Health equity is a global concern. Although health equity extends far beyond the equitable distribution of healthcare, equitable access to healthcare is essential to the achievement of health equity. In Canada, Indigenous Peoples experience inequities in health and healthcare access. Cultural safety and trauma‐ and violence‐informed care have been proposed as models of care to improve healthcare access, yet practitioners lack guidance on how to implement these models. In this paper, we build upon an existing framework of equity‐oriented care for (...) primary healthcare settings by proposing strategies to guide nurses in operationalizing cultural safety and trauma‐ and violence‐informed care into nursing practice at the individual level. This component is one strategy to redress inequitable access to care among Indigenous Peoples in Canada. We conceptualize barriers to accessing healthcare as intrapersonal, interpersonal, and structural. We then define three domains for nursing action: practicing reflexivity, prioritizing relationships, and considering the context. We have applied this expanded framework within the context of Indigenous Peoples in Canada as a way of illustrating specific concepts and focusing our argument; however, this framework is relevant to other groups experiencing marginalizing conditions and inequitable access to healthcare, and thus is applicable to many areas of nursing practice. (shrink)

Inequities in access to oncology care among Indigenous peoples in Canada are well documented. Access to oncology care is mediated by a range of factors; however, emerging evidence suggests that healthcare providers, including nurses, play a significant role in shaping healthcare access. The purpose of this study was to critically examine access to oncology care among Indigenous peoples in Canada from the perspective of oncology nurses. Guided by postcolonial theoretical perspectives, interpretive descriptive and critical discourse analysis methodologies informed study design (...) and data analysis. Oncology nurses were recruited from across Canada to complete an online survey (n = 78). Nurses identified a range of barriers experienced by Indigenous peoples when accessing oncology care, yet located these barriers primarily at the individual and systems levels. Nurses perceived themselves as mediators of access to oncology care; however, their efforts to facilitate access to care were constrained by the dominance of biomedicine within healthcare. Nurses' constructions of access to oncology care highlight the embedded narrative of individualism within nursing practice and the relative invisibility of racism as a determinant of equitable access to care among Indigenous peoples. This suggests a need for oncology nurses to better understand and incorporate structural determinants of health perspectives. (shrink)

