The prevalence and complexity of local sustainable development challenges require coordinated action from multiple actors in the business, public, and civil society sectors. Large multi-stakeholder partnerships that build capacity by developing and leveraging the diverse perspectives and resources of partner organizations are becoming an increasingly popular approach to addressing such challenges. Multi-stakeholder partnerships are designed to address and prioritize a social problem, so it can be challenging to define the value proposition to each specific partner. Using a resource-based view, this (...) study examines partner outcomes from the perspective of the strategic interest of the partner as distinct from the strategic goal of the partnership. Based on 47 interviews with representatives of partner organizations in four Canadian case studies of community sustainability plan implementation, this article details 10 resources partners can gain from engaging in a multi-stakeholder partnership. (shrink)

The literature on cross-sector partnerships has increasingly focused attention on broader systemic or system-level change. However, research to date has been partial and fragmented, and the very idea of systemic change remains conceptually underdeveloped. In this article, we seek to better understand what is meant by systemic change in the context of cross-sector partnerships and use this as a basis to discuss the contributions to the Thematic Symposium. We present evidence from a broad, multidisciplinary systematized review of the extant literature, (...) develop an original definition of systemic change, and offer a framework for understanding the interactions between actors, partnerships, systemic change, and issues. We conclude with some suggestions for future research that we believe will enhance the literature in its next phase of development. (shrink)

Systems change requires complex interventions. Cross-sector partnerships face the daunting task of addressing complex societal problems by aligning different backgrounds, values, ideas and resources. A major challenge for CSPs is how to link the type of partnership to the intervention needed to drive change. Intervention strategies are thereby increasingly based on Theories of Change. Applying ToCs is often a donor requirement, but it also reflects the ambition of a partnership to enhance its transformative potential. The current use of ToCs in (...) partnering efforts varies greatly. There is a tendency for a linear and relatively simple use of ToCs that does limited justice to the complexity of the problems partnerships aim to address. Since partnership dynamics are already complex and challenging themselves, confusion and disagreement over the appropriate application of ToCs is likely to hamper rather than enhance the transformative potential of partnerships. We develop a complexity alignment framework and a diagnostic tool that enables partnerships to better appreciate the complexity of the context in which they operate, allowing them to adjust their learning strategy. This paper applies recent insights into how to deal with complexity from both the evaluation and theory of change fields to studies investigating the transformative capacity of partnerships. This can serve as a check to define the challenges of partnering projects and can help delineate the societal sources and layers of complexity that cross-sector partnerships deal with such as failure, insufficient responsibility taking and collective action problems at four phases of partnering. (shrink)

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses’ opinions of the content and function of codes and their use in nursing practice. A total of 49 focus (...) groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be ‘paper tigers’ with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice. (shrink)

The focus of this article is on multi-organizational cross-sector social partnerships (CSSP), an increasingly common means of addressing complex social and ecological problems that are too extensive to be solved by any one organization. While there is a growing body of literature on CSSP, there is little focus on collaborative strategic management, especially where implementation and outcomes are concerned. This study addresses these gaps by offering a conceptual model of collaborative strategic management, which is then tested through the use of (...) two qualitative empirical cases of collaborative regional sustainable development strategies (CRSDS). The model augments previous collaboration models by highlighting two levels of implementation (the collaboration and the organizational levels) and by considering the different types of outcomes, and the feedback loops. (shrink)

To address the prevalence and complexities of sustainable development challenges around the world, organizations in the business, government, and non-profit sectors are increasingly collaborating via multi-stakeholder partnerships. Because complex problems can be neither understood nor addressed by a single organization, it is necessary to bring together the knowledge and resources of many stakeholders. Yet, how these partnerships coordinate their collaborative activities to achieve mutual and organization-specific goals is not well understood. This study takes an organization design perspective of collaborative decision-making (...) processes to explore how they impact the effectiveness of multi-stakeholder partnerships. We compare the decision-making processes of 94 sustainability-focused multi-stakeholder partnerships and find that collaborative decision-making has an indirect and positive impact on partnership capacity through systems that keep partners informed, coordinate partner interactions, and facilitate ongoing learning. The implications of this study for multi-stakeholder partnership research and practice are that partnership capacity is contingent on the design of decision-making processes, as well as internal mechanisms that coordinate and monitor collaborative activities. (shrink)

