In this article, we introduce Vilém Flusser’s theoretical trajectory from the philosophy of language and multilingualism to communication and media theory. Our focus lies on his works Kommunikologie [ Communicology] and Kommunikologie weiter denken [ Thinking Communicology Further]. Kommunikologie, which was written in Flusser’s mid-career in the 1970s, but only published in the 1990s, consists of a set of articles and lectures and offers, among other notions, a great distinction between dialogue and discourse. The article takes this differentiation and explains (...) its advantages and limitations. This leads to the introduction of the concept of algorithmic mediation as a ‘communicological’ take on current media developments. This also allows us to return to Flusser’s question about the disappearing home and the need for windows to the world. We hence offer a combination of different aspects of his work less as a tool for the analysis of current developments than as a call for action. (shrink)

Communities, scientists, policy-makers and industries are requiring farmers to address environmental and wellbeing challenges in their on-farm management, transitioning away from a productivity dominated focus towards a multi-faceted system focus that includes environmental and social values. This paper analyses how Miraka Ltd., an Aotearoa-New Zealand indigenous owned and operated milk company, has taken on the role of institutional entrepreneur to enable and support change towards a multi-faceted system amongst its supply farmers. Observations and interviews were carried out to: (i) identify (...) farmers’ changes in practices, beliefs and values over the last ten years; and (ii) identify how Miraka functions as an indigenous entrepreneur in the agricultural sector. Findings show that interviewees were initially guided by business and family-oriented values, beliefs and practices, but in response to the institutional entrepreneurship by Miraka, approximately half of the interviewees changed these values, beliefs and practices, by internalising people and environmental values. The main strategies employed by Miraka were mobilisation of material resources such as incentives and awards, creation of a rationale addressing environmental and social concerns in the dairy sector, and proactive connection with new actors. The research shows an indigenous owned small-medium enterprise can make changes in values, beliefs and practices amongst its supply farmers, but requires a stronger shared base of values to contribute to a wider economic change. The discussion connects these findings to wider literature on diverse economies and indigenous entrepreneurship to identify to what extent an indigenous small-medium enterprise can contribute to a system change. (shrink)

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic (...) injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

A main objective of this study is to assess the opinions of 50 behavioral health patients on selective control over their behavioral and physical health information. We explored patients' preferences regarding current consent models, what health information should be shared for care and research and whether these preferences vary based on the sensitivity of health information and/or the type of provider involved. The other objective of this study was to solicit opinions of 8 behavioral health providers on patient-driven granular control (...) of health information and potential impact on care.Electronic surveys were implemented at an outpatient Behavioral Health facility that provides care for behavioral health patients with non-serious mental illnesses. The Patient Survey included questions regarding patients' demographics and about their concerns and preferences for data sharing for care and research. The Provider Survey included questions about their view on the current consent process and perceptions on barriers and facilitators to implement patient-controlled granular consent models.This novel study provides valuable preliminary data that can help guide future studies to better understand privacy choices of this underrepresented patient group. (shrink)

Management of effort is one of the biggest challenges in any team, and is particularly difficult in distributed teams, where behavior is relatively invisible to teammates. Awareness systems, which provide real-time visual feedback about team members’ behavior, may serve as an effective intervention tool for mitigating various sources of process-loss in teams, including team effort. However, most of the research on visualization tools has been focusing on team communication and learning, and their impact on team effort and consequently team performance (...) has been hardly studied. Furthermore, this line of research has rarely addressed the way visualization tool may interact with team composition, while comprehension of this interaction may facilitate a conceptualization of more effective interventions. In this article we review the research on feedback in distributed teams and integrate it with the research on awareness systems. Focusing on team effort, we examine the effect of an effort visualization tool on team performance in 72 geographically distributed virtual project teams. In addition, we test the moderating effect of team composition, specifically team members’ conscientiousness, on the effectiveness of the effort visualization tool. Our findings demonstrate that the effort visualization tool increases team effort and improves the performance in teams with a low proportion of highly conscientious members, but not in teams with a high proportion of highly conscientious members. We discuss the theoretical and practical implications of our findings, and suggest the need of future research to address the way technological advances may contribute to management and research of team processes. (shrink)

