If, as many suppose, pornography changes people, a question arises as to how.1 One answer to this question offers a grand and noble vision. Inspired by the idea that pornography is speech, and inspired by a certain liberal ideal about the point of speech in political life, some theorists say that pornography contributes to that liberal ideal: pornography, even at its most violent and misogynistic, and even at its most harmful, is political speech that aims to express certain views about (...) the good life, 2aims to persuade its consumers of a certain political point of view—and to some extent succeeds in persuading them. Ronald Dworkin suggests that the pornographer contributes to the ‘moral environment, by expressing his political or social convictions or tastes or prejudices informally’, that pornography ‘seeks to deliver’ a ‘message’ , that it reflects the ‘opinion’ that ‘women are submissive, or enjoy being dominated, or should be treated as if they did’, that it is comparable to speech ‘advocating that women occupy inferior roles’.3 Pornography on this view is political speech that aims to persuade its listeners of the truth of certain ideas about women, and of course ‘the government must leave to the people the evaluation of ideas’.4 Another answer offers a vision that is not grand and noble, but thoroughly reductive. Pornography is not politically persuasive speech, but speech that works by a process of psychological conditioning. This view seems common enough in the social science literature. Consider, for example, this description of an early experiment, from a time that pre-dates contemporary political debate. (shrink)

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a “living (...) ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process. (shrink)

Some theories of personal identity allow some variation in what it takes for a person to survive from context to context; and sometimes this is determined by the desires of person-stages or the practices of communities.This leads to problems for decision making in contexts where what is chosen will affect personal identity.‘Temporal Phase Pluralism’ solves such problems by allowing that there can be a plurality of persons constituted by a sequence of person stages. This illuminates difficult decision making problems when (...) persons have to choose between different life-altering choices. (shrink)

Visual research methods like photography and digital storytelling are increasingly used in health and social sciences research as participatory approaches that benefit participants, researchers, and audiences. Visual methods involve a number of additional ethical considerations such as using identifiable content and ownership of creative outputs. As such, ethics committees should use different assessment frameworks to consider research protocols with visual methods. Here, we outline the limitations of ethics committees in assessing projects with a visual focus and highlight the sparse knowledge (...) on how researchers respond when they encounter ethical challenges in the practice of visual research. We propose a situated approach in relation to visual methodologies that encompasses a negotiated, flexible approach, given that ethical issues usually emerge in relation to the specific contexts of individual research projects. Drawing on available literature and two case studies, we identify and reflect on nuanced ethical implications in visual research, like tensions between aesthetics and research validity. The case studies highlight strategies developed in-situ to address the challenges two researchers encountered when using visual research methods, illustrating that some practice implications are not necessarily addressed using established ethical clearance procedures. A situated approach can ensure that visual research remains ethical, engaging, and rigorous. (shrink)

Wilfrid Sellars [1962: 1] described philosophy as an attempt to ‘understand how things in the broadest possible sense of the term hang together in the broadest possible sense of the term’. But it is distinctive of philosophy that many of us are interested not only in how the world is but in ways that it could be. That is, philosophy is concerned with facts about modality. Some of the most important arguments in philosophy hinge on modal premises, and philosophers have (...) typically assumed special expertise in evaluating these modal premises. Replicating Goldvarg and Johnson-Laird’s [2000] study of modal illusions, we show that training in mathematics and not philosophy predicts success in overcoming such illusions (n = 395). This study is the first to test the modal expertise of professional philosophers directly. Our findings undermine claims to modal expertise. Philosophical training does not inoculate expert philosophers against basic mistakes in modal judgment. (shrink)