In the highly contentious abortion arena, the new oral abortifacient technology RU486 is one among many actors. This article offers an arena analysis of the heterogeneous constructions of RU486 by various actors, including scientists, pharmaceutical compa nies, medical groups, antiabortion groups, women's health movement groups, and others who have produced situated knowledges. Conceptually, we find not only that the identity of the nonhuman actor-RU486 -is unstable and multiple but also that, in practice, there are other implicated actors—the downstream users and (...) consumers of the technology. If we try to follow all the actors, we find a fuller and more historicized arena, and, ironically, we too can be construed as implicated actors in it. (shrink)

Cross-sector social partnerships (CSSPs) are relevant units of analysis for understanding sustainable business models (SBMs). This research examines how organizations value their motivations to participate in large sustainability-focused partnerships, how they perceive the value captured, and their structures implemented to address sustainability partnerships. Two hundred and twenty-four organizations partnering within four large sustainability CSSPs were surveyed using an augmented resource-based view (RBV) theoretical framework. Results show that partners were motivated by and captured value related to sustainability-, organizational-, and human-oriented resources, (...) and that organizations prefer more informal than formal structural elements to implement their partnerships’ sustainability strategies. Contributions to SBM and CSSP fields are revealed. SBM thinking is a provocation toward seeking integrated sustainable value creation, helping show the value of large CSSPs. Conversely, by conceiving of large, pluralistic CSSPs as “collaborative SBMs,” we extend the idea of the “business model” to the societal level, exploring how value is captured in partnership. (shrink)

Non-invasive prenatal testing is an emerging form of prenatal genetic testing that provides information about the genetic constitution of a foetus without the risk of pregnancy loss as a direct result of the test procedure. As with other prenatal tests, information from NIPT can help to make a decision about termination of pregnancy, plan contingencies for birth or prepare parents to raise a child with a genetic condition. NIPT can also be used by women and couples to test purely ‘for (...) information’. Here, no particular action is envisaged following the test; it is motivated entirely by an interest in the result. The fact that NIPT can be performed without posing a risk to the pregnancy could give rise to an increase in such requests. In this paper, we examine the ethical aspects of using NIPT ‘purely for information’, including the competing interests of the prospective parents and the future child, and the acceptability of testing for ‘frivolous’ reasons. Drawing on several clinical scenarios, we claim that arguments about testing children for genetic conditions are relevant to this debate. In addition, we raise ethical concerns over the potential for objectification of the child. We conclude that, in most cases, using NIPT to test for adult-onset conditions, carrier status or non-serious traits presenting in childhood would be unacceptable. (shrink)

Speakers’ perception of a visual scene influences the language they use to describe it—which objects they choose to mention and how they characterize the relationships between them. We show that visual complexity can either delay or facilitate description generation, depending on how much disambiguating information is required and how useful the scene's complexity can be in providing, for example, helpful landmarks. To do so, we measure speech onset times, eye gaze, and utterance content in a reference production experiment in which (...) the target object is either unique or non-unique in a visual scene of varying size and complexity. Speakers delay speech onset if the target object is non-unique and requires disambiguation, and we argue that this reflects the cost of deciding on a high-level strategy for describing it. The eye-tracking data demonstrate that these delays increase when speakers are able to conduct an extensive early visual search, implying that when speakers scan too little of the scene early on, they may decide to begin speaking before becoming aware that their description is underspecified. Speakers’ content choices reflect the visual makeup of the scene—the number of distractors present and the availability of useful landmarks. Our results highlight the complex role of visual perception in reference production, showing that speakers can make good use of complexity in ways that reflect their visual processing of the scene. (shrink)

Due to new developments in prenatal testing and therapy the fetus is increasingly visible, examinable and treatable in prenatal care. Accordingly, physicians tend to perceive the fetus as a patient and understand themselves as having certain professional duties towards it. However, it is far from clear what it means to speak of a patient in this connection. This volume explores the usefulness and limitations of the concept of ¿fetal patient¿ against the background of the recent seminal developments in prenatal or (...) fetal medicine. It does so from an interdisciplinary and international perspective. Featuring internationally recognized experts in the field, the book discusses the normative implications of the concept of ¿fetal patient¿ from a philosophical-theoretical as well as from a legal perspective. This includes its implications for the autonomy of the pregnant woman as well as its consequences for physician-patient-interactions in prenatal medicine. (shrink)

This paper provides a brief comparative overview of the development of the reproductive sciences especially in agriculture in the UK and the US. It begins with the establishment by F. H. A. Marshall in 1910 of the boundaries that framed the reproductive sciences as distinct from genetics and embryology. It then examines how and where the reproductive sciences were taken up in agricultural research settings, focusing on the differential development of US and UK institutions. The reproductive sciences were also pursued (...) in medical and biological settings, and I discuss how the intersections among all three allowed the circulation of both ideas and scientists’ careers. Across the twentieth century, scientific leadership in the reproductive sciences alternated between the UK and US, and these patterns are elucidated. I conclude with thoughts on future research that might emphasize the elaboration of industrialization processes in agriculture and new capacities to transform both reproductive processes and their products—life itself—as biopower comes to be more ambitiously understood as extending across all species. (shrink)