Background Previous research mainly focuses on how to support nursing students in caring for the patient and on educators’ views of students’ development as professional caring nurses. Against this background, it is important to further investigate nursing students’ perspectives on what it means to become a professional caring nurse. Research aim This qualitative systematic review study aims to identify and synthesize nursing students’ perceptions on the meaning of becoming a caring nurse. Research design and data sources Systematic data searches were (...) conducted by using the electronic databases MEDLINE (Ovid), CINAHL (EBSCO), Academic Search Premiere (EBSCO), and Philosopher`s Index. In total, 13 studies met the inclusion and quality criteria. The articles were analyzed by a systematic review and a thematic synthesis according to Thomas and Harden. Ethical consideration The study followed good ethical practice guidelines outlined in the Northern Nurses’ Federation. Findings The analysis resulted in eight descriptive themes and finally in three analytical themes: Becoming is to get in touch with one’s inner ethic or ethos, Becoming is a movement between courage, understanding, and being touched, and Becoming is strengthened through caring role models and a learning culture. Conclusions Becoming a professional caring nurse is seen as an ongoing movement toward a deeper understanding of oneself and one’s being and bearing. This movement is enabled when nursing students have a sense of self-awareness, courage to stand in their vulnerability, and reflect on their responsibility, caring attitude, and inner values and ethics. The force of becoming is that the attention is directed beyond self to care for and feel empathy for others in a caring manner. Becoming is released through a caring relationship, external confirmation, and good role models. A lack of external support in the movement can potentially prevent the students from becoming a professional caring nurse. (shrink)

A significant amount of discussion in the bioethics community has been devoted to the question of whether individuals performing ethics consultations in healthcare institutions have any special expertise. In addition, articles in the lay press have questioned the “added value” that bioethicists bring to ethical dilemmas. Those at the forefront of the bioethics community have argued repeatedly that those doing ethics consults cannot simply be well-intentioned individuals, that some training in bioethics, group process, and facilitation is necessary to competently execute (...) a consult. As one bioethicist commented:if you approach any endeavor as an amateur activity, you will get, in the end, an amateurish version of the activity. Without a sufficient commitment of personnel, time, support, and financial resources, a healthcare organization will get the ‘ethics’ program … it set out to create: an inept, unskilled, inefficient, and highly risky ‘program’ in healthcare ethics and bioethics. (shrink)

A significant amount of discussion in the bioethics community has been devoted to the question of whether individuals performing ethics consultations in healthcare institutions have any special expertise. In addition, articles in the lay press have questioned the “added value” that bioethicists bring to ethical dilemmas. Those at the forefront of the bioethics community have argued repeatedly that those doing ethics consults cannot simply be well-intentioned individuals, that some training in bioethics, group process, and facilitation is necessary to competently execute (...) a consult. As one bioethicist commented:if you approach any endeavor as an amateur activity, you will get, in the end, an amateurish version of the activity. Without a sufficient commitment of personnel, time, support, and financial resources, a healthcare organization will get the ‘ethics’ program … it set out to create: an inept, unskilled, inefficient, and highly risky ‘program’ in healthcare ethics and bioethics. (shrink)

To the woman, God said, “I will greatly multiply your pain in child bearing; in pain you shall bring forth children, yet your desire shall be for your husband, and he shall rule over you.”Genesis 3:16There is now a well-established body of literature documenting the pervasive inadequate treatment of pain in this country. There have also been allegations, and some data, supporting the notion that women are more likely than men to be undertreated or inappropriately diagnosed and treated for their (...) pain.One particularly troublesome study indicated that women are more likely to be given sedatives for their pain and men to be given pain medication. Speculation as to why this difference might exist has included the following: Women complain more than men; women are not accurate reporters of their pain; men are more stoic so that when they do complain of pain, “it's real”; and women are better able to tolerate pain or have better coping skills than men. (shrink)

Hydrogen is a very important industrial gas in chemical processes. It is very volatile; therefore, it can escape from the process units and its mass balance is not always correct. In many industrial processes where hydrogen is reacted, kinetics are often related to hydrogen pressure. The right thermodynamic properties of hydrogen can be found for a process simulation and optimization; they can be estimated by the Grayson-Streed model. In the case studied, a methanol plant with a capacity of 150,000 tons/year, (...) the flow rate of hydrogen (H2) can be optimized using nonlinear programming, but good estimates of thermodynamic properties of hydrogen had to be found. In the case study, the model is in relatively good agreement with experimental measurements in the existing methanol production plant. An additional flow rate of hydrogen can increase the methanol production by 1.2%. Total potential profit increase of the additional methanol production was estimated to be 30 kEUR/a (or 103 euros/year). (shrink)

