- a distinctive medium of perception. For both these reasons moral sense theorists can only be proposing an analogy with the external senses. In Hume's case in particular, however, there appear to be reasons for doubting whether the analogy can be more than superficial. Perhaps the most obvious of these lies with Hume's insistence on the action-guiding character of the distinction between moral good and evil (see e.g., T 437-462). For it seems clear that sense-perceptions g as such can have no direct influence upon our actions. 63 Then there is Hume's denial that morality consists in any matter of fact (T 468; EPM 292). If virtue and vice are to be considered the objects of some form of moral sense-perception their existence presumably does become a matter of fact. Finally, a moral sense theory seems to imply that judgements of virtue and vice are straightforwardly true or false, according to whether or not we perceive veridical Iy; while Hume's own discussion sometimes points to a non-propositional view of moral utterances as the expression of certain feelings or sentiments. These last two points remind us that Hume often appears to deny that values belong as intrinsic properties to the objects evaluated. This is obviously true of the following, much quoted, passage: Take any... (shrink)

Conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest (40% of physicians in Florida invest in medical centers); for hospitals to offer incentives to physicians who refer patients (a practice that can lead to unnecessary hospitalization); or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs (which are much more expensive than (...) generic drugs). In Medicine, Money and Morals, Marc A. Rodwin draws on his own experience as a health lawyer--and his research in health ethics, law, and policy--to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals --lawyers, government officials, and businessmen--all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change. (shrink)

