Innovative surgery raises four kinds of ethical challenges: potential harms to patients; compromised informed consent; unfair allocation of healthcare resources; and conflicts of interest. Lack of adequate data on innovations and lack of regulatory oversight contribute to these ethical challenges. In this paper these issues and the extent to which problems may be resolved by better evidence-gathering and more comprehensive regulation are explored. It is suggested that some ethical issues will be more resistant to resolution than others, owing to special (...) features of both surgery and innovation. (shrink)

Financial and nonfinancial conflicts of interest in medicine and surgery are troubling because they have the capacity to skew decision making in ways that might be detrimental to patient care and well-being. The recent case of the Articular Surface Replacement (ASR) hip provides a vivid illustration of the harmful effects of conflicts of interest in surgery.

The development and deployment of medical devices, along with most areas of healthcare, has been significantly impacted by the COVID-19 pandemic. This has had variable ethical implications, two of which we will focus on here. First, medical device regulations have been rapidly amended to expedite approvals of devices ranging from face masks to ventilators. Although some regulators have issued cessation dates, there is inadequate discussion of triggers for exiting these crisis standards, and evidence that this may not be feasible. Given (...) the relatively low evidence standards currently required for regulatory approval of devices, this further indefinite reduction in standards raises serious ethical issues. Second, the pandemic has disrupted the usual operations of device representatives in hospitals, providing an opportunity to examine and refine this potentially ethically problematic practice. In this paper we explain and critically analyse the ethical implications of these two pandemic-related impacts on medical devices and propose suggestions for their management. These include an endpoint for pandemic-related adjustments to device regulation or a mechanism for continued refinement over time, together with a review of device research conducted under crisis conditions, support for the removal and replacement of emergency approved devices, and a review of device representative credentialling. (shrink)

Traditionally, physicians and parents made decisions about children’s health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children — of diverse levels of cognitive development — are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning (...) children’s ‘best interest’. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families. (shrink)

A care deficit is clearly evident in global cities such as London and is attributable to an ageing population, the increased employment of native-born women, prevalent gender ideologies that continue to exempt men from much reproductive work, as well as the failure of the state to provide viable alternatives. However, while it is now acknowledged that migrant women, and to a lesser extent, migrant men, step in to provide care in cities such as London, there is less research on how (...) this shapes the nature, politics and ethics of care. Drawing upon empirical research with low-paid migrant workers employed as domiciliary care providers in London, this paper explores the emergence of a distinct migrant ethic of care that is critically shaped by the caring work that migrant women and men perform. (shrink)

Buddhisms and Deconstructions considers the connection between Buddhism and Derridean deconstruction, focusing on the work of Robert Magliola. Fourteen distinguished contributors discuss deconstruction and various Buddhisms—Indian, Tibetan, and Chinese —followed by an afterword in which Magliola responds directly to his critics.

Volume 19, Issue 6, June 2019, Page 28-29.