Formalisms such as description logics (DL) are sometimes expected to help terminologies ensure compliance with sound ontological principles. The objective of this paper is to study the degree to which one DL-based biomedical terminology (SNOMED CT) complies with such principles. We defined seven ontological principles (for example: each class must have at least one parent, each class must differ from its parent) and examined the properties of SNOMED CT classes with respect to these principles. Our major results are: 31% of (...) the classes have a single child; 27% have multiple parents; 51% do not exhibit any differentiae between the description of the parent and that of the child. The applications of this study to quality assurance for ontologies are discussed and suggestions are made for dealing with multiple inheritance. (shrink)

Background: Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students’ perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. Research design: An Italian national cross-sectional study design was performed in 2015–2016. Participants were invited to answer a questionnaire composed of four sections regarding: socio-demographic data, previous clinical learning (...) experiences, current clinical learning experience quality and outcomes, and the opportunity to discuss ethical issues with nurses in the last clinical learning experience. Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. Findings: Overall, 4707 perceived to have discussed ethical issues ‘much’ or ‘very much’; among the remaining, 3683 and 1217 students reported the perception of having discussed, respectively, ‘enough’ or ‘never’ ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels. In contrast, being male was associated with a perception of less opportunity to discuss ethical issues. Conclusion: Nursing faculties should assess the clinical environment prerequisites of the settings as a context of student experience before deciding on their accreditation. Moreover, the nursing faculty and nurse managers should also enhance competence with regard to discussing ethical issues with students among clinical nurses by identifying factors that hinder this learning opportunity in daily practice. (shrink)

Background Clinical Ethics Committees are well established at healthcare institutions in resource-rich countries. However, there is limited information on established CECs in resource poor countries, especially in Africa. This study aimed to establish baseline data regarding existing formal CECs in Africa to raise awareness of and to encourage the establishment of CECs or Clinical Ethics Consultation Services on the continent. Methods A descriptive study was undertaken using an online questionnaire via SunSurveys to survey healthcare professionals and bioethicists in Africa. Data (...) were subjected to descriptive analysis and Fischer's exact test was applied to determine associations. Texts from the open-ended questions were thematically analysed. Results In total 109 participants from 37 African countries completed the survey in December 2019. A significant association was found between participants’ bioethics qualification or training and involvement in clinical ethics. All participants were familiar with Research Ethics Committees, and initially conflated RECs with CECs. When CECs were explained in detail, approximately 85.3% reported that they had no formal CECs in their institutions. The constraints to developing CECs included lack of training, limited resources, and lack of awareness of CECs. However, the majority of participants were interested in establishing CECs. Participants listed assistance required in establishing CECs including funding, resources, capacity building and collaboration with other known CECs. The results do not reflect CECs established since the onset of COVID-19 in Africa. Conclusions This study provides a first look into CECs in Africa and found very few formal CECs on the continent indicating an urgent need for the establishment of CECs or CESs in Africa. While the majority of healthcare professionals and bioethicists are aware of ethical dilemmas in healthcare, the concept of formal CECs is foreign. This study served to raise awareness of CECs. Research ethics and RECs overshadow CECs in Africa because international funders from the global north support capacity development in research ethics and establish RECs to approve the research they fund in Africa. Raising awareness via educational opportunities, research and conferences about CECs and their role in improving the quality of health care in Africa is sorely needed. (shrink)

State medical boards are beginning to take a more balanced approach to monitoring and disciplining for prescribing of pain medications, according to this survey of state medical boards across the country. Overall, respondents indicated that they are becoming more educated and more sophisticated in their approach to complaints of opioid overprescribing. In addition, their responses reflect a heightened awareness of the appropriateness of treating chronic pain with controlled substances.Yet, despite these inroads, boards generally demonstrate a continued tolerance of pain undertreatment, (...) the survey found. There is a discrepancy in the weight given to violation of standard of care, patient harm, and gross negligence for opioid overprescribing versus undertreatment of pain. Boards appear to have a higher threshold for patient harm in cases involving pain undertreatment — particularly for chronic nonmalignant pain. (shrink)

The field of clinical ethics consultation has matured into a multidisciplinary profession, with clinical ethics consultants (CECs) being trained in bioethics, philosophy, theology, law, medicine, n...