continent. 1.1 (2011): 27-32. “My”—what does this word designate? Not what belongs to me, but what I belong to,what contains my whole being, which is mine insofar as I belong to it. Søren Kierkegaard. The Seducer’s Diary . I can’t sleep till I devour you / And I’ll love you, if you let me… Marilyn Manson “Devour” The role of poetry in the relationalities between people has a long history—from epic poetry recounting tales of yore; to emotive lyric poetry; to (...) rude, irreverent limericks; to Hallmark cards which have ditties that allow one to cringe, and somehow fall in love at the same moment. Without going into a notion of aesthetics, or attempting to choose which form of poetry is superior, we might want to consider why the form of poetry itself has long been a part of relationality. And whilst doing so, we might always keep in mind that poetry—especially poetry that moves, transports us—is the form that Plato has been warning us about, particularly if we want to become good citizens.As Avital Ronell teaches us in Stupidity : the poet, irremediably split between exaltation and vulgarity, between the autonomy that produces the concept within intuition and the foolish earthly being, functions as a contaminant for philosophy—a being who at least since Plato, has been trying to read and master an eviction notice served by philosophy. The poet as genius continues to threaten and fascinate, menacing the philosopher with the beyond of knowledge. Philosophy cringes (287). And considering that the philosopher is the lover of wisdom, we might begin to ask ourselves why one lover is warning against another—if the philosopher is in love with wisdom, then is the poet perhaps his rival, his challenger, for that very love? For, one must also remember that Plato—through Socrates—mentions constantly that Homer is his favourite. Moreover, by adopting both his own voice, whilst mixing it with Socrates’, Plato is adopting the form of poetry that he warns most about—the warning almost serves more as a homage to poetry than anything else. Here, we might open the register that one of the main reasons that he ejects a particular kind of poet is on the grounds of effecting effeminacy on the populace—good poetry moves you, affects you, transports you, shifts you beyond reason, puts you “out of your mind.” However, Plato also teaches us that rhetoric in its highest form requires divine inspiration by way of the daemon, or the muse. This moment of divine intervention is one that seizes—perhaps even ceases—you; putting you “beyond yourself.” In other words, a good rhetorician must always already be open to the possibility of otherness—the same otherness that possibly resides in the feminine. One could also trace this back to the poet that he both loved, and feared, most—Homer. Perhaps the effect of effeminacy that Homer's poetry opened is precisely the source of its power: through listening to Homer, one's body, one’s habitus is opened to the possibility of the feminine. And here, one must remember that the source of all learning—and all teaching—also lies in mimesis, in repetition, in habit. Once the habitus is opened to the possibility of invasion, of intervention, of otherness, there is quite possibly no possibility of distinguishing whether the mimesis is that of reproduction, or if there is always already a productive aspect to it. And by extension, if learning cannot be controlled, the very notion of teaching itself is shifted from a master-student relationality to one where the master is potentially changed as well—the relationality between the master and the student is not only inter-changing, but one cannot even know who is teaching, or learning, at any point. All that can be said is that they are in a relationality; which means that one is ultimately unable to locate the locus of knowledge, of wisdom—the site of which Plato is attempting to convince us is the sole domain of the philosopher. And it is this that philosophy is cringing from. To compound matters, philosophy is striving for wisdom; which can only come from the Gods. In other words, this is a gift that has to be bestowed on them—and more than that, wisdom is always already exterior to one’s control and knowledge. At best, it is the role of one to recognise the gift, to answer the call as it were. Here, if we listen carefully, we can hear the echo of Alexander Graham Bell, and the telephone. And as we are attempting to respond to the call of wisdom—the call that both poetry and philosophy are listening out for—it might be helpful to recall the agreement between Alexander Graham Bell and his brother Melville. In the biography, Alexander Graham Bell and the Conquest of Solitude , Robert V. Bruce notes that Aleck and Melly made a “solemn compact that whichever of us should die first would endeavour to communication with the other if it were possible to do so” (63). Since Melville was the one who passed on first, this pact put the onus on Aleck to receive the call of his brother. If you take into consideration the fact that until Melville’s death, both brothers had been working on an early prototype of the telephone, the instrument of distant sound can be read as an attempt by Aleck to maintain the possibility of keeping in touch with Melly, of hearing the voice from beyond. However, this was a connection that was not premised on any knowing, reason, or rationality; it was rather, one that was based on hope, and born out of love. And here, if we eves-drop on a cross-line with The Telephone Book , we can pick up the voice of Avital Ronell once again and hear, “the connection to the other is a reading—not an interpretation, assimilation, or even a hermeneutic understanding, but a reading” (380). In other words, the telephone can be read as the openness to the possibility of responding to the other; one that might always remain unknown. Even in this day of caller-identification, we can never know for sure who the other person on the line is until we pick up: hence, the only decision we can make—the effects of which we remain blind to until it affects us—is to either pick up or not, to either respond or not. And it is not as if the decision to pick up comes without risks: each time we answer a call, we run the risk of it ruining our day. Even when we don’t know who the caller is, perhaps especially when we don’t know who the person on the other end of the line is—and here one only has to think of prank calls—we are leaving ourselves completely open to being affected by another. Thus, philosophy finds itself in the position of Vladimir and Estragon. Since they have no idea who Godot is, they can never know if or when he shows up—thus, if he (and we are taking his gender on the word of the boy, some boy—we don’t even know if it is the same boy—who comes round in the evening) has already come, they would not be in the position to know it. And even if someone comes to them and announces that “I am Godot,” the wait would not be over—without referentiality to the name, they would have to take on faith that that person is indeed Godot. Hence, all they can know is that they are waiting for Godot; and Godot is the name of that waiting itself. All philosophy can know is that it is waiting; and wisdom is the name of that waiting itself. Which brings us to Tina Turner’s eternal question, “what’s love got to do, got to do with it?” In order to begin to consider that, we have to first attempt to examine the notion of love itself. Perhaps we might begin to consider what the difficulty of the statement “I love you.” For, if love is a relationality between two persons—both of whom remain singular, and are attempting to respond to each other—this suggests that neither of them subsume the other under themselves. In other words, the other remains wholly other. If this is so, then the “you” in the statement always remains shrouded in mystery. And even if the “you” was replaced with the name of the person, the veiling remains: for, names refer both to the singularity that is the person, and also every other person bearing that name, at exactly the same time. To compound matters, the only time one has to utter a persons name is in their absence—thus, the correspondence of a name to that particular person is at best an affect of memory. And if we consider the notion of memory, we have to also open the register of forgetting—bringing along with it the problem that there is no object to forgetting. For instance, when one utters “I forgot,” all one is uttering is the fact that one has forgotten, and nothing more—the moment there is an object to the statement, one has strictly speaking remembered what one has forgotten. Moreover, we have no control over when forgetting happens to us. And since it is always already exterior to us, affects us, and has no necessary object, there is no reason to believe that every moment of memory might not bring with it a moment of forgetting. Hence, whenever we utter a name—even if we accept the correspondence between the utterance and the person in front of us—all we are doing is uttering the fact that we are naming. Thus, it is not so much that ‘a rose by any other name would smell as sweet’ but more appropriately, ‘a rose is a rose is a rose’—the relationality between its name and the phenomenon of its sweet smell can only be established after that moment of naming, that instance of catachresis. So, whenever one utters “I love you,” not only is it a performative statement, it is the very naming of that love—all you are doing is establishing a relationality between you and the other. And since there is no necessary referent—one is naming that referentiality as one utters it—this suggests that it is always already a symbolic statement; without which the mystery of the other cannot me maintained. In other words, one cannot love the other without maintaining this symbolic distance—through a ritual; in this case the utterance “I love you.” This might be why Valentine’s Day seems to provoke such a massive reaction: the most common one from people (besides florists) being, Valentine’s Day is mere commercialism. Those among the nay-sayers who maintain a soft spot for Karl Marx would proceed to call it the commodification of relationships; those who prefer the Gods would claim that the sanctity of relationships has been profaned; the gender theorists would note how the fact that males buy the gifts only serves to highlight the unequal power-relation between the genders. Whichever side and variation of the arguments they choose boils down to this: the discomfort lies in the fact that they are confronted with the notion of relationships moving into a mediated sphere. The underlying logic is that love is between two persons only; it should not only remain between them, but more pertinently, be an unmediated experience between two persons. Which of course completely misses the point. For, if we reopen the register that relationships are the result of a negotiation between two persons, there must then be a space between them for this very negotiation to occur. Otherwise, all that is happening is, one person is subsuming the other within their own sphere of understanding; effectively effacing the other. If that were the case, there would no longer be any relationality; all negotiation is gone and the other person is a mere extension of the self—one is in a masturbatory relationality with one’s imaginary. Hence, any relationship must always already carry with it the unknown, and possibly always unknowable. The other person is an enigma, remains—must remain—enigmatic to you. This is the only way in which the proclamation “I love you” remains singular, remains a love that is about the person as a singular person—and not merely about the qualities of the person, what the person is. For, if the mystery of the other is unveiled, then the love for the other person is also a completely transparent love: one that you can know thoroughly, calculate; a check-list. And if they are knowable, this suggests that they can also be negated, and hence, the love can also go away. Only when the love for the other person is an enigmatic one, one that cannot be understood, can that love potentially be an event—and if it is an event, then strictly speaking, it cannot be known before it happens; at best, it can be glimpsed as it is happening, or perhaps even only realised retrospectively. At the point in which it happens, it is a love that comes from elsewhere: this strange phenomenon is best captured in the colloquial phrase, I was struck by love;” or even more so by, “I was blinded by love.” This is a blinding to not only the subject of the encounter—the self—but also of the very object of that encounter, the “you”—all that can be said is that there is an encounter. And it is for this reason Cupid is blind: not just because love is random (and can happen to anyone at any time), but more importantly because even after it happens, both the reason you are in love, and the person you are in love with, remain blind to you. Since there is an unknowable relationality with the other person, the only way you can approach it is through a ritual. This is the lesson that religions have taught us: since one is never able to phenomenally experience the God(s), one has no choice but to approach them symbolically. These rituals are strictly speaking meaningless—the actual content is interchangeable—as it is the form that is important. Rituals allow us momentary glimpses at secrets; and secrets are never about their content(s). Rather, secrets entail the recognition that they are secrets; the secret lies in their form as secret. This can be seen when we consider how group secrets work: since the entire group knows the secret, clearly the content of the secret is not as important as the fact that only members within the group are privy to this secret. Occasionally the actual content can be so trivial that even other people outside the group might know the information; they just do not realize its significance. For instance, if I used my date of birth as my bank-account password, merely knowing when I was born would not instantly give you the key to my life savings. In order for that to happen, you would have had to recognise the significance of the knowledge of my birthday. This means that you have to know that you know something. Since the God(s) are, strictly speaking, unknowable, this suggests that rituals put one in a position to potentially experience the God(s). The meaningless gestures on Valentine’s Day play precisely this ritualised role. It is not so much what you give the other person, but the fact that you give it to them. The gift in this sense is very much akin to an offering; the gift opens the possibility of an exchange. Gift-giving does not guarantee that you will like what is returned; there is always a reciprocation of the gift, but what is returned to you is never known in advance, until the moment it is received. This means that the worst thing that one can do is not give the gift: that would be akin to a cutting off of all possibilities, a complete closing of all communication with the other person. This at the same time also means that you cannot wait for the other person to give you something before you get them their gift: if that were the scenario, the reciprocal gift would be nothing more than a calculated return. The only manner in which both persons can give true gifts is to offer them independently of the other person, whilst keeping them in mind. In this way, the two gifts are always already both uncalculated (in the sense of not knowing what the return is) and also a reciprocation for the other (without knowing whether the other person actually has a gift in the first place). Naturally, this would seem like an irrational, even stupid, way of buying gifts. But it is precisely the stupidity involved that saves the relationship from being banal—more importantly, stupidity prevents it from entering the mere profane. This is not to say that an enigmatic love cannot end—of course it can. However, the difference lies in the fact that if the relationality is wholly transparent, it is subsumed under reason—completely predictable, within the self, and thus never open to the possibility of otherness, exteriority, musing. A love that is an event is one that is also open to the possibility of the divine, the sacred—always already closer to the possibility of wisdom. If we establish that both love and wisdom are exterior, to our knowledge, and the finitude to our selves, this suggests that both are names for the possibility of openness to otherness. In other words, and what choice do we have here but to use the words of the other, the philosopher—the lover of wisdom—is a name for one who is waiting, and nothing more. But that still leaves us with the question of this uncomfortable relationality between philosophy and poetry. But before we address that question, we have to take a momentary detour, and consider the whether it is possible to call one a poet. For, if we take the notion of a poet to be one who reaches the highest levels of rhetoric (beyond the lawyer, and the orator, who only aim to either please the crowds, or convince by way of sophistry), then we must also acknowledge that one can only become a poet at the moment of seizing, the point of inspiration, by the muses. Without this divine moment, all (s)he can do is practice her craft. As no one can control when the muses make their appearance, one could always be practising in vain—in some way, one is always already practising to be least in the way when the muse whispers into one’s ear; one is practising so as not to be vain. And since one cannot know when the muse will appear, there is no time frame to the practising—unlike the lawyer who speaks against a clock, poetry knows no time; the only time that matters is the time appropriate to poetry itself. Thus, all the poet (if one can use this term) is practising for the possibility of effacing her/him self—and waiting. Thus, in order for poetry to occur, in order to be seized, the poet—along with all her concerns—must cease. In other words, there is no poet; there is only the possibility of poetry. However, even as there is no time frame to this waiting, even as all we can say is that poetry is a name for waiting, the one who is practising is always already also in time. And since (s)he is in a symbolic relationality with the possibility of poetry, this suggests that the practising is her sacrifice, and time is precisely what she is sacrificing. Here, it might be helpful to turn to a strange source when it comes to poetry—Georges Bataille—and consider his teachings in the first volume of The Accursed Share where he reminds us that, the “essence [of sacrifice] is to consume profitlessly .” This is where each exchange is beyond rationality, beyond calculability, beyond reason itself, “unsubordinated to the ‘real’ order and occupied only with the present.” He continues: Sacrifice destroys that which it consecrates. It does not have to destroy as fire does; only the tie that connected the offering to the world of profitable activity is severed, but this separation has the sense of a definitive consumption; the consecrated offering cannot be restored to the real order.” (58) Since there is no need for a physical change in the object of sacrifice—“it does not have to destroy as fire does”—this suggests that the tie is severed symbolically. Hence, there is an aspect of trans-substantiation in this sacrifice: the form remains the same; in fact there is no perceivable change—this is the point at which all phenomenology fails—but there is always already a difference, an absolute separation from the “real order,” from logic, calculability, reason. The object of sacrifice, the victim [,] is a surplus taken from the mass of useful wealth…Once chosen, he is the accursed share , destined for violent consumption. But the curse tears him away from the order of things…” (59). And it is this tearing away from the order of things—the order of rationality—that “restores to the sacred world that which servile use has degraded, rendered profane” (55). For, only when it is no longer useful, when it is no longer abstracted—subjected, subsumed under—merely a use-value, can the object be an object as such, can a subject be a subject as such; be a singularity. Thus, it is never so much who or what is sacrificed, but the fact that there is a sacrifice. So even as (s)he is sacrificing her time to poetry, it is always already beyond her knowledge whether what (s)he is doing is actually preparing her for poetry or not—all (s)he can know is that she is sacrificing and nothing more. Hence, all (s)he can do is to open her self to the possibility of this relationality—all (s)he can do is be in love with poetry. At the moment the muse whispers into her ear, (s)he ceases to be, and becomes a medium for poetry—and since this possession is always already beyond our cognitive knowledge, this is also a moment of divine wisdom. In other words, there is no difference between poetry and wisdom—the moment of poetry is the moment of wisdom. And this might be the very reason for the philosopher’s aversion to poets. Not so much because they may corrupt the youth (this is after all the aim of all thinking, all philosophy), but precisely because in order to do so, the philosopher must wait for a moment of possession, for divine musing, for poetry. Hence, all thought, all thinking, all philosophy, is nothing but the waiting for the possibility of poetry itself. (shrink)