In this paper we argue that surgeons face a particular kind of within-role conflict of interests, related to innovation. Within-role conflicts occur when the conflicting interests are both legitimate goals of professional activity. Innovation is an integral part of surgical practice but can create within-role conflicts of interest when innovation compromises patient care in various ways, such as by extending indications for innovative procedures or by failures of informed consent. The standard remedies for conflicts of interest are transparency and recusal, (...) which are unlikely to address this conflict, in part because of unconscious bias. Alternative systemic measures may be more effective, but these require changes in the culture of surgery and accurate identification of surgical innovation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Right Thing to DoJane RogersIn stark contrast to getting my graduate degree in bioethics in which I discovered that I am inclined to favor an ethics based on my religious beliefs, in nursing school I learned that I had to take my religion out of nursing care. As a bioethics student, I read in my textbook, Bioethics: A Systematic Approach, that “… just because an action is rationally (...) allowed does not mean that everyone agrees one ought to act in that way.” Yet often in nursing I found that we nurses knew what was best for our patients, even if they did not. At least, we believed that we did. This general paternalistic belief spread into every area of the care we gave except for one, and that was religion. [End Page 208]As student nurses, we learned to separate our religion from our care to focus on the patient’s religion or spiritual needs. Our patients should never know of our religious beliefs or even if we had a lack of them. We needed to be completely neutral on all religious issues and focus solely on the patient’s preference. If our patients needed spiritual care, we would find someone to provide it and we would incorporate it into the nursing plan of care. Providing care of the whole patient including their religious needs was the definition of a good nurse. Certainly I wanted to be a good nurse, so I swore I would always include the spiritual needs of my patients as part of my care, while never expressing my own.As fate would have it, as a new nurse I found myself overwhelmed running around just trying to give medications, admit and discharge patients, start IV’s, insert catheters, note doctor’s orders and get my charting done. My time was engaged in trying to calm confused and combative patients, running to grab an emesis basin for a patient to throw up in or answering the phone, so thinking about religion or spiritual care for my patients most of the time amounted to “God help me and my patients get through this shift.” My goal of being a good nurse was starting to look dismal as I realized I had no idea if I could find the time or means and ways to incorporate religion into the care I gave, or if it even mattered if I did.Fortuitously for me, most of my patients never mentioned religion, although at times they did leave some nonverbal clues. I could see a rosary laying on a bedside table or a bible or prayer book next to them in bed. While I would make sure their religious item was always within reach, I remained respectful yet distant in religious matters, never offering any spiritual care or assistance. I was quite accepting of my first Mormon patient wearing the garment under the traditional hospital gown. I was appalled when an unconscious Jehovah Witness patient was nearly given blood. When a minister or priest came to visit, I’d excuse myself quickly so that the work of their God could do what I could not or should not do. Occasionally I was asked by family members to call in a minister or a priest or chaplain and I did that with a great feeling of satisfaction as I was surely providing the spiritual care they requested.Eventually however I did start to indulge in highly spontaneous and random acts of religion. These were always done secretly. The patient or family must never know. Thinking it would help I once covertly gave a patient a special rosary I had with Lourdes water in it thinking it might heal him. I waited to see a miracle. It never came. Despite the absence of that miracle I was still hopeful that perhaps my prayers or another rosary could heal or at least help some of my patients. After all, as a nurse I witnessed lots of healings that astounded me. People I never thought would get better sometimes did anyway.Although I was cognizant that some healing was the direct result of superb medical intervention and excellent nursing care, there were always... (shrink)

Transnational food retailers expanded to middle-income countries over recent decades responding to supply and demand. Control in new markets diffuses along three axes: socio-economic, geographic, and product category. We used a mixed method approach to study the progression of modern retail in Thailand on these three axes and consumer preferences for food retailing. In Thailand modern retail controls half the food sales but traditional fresh markets remain important. Quantitative questionnaires administered to members of a large national cohort study revealed around (...) half of respondents were primarily traditional shoppers and half either utilized modern and traditional formats equally or primarily shopped at supermarkets. Fresh foods were mainly purchased at traditional retail formats and dry packaged foods at supermarkets. Qualitative interviews found price and quality of produce and availability of culturally important products to be significant reasons for continued support of fresh markets. Our results show socio-economic and geographic diffusion is already advanced with most respondents having access to and utilizing modern retail. Control of the fresh food sector by transnationals faces barriers in Thailand and may remain elusive. The short to mid-term outcome may be a bifurcated food system with modern and traditional retail each retaining market share, but fresh markets longer term survival may require government assistance as supermarkets become more established. Fresh markets supply affordable, healthy foods, and livelihoods for poorer Thais and are repositories of Thai food culture and social networks. If they survive they will confer cultural, social, economic, and health benefits. (shrink)

Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide (...) advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: impacts on healthcare costs, the outsourcing of expertise and issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries. (shrink)