All large-scale telescope facilities are constructed within a geographical, social, historical, and political context that includes nested layers at the global, national, and local levels. However, discussions about the geographic siting of astronomy facilities, for example, the communities in which they are embedded or the interactions between the facility and its locale, are uncommon in social science studies of astronomy, and no extant review focused on this gap in the literature. In this literature review and discourse analysis, we explore the (...) ways in which research about astronomy facilities and their local communities has emerged, and the extent to which it focuses on the Global South. We find that literature addressing the social and policy aspects of astronomy facilities has an emphasis on the Global North. However, literature addressing host communities has an emphasis on the Global South. Broadly, the discourses related to host communities in the Global South have emerged from reflections on the controversies related to large-scale telescopes in Hawai’i, Chile, and South Africa. One common theme linking these discourses is that a focus on benefits at the national and international levels obscures a range of problematic power dynamics and outcomes at the local level. The notion of the Global South as an ‘empty space’ in which astronomical observation does not constitute impactful action amongst local communities, is challenged by discourses that centre local contexts, and challenged by discourses that employ conceptual frameworks with a focus on revealing power dynamics. (shrink)

IntroductionConcussion is a growing public health concern. No uniformly established therapy exists; neurofeedback studies report treatment value. We use infralow frequency neuromodulation to remediate disabling neurological symptoms caused by traumatic brain injury and noted improved outcomes with a novel concussion protocol. Postconcussion symptoms and persistent postconcussion symptoms are designated timelines for protracted neurological complaints following TBI. We performed a retrospective study to explore effectiveness of ILF in PCS/PPCS and investigated the value of using this concussion protocol.MethodPatients with PCS/PPCS seen for (...) their first neurology office visit or received their first neurofeedback session between 1 August 2018 and 31 January 2021 were entered. Outcomes were compared following treatment as usual vs. TAU with ILF neurotherapy. The study cohort was limited to PPCS patients; the TAU+ILF group was restricted further to PPCS patients receiving at least 10 neurotherapy sessions. Within the TAU+ILF group, comparisons were made between those who trained at least 10 sessions using concussion protocol and those who trained for at least 10 sessions of ILF regardless of protocol.ResultsAmong our resultant PPCS cohort leading persistent neurological complaints were headache, memory impairment, and brain fog. PPCS patients in TAU+ILF+CP demonstrated greater net and percent improvement of symptoms compared to PPCS subjects in TAU. PPCS patients in TAU+ILF-CP trended toward significant symptom improvements compared to TAU, and TAU+ILF+CP trended toward greater efficacy than TAU+ILF-CP.ConclusionPPCS patients who received TAU+ILF+CP demonstrated significantly greater improvement as a group when compared to TAU. When used as an integrative modality to treatment as usual in managing patients with PPCS, ILF neuromodulation with use of concussion protocol provided significant symptom improvements. (shrink)

The current experiments examine mental health clinicians’ beliefs about biological, psychological, and environmental bases of the DSM‐IV‐TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians’ beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding by having clinicians list what (...) they thought were the specific causes of nine familiar mental disorders and rate their bio–psycho–environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena. (shrink)

As donor trust legitimises research, trust is vital for research in the fields of biomedicine, genetics, translational medicine and personalised medicine. For parts of the donor community, the consent signature is a sign of trust in research. Many consent processes in biomedical research ask donors to provide their data for an unspecified future use, which introduces uncertainty of the unknown. This uncertainty can jeopardise donor trust or demand blind trust. But which donor wants to trust blindly? To reduce this uncertainty, (...) we explore first, which future-proof actors donors could trust when signing a consent form. Second, we discuss the question Can we know if donor trust expires? and what prevents donor trust from expiring. Finally, we present possible measures that can help to nurture trust in the far future. In this article, we draw on our previous research on trust in biomedical research, on trust in the broader healthcare system and Niklas Luhmann’s and Anthony Giddens’ trust theories. Our findings suggest that, in the far future, researchers will need to consider donor autonomy, as well as societal norms and values of the time period in which the data were donated. They will need to find mechanisms where possible to publicly announce the use of old data sets. However, foremost researchers will need to treat the data respectfully. It remains vital that professionals and the society continue to elaborate on the norms and values that shape the common understanding of what is morally right and wrong when researching data. (shrink)

We define an easily verifiable notion of an atomic formula having uniformly bounded arrays in a structure M. We prove that if T is a complete L-theory, then T is mutually algebraic if and only if there is some model M of T for which every atomic formula has uniformly bounded arrays. Moreover, an incomplete theory T is mutually algebraic if and only if every atomic formula has uniformly bounded arrays in every model M of T.