Being attentive to the needs of others, feeling responsible for each other, and taking care are necessary elements for the good life. Care, however, is a fragile activity: it is hard to predict its results. In this article, Homer's story of the Phaeacians bringing Odysseus back to Ithaca is interpreted to investigate what care could be when we admit the fragility of care. We consider two theoretical perspectives on care to interpret the story, namely Martha Nussbaum’s Aristotelian ethics, (...) and the Ethics of Care approach of authors like Ruddick, Sevenhuijsen, Tronto, Verkerk and others. In the first approach, the emphasis is on the attitude of care; in the second, on care as a social practice. Following Nussbaum, the caring response of the Phaeacians can be understood as an example of what Aristotle called ‘practical rationality’. The unexpected result of their care – they come into conflict with Poseidon – shows the fragility of human life and the tragic condition of humanity. According to Nussbaum, one should take responsibility for the fact that choosing for the one implies neglecting the other . From the perspective of Ethics of Care, the caring response is not so much the result of individual virtues; it is rather an element of a care practice that motivates people to act in conformity with basic values like solidarity and responsibility. The fragility of care is regarded as an ordinary quality of praxis and humanity rather than something essentially tragic. In the process of caring, misfortunes can never be totally prevented. Whenever they happen, they should be used as a way to learn and develop more adequate ways of handling the situation. The comparison of the two perspectives, both inspired by Aristotle's philosophy, gives rise to a richer view of the fragility of care. (shrink)

HSÜN Tzu's essay on "Rectifying Terms" is justly considered a work of "great logical interest." For in this essay, one finds a remarkably modern concern with such topics as the rationale for having terms; the empirical and pragmatic bases for the classification of terms; the formation of generic and specific terms; the importance of observing established linguistic practices; the necessity of complying with proper standards for the institution, ratification, and regulation of the uses of language ; the nature of (...) argumentative discourse ; and the problems inherent in successful linguistic communication. A careful examination of some passages in other essays also suggests an awareness of the distinction between deductive, inductive, and analogical inferences, though Hsün Tzu provides us no explicit discussion of the nature of reasoning and its validating rules. (shrink)

Research indicates the essentiality of dignity as a vital component for quality of life, reconfirming the emphasis on dignity preservation in the international code of nursing ethics. Applying Noblit and Hare’s meta-ethnography, the aim of the study was to develop a theory model by synthesizing 10 qualitative articles from various cultural contexts, exploring nurse and allied healthcare professional perception/practice concerning dignity-preserving dementia care. “Advocating the person’s autonomy and integrity,” which involves “having compassion for the person,” “confirming the person’s worthiness (...) and sense of self,” and “creating a humane and purposeful environment,” was identified as a primary foundation for dignity-preserving dementia care. “Balancing individual choices among persons no longer able to make sound decisions, against the duty of making choices on behalf of the person,” which involves “persuasion” and/or “mild restraint,” was considered a crucial aspect in certain situations. “Sheltering human worth—remembering those who forget” was identified as a comprehensive motive and core value within dignity-preserving dementia care. (shrink)

A critic of utilitarianism, in a paper entitled “Innocence and Consequentialism” Laing argues that Singer cannot without contradicting himself reject baby farming (a thought experiment that involves mass-producing deliberately brain damaged children for live birth for the greater good of organ harvesting) and at the same time hold on to his “personism” a term coined by Jenny Teichman to describe his fluctuating (and Laing says, discriminatory) theory of human moral value. His explanation that baby farming undermines attitudes of care (...) and concern for the very young, can be applied to babies and the unborn (non-persons on his view) and contradicts positions that he adopts elsewhere in his work. (shrink)

Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical terms on (...) which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery."Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education. (shrink)