Mobile technologies such as tablets, iPads, laptops, netbooks as well as mobile phones with internet connectivity and recording features present new challenges to the academy. In the age of convergence and with the encoding of several features into mobile telephony, private spaces of the classroom can be reconfigured through the mediation of technologies. In most cases, existing rules and regulations of higher education institutions do not comprehensively address these challenges. The introduction of new technologies into the classroom has been often (...) framed historically as vital and relevant for a progressive academic society or as part of a national imperative to transform the ways in which the authors access and engage with knowledge. This paper surveys British universities to examine how they govern the phenomenon of recording content through mobile technologies. The results reveal a pervasive use of mobile devices in UK universities and clear divergences in approaches to enacting mobile device-specific policies to govern the usage of these technologies. (shrink)

Uncertainty regarding potential disciplinary action may give physicians pause when considering whether to accept a chronic pain patient or how to treat a patient who may require long-term or high doses of opioids. Surveys have shown that physicians fear potential disciplinary acrion for prescribing controlled substances and that physicians will, in some cases, inadequately prescribe opioids due to fear of regulatory scrutiny. Prescribing opioids for long-term pain management, particularly noncancer pain management, has been controversial; and boards have investigated and, in (...) some cases, disciplined physicians for such prescribing. While in virtually all of these cases the disciplinary actions were successfully appealed, news of the success was not often as well-publicized as news of the disciplinary actions, leaving some physicians confused about their potential liability when prescribing opioids for pain. The confusion has perhaps increased as a result of two relatively recent cases, one where a physician was successfully disciplined by a state medical board for undertreatment of his patients’ pain, and another where the physician was successfully sued for inadequate pain treatment. (shrink)

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

A woman’s lack of or limited reproductive autonomy could lead to adverse health effects, feeling of being inferior, and above all being unable to adequately care for her children. Little is known about the reproductive autonomy of married Ikwerre women of Rivers State, Nigeria. This study demonstrates how Ikwerre women understand the terms autonomy and reproductive rights and what affects the exercise of these rights. An exploratory research design was employed for this study. A semi-structured interview schedule was used to (...) conduct thirty-four in-depth interviews and six focus group discussions with purposively sampled educated, semi-educated, and uneducated Ikwerre women in monogamous or polygynous marriages. The collected data was analysed qualitatively with MAXQDA 11 using open and axial coding. The interviews and focus group responses reveal a low level of awareness of autonomy and reproductive rights amongst the Ikwerre women in Nigeria. While some educated women were aware of their reproductive rights, cultural practices were reported to limit the exercise of these rights. Participants reported that Ikwerre culture is a patriarchal one where married women are expected to submit and obey their husbands in all matters; and a good married woman according to Ikwerre standard is one who complies with this culture. Women’s refusal of sexual advances from their husbands is described as not being acceptable in this culture; and hence rape in marriage is not recognized in Ikwerre culture. Education and awareness creation on the importance of women’s reproductive autonomy could improve their reproductive rights and autonomy in marital settings. Overcoming the patriarchal aspects of Ikwerre culture—for example, the greater value placed on male children than female children and treating women as incompetent individuals—is necessary to promote gender equality as well as help improve women’s reproductive autonomy. (shrink)

Due to the advance computer technology, the use of probability distributions has been raised up to solve the real life problems. These applications are found in reliability engineering, computer sciences, economics, psychology, survival analysis, and some others. This study offers a new probability model called Marshall–Olkin Extended Gumbel Type-II which can model various shapes of the failure rate function. The proposed distribution is capable to model increasing, decreasing, reverse J-shaped, and upside down bathtub shapes of the failure rate function. Various (...) statistical properties of the proposed distribution are derived such as alternate expressions for the density and distribution function, special cases of MOEGT-II distribution, quantile function, Lorenz curve, and Bonferroni curve. Estimation of the unknown parameters is carried out by the method of maximum likelihood. A simulation study is conducted using three different iterative methods with different samples of sizes n. The usefulness and potentiality of the MOEGT-II distribution have been shown using three real life data sets. The MOEGT-II distribution has been demonstrated as better fit than Exponentiated Gumbel Type-II, Marshall–Olkin Gumbel Type-II, Gumbel Type-II, Marshall–Olkin–Frechet, Frechet, Burr III, Log Logistic, Beta Inverse Weibull, and Kumaraswamy Inverse Weibull distributions. (shrink)