The article reconsiders the nature and location of science in the development of genetic classification. Drawing on field studies of medical genetics, we explore how patient categorization is accomplished in between the clinic and laboratory. We focus on dysmorphology, a specialism concerned with complex syndromes that impair physical development. We show that dys-morphology is about more than fitting patients into prefixed diagnostic categories and that diagnostic process is marked by moments of uncertainty, ambiguity, and deferral. We describe how different forms (...) of evidence are brought into play and how patterns of physical features are identified as genetic or not. We suggest that clinical categorical work helps articulate the genetic as an emergent domain of medical classification and that moments of ambiguity and deferral create an imperative space that helps legitimate the need for more technoscience, and consequently, more clinical judgment with which to fix the genetic future. (shrink)

BackgroundEthics consultation is recognized as an opportunity to share responsibility for difficult decisions in prenatal medicine, where moral intuitions are often unable to lead to a settled decision. It remains unclear, however, if the general standards of ethics consultation are applicable to the very particular setting of pregnancy.Main textWe sought to analyze the special nature of disagreements, conflicts and value uncertainties in prenatal medicine as well as the ways in which an ethics consultation service (ECS) could possibly respond to them (...) and illustrated our results with a case example. Ethics facilitation and conflict mediation, currently, have no broadly consented normative framework encompassing prenatal diagnosis and therapy as well as reproductive choice to draw on. Even so, they can still be helpful instruments for ethically challenging decision-making in prenatal medicine provided two additional rules are respected: For the time being, ECSs should (a) refrain from issuing content-heavy recommendations in prenatal medicine and (b) should not initiate conflict mediations that would involve the pregnant woman or couple as a conflict party.ConclusionIt seems to be vital that ethics consultants as well as health care professionals acknowledge the current limitations and pitfalls of ethics consultation in prenatal medicine and together engage in the advancement of standards for this particularly complex setting. (shrink)

The prevention, treatment and management of disease are closely linked to how the causes of a particular disease are explained. For multi-factorial conditions, the causal explanations are inevitably complex and competing models may exist to explain the same condition. Selecting one particular causal explanation over another will carry practical and ethical consequences that are acutely relevant for health policy. In this paper our focus is two-fold; the different models of causal explanation that are put forward within current scientific literature for (...) the high and rising prevalence of the common complex conditions of coronary artery disease and type 2 diabetes mellitus ; and how these explanations are taken up within national health policy guidelines. We examine the causal explanations for these two conditions through a systematic database search of current scientific literature. By identifying different causal explanations we propose a three-tier taxonomy of the most prominent models of explanations: evolutionary, lifecourse, and lifestyle and environment. We elaborate this taxonomy with a micro-level thematic analysis to illustrate how some explanations are semantically and rhetorically foregrounded over others. We then investigate the uptake of the scientific causal explanations in health policy documents with regard to the prevention and management recommendations of current National Service Frameworks for CAD and T2D. Our findings indicate a lack of congruence between the complexity and frequent overlap of causal explanations evident in the scientific literature and the predominant focus on lifestyle recommendations found in the mainstream health policy documents. (shrink)

Contributions to this study are drawn both from health professionals engaged in genetic counselling and from observers and critics with backgrounds in law, philosophy, biology, and the social sciences. This diversity will enable health professonals to examine their activities with a fresh eye, and will help the observer-critic to understand the ethical problems that arise in genetic counselling practice, rather than in imaginary encounters. Most examinations of the ethical issues raised by genetics are concerned in a broad sense with the (...) application of new technology to human reproduction. This volume focuses on genetic counselling and screening as such, providing valuable insights for the health professional, social scientist, philosopher, lawyer, and bioethicist. (shrink)