What motivates grandparents to their altruism? We review answers from evolutionary theory, sociology, and economics. Sometimes in direct conflict with each other, these accounts of grandparental investment exist side-by-side, with little or no theoretical integration. They all account for some of the data, and none account for all of it. We call for a more comprehensive theoretical framework of grandparental investment that addresses its proximate and ultimate causes, and its variability due to lineage, values, norms, institutions (e.g., inheritance laws), and (...) social welfare regimes. This framework needs to take into account that the demographic shift to low fecundity and mortality in economically developed countries has profoundly altered basic parameters of grandparental investment. We then turn to the possible impact of grandparental acts of altruism, and examine whether benefits of grandparental care in industrialized societies may manifest in terms of less tangible dimensions, such as the grandchildren's cognitive and verbal ability, mental health, and well-being. Although grandparents in industrialized societies continue to invest substantial amounts of time and money in their grandchildren, we find a paucity of studies investigating the influence that this investment has on grandchildren in low-risk family contexts. Under circumstances of duress there is converging evidence that grandparents can provide support that helps to safeguard their children and grandchildren against adverse risks. We conclude by discussing the role that grandparents could play in what has been referred to as Europe's demographic suicide. (shrink)

For at least the past several decades, medicine has been embroiled in a crisis concerning the nature of its professionalism. The fundamental questions that drive this ongoing crisis are primarily three. First, what is the nature of medical professionalism? Second, who are medical professionals? Third, what does medicine or these professionals profess or promise? In this paper, the professionalism crisis vis-à-vis these questions is examined and analyzed chiefly in terms of both Francis Peabody’s and Edmund Pellegrino’s writings. Based on their (...) writings, I introduce a conceptual framework for professionalism to address the crisis. In addition, I contend that to address the professionalism crisis adequately, medicine’s position within an evolving health care network must also be considered. To that end, I first discuss the genesis of the crisis in terms of the Flexner Report and especially Peabody’s response to it. Next, I explore how the crisis intensified during the twentieth century, particularly in terms of medicine’s ultimate scientification and eventual commercialization, and how Pellegrino reacted to this. I then propose a health care professionalism cycle and a care-competence cycle to provide a conceptual framework for addressing the crisis. I conclude that medicine’s position is no longer as the center of health care but rather as another node within a wider evolving health care network. And the resolution of medicine’s professionalism crisis depends on medicine’s positioning and defining itself in terms of the professionalism for each of the other professions within the health care network. (shrink)

Section 47 of the National Assistance Act is controversial in that it makes provision for the compulsory removal and care of mentally competent adults in certain limited circumstances. A case is described in which it is argued that compulsory management could be justified. This is because the diversity and potentially conflicting nature of the relevant considerations involved in this and a restricted range of other cases, defies their being captured in any wholly rational moral scheme. It follows that if the (...) law is to be both sensitive and just it cannot always provide definitive guidance as to how the community doctor, as the designated decision-maker, should act. The acceptance of his or her judgement is therefore necessary and depends for its proper working on trust, which can only be gained through compassion and respect for the patients concerned. (shrink)

In this companion volume to their 1981 work, A Philosophical Basis of Medical Practice, Pellegrino and Thomasma examine the principle of beneficence and its role in the practice of medicine. Their analysis, which is grounded in a thorough-going philosophy of medicine, addresses a wide array of practical and ethical concerns that are a part of health care decision-making today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decision-making, quality-of-life determinations, (...) the allocation of scarce health care resources, medical gatekeeping, and for-profit medicine. The authors argue for the restoration of beneficence to its place as the fundamental principle of medical ethics. They maintain that to be guided by beneficence a physician must perform a right and good healing action which is consonant with the individual patient 's values. In order to act in the patient 's best interests, or the patient 's good, the physician and patient must discern what that good is. This knowledge is gained only through a process of dialogue between patient and/or family and physician which respects and honors the patient 's autonomous self-understanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patient 's good rejects the assumption long held in medicine that what is considered to be the medical good is necessarily the good for this patient. In viewing autonomy as a necessary condition of beneficence, the authors move beyond a trend in the medical ethics literature which identifies beneficence with paternalism. In their analysis of beneficence, the authors reject the current emphasis on rights- and duty-based ethical systems in favor of a virtue-based theory which is grounded in the physician- patient relationship. This book's provocative contributions to medical ethics will be of great interest not only to physicians and other health professionals, but also to ethicists, students, patients, families, and all others concerned with the relationship of professional to patient and patient to professional in health care today. (shrink)

Substance use disorders (SUDs) constitute a growing global health crisis, yet many limitations and challenges exist in SUD treatment research, including the lack of objective brain-based markers for tracking treatment outcomes. Electroencephalography (EEG) is a neurophysiological technique for measuring brain activity, and although much is known about EEG activity in acute and chronic substance use, knowledge regarding EEG in relation to abstinence and treatment outcomes is sparse. We performed a scoping review of longitudinal and pre-post treatment EEG studies that explored (...) putative changes in brain function associated with abstinence and/or treatment in individuals with SUD. Following PRISMA guidelines, we identified studies published between January 2000 and March 2022 from online databases. Search keywords included EEG, addictive substances (e.g., alcohol, cocaine, methamphetamine), and treatment related terms (e.g., abstinence, relapse). Selected studies used EEG at least at one time point as a predictor of abstinence or other treatment-related outcomes; or examined pre- vs. post-SUD intervention (brain stimulation, pharmacological, behavioral) EEG effects. Studies were also rated on the risk of bias and quality using validated instruments. Forty-four studies met the inclusion criteria. More consistent findings included lower oddball P3 and higher resting beta at baseline predicting negative outcomes, and abstinence-mediated longitudinal decrease in cue-elicited P3 amplitude and resting beta power. Other findings included abstinence or treatment-related changes in late positive potential (LPP) and N2 amplitudes, as well as in delta and theta power. Existing studies were heterogeneous and limited in terms of specific substances of interest, brief times for follow-ups, and inconsistent or sparse results. Encouragingly, in this limited but maturing literature, many studies demonstrated partial associations of EEG markers with abstinence, treatment outcomes, or pre-post treatment-effects. Studies were generally of good quality in terms of risk of bias. More EEG studies are warranted to better understand abstinence- or treatment-mediated neural changes or to predict SUD treatment outcomes. Future research can benefit from prospective large-sample cohorts and the use of standardized methods such as task batteries. EEG markers elucidating the temporal dynamics of changes in brain function related to abstinence and/or treatment may enable evidence-based planning for more effective and targeted treatments, potentially pre-empting relapse or minimizing negative lifespan effects of SUD. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:386 HISTORY OF PHILOSOPHY species of pragmatism, it could be said that there is indeed some justification for discovering analogies between the Heideggerian theory of truth and pragmatism. What is deplored by Vers6nyi is the loss of the concrete significance of tIeidegger's early theory of truth (as Vers~nyi characterizes it) and its replacement by a conception of truth which is paradoxical and ultimately fruitless for an understanding of the (...) world in which man finds himself. If Being is the groundless Ground, the Wholly Other, and if Being is truth, then truth is inaccesible to man. Truth, in Heidegger's later works, is beyond the finitude of self-reflective thought and can only be approached by means of a via negativa. This, however, is described as the "abandonment of reason." This critical analysis of Heidegger's thought is an interesting and challenging work which attempts a much needed appraisal of Heidegger's philosophical "voyage" from Being and Time to Gelassenheit. Some will be angered by the author's incisiveness; some will applaud his hostility to the dissolution of reason in mysticism; none can be indifferent to this valuable contribution to the study of Heidegger. GEORGEJ. STACK Long Island University A Short History o] Ethics. By Alasdair MacIntyre. (New York: The Macmillan Co., 1966. Pp. viii + 280 $4.95.) Professor MacIntyre's Short History o] Ethics turned out, to my surprise and pleasure, to be a quite different book from what I had expected. I had assumed from its title that it would consist of an exposition, analysis, and perhaps criticism of the theories of the standard great figures from the history of Western moral philosophy, stitched together by a thin thread of historical narrative. It does contain this standard material and the quality of exposition and analysis is very high. But there is much more to the book than that. For in it MacIntyre devotes a great deal of space to political and social philosophy, with discussions of figures like Machiavelli, Locke, Montesquieu, Rousseau, and Marx. Another subject that gets a good deal of attention is religion, including such writers as Luther, Calvin, and Kierkegaard. Even further afield, Professor MacIntyre surveys the beliefs and activities of certain social reformers---for example, the Diggers and Levellers in 17th century England--and the developments and changes in the moral attitudes and relationships of people in certain societies--for example, in ancient Greece. The result is a book that is very rich and varied in content, fascinating to read, and informative. Anyone, student or teacher, who is interested in technical ethics would be well advised to study it. Maclntyre has reasons for giving his book the wide scope it has. For he believes that ethics is a broad subject, concerned with the whole range of man's activities as a practical being. He rejects the notion currently popular that ethics should be a second-order undertaking, morally neutral in itself and limiting its activities to the logical analysis of first-order moral utterances (p. 3). The ethicist cannot, he believes, divorce himself from the social setting in which he lives, taking up a neutral position above the fray, because the very concepts he uses in his thinking and writing are "embodied in and are partially constitutive of forms of social life" (p. 1). The moral philosopher, in other words, is and must be articulating a set of beliefs and ideals that arise out of the general social and historical setting of which he is a part. To understand and appreciate his theories, therefore, we must be conversant with the social organization, political structure, and religious faith of his society. For it is only within this broad context that the concepts that any given ethicist employs become intelligible. MacIntyre's view seems to have one very controversial implication, on which I should like to comment. If the concepts employed by the ethicist are embodied in a given form of social life, then no ethical theory can transcend its historical setting, hence the question, Is a given ethical theory true or false? cannot legitimately be asked. The result is historical BOOK REVIEWS 387 relativism. MacIntyre recognizes this implication and has a good deal to... (shrink)