Caroline New is an energetic activist who has interpolated critical realist ideas into the front-line of political activism. In this wide-ranging interview, she begins by reflecting on her life and how she became a realist and her account is illustrated with personal anecdotes recalling memories of well-known philosophers and activists from the time. She discusses how her position set her apart from other feminists and she examines the interacting threads of longstanding debates on the political left, as well as (...) longstanding debates within critical realist circles, such as the relative importance of quantitative methods in social research and the scope for agency as a source of intentional change. Finally she brings some of her ideas to bear on contemporary issues. This engaging interview notably provides some of the social context in which critical realism developed, while also pointing towards its future potential. (shrink)

Wijdicks and colleagues1 recently presented the Full Outline of UnResponsiveness (FOUR) scale as an alternative to the Glasgow Coma Scale (GCS)2 in the evaluation of consciousness in severely brain-damaged patients. They studied 120 patients in an intensive care setting (mainly neuro-intensive care) and claimed that “the FOUR score detects a locked-in syndrome, as well as the presence of a vegetative state.”1 We fully agree that the FOUR is advantageous in identifying locked-in patients given that it specifically tests for eye movements (...) or blinking on command. This is welcomed given that misdiagnosis of the locked-in syndrome has been shown to occur in more than half of the cases (see Laureys and colleagues3 for review). As for the diagnosis of the vegetative state, the scale explicitly tests for visual pursuit, and hence can disentangle the vegetative state from the minimally conscious state (MCS). The diagnostic criteria for MCS have been proposed4 only recently, but Wijdicks and colleagues1 do not mention the existence of this clinical entity in their article. As for the vegetative state, MCS can be encountered in the acute or subacute setting as a transitional state on the way to further recovery, or it can be a more chronic or even permanent condition. The MCS refers to patients showing inconsistent, albeit clearly discernible, minimal behavioral evidence of consciousness (eg, localization of noxious stimuli, eye fixation or tracking, reproducible movement to command, or nonfunctional verbalization).4 The FOUR scale does not test for all of the behavioral criteria required to diagnose MCS.4 It is known from the literature (see Majerus and colleagues5 for review) that about a third of patients diagnosed with vegetative state are actually in MCS, and this misdiagnosis can lead to major clinical, therapeutic, and ethical consequences. We tested the ability of the newly proposed FOUR scale to correctly diagnose the vegetative state in an acute (intensive care and neurology ward) and chronic (neurorehabilitation) setting.. (shrink)

Psychedelic experiences are often compared to “transformative experiences” due to their potential to change how people think and behave. This study empirically examines whether psychedelic experiences constitute transformative experiences. Given psychedelics’ prospective applications as treatments for mental health disorders, this study also explores neuroethical issues raised by the possibility of biomedically directed transformation—namely, consent and moral psychopharmacology. To achieve these aims, we used both inductive and deductive coding techniques to analyze transcripts from interviews with 26 participants in psychedelic retreats. Results (...) indicate that psychedelic experiences can constitute transformative experiences. Twenty participants reported experiences or insights that were seemingly inaccessible or impossible to attain if not for the psychoactive effects of psychedelics. All participants besides one reported some change in identity, values, beliefs, desires, and behavior—changes in behavior being the most common. Participants also reported feeling capable deciding to use psychedelics in part due to information seeking prior to their retreats. Finally, several participants reported an enhanced capacity for enacting changes in their lives. Our results underscore both the importance of subjective embodiment to transformation and the role of transformative agency in shaping outcomes of the psychedelic experience. We examine our results relative to neuroethical issues and advocate for centering the person in psychedelic research and neuroethical inquiry about psychedelics to avoid pitfalls associated with psychedelics’ potential as moral psychopharmacological agents. (shrink)