This paper reports a literature review on the topic of ethical issues in in-depth interviews. The review returned three types of article: general discussion, issues in particular studies, and studies of interview-based research ethics. Whilst many of the issues discussed in these articles are generic to research ethics, such as confidentiality, they often had particular manifestations in this type of research. For example, privacy was a significant problem as interviews sometimes probe unexpected areas. For similar reasons, it is difficult to (...) give full information of the nature of a particular interview at the outset, hence informed consent is problematic. Where a pair is interviewed (such as carer and cared-for) there are major difficulties in maintaining confidentiality and protecting privacy. The potential for interviews to harm participants emotionally is noted in some papers, although this is often set against potential therapeutic benefit. As well as these generic issues, there are some ethical issues fairly specific to in-depth interviews. The problem of dual role is noted in many papers. It can take many forms: an interviewer might be nurse and researcher, scientist and counsellor, or reporter and evangelist. There are other specific issues such as taking sides in an interview, and protecting vulnerable groups. Little specific study of the ethics of in-depth interviews has taken place. However, that which has shows some important findings. For example, one study shows participants are not averse to discussing painful issues provided they feel the study is worthwhile. Some papers make recommendations for researchers. One such is that they should consider using a model of continuous (or process) consent rather than viewing consent as occurring once, at signature, prior to the interview. However, there is a need for further study of this area, both philosophical and empirical. (shrink)

Discussion of a “duty to recontact” emerged as technological advances left professionals considering getting back in touch with patients they had seen in the past. While there has been much discussion of the duty to recontact as a matter of theory and ethics, there has been rather little empirically based analysis of what this “duty” consists of. Drawing on interviews with 34 professionals working in, or closely with, genetics services, this paper explores what the “duty to recontact” means for healthcare (...) professionals involved in genetics. Using a discourse analytic framework, the paper identifies three system generated discourses on recontact (governance, legal and responsibilizing discourses) and three lifeworld discourses (situating recontact as a formal duty; more loosely as an obligation; and as a personal sense of responsibility). In summary, the paper shows that the “duty” to recontact involves a complex interplay of system responsibilities with professional duties, responsibilities and obligations. (shrink)

The paper by Mand et al raises important questions about the predictive genetic testing of children. They focus on those claims made by professionals that are open to empirical enquiry and give too little weight to those claims that do not require empirical support. The authors remind us that some commentators oppose empirical enquiry because of the concern that gathering evidence of the consequences of such testing may itself be harmful or unethical. They respond by asserting that the relevant research (...) questions are ‘eminently testable’ but fail to discuss the challenges of such research, including the questions of timescale, consent or the nature of the data whose collection (they assert) would resolve the perceived difficulties with the genetic testing of children. They conclude that empirical research is required without resolving the weighty arguments against predictive testing of young children or explaining how the evidence they wish to collect could overcome the force of the arguments that favour caution. (shrink)

The multifaceted work of the late Susan Leigh Star is explored through a selection of her writings and essays by friends and colleagues. Susan Leigh Star (1954–2010) was one of the most influential science studies scholars of the last several decades. In her work, Star highlighted the messy practices of discovering science, asking hard questions about the marginalizing as well as the liberating powers of science and technology. In the landmark work Sorting Things Out, Star and Geoffrey Bowker revealed the (...) social and ethical histories that are deeply embedded in classification systems. Star's most celebrated concept was the notion of boundary objects: representational forms—things or theories—that can be shared between different communities, with each holding its own understanding of the representation. Unfortunately, Leigh was unable to complete a work on the poetics of infrastructure that further developed the full range of her work. This volume collects articles by Star that set out some of her thinking on boundary objects, marginality, and infrastructure, together with essays by friends and colleagues from a range of disciplines—from philosophy of science to organization science—that testify to the wide-ranging influence of Star's work. Contributors Ellen Balka, Eevi E. Beck, Dick Boland, Geoffrey C. Bowker, Janet Ceja Alcalá, Adele E. Clarke, Les Gasser, James R. Griesemer, Gail Hornstein, John Leslie King, Cheris Kramarae, Maria Puig de la Bellacasa, Karen Ruhleder, Kjeld Schmidt, Brian Cantwell Smith, Susan Leigh Star, Anselm L. Strauss, Jane Summerton, Stefan Timmermans, Helen Verran, Nina Wakeford, Jutta Weber. (shrink)

Clinical genetics encompasses a wider range of activities than discussion of reproductive risks and options. Hence, it is possible for a clinical geneticist to reduce suffering associated with genetic disease without aiming to reduce the birth incidence of such diseases. Simple cost-benefit analyses of genetic-screening programmes are unacceptable; more sophisticated analyses of this type have been devised but entail internal inconsistencies and do not seem to result in changed clinical practice. The secondary effects of screening programmes must be assessed before (...) they can be properly evaluated, including the inadvertent diagnosis of unsought conditions, and the wider social effects of the programmes on those with mental handicap. This has implications for the range of prenatal tests that should be made available. While autonomy must be fully respected, it cannot itself constitute a goal of clinical genetics. The evaluation of these services requires interdepartmental comparisons of workload, and quality judgements of clients and peers. (shrink)