The Vestal Virgins are one of the most famous elements of Roman religion, yet despite their perennial appeal and the importance of some smaller scale studies of the priesthood, the priestesses have not received a monograph-length study since F. Giuzzi, Aspetti giuridici del sacerdozio romano. II sacerdozio di Vesta (Naples, 1968). Now we have books by R.L. Wildfang and M.C. Martini that could not be more different. The former offers a thorough survey of what the sources can tell us about (...) the priesthood in the period from the end of the Second Carthaginian War to the first century C.E. The latter is an analysis of early Roman historiography and the role the Vestals, in particular their periodic unchastity, played in the creation of the traditional account of the development of Rome. W's book puts forward two main arguments: (1) the Vestals were charged with the ritual purification of the city and with the storage and preparation of ritual materials, and (2) many aspects of the priesthood that have long puzzled scholars are tied to the Vestals' status as Roman citizens, but citizens who existed outside the traditional family structure. The book will be accessible to those new to the topic, but the notes will repay specialists. Ancient sources are quoted in translation, with original texts provided in an appendix. A second appendix provides a list of known Vestals. This slender volume could have been even thinner if the frequent repetitions were cut down. W's work might have been better as a hefty article, so little is there to know about the Vestals. The Classical Review vol. 58 no. 1 C The Classical Association 2008; all rights reserved This content downloaded from 204.235.148.90 on Sat, 26 Jul 2014 11:47:09 AM All use subject to JSTOR Terms and Conditions THE CLASSICAL REVIEW 213 In the Introduction, W makes a welcome distinction among types of rituals often lumped together in discussions of 'fertility' rituals, with which the Vestals are often associated (p. 4). W reserves 'fertility' to describe only those rites that deal with the reproduction of people, livestock and the growth of crops. Harvest rituals are linked to the harvesting of crops, while another set of rites, 'storage rites', are tied to the preservation of the harvest. The final group, purification rituals, aim at the cleansing of an individual, place or object of 'all forms of pollution that would render it or them unfit to come into contact with the religious sphere'. The book is arranged thematically. The first two chapters lay out all we can know about the priestesses' ritual obligations performed in the seclusion of the temple and out amongst the people. While a reader may not find W's interpretation of each of the Vestals' actions equally persuasive, the overall argument that the priestesses' activities were, by and large, purificatory is convincing. Two of the more interesting aspects of W.'s discussion are her considerations of Vesta's fire and of the water required for some of her rituals (pp. 8-11). Fire was seen by the Romans as both a fertile and a sterile force, and scholars have emphasised one or the other, or the contrast between them, in their interpretation of the Vestals. W points out that fertile fire is always described in masculine terms and is associated with Vulcan. Vesta's fire, however, is always associated with sterility and purity, and so should be understood as having a purificatory significance. W points out that Vesta's fire was used only in the manufacture of ritually necessary items: roasting spelt for mola salsa, baking brine for muries and burning ashes from the fetal cow from the Fordicidia and the tail of the October horse, both of which were used at the Parilia. For other rituals, the Vestals were required to use water, the purificatory substance par excellence, drawn only from the spring of Juturna and carried only in vessels that could not be set down. These restrictions ensured that the water was always fresh, running water that never touched profane earth. Chapters 3-5 trace out the unique position the Vestals occupied in Roman society, arguing that they existed outside the standard Roman familial and other social structures, yet remained fully part of the Roman state. W suggests that the initiation rite of captio removed the new priestess not only from her family but, more importantly, from her family cult, thus avoiding any potential contamination of familial and public cult. Virginity was required for multiple reasons, the most significant being that such a status allowed the priestess to remain a full member of the Roman state, but prevented her from being a member of a traditional family structure. Throughout the book, W makes much of the idea of Vestals as represen tatives of Roman citizen women without ever really dealing with the question to what extent any Roman woman, priestess or not, was a ciuis. Though W is probably correct, it is not entirely certain to what extent women were citizens in the Republic, and at least a reference to some key ancient sources and to recent scholarship on this question should be made (e.g. L. Peppe, Posizione giuridica e ruolo sociale della donna romana in eta repubblicana [Milan, 1984]). The sixth chapter, 'The Vestals in the Romans' History', looks at the appearance of Vestals in the early history of Rome, refining the common assumption that accusations of, and convictions for, incestum arose only in periods of great stress and danger. W adds that a priestess's involvement, or her family's involvement, in one of the groups taking part in the conflict or struggle of the moment also played a role. This chapter traces changes over the course of 300 years in the attitudes of the priestesses and the Romans more generally toward the priesthood, its role in society This content downloaded from 204.235.148.90 on Sat, 26 Jul 2014 11:47:09 AM All use subject to JSTOR Terms and Conditions 214 THE CLASSICAL REVIEW and its requirement of 30 years of chastity. The argument hangs on even less evidence than other sections of the work. In contrast to their central place in W's book, the Vestals play only a small (though crucial, in her interpretation) role in M.'s work. The basic argument of the book is that episodes of Vestal incestum are linked in the historiographic tradition to key moments in the development of the Roman state: the separation of augurium from regnum, the development of a mixed patrician-plebeian aristocracy, the creation of a monetary system and the expansion of the colonial system outside Italy. The history of Rome can be seen as alternating phases of stasis and transformation; instances of Vestal incestum mark the transitions (p. 95). The work falls into two parts that are not well integrated. The first is a useful discussion of the historiography of the Roman Republic, taking in turn each element of the story of the founding of Rome from the arrival of Aeneas to the death of