Effective communication and interpersonal skills have long been recognized as fundamental to the delivery of quality health care. However, there is mounting evidence that the pressures of communication in high stress work areas such as hospital emergency departments present particular challenges to the delivery of quality care. A recent report on incident management in the Australian health care system cites the main cause of critical incidents, as being poor and inadequate communication between clinicians and patients. This article presents research that (...) describes and analyses spoken interactions between health care practitioners and patients in one ED of a large, public teaching hospital in Sydney, Australia. The research aimed to address the challenges and critical incidents caused by breakdowns in communication that occur between health practitioners and patients and by refining and extending knowledge of discourse structures, to identify ways in which health care practitioners can enhance their communicative practices thereby improving the quality of the patient journey through the ED. The research used a qualitative ethnographic approach combined with discourse analysis of audio-recorded interactions. Some key findings from the analysis of data are outlined including how the absence of information about processes, the pressure of time within the ED, divergent goals of clinicians and patients, the delivery of diagnoses and professional roles impact on patient experiences. Finally, the article presents an in-depth linguistic analysis on interpersonal and experiential patterns in the discursive practices of patients, nurses and doctors. (shrink)

Embryos, cells, genes, and organisms : reflections on the history of evolutionary developmental biology / Manfred D. Laubichler and Jane Maienschein The organismic systems approach : streamlining the naturalistic agenda / Werner Callebaut, Gerd B. Müller, and Stuart A. Newman Complex traits : genetics, development, and evolution / H. Frederik Nijhout Functional and developmental constraints on life-cycle evolution : an attempt on the architecture of constraints / Gerhard Schlosser Legacies of adaptive development / Roger Sansom Evo-devo meets the mind (...) : toward a developmental evolutionary psychology / Paul E. Griffiths Reproducing entrenchments to scaffold culture : the central role of development in cultural evolution / William C. Wimsatt and James R. Griesemer. (shrink)

Murdoch makes some ambitious claims about love’s epistemic significance which can initially seem puzzling in the light of its heterogeneous and messy everyday manifestations. I provide an interpretation of Murdochian love such that Murdoch’s claims about its epistemic significance can be understood. I argue that Murdoch conceives of love as a virtue, and as belonging at the pinnacle of the hierarchy of the virtues, and that this makes sense of the epistemic role Murdochian love fulfills. Moreover, I suggest that there (...) is good reason to think that Murdochian love is not as far from everyday conceptions of love as it can initially appear. (shrink)

Introduction: Conversion and the practice of transformation -- The philosophical structure of Jonathan Edwards's religious affections -- Habit, habit change, and conversion in C.S. Peirce -- Reconstructing faith : religious overcoming in Dewey's pragmatism -- Transforming obligation in William James -- Dwelling in absence: the reflective origin of conversion -- Creative transformation : the work of conversion -- The evasion of conversion in recent American philosophy.

Background: One of the barriers to interprofessional ethics education is a lack of resources that actively engage students in reflection on living an ethical professional life. This project implemented and evaluated an innovative resource for interprofessional ethics education. Objectives: The objective of this project was to create and evaluate an interprofessional learning activity on professionalism, clinical ethics, and research ethics. Design: The Brewsters is a choose-your-own-adventure novel that addresses professionalism, clinical ethics, and research ethics. For the pilot of the book, (...) a pre-test/post-test design was used. Once implemented across campus, a post-test was used to evaluate student learning in addition to a student satisfaction survey. Participants and research context: A total of 755 students in six academic schools in a health science center completed the activity as part of orientation or in coursework. Ethical considerations: The project was approved as exempt by the university’s Committee for the Protection of Human Subjects. Findings: The pilot study with 112 students demonstrated a significant increase in student knowledge. The 755 students who participated in the project had relatively high knowledge scores on the post-test and evaluated the activity positively. Discussion: Students who read The Brewsters scored well on the post-test and had the highest scores on clinical ethics. Clinical ethics scores may indicate issues encountered in mass media. Conclusion: The Brewsters is an innovative resource for teaching interprofessional ethics and professionalism. Further work is needed to determine whether actual and long-term behavior is affected by the activity. (shrink)