“Looking for Asian America shows real people engaged in the full range of human activity. This is no small accomplishment for the photographer or his subjects. For Asian Americans it is extraordinary to be merely ordinary. To others, even if not to themselves, Asian Americans appear to be contradictions of identity—a Chinese-Yankee is a knockoff.” —Frank H. Wu, from the Foreword In search of contemporary Asian America, celebrated photographer Wing Young Huie—the only member of his family not born in China—traveled (...) with his wife Tara through nearly forty states to explore and document the funny, touching, and sometimes strange intersection of Asian American and American cultures. Looking for Asian America illustrates their rich and surprising journey across the United States. Through Huie’s eyes, keenly aware of his own Midwestern roots and perspective, we witness such images as a Vietnamese Elvis, Miss Congeniality on her cell phone in San Francisco’s Chinatown, a Hmong street sign in rural North Carolina, a meditating Falun Gong protestor in Washington, D.C., a bubble tea Valley Girl, and a Chinese theme park in Orlando. Huie’s camera captures ABCs, FOAs, and a self-described “redneck” Chinese restaurant owner near the Okefenokee Swamp. Taken together the photographs reveal a complex portrait of the U.S. cultural landscape, and their dignified elegance invites a closer, deeper look. Accompanied by the personal reflections of both Wing and Tara Huie, the nearly one hundred spectacular photos tell a story that both mirrors and contradicts stereotypes of Asian Americans, ultimately questioning what it means to be ethnic and American in the twenty-first century. Wing Young Huie has received widespread acclaim for his works, including Lake Street USA, documenting the cultural landscape of his native Minnesota. He is a recipient of a Bush Artist Fellowship and two-time recipient of the McKnight Photography Fellowship. He lives in Minneapolis. Frank H. Wu is dean of Wayne State University Law School and the author of Yellow: Race in America Beyond Black and White. Anita Gonzalez teaches in the Master of Liberal Studies Program at the University of Minnesota. (shrink)

We assessed students’ and employees’ perception of ethical climate at a university school of medicine compared to that of social sciences and humanities, as well as temporal changes in the employees’ perception of ethical climate. We also explored potential predictors of ethical climate, including moral foundations. This cross-sectional questionnaire study was conducted at the University of Split School of Medicine and the Faculty of Humanities and Social Sciences, in Croatia, from April to September 2019. We used 36-item Ethical Climate Questionnaire (...) and 22-item Moral Foundation Questionnaire to survey employees, senior and doctoral students. We collected responses using ballot boxes as well as online survey. We collected 449 complete responses. The dominant ethical climates at two schools were “Company rules and procedures” and “Laws and professional codes”. We compared our results with a study conducted in 2012 and found that the perception of ethical climate had not changed dramatically in last 8 years. Ethical climate, or shared social and work-related behaviours, does not seem to change in these institutions even when students and staff are included with faculty in surveys. We provide further discussion of why this seems to be the case. (shrink)

Out from the Shadows showcases the work of 18 analytical feminists from a variety of traditional areas of philosophy: social and political philosophy, normative ethics, virtue theory, metaethics, philosophy of language, metaphysics, epistemology, and philosophy of science. The collection is unique both in its focus on analytical feminism and in its breadth across the subdisciplines within philosophy. The book highlights successful uses of concepts and approaches from traditional philosophy, and illustrates the contributions that feminist approaches have made and could make (...) to the analysis of issues in key areas of traditional philosophy, while also demonstrating that traditional philosophy ignores feminist insights and feminist critiques of traditional philosophy at its own peril. (shrink)

Rossbank functioned from 1840 to 1854 as one of a chain of British Colonial Observatories which combined with European and Asian observatories in the study of terrestrial magnetism. It was established in Hobart, Tasmania, by the Governor of Van Diemen's Land, Sir John Franklin, and Captain James Clark Ross, R.N., commanding H.M. ships Erebus and Terror. The history and operation of the Rossbank Observatory is related, its instruments described, and the results discussed.Biographical notes on the Observatory staff, with lists of (...) its archives and instruments are provided. A number of previously unpublished pictures show the Observatory in use and the surviving buildings and instruments today. (shrink)