Evidence based medicine has had an increasing impact on primary care over the last few years. In the UK it has influenced the development of guidelines and quality standards for clinical practice and the allocation of resources for drug treatments and other interventions. It has informed the thinking around patient involvement in decision making with the concept of evidence based patient choice. There are, however, concerns among primary care clinicians that evidence based medicine is not always relevant to primary care (...) and that undue emphasis placed on it can lead to conflict with a clinician’s duty of care and respect for patient autonomy. In this paper we consider the impact of evidence based medicine on primary care, and the ethical implications of its increasing prominence for clinicians and managers in primary care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:MATERNAL COMPASSION IN THE THOUGHT OF RENÉ GIRARD, EMIL FACKENHEIM, AND EMMANUEL LÉVINAS Ann W. Astell Purdue University l;ike empathy, compassion is a word that seldom occurs in the /writings of René Girard,' who prefers to answer to Martin Heidegger's "anxiety" [Die Sorge] before death by speaking instead of a "concern for victims" [le souci des victims].2 Maternal corn-passion does enter Girardian analysis directly, however, in (...) his discussion ofthe biblical good harlot, a compassionate mother whom Girard calls "the most perfect figura Christi that can be imagined" (1978, 241). In this paper I focus on the neglected theme of maternal compassion in the writings of Girard, letting them enter into conversation, first, with Emil Fackenheim's reflections on the plight and actions of Jewish mothers during the Holocaust and, second, with themes sounded in the philosophy of Emmanuel Lévinas. I argue that maternal compassion is actually central to Girard's understanding of the unveiling of the victimage mechanism, because it sees goodness in the very life of every potential victim, regardless ofwhat that person has done or is capable ofdoing, simply because he or she exists, has a face. The "innocence" of every victim is reducible to the innocence of the infant, because an infant within a sacrificial system can substitute for every other possible victim. The infant and, even more, the unborn bring us back to the very origins of life, to the Creator. There 1 On empathy and Girard, see my "Saintly Mimesis, Contagion, and Empathy." " See James William's comment on this topic in René Girard, ISee Satan Fall Like Lightning (177, note 4). The locus classicus for Martin Heidegger's "anxiety" is his Being and Time, sections 39-42. 16Ann W. Astell is, as Plato asserts and Lévinas reminds us, a "Good beyond being" that, on a transcendent plane, constitutes the "innocence" ofevery human being that lives, protesting against any one's murder. To illustrate the triangulation of desire, the rivalry of doubles, the mimetic crisis, and its possible outcome in victimage, René Girard turns to the famous biblical story ofthe judgment of Solomon in 3 Kings 3:16-28. In that story two women, two harlots, approach the king, each claiming to be the mother ofa single, living infant, over whom they are fighting. "The symmetry is obvious," Girard writes, "and it represents the very essence of human conflict" (1978, 238). Unable to determine the truth ofthe case on the basis of their conflicting testimonies, the wise king tests them by proposinga sacrificial solution that parodies distributivejustice. He decides to cut the baby in half, giving each woman an equal share, the symmetrical division ofthe victim mirroring the symmetry between the litigants. "The Latin word decidere," Girard notes, "mean etymologicalIy to divide by the sacrificial knife, to cut the throat of a victim" (1978, 238). The proposed sacrifice is averted because its horrific promise of an equal apportionment of parts of the baby's body—a sameness that would confirm the two as doubles—reveals a significant difference between the two women. According to the usual reading of the passage, one of the mothers, having (either deliberately or accidentally) killed her own baby by smothering him, lacks any genuine love for the other woman's infant. As Girard explains, "The only thing that counts for her ispossessing what the other onepossesses. In the last resort, she is ready to accept being deprived ofthe child as long as her opponent is deprived of it in the same way.... All that counts is her fascination with her hated model and rival" (1978, 239). The other woman, however, filled with yearning for the life ofthe child to whom she has given birth, reveals herself to be its true mother by renouncing her maternal rights in a passionate plea: "I beseech thee, my lord, give her the child alive, and do not kill it" (3 Kings 3:26). Commenting on the passage, Girard characterizes the values of the false mother as sacrificial, those ofthe good mother as anti-sacrificial. With reference to the child whose fate hangs in the balance, the distinction is clear enough. The true mother begs for the baby... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:141. ON HARRISON'S INTERPRETATION OF TREATISE III ii 1 In Treatise III ii 1, Hume is concerned to argue that justice is an artificial virtue, not a natural one. Commenting on this Section, Jonathan Harrison has pointed out that, on his reading and interpretation, Hume's argument runs into many difficulties. I shall argue in this paper that a more sympathetic reading of Hume will show that his argument is (...) a whole lot more plausible than Harrison takes it to be. Harrison raises many separate points, but instead of taking up these points one by one, I shall concentrate on one that seems to be most serious, and to lie at the heart of his criticism. The point is as follows. Hume's argument, designed to prove that justice is an artificial virtue as opposed to natural, proves too much: '(It) proves that justice is not a virtue at all' (HTJ 6). According to Harrison, Hume's first premise is [1] That actions are not duties unless there is in the mind of man a motive which normally prompts him to perform them, and the second premise is [2] That there is in the mind of man no motive which normally prompts him to perform just actions ( ibid. ) Harrison goes on to argue that we can derive from these two premises the 'embarrassing conclusion' that 'it cannot be a duty to perform just actions,' or that 'justice is not a virtue at all.' If Hume did indeed assert [1] and [2], the embarrassing conclusion would seem to follow. I shall argue that there is more than meets the eye as regards [1], and that Hume does not assert [2], 142. It would appear that in attributing [1] to Hume, Harrison has the following passage in mind: (It) may be establish'd as an undoubted maxim, that no action can be virtuous, or morally good, unless there be in human nature some motive to produce it, distinct from the sense of its morality (T 479). As I interpret this passage, the main point of the maxim is that the virtuousness of an action resides not in the sense of the morality of the action, as this is clearly circular, but in some other motive. This maxim does imply [1] above provided that we take Harrison's 'actions are not duties' to mean 'actions are not virtuous,' and his 'motive' to mean 'motive other than a sense of duty or morality.' In general, however, Harrison's way of rendering the passage above is quite unsatisfactory because it obscures what Hume means by 'duty' and what for Hume renders an action virtuous. To clarify matters, we need to look more closely at Hume's maxim. The first thing to note is that, while it is not clear what Harrison means by 'motive, ' Hume clearly uses the term 'motive' to mean 'passion.' Hume talks about 'the motives that produced' actions (T 477, my emphasis). Given Hume's psychology of actions, it is obvious that Hume is talking about the passions that produced actions. The sense of morality or duty, or the moral sentiment, is itself a passion which is capable of producing actions, and can do so 'without any other motive' (T 479). However, what Hume stresses in the passage above is that it is not the sense of duty that gives an action a good moral character, but some other motive, or passion. Hume is saying that the sense of duty is a derivative passion: an action has to 143, be established as virtuous in the first place for there to be a sense of duty concerning that action, or a sense of its morality; and it has to be so established by some other motive of which the sense of duty can be said to be derivative. Hume spells this out explicitly when he talks about humane actions. Thus, it is the humanity that 'bestows a merit on the actions' (T 478), not a regard to this merit, or a sense of duty concerning the actions, which is 'deriv'd from the antecedent principle of humanity' ( ibid., my emphasis). Now a sense of duty or obligation has to be distinguished from... (shrink)