Because of the coronavirus pandemic, reminders of death are particularly salient. Although much terror management theory research demonstrates that people engage in defensive tactics to manage mortality awareness, other work shows that existential concerns can motivate growth-oriented actions to improve health. The present study explored the associative link between coronavirus anxieties, fear of death, and participants' well-being. Results, using structural equation modeling, found that increased mortality concerns stemming from COVID-19 were associated with heightened benefit finding from the pandemic. Increased benefit (...) finding, in turn, was related to higher life satisfaction, meaning in life, self-esteem, resilience, and vitality while also correlating negatively with depression and stress scores. There was no evidence for reverse mediation in that fear of mortality did not predict well-being through coronavirus worries. Overall, although many persons have experienced mental health concerns as a function of the COVID-19 pandemic, our findings demonstrate positive benefits that paradoxically follow in terms of an increased appreciation of life, improved relationships, and better health. (shrink)

Music education has historically had a tense relationship with social justice. One the one hand, educators concerned with music practices have long preoccupied themselves with ideas of open participation and the potentially transformative capacity that musical interaction fosters. On the other hand, they have often done so while promoting and privileging a particular set of musical practices, traditions, and forms of musical knowledge, which has in turn alienated and even excluded many children from music education opportunities. The Oxford Handbook of (...) Social Justice in Music Education provides a comprehensive overview and scholarly analyses of the major themes and issues relating to social justice in musical and educational practice worldwide.The first section of the handbook conceptualizes social justice while framing its pursuit within broader contexts and concerns. Authors in the succeeding sections of the handbook fill out what social justice entails for music teaching and learning in the home, school, university, and wider community as they grapple with cycles of injustice that might be perpetuated by music pedagogy. The concluding section of the handbook offers specific practical examples of social justice in action through a variety of educational and social projects and pedagogical practices that will inspire and guide those wishing to confront and attempt to ameliorate musical or other inequity and injustice. Consisting of 42 chapters by authors from across the globe, the handbook will be of interest to anyone who wishes to better understand what social justice is and why its pursuit in and through music education matters.Music education has historically had a tense relationship with social justice. One the one hand, educators concerned with music practices have long preoccupied themselves with ideas of open participation and the potentially transformative capacity that musical interaction fosters. On the other hand, they have often done so while promoting and privileging a particular set of musical practices, traditions, and forms of musical knowledge, which has in turn alienated and even excluded many children from music education opportunities. The Oxford Handbook of Social Justice in Music Education provides a comprehensive overview and scholarly analyses of the major themes and issues relating to social justice in musical and educational practice worldwide.The first section of the handbook conceptualizes social justice while framing its pursuit within broader contexts and concerns. Authors in the succeeding sections of the handbook fill out what social justice entails for music teaching and learning in the home, school, university, and wider community as they grapple with cycles of injustice that might be perpetuated by music pedagogy. The concluding section of the handbook offers specific practical examples of social justice in action through a variety of educational and social projects and pedagogical practices that will inspire and guide those wishing to confront and attempt to ameliorate musical or other inequity and injustice. Consisting of 42 chapters by authors from across the globe, the handbook will be of interest to anyone who wishes to better understand what social justice is and why its pursuit in and through music education matters. (shrink)

An overview of a philosophical movement originating in the United States of America in the 19th century.

This article draws on the qualitative research component of a mixed-methods project exploring the Australian news media’s representation of violence against women. This critical discourse analysis is on print and online news reporting of the case of ‘Kings Cross Nightclub Rapist Luke Lazarus’, who in March 2015 was tried and convicted of raping a female club-goer in a laneway behind his father’s nightclub in Sydney, Australia. We explore the journalism discursive practices employed in the production of the news reports about (...) the Lazarus trial. Our analysis shows how some lexical features, quoting strategies and structuring elements serve to minimise the victim’s experience while emphasising the adverse effects of the trial on the accused. Furthermore, we demonstrate how such practices allow for the graphic representation of the attack in a salacious manner while minimising the impact of the crime on the victim by selectively referencing her victim impact statement. We found some differences between print and online news stories about this case, some of which may be attributable to the greater space available to the telling of news stories online. We conclude that in news reporting of the Lazarus case, routine journalism discursive practices, such as the inverted pyramid news-writing structure and decisions about who and what to quote, serve simultaneously to diminish the victim’s experience while objectifying her. These results build on international findings about media reporting practices in relation to violence against women and add substantially to what we know about these practices in Australia. (shrink)