Medical anatomy is one of the key sites of the scientific production, reproduction and maintenance of sex and gender. Our Human Anatomies Project explores the construction, reconstruction and maintenance of difference in genital anatomies, focusing especially on the clitoris. This article focuses on representations of human genitalia in the form of cyberanatomies - video, CD-ROM and internetbased renderings of human bodies. In cyberspace as elsewhere, the biomedical expert remains the proper and dominant mediator between humans and their own bodies, despite (...) the democratization of knowledges supposedly possible through the Internet. Special attention is given to the specific sites of production and distribution of these different cyberanatomies. Through our review of the globalization of cyberanatomies, we have come to witness the very sedimentation of sex/gender/sexuality in new arenas of representations of human bodies. Western biomedical imperialism and globalization of a standardized (American) body are taken up as core theoretical concerns. (shrink)

The paper by Bowman-Smart et al. (2023) on noninvasive prenatal genetic testing (NIPT) for non-medical traits aims to set out the case for and the case against such testing. In response to their pa...

Abstract:In this forum, Marilyn Strathern and Jade S. Sasser review Adele Clarke and Donna Haraway's edited volume Making Kin, Not Population: Reconceiving Generations (Prickly Paradigm Press, 2018). Responses from multiple authors featured in the book follow.

Arts and Humanities in Higher Education, Volume 20, Issue 4, Page 403-425, October 2021. Despite the plethora of research on widening participation in the last 20 years, access to the arts and humanities has remained relatively under-explored, especially in relation to the preparedness of adult learners. This article reports a case study investigating the impact of an arts and languages Access module at the UK Open University. Findings from interviews with 37 Access students were analysed in relation to four themes: (...) the need for Access preparation; generic studentship skills; discipline-specific skills; intrinsic enjoyment and interdisciplinary study. We conclude embedded generic skills enhance learner confidence and time management, while academic literacy skills relevant to the arts and humanities enhance cultural capital and enable disadvantaged learners to access challenging disciplines. The impact of a preparatory arts and humanities module extends into the lives of individual students, suggesting a counter-narrative to the prevailing, ‘economic value’ paradigms of higher education policymakers. (shrink)

In the current political climate, understanding women’s health is necessary to achieve progressive and equitable health care reform. Women access the healthcare system more frequently and in greater numbers than men, and are more likely to vote at the polls.1 Yet politicians, corporations, activists, and patients continue to disagree on the scope and definition of women’s health. In her book Beyond Reproduction: Women’s Health, Activism, and Public Policy, Karen L. Baird offers a retrospective analysis of the women’s health movement in (...) recent decades. She discusses landmark legislation and examines how the movement has evolved in response to a changing social and political landscape. Baird’s text is both timely .. (shrink)

Karen L. Baird, Beyond reproduction: Women’s health, activism, and public policy, Madison, NJ: Fairleigh Dickinson University Press, 2009, reviewed by Amanda R. Clarke.

Contributions to this study are drawn both from health professionals engaged in genetic counselling and from observers and critics with backgrounds in law, philosophy, biology, and the social sciences. This diversity will enable health professonals to examine their activities with a fresh eye, and will help the observer-critic to understand the ethical problems that arise in genetic counselling practice, rather than in imaginary encounters. Most examinations of the ethical issues raised by genetics are concerned in a broad sense with the (...) application of new technology to human reproduction. This volume focuses on genetic counselling and screening as such, providing valuable insights for the health professional, social scientist, philosopher, lawyer, and bioethicist. (shrink)

This chapter contains sections titled: Information Management: Confidentiality, Autonomy and Non‐Directiveness Predictive Genetic Testing Childhood Genetic Testing Genetic Screening Informed Consent to Screening Newborn Screening Carrier Screening Prenatal Screening Susceptibility Screening Further Information Management Goals of Genetic Screening: Public Health vs Individual Choice Conclusion References Further reading.

Despite the controversial nature of studies of reproductive phenomena, a major center of reproductive biology emerged and coalesced in the Department of Zoology at the University of Chicago circa 1892–1940. Led by Frank R. Lillie, several small groups of researchers pioneered the study of sex determination and sex hormones, pursuing these via a Chicago approach to framing biological practice at both cellular and organismic levels. They worked in an interdisciplinary manner, however much in tandem, and drew strongly on local resources—from (...) the stockyards to local philanthropy. Most remarkably, Lillie redirected the mission of the major National Research Council Committee for Research Problems of Sex to address the biology of sex and then garnered about a fifth of its funds for Chicago. He thus guided Chicago biology into the fully modern era of external support for on-campus research and elaborate national scientific networks via promising biological solutions to social problems. (shrink)