This article examines recent developments in the regulation of the medical profession in England, with particular reference to doctors working in the National Health Service (NHS). It is argued that the Health Act 1999 and associated government policies are bringing about a shift from a «light touch», self-regulatory paradigm to a government-driven, interventionist approach. It is suggested that the reason for the change is not simply a governmental concern with the quality and nature of care provided by doctors, but (...) more significantly, a concern with the cost of that care. The article offers a critique of the new regime, drawing on the socio-legal literature on regulation. Some aspects of the reforms ignore the need to persuade doctors to comply, and may therefore result in cheating or «creative compliance»; other aspects of the reforms provide doctors with opportunities to «neutralize» their impact. It concludes with an examination of the wider significance of the change in regulatory paradigm, and of the agenda for future research in this field. (shrink)

Institutional ethics committees (IECs) in health care facilities now create moral policy, provide moral education, and consult with physicians and other health care workers. After sketching reasons for the development of IECs, this paper first examines the predominant moral standards it is often assumed IECs are now using, these standards being neo-Kantian principles of justice and utilitarian principles of the greatest good. Then, it is argued that a feminine ethics of care, as posited by Carol Gilligan and Nel (...) Noddings, is an unacknowledged basis for IEC discussions and decisions. Further, it is suggested that feminine ethics of care can and should provide underlying theoretical tools and standards for IECs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume on Human Excellence Marie A. Martin Hume was, in important respects, still verymuch a part ofthe classical ethical tradition. This is something we tend to overlook because we come out of a distinctly modern moral tradition, and we normally approach Hume looking for answers to a set of questions that are distinct, and often far removed, from the central questions of the classical tradition. Yet, the classical aspects (...) of Hume's ethics are not irrelevant to contemporary moral debates. There is evidence in recent years of a growing discontent with all the permutations of the two dominant strands of contemporary moral thought, Kantianism and utilitarianism. The sort of radical critique found in the works of Maclntyre, the increasing popularity of communitarian theories, and the resurgence of interest in virtue ethics in general, and Aristotelianism in particular, are all indications of this discontent. What I wish to suggest is that Hume's moral thought might prove a rich source for those who are dissatisfied with the direction ofmodern moral theory, and especially for those who believe that there is something within the classical tradition of virtue ethics worth salvaging. For Hume is a virtue ethicist, albeit one in modern dress, who, poised between the ancients and moderns, self-consciously chose to align himself with the ancient tradition, asserting its superiority over the modern. The ancient moralists are, Hume claims, the "best models,"1 morals being the one science "inwhich theyare not surpassed by the moderns" (E 330). The aim of this paper is to take an initial step towards refocusing our view on the largely neglected classical aspects of Hume's moral thought. The relationship between Hume's moral thought and the classical tradition is both extensive and complex, and I do not pretend to do anything more in this paper than present the tip of the iceberg. But the tip I shall examine is central to all that lies below; it is Hume's conception ofhuman excellence. Virtue or Human Excellence Perhaps Hume's most complete description ofhuman excellence occurs in the conclusion ofAn Enquiry Concerning the Principles ofMorals. Hume presents us with the fictional character, Cleanthes, as one whom "a philosopher might select... as a model ofperfect virtue" (E 270). He is, Hume claims, "a man ofhonour andhumanity," one ofwhom "[e]very one, who has anyintercourse... is sure offair and kind treatment." His Volume XVIII Number 2 383 MARIE A. MARTIN "assiduous application... [and] quick penetration... prognosticate the greatest honours and advancement." His company is enjoyed by all because he has "so much wit with good manners; so much gallantry without affectation" and "so much ingenious knowledge." His "cheerfulness... runs through the whole tenor ofhislife, and preserves a perpetual serenity on his countenance, and tranquillity ofhis soul." Finally, "[h]e has met with severe trials, misfortunes as well as dangers; and by his greatness ofmind, was still superior to all ofthem" (E 269-70). In the Treatise, Hume offers a less specific, yet similar portrait of human excellence: when we enumerate the good qualities of any person, we always mention those parts ofhis character, which renderhim a safe companion, an easy friend, a gentle master, an agreeable husband, or an indulgent father. We consider him with all hisrelations in society; andlove orhate him, according as he affects those, who have any immediate intercourse with him. And 'tis a most certain rule, that if there be no relation oflife, in which I cou'd not wish to stand to aparticular person, his character must so far be allow'd to be perfect. If he be as little wanting to himselfas to others, his character is entirely perfect.2 Although there are numerous passages throughout Hume's works that paint the same general picture, I will offer only one more, his description of an ideally virtuous disposition from his essay, The Sceptic: that which leads to action and employment, renders us sensible to the social passions, steels the heart against the assaults offortune, reduces the affections to ajustmoderation, makes our own thoughts an entertainment to us, and inclines us rather to the pleasure of society and conversation, than to those ofthe senses.3 What is common to all these descriptions... (shrink)