BackgroundWhile previous research has examined various aspects of ethics consultation (EC) in U.S. hospitals, certain EC practices have never been systematically studied.MethodsTo address this gap, we surveyed a random stratified sample of 600 hospitals about aspects of EC that had not been previously explored.ResultsNew findings include: in 26.0% of hospitals, the EC service performs EC for more than one hospital; 72.4% of hospitals performed at least one non-case consultation; in 56% of hospitals, ECs are never requested by patients or families; (...) 59.0% of case consultations involve conflict; the usual practice is to visit the patient in all formal EC cases in 32.5% of hospitals; 56.6% of hospitals do not include a formal meeting in most EC cases; 61.1% of hospitals do not routinely assess ethics consultants’ competencies; and 31.6% of hospitals belong to a bioethics network. We estimate the total number of non-case consultations performed in U.S. hospitals to be approximately one half the number of case consultations; we estimate the total number of ECs performed in U.S. hospitals, including both case and non-case consultations, to be just over 100,000 per year.ConclusionsThese findings expand our current understanding of EC in U.S. hospitals, and raise several concerns that suggest a need for further research. (shrink)

Because medicine can preserve and restore health and function, it is widely acknowledged as a basic good that a just society owes its members. Yet there is controversy over the scope of what should be provided, to whom, how, when and why. This comprehensive and authoritative book - by well-known philosophers, doctors, lawyers, political scientists, and economists - lays a theoretical foundation for understanding the debate, assesses how health care is distributed in different countries and to various social groups, and (...) analyzes practical issues in constructing a socially just health care system. (shrink)

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has (...) initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (shrink)

Evidence for one or more loci on the human X chromosome influencing social cognition was recently presented by Skuse et al.(1). The imprinted locus is only expressed from a paternally inherited X chromosome, which means that boys do not express it because their only X chromosome comes from their mother. This raises the possibility of genetic as well as cultural influences on sex differences in behaviour and cognition. It may also offer some explanation for why boys are more vulnerable to (...) developmental disorders that affect social behaviour, such as autism. (shrink)

End-of-life decision making constitutes a major challenge for bioethical deliberation and political governance in modern democracies: On the one hand, it touches upon fundamental convictions about life, death, and the human condition. On the other, it is deeply rooted in religious traditions and historical experiences and thus shows great socio-cultural diversity. The bioethical discussion of such cultural issues oscillates between liberal individualism and cultural stereotyping. Our paper confronts the bioethical expert discourse with public moral attitudes. The paper is based on (...) a qualitative study comprising 12 focus group discussions with religious and secular persons in the USA, Germany, and Israel. Considering the respective socio-political and legal frameworks, the thematic analysis focuses on moral attitudes towards end-of-life decision making and explores the complex interplay between individual preferences, culture, and religion. Our findings draw attention to the variety and complexity of cultural and religious aspects of end-of-life decision making. Although there is local consensus that goes beyond radical individualism, positions are not neatly matched with national cultures or religious denominations. Instead, the relevance of the specific situatedness of religious beliefs and cultural communities becomes visible: Their status and role in individual situations, for example, as consensual or conflicting on the level of personal perspectives, family relationships, or broader social contexts, e.g., as a majority or minority culture within a political system. As the group discussions indicate, there are no clear-cut positions anchored in “nationality,” “culture,” or “religion.” Instead, attitudes are personally decided on as part of a negotiated context representing the political, social and existential situatedness of the individual. Therefore, more complex theoretical and practical approaches to cultural diversity have to be developed. (shrink)

Enhancing body awareness has been described as a key element or a mechanism of action for therapeutic approaches often categorized as mind-body approaches, such as yoga, TaiChi, Body-Oriented Psychotherapy, Body Awareness Therapy, mindfulness based therapies/meditation, Feldenkrais, Alexander Method, Breath Therapy and others with reported benefits for a variety of health conditions. To better understand the conceptualization of body awareness in mind-body therapies, leading practitioners and teaching faculty of these approaches were invited as well as their patients to participate in focus (...) groups. The qualitative analysis of these focus groups with representative practitioners of body awareness practices, and the perspectives of their patients, elucidated the common ground of their understanding of body awareness. For them body awareness is an inseparable aspect of embodied self awareness realized in action and interaction with the environment and world. It is the awareness of embodiment as an innate tendency of our organism for emergent self-organization and wholeness. The process that patients undergo in these therapies was seen as a progression towards greater unity between body and self, very similar to the conceptualization of embodiment as dialectic of body and self described by some philosophers as being experienced in distinct developmental levels. (shrink)