Remus. M. traces how early Roman writers, especially Fabius Pictor, reshaped the tradition already present in some Greek authors, distancing Rome from the Greek world and adding an Italic element to the tale. This detailed analysis is well worth consulting and will be of interest to those working on many aspects of cultural life in the Republic. The second, larger, section of the book comprises a series of studies of the Vestals known to have been convicted of incestum during the Republic. After dealing with issues of dating and sources, M. links each case of incestum to a major event in Roman history. Not all the events are equally important for the creation of the Rome of the middle and late Republic. One wonders why M. chose to tie the conviction of Minucia, somewhere between 339 and 332, to the admission of plebeians to the praetorship in 337 rather than to the conclusion of the Latin War in 338. Some explanation is warranted. The connection M. draws is often very vague, as in the case of Sextilia (pp. 144-54), convicted and interred alive in either 275 or 274. M. sees this as marking the end of any meaningful distinction between patricians and plebeians, following as it does the first time a plebeian censor completed a lustrum. The gap of five or six years between Sextilia's conviction and Cn. Domitius Calvinus Maximus' censorship in 280 passes unremarked. Similarly, in discussing the three Vestals accused of incestum in 114-113 (pp. 188-210), M. steps away from the commonly accepted interpretation of the event as part of the continuing struggle between Gracchan and senatorial forces, arguing instead that it is tied to the establishment in 118 of the colony of Narbo Martius, Rome's first colony in Gaul. Here, as elsewhere, there is no evidence that any ancient author linked the founding of the colony and Vestal unchastity; the temporal gap makes an association even more unlikely. Ultimately, it is not possible to accept M.'s argument that Vestal incestum punctuated key stages in the development of the 'cosmo Romano' in the way she imagines. Even so, M.'s effort to reintegrate the Vestals into the larger narrative of Rome's history is thought-provoking, and it is to be hoped that it will spark further work in the same vein. The field is perhaps in a better position to undertake work on this scale now that we have W's careful and comprehensive collection and interpre tation of what there is to know about the Vestals. Yale University CELIA E. SCHULTZ celia.schultz(yale.edu This content downloaded from 204.235.148.90 on Sat, 26 Jul 2014 11:47:09 AM All use subject to JSTOR Terms and Conditions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:THOMISTIC METAETIDCS AND A PRESENT CONTROVERSY XOOD STARTING point for understanding the recent controversy regarding the Grisez-Finnis interpretaition oi St. Thomas Aquinas's ethical theory is Finnis's claim that "by a 'Simple act of non-inferential understanding one grasps that the objeot of the [natural] inclination which one experiences is an instance of a general form of good, for oneself (and others like one)." 1 For here Finnis is denying an (...) inferential process by which one moves from a theoretical understanding (" understanding this nature from the outside, as it were" 2) of what inclinations humans,as humans have to the conclusion that the object oi the particular inclination in question is ·a human good. Instead, he is asserting that it is in a practical context that one understands an object of an inclination to be a human good, and thus generates, via the practical reason, ·a practical, prescriptive principle. An example of such a principle is " Knowledge is something good to have " which, for Finnis, is the same logically as " Knowledge is a good to be pursued " 3 which, in turn, is equivalent to "Knowledge ought to be pursued ",4 which is a prescriptive ("normative") rather than descriptive (factual) utterance.5 1Natural Law and Natural Rights (Oxford: Clarendon Press, 1980; hereafter NLNR), p. 34. Cf. Fundamentals of Ethics (Washington, D.C.: Georgetown University Press, 1983; hereafter FE), pp. 20-22. 2NLNR p. 34. s Ibid., p. 63. 4lbid., p. 42, note 56; "The Basic Principles of Natural Law: A Reply to Ralph Mclnerny," John Finnis and Germain Grisez, American Journal of Jurisprudence 26 (1981), pp. 21-31 (hereafter Reply to Mcinerny), pp. 23-24. See also Germain Grisez's well-known article "The First Principle of Practical Reason: A Commentary on the Summa theologiae, 1-2, Question 94, Article 2," Natural Law Forum 10 (1965), pp. 168-201 (hereafter FPPR), p. 194. 5 See, e.g., NLNR, pp. 44-45; Reply to Mcinerny, p. 23. Grisez and Finnis attempt to distinguish imperatives and prescriptions, which I argue against in 40 THOMISTIC METAETHICS AND A PRESENT CONTROVERSY 41 Finnis and Grisez, then, argue that practical principles, which encompass value-judgments about human goods, are arrived at through the practical reason and thus are prescriptive ("normative ") utterances, as opposed to descriptive or theoretical truths "of metaphysical anthropology ".6 Hence these principles cannot be derived from metaphysical claims.7 To argue for such,a derivation would he to hold that prescriptivity or normativity can emerge from pure descriptivity. Such a derivation, of course, would not account for the appearance of the prescriptive or action-guiding element. An alternative position, to be returned to below, is that value-judgments about human goods are descriptive in themselves. At the same time, owing to the natural inclination to do what we understand to be morally or humanly good, human beings could prescribe to themselves the pursuit of such human goods, once they are understood to be human goods. It should be noted that for Grisez and Finnis the basic practical principles are not moral but pre-moraL8 Still, Grisez and Finnis consider that they direct to ends completive of human nature. Hence, although these authors reserve the characterization of "' moraily right choices " to those that are not simply harmonious with one or another basic human good but rather to those that also do not run counter to any other human good,9 my paper "Is-Ought: Prescribing and a P1·esent Controversy," The Thomist 49, l (January, 1985), pp. 1-23 (hereafter Schultz), esp. pp. 10-Hl. s Reply to Mcinerny, pp. 23-24. 7 Ibid.; see note 13 below. In the paper mentioned in note 5 above I point out that Finnis seems to allow for the possibility of arriving at value-judgments through theoretical reasoning, since he says "I assert that judgments [about man's natural goods, about what man should be] are primarily (though perhaps not exclitsively) judgments of practical reason...." ("Natural Law and 'Is'-'Ought' Question: An Invitation to Professor Veatch," Catholic Lawyer 26, 4, 1981, p. 272, my emphasis. This article is subsequently referred to as Response to Veatch.) But he doesn't explain this, and in Reply to... (shrink)