Evidence based medicine has much to offer, but a great deal remains to be done to create a better understanding of what it can and cannot do.The term EBM , as we use it nowadays, was introduced in 1992 by the same group of people who, years before, founded the discipline called “Clinical epidemiology” .1 CE stemmed essentially from the idea of adapting and expanding epidemiological methods to medical and health care decision making; CE was in fact defined as “ (...) the discipline dealing with the study of the occurrence of medical decisions in relation to their determinants”.1CE has been very successful in illustrating new ways of teaching medicine and training health professionals, and has positioned itself around the notion that “critical appraisal skills” are yet another set of essential abilities which—in addition to the interpersonal, diagnostic, and prognostic skills—a good doctor should master. An important by product of CE was documentation which showed that much of the available evidence on diagnosis, prognosis, and treatment of diseases was of poor methodological quality and quite often of dubious transferability to everyday clinical practice.This led to a strong call for improving the scientific basis of clinical practice, which was seen as too often dominated by practices of unproven effectiveness. This was the background for the 1992 Journal of the American Medical Association article that first used the term “evidence based medicine”.2In essence, proponents of EBM said that “all medical action of diagnosis, prognosis, and therapy should rely on solid quantitative evidence based on the best of …. (shrink)

Institutional ethics committees in health care facilities now create moral policy, provide moral education, and consult with physicians and other health care workers. After sketching reasons for the development of IECs, this paper first examines the predominant moral standards it is often assumed lECs are now using, these standards being neo-Kantian principles of justice and utilitarian principles of the greatest good. Then, it is argued that a feminine ethics of care, as posited by Carol Gilligan and Nel Noddings, (...) is an unacknowledged basis for /EC discussions and decisions. Further, it is suggested that feminine ethics of care can and should provide underlying theoretical tools and standards for lECs. (shrink)

Next SectionAccess to medicines, vaccination and care in resource-poor settings is threatened by the emigration of physicians and other health workers. In entire regions of the developing world, low physician density exacerbates child and maternal mortality and hinders treatment of HIV/AIDS. This article invites philosophers to help identify ethical and effective responses to medical brain drain. It reviews existing proposals and their limitations. It makes a case that, in resource-poor countries, ’locally relevant medical training’—teaching primarily locally endemic diseases and practice (...) in scarcity conditions, training in rural communities and admitting rural students preferentially—could help improve retention. Locally relevant training would arguably diminish medical brain drain in five ways. It would (i) make graduates less attractive for Western employers, (ii) align graduates’ expectations with actual practice, diminishing ‘burn-out’, (iii) enhance the professional prestige of local practice, (iv) hold rotations in, and recruit applicants from, rural areas, which is known to improve retention there, and (v) create local career development options that attract practitioners to stay. Such educational reform may raise worries about poor-quality care, breach of the freedom of education and occupation, breach of the freedom of movement, unequal distribution of opportunities among students, hypocrisy and resistance from influential actors. We address these worries. (shrink)