With increasing development in the field of early childhood education and care, and new interest in alternative approaches to early years provision internationally, there is an urgent need for a book which explores and explains historical roots of practices and philosophical ideas which have underpinned the development of those practices in the field. This book traces historical ideas and their pioneers. It provides brief biographies and critical insights into their work as individuals and compares their principles and practices to those (...) of others past and present. Traditionally, historical reflections and philosophical critiques can be dense and difficult for readers to access and so many students and practitioners remain unaware of the roots of their current practice. This book takes an innovative and accessible approach to the history and philosophy of early childhood education. It gives sufficient, meaningful detail about individual educators and contributors to the field in order to help readers understand how contributions and developments in the past have created routes to present thinking and practice. So, the book offers five things: " An historical overview of the development of key ideas and practices in ECE from JJ Rousseau to the present time; " A series of biographical accounts of some 20 key contributors to the field, with summaries of their major achievements and key texts; " An exploration of ways in which their ideas compare through lively, imagined conversations based on their writings; " An analysis of ways in which certain common themes can be seen in both early writings and current practices; and " An illustration of how teachers can use these ideas in professional development activities in LEA and HE contexts. (shrink)

In _Vibrant Matter_ the political theorist Jane Bennett, renowned for her work on nature, ethics, and affect, shifts her focus from the human experience of things to things themselves. Bennett argues that political theory needs to do a better job of recognizing the active participation of nonhuman forces in events. Toward that end, she theorizes a “vital materiality” that runs through and across bodies, both human and nonhuman. Bennett explores how political analyses of public events might change were we (...) to acknowledge that agency always emerges as the_ _effect of ad hoc configurations of human and nonhuman forces. She suggests that recognizing that agency is distributed this way, and is not solely the province of humans, might spur the cultivation of a more responsible, ecologically sound politics: a politics less devoted to blaming and condemning individuals than to discerning the web of forces affecting situations and events. Bennett examines the political and theoretical implications of vital materialism through extended discussions of commonplace things and physical phenomena including stem cells, fish oils, electricity, metal, and trash. She reflects on the vital power of material formations such as landfills, which generate lively streams of chemicals, and omega-3 fatty acids, which can transform brain chemistry and mood. Along the way, she engages with the concepts and claims of Spinoza, Nietzsche, Thoreau, Darwin, Adorno, and Deleuze, disclosing a long history of thinking about vibrant matter in Western philosophy, including attempts by Kant, Bergson, and the embryologist Hans Driesch to name the “vital force” inherent in material forms. Bennett concludes by sketching the contours of a “green materialist” ecophilosophy. (shrink)

When discussing the problem of evil, philosophers often distinguish between physical evil (harm caused within the natural world such as natural disasters, disease, and the like), and moral evil (harm caused by human agency). Mapping this traditional distinction is mapped onto the third section of Fichte’s The Vocation of Man would at first seem fairly straightforward: for Fichte, evil arising from nature occurs through “blind mechanism” and is unfree; in contrast, evil done by human beings arises out of free agency. (...) The answer may be more complicated, however, in two different ways. First, Fichte holds that nature is to be cultivated and controlled by human beings so that it is no longer a source of harm; this may imply that the continuing harm done by nature is the result of humans’ failure to have sufficiently tamed nature. In that case, some of the harm caused by nature may be attributable to free human causality and thus no longer be a clearcut instance of natural evil. Second, Fichte repeatedly states that those who fail to act morally and who fail to conform their wills to the moral law are still be in the power of the mechanisms of nature. Even though we must think of them as free, Fichte compares their actions to the operation of nature and its mechanism of necessity. By presenting a careful and nuanced Fichtean account of the traditional distinction between physical and moral evil, we can better appreciate how Fichte understood the meaning and scope of human responsibility. (shrink)