Great effort is invested in identifying ways to change people's minds on an issue. A first priority should perhaps be enriching their thinking about the issue. With a goal of enriching their thinking, we studied the views of community adults on the DACA issue—young adults who entered the United States illegally as children. A dialogic method was employed, offering dual benefits in providing participants the opportunity to further develop their own ideas and to consider differing ideas. Yet, participants engaged in (...) dialog only vicariously by observing the talk of a pair of actors who held opposing positions on DACA. The effect on participants’ thinking was greatest in the condition in which they viewed a dialog between the two actors, rather than a comparison condition in which the actors individually expressed their positions. In control conditions, no presentation was observed. Probing questions included in all conditions encouraged a participant to examine and clarify for themselves their own position, potentially enriching it. This condition proved unsuccessful in enriching thinking; participants’ justifications for their own positions in fact became simpler and less qualified. In contrast, observing a video of a like-minded and opposing other did enrich observers’ thinking, yet to a greater degree in the dialogic than nondialogic condition. The findings thus suggest observed dialog as a promising practical approach in promoting deeper thinking. (shrink)

This study investigated the beliefs that formed teachers’ intentions to integrate STEM content into their social studies instruction. Participants were 60 elementary, middle, and high school in-service teachers who attended a summer history workshop on Abraham Lincoln. Data were collected by qualitative and quantitative instruments. Beliefs about likely outcomes of integrating STEM, and beliefs about persons who would approve, or disapprove, of STEM integration were elicited from teachers, and content analyzed. The resulting outcome and normative beliefs were used as stems (...) for items in the quantitative instrument. Quantitative data were analyzed primarily by correlation and multiple regression. This study found that attitude toward the behavior, integrating STEM, was formed by 15 outcome beliefs, subjective norm was formed by five normative beliefs, and that attitude and norm predicted behavioral intention. The theory we used enabled us to calculate the numerical contribution of each of the beliefs that were important in forming teachers’ intentions. The results have implications for theory, research, and practice in social studies education. In the realm of practice, these implications are for the initial preparation of, and the subsequent professional development of social studies teachers, both at the elementary and secondary levels. (shrink)

Despite general agreement within philosophy that peer review is indispensable, its fairness and reliability is often questioned. This article suggests that such worries can to a large extent be met by adopting the practice that reviews as well as earlier versions of papers are made publicly available when the final version of a paper is published. This suggestion combines the advantages of transparency with the merits of anonymity of reviewers. While there are obstacles to this suggestion, the article argues that (...) it would be worthwhile to implement it because it can help map patterns of conduct and secure confidence in the fairness and reliability of review procedures and journal editing within philosophy. (shrink)

Discute-se a interface entre discursos poéticos e proféticos e a área de atuação de seus respectivos especialistas, na Grécia arcaica, a partir de uma análise de certas passagens dos poemas Teogonia e Trabalhos e dias de Hesíodo. O enfoque é a afirmação, na Teogonia , que a consagração do poeta pelas Musas, ou seja, sua união com uma realidade sagrada, lhe permite celebrar o futuro. A afirmação é discutida através da interpretação de passagens em Trabalhos e dias.