This work belongs to what Adam Smith called "the theory of moral sentiments," in particular, it is concerned with the operation of sympathetic affections, which are termed "vicarious affects"; and their rationality and legitimate role in moral theory. Professor Rescher forcefully argues for the thesis that the crucial aspect of vicarious affects lies in their function as motivational factor or reason rather than as a cause of personal conduct. A formal machinery is proposed for the quantitative aspect of the workings (...) of vicarious affects and applied to the problem of the "prisoner’s dilemma." In the latter connection, Rescher shows with insight that there is really nothing paradoxical about the "prisoner’s dilemma." The apparent paradox arises only because the game theorist failed to distinguish sharply rationality and prudence. "It is a travesty... to construe rationality in terms of prudential self-advantage, for there is nothing in any way inherently unreasonable or irrational about a concern for others." "There is no reason why ’self-interest’ should not be construed in an enlightened and widened sense to include the interests of others, through the operation of the vicarious affects." Rescher also points out that there are two alternatives, other than prudence, to the "solution" of conflict interaction situations, i.e., negotiation and impartial arbitration, when both are construed as tacit rather than explicit processes. One chapter is devoted to a fuller analysis and defense of the "impartial arbiter" approach as superior to the negotiation approach, and followed by a sustained critique of utilitarian doctrine of morality. Complex distinctions and arguments are set forth. The fatal weakness of utilitarianism, of various versions, is said to lie in its failure to distinguish de facto utilities and de jure utilities. De jure utilities have rational warrant "exterior to the utilitarian perspective." "An evaluative assessment of the means by which such legitimate human ends as welfare requires the background of a larger vision of the ends of man." The final chapter elaborates this vision as Hegelian in character. While the gap between morality and self-interest is recognized, Rescher postulates as a regulative ideal "a reciprocal coordination of personal and social advantage." But this larger vision includes welfare-transcending considerations, e.g., the various ideals of the quality of life, those "higher" aspirations. "Excellence, dignity, and the sense of worth are its leading themes." In the Primacy of Practice, one finds a fuller discussion of moral excellence, but on the whole Rescher has not offered us a detailed account of this ideal dimension of morality. For the present work, at any rate, Rescher has succeeded in arguing for the significant role of vicarious affects in moral philosophy and its implication for the legitimacy of differential treatments based on personal relationships. It is hoped that, in some future work, Professor Rescher will systematically integrate this role of vicarious affects in an ideal moral theory.—A.S.C. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Sighs and Tears:Biological Signals and John Donne's "Whining Poetry"Michael A. WinkelmanPhebe: Good shepherd, tell this youth what 'tis to love. Silvius: It is to be all made of sighs and tears...—Shakespeare, As You Like It (5.2.83–84)ISighs and tears permeate John Donne's poetry, as well they should. Crying in particular functions as a costly signal in biological terms: a blatant, physiologically-demanding, involuntary indicator of hurt feelings. "Tears dim mine (...) eyes," laments Donne's Sappho ("Sappho to Philaenis," l. 56); they are "Fruits of much grief" in "A Valediction of Weeping" (l. 7).1 The theory of costly signaling, related to the handicap principle, was developed fairly recently by Israeli zoologists Amotz and Avishag Zahavi. As the Zahavis explain: "in order to be effective, signals have to be reliable; in order to be reliable, signals have to be costly."2 Initially their idea was resisted, but it has since become widely accepted and it has proven very helpful in making sense of both animal and human behavior. Wasteful conspicuous consumption among upper-class Americans, as noted a century ago by sociologist Thorstein Veblen, exemplifies this handicap principle in action. Like gazelles jumping in place or stotting rather than running away when wolves appear, it indicates fitness by flaunting excess resources.Shedding tears when feeling sad is an evolved human adaptation that broadcasts unhappiness. The wailing of infants demands attention, and crying does something similar for grown-ups: among other things, it tests the commitment of hearers to appease the distressed. For instance, in Chaucer's tragic medieval romance Troilus and Criseyde, Pandarus advises [End Page 329] Troilus to provoke a suitable reaction from Criseyde by embellishing his billet-doux: "Towchyng thi lettre... Biblotte it with thi teris ek a lite" (touching thy letter... Be-blot it with thy tears a little).3 Early modern authors also knew their importance. In the words of Robert Herrick, "tears are tongues," while Claudius suspects that "There's matter in these sighs, these profound heaves" (Hamlet, 4.1.1).4As a case in point, Donne was overwhelmed by the death of his dear wife Anne in 1617. As his contemporaneous biographer Izaak Walton reported: "his very soul was elemented of nothing but sadness; now, grief took so full a possession of his heart, as to leave no place for joy."5 Donne even hoped to be literally entombed with her soon: "as the grave is become her house, so I would hasten to make it mine also; that we two might there make our beds together in the dark" (Walton, p. 51). His miserable mood was revealed in his initial sermon after her demise:His first motion from his house was to preach, where his beloved wife lay buried (in St. Clement's Church, near Temple-Bar, London) and his text was a part of the Prophet Jeremiah's Lamentation: "Lo, I am the man that have seen affliction."And indeed, his very words and looks testified him to be truly such a man; and they, with the addition of his sighs and tears expressed in his Sermon, did so work upon the affections of his hearers as melted and molded them into a companionable sadness; and so they left the Congregation.(Walton, p. 52)Listeners responded in kind to his honest confessions, a textbook illustration of the empathy generated by crying. (A related issue—how and why literature affects audiences so strongly—is currently generating some very interesting work from New Humanists investigating the question from an evolutionary perspective.)These qualities make sighs and tears fundamental to love poetry. In other words, writers deploy them because they reflect universal states of mind, rather than originating as some arbitrary, socially-constructed literary device. The copious opening sonnet of Petrarch's magnificent Rime sparse codifies the theme:6You who can hear in scattered rhymes the soundof all that sighing which once fed my heartin my first youthful error, when in partI was a person of a different kind—my changing manner as I weep and reason, [End Page 330] between vain aspirations and vain grief,leads everyone who has known... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Adam Smith Reconsidered: History, Liberty, and the Foundations of Modern Politics by Paul SagarJames A. HarrisPaul Sagar. Adam Smith Reconsidered: History, Liberty, and the Foundations of Modern Politics. Princeton, NJ: Princeton University Press, 2022. Pp. xii + 229. Hardback, $37.00.Paul Sagar's invigorating book is a reconsideration of Adam Smith in the sense that it challenges much that is received wisdom in current scholarship. First and foremost, it rejects (...) the idea that Smith was preeminently a moral philosopher concerned with the threat to civic virtue posed by commercial society, and yet intent on giving commercial society a moral vindication nevertheless. Sagar—rightly, in my view—wants us to recognize Smith as having been a political thinker. Too much work on Smith still assumes that there is not much to say [End Page 323] about his political thought because he regarded all but the most minimal government as an obstacle to the proper functioning of markets. Smith is supposed to be a "classical liberal" bent on preserving as much natural liberty as possible in the face of government's relentless overextension of its powers of regulation. In Adam Smith's Politics: An Essay in Historiographic Revision (Cambridge: Cambridge University Press, 1978), Donald Winch rejected that approach to Smith in favor of a portrait of the author of The Theory of Moral Sentiments and The Wealth of Nations as an eighteenth-century thinker with an eighteenth-century thinker's concerns. Sagar's project is quite different. This is a book on Smith's political thought that does not once deploy the term 'Whig.' Sagar's Smith does not wholly float free of his historical situation—the questions he addresses are those posed by the end of feudalism and the advent of modernity—but situating him in the particular circumstances of Britain in the age of revolutions is not Sagar's concern. As Sagar sees it, the fundamental issues addressed by Smith's political thought concern the distinctive form taken by commercial society in the modern era. Smith, according to Sagar, held that all advanced societies are commercial societies. Commercial society as such needed no vindication. The question, rather, was what kind of commercial society a modern state wanted to be. That was a political question insofar as it was a question about the kind of freedom that mattered and about the kind of institutions needed to make that freedom a reality.Defined in maximally general terms, freedom for Smith was the absence of domination, where domination is understood as a lack of security in respect of one's physical safety and possessions. The condition of the poor and powerless had always been one of subjection to the will of the rich and powerful. What changed that, according to Smith, was implementation of the rule of law. This is in itself not a new reading of Smith, but what distinguishes Sagar's version of it is the care with which he examines both the place of the rule of law in Smith's historical account of the emergence of liberty in modern Europe and the precise nature of the connection between the rule of law and freedom. First, on Sagar's view, there needed to be a comprehensive picture of domination and slavery, which had been the normal condition of almost everyone for almost all of human history. Then there needed to be an explanation of how it was that, at one particular historical moment, domination was slowly but surely challenged by the emergence of law and law courts considered as independent of political power. In England, this was the story of the common law and of judges who held office for life, rather than at the pleasure of traditional possessors of power. It was the story of security in property, of the backing of property by law, and it was a largely urban story, of burghers who managed to enlist monarchs on their side in the battle against the barons. It was, in other words, in large part a medieval story, and one consequence is that there was more to say about the rise of liberty in the modern age than that it was caused inadvertently by... (shrink)

ObjectivesMany older adults with visual impairment also have significant hearing loss. The aim was to investigate the effectiveness of a newly developed Dual Sensory Loss protocol on communication and wellbeing of older persons with DSL and their communication partners in the Netherlands and Belgium.MethodsParticipants and their communication partners were randomized in the “DSL-protocol” intervention group or a waiting-list control group. The intervention took 3 to 5 weeks. Occupational therapists focused on optimal use of hearing aids, home-environment modifications and effective communication (...) strategies. The primary outcome was the Communication Strategies domain of the Communication Profile for the Hearing Impaired. Secondary outcomes measured in participants were the Low Vision Quality Of Life Adjustment subscale, the Center for Epidemiological Studies - Depression Scale, De Jong Gierveld Loneliness Scale and the Fatigue Assessment Scale. The Hearing Handicap and Disability Inventory - Reaction of Others subscale and the Care-related Quality of Life - 7 Dimensions was measured in communication partners. Measurements were taken at baseline and 3-month follow-up. Linear mixed models were used to analyze effects between groups over time for every outcome measure.ResultsIntention-to-treat analyses showed a significant effect of the DSL-protocol on the use of verbal strategies in favor of the control group, however, this effect was non-significant after adjustment for confounding. Effect sizes of other outcomes varied between −0.23 [−0.57, 0.12] and 0.30 [−0.05, 0.64]. The LMM showed a significant effect on the HHDI-Reaction of others scale in favor of communication partners in the treatment group, however, the effect did not remain significant at a 0.01 significance level and the effect size was very small and non-significant 0.12, 95% CI [−0.27 to 0.51]. Adjusted analyses did not reveal treatment effects.ConclusionThe DSL-protocol did not clearly contribute to the enhancement of communication and wellbeing in DSL-patients. Possible reasons for the lack of effects are OTs not being comfortable giving advice on communication and psychosocial issues or the short-term treatment and follow-up period. Further study is warranted to find out how the protocol may be adapted or whether it is necessary to involve mental healthcare professionals.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NTR2843. (shrink)