De uma perspectiva comportamentalista radical, o eu é um repertório verbal complexo, que, como tal, tem uma gênese social. O reconhecimento da origem social do “eu” abre caminho para uma análise política, incluindo uma discussão do pa- pel das relações de poder na constituição do eu. Entretanto, uma concepção radicalmente social do “eu”, como a proposta pelo comportamentalismo, suscita um problema político: se o eu é integralmente produto do ambiente social, de onde viria uma eventual “vontade” de romper com esse (...) sistema? Parece que para reconhecer a possibilidade de ação política transformadora seria preciso preservar uma noção descontextualizada de “eu”. Considerando essa dificuldade, o objetivo deste artigo é propor uma interpretação política da constituição do “eu” no âmbito do comportamentalismo radical, mantendo no horizonte a possibilidade de uma ação política transformadora. Para tanto, destacamos como “eus” oprimidos são tornados submissos, mas também como de certas contingências podem emergir “eus” subversivos, que se opõem a um sistema social opressivo. Esse “eu” subversivo é caracterizado por um repertório de autoconhecimento mais amplo, que inclui a discriminação do papel das relações de poder e do controle promovido por instituições. Concluímos, com isso, que um “eu” socialmente constituído pode ser politicamente ativo. (shrink)

Investigates the resolution of contradictions and ambiguous derogations in a code, by means of the imposition of partial orderings. Although formulated as a study in the logic of norms, it provided the initial ideas for work on the logic of theory (or belief) change, developed by the authors in a series of papers by the authors and Peter Gardenfors beginning in 1985.

The Sarbanes–Oxley Act of 2002 requires audit committees of public companies’ boards of directors to install an anonymous reporting channel to assist in deterring and detecting accounting fraud and control weaknesses. While it is generally accepted that the availability of such a reporting channel may reduce the reporting cost of the observer of a questionable act, there is concern that the addition of such a channel may decrease the overall effectiveness compared to a system employing only non-anonymous reporting options. The (...) rationale underlying this concern involves the would-be reporter’s likelihood of reporting, the seriousness with which the organization treats an anonymous report, and the organization’s ability to thoroughly follow-up the report. Thus, we explore the extent to which the availability of an anonymous reporting channel influences intended use of non-anonymous reporting channels. Further, in response to Sarbanes–Oxley and the environment of financial scandals that led to its passage, many firms are strengthening their internal audit departments, and providing them with greater independence from upper management’s direct control. Accordingly, our examination tests whether the intended use of the internal audit department as an internal reporting channel is greater when the internal audit department is of “high” versus “low” quality. Finally, the study investigates intended reporting behavior across three different cases (e.g., settings). Results show that the existence of an anonymous channel does reduce the likelihood of reporting to non-anonymous channels, that generally the internal audit department quality does not affect reporting to non-anonymous channels, and that case-setting affects the type of channel to be used. Implications from the study are discussed. (shrink)

For all of the emphasis on quality improvement—as well as the acknowledged overlap between assessment of the quality of healthcare services and clinical ethics—the quality of clinical ethics consultation has received scant attention, especially in terms of empirical measurement. Recognizing this need, the second edition of Core Competencies for Health Care Ethics Consultation identified four domains of ethics quality: (1) ethicality, (2) stakeholders’ satisfaction, (3) resolution of the presenting conflict/dilemma, and (4) education that translates into knowledge. This study is the (...) first, to our knowledge, to directly measure all of these domains. Here we describe the quality improvement process undertaken at a tertiary care academic medical center, as well as the tools developed to measure the quality of ethics consultation, which include post-consultation satisfaction surveys and weekly case conferences. The information gained through these tools helps to improve not only the process of ethics consultation, but also the measurement and assurance of quality. (shrink)