Coming to Life: Philosophies of Pregnancy, Childbirth and Mothering is a superlative collection of essays that does what too few scholarly works have dared: it takes seriously the philosophical significance of women’s lived experience. Every woman, regardless of her own reproductive story, is touched by the often restrictive beliefs and norms governing discourses about pregnancy, childbirth and mothering. Thus the concerns of this anthology are relevant to all women and central to any philosophical project that takes women’s lives seriously. In (...) this volume 16 authors- including both established feminists and some of today’s most innovative new scholars- engage in sustained reflection on the experiences of pregnancy, childbirth and mothering, and on the beliefs, customs, and political institutions by which those experiences are informed. Many of the topics in this collection, though familiar, are here taken up in a new way: contributors think beyond the traditional pro-choice/pro-life dichotomy, speak to the manifold nature of mothering by considering the experiences of adoptive mothers and birthmothers, and upend the belief that childrearing practices must be uniform despite psycho-sexual differences in children. Many chapters reveal the radical shortcomings of conventional philosophical wisdom by placing trenchant assumptions about subjectivity, gender, power and virtue in dialogue with women’s experience. The volume is diverse both in its content and in its scholarly approach; certain of the essays are informed by their authors’ own experiences, others draw from extant narratives; many engage such canonical thinkers as Plato, Aristotle, Nietzsche and Heidegger, while others draw from the works of contemporary feminists including Sara Ruddick, Iris Marion Young, Virginia Held, Julia Kristeva and Luce Irigaray. All readers, regardless of their philosophical training and commitments, will find much to appreciate in this volume. (shrink)

In this paper we suggest that there is a need to examine what is meant by “context” in Social Psychology and present an example of how to place identity in its social and institutional context. Taking the case of British naturalisation, the process whereby migrants become citizens, we show that the identity of naturalised citizens is defined by common-sense ideas about Britishness and by immigration policies. An analysis of policy documents on “earned citizenship” and interviews with naturalised citizens shows that (...) the distinction between “elite” and “non-elite” migrants is evident in both the “reified” sphere of policy and the “common sense” sphere of everyday identity construction. While social representations embedded in lay experience construct ethno-cultural similarity and difference, immigration policies engage in an institutionalised positioning process by determining migrants' rights of mobility. These spheres of knowledge and practice are not disconnected as these two levels of “managing otherness” overlap—it is the poorer, less skilled migrants, originating outside the West who epitomise difference (within a consensual sphere) and have less freedom of mobility (within a reified sphere). We show that the context of identity should be understood as simultaneously psychological and political. (shrink)

Background Thirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area. Aim The aim of this study was to explore palliative care physicians’ experiences of ethical challenges in relation to thirst in terminally ill patients. Methods A qualitative interview (...) study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. Results When presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patient’s autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering. Conclusions All physicians in this study reported that “Starting, continuing or discontinuing drips” was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular. (shrink)

Caroline Guibet Lafaye | : Notre rapport à la propriété et à la propriété privée repose aujourd’hui encore sur une interprétation de celle-ci qui a émergé au XVIIe, par référence à un contexte qui était celui de l’état de nature. Bien que ce contexte interprétatif ait évolué persiste la prévalence d’une interprétation individualiste et substantialiste du rapport à ce qui est possédé. Notre ambition sera de mettre au jour d’autres modèles interprétatifs de la propriété qui ne soient pas avant (...) tout attachés à l’individu en tant que tel, dans sa singularité, mais qui se construisent par exemple à partir de l’attribution à l’individu de droits sur les qualités des choses. Dans un premier temps, nous identifierons les éléments (tels le Code civil) et les mécanismes qui ont conduit à construire la sphère familiale comme l’espace légitime au sein duquel se réalisent la négociation des biens et la transmission du patrimoine. Il s’agira, dans un deuxième temps, de concevoir la propriété par référence à une convention plutôt qu’à un état de nature, fût-il familial, et par référence à une finalité sociale plutôt qu’à des finalités individualistes. Enfin, nous envisagerons les reformulations possibles du concept de propriété privée et de propriété sociale à partir d’un contrat social plus juste pour l’ensemble des contractants. | : The contemporary conception of private property is still nowadays based on an interpretation of it that emerged in the seventeenth century, in reference to the state of nature. Although this interpretive context has changed, the prevalence of an individualistic and substantialist interpretation of what is possessed persists. In this paper, we will highlight some interpretative models of property which are not primarily attached to the individual but which are grounded on the entitlement of rights over the qualities of things to the individual. Firstly, we will identify the elements and the mechanisms that led to build the domestic sphere as the legitimate space in which to the goods are negotiated and the property transferred. Then we will propose an interpretation of private property referring to a convention rather than to a state of nature — even a familial one —, i.e. referring to social aims rather than to individualistic goals. Thirdly, we will examine the meanings of a concept of private property and social property taking into account the conditions of a fairer social contract for all. (shrink)