These essays by Old Dominion University students deal with two questions: What impact do their own race, class, gender, and ethnic identities have upon them as students? How do their culture and the university culture interact to affect their ability to learn? The focus of these essays is on the overlap between the students’ identities as students and their identities based on gender, race, class, and ethnic origin. The project began as an assignment in a women’s studies class at Old (...) Dominion University in 1993, when students in a mixed graduate and undergraduate course were asked to write a brief analysis of themselves as students, accounting for the impact of gender, race, and social class on what they studied, what they heard in class, how they were treated in the classroom, how they treated others there, and what their level of comfort in the university was. Invited to add other variables, such as religion, nationality, age, sexual orientation, or disability— if they considered these significant to their identities as students—the students were urged to consider not only the disadvantages these various identities gave them but also the privileges and advantages. The resulting essays stimulated great interest in what students had to say and led to the formation of The Broad Minds Collective—made up of four students from the class as well as its instructor—which set about the task of soliciting and collecting additional essays. Although most essays contain overlapping themes, the editors detected four motifs that encompass virtually every essay included in the book. In the section "Cultural Perceptions and Assumptions," students show their awareness of how culturally defined categories affect education. Essays in "Belonging and Alienation in the Classroom" discuss the students’ level of comfort in the classroom and the degree to which they feel they belong at the university. The essays in "Making Sense of Our Lives Through Education" reveal the students’ use of education to learn more about the forces that shape them. "In Search of an Education" highlights students’ efforts to wrest what they feel they need from a college education. Rather than presenting a "multicultural educational theory" or conducting a sterile sociological study, The Broad Minds Collective has allowed students to speak for themselves.ion is replaced by stories of personal conflict, struggle, and victory. __. (shrink)

The larger part of Yearbook 6 of the Institute Vienna Circle constitutes the proceedings of a symposium on Alfred Tarski and his influence on and interchanges with the Vienna Circle, especially those on and with Rudolf Carnap and Kurt Gödel. It is the first time that this topic has been treated on such a scale and in such depth. Attention is mainly paid to the origins, development and subsequent role of Tarski's definition of truth. Some contributions are primarily historical, others (...) analyze logical aspects of the concept of truth. Contributors include Anita and Saul Feferman, Jan Wolenski, Jan Tarski and Hans Sluga. Several Polish logicians contributed: Gzegorczyk, Wójcicki, Murawski and Rojszczak. The volume presents entirely new biographical material on Tarski, both from his Polish period and on his influential career in the United States: at Harvard, in Princeton, at Hunter, and at the University of California at Berkeley. The high point of the analysis involves Tarski's influence on Carnap's evolution from a narrow syntactical view of language, to the ontologically more sophisticated but more controversial semantical view. Another highlight involves the interchange between Tarski and Gödel on the connection between truth and proof and on the nature of metalanguages. The concluding part of Yearbook 6 includes documentation, book reviews and a summary of current activities of the Institute Vienna Circle. Jan Tarski introduces letters written by his father to Gödel; Paolo Parrini reports on the Vienna Circle's influence in Italy; several reviews cover recent books on logical empiricism, on Gödel, on cosmology, on holistic approaches in Germany, and on Mauthner. (shrink)

Ethically challenging situations routinely arise in the course of illness and healthcare. However, very few studies have surveyed patients and family members about their experiences with ethically challenging situations. To address this gap in the literature, we surveyed patients and family members at three hospitals. We conducted a content analysis of their responses to open-ended questions about their most memorable experience with an ethical concern for them or their family member. Participants described 219 unique ethical experiences that spanned many of (...) the prevailing themes of bioethics, including the patient-physician relationship, end-of-life care, decision-making capacity, healthcare costs, and genetic testing. Participants focused on relational issues in the course of experiencing illness and receiving medical care and concerns regarding the patient-physician encounters. Many concerns arose outside of a healthcare setting. These data indicate areas for improvement for healthcare providers but some concerns may be better addressed outside of the traditional healthcare setting. (shrink)

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)