As nursing professionals, we believe access to healthcare is fundamental to health and that it is a determinant of health. Therefore, evidence suggesting access to healthcare is problematic for many Indigenous peoples is concerning. While biomedical perspectives underlie our current understanding of access, considering alternate perspectives could expand our awareness of and ability to address this issue. In this paper, we critique how access to healthcare is understood through a biomedical lens, how a postcolonial theoretical lens can extend that understanding, (...) and the subsequent implications this alternative view raises for the nursing profession. Drawing on peer‐reviewed published and gray literature concerning healthcare access and Indigenous peoples to inform this critique, we focus on the underlying theoretical lens shaping our current understanding of access. A postcolonial analysis provides a way of understanding healthcare as a social space and social relationship, presenting a unique perspective on access to healthcare. The novelty of this finding is of particular importance for the profession of nursing, as we are well situated to influence these social aspects, improving access to healthcare services broadly, and among Indigenous peoples specifically. (shrink)

As human beings age, they become weak, fragile, and feeble. It is a slowly progressing yet complex syndrome in which old age or some disabilities are not prerequisites; neither does loss of human parts lead to frailty among the physically fit older persons. This paper aims to describe the influences of transhumanist perspectives on human‐technology enhancements and replacements in the transcendence of human frailties, including those of older persons, in which technology is projected to deliver solutions toward transcending these frailties. (...) Through technologies including genetic screening and other technological manipulations, intelligent machines and augmented humans improve, maintain, and remedy human‐linked susceptibilities. Furthermore, other technologies replace parts fabricated through inorganic‐mechanical processes such as 3D‐printing. Advancing technologies are reaching the summit of technological sophistication contributing to the transhumanist views of being human in a technological world. Technologies enhance the transcendence of human frailties as essential expressions of the symbiosis between human beings and technology in a transcendental world. (shrink)

It’s certainly wrong for employers to accept applications from only white people. Universities that open admissions to only white people surely act wrongly. But do people who date, or consider dating, only white people do something wrong? Many people say that racialized attraction is just a matter of personal preference. Against this view, it will be argued that it often constitutes wrongful discrimination.

When faced with adverse circumstances, there may be a tendency for individuals, agencies, and governments to search for a target to assign blame. Our focus will be on the novel coronavirus outbreak, where racial groups, political parties, countries, and minorities have been blamed for spreading, producing or creating the virus. Blame—here defined as attributing causality, responsibility, intent, or foresight to someone/something for a fault or wrong—has already begun to damage modern society and medical practice in the context of the COVID-19 (...) outbreak. Evidence from past and current pandemics suggest that this tendency to seek blame affects international relations, promotes unwarranted devaluation of health professionals, and prompts a spike of racism and discrimination. By drawing on social and cognitive psychology theories, we provide a framework that helps to understand the effect of blame in pandemics, when people blame, whom they blame, and how blame detrimentally affects the COVID-19 response. Ultimately, we provide a path to inform health messaging to reduce blaming tendencies, based on social psychological principles for health communication. (shrink)

Volume 20, Issue 4, May 2020, Page 76-78.

Online research offers advantages including recruitment cost, diminished equity-related participation barriers, and convenience; however, there are growing concerns regarding fraudulent participation. Guidance to navigate these challenges exists for online research generally (e.g. surveys), but remains sparse for the specific challenge of fraudulent participation within virtual synchronous interviews. No work has explored this topic within an explicit, detailed ethical framework. Reflecting on our experiences navigating fraudulent participation in virtual synchronous research, we address this gap using the Canadian Code of Ethics for (...) Psychologists as a guiding framework to describe challenges, explore ethical considerations, and identify potential solutions and research directions. (shrink)

Realist evaluation has gained prominence in the field of evaluation in recent years. Its theory-driven approach to explaining how and why programmes work or not makes it attractive to many novices, early career researchers, and organizations implementing various programmes globally and relevant to policymakers and programme implementers. While realist evaluation seeks to be pragmatic, adopting principles and methods that can be used to help focus an evaluation, its deep ontological and epistemological foundations make its application in real-life situations challenging. In (...) this paper, we seek to unpack the key tenets scaffolding the practical application of realist evaluation. Although Pawson and Tilley foreground realist evaluation in applied scientific realism, we argue that an amalgam of scientific and critical realist principles underpins realist evaluation. We unpack these principles and illustrate how they fit into each other to provide a cogent theoretical foundation for realist evaluation. (shrink)

This commentary argues against the indictment of current experimental practices such as piecemeal testing, and the proposed integrated experiment design (IED) approach, which we see as yet another attempt at automating scientific thinking. We identify a number of undesirable features of IED that lead us to believe that its broad application will hinder scientific progress.

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

System-level change is crucial for solving society's most pressing problems. However, individual-level interventions may be useful for creating behavioral change before system-level change is in place and for increasing necessary public support for system-level solutions. Participating in individual-level solutions may increase support for system-level solutions – especially if the individual-level solutions are internalized as part of one's social identity.