Liberals agree that free speech should be protected, where speech is understood broadly to include all forms of intentional communication, including actions and pictures, not merely the spoken or written word. A surprising view about free speech in some liberal and legal circles is that communications should be protected on free-speech grounds only if the communications are mentally mediated. By “mentally mediated communication” we mean speech which communicates its message in such a way that the message can be rationally evaluated (...) by hearers, and causes the hearers to believe it, when it does, through the mechanism of those hearers employing their rational capacity to judge that it is correct. The mental-mediation or persuasion principle, as it is sometimes called, has some important legal and public policy implications. It has been applied to argue that certain forms of expression, despite being forms of speech or expression, lack even a prima facie claim to protection on free speech grounds. -/- Our central aim is to show why the mental mediation principle is mistaken. Liberals should think that some speech which is not mentally mediated deserves protection for the very same reasons that speech which is mentally mediated is often thought to deserve protection. (shrink)

Some patients awaken from their coma but only show reflex motor activity. This condition of wakeful (eyes open) unawareness is called the vegetative state. In 2002, a new clinical entity coined ‘‘minimally conscious state’’ defined patients who show more than reflex responsiveness but remain unable to communicate their thoughts and feelings. Emergence from the minimally conscious state is defined by functional recovery of verbal or nonverbal communication.1 Our empirical medical definitions aim to propose clearcut borders separating disorders of consciousness such (...) as coma, vegetative state and minimally conscious state but clinical reality shows that these boundaries can often be fuzzy (fig 1). Recent clinical, electrophysiological and neuroimaging studies are shedding light on these challenging limits of consciousness encountered following severe acute brain damage. At the patient’s bedside, it is very challenging to differentiate reflex or automatic motor behaviour from movements indicating signs of consciousness, and hence some minimally conscious patients might be misdiagnosed as being vegetative. For some motor responses (eg, blinking to visual threat, brief fixation, normal flexion response to pain, etc) it remains unclear whether they truly are voluntary or willed because we lack convincing scientific evidence. We also lack consensus on how to practically assess some of these behavioural responses. For example, there is no agreement on what stimulus to employ in the assessment of visual pursuit movements— often one of the first clinical signs heralding the transition from the vegetative to the minimally conscious state. Vanhaudenhuyse and colleagues2 recently studied visual pursuit in 51 post-comatose patients comparing eye tracking of a moving object, person or mirror. It was shown that more.. (shrink)

Background Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts need to be taken without the possibility to discuss matters with colleagues. Little is known whether these considerations regarding ethical issues in crucial life-and-death decisions are documented prehospitally. This is a review of the ethical considerations documented in the prehospital medical records (...) of patients in a Danish prehospital setting for whom the decision to resuscitate or not was made at the scene. Methods The study is based on discharge summaries of all patients subjected to crucial life-and-death decisions by the Mobile Emergency Care Unit in Odense in the years 2010 to 2014. The medical records with possible documentation of ethical issues were independently reviewed by two philosophers in order to identify explicit ethical or philosophical considerations pertaining to the decision to resuscitate or not. Results In total, 1275 patients were either declared dead at the scene without exhibiting layman’s reliable signs of death or admitted to hospital following resuscitation. In a total of 62 patients, 85 specific ethical issues related to resuscitation were documented. The expressions of the ethical considerations were generally vague or unclear and almost exclusively concerned the interests of the patient and not the relatives. In the vast majority of cases where an ethical content was identified, the ethical considerations led to a decision to terminate treatment. Conclusions A strengthened practice of documenting ethical considerations in prehospital life-and-death decision-making in the patient’s medical records is required. We suggest that a template be implemented in the prehospital medical records describing the basis for any ethical decisions. This template should contain information regarding the persons involved in the deliberations and notes on ethical considerations. The documentation should include considerations concerning the patient’s end-of-life wishes, the estimations of the quality of life before and after the incident, and a summary of other ethical concerns taken into account, such as the integrity of the patient and frame of mind of relatives. (shrink)