Behavioral ethics research has focused predominantly on how the attributes of individuals influence their ethicality. Relatively neglected has been how macro-level factors such as the behavior of firms influence members’ ethicality. Researchers have noted specifically that we know little about how a firm’s CSR influences members’ behaviors. We seek to better merge these literatures and gain a deeper understanding of the role macro-level influences have on manager’s ethicality. Based on agency theory and social identity theory, we hypothesize that a company’s (...) commitment to CSR shifts managers’ focus away from self-interests toward the interests of the firm, bolstering resistance to temptation. We propose this occurs through self-categorization and collective identification processes. We conduct a 2 × 2 factorial experiment in which managers make expense decisions for a company with commitment to CSR either present or absent, and temptation either present or absent. Results indicate that under temptation, managers make decisions consistent with self-interest. More importantly, we find when commitment to CSR is present, managers are more likely to make ethical decisions in the presence of temptation. Overall, this research highlights the interactive role of two key contextual factors—temptation and firm CSR commitment—in influencing managers’ ethical decisions. While limited research has highlighted the positive effects that a firm’s CSR has on its employees’ attitudes, the current results demonstrate CSR’s effects on ethical behavior and imply that through conducting and communicating its CSR efforts internally, firms can in part limit the deleterious effects of temptation on managers’ decisions. (shrink)

The inclusion of girls and women in sport at all levels depends on single sex categories for most sports from puberty onwards, because of the biological differences between the sexes. Most sport is, by definition, competitive; involving invasion games, teams, leagues, races, competitions and sometimes rankings, from foundation to excellence. Girls and women are underrepresented, particularly in traditional sport, as recognised by the UK Sports Councils and most governing bodies of sport. This paper uses feminist philosophy: Lister on androcentric citizenship, (...) and Fraser on justice as balance, framing, recognition, representation and redistribution. It investigates the impact on the inclusion of girls and women, of eligibility policies adopting ‘self-identification of gender’ guidelines for the inclusion of transgender people in sport, at participation rather than elite levels. It explores fairness and equality as incorporated in law in the 2010 Equality Act in Britain, and contributes to ‘equality evidence’ available to the UK Sports Councils and GBS. These bodies are charged with developing fair and inclusive evidence-based eligibility criteria, in sports participation settings, for both girls and women, and transgender people. (shrink)

The inclusion of girls and women in sport at all levels depends on single sex categories for most sports from puberty onwards, because of the biological differences between the sexes. Most sport is, by definition, competitive; involving invasion games, teams, leagues, races, competitions and sometimes rankings, from foundation to excellence. Girls and women are underrepresented, particularly in traditional sport, as recognised by the UK Sports Councils and most governing bodies of sport. This paper uses feminist philosophy: Lister on androcentric citizenship, (...) and Fraser on justice as balance, framing, recognition, representation and redistribution. It investigates the impact on the inclusion of girls and women, of eligibility policies adopting ‘self-identification of gender’ guidelines for the inclusion of transgender people in sport, at participation rather than elite levels. It explores fairness and equality as incorporated in law in the 2010 Equality Act in Britain, and contributes to ‘equality evidence’ available to the UK Sports Councils and GBS. These bodies are charged with developing fair and inclusive evidence-based eligibility criteria, in sports participation settings, for both girls and women, and transgender people. (shrink)

In this paper, we outline some of the connections between the literatures of organizational storytelling, spirituality in the workplace, organizational culture, and authentic leadership. We suggest that leader storytelling that integrates a moral and spiritual component can transform an organizational culture so members of the organization begin to feel connected to a larger community and a higher purpose. We specifically discuss how leader role modeling in authentic storytelling is essential in developing an ethically and spiritually based organizational culture. However, we (...) also acknowledge a potential dark side to leader storytelling. Implications for authentic storytelling research and practice are discussed. (shrink)