As more young people feel safe to outwardly identify as transgender or gender expansive (TGE), meaning that their gender identity does not align with the sex they were assigned at birth, an increasing number of youth who identify as TGE seek gender-affirming medical care (GAMC). GAMC raises a number of ethical questions, such as the capacity of a minor to assent or consent, the role of parents or legal guardians in decisions about treatment, and implications for equitable access to care (...) when differing parental or custodial viewpoints are present. These questions are further complicated by the difficulties in explaining the limits of long-term research in GAMC, with regard to the preservation of fertility, for example. We present two de-identified composite case studies to highlight dilemmas that may arise and offer recommendations to better support patient- and family-centered decision making for GAMC. These include employing a multidisciplinUniverary shared decision-making approach, disentangling informed consent and assent from chronological age, developing a consistent approach to the assessment of decisional capacity, and developing age-appropriate informational materials. (shrink)

BackgroundImplementation of recommendations from clinical practice guidelines is essential for evidence based clinical practice. However, the most effective methods of implementation are unclear. We conducted a national, cluster-randomised, blinded implementation trial to determine if midwife or doctor local implementation leaders are more effective in implementing a guideline for use of oral dextrose gel to treat hypoglycaemic babies on postnatal wards. To prevent any conscious or unconscious performance bias both the doctor and midwife local implementation leaders were kept unaware of the (...) trial. This paper reports the ethical dilemmas and practical challenges of ensuring clinicians remained unaware of their involvement in an implementation trial.MethodsWe sought approval from the National Health and Disability Ethics committee to keep clinicians unaware of the trial by waiving the standard requirement for locality approval usually required for each district health board. The ethics committee did not approve a waiver of consent but advised that we approach the chief executive of each district health board to ask for provisional locality approval. Ultimately it was necessary to seek ethics approval for three separate study designs to keep clinicians unaware of the trial.ResultsThe median time for chief executive approval was 16 days and for locality approval was 57 days. We completed 21 different locality approval forms for 27 hospitals.ConclusionsKeeping clinicians unaware of their involvement in a national implementation cluster-randomised trial is feasible. However, despite a national ethics committee, significant logistical challenges were time consuming and delayed trial completion. Co-ordination of the locality approval process would help facilitate multi-centre trials. (shrink)

This article aims to deepen and extend theoretical understanding of mobility by exploring some of the mechanisms by which it operates. It introduces the concept and practices of ‘tacking’ as a frame for examining the creative processes of navigation and improvisation through which people approach and reflect on the irregularities and uncertainties of their everyday rounds, enacted or otherwise narrated as spatial biography – lives conceived in mobile-spatial terms. ‘Tacking’ also travels beyond this frame of reference, i.e. it is ‘good (...) to think with’ across different substantive contexts of social interaction. Tacking suggests ongoing adjustment and modification that respond to shifting circumstances and may create new facts on the ground, which elicit further adjustments. (shrink)

This study investigates the choice of genitive forms (the woman’s book vs. the book of the woman) in the English of Japanese-English bilingual returnees (i.e. children who returned from a second language dominant environment to their first language environment). The specific aim was to examine whether change in language dominance/exposure influences choice of genitive form in the bilingual children; the more general question was the extent to which observed behaviour can be explained by cross linguistic influence (CLI). First, we compared (...) the choice of genitive form between monolingual Japanese speakers and bilinguals who had recently returned to Japan from an English monolingual environment. Second, we tracked changes in genitive preference within bilingual children, comparing their performances upon return to Japan to those of one year later. Results show that CLI alone is insufficient to explain the difference in genitive evaluation between bilinguals and monolinguals, as well as the intra-group bilingual variation over time. We suggest that both CLI and general processing considerations couple together to influence the changes in genitive preference